title: Patients' experience of asthma control and clinical guidelines: perspectives from a qualitative study.
abstract: BACKGROUND
  Clinical guidelines consider the concept of 'asthma control' as the primary goal of asthma treatment. This study aimed to explore patients' views of concepts that are important for understanding and evaluating asthma control.
  
  
  METHODS
  Patients with mild to severe asthma in four countries completed the Asthma Control Questionnaire (ACQ) and discussed their experiences in focus groups. Clinicians evaluated patients' levels of asthma control based on Global Initiative for Asthma (GINA) guidelines. Clinician- and questionnaire-based ratings of asthma control were compared. Thematic analysis was used to identify key concepts from focus group transcripts.
  
  
  RESULTS
  The sample consisted of 55 patients. Classification of asthma control, based on the ACQ, was consistent with clinician rating in 28 cases (51%). In focus groups, patients discussed concepts related to symptoms, asthma attacks (exacerbations), activity limitations, panic/fear, tiredness, sleep disturbances (nocturnal awakening and difficulty falling asleep), and rescue medication use when describing asthma control. Clinical guidelines also focus on symptoms, activity limitations, rescue medication use, and exacerbations but, in addition include lung function parameters. Guidelines do not take into account asthma-related panic/fear or tiredness and sleep disturbances beyond nocturnal awakening.
  
  
  CONCLUSIONS
  The results of this study suggest that patients' understanding of asthma control extends beyond the usual clinical manifestation of respiratory symptoms and lung function. This may have implications for clinical practice, for setting and achieving the goals of asthma control as well as for evaluation of treatments for asthma from the patients' perspective.
authors.affiliation: Patient Reported Outcome, Centre of Excellence, Market Access, Primary Care Business Unit, Pfizer Ltd, Dorking Road, Tadworth KT20 7NS, UK. katja.rudell@pfizer.com
authors.forename: Katja
authors.initials: K
authors.lastname: Rudell
authors.forename: Asha
authors.initials: A
authors.lastname: Hareendran
authors.forename: Nikki
authors.initials: N
authors.lastname: Bonner
authors.forename: Rob
authors.initials: R
authors.lastname: Arbuckle
authors.forename: Claire
authors.initials: C
authors.lastname: Burbridge
authors.forename: Linda
authors.initials: L
authors.lastname: Abetz
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology / Q000534:rehabilitation; D001294:Attitude to Health; D005260:Female; D017144:Focus Groups; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010200:Panic; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D017410:Practice Guidelines as Topic; D012893:Sleep Wake Disorders / Q000209:etiology; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents