Asthma self management preferences, attitudes and beliefs in primary care

Purpose: To describe self management preferences, attitudes and beliefs of urban adults with persistent asthma. Subjects: Primary care patients prescribed inhaled corticosteroids (ICS). Methods: Survey. Results: A convenience sample of 141 subjects (78% female; 81% Black; 51% with ≤ high school education; 29% with commercial insurance; mean age 50.4 + 13.4; range 19-83) prescribed inhaled ICS for persistent asthma were enrolled from 5 sites (2 internal medicine, 2 family medicine and 1 federally qualified health clinic). Subjects completed a self-administered 39-item survey about their conventional and alternative asthma self management preferences, attitudes and beliefs. Seventy-six percent felt they needed daily ICS. Twenty-four subjects (17%) used ICS symptomatically. Additionally, 37% believed they were the best judge of whether they needed ICS or not. Several feared ICS addiction (21%) or tolerance (18%). Perhaps most distressing – 16% voiced concern that “someone may be experimenting on me by prescribing [ICS]” or that “someone may be experimenting on me by prescribing [ICS]” for writing ICS prescriptions. All subjects used some form of alternative self management, including fresh air/fan (84%), water (46%), steam/using warming therapies (35%), bathing/dressing prescriptives (30-35%), prayer (36%), teas (28%), coffee or “natural therapies” (18%), percussion (17%), or herbs, vitamins or mentholatum rubs (16%). Importantly, 31% felt the integration of both conventional and alternative approaches was superior to either one alone. Conclusions: Patients have unique self management preferences, attitudes and beliefs that, if identified and discussed, could serve as the foundation of a tailored plan of care that may reduce barriers to ICS use.