Pan-European burden of asthma revealed

Data from the REALISE™ survey highlight a high incidence of recent exacerbations, even among patients whose asthma is controlled according to clinical guidelines.(1)

Data from the REALISE™ survey highlight a high incidence of recent exacerbations, even among patients whose asthma is controlled according to clinical guidelines.(1)

Worryingly, many patients continue to cope with their symptoms rather than consider these as indicators of a continuing problem that should be addressed.(1) With approximately one in 25 people across Europe affected by asthma(3,4) and around 15,000 people dying due to the condition each year, five respiratory experts highlight the published findings as a reality check and encourage healthcare professionals to renew their focus on standardised assessment of asthma symptoms and lifestyle limitations.

The REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey provides the largest pan-European data on incidence of exacerbations and symptoms, levels of Global Initiative for Asthma (GINA)-defined control, as well as insights into patient attitudes.(1)

The survey highlights that 45% of respondents had uncontrolled and 35% partially controlled asthma according to the GINA criteria, although more than two-thirds of patients did not recognise this and did not consider their asthma as serious.(1)

According to REALISE, many patients accept the lifestyle limitations their asthma brings without considering their symptoms as an important health matter that could be better managed and prevented.(1) Almost half (44%) of respondents reported having used oral steroids for asthma in the previous 12 months, with over 40% having used their reliever three or more times in the previous week.(1) The findings also show that 56% of those respondents who thought their asthma was controlled continued to experience symptoms that interfered with normal activities,(1) with 53% waking at night due to asthma in the week prior to the survey.(1)

Professor David Price, University of Aberdeen, and lead author of the REALISE publication explains: “Asthma remains a major problem and our research comes as a reality check. Even those patients considered controlled continue to be at risk of exacerbations. We need to refocus on what matters: accurately assessing asthma in clinical practice and improving patients’ understanding of what effective disease management means for their day-to-day life.”

He continues: “We have an armoury of clinical guidelines, treatments and resources at hand, and when combined with a clear understanding of what makes our patients tick, we can produce much better outcomes for all involved.”

The REALISE findings highlight a disconnect between patients’ perceptions of control and guideline-defined control,(1) suggesting a need for healthcare professionals to better understand individual patient attitudes towards asthma to build a shared language that supports effective disease management. Of all REALISE respondents, 82% said they do not want to be labelled as sick,(1) 62% believe they are not like other people with asthma(1) and 43% ignore their asthma to feel normal and fit in.(1) These findings are further supported by patients’ attitudes towards their inhaler, with two out of five respondents considering it a nuisance and 26% reporting to feel embarrassed about using it.(1) Overall, 33% of all REALISE respondents preferred managing their asthma themselves rather than seeking their doctor’s advice,(2) with 33% using the internet and social media for information about managing their condition.(2)

Monica Fletcher, Chair of the European Lung Foundation, Chief Executive of Education for Health and co-author of the REALISE publication, adds: “Patients have normalised their asthma so we need to dig deeper in consultations. Our research signposts that understanding patients’ attitudes towards asthma is a key component of successful asthma management. We know there is a disconnect between how patients think about control and the pre-defined level of symptom control that healthcare professionals are aiming for. We need to close this gap to curb the impact of the disease.”

The REALISE survey was sponsored by Mundipharma, which is committed to collaborating with the asthma community to discover new perspectives on asthma management with the goal of improving the lives of people with the condition.

1. Price D, et al. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med 2014;24:14009.
2. Mundipharma International Limited data on file: REALISE™ – European Asthma Patient Survey Results, 2012.
3. European Federation of Allergy and Airway Diseases Patient Association. The Severe Asthma Survey: Severe Asthma Backgrounder. Available at: http://www.efanet.org/wp-content/documents/SASSevereAsthmaBackgrounder050307.pdf (accessed April 2014).
4. United Nations Population Division, World Population Prospects: The 2008 Revision Highlights. Available at: http://www.un.org/esa/population/publications/wpp2008/wpp2008_text_tables.pdf (accessed April 2014).
5. Asthma UK. News: Asthma experts form new partnership to halve European asthma deaths. Available at: http://www.asthma.org.uk/News/asthma-experts-form-new-partnership-to-halve-european-asthma-deaths ( accessed April 2014).
6. European Respiratory Society. The European White Lung Book: The First Comprehensive Survey in Respiratory Health in Europe, 2003.