Identification of attitudinal clusters in patients with asthma: analysis from REALISE Asia

Abstract

BACKGROUND/AIM: Similar to the identification of clusters of patients in Europe based on survey of their attitudes towards asthma (REALISE), we sought to understand such attitudinal groups among Asian patients. METHODS: Online surveys were conducted among 2,467 adult patients with asthma across 8 countries in Asia. Using two-step approach, the respondents were segmented into groups, each containing patients who are similar in their attitudes, yet distinct from those in other groups. RESULTS: Five attitudinal clusters were uncovered: 1) ‘Well-adjusted’ (29%) • Generally cope well with their asthma • Asthma has minimal impact on their daily lives • Happy to go along with doctor’s advice • No problem using their inhaler, reflecting carefree attitude and lower stress levels 2) ‘Rejectors’ (17%) • Refuse to accept asthma label • Yet to come to terms with emotional burden of living with asthma • Deprioritize their health despite some concerns about their asthma • High social consciousness about using inhaler 3) ‘Lost’ (14%) • High level of stress and anxiety about their asthma • Asthma has high impact on their daily lives • Avoid thinking about their health • High asthma information seeking frequency but do not know where to turn for answers 4) ‘Endurers’(29%) • Accept their condition and that they do not have control over it • High acceptance of condition means they do not allow asthma to have a major impact on their daily life • Low level of confidence in managing their asthma • Less interested in seeking information than other uncontrolled patient types 5) ‘Worriers’ (11%) • Asthma is a constant worry on their mind • Accept their condition but live with a high level of stress and anxiety about their asthma • Exhibit high asthma information seeking frequency due to their concern Based from GINA-defined control status, cluster 5 has the most number of uncontrolled patients (92%), followed by clusters 3 (79%) and 4 (74%). Meanwhile, clusters 1 and 2 have the most number of controlled patients (34 and 38% respectively). Cluster 3 has significantly higher number of days and nights when their activities are interrupted by asthma. Cluster 1 has the highest proportion of those who did not experience exacerbation in the last 12 months – no emergency visits (83%), no oral steroids (51%) and no antibiotics (42%) for asthma. In contrast, 95% of patients in cluster 5 had > 1 course of antibiotics for asthma-related problems in the past year. CONCLUSION: Asian patients can be grouped into five clusters based on their concerns about their asthma and its management. The recognition of the clusters, offers an opportunity to customize management approaches for patients, and leverage on their attitudes to improve asthma control.