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Global Asthma Physician and Patient (GAPP) Survey

Global Asthma Physician and Patient (GAPP) Survey. Key Global Pediatric Findings. GAPP Survey Contents. Key Global Findings Objectives and Overview Methodology Global Pediatric Findings Physician-parent-patient communication gaps Factors affecting compliance Need for new treatments

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Global Asthma Physician and Patient (GAPP) Survey

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  1. Global Asthma Physician and Patient (GAPP) Survey Key Global Pediatric Findings

  2. GAPP Survey Contents • Key Global Findings • Objectives and Overview • Methodology • Global Pediatric Findings • Physician-parent-patient communication gaps • Factors affecting compliance • Need for new treatments • Conclusions and Implications

  3. GAPP Survey Global Key Findings

  4. Physicians and parents/patients agree there is a need for new ICS treatments with an improved safety profile • Asthma education is insufficient and inadequate • Parents may not understand that asthma is a serious disease that they need to continually manage • Physician and parents/patient communication needs to improve in order to increase understanding of asthma management GAPP Survey: Global Key Findings Patient compliance and outcomes may be enhanced by: • New treatment options with lower side effect profiles Better physician/parent/patient communication and asthma education Education Compliance Treatment • Treatment non-compliance decreases quality of life and increases resource utilization • Experience and concern about the potential for side effects were patients’ primary reasons for non-compliance • Parents who report having more discussions with their physicians about techniques for successful asthma management report greater treatment compliance

  5. GAPP Survey Overview

  6. GAPP Survey: Overview A large-scale global survey was conducted with physicians and parents of patients with asthma to build on the existing body of research regarding asthma attitudes and treatment practices

  7. GAPP Survey Objectives • Enhance understanding and awareness of likely contributors to suboptimal asthma management • Explore content and dynamics of physician-parent/patient communications • Ultimately enhance treatment compliance and outcomes

  8. The GAPP Survey is Unique • The GAPP Survey was designed to uncover asthma attitudes and treatment practices among physicians and parents/patients, with the goal of identifying barriers to optimal management • First-ever global quantitative survey to: • Examine the same themes in parents/patients and physicians • Ask similar questions to both parents and physicians

  9. GAPP Survey Background

  10. The Seriousness of Asthma Despite advances in asthma management, many patients still experience: • Asthma exacerbations including acute attacks • Frequent symptoms • Unscheduled and increased doctor visits • Emergency room visits and hospitalizations • Mortality1,2 • Missed lifestyle and social effects • Economic burden 1. GINA Asthma Fact Sheet: “What is Asthma?” Available at: http://207.159.65.33/wadsetup/materials_04/asthma04.doc. 2. GINA “Global Strategy for Asthma: Global Strategy for Asthma Management and Prevention,” 1995. Available at: http://www.iaqoc.com/library/workshop.pdf.

  11. Previous Asthma Research • Asthma Insights and Reality (AIR) studies described the current state of patient knowledge, attitudes and behavior towards asthma1: • Patients underestimate the severity of their disease; asthma practice falling short of treatment guidelines • Patients do not understand how asthma is caused or how it is treated • Findings suggested need to: • Improve physician and patient expectations of asthma treatment • Increase awareness of anti-inflammatory agents • AIR studies raised even more questions about patient/physician disconnect regarding side-effects, treatment regimens and communication Unanswered Questions from AIR led to Development of the GAPP Survey 1. Rabe KF, et. al. J Allergy Clin Immunol. 2004 Jul;114(1):40-7.

  12. GAPP Survey Advisory Board • Comprised of professional organizations: • The World Allergy Organization (WAO) • The American College of Allergy, Asthma & Immunology (ACAAI)

  13. GAPP Survey Working Group • Carlos E. Baena-Cagnani • Catholic University of Córdoba, Córdoba, Argentina, for WAO • Michael S. Blaiss • University of Tennessee Health Science Center, Memphis, TN, USA, for ACAAI • G. Walter Canonica • University of Genova DIMI, Genova, Italy, for WAO • Ronald Dahl • Aarhus University Hospital, Department of Respiratory Diseases, Aarhus, Denmark, for WAO • Past-President of the European Respiratory Society (ERS) • Michael A. Kaliner • Institute for Asthma & Allergy, Chevy Chase, MD, USA, for WAO • President of the World Allergy Organization • Erkka J. Valovirta • Turku Allergy Center, Turku, Finland, for WAO • Past-President of European Federation of Allergy and Airways Diseases Patients Associations (EFA)

  14. GAPP Survey Methodology

  15. UK asthma nurses Global pediatric research GAPP Survey : Population Global adult research

  16. GAPP Survey: Pediatric Survey 9 Countries: • Asia: Japan • Europe:France, Germany,Italy, Spain, Switzerland, the United Kingdom • North America: Canada, the United States of America

  17. GAPP Survey: Methodology • Harris Interactive conducted the research on behalf of the GAPP Survey global advisory board • A prominent global survey company with a specialized healthcare market research department • Recruiting was accomplished via: • Harris Interactive’s online panel • Physician referrals • Existing sample lists • 20-minute close-ended questionnaires

  18. GAPP Survey: Methodology Harris Interactive conducted the survey on behalf of the GAPP Survey Advisory Board Conducting the Survey Criteria Sample Sizes • Physicians currently practicing medicine for 3-30 years, sees ≥ 3 pediatric patients with asthma /week and writes ≥ 1 prescription for asthma medications /week • Parents of children diagnosed with asthma • Online, telephone and face-to-face interviews • 18 May through 24 August 2005 • Each country surveyed about 100 each for parents and physicians • In the U.S., where the sample sizes were about 200 for each group (only data weighted)

  19. GAPP Survey: Interviews 5482 physician and parent/patient interviews conducted worldwide

  20. GAPP Survey Global Pediatric Findings

  21. GAPP Survey: Pediatric Arm 2023 physician and parents of children with asthma were interviewed worldwide • PARENTS • 1017 parents of children diagnosed with asthma • Recruiting was accomplished via: Harris Interactive’s online panel, physician referrals and existing sample lists • PHYSICIANS • 1006 physicians who treat children with asthma: • 230 generalists (family, general and internal medicine practitioners) • 776 pediatricians

  22. Pediatrician 45% PCP 31% Not Seeing Anyone 2% Specialist 19% Nurse 3% Other Type of Physician 1% Pediatric Asthma Treated Mostly by Pediatricians Which type of doctor or healthcare professional does your child usually see to treat his or her asthma? Base: All Respondents (Parents)

  23. A Majority of Parents Perceive their Child’s Asthma as Mild Overall, based on your child’s symptoms, how would you describe his or her asthma? Base: All Respondents (Parents)

  24. Resource Utilization in the Past 12 Months Indicates Poor Patient Asthma Control During the past 12 months, have you… because of your asthma? Base: All Respondents (Parents)

  25. A Great Not at All Deal 22% 8% Somewhat 34% Not Much 36% According to ParentsAsthma Limits Patients’ Daily Activities 42% have limited daily activities Overall, how much has your child’s asthma limited his or her ability to do daily activities? Base: All Respondents (Parents)

  26. GAPP SurveyDisconnect between parents and physicians on factors affecting compliance

  27. Parents Report Physicians Disconnect Found Between Parent-Reported Compliance & Physician-Perceived Pediatric Patient Compliance 100 80 60 40 20 0 59% 56% Incidence Reported (%) 25% 14% 15% 10% 9% 9% 2% 0% 81-99% of the time 0% of the time 1-50% of the time 51-80% of the time 100% of the time What percentage of the time do or did your child take his or her asthma medication according to his or her doctor or other health care professional’s instructions? Base: Currently or Has Ever Taken Asthma Medications (Parents) What percentage of the time does your average pediatric asthma patient take his or her medication according to your instructions? Base: All Respondents (Pediatric Physicians)

  28. Parents Report Physicians Parents and Physicians Disagree on Content of Education Provided and Received Correct inhaler technique 82% 95% Develop individual management plan 65% 85% Monitor peak expiratory flow 51% 71% Keep daily symptom/ medication diaries 33% 57% Contact patient support organizations 15% 36% 0 50 100 Incident Reported (%) Does your child’s doctor or other healthcare professional in his or her office discuss any of the following with you or your child? Base: All Respondents (Parents) Do you regularly discuss the following with your pediatric asthma patients or their parents? Base: All Respondents (Pediatric Physicians)

  29. Almost Half of Parents are Unaware or do not Believe that Asthma can be Fatal in Patients with Mild Asthma False: 24% True: 51% 49% are unaware Not sure:25% Is the following statement true or false or are you not sure? Asthma attacks can be fatal in patients with mild asthma. Base: All Respondents (Parents)

  30. Increase in Compliance (%) Treatment Compliance Increases with Increased Parent/Patient Education Parent/Patient Treatment Compliance < 51% 51-80% 81-99% 100% compliant compliant compliant compliant Amount of time spent on patient education 23% 35% 36% 40%

  31. Physicians and Patients Disagree on Who Starts the Discussion on Side Effects Physicians Patients 2% do not discuss side effects 41% Doctor Or healthcare provider 29% Parent or child 69% Me 59% Me or my child When you discuss or discussed side effects of asthma medications with your child’s doctor or other health care professional, who typically brings up the topic, you or your child, or your child’s doctor or health care provider? Base: Always, Sometimes or Rarely Discusses Short or Long Term Side Effects (Parents) When you discuss side effects of asthma medications, who typically brings up the topic, you or your patient or their parent – or you don't discuss side effects? Base: All Respondents (Pediatric Physicians)

  32. Parents Report Physicians Parents’ Lack Awareness of Potential ICS Side Effects Parents and Physicians Differ in Opinion Decreased production of cortisol 39% 21% 27% Long-term side effects* 8% 14% Short-term side effects** 5% 0 10 20 30 40 50 % of Parents Who Were Not Aware of Side Effects % of Physicians Stating Their Patients Were Not Aware of Side Effects *Such as weight gain, weakening of the bones or changing bone density, or cataracts ** Such as such as fungal infection, sore throat or hoarseness On a scale of 1 – 10 where “1” means “not at all concerned” and “10” means “extremely concerned,” how concerned have you been with the following potential side effects or, were you not previously aware of these as potential side effects for your child? Base: All Respondents (Parents) On a scale of 1 – 10 where “1” means “not at all concerned” and “10” means “extremely concerned,” how concerned are your patients or their parents with each of the following potential side effects of inhaled corticosteroids, or are they not aware of potential side effects? Base: Prescribes Inhaled Corticosteroids (Pediatric Physicians)

  33. Reasons Patients Switched/Discontinued Asthma Medications Side Effects Lead to Parents/Patients Switching or Discontinuing Treatment 50 40 30 20 10 0 39% Incidence Reported (%) 18% 12% 11% 6% Inconvenient to use Symptoms went away or lessened Concerned about potential side effects Medication was too expensive Experienced side effects Since being diagnosed with asthma, has your child ever switched from one asthma medication to another or discontinued an asthma medication because…? Base: Currently or Has Ever Used Asthma Medication (Parents)

  34. Significant Numbers of Pediatric Patients with Asthma Experience Side Effects (SEs) 50 40 30 20 10 0 26% Incidence Reported (%) 10% Long-term SEs Short-term SEs While taking asthma medications, has your child ever experienced …? Base: Child Currently or Has Ever Taken Asthma Medication (Parents)

  35. Of patients who have experienced side effects, SEs have caused them to: Side Effects Contribute to Treatment Non-Compliance 50 40 30 20 10 0 33% 33% 30% 28% Incidence Reported (%) 15% Consider switch medications Consider skipping doses Skip doses Change dosage Stop taking medications Have any of the asthma medication side effects you experienced since being diagnosed caused you or your child to…? Base: Experienced at Least One Side Effect of Asthma Medications (Parents)

  36. Treatment Non-Compliance Decreases Quality of Life 66% Increased symptoms 48% Limited physical activity 46% Nocturnal waking More frequent attacks/ exacerbations 40% Increased Bronchodilator use 34% 21% Less interaction with family/friends 9% Life-threatening attacks 0 10 20 30 40 50 60 70 Incidence Reported (%) Has your child ever experienced the following if he or she doesn’t or didn’t take his or her asthma medication as instructed? Base: Child Takes or Took Asthma Medication Less Than 100% of the Time (Parents)

  37. Treatment Non-Compliance Increases Resource Utilization More physician visits 38% More hospitalizations/ ER visits 14% 0 10 20 30 40 50 60 70 Incidence Reported (%) Has your child ever experienced the following if he or she doesn’t or didn’t take his or her asthma medication as instructed? Base: Child Takes or Took Asthma Medication Less Than 100% of the Time (Parents)

  38. Consequences of Non-Compliance:IncreasedResource Utilization • The number of disability-adjusted life years (DALYs) lost due to asthma worldwide has been estimated to be currently about 15 million per year • Asthma was the 25th leading cause of DALYs lost worldwide in 20011 • World-wide, the economic costs associated with asthma are estimated to exceed those of TB and HIV/AIDS combined2 1. GINA “Global Burden of Asthma,” 2004. Available at: http://www.ginasthma.com/ReportItem.asp?l1=2&l2=2&intId=94. 2. WHO http://www.who.int/mediacentre/factsheets/fs206/en/

  39. Impaired Quality of Life and Resource Utilization Side-effects Poorcompliance Side Effects Contribute to Diminished Quality of Life & Increased Resource Utilization

  40. GAPP SurveyPhysicians and Parents/Patients Assess Need for New Asthma Treatment Options

  41. Physicians Agree: Inhaled Corticosteroids are First-Line Therapy 100 80 60 40 20 0 98% 92% 53% Strongly Agree Incidence Reported (%) 78% Somewhat Agree 39% 20% Inhaled corticosteroids (ICS) are the “gold standard”treatment for asthma In treating asthma, if youtreat the inflammation, youreduce the risk of broncho-constriction Please indicate whether you agree strongly, agree somewhat, disagree somewhat or disagree strongly with the following statements. Base: All Respondents (Pediatric Physicians)

  42. First-Line Treatment Used By Physician; Not Following GINA Guidelines Generalist Pediatrician Mild Intermittent Mild Persistent Moderate Persistent Severe Persistent SABA ICS LABA Combi LTRA Which medication or medications do you prescribe as first-line treatment for mild intermittent, mild persistent, moderate persistent and severe persistent asthma in your pediatric patients? Base: All Respondents (Pediatric Physicians)

  43. Highlight: Physicians are not Following GINA Guidelines for Treatment of Pediatric Patients with Mild Persistent Asthma Generalist Pediatrician Mild Intermittent Low-dose inhaled corticosteroid is recommended Mild Persistent Moderate Persistent Severe Persistent SABA ICS LABA Combi LTRA Which medication or medications do you prescribe as first-line treatment for mild intermittent, mild persistent, moderate persistent and severe persistent asthma in your pediatric patients? Base: All Respondents (Pediatric Physicians)

  44. Global Initiative for Asthma (GINA) guidelines low-dose glucocorticosteroids mono-therapy is the recommended medication for children with mild persistent asthma The SMART trial, addressed emerging safety issues concerning salmeterol (LABA). Thirteen patients taking salmeterol suffered asthma-related deaths compared to the three asthma-related deaths involving patients taking the placebo. The FDA and the MHRA announced a warning that LABA treatments should not be used for first-line treatment, and LABAs should be added to the asthma treatment plan only if other medicines do not control asthma, including the use of low-or-medium dose corticosteroids.1, 2 First-line treatment physicians are using for their pediatric mild persistent patients (based on GAPP Findings) 41% of physicians are prescribing long acting beta-agonists (LABA) 48% are prescribing fixed combination medications (ICS + LABA) USA Food and Drug Administration (FDA) and the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) LABA Warning 1. United States Food and Drug Administration.  “Long Acting Beta Agonists Advisory.” November 2005. Available at http://www.fda.gov/cder/drug/infopage/LABA/default.htm. Accessed February 7, 2006. 2. Medicines and Healthcare products Regulatory Agency. Safety information for long acting beta agonists. Available at http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary=true&ssDocName=CON2022601&ssTargetNodeId=221. Accessed February 7, 2006.

  45. Parents Report Physicians Physicians and Parents Agree: Need for Improved Asthma Treatment Options 100 80 60 40 20 0 84% 80% % Reported Think There is a Need for New Treatments Physicians who believe there should be more treatment options are less satisfied with side effect profiles of existing treatments Do you think there is a need for new medication options for children with asthma? Base: All Respondents (Parents) Do you believe there are still unmet needs in the area of inhaled corticosteroid therapy? Base: All Respondents (Pediatric Physicians)

  46. ICS Key Attributes: Physician Are Least Satisfied with Side Effects Extremelysatisfied 10 9 8.1 7.9 7.5 7.4 8 7.1 6.8 7 6 5 4 3 2 Extremelydissatisfied 1 Efficacy Availability in Combination with LABA Frequency of Dosing Convenience Systemic Side Effects Local Side Effects On a scale of 1 – 10 where “1” means “extremely dissatisfied” and “10” means “extremely satisfied,” how satisfied are you with the following features of available inhaled corticosteroids? Base: All Respondents (Pediatric Physicians)

  47. Key Attribute of Current Therapies: Parents Are Least Satisfied with Side Effects 100 80 60 40 20 0 92% 91% 89% 85% 85% 72% Reported Level of Satisfaction (%) Potential for Side Effects Ease of Use Fast Acting How Many Times a Day Safety Effectiveness Overall, how satisfied or dissatisfied are you with the following features of your current asthma medication or medications? Base: Currently Taking Asthma Medication (Patients)

  48. Need for a New Treatment • PHYSICIANS • 84% of physicians believe there are still unmet needs in the area of ICS therapy • Physicians report that a new ICS therapy with comparable efficacy and an improved safety and tolerability profile is needed • PARENTS • 80% of parents believe there is a need for new medication options • Those who have been more affected by their disease, were more likely to believe there is a need for a new treatment

  49. Conclusions and Implications Asthma education is insufficient and inadequate; there is a disconnect between physician-parent/patient communication Side effects and fear of side effects reduce compliance with treatment, decreasing quality of life and increasing resource utilization Parent/patient compliance and outcomes may be improved by: Better physician/patient communication and asthma education New treatment options with lower side effect profiles Parents and physicians are looking for improved asthma treatments

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