title: The importance of clinical management problems in older  people with COPD and asthma: do patients and physicians  agree?
abstract: BACKGROUND
  COPD and asthma in older people are complex conditions associated with multiple clinical problems. The relative importance of these problems to both patients and physicians and the level of agreement between them is largely unknown.
  
  
  METHODS
  Older people with asthma and COPD underwent a multidimensional assessment to characterise the prevalence of clinical problems. Each individual's problems were then summarised and presented separately to the patient and physician to rate problem importance. Problems were scored using a 5-point Likert scale from unimportant to very important.
  
  
  RESULTS
  The highest-rated problems were dyspnoea, activity limitation and airway inflammation, and these areas had good patient-physician concordance. Poor concordance was found for inhaler technique adequacy, airflow obstruction and obesity. Good concordance was found for written action plans, but this was less important to both patients and physicians.
  
  
  CONCLUSIONS
  In asthma and COPD, patients and their physicians agree about the importance of managing activity limitation, dyspnoea, and airway inflammation. Other areas of management had little concordance or were viewed as less important. Self-management skills were not rated as important by patients and this may hinder successful management. Eliciting problems and addressing their importance to treatment goals may improve care in COPD and asthma.
authors: Department of Respiratory and Sleep Medicine, John Hunter Hospital, New South Wales, Australia. Vanessa.McDonald@hnehealth.nsw.gov.au
authors: Vanessa M
authors: VM
authors: McDonald
authors: Isabel
authors: I
authors: Higgins
authors: Jodie L
authors: JL
authors: Simpson
authors: Peter G
authors: PG
authors: Gibson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000453:epidemiology; D001249:Asthma / Q000150:complications* / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D015897:Comorbidity; D004417:Dyspnea / Q000150:complications / Q000453:epidemiology; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D010817:Physician-Patient Relations; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D012648:Self Care