Comparison of doctor and patient assessments of asthma control

The objective of asthma management is to control the condition. However, world-wide surveys reveal that only 5% of asthmatics are well controlled. One reason for this phenomenon is the fact that patients and doctors consistently over-estimate control. This study compared patient and doctor assessment of asthma control.

A random sample of asthmatics was identified by practitioners in South Africa. Patients completed an Asthma Control Test (ACT) and provided a list of medications currently being taken. The doctor also provided an assessment of control which was summarised into the categories - 'not controlled' and 'controlled' and listed all medications prescribed.

The mean ACT score was 12.8 where doctors assessed the patients as being 'not controlled' and 20.7 where doctors assessed the patients as being 'controlled'. Half of the patients classified themselves as being 'not controlled' (ACT score <20, category 1), while doctors classified only 33% of patients as being 'not controlled'. Although only 7% of patients disagreed with the doctor's classification of 'not controlled', 29% disagreed with the doctor's assessment of being 'controlled'. There was a significant difference in ACT score between the sexes (p < 0.0001). Most therapeutic interventions (with the exception of combination products [ICS + LABA]) performed poorly with regard to level of control.

This study suggests that asthma still appears to be relatively poorly controlled in South Africa, although levels of patient control appear to have improved compared to previous surveys, and confirms that physicians and patients differ in their assessments of asthma control.