Original Article
Taking Aim at Asthma Around the World: Global Results of the Asthma Insight and Management Survey in the Asia-Pacific Region, Latin America, Europe, Canada, and the United States

https://doi.org/10.1016/j.jaip.2015.04.013Get rights and content

Background

Asthma, a worldwide health problem, can be controlled if properly diagnosed and managed. Multinational surveys conducted in patients with asthma from 1998 to 2003 indicated that asthma was inadequately controlled. The Asthma Insight and Management (AIM) study represents the largest survey conducted on patients with asthma since 2003.

Objective

The objective of this study was to assess findings from the United States (US), Europe and Canada (EUCAN), Latin America (LA), and the Asia-Pacific (AP) region surveys to identify differences and similarities with earlier surveys on patients with asthma.

Methods

The US, EUCAN, LA, and AP AIM surveys conducted from 2009 to 2011 all used a common set of questions. Responses to these are reported as proportions of patients with asthma for each country individually, and as totals for all regions. Results are presented as mean/median proportions for US, EUCAN, LA, and AP survey populations individually. Global medians and the range of regional response values are also described.

Results

A total of 10,302 patients or parents of adolescents with asthma were interviewed. Approximately one-quarter reported daytime symptoms daily or on most days over the previous 4 weeks. Globally, a median of 67% (range, 27%-88%) of patients perceived their asthma as completely and/or well controlled, but a median of only 9% (range, 0%-29%) of patients had well-controlled asthma using criteria from asthma guidelines. A majority (≥60%) of patients felt that quick-relief medication could be used daily if needed, contrary to guideline recommendations.

Conclusions

Patients exhibited a lack of knowledge and conviction for treatment recommendations and guidelines that was relatively uniform across the regions, similar to earlier survey findings. These results reveal an ongoing need for improvement in asthma care and education in most populations.

Section snippets

Methods

The AIM study was conducted from 2009 to 2011 in 20 countries in North America, Europe, Latin America, and the AP region. The details of the study designs and methodology have been published previously7, 8, 10, 11 or presented online.12 In the AP region, the original US AIM survey was translated from English to local languages, then back-translated to English, and compared with the original US version. In addition, the survey questions were pretested to increase the confidence that these

Results

Globally, 268,186 households were screened, and a total of 10,302 respondents completed the survey. The mean age of patients in the AP region was 45 years, which ranged from 33 years in Taiwan to 52 years in South Korea.10 In the LA region, the mean age of patients was 37 years, which ranged from 35 years in Venezuela to 43 years in Puerto Rico.11 In the United States, 62% (1555 of 2499) of patients were ≥35 years of age and 38% (944 of 2499) of patients were <35 years of age.15 In the EUCAN

Discussion

The results of this study conducted in more than 10,000 patients with asthma offer a snapshot of real-life asthma management practices across different regions of the world, using 53 questions common to all of the regional surveys. The US and EUCAN surveys also included a question asking patients if their doctor or other health care practitioner ever had them fill out a questionnaire. Patients' acceptance of asthma burden is evident in the global AIM surveys, in which high proportions of

Conclusion

In the AIM surveys, the burden of asthma was evident in the frequency of symptoms, in the episodes of worsening asthma, and more important, by the frequent need for hospital admission or acute intervention. The data from our studies strongly suggest that the level of control of asthma in real life is strikingly lower than the level of control recommended by guidelines.

Although about half of the patients across global regions reported that controller medication should be taken every day, daily

Acknowledgments

Editorial assistance was provided by Ken Kauffman and Patricia Abramo, Adelphi Communications, New York, NY. This assistance was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

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    James E. Fish, MD, was employed by Merck & Co., Inc. when this manuscript was prepared, but he is no longer a Merck employee.

    The Asthma Insight and Management surveys were funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

    Conflicts of interest: R. A. Nathan has received research support from Alcon, Amgen, Array, AstraZeneca, Boehringer Ingelheim, Cephalon, Dyax, Forest, Genentech, GlaxoSmithKline, KaloBios, MAP, MedImmune, Merck, Novartis, Pearl, Rigel, Sanofi Aventis, Shire, Sunovion, Teva, Vectura, and Viropharma; has received consultancy fees from Boehringer Ingelheim, GlaxoSmithKline, Bausch and Lomb, CSL Behring, and Sunovion; and has received speakers' fees from AstraZeneca, GlaxoSmithKline, Merck, and Sunovion. P. J. Thompson has received consultancy fees and travel support from Merck. D. Price has received travel support from Merck; on the boards for Aerocrine, Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis, and Teva; has received consultancy fees from Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Meda, Mundipharma, Napp, Novartis, Nycomed, Pfizer, and Teva; has received research support from UK National Health Service, Aerocrine, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Meda, Merck, Mundipharma, Novartis, Nycomed, Orion, Pfizer, Takeda, Teva, and Zentiva; has received lecture fees from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Meda, Merck, Mundipharma, Novartis, Pfizer, SkyePharma, Takeda, and Teva; has received payment for manuscript preparation from Mundipharma and Teva; has stock in AKL Ltd.; has received travel support from Aerocrine, Boehringer Ingelheim, Mundipharma, Napp, Novartis, and Teva; has received funding for patient enrollment or completion of research from Almirall, Chiesi, Teva, and Zentiva; and owns 80% of Research in Real Life, Ltd. (and its subsidiary social enterprise Optimum Patient Care), which conducts Contract research for Aerocrine, AKL Ltd., Almirall, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis, Orion, Takeda, Zentiva. L. M. Fabbri is on the advisory committee for Forest Laboratories, GlaxoSmithKline, Nycomed, Mundipharma, Grunenthal, Medical Exchan. Inter, Lab Guidotti, and Bayer; is on the advisory board for Dey Pharma; is on the Pearl Therapeutic board; has received consultancy fees from Almirall, Ag Slovena per la ricera, Boehringer, and Boston Scientific; has provided expert testimony for Takead, OM Pharma, MDS, Ferner Group, AstraZeneca, and Kyorin; and receives royalties from Elsevier. J. F. Maspero is on the Novartis board; and has received consultancy fees from Allergy Therapeutics. J. J. Moreno-Cantu is employed by Merck. J. E. Fish is employed by and has stock/stock options from Merck. K. Murphy has received consultancy and lecture fees from Merck, AstraZeneca, Novartis, and Genentech. The rest of the authors declare that they have no relevant conflicts.

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