Qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across England
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 patients with asthma ar...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-02-01
|
| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/12/1/e002898.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832542428771385344 |
|---|---|
| author | Chloe I Bloom Adam Lewis Jack Middleton |
| author_facet | Chloe I Bloom Adam Lewis Jack Middleton |
| author_sort | Chloe I Bloom |
| collection | DOAJ |
| description | 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 patients with asthma are managed. Little is known about the experiences and views of patients regarding stepping down.Methods Patients with stable asthma, with regular use of a preventer inhaler, from general practitioner 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 multidisciplinary 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 patients with stable asthma, 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, (1) experiences of living with asthma and needing inhalers, (2) insufficient education regarding preventer inhalers, (3) stepping down is agreeable and possible and (4) current asthma care is suboptimal.Conclusion Patients with stable asthma 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. |
| format | Article |
| id | doaj-art-2572f4c88f3047539fa3dc7cff55ef43 |
| institution | Kabale University |
| issn | 2052-4439 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj-art-2572f4c88f3047539fa3dc7cff55ef432025-02-04T05:05:10ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392025-02-0112110.1136/bmjresp-2024-002898Qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across EnglandChloe I Bloom0Adam Lewis1Jack Middleton2National Heart and Lung Institute, Imperial College London, London, UKSchool of Health Sciences, University of Southampton, London, UKOxford University Hospitals NHS Foundation Trust, Oxford, UKBackground 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 patients with asthma are managed. Little is known about the experiences and views of patients regarding stepping down.Methods Patients with stable asthma, with regular use of a preventer inhaler, from general practitioner 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 multidisciplinary 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 patients with stable asthma, 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, (1) experiences of living with asthma and needing inhalers, (2) insufficient education regarding preventer inhalers, (3) stepping down is agreeable and possible and (4) current asthma care is suboptimal.Conclusion Patients with stable asthma 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.https://bmjopenrespres.bmj.com/content/12/1/e002898.full |
| spellingShingle | Chloe I Bloom Adam Lewis Jack Middleton Qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across England BMJ Open Respiratory Research |
| title | Qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across England |
| title_full | Qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across England |
| title_fullStr | Qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across England |
| title_full_unstemmed | Qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across England |
| title_short | Qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across England |
| title_sort | qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across england |
| url | https://bmjopenrespres.bmj.com/content/12/1/e002898.full |
| work_keys_str_mv | AT chloeibloom qualitativestudyofpatientsexperiencesandperceptionsofsteppingdownasthmamedicationinprimarycareacrossengland AT adamlewis qualitativestudyofpatientsexperiencesandperceptionsofsteppingdownasthmamedicationinprimarycareacrossengland AT jackmiddleton qualitativestudyofpatientsexperiencesandperceptionsofsteppingdownasthmamedicationinprimarycareacrossengland |