TOPIC: Signs and Symptoms of Chest Diseases
TYPE: Original Investigations
PURPOSE: To inform asthma management approaches by determining the association and correlation between perceptions of control and/or symptoms, and asthma control.
METHODS: A rapid review of the association and correlation between perceptions of control and/or symptoms, and asthma control was conducted [PROSPERO CRD42021230152]. Searches were conducted in MEDLINE, Embase, and the Cochrane Library. Eligibility criteria included a date limit of 2011–2021 and English language. Quality appraisal of articles was conducted using the Joanna Briggs Institute (JBI) critical appraisal instruments.
RESULTS: A total 22 eligible articles were identified; nine (9) reported association, and thirteen (13) reported correlation studies between perception of control and/or symptoms and asthma control. The association studies (n=5) that conducted chi-square tests (χ2) reported, respectively: (1) 28.9% of patients accurately perceived their asthma as controlled (71.1% inaccurately reported their asthma as controlled), and 67.4% patients correctly perceived their asthma as uncontrolled (28.9% vs. 67.4%; χ2 p = 0.010); (2) nearly 90% of patients with uncontrolled asthma perceived their asthma as controlled (χ2 p < 0.001); (3) 56% of patients accurately estimated lung function versus 18% who underestimated and 26% who overestimated lung function (χ2 p = 0.037); (4) 66.5% of patients perceived asthma control when only 11.5% were controlled and 49% of uncontrolled patients perceived asthma control (χ2 p < 0.001); and (5) 45% patients overestimated control (χ2 not reported). Other studies reported: a disparity between patients’ perception of control and ACT (two-sided test p < 0.05); uncontrolled patients with poorer perception of asthma control versus controlled patients (t-test p < 0.001); uncontrolled patients had a lower perception of asthma control than those with well-controlled asthma (χ2 p<0.01); and patients with worse perception of asthma having worse clinical control (p = 0.001). In the correlation studies, the coefficients ranged from 0.12 to 0.74, where perception of more frequent or worse symptoms correlated with more poorly controlled asthma. Lower correlation coefficients were observed in studies of symptom perception and lung function tests [0.12–0.49]. All analyses were based on cross-sectional observations and there was paucity of analysis of explanatory factors.
CONCLUSIONS: Patients tend to overestimate their level of asthma control and may accept their symptoms as normal. More frequent or worse symptoms is correlated with worsening asthma control, with wide variation in correlation strengths. Possible explanatory factors for the correlation heterogeneity is not well reported.
CLINICAL IMPLICATIONS: Symptom perception varies among asthma patients and the reasons for the variation is not well known. Hence, appropriate asthma treatment decisions should be based on assessment of asthma control.
This study was sponsored by GSK (study number 215384)
DISCLOSURES: No relevant relationships by Hamdan Al-Jahdali, source=Admin input
No relevant relationships by Christopher Bly, source=Web Response
Consultant relationship with Medical Decision Modeling, Inc. Please note: 01/2019-Current Added 06/03/2021 by Pamela Martin, source=Web Response, value=Consulting fee
Employee relationship with GlaxoSmithKline Please note: 2016-date Added 05/06/2021 by Steve McLachlan, source=Web Response, value=Salary
Stock holder relationship with GlaxoSmithKline Please note: 2016-date Added 05/06/2021 by Steve McLachlan, source=Web Response, value=shares
No relevant relationships by Julie Myers, source=Web Response
No relevant relationships by Hugo Neffen, source=Admin input
Employee relationship with GSK Please note: 06/31/2014 to date Added 04/01/2021 by Saeed Noibi, source=Web Response, value=Salary
© 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.