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Asthma
Concordance of opinions between patients and physicians and their relationship with symptomatic control and future risk in patients with moderate–severe asthma
  1. Astrid Crespo-Lessmann1,
  2. Vicente Plaza1,
  3. Francisco-Javier González-Barcala2,
  4. Toni Fernández-Sánchez3 and
  5. Joaquín Sastre4
  6. on behalf of The CONCORD Study Group
  1. 1Service of Pneumology, Hospital de la Santa Ceu i Sant Pau, Institute of Sant Pau & Biomedical Research (IBB Sant Pau), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
  2. 2Service of Pneumology, Complejo Hospitalario Universitario de Santiago de Compostela. Department of Medicine, University of Santiago de Compostela. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
  3. 3Medical Advisor de Respiratorio, Mundipharma Farmaceuticals, Madrid, Spain
  4. 4Department of Allergy, Hospital Universitario Fundación Jiménez Díaz. Centro deInvestigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
  1. Correspondence to Dr Astrid Crespo-Lessmann, Service of PneumologyHospital de la Santa Ceu i Sant Pau, Institute of Sant Pau & Biomedical Research (IBB Sant Pau), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; acrespo{at}santpau.cat

Abstract

Introduction Differences 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.

Methods A 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.

Results The 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.

Conclusion Patient–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.

  • Asthma
  • perception of Asthma/breathlessness

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjresp-2017-000189

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    Footnotes

    • Contributors All authors made substantial contributions to the study. ACL: enrolled patients and wrote the first draft of the manuscript; VP and JS: generated the hypothesis, designed the study, built the database and performed statistical analysis; F-JG-B and TF-S: participated in data interpretation and manuscript writing.

    • Funding Mundipharma Pharmaceuticals had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. The authors confirm that all personal identities have been removed or disguised so that participants are not identifiable.

    • Competing interests ACL was consultant for Mundipharma Pharmaceuticals in relation to the present study. VP in the last 3 years received honoraria for speaking at sponsored meetings from Chiesi, Esteve Laboratories, GlaxoSmithKline (GSK), Novartis, Orion and Pfizer; received assistance with travel to meetings from Chiesi and Novartis; acted as a consultant for Mundipharma Pharmaceuticals, Orion and Teva; and received funding/grant support for research projects from a variety of Government agencies and not-for-profit foundations as well as AstraZeneca, Chiesi, Menarini, GSK and ALK. F-JG-B: no conflicts to be declared. TF-S was a full-time employee of Mundipharma Pharmaceuticals. JS served as a consultant to Thermofisher, MSD, Novartis, Genentech, Sanofi, Leti, Roche, FAES FARMA, Mundipharma, and GSK; received lecture fees from Novartis, GSK, Stallergenes, LETI and FAES FARMA and grant support for research from Thermofisher.

    • Patient consent Obtained.

    • Ethics approval the protocol was approved by the Ethics Committee of the participating hospitals of the study coordinators.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data are available to the public for a maximum period of 5 years after the publication of this article.

    • Collaborators The CONCORD Study Group (ALBACETE): Callejas González, F; Jiménez López, J; Martínez Riaza, M; Moscardó Orenes, M; Prieto Montaño, P; Torrecillas Toro, M; (ALICANTE): Andreu Balaguer, C; Antón Girones, M; Baeza Martinez, C; Flores Martín, I; Gonzalez Delgado, P; Martos Calahorro, M; Mediero Carrasco, G; Rodríguez Pacheco, R; Vilella Tomás, V; (ALMERÍA): Mota Godoy, M; Zapata Yébenes, J; (ÁLAVA): Villarreal Balza De Vallejo, O; (ASTURIAS): Alvarez Fernandez, J; Bazus Gonzalez, T; Castaño De Las Pozas, G; Diaz Donado, C; Díaz Angulo, S; Gala Ortiz, G; Requejo Mañana, B; (ÁVILA): Blanco Gonzalez, R; (BADAJOZ): Gómez Nieves, E; Marin Torrado, J; (BARCELONA): Dordal Culla, M; Juanola Pla, J; Lleonart Bellfill, R; Martos Velasco, J; Pinto Nogues, E; Rivera Ortun, M; Rubinstein Aguñin, P; Subira Farre, N; Valldeperas Combas, J; (BIZKAIA): Ansotegui Zubeldia, I; Bernaola Hortigüela, G; Ciruelos Ayuso, J; González Álvarez, G; Herrerias Peña, M; Lahuerta Castro, A; Losada Llorente, P; Marin Martinez, P; Marina Malanda, N; (BURGOS): Garcia Gonzalez, F; Peña Miguel, T; (CÁCERES): Hernandez Hernandez , M; Jimenez Timon, S; Porcel Carreño, S; (CÁDIZ): Alwakil Olbah, M; Arnedillo Muñoz, A; Chamorro Mohedad, J; Gutierrez Fernandez, D; Letran Camacho, A; Merinas Lopez, C; Millan Gonzalez, M; Niño Bernal, S; Fernandez Pellon, L; (CANTABRIA): Morchon Miguel, E; Ortiz Portal, F; Suárez Rodríguez, A; (CASTELLÓN): Modesto Alapont, M; Raducan , I; Salvador Segarra, M; (CIUDAD REAL): Galindo Bonilla, P; Mata Calderon, P; Mena Rodriguez, M; (CÓRDOBA): Lama Martinez, R; Martín Pérez, M; Morales Villarejo, M; (CORUÑA): Blanco Aparicio, M; Do Muíño Joga, M; Fontan Garcia-Boente, L; García Paz, V; Gonzalez Barcala, F; Nuñez Orjales, R; Rabade Castedo, C; Rico Diaz, M; (CUENCA): Moreno Fernandez, A; (GIRONA): Aparicio Español, S; Ruiz San Francisco, A; (GRANADA): Alcázar Navarrete, B; Cassini Gomez De Cadiz, L; Escribano Rodriguez, M; Florido Lopez, J; Lara Jiménez, M; Lopez Caballero, J; Martínez Ceres, M; Mayorgas Costoya, R; Morales García, C; Rojas Vilchez, M; Romero Ortiz, A; (GUADALAJARA): Beitia Mazuecos, J; Vega Castro, A; ((GUIPUZCOA): Labeguerie Arenaza, B; Lizarza Mendizabal, S; Perez Sampedro, I;(HUELVA): Valverde Vazquez, L; (HUESCA): Cegoñino De Sus, J; Compaired Villa, J; Ferrer Pargada, D; Herrero Jarque, J; (ILLES BALEARS): Chacon Patiño, M; Fuster Gomila, A; Nicolau Pastrie, F; (JAÉN): Almagro Lopez, J; (LEÓN): Benito Martinez, P; Velez Ruiz De Lobera, A; (LUGO): Carballada Gonzalez, F; Perez Carral, C; Veres Racamonde, A; (LLEIDA): Cervera Del Pino, M; Rozadilla Sacanell, J; (MADRID): Ali García, I; Anta Mejias, Y; Añíbarro Bausela, B; Arroyo Cozar, M; Barranco Sanz, P; Bobolea , I; Bueso Fernandez, A; De Santiago Delgado, E; Diaz Campos, R; Donado Uña, J; Feliu Vila, A; Gandolfo Cano, M; Garcia De Pedro, J; Garcimartin Galicia, M; González De Olano, D; Huertas Barbudo, B; López Viña, A; Losada Peña, A; Minguez Martin, G; Montoro De Francisco, A; Moreno Borque, R; Moro Moro, M; Ramirez Prieto, M; Reche Frutos, M; Rodriguez Jimenez, B; Rodríguez Rodríguez, M; Romero Ribate, D; Ruano Perez, F; Ruiz Hornillos, J; Sánchez López, P; Sola Martinez, F; Subiza Garrido-Lestache, J; Vasquez Gambasica, Z; Vila Albelda, C; (MÁLAGA): Alcazar Ramirez, J; De Luiz Martínez, G; García Núñez, I; Linde De Luna, F; Ortega Sáenz De Tejada, E; Padilla Galo, A; Rodriguez Martinez, R; Soria Esojo, M; (MURCIA): Andujar Espinosa, R; Avilés Inglés, M; Bernabeu Mora, R; Franco Campos, M; Peña Arellano, M; (NAVARRA): Alvarez Puebla, M; García Figueroa, B; Garrido Fernández, S; Olaguibel Rivera, J; Tabar Purroy, A; (OURENSE): Presedo Garazo, B; Varela Losada, S; (PALENCIA): García Villamuza, Y; (PALMAS,LAS) Cumplido Bonny, J; (PONTEVEDRA): Alvarez Sintes, R; Castro Landin, J; Cobas Paz, A; Corbacho Abelaira, M; Iglesias Rio, F; Pallarés Sanmartín, A; Picans Picans, I; Regueiro Moreira, A;(RIOJA): Tejedor Romera, R; (SALAMANCA): Igea Aznar, J; Muñoz Bellido, F; Rodriguez Hernandez, M; (SANTA CRUZ DE TENERIFE): González Perez, R; Izaguirre Flores, H; (SEVILLA): Alvarez Gutierrez, F; Cimbollek , S; De Luque Piñana, V; Medina Gallardo, J; Moreno Garcia, V; Orta Cuevas, J; Puente Crespo, Y; Quiralte Enriquez, J; Serrano Dominguez, P; (TARRAGONA): Sotorra Elias, Ò; (TERUEL): Muñoz Pamplona, M; (TOLEDO): Jimenez Lara, M; Moral De Gregorio, A; (VALENCIA): Alvariño Martin, M; Ballester Canelles, M; Burches Baixauli, E; Catalán Serra, P; Climent Gregori, M; Cordero Rodriguez, P; De Las Marinas Alvarez, M; Díaz Palacios, M; El-Qutob López, D; Greses Giner, J; Herrera Lara, S; Jorro Martínez, G; Liñana Santafé, J; Lloris Bayo, A; Martinez Moragon, E; Molero Sancho, I; Montoro Lacomba, J; Naval Sendra, E; Navarro Seisdedos, L; Orosa Bertol, B; Robles Iniesta, A; Ruiz Cubillan, J; Sánchez-Toril López, F; Saura Vinuesa, A; (VALLADOLID): Alonso Gomez, A; De Frutos Arribas, J; Macias Fernandez, E; Sanchez Alonso, A; (ZARAGOZA): Colás Sanz, C; Domínguez Fuentes, M; Garcés Sotillos, M; Segura Arazuri, N.