Qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across England

Abstract

Background: guidelines recommend that asthma medication should be stepped down to the minimally effective dose that achieves symptom control. Stepping down aims to prevent adverse medication effects and unnecessary costs but is often not implemented in primary care, where most asthma patients are managed. Little is known about the experiences and views of patients regarding stepping down.

Methods: stable asthma patients, with regular use of a preventer inhaler, from GP practices across England, participated in a survey and/or semi-structured interview. Questions explored the patient’s understanding of their asthma, views and knowledge of preventer inhalers, experiences and perceptions of stepping down asthma medication. Qualitative group-based multi-disciplinary thematic analysis by two healthcare professionals and a patient were performed.

Results: 143 patients responded to the survey, 63% were female, between the ages 18-80 years, and including geographical areas across the UK, 17 of whom participated in an interview. Half of these stable asthma patients, most with asthma for more than 10 years, had never had a discussion regarding stepping down asthma medication. Most stepping down that had occurred was related to seasonal changes in asthma control. Four overarching themes from the interviews were identified, (i) experiences of living with asthma and needing inhalers, (ii) insufficient education regarding preventer inhalers, (ii) stepping down is agreeable and possible and (iv) current asthma care is suboptimal.

Conclusion: stable asthma patients were able to self-manage their asthma well. They had little awareness of medication adverse effects and minimal experience of having their medication stepped down by a healthcare professional. Most were inclined to step down, if clinically safe to do so, indeed some had reduced their medication doses themselves, without professional guidance.

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Identifiers

ORCID for Adam Lewis: orcid.org/0000-0002-0576-8823

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