Definitions of severe and difficult asthma by a group of UK general practitioners

Abstract

Aims:

This qualitative study explores how general practitioners (GPs) in the United Kingdom perceive “severe” and “difficult” asthma.

Methods:

13 GPs were interviewed using grounded theory method, the interviews were recorded, transcribed and analysed for themes pertaining to severe and difficult asthma.

Results:

GPs conceptualised ‘severe’ asthma and ‘difficult’ asthma in different ways. ‘Severe’ asthma was understood in more medical terms where ‘difficult’ asthma tended to be asthma that was difficult to get under control due to a variety of reasons including social and psychological patient variables. Perceived patient barriers fell into five main categories; knowledge (e.g., lack of understanding of medication and/or disease), identity, coping, health behaviours (e.g., smoking) and other, non-disease, factors such as chaotic lifestyle. Two GPs expressed difficulty using the term ‘difficult’ asthma due to the excessive numbers of terms being used in asthma and the pejorative nature or this term.

Conclusions:

The different conceptions found in this study confirm that there is no one agreed definition for “severe” or “difficult” asthma. However, most interviewees defined “difficult” asthma using a broader, biopsychosocial definition than that applied to severe asthma. This research is part of an ongoing study investigating healthcare professionals' experiences of, and attitudes towards, managing severe and difficult asthma.