The Woolcock Institute of Medical Research

Most people who think their asthma is well controlled are wrong, according to new research which raises serious concerns about how the wheeze condition is managed at home.

A study involving the Woolcock Institute of Medical Research in Sydney reveals female asthmatics are most likely to mistakenly believe their disease is under control, putting them at risk of dangerous – and sometimes deadly - exacerbations. The results, published this month in the international journal Primary Care Respiratory Medicine, were found in a large multinational cohort of 4,274 asthma patients.

“We found that most people believe their asthma is well controlled, but 70 per cent are wrong,” says Dr Vicky Kritikos, Clinical Lead of the Quality Use of Respiratory Medicines Group at the Woolcock. “That is a huge number of people with asthma living with the silent burden of disease and increased risk of asthma-related health problems.”

The discrepancy arises partly because people with asthma believe that using high daily doses of reliever medication to treat troublesome symptoms is ‘taking control of their asthma’ when it is actually a worrying indicator of poor asthma control, Dr Kritikos explains. “We have thousands of people out there, particularly women, who think they are doing the right thing managing their asthma in this way when it’s exactly what professionals warn against. We need an urgent change to the way many people are managing this disease.”

About 2.7 million Australians - one in nine people - have asthma, a chronic lung condition that inflames and narrows the airways, causing wheezing, shortness of breath, chest tightness and coughing. The causes are still not well understood, but triggers are known to include viral infections, exercise, and exposure to allergens and irritants. 

Despite a global strategy for asthma management, and national guidelines and effective treatments, rates of poor asthma control remain high worldwide. Many patients fail to use their preventer inhaler as often as needed to manage their condition, instead relying on reliever medication for rapid symptom relief. Global asthma experts recently moved to officially condemn reliever-only use as a high-risk practice that fails to manage the disease.

Dr Kritikos and colleagues investigated the factors that are associated with inaccurately reported ‘well-controlled’ asthma among a large cohort of adults who have regular contact with their GP and believe their condition is well controlled. “Of our sample, just 30 per cent were assessed as having good asthma symptom control,” the specialist asthma pharmacist says. “Contrarily, 60 per cent of patients considered their asthma to be ‘well controlled’, but more than two thirds were wrong in this assessment.”

Those most likely to make this mistake were female, had overused their reliever inhaler in the past month, and hadn’t seen a respiratory specialist in the past year.

“It was really concerning to see that self-management tools currently available for asthma are not meeting the needs of women,” Dr Kritikos says. “There is clearly a need to focus on giving women the tools to enable them to become better managers of their respiratory health.” 

The researchers also called for new asthma terminology and assessment tools that represent patient’s actual asthma status, and better education of patients about the frequent or high-dose use of reliever medication as an indicator of poor asthma control.

The paper, A multinational observational study identifying primary care patients at risk of overestimation of asthma control, was a collaboration between researchers in Australia, United Kingdom, France, Italy, Sweden, Spain, Norway and the Netherlands. It can be viewed here.

Dr Vicky Kritikos from the Woolcock Institute was interviewed by the Sydney Morning Herald, click here to read the full story.