Attitudes and beliefs of patients with asthma

Abstract

SUMMARYThis review summarises current research into patients' attitudes and beliefs about asthma. We found few papers which explore the relationship between findings from qualitative research and measures of diseases process or outcome.Asthma is widely experienced as a stigmatising, emotionally disturbing and socially restricting disease. There is no single view of asthma that clinicians can learn and apply. Patients' responses to the disease are individual and complex, and the key to understanding patients' attitudes to and beliefs about asthma lies in the recognition of the enormous variation in their responses.It is clear from current research that the complex interplay of physiological, psychological and social influences which affect patients' attitudes and beliefs are discreet and accessible in individuals and should be brought to bear on the process of the consultation between the patient and the health professional.T he aim of this review was to draw together and summarise current evidence from research into patients' attitudes and beliefs about, and experience of, asthma. Much of the research identified is qualitative, and few papers have been found which explore the relationship between findings from qualitative research and measures of the disease process or outcome. The review was carried out by searching the electronic databases Medline, Bids-Embase, Bids-SSSI and BIDS IBSS, and by manual search of three leading respiratory journals and two leading medical sociology journals. The research databases of the National Health Service and the National Asthma Campaign were also examined. A variety of search histories were used including the key words 'adherence', 'attitudes', 'beliefs', 'compliance', 'experience', 'impact', 'morbidity' and 'symptoms'. EXPERIENCE OF ASTHMAAsthma is a disease characterised by unpredictable symptoms. For most patients it is relatively mild although, for some, it leads to hospital admission or even death. [1][2][3] There is a broad consensus among health professionals that asthma symptoms can be at least partially prevented or controlled by regular use of inhaled steroids and by high-dose inhaled ß2-agonists during acute attacks in conjunction with short courses of oral steroids. [4][5][6] To prevent or relieve attacks quickly, increasing emphasis has been placed on self-management of asthma. 7,8 In the selfmanagement of asthma, patients are encouraged to react to changing symptoms by changing the dosage and combination of their own drugs. There are few diseases in which the patient is expected to undertake such an active role in determining their own drug regimens. For many asthmatics, these treatment strategies have not succeeded, and rates of morbidity and mortality remain stubbornly high.As the experience of asthma varies widely, it is not surprising that attitudes and beliefs are also widely differing. Juniper and colleagues 9 found that, from among symptoms, emotions, environmental factors, physical activities and practical problems, shortness of breath and chest tightne...