Asthma patients' and physicians' perspectives on the burden and management of asthma: Post-hoc analysis of APPaRENT 1 and 2 to assess predictors of treatment adherence.

Introduction: Patient adherence to maintenance medication is critical for improving clinical outcomes in asthma and is a recommended guiding factor for treatment strategy. Previously, the APPaRENT studies assessed patient and physician perspectives on asthma care; here, a post-hoc analysis aimed to identify patient factors associated with good adherence and treatment prescription patterns.
Methods: APPaRENT 1 and 2 were cross-sectional online surveys of 2866 adults with asthma and 1883 physicians across Argentina, Australia, Brazil, Canada, China, France, Italy, Mexico, and the Philippines in 2020-2021. Combined data assessed adherence to maintenance medication, treatment goals, use of asthma action plans, and physician treatment patterns and preferences. Multivariable logistic regression models assessed associations between patient characteristics and both treatment prescription (by physicians) and patient treatment adherence.
Results: Patient and physician assessments of treatment goals and adherence differed, as did reporting of short-acting β ₂ -agonist (SABA) prescriptions alongside maintenance and reliever therapy (MART). Older age and greater patient-reported severity and reliever use were associated with better adherence. Patient-reported prescription of SABA with MART was associated with household smoking, severe or poorly controlled asthma, and living in China or the Philippines.
Conclusions: Results revealed an important disconnect between patient and physician treatment goals and treatment adherence, suggesting that strategies for improving patient adherence to maintenance medication are needed, focusing on younger patients with milder disease. High reliever use despite good adherence may indicate poor disease control. Personalised care considering patient characteristics alongside physician training in motivational communication and shared decision-making could improve patient management and outcomes.
Competing Interests: Declaration of competing interest Giorgio Walter Canonica reports having received research grants as well as being a lecturer or having received advisory board fees from A. Menarini, Alk-Abello, Allergy Therapeutics, AstraZeneca, Chiesi Farmaceutici, Firma, Genentech, Guidotti-Malesci, GSK, Hal Allergy, Mylan, Novartis, Regeneron, Roche, Sanofi-Aventis, Sanofi-Genzyme, Stallergenes Greer, Valeas, and OM Pharma, outside the submitted work. Christian Domingo has received funding for travel or speaker fees from ALK, Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Menarini, Novartis, Stallergenes, Takeda, and Pfizer, and declares no specific conflicts of interest to report regarding this paper. Kim L. Lavoie reports investigator-initiated research support and speaking fees from AbbVie, consulting fees and speaking fees from Astellas, Boehringer Ingelheim, GSK, X-Factor, Respiplus, and Novartis, consulting fees from Janssen, Sojecci Inc., and AstraZeneca, and speaking fees from Bayer and Mundipharma, outside the submitted work. Amrit Kaliasethi is an employee of Fishawack Communications Ltd, part of Avalere Health. Shireen Quli Khan, Anurita Majumdar, and Sourabh Fulmali are full-time employees of GSK and hold shares in GSK.
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