Original Articles: Asthma, Lower Airway Diseases
Asthma patients’ perception of their ability to influence disease control and management

https://doi.org/10.1016/S1081-1206(10)60508-XGet rights and content

Background

Patients’ perception of their ability to influence their asthma symptoms has not been sufficiently addressed.

Objective

To study the relationship between patients’ perceived ability to self-care, as approached by internal locus of control (LOC) orientation, and concomitant level of asthma control.

Methods

A cross-sectional study was conducted from May 19, 2004, through July 7, 2005. Asthma patients receiving inhaled corticosteroids and supervised in primary care were identified. Asthma control was measured with the Asthma Control Test. Patients reported their LOC orientation on a 100-mm visual analog scale (0%, “I have absolutely no influence on asthma change,” to 100%, “this change only depends on me”). Asthma therapy was obtained from a prescription database. The risk of an internal LOC of less than 50% was studied.

Results

Among the 163 patients with documented LOC (mean age, 52 years; 58% female), 72 (44.2%) had an internal LOC of less than 50%. Asthma control was inadequate for 65 of the 157 patients with available data on the global score of the Asthma Control Test (41.4%). Patients with inadequately controlled asthma had a higher risk of a LOC of less than 50% (odds ratio, 2.68; 95% confidence interval, 1.23-5.81). A 3-fold increased risk also appeared for patients older than 65 years compared with those younger than 45 years. Conversely, no association was identified with sex, asthma severity markers, or therapy.

Conclusions

Asthma control was related to internal LOC orientation (ie, perceived ability to self-care). Improved self-care efficiency is a target for adequate disease management.

Section snippets

INTRODUCTION

Patients’ beliefs and perception of their disease and treatments play a role in the management of chronic diseases, markedly asthma. 1, 2, 3 Locus of control (LOC) refers to the extent to which individuals believe that they can control events that directly affect them. Individuals with a high internal LOC believe that events result primarily from their own behavior and actions. Such people tend to presume that their efforts to control their disease will be successful. They are more active in

Study Design and Population

A cross-sectional study was conducted from May 19, 2004, through July 7, 2005. Asthma patients 15 years or older, receiving inhaled anti-inflammatory therapy during the past 6 months, and supervised by general practitioner (GP) members of the Cegedim France network were eligible for inclusion. Patients were excluded if they had an associated diagnosis of chronic obstructive pulmonary disease or language or understanding problems. When they visited their GP, the GP explained the study to the

RESULTS

Of the 204 patients who completed questionnaires, analyses were restricted to the 163 who used the visual analog scale to indicate their LOC. Median LOC value was 50% (25th-75th percentiles, 35%-67%). These 163 patients did not differ from the remaining 41 as to sex, asthma control, and severity markers, but they were younger (P = .004).

DISCUSSION

This is 1 of the few investigations of LOC in asthma. Likewise, changes in LOC orientation over time are seldom documented. LOC orientation markedly varied among asthma patients, and those with a lower internal LOC orientation were more likely to be older and to have uncontrolled asthma. LOC seems also to fluctuate with time, in parallel to change of asthma control status. In contrast, no association was observed with other personal characteristics, asthma-related factors, or management-related

ACKNOWLEDGMENTS

We thank Myriam Balmy (Cegedim-France) for her valuable assistance in the data management process and Liel Osman, PhD, and Philippe Le Jeunne, MD, for their help in improving the manuscript

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    Disclosures: Authors have nothing to disclose.

    Funding Sources: This study was supported by a grant from Glaxo-SmithKline France.

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