Asthma patients with low perceived burden of illness: a challenge for guideline adherence.
OBJECTIVE
The reason why many patients seem to tolerate suffering from sub-optimal treated asthma remains unclear. The aim was to evaluate the guideline adherence combined with quality of life of patients with moderate to severe asthma.


METHODS
256 asthma patients from 43 primary care practices in Saxony-Anhalt filled in a questionnaire including the Asthma Quality of Life Questionnaire (AQLQ), the Patient Health Questionnaire (PHQ-D) and questions evaluating the asthma severity, medication and self-management.


RESULTS
43.4% suffered from moderate to severe asthma. Drug treatment accorded with guidelines in 36.9%, drug dosage of inhaled steroids was too low in 34.3%, and 21.5% were not treated according to guidelines. A total of 7.3% of the patients received end-of-dose therapy. AQLQ declined and depression rose with asthma severity and guideline non-adherence (P < 0.001). Only 29.1% received asthma education. However, 64.5% of the patients without education did not want to receive education. They had a higher quality of life, lower depression (P < 0.001) and lower use of steroids (P = 0.016). Higher depression scores where related with hospital admission (OR 3.29; 95% CI 1.57-6.87 for each quartile of PHQ-D) and unscheduled home visits or ambulatory care (OR 1.58; 1.07-2.33).


CONCLUSIONS
There is a large variation of asthma severity which can partly be explained by the guideline adherence of medication and deficits of patients' management. The perceived burden of illness plays a more important role for education and self-management than the real severity of disease. Therefore, target-oriented interventions are needed to identify and motivate patients at risk.
Schneider
Antonius
A
Department of General Practice and Health Services Research, University Hospital, University of Heidelberg, Heidelberg, Germany. antonius.schneider@med.uni-heidelberg.de
Biessecker
Kathrin
K
Quinzler
Renate
R
Kaufmann-Kolle
Petra
P
Meyer
Franz Joachim
FJ
Wensing
Michel
M
Szecsenyi
Joachim
J
D000203:Activities of Daily Living; D000553:Ambulatory Care; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology*; D001294:Attitude to Health; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D004644:Emotions; D005194:Family Practice; D005260:Female; D019983:Guideline Adherence; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012648:Self Care
D018927:Anti-Asthmatic Agents