Patients' experiences of asthma exacerbation and management: a qualitative study of severe asthma

Abstract

BackgroundExacerbation is a defining feature of severe asthma, and oral corticosteroids (OCSs) are frequently prescribed to manage exacerbations. This qualitative study was conducted to examine the experience of patients with severe asthma, with a focus on asthma exacerbation and OCS treatment.MethodsAdults with severe asthma were recruited from three tertiary hospitals in South Korea. Data were collected through in-depth qualitative interviews. Verbatim transcripts were analysed using Colaizzi's phenomenological method to uncover the meaning of the participants’ experience. Recruitment of participants continued until thematic saturation.ResultsFourteen patients with severe asthma were recruited. Four theme clusters emerged: 1) experience of asthma exacerbation, 2) impact on life, 3) OCS treatments, and 4) disease perception. The patients experienced severe physical and psychosocial distress from asthma exacerbations, felt helpless due to failed efforts to prevent exacerbation, and were living a restricted life due to fear of exacerbation. They feared OCS side effects but had no other choice but to rely on OCS because other interventions were ineffective. Most had poor knowledge and understanding of severe asthma and the longterm health consequences.ConclusionAsthma exacerbation affects wide aspects of life in patients with severe asthma. Several components may underlie OCS reliance, including experience of distress during exacerbation, fear of future exacerbation, and lack of proper knowledge about long-term health consequences of severe asthma and OCS treatments. Multi-disciplinary approach is warranted to support the patients and to provide systematic education about long-term health implications of severe asthma.

Clinical Characteristics and Disease Burden of Severe Asthma According to Oral Corticosteroid Dependence: Real-World Assessment From the Korean Severe Asthma Registry (KoSAR)

“… 27 A recent qualitative study in severe asthmatics described the psychologic side effects of OCS, such as mood swings and anxiety derived from OCS reliance. 28 In our data, the prevalence of hypertension, osteoporosis, and diabetes mellitus were similar between the OCS-dependent group and the OCS-independent group.…”

Study of use of non-invasive ventilation in patients of acute exacerbation of chronic obstructive pulmonary disease

“…Song et al, conducted a study of 21 patients having acute exacerbation of asthma. 20 The authors found that breathlessness and cough were the most common presenting complaints of the patients presenting with acute exacerbation. The authors also reported complications secondary to cough such as chest pain, inability to talk, and psychosocial problems associated with severe coughing.…”

The Korean Severe Asthma Registry (KoSAR): real world research in severe asthma

“…Higher chronic use of OCS leads to increased risk of complications, costs, and dose-dependent mortality [16][17][18]. Furthermore, patients with severe asthma experience severe physical and psychological distress from exacerbations [19]. Nonetheless, physicians and regulatory authorities have not acknowledged the extent of the severe asthma burden.…”