title: Disease variability in asthma: how do the patients respond?--and why?
abstract: OBJECTIVE
  Asthma is a variable disease, and therapy should be tailored accordingly. The aim of this study was to explore patterns of self-management in response to disease variability in adult asthmatics.
  
  
  METHODS
  Adult asthmatics (n = 509), recruited through a web-based panel, answered a questionnaire concerning asthma knowledge, compliance, and treatment, including specified treatment options, through the Internet.
  
  
  RESULTS
  Two-thirds of the patients on inhaled corticosteroids (ICS) stepped-up and down their daily dose without prior contact to their doctor, and more than 50% took less ICS than prescribed during periods with fewer symptoms. In case of deterioration, 57% of the patients would only increase their reliever medication, whereas 23% would also increase their controller medication, although 59% were instructed by their doctor to do so. The self-perceived severity of asthma (graded as mild, moderate or severe) was not associated with the patients' response pattern. The preferred treatment strategy, differing primarily with regard to dosing and timing of controller medication, was associated with feeling safe about self-adjustment of controller medication (p < 0.001), but not with self-reported knowledge of asthma (p > 0.5).
  
  
  CONCLUSIONS
  In case of deterioration, the majority of adult asthmatics only increase their reliever medication, although instructed by their doctors also to increase their controller medication. Furthermore, the patients' preferred strategy for management of disease variability seems not to be driven by their knowledge of the disease.
authors.affiliation: Department of Heart and Lung Diseases, Hvidovre Hospital, Copenhagen.
authors.forename: Charlotte Suppli
authors.initials: CS
authors.lastname: Ulrik
authors.forename: Ulrik
authors.initials: U
authors.lastname: Søes-Petersen
authors.forename: Vibeke
authors.initials: V
authors.lastname: Backer
authors.forename: Peter
authors.initials: P
authors.lastname: Lange
authors.forename: Henrik
authors.initials: H
authors.lastname: Harving
authors.forename: Peter
authors.initials: P
authors.lastname: Plaschke
mesh_terms: D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010820:Physicians / Q000706:statistics & numerical data; D012648:Self Care; D011795:Surveys and Questionnaires
chemical_list: D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids