27 February 2019

GPs battling the psychology of asthma

Clinical Respiratory

Many people with asthma don’t take the disease seriously and are lax about their medication regimens – even though asthma kills hundreds of people every year in Australia, experts say.

In a qualitative study published by the National Asthma Council Australia in February, a dozen key stakeholders shared their concerns about the poor adherence to medications among people with asthma.

Little progress had been made towards lowering the health costs associated with asthma in the past decade, the paper said. One of the main reasons was many patients just didn’t think of asthma as a disease that needed to be proactively managed, the experts who were interviewed said.

According to AIHW data, only around one in every nine Australians have asthma, and around 20% have a written asthma plan.

“A common theme was that people with asthma were not doing what practitioners told them to do, and practitioners felt frustrated that they lacked the skills to affect changes in behaviour, particularly around medication adherence,” the paper stated.

While patients are often willing to take antihypertensives to prevent a stroke or statins for high cholesterol (usually in the absence of any symptoms), patients downplayed the significance of asthma.

“They just say ‘oh, I have a touch of it’,” said one contributor. “Unless they come in gasping and blue, it’s not a priority.”

A misconception is that asthma is a childhood condition that people outgrow.

People with intermittent asthma symptoms, or with well-controlled or dormant asthma, tended to “lapse into a state of complacency”, one contributor said.

For GPs, the blasé attitude of patients was a major barrier to helping them self-manage their asthma.

“GPs felt like they were sort of swimming against the tide when it comes to encouraging people to self-manage and to be motivated to self-manage their asthma … motivating people is pretty hard,” one contributor said.

Training GPs in behavioural interviewing and motivational techniques could help change patient perceptions and improve adherence, the paper stated.

“You really have to get to the core of what’s underlying that patient’s behaviour, and that’s quite a skilful thing for a health practitioner to be able to do – and time consuming,” another contributor said. 

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