Survey: Adults With Asthma Routinely Underestimate Severity of Their Cases

The report, based on a survey conducted in Spain, suggests patients are suffering from additional asthma exacerbations due to a lack of understanding of their disease.

Adults with asthma frequently underestimate the severity of their asthma, even though they also report that it has a significant impact on their daily lives, according to a new survey of Spanish patients.

The report offers fresh insights into the ways asthma affects adults, and into their expectations and experiences of therapy. The study was published in The Clinical Respiratory Journal.

About 400 million people in the world suffer from asthma, and rates of the respiratory disease are on the rise, noted corresponding author Eusebi Chiner, MD, PhD, of the Hospital Universitari Sant Joan d’Alacant in Spain. Many children with asthma outgrow it, and others who continue to suffer from asthma as adults have relatively mild cases. Yet, some patients continue to need high-dose inhaled corticosteroids and a systemic corticosteroid to control their asthma. These patients are considered to have severe asthma, according to guidelines from the European Respiratory Society and the American Thoracic Society.

Although the disease represents a major health care burden globally, Chiner and colleagues said little research has been published that looks specifically at how the disease impacts the daily lives of adults. In order to correct that, the investigators created an online questionnaire designed to elucidate patients’ knowledge and perception about their own asthma and its impact on their lives.

The investigators used a database of more than 84,000 adults living in Spain in order to send out an initial survey that asked respondents about their medical conditions. Those who did not select asthma as one of their medical conditions were excluded from the full survey. A random selection of 600 people, 200 with severe asthma and 400 with non-severe asthma, were then asked to complete the full survey. The median age of the respondents was 38, and most were women.

The data showed that the vast majority of patients with severe asthma did not realize their cases qualified as such. Just 2% considered their asthma to be severe, while 52% said their cases were “mild.”

“This may be related to a poor understanding of disease severity by patients and health care professionals,” Chiner and colleagues wrote. “Given that the assessment of asthma severity determines the medications required to achieve disease control, it is reasonable to think that patients with a misperception of asthma severity might not achieve optimal control.”

The data pertaining to exacerbations seems to bear out that assumption. Half of the patients with non-severe asthma, and 96% of patients with severe asthma said they had experienced at least one exacerbation in the prior year.

“This is a striking observation in patients whose asthma was considered non-severe at the time of the survey, and could reflect poor asthma control, since underestimation of asthma severity and a low concordance rate between patients and professionals may contribute to poor treatment adherence, and as a result, poor asthma control,” the authors said.

More than one-third of patients with non-severe asthma (37%) said their asthma impacts their daily lives, and a similar number (34%) said it worsens their quality of life. Among patients with severe asthma, the rates were 67% and 59%, respectively. Similar numbers of patients said their preferred source of information was their specialist (non-severe asthma:42%; severe asthma: 38%) and primary care physicians (non-severe asthma: 41%; severe asthma: 33%).

The investigators said these data show there is a disconnect not only between patient perceptions of their disease severity and their actual case severities, but also between the availability of high-quality therapies and the optimal utilization of those therapies.

“The impact on daily life, workdays lost, and a considerable number of exacerbations and hospitalizations are indicators that there is still room for a massive improvement in the management of asthma,” the authors said.


Chiner E, Hernández C, Aparicio MB, Fitas EF, and Jiménez-Ruiz C. Patient perspectives of the influence of severe and non-severe asthma on their quality of life: a national survey of asthma patients in Spain. Clin Respir J. Published online November 12, 2021. doi:10.1111/crj.13461