Self-Assessed Treatment Effects Can Mislead, Asthma Studies Show — Physician’s First Watch

Medical News |
July 14, 2011

Self-Assessed Treatment Effects Can Mislead, Asthma Studies Show

In clinical trials, patients' self-assessed outcomes can mask a real lack of an objective effect, according to a New England Journal of Medicine study. An editorialist offers a different take on the study's meaning, however.

Nearly 50 patients with stable asthma underwent each of four treatments over a series of visits: albuterol inhaler, sham inhaler, sham acupuncture, or watchful waiting in the clinic (control). Forced expiratory volumes at 1 second (FEV1s) were measured during each visit, as were patients' subjective ratings of symptom improvement.

Improvements in FEV1s were significant only after albuterol treatment, but not after any of the other three. However, subjective measures of symptom improvement increased markedly after all but the control treatment.

The authors conclude: "Objective outcomes should be more heavily relied on for optimal asthma care." An editorialist questions this interpretation, asking, "What is the more important outcome in medicine: the objective or the subjective, the doctor's or the patient's perception?"

Reader Comments (3)

George G. Shaw

In a condition like reactive airways disease (asthma) objective measures are more important because patients often under estimate their symptoms and can thus find themselves in trouble.

Competing interests: None declared

Sanford R. Kimmel

Many years ago, when I was much more familiar with the asthma literature, I recall a study that demonstrated that asthma patients had difficulty subjectively telling when they were getting into difficulty. As a result, we were encouraging our asthma patients to use peak flow meters to monitor their astha just like a diabetic uses a glucometer to check his/her blood sugar. Unfortunately, during my years in practice, I have found that many of my asthmatic patients, even well-educated ones, rarely used the peak flow meters, even when i provided them from my office without charge. They usually stated that they were a bother to carry or more likely they lost them.

Competing interests: None declared

Bernard A. Yablin

After all these years,isnt the FDA about to begin a large controlled study of asthma treatments?

Competing interests: None declared

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