Table 2 Themes, sub-themes and exemplar quotes
Themes | Sub-themes | Exemplar quotes |
|---|---|---|
Attitudes and knowledge | Healthcare professionals | “They can sometimes treat you like a waste of space, and from experience I have been left in an A&E (accident and emergency) corridor alone after being brought in having an asthma attack wheezing and struggling to breathe” |
“I have been having a bad couple of years with my asthma and have become so fed up with the continual disbelief from anyone in healthcare that what I'm reporting is actually happening (even when it happens in front of them!). This is compounded by the fact that every time I talk to someone about it they find a way to say this is all my fault - anxiety, not taking medications or just making it up - when all the evidence proves none of that is true. Asthma = panic attacks is a very outdated and dangerous assumption which seems more rife amongst healthcare professionals now than ever before. Sadly, from my perspective, this all seems to be worse in hospitals and often strongest in A&E where you need the most support and fastest action” | ||
“I have been discharged advising I'm not asthmatic only to be ventilated hours later! The arrogance can be astounding!” | ||
“Doctors saying take a breath or slow your breathing down, they really need to put themselves in the patient’s position when having an asthma attack” | ||
“GP services = don’t understand/care about how serious this condition can be” | ||
“Being told to just breathe and my oxygen stats are fine. I don't care what my oxygen is doing I just want to breathe” | ||
“Many healthcare professionals see difficult asthma as nothing more than difficult patients with asthma” | ||
(What things help your asthma most?) “Health professionals working with me and listening to my needs” | ||
Others | “I personally don’t think asthma is taken seriously enough, especially in schools” | |
“The way others treat you, like asthma is like nothing more serious than a scraped knee” | ||
Costs | Prescription charges | “Cost can be prohibitive” |
“Cost is a big issue. Prescription charges are ridiculous” | ||
Environmental factors and triggers | Weather | “Living in Scotland the constant change in weather means I have to have 2 of each inhaler” |
“The environment......unfortunately you can't control the elements and they set asthma off” | ||
“The unpredictable weather always is barrier” | ||
“But a brisk day with some fresh wind is great! I don't feel like I'm struggling to breathe” | ||
Allergens | “Limited help from NHS (National Health Service) with allergen reduction” | |
“Allergies....allergic to everything from food, animals, pollen, grass! The allergies are unknown so it makes controlling it hard” | ||
Other triggers | “Catching colds which can drop peak flow in a matter of 1 or 2 days which frequently leads to chest infection which can take doubled up inhalers, blue inhalers, prednisolone and at least 2 courses of antibiotics” | |
“Brittle asthma difficult to control anything can set me off” | ||
“Not sure of all my triggers there are so many” | ||
Healthcare systems | Timely access to care | “Slow replies and long wait times for appointments” |
“Sometimes slow to respond - I know what I need but still have to go through the bureaucracy to get it!” | ||
“It’s usually quicker to get an appointment with my GP to discuss my needs as opposed to the asthma nurse where waiting times are often several weeks” | ||
Follow up and continuity | “Different doses of prednisolone prescribed depending on which doctor I speak to within the same practice” | |
“Lack of continuity of care when I see a GP at my local health centre” | ||
“Not getting the right follow up care with GP after asthma attack” | ||
“Lack of continuity of care from my GP as you never see the same one and have to tell your story every time” | ||
Communication | “Doctors don't read what my consultant writes” | |
“They will not contact Royal Brompton, will nor read letters from RBH (Royal Brompton Hospital)” | ||
“Also delays between being seen at casualty and the info reaching health centre” | ||
Obtaining medication | “My GP keeps messing up my prescription, meaning I can't always get my inhaler and tablets for asthma when I run out as they refuse to sign the meds over due to communication error with dosage. I have also been told I can't have an inhaler at one point when I had run out because my hospital was the one who authorised the drug and not my GP” | |
“Not getting my meds when I need them, which means I end up in hospital with a flare up” | ||
“I have to allow 3 days for a new prescription to be emailed” | ||
Lifestyle factors | Inconvenience/time | “Remembering to take them (inhalers) in the evening before I go out. If I forget I have to come home early as I struggle to breathe” |
“I also use the small vent (spacer device) which needs washed out, it would be easier if an inhaler lasted all day as I do forget” | ||
“Self-management is also hard as life tends to take over sometimes, since I work in a hospital myself I know the importance but I wish it would just go away!” | ||
Exercise | (What are the barriers to controlling your asthma?) “Coming up with an appropriate exercise plan” | |
“Little but often exercise learning what I can or can’t do without taking the inhaler first” | ||
Diet | “I once tried an anti-candida (low sugar) diet. reduced it by two thirds and had quite a lasting effect but difficult to maintain” | |
(What things help your asthma most?) “Eating healthily and small portions” | ||
Medication | Efficacy | (What do you do when you have an asthma attack?) “Take my inhaler (2puffs) and continue to do so until I feel improvement” |
(What do you do when you have an asthma attack?) “Take two puffs of my reliever inhaler. If still not better take a further two puffs one at a time every two minutes, for up to 10 puffs, or until symptoms have improved” | ||
(What things help your asthma most?) “Taking my medication regularly and when needed quickly” | ||
Education | (What are the problems/issues you face in taking your regular asthma medication?) “Knowing when to take brown pump” | |
“Sometimes I can’t do it at all because the attack makes me unable to remember what do” | ||
Side effects | “My wife was on every tablet inhaler and even having xolair injections but the main problem she had was controlling her weight due to the steroids” | |
“The steroid tablets for me are an issue with all the different side effects. Especially the weight issue when you are told you need to lose weight but know yourself that it is almost impossible to do this when you are taking inhalers with steroids plus the tablets” | ||
“Moon face, gaining weight, bad bones, mood swings, sleepless nights, mouth thrush” | ||
Self-care | Monitoring | (What do you do when you have an asthma attack?) “Check my peak flow” |
(What things help your asthma most?) “Air alert service” | ||
Personalised action plan | (What things help your asthma most?) “Having an asthma attack plan and to know what to do if i have one i.e. keep calm” | |
‘Common sense’ measures | (What things help your asthma most?) “Me knowing my limits and not pushing myself” | |
(What do you do when you have an asthma attack?) “Sit down or stand and place my back against something” | ||
Staying calm/breathing exercises | (What do you do when you have an asthma attack?) “Practise good breathing techniques” | |
(What do you do when you have an asthma attack?) “Slow deep breaths (as deep as I can manage)” | ||
(What things help your asthma most?) “Remaining calm when having an attack” | ||
Support | Healthcare professionals | (What things help your asthma most?) “Having a very good GP who tries to understand and listen to me” |
Others | (What things help your asthma most?) “Having understanding people around” | |
(What do you do when you have an asthma attack?) “Call my husband to stay near” |