In the eye of the patient

Minimal difference in the prevalence of asthma in the urban and rural environment

Multiple risk factors can be modified to decrease asthma incidence. It is important to understand early risks to decrease exposure to harmful conditions in the environment that can trigger asthma which may not be clinically evident in children until they reach adulthood. A retrospective literature review of articles on the prevalence of asthma in the urban versus rural environment was initiated in order to understand the effect of the environment on asthma. The urban-living effect is a global problem in the face of growing population, industrialization and pollution. The socioeconomic dichotomy in the urban versus rural environment also affects access and quality of health care.

Articles reviewed had differences in the urban versus rural prevalence of asthma. However, further analysis of specific risk factors and socioeconomic trends that increased susceptibility to asthma was the same in these studies. Some rural areas may have similar environmental and socioeconomic issues that place them at the same risk for the development of asthma as their urban counterparts.

Urban locations generally tend to have the prototype environment that can lead to the predisposition of asthma. Ultimately, the incidence of asthma can be decreased if these environmental and socioeconomic issues are addressed. However, every effort is needed from the level of the individual to the community at large.

Severe asthma and adherence to peak flow monitoring: longitudinal assessment of psychological aspects

BACKGROUND

Adherence in severe asthma is a difficult health problem. Although psychosocial factors may be responsible for non-adherence, few longitudinal studies have investigated their link with adherence, with most studies having focused on pharmacology.

METHODS

Sixty patients with severe asthma were recruited. Adherence was electronically monitored using peak flow measurements at entry and after 1 year of follow-up. Eysenck's Personality Inventory, Rotter's Locus of Control (LOC), and health control beliefs were all studied. Multiple logistic regression (MLR) was used for risk calculations.

RESULTS

Initially, subjects with poor adherence had an external LOC (P=.001) and a high extraversion score (P=.003) compared to those with good adherence. The lie score was high in all patients. Nocturnal awakenings were highly significantly correlated with poor adherence (P=.006). After 1 year, patient adherence, extraversion, and neuroticism remained unchanged. The LOC changed in subjects with poor adherence, showing a less "external" orientation (P=.007). The health parameters were better at the end of the study. By MLR analysis, externality, extraversion, and low social desirability were associated with poor adherence. Patients with poor adherence had a greater probability of nocturnal symptoms.

CONCLUSION

No specific personality type was associated with lack of adherence in the present study, but a high extraversion score, a low social desirability score, and a high level of externality were all predictors of poor adherence.

Factors influencing patient decisions about the use of asthma controller medication

BACKGROUND

Patient nonadherence with asthma controller medication is pervasive and impedes successful adoption of national treatment guidelines.

OBJECTIVE

To survey adult patients with asthma about the factors influencing their decisions about when to use their asthma controller medications.

METHODS

Two hundred adults with asthma were randomly selected from a national database and were surveyed by telephone about medication use, barriers to adherence, and treatment preferences.

RESULTS

Adherence to daily controller medication in the group was generally well below the prescribed level despite the fact that many had relatively severe asthma and inadequately controlled symptoms. Thirty percent of the respondents indicated that they had been instructed by their physician to use their controller medication intermittently as guided by their symptoms. Most respondents expressed a desire to be more in control of their treatment and for that treatment to be more immediately effective and long-lasting but did not perceive inadequate information to be a barrier to adherence.

CONCLUSION

These insights into patient perception and motivation suggest the importance of developing treatment plans that allow patients some degree of control over medication use.