Understanding the discrepancy between perceived and actual asthma control in Australia

Introduction: Asthma is a major chronic respiratory health issue in Australia, and is the focus of significant clinical and public health interventions. A well-documented barrier to optimal asthma management is patients’ overestimation of how well their disease is controlled. This overestimation is quite prevalent in Australia, and it represents a major barrier to the design and uptake of asthma interventions. However, almost nothing is known about the factors that affect patients’ overestimation of their asthma control.

Aims: To investigate the factors associated with the over-estimation of asthma control in Australia.

Methods: Australians over the age of 18 with a current diagnosis of asthma were recruited via Facebook to complete an online survey. The survey contained basic demographic questions and validated questionnaires assessing asthma control, asthma knowledge, medication adherence, medication beliefs and illness perception. Over-estimation of asthma control was determined by comparing patients’ self-reported asthma symptoms to their self-rating of asthma control. Patients’ over-estimation of control was analysed across the other dimensions of the survey.

Results: Of 2,971 responses, 1,950 (65.6%) were complete and eligible for inclusion. Over-estimation of control was apparent in 45.9% of participants. In multivariate analysis, older age, lower education level, use of regular preventer medication, agreement to the statement ‘most medications are addictive’, increased patient feelings of control over their asthma and greater experience of asthma symptoms were shown to be independent predictors of over-estimation of asthma control.

Discussion: This study demonstrates that over-estimation of asthma control is still a problem in Australia. To our knowledge, this is the first national study that has identified modifiable predictors of overestimation of asthma control. By identifying these factors, this study has paved the way for targeted interventions designed to improve the discrepancy between perceived and actual asthma control. This will empower patients, encourage them to be more proactive and help them to achieve better asthma management, including more appropriate use of medications and improved health outcomes.