Physician-patient concordance in the assessment of asthma control.

Abstract Background Discordance between physician and patient perceptions of asthma control may negatively impact symptom control, treatment, and outcomes. Objective To evaluate concordance between physician and patient perception of overall asthma control and the association between perceived overall control and individual components of control. Methods US survey data (Dec 2015–Feb 2016; Apr–Aug 2018) from the Respiratory Disease Specific Programme™ were analyzed. Physicians recorded patient disease characteristics and their perception of patients' asthma control. Patient perception of control was assessed using the Asthma Control Test (ACT); responses were compared with level of symptom control per the Global Initiative for Asthma (GINA) criteria and Work Productivity and Impairment questionnaire responses. Agreement and association were assessed by weighted Kappa (κ) and Spearman's Rho (r), respectively. Results 1288 patients were included. Concordance between physician-perceived and patient-perceived asthma control in the prior 4 weeks was moderate (κ=0.4951). Association between physicians' overall perception of asthma control and patients' overall ACT score was also moderate (r=0.5450). However, 61.5% of patients with self-reported, well-controlled asthma had shortness of breath 1–2 times/week, 45.6% had 1–2 night-time awakenings/week, and patients reported a mean (SD) daily activity impairment of 17.5% (16.2%). Only 21.8% of patients with self-reported, well-controlled asthma were classified as such by GINA symptom criteria. Conclusion Patients' self-assessment of overall control does not accurately characterize true level of control, thus patients and physicians may benefit from working together to assess the individual components of asthma control to achieve better disease management, treatment decisions, and improved outcomes.