Smoking is linked to a large range of health problems. Not only can it cause certain diseases, it can also make diseases worse if people continue to smoke. Asthma is a common disease that affects the lungs and makes it hard for people to breathe. If people with asthma continue to smoke, it can make their asthma worse. Good management and treatment can have a big impact on how asthma affects peoples’ lives and their health across their lives. People who smoke might also be reluctant to visit their GP if they think they will be blamed for smoking or the emphasis of the conversation is just about quitting smoking. It is also possible that people who smoke may also be treated differently by healthcare professionals, despite what asthma management guidelines recommend. This could lead to worse asthma in people with asthma who smoke compared with people with asthma who do not smoke, for example they could end up going to hospital more often due to their asthma. Therefore, it is vital that we understand whether people with asthma who smoke are managed and treated the same was as people with asthma who do not smoke.
Asthma is a chronic respiratory condition characterised by wheeze and breathlessness. Appropriate management can have a significant impact on patient outcomes. Smoking is a risk factor for many chronic conditions, and even when it does not cause disease, it may worsen disease. Smoking has a high potential for negative social perceptions (stigma) relating to
perceptions of disease attribution or patient “blame” for their condition since there may be a perception that these factors are related to an individual’s behaviour and therefore directly under their control. Where health conditions are associated with stigma this can lead to worse health outcomes through variation in patient pathways, at both a patient and healthcare level.
It'd unknown whether patients with asthma who smoke receive different treatment or management to those who do not and to what extent stigma is a modifiable factor involved in differential treatment/management. This is important to explore in order to address potential health inequalities. Inhaled corticosteroids prescriptions and asthma annual review visits are two asthma management variables that do not differ by smoking status according to asthma management guidelines. However, it is unknown whether stigma around smoking leads to differences in asthma management. Using CPRD Aurum primary care data linked with hospital inpatient data and socioeconomic status data (IMD), we will determine a population of people diagnosed with asthma and investigate whether baseline smoking status (never, ex, or current smoking) is associated with differences in 1) time to first inhaled corticosteroid prescriptions, 2) time to first asthma annual review, 3) the proportion of people who had an inhaler check, an asthma action plan, and were asked the royal college of physicians (RCP) asthma 3 questions using Cox proportional hazards and descriptive statistics, and 4) test for interactions with sex as smoking status is known to differ by males and females.
The following outcomes will be investigated:
1) Time to first inhaled corticosteroid (ICS) prescription following asthma diagnosis
2) Time to first asthma annual review within 18 months of asthma diagnosis
3) Of those who had an asthma annual review visit within 18 months, the proportion who specifically had an inhaler check, an asthma action plan, and were asked the royal college of physicians (RCP) asthma 3 questions.
Jennifer Quint - Chief Investigator - Imperial College London
Hannah Whittaker - Corresponding Applicant - Imperial College London
Maisarah Halim - Collaborator - Imperial College London
Sarah Cook - Collaborator - Imperial College London
Zakariah Gassasse - Collaborator - Imperial College London
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation