title: Patient factors that physicians use to assign asthma treatment.
abstract: BACKGROUND
  Asthma guidelines recommend severity assessment to assign treatment, often quantified as current control. It is unknown how strongly control assessment affects clinician treatment decisions, nor if control is sufficient.
  
  
  METHODS
  To determine patient factors used by physicians to assign treatment, we surveyed pulmonary specialists (PSs) and family physicians (FPs) using vignettes. We tested whether recent acute care (hospitalization 6 months ago), bother (patient bothered by asthma), control (symptom or reliever medication frequency), and direction (change since last visit) influence treatment decisions. Factors used for stepping up and stepping down were assessed.
  
  
  RESULTS
  A total of 461 physicians participated (236 PSs and 225 FPs). As expected, physicians indicated a greater likelihood of stepping up treatment for persistent (4-5 times per week) than for intermittent (1 time per 2 weeks) symptoms (PSs 97% vs 24%, P < .001; FPs 97% vs 33%, P < .001). All else being equal, physicians were more likely to step up treatment of a patient with intermittent symptoms if the patient reported recent acute care (PSs 49% vs 24%; FPs 72% vs 33%), was bothered (PSs 81% vs 24%; FPs 80% vs 33%), or was worse since the last visit (PSs 68% vs 24%; FPs 66% vs 33%) (all P < .001). These factors were also predictive of stepping down from high-intensity therapy and remained significant in multivariate analyses (all P < .05).
  
  
  CONCLUSIONS
  Asthma control greatly influences physician decisions about asthma treatments. However, recent acute care, bother, and direction of illness also influence decisions, particularly those that involve increasing the amount of medication prescribed. Further work is needed to determine if use of these additional indicators leads to better asthma outcomes.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, 1830 E Monument St, Fifth Floor, Baltimore, MD 21205, USA. gdiette@jhmi.edu
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Diette
authors.forename: Cecilia M
authors.initials: CM
authors.lastname: Patino
authors.forename: Barry
authors.initials: B
authors.lastname: Merriman
authors.forename: Laura
authors.initials: L
authors.lastname: Paulin
authors.forename: Kristin
authors.initials: K
authors.lastname: Riekert
authors.forename: Sande
authors.initials: S
authors.lastname: Okelo
authors.forename: Kathy
authors.initials: K
authors.lastname: Thompson
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Krishnan
authors.forename: Ruth
authors.initials: R
authors.lastname: Quartey
authors.forename: Deanna
authors.initials: D
authors.lastname: Perez-Williams
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rand
mesh_terms: D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000517:prevention & control; D003657:Decision Making; D005194:Family Practice; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D015272:Pulmonary Medicine