Original Article
Identifying Patient Attitudinal Clusters Associated with Asthma Control: The European REALISE Survey

https://doi.org/10.1016/j.jaip.2017.10.007Get rights and content
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Background

Asthma is a highly heterogeneous disease that can be classified into different clinical phenotypes, and treatment may be tailored accordingly. However, factors beyond purely clinical traits, such as patient attitudes and behaviors, can also have a marked impact on treatment outcomes.

Objective

The objective of this study was to further analyze data from the REcognise Asthma and LInk to Symptoms and Experience (REALISE) Europe survey, to identify distinct patient groups sharing common attitudes toward asthma and its management.

Methods

Factor analysis of respondent data (N = 7,930) from the REALISE Europe survey consolidated the 34 attitudinal variables provided by the study population into a set of 8 summary factors. Cluster analyses were used to identify patient clusters that showed similar attitudes and behaviors toward each of the 8 summary factors.

Results

Five distinct patient clusters were identified and named according to the key characteristics comprising that cluster: “Confident and self-managing,” “Confident and accepting of their asthma,” “Confident but dependent on others,” “Concerned but confident in their health care professional (HCP),” and “Not confident in themselves or their HCP.” Clusters showed clear variability in attributes such as degree of confidence in managing their asthma, use of reliever and preventer medication, and level of asthma control.

Conclusions

The 5 patient clusters identified in this analysis displayed distinctly different personal attitudes that would require different approaches in the consultation room certainly for asthma but probably also for other chronic diseases.

Key words

Asthma
Attitudes
Beliefs
Cluster
Control
Management
Patient

Abbreviations used

BIC
Bayesian information criterion
GINA
Global Initiative for Asthma
HCP
Health care professional
LCA
Latent class analysis
REALISE
REcognise Asthma and LInk to Symptoms and Experience

Cited by (0)

Funding for the survey and medical writing support was provided by Mundipharma International Limited.

Conflicts of interest: T. van der Molen is on the Certe Laboratories board; and has received research support from AstraZeneca, Almirall, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mundipharma, Novartis, and Teva. M. Fletcher has received honoraria (paid to Education for Health) from Almirall, Chiesi, Teva, Abbott Laboratories, AstraZeneca, Novartis AG, Novartis UK, Boehringer Ingelheim, Pfizer, and UCB; and has received travel support from Almirall UK, Teva, and Novartis AG. D. Price is on the boards for Aerocrine, Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis, and Teva Pharmaceuticals; has received consultancy fees from Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Meda, Mundipharma, Napp, Novartis, Pfizer, Teva Pharmaceuticals, and Theravance; has received research support from UK National Health Service, British Lung Foundation, Aerocrine, AKL Ltd, Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Eli Lilly, GlaxoSmithKline, Meda, Merck, Mundipharma, Napp, Novartis, Orion, Pfizer, Skyepharma, Takeda, Teva Pharmaceuticals, and Respiratory Effectiveness Group; has received lecture fees from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Meda, Merck, Mundipharma, Novartis, Pfizer, Skyepharma, Takeda, and Teva Pharmaceuticals; has received payment for manuscript preparation from Mundipharma and Teva Pharmaceuticals; has a patent with AKL Ltd; has received payment for developing educational presentations from GlaxoSmithKline, Novartis, and Mundipharma; has stock/stock options in AKL Ltd; has received travel support from Aerocrine, Boehringer Ingelheim, Mundipharma, Napp, Novartis, and Teva Pharmaceuticals; has received funding for patient enrolment or completion of research from Almirall, Chiesi, Teva Pharmaceuticals, Zentiva, and Novartis (fees paid to Observational and Pragmatic Research Institute); is peer reviewer for grant committees of Medical Research Council (2014), Efficacy and Mechanism Evaluation programme (2012), and Health Technology Assessment (HTA) (2014); and owns 80% of Research in Real Life Ltd, 74% of the social enterprise Optimum Patient Care Ltd, UK, and 74% of Observational and Pragmatic Research Institute Pte Ltd, Singapore.