IntroductionDifferences between the opinions of patients and physicians on the impact of asthma are common. We hypothesised that patient–physician discordance may negatively affect asthma outcome.MethodsA total of 2902 patients (61% women, mean age 47 years) with moderate–severe asthma and 231 physicians participated in a prospective study. At the baseline visit, data on demographics, clinical variables, degree of asthma control according to the Asthma Control Test (ACT), basic spirometry and the Hospital Anxiety and Depression Scale (HADS) were collected and an ad hoc questionnaire was completed that allowed the degree of concordance between doctors and patients to be assessed. A scheduled telephone call after 3 months was used to elicit the ACT score and the future risk of asthma. At the final visit at 6 months, the following data were recorded: ACT score, spirometry, HADS score and an ad hoc questionnaire to assess the agreement between the doctor and the patient. Changes in study variables according to patient–physician concordance or discordance were analysed.ResultsThe rate of patient–physician discordance was 27.2%, with overestimation of disease impact by the physician in 12.3% and underestimation in 14.9%. Patient–physician opinion discordance, particularly in the case of physicians underestimating the impact of asthma, showed worse results with statistically significant differences in ACT score, a higher percentage of patients with poor asthma control and lower HADS scores. The need for hospital and emergency department admissions was also higher.ConclusionPatient–physician opinion discordance may be contributing to lower symptomatic control and increased future risk, with a higher impact when physicians underestimate the impact of asthma on their patients.

ObjectiveTo determine treatment persistence and exacerbations in patients initiating inhaler treatment with fixed-dose combinations of inhaled corticosteroids/long-acting beta-2-adrenergic agonists (ICS/LABA) for the treatment of asthma.DesignRetrospective observational study conducted by review of electronic medical records (database: Fundación RediSS).SettingRetrospective cohort study. The follow-up period was 1 year.ParticipantsThe study included patients aged ≥18 years who started treatment with ICS/LABA and met the inclusion/exclusion criteria.Main outcomes and measuresThe study groups were fluticasone propionate/salmeterol (FP/SAL), beclomethasone/formoterol (BDP/FORM), budesonide/formoterol (BUD/FORM), fluticasone furoate/vilanterol (FF/VI) and fluticasone propionate/formoterol (FP/FORM). The main measurements were persistence, medication possession ratio (MPR) and exacerbations. Statistical significance was established as p<0.05.ResultsIn total, 3203 patients were recruited for the study. By groups, 31.1% FP/SAL, 28.6% BDP/FORM, 25.0% BUD/FORM, 8.2% FF/VI and 7.0% FP/FORM. The mean age was 52.2 years, 60.8% were female and 44.9% had persistent-moderate asthma. Treatment persistence was 61.7% (95% CI 60.0% to 63.4%) and by study group it was FP/SAL: 60.7%, BDP/FORM: 61.2%, BUD/FORM: 60.3%, FF/VI: 66.7% and FP/FORM: 67.6% (p=0.046). MPR by study group was FP/SAL: 74.3%, BDP/FORM: 73.8%, BUD/FORM: 74.6%, FF/VI: 79.4% and FP/FORM: 80.6% (p=0.028). The mortality rate was 2.9%. By treatment group, exacerbations were FP/SAL: 21.9% (95% CI 19.3% to 24.5%), BDP/FORM: 22.2% (95% CI 19.5% to 24.9%), BUD/FORM: 22.8% (95% CI 19.9% to 25.7%), FF/VI: 17.9% (95% CI 14.9% to 20.7%) and FP/FORM: 16.0% (95% CI 12.2% to 19.3%), p=0.036.ConclusionsPatients undergoing treatment with FP/FORM and FF/VI versus FP/SAL, BDP/FORM and BUD/FORM were associated with greater treatment adherence (persistence, MPR) and lower rates of exacerbations. However, further studies will be needed to strengthen the consistency of the results.

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Introduction:Clinical practice guidelines recommend regularadjustment of treatment to achieve control of asthma. A step-up approach based on the degree of disease control should be followed.Objective: To perform a real-lifeanalysis of the factors that affect the success or failure of this therapeutic strategy and of the criteria applied by clinicians when applying a step-up approach in a representative sample of patients diagnosed with moderate-severe asthma. Material and Methods:We performed a multicenter retrospective cohort study involving 226 Spanish specialist physicians (98 allergologists, 127 pulmonologists, and 1 family physician).We included 1254 patients (787 women) diagnosed with moderate-severe asthma who underwent step-up therapy during 2016. Results:Step-up was successful in 44% of cases. The factors associated with success were presence of < 2 comorbid conditions, lower grade of severity and therapy step before modification, absence of exacerbations during the previous year, fewer daytime/nighttime symptoms, and limitation in activities,as well as type of inhaled corticosteroid (ICS)/long-acting β₂-agonist(LABA) combination after modification, lower body mass index, and higher fractional exhaled nitric oxide. An early increase in the maintenance dose once a lack of control was detected (≤ 3 months, >3 to≤6months, > 6 to ≤ 12 months) was more likely to be successful. Conclusion:The factors that determine whether or not this therapeutic strategy manages to control asthma are time since onset of clinical impairment, previous grade of severity, number of comorbid conditions, previous exacerbations, and frequency of symptoms. ResumenIntroducción: Las guías de práctica clínica recomiendan el ajuste del tratamiento hasta alcanzar el control del asma, siguiendo un escalado progresivo basado en el grado de control de la enfermedad.Objetivo: Realizar un análisis en vida real de los criterios que utilizan los clínicos para realizar el escalado terapéutico y de los factores que condicionan el éxito o el fracaso de esta estrategia terapéutica en una muestra representativa de pacientes diagnosticados de asma persistente moderada y grave. Material y métodos:Estudio multicéntrico retrospectivo de cohorte en el que participaron 226 médicos especialistasespañoles (98 alergólogos, 127 neumólogos y un médico de atención primaria). Incluimos 1254 pacientes (787 mujeres) diagnosticados de asma persistente moderada o grave en los que se realizó un escalado de tratamiento durante 2016.Resultados: El escalado terapéutico fue exitoso en el 44% de los casos. Los factores asociados con el éxito fueron la presencia de <2 comorbilidades, menor grado de gravedad y del escalón terapéutico de la terapia antes de la modificación, ausencia de exacerbaciones durante el año anterior, menos síntomas diurnos/nocturnos y limitación en las actividadesordinarias, así como el tipo de corticosteroide inhalado (ICS) / combinación de β₂-agonista de acción prolongada (LABA) después de la modificación, índice de masa corporal inferior y fracción...