Disease variability in asthma: how do the patients respond?--and why?

BACKGROUND AND AIM: Asthma is a variable disease, and therapy should be tailored accordingly. The aim of this study was to explore patterns of self-management in response to disease variability in adult asthmatics. METHODS: Adult asthmatics (n = 509), recruited through a web-based panel, answered a questionnaire concerning asthma knowledge, compliance, and treatment, including specified treatment options, through the Internet. RESULTS: Two-thirds of the patients on inhaled corticosteroids (ICS) stepped-up and down their daily dose without prior contact to their doctor, and more than 50% took less ICS than prescribed during periods with fewer symptoms. In case of deterioration, 57% of the patients would only increase their reliever medication, whereas 23% would also increase their controller medication, although 59% were instructed by their doctor to do so. The self-perceived severity of asthma (graded as mild, moderate or severe) was not associated with the patients' response pattern. The preferred treatment strategy, differing primarily with regard to dosing and timing of controller medication, was associated with feeling safe about self-adjustment of controller medication (p < 0.001), but not with self-reported knowledge of asthma (p > 0.5). CONCLUSION: In case of deterioration, the majority of adult asthmatics only increase their reliever medication, although instructed by their doctors also to increase their controller medication. Furthermore, the patients' preferred strategy for management of disease variability seems not to be driven by their knowledge of the disease.