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Asthma Patients and Their Doctors Don't Always Communicate Well

Survey finds disconnect between what each believes defines adequate control of symptoms

FRIDAY, April 6, 2007 (HealthDay News) -- People with asthma and their doctors often don't communicate effectively, and that disconnect may lead to poorly controlled asthma and an unnecessary worsening of quality of life, a recent survey found.

The biggest reason for this communication breakdown is that doctors and patients look at asthma in completely different ways, said Mike Tringale, director of external affairs for the Asthma and Allergy Foundation of America, which conducted the survey.

Doctors tend to look at the quantitative factors, such as how often you or your child needs a rescue inhaler or what are peak flow readings, while people with asthma or their parents tend to look more at qualitative factors, such as how well did you sleep or how did you feel in school?

"It's not that anybody's saying the wrong thing, but nobody's talking about the whole story," Tringale said.

As an example of the way these factors could easily be misunderstood, Dr. Jonathan Field, director of the allergy and asthma clinic at the New York University Medical Center/Bellevue in New York City, recalled a marathon-runner patient who complained that his asthma wasn't under control. When Field ran the standard tests, the runner appeared to have well-functioning lungs, with 100 percent of the expected lung function.

However, Field decided to treat the patient based on his symptoms, and because the patient felt there had been a worsening of his asthma. After treatment, the runner's lung function tests were at 150 percent of what the average is, said Field. Because he was a runner, his baseline lung function was much higher than normal -- a factor that could easily have been missed, depending on what questions the doctor asked and what information the patient volunteered.

The AAFA's survey included 354 physicians -- 254 primary-care doctors and 100 pediatricians -- and 585 people with asthma and 274 adult mothers of children under 18 with asthma.

The survey found that both doctors and people with asthma agreed that they should work as partners to control the condition.

But, they seemed to agree on little else. Here are some of the highlights of the areas where doctors and people with asthma need to work to improve communication, the survey found:

  • Just 40 percent of doctors felt their patients were "very good" or "good" at controlling their asthma, while 77 percent of patients felt their asthma was in control.
  • Ninety percent of doctors, but just 39 percent of people with asthma, felt that asthmatics don't always take their medications properly and could do a better job of controlling their asthma.
  • Only 11 percent of people with asthma felt their doctors had discussed the meaning of asthma control with them, yet 80 percent of doctors felt they had done so.
  • The No. 1 factor indicating poorly controlled asthma was the number of times a patient needed a fast-acting inhaler, according to 89 percent of the doctors. For patients, the No. 1 indication of poor control was quality-of-life issues.

Field said the survey "underscores a lot of important issues," particularly in the different ways -- qualitative and quantitative -- that people with asthma and their doctors view the disease.

"Patients may say they're fine. They're conditioned to think this is the way it is. They assume it's their lot in life," said Field. But, if you ask the right questions, he added, you might find out that a patient isn't fine. They may be feeling tired all day or have stopped going to the gym, but they've decided that's normal, even when it's not.

"All asthma is controllable, but not all asthma is controlled," said Tringale. "Patients need a higher expectation of control. Often, asthma patients just learn to live with their symptoms. There should be no asthma attacks. More than 4,000 people still die from asthma each year, and they're not just severe asthmatics. The deaths are equally distributed between mild, moderate and severe asthmatics. Asthma should be in control. There's just not enough questioning going on."

To help people with asthma and their doctors bridge the communication gap, the AAFA, with funding from Merck & Co. -- an asthma medication manufacturer -- have started a new education program called, Get A.H.E.A.D. of Asthma, which explains what good asthma control is and how to improve your health.

What's most important, emphasized Field, "is to be aware of any change from whatever your baseline is. If you see any derivation in the way you feel, don't just blow it off. Check with your doctor and make sure it's not something that can be treated."

More information

For suggestions on how to communicate more effectively with your doctor about your asthma, visit the Asthma and Allergy Foundation of America's Get A.H.E.A.D. of Asthma Web site. You can also call for a brochure at 1-800-7ASTHMA (1-800-727-8462).

SOURCES: Mike Tringale, director of external affairs, the Asthma and Allergy Foundation of America, Washington, D.C.; Jonathan Field, M.D., director, asthma and allergy clinic, New York University Medical Center/Bellevue, New York City; March 2007, Asthma and Allergy Foundation of America's Harris Interactive Get A.H.E.A.D. of Asthma Survey
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