Identifying patient clusters, tailoring treatment plans proposed over “one size fits all” approach
SINGAPORE, Nov. 20, 2014 /PRNewswire/ — New data from a survey of over 2,000 asthma patients in Asia show that a better understanding of patients’ underlying attitudes may help clinicians improve the lives of the estimated 70 million sufferers in the region.
Findings from the REALISE™ Asia survey were presented in three posters and three oral presentations at the 19th Congress of the Asian Pacific Society of Respirology in Bali, Indonesia from 13-16 November 2014.
Though 89% of respondents consider their asthma to be well-controlled, according to GINA clinical guidelines (adhered to by medical practitioners) only 18% have their asthma under control. Even in those who think their asthma is controlled, indicators of poor control are high. Of respondents who indicate their asthma is under control, 61% say their daily activities are affected and 69% are woken up at night by asthma. Still, 78% said their asthma symptoms were not very serious.
The findings also highlight an aspect of asthma management that has gone mostly overlooked: patients’ beliefs about their condition and their definitions of controlled asthma. Patients’ understanding of ‘asthma control’ deviates from how guidelines have defined this treatment goal. Patients tend to relate asthma control more to managing attacks rather than preventing it. Such understanding translates to a patient mindset that asthma lacks immediacy and relevance.
Additionally, the findings revealed:
- 41% of respondents don’t see the need for taking their medication regularly when they’re not experiencing incapacitating symptoms or asthma attacks
- Nearly half find using their inhaler a nuisance
- Only 14% took their regular asthma medication daily, as it is prescribed, but 35% used their reliever medication more than 3 times in the past 7 days
The data point to opportunities for improving asthma management through interventions that might address the discrepancy between how patients perceive asthma control and actual control over their condition. Instead of the "one size fits all" approach to treatment, clinicians would do better to recognise and appreciate the role that patient attitudes play in asthma management. By matching patients to pre-defined "clusters", the data suggest that clinicians can more easily develop tailored treatment plans to which patients might better adhere.
Cluster analysis of the REALISE™ Asia data identified 5 segments in which patients with similar characteristics report comparable attitudes and subsequent treatment outcomes:
- Well-Adjusted: Patients cope well with asthma, which has minimal impact on their daily lives. They are happy to go along with doctor’s advice and have lower stress levels.
- Rejector: Patients refuse to accept the "asthma" label and are very independent in managing their condition. They are more inclined to deprioritise health and feel embarrassed using inhalers.
- Lost: Patients have high levels of stress and anxiety about asthma, which has a large impact on their daily lives. They report problems with inhalers and have unanswered questions.
- Endurer: Asthma doesn’t have a huge impact on their daily lives and they’re highly accepting of the "asthma" label, though they’re not very confident in managing their condition.
- Worrier: Patients are highly impacted by asthma, are stressed and have the lowest confidence in managing their condition. They have the highest percentage of uncontrolled asthma and need emotional support.
Patients in the different clusters reported strikingly different outcomes, highlighting the effects that attitudes play in asthma management. Overall, Well-adjusted and Rejector clusters reported less healthcare resource utilisation compared with those in the Lost, Endurer and Worrier clusters.
Well-Adjusted patients (51%) are significantly more likely not to have used steroids in the past year, compared to the other clusters (27%). Over half of patients in the Lost and Worrier clusters required treatment at a hospital due to asthma hospitalised in the past year because of asthma, compared to only 17% in the Well-Adjusted cluster. 72% of those in the Worrier cluster reported using their reliever inhaler, compared to <50% for all other clusters.
Uncontrolled asthma is associated with higher healthcare utilisation rates in Asia-Pacific countries and these different healthcare utilisation rates reflects different levels of asthma control. The results also suggest that clusters may require different management approaches guided by the specific attitudes patients have about their condition.
Additional data to be presented sheds light on the importance of regularly monitoring patients’ inhaler techniques and how understanding country-by-country differences in perceived asthma control, asthma exacerbations, and use of asthma medications and inhalers can help clinicians to develop relevant interventions.
Hanlim Moon, Head of Medical Affairs Mundipharma, Asia Pacific, Latin America, Middle East and Africa, commented: "Findings from REALISE™ Asia are shedding light on new ways — such as clustering patients by attitudes — for clinicians to approach patients. The data support targeted approaches like tailored treatment plans to allow clinicians to work more closely with patient to improve asthma management and lower the burden of disease in Asia. Based on the findings, we at Mundipharma are able to better support our growing portfolio of respiratory medications with educational initiatives and informed outreach."
Raman Singh, President, Asia Pacific, Latin America, Middle East, and Africa, commented:
"Asthma is a serious condition that often is not addressed seriously. The number of patients considered uncontrolled has remained stagnant for years, and insights from REALISE™ Asia are beginning to give us a better idea of why that is."
"The disconnect between patient-defined and clinician-defined control is a huge hurdle to overcome, but we believe that new approaches will allow clinicians to work more closely with patients to improve asthma management. Mundipharma’s support for REALISE™ Asia demonstrates our commitment to investing in research that supports both doctors and patients with the ultimate goal of reducing the burden of asthma on the more than 70 million Asians living with the debilitating condition."
About REALISE™ Asia
The REALISE™ Asia, REcognise Asthma and LInk to Symptoms and Experiences, survey, sponsored by Mundipharma Pharmaceuticals Pte Ltd and developed in partnership with asthma experts, is a survey of asthma patients in Asia which aimed to assess patient attitudes and behaviours towards their disease. The survey was conducted with 2,467 people with asthma aged 18-50 across 8 Asian countries/regions. In order to take part in the survey, respondents must have received at least two prescriptions for their asthma in the past two years and also had to be active on social media.
Asthma is a chronic (long-term) inflammatory disorder of the airways which leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing. Asthma is a serious condition affecting over 70 million people in Asia. Patients with poorly managed asthma are at an increased risk of exacerbations, hospitalisation and death. Poorly managed asthma can also have a huge impact on a person’s quality of life and day-to-day activities.vi
The Mundipharma network of independent associated companies consists of privately owned companies and joint ventures covering the world’s pharmaceutical markets. These companies are committed to bringing to patients the benefits of pioneering treatment options in the core therapy areas of oncology, pain, respiratory and rheumatoid arthritis.
For further information please visit: www.mundipharma.com.sg.
Copies of the posters can be made available on request.
P-A-022 Awareness and usage of inhalers among patients with asthma: findings from REALISE Asia J.C. Ho et al. (2014)
Friday, 14 November, 2014 1:00 – 3:00 PM
P-A-023 Preferred sources of information on asthma: data from multinational survey of patients in Asia
A. David-Wang et al. (2014)
Friday, 14 November, 2014 1:00 – 3:00 PM
P-A-031 Differences in patient-perceptions and levels of asthma control across 8 Asian countries: data from the REALISE Asia survey
A.R. Muttalif et al. (2014)
Saturday, 15 November, 2014 1:00 – 3:00 PM
Overview slides can be made available on request.
O-A-011 Identification of attitudinal clusters in patients with asthma: analysis from REALISE Asia
S.H. Cho et al. (2014)
Saturday, 15 November, 2014 8:30 – 8:40 AM
O-A-013 Discrepancy between patient-perception and guideline-defined asthma control in Asia: a survey of over 2400 patients
S.H. Cho et al. (2014)
Saturday, 15 November, 2014 8:50 – 9:00 AM
O-A-014 Patterns of hospitalization and healthcare utilization across attitudinal clusters: analysis from patient survey in Asia
D.W. Perng et al. (2014)
Saturday, 15 November, 2014 4:15 – 4:25 PM
 The International Union Against Tuberculosis and Lung Disease. The Global Asthma Report 2011. Available from: http://www.globalasthmanetwork.org/publications/Global_Asthma_Report_2011.pdf . Last accessed on 13 November 2014.
 REcognise Asthma and LInk to Symptoms and Experience (REALISE™) Asia. REALISE™ Asia was conducted online, by phone and face-to-face with 2,467 people with asthma aged 18-50 in Mainland China, Hong Kong, South Korea, Taiwan, Malaysia, Indonesia, the Philippines and Singapore. It was sponsored by Mundipharma Pharmaceuticals Pte Ltd and developed in partnership with asthma experts.
 GINA-defined control status (iHARP index). http://iharp.org Last accessed on 13 November 2014.
 S.H. Cho et al (2014). O-A-011, to be presented at APSR.
 D.W. Perng et al (2014). O-A-014, to be presented at APSR.
 Gold LS et al. Resp Med 2014; 108:271-7.