Introduction:
Asthma treatments and guidelines change and can vary by country. Guidelines include
the option to prescribe a single inhaled corticosteroid and long-acting ß-agonist
fixed dose combination (ICS/LABA) as both a maintenance and reliever medication (SMART)
with low dose ICS/formoterol as a reliever rather than a short-acting ß-agonist (SABA)
for patients requiring low dose ICS/LABA treatment. GAPS aimed to describe physician
perceptions and behaviors regarding asthma management in 6 countries.
Methods:
1809 physicians seeing ≥4 adult asthma patients/month in Australia, Japan, China,
Canada, France and Germany were surveyed (n≈300/country). Standardized questionnaires
on asthma management were administered from 05 – 09/2015. Statistics were weighted
to account for the sampling scheme.
Results:
Physicians generally (71%) estimated that most of their asthma patients were prescribed
maintenance medication. Most physicians monitored adherence to maintenance medications
(87% overall). Few patients received written asthma action plans (37%) and technology
(i.e. mobile apps) was seldom used (15%). Physicians did not utilize validated patient
reported questionnaires (10% overall) to assess asthma control, instead utilizing
asthma symptoms, exacerbations and lung function measurements. 72% (n = 1286) had
prescribed SMART and reported their SMART information source was from conferences
(54%) or sales representatives (49%) rather than from guidelines. Almost all (91%)
of the physicians who prescribed SMART co-prescribed a separate SABA reliever. 32%
reported not writing anything different than the standard maintenance dosing instructions
on a prescription for ICS/LABA.
Conclusions:
Asthma management practices vary by country. Despite physicians' interest in SMART,
the strategy is misunderstood, rarely being prescribed as outlined in randomized trial
or guideline descriptions. Better education is needed, tailored to the healthcare
system and physicians' preferences.
Abstract previously presented at ATS 2016, A1708.
