Claudia Crimi, MD, PhD, on Patients’ Perceived Control of Asthma Symptoms

To quickly estimate patients’ asthma symptom control, you may administer the Asthma Control Test (ACT). However, results of a new study1 show that patients’ education level may influence their symptom perception and disease control. 

According to the findings, there was a statistically significant difference between patients with lower and higher education levels for a few ACT single items, with patients with lower education levels having a worse perception of their asthma control compared with physician assessment.

Claudia Crimi, MD, PhD, a pulmonologist with the Respiratory Medicine Unit at Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele in Catania, Italy, was one of the study’s coauthors. She answered Consultant360’s questions about why being aware of this disparity in asthma perception is vital and how you can help bridge the perception gap among your patients.

CONSULTANT360: You wrote that matching patients’ perception of asthma control with physicians’ evaluation is a key issue for asthma management. Why is it important that the patient perception and physician evaluation align? 

Claudia Crimi: The doctor-patient relationship and communication are crucial in medicine, particularly in the management of chronic respiratory diseases such as asthma, where patient involvement in the treatment of the disease is the best strategy to achieve individual treatment goals. The lack of agreement between patients’ perception of asthma control and physician evaluation may lead to a wrong evaluation of the disease’s severity, as well as of which treatment to prescribe.

C360: You and your team found statistically significant differences in a few ACT single items. What are the most common disparities between patient perception and physician assessment of asthma control, and where do they stem from? How can physicians help bridge these gaps?

CC: Patients’ opinions about the use of rescue medication differ from physician evaluation. Perceptions and beliefs might influence medication use. Sometimes patients may overestimate their use of rescue inhalers because they believe to be “dependent” on it. Therefore, physicians should foster patient education for optimal rescue medication use.

C360: Overall, there was no significant difference in ACT score obtained by patient vs physician. How should this finding impact the way physicians choose to administer the test (patient vs physician)?

CC: The ACT was developed as a screening tool for a simple and rapid patient-completed measure of asthma control. Therefore, it relies entirely on patient self-reporting of asthma symptoms, and this should be the preferred way of administration. Nevertheless, among patients with a low level of education, physicians should ensure that patients fully understand the questions and that they give appropriate answers.

C360: You found a significant difference in the evaluation of asthma control between the ACT and the Global Initiative for Asthma (GINA) assessment of symptom control. Can you expand on this finding?

CC: The gold standard in assessing asthma control are the GINA criteria, which also require a lung function test. ACT can be as useful as the GINA-guideline criteria in assessing asthma control, but ACT is easier to perform. Nevertheless, ACT tends to underestimate asthma control as compared with disease control defined by GINA.

C360: How do you hope this research impacts clinical practice or the development of future guidelines and best-practice statements?

CC: I think that physicians should better explore patients’ perspectives in terms of asthma symptom perception and control during their complete assessment and make sure to have interpreted the impact of the disease among these patients. I hope that this research will encourage physicians to further implement educational programs for patients not only on the correct use of inhalers, but also on asthma knowledge and symptom perceptions.


1. Crimi C, Campisi R, Noto A, et al. Comparability of asthma control test scores between self and physician-administered test. Respir Med. 2020;170. doi:10.1016/j.rmed.2020.106015