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The Global Asthma Physician and Patient (GAPP) Survey is the first-ever global quantitative survey designed to uncover asthma attitudes and treatment practices among physicians and patients. It identifies and explores key barriers to optimal management and reveals limitations of currently available treatments. Specifically, the areas of medication side effects and compliance, and patient education are explored.

Summary of Global Adult Patient and Physician Findings
Asthma prevalence and impact

• Worldwide asthma related fatalities among diagnosed asthma patients, have reached as many as 180,000 annually¹
• More than half (53%) of asthma patients don’t recognize that asthma attacks in mild sufferers can be fatal

Side effects are a critical issue in asthma treatments exacerbated by physician-patient communication gap

• 95% of physicians say they strongly or somewhat agree that inhaled corticosteroids (ICS) are the “gold standard” treatment for asthma
• Patients have limited awareness of asthma treatment side effects
  • 31% of patients are unaware of long-term side effects associated with asthma medications, such as osteoporosis, cataracts and glaucoma
  • 20% are unaware of the short-term side effects of asthma medications, such as oral thrush, pharyngitis and hoarseness
• Patients and physicians have differing opinions about the frequency with which side effects are discussed
  • Approximately one-half of patients report never discussing short- or long-term side effects with their physicians; however, 92% of physicians say they sometimes or always discuss short-term side effects, and 66% say they sometimes or always discuss long-term side effects
  • According to patients, side effect discussions are initiated by the patients (60% of the time), especially those who are concerned about, or experience, side effects. Conversely, physicians state they initiate the conversation 76% of the time

Patients’ experiences with, and concerns about, side effects influence their treatment compliance

• 34% of patients who have taken medication report having experienced short-term side effects; 19% of patients report having experienced long-term side effects
• Side effects may lead to sub-optimal treatment and decreased quality of life
  • Among patients who have experienced side effects 37% report that because of side effects they have changed doses, 31% have skipped doses, and 21% have discontinued medication
• Among patients who have taken medication, aside from a perceived improvement in symptoms, “experienced side effects” and “concerned about the potential for side effects” were patients’ primary reasons for switching medications
  • Of patients who have taken medication, 21% have switched asthma medications because they experienced side effects; 18% have switched medications because they were concerned about the potential for side effects
• The top four reasons patients are not 100% compliant with their physicians’ treatment instructions are: “believe they do not need to take their medication if their symptoms go away” (6.0); “believe they do not need to take their medication so often” (5.7); “they forget” (5.2); and “they are concerned about side effects” (4.4)²

Health outcomes are greatly impacted by asthma treatment compliance

• 82% of patients who are not compliant 100% of the with their asthma medication regimen, experienced at least one of the following consequences decreasing quality of life:
  • Increased symptoms (69%)
  • Nighttime awakenings (53%)
  • More frequent asthma attacks or exacerbations (41%)
  • More severe asthma attacks (31%)
• In addition, some consequences impact resource utilization:
  • More physician visits (26%)
  • More hospitalizations or ER visits (14%)
• Patients may be more compliant if they experience fewer side effects

Physicians believe patient compliance with medication is significantly better than patients actually report

• Only 12% of patients are compliant 81-99% of the time; this contrasts with 9% of physicians who believe their patients comply 81-99% of the time
• Patients who comply more frequently report having more discussions with their physicians about techniques for successful asthma management

Perceptions of in-office patient education vary widely between physicians and patients

• 23% of patients estimate that no time during office visits is spent discussing techniques for successful asthma management; 87% of physicians estimate that up to one-half of the time during appointments is spent discussing techniques for successful asthma management
• Twice as many physician (44%), compared with patients (22%) report discussing a symptom diary

Both physicians and patients would welcome new treatment options

• 76% of patients believe there is a need for new medications
  • Fewer than 40% of patients are “very satisfied” that their current asthma medication will not cause side effects
• 81% of physicians believe there are unmet needs in the ICS treatment category
  • Physicians are less satisfied with side effect profiles of currently available ICS treatments than they are with other attributes of ICS, such as efficacy and convenience
  • “The potential for side effects with ICS” was a major driver among physicians in evaluating whether there is an unmet asthma therapeutic need
• Patients who have been more affected by their asthma are more likely to feel there is a need for new treatment options
  • Patients whose asthma has limited their daily activities are more likely to feel there is a need for new treatment options (45%) than patients whose daily activity have not been limited (29%)
  • Patients who made unscheduled doctor visits are more likely to feel there is a need for new treatment options (31%) than those who have not made unscheduled visits (16%)

Study Design/Methodology
To better understand barriers to optimal asthma management in adults, Harris Interactive conducted interviews online, by telephone and face-to-face in 16 countries: Australia, Belgium, Brazil, Canada, France, Germany, Ireland, Italy, Japan, The Netherlands, Poland, South Africa, Spain, Switzerland, the UK and the U.S., on behalf of GAPP. A total of 3,459 interviews were conducted:

• 1,726 adults age 18+ diagnosed with asthma
• 1,733 physicians³ who treat adults, including:
  • 916 generalists (family practitioners, general practitioners and internal medicine practitioners)
  • 817 specialists (chest physicians)

The U.S. data were the only data weighted. Physician data were weighted by physician specialty, gender and years in practice to reflect the characteristics of physicians in the master file of physicians in the American Medical Association. Patient data were weighted by gender, education, age, household, income and region to reflect the characteristics of adult asthma patients from the National Health Interview. Data from the other countries surveyed were not weighted.

¹These data were not collected through the Harris Interactive Survey

²Average scores on 1-10 scale where “1” means “not at all important” and 10 means “extremely important”

³Physicians surveyed had to meet the following criteria: currently practicing medicine for 3-30 years, sees at least three adults asthma patients per week, writes at least one prescription for asthma medications per week. Generalists include family practitioners, general practitioners and internal medicine practitioners. Specialists include allergists, pulmonologists and respirologists.