The importance of clinical management problems in older people with COPD and asthma: do patients and physicians agree?

BACKGROUND: COPD and asthma in older people are complex conditions associated with multiple clinical problems. The relative importance of these problems to both patients and physicians and the level of agreement between them is largely unknown.
METHODS: Older people with asthma and COPD underwent a multidimensional assessment to characterise the prevalence of clinical problems. Each individual's problems were then summarised and presented separately to the patient and physician to rate problem importance. Problems were scored using a 5-point Likert scale from unimportant to very important.
RESULTS: The highest-rated problems were dyspnoea, activity limitation and airway inflammation, and these areas had good patient-physician concordance. Poor concordance was found for inhaler technique adequacy, airflow obstruction and obesity. Good concordance was found for written action plans, but this was less important to both patients and physicians.
CONCLUSIONS: In asthma and COPD, patients and their physicians agree about the importance of managing activity limitation, dyspnoea, and airway inflammation. Other areas of management had little concordance or were viewed as less important. Self-management skills were not rated as important by patients and this may hinder successful management. Eliciting problems and addressing their importance to treatment goals may improve care in COPD and asthma.