Asia Pacific Survey of Physicians on Asthma and Allergic Rhinitis (ASPAIR): Insights from China

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Asia Pacific Survey of Physicians on Asthma and Allergic Rhinitis (ASPAIR): Insights from China

Over the past decade, China has seen a sharp rise in allergic rhinitis (AR) and asthma—two chronic conditions that often coexist. As these diseases become more prevalent (linked to rapid urbanization and air pollution), understanding how doctors diagnose and treat patients with both conditions (called coexistent asthma-AR) is critical to improving care. The Asia-Pacific Survey of Physicians on Asthma and Allergic Rhinitis (ASPAIR)—a 2019 study published in the Chinese Medical Journal—set out to answer this question by polling 200 Chinese physicians about their beliefs and practices. Here’s what it found.

Who Was Surveyed?

Researchers targeted hospital-based general physicians and pediatricians from five major Chinese cities: Beijing (north), Chengdu (west), Guangzhou (south), Shanghai (east), and Wuhan (south-central). These cities represent China’s largest metro areas and diverse regions. All participants treated at least 10 asthma patients monthly (adults or children). The survey was conducted in Mandarin or Cantonese, with face-to-face interviews using tablets/laptops.

Key Findings About Chinese Physicians’ Practices

The ASPAIR study revealed that while doctors understand the burden of coexistent asthma-AR, there’s a gap between knowledge and real-world practice. Here are the most striking results:

1. Most Doctors Check for Both Conditions—but Not Always with Objective Tools

  • 70% of physicians routinely evaluated asthma patients for AR symptoms (and vice versa) at every visit. External factors like local allergen levels (44%) or pollution (33%) also prompted checks—showing awareness of how environmental triggers worsen both diseases.
  • However, only 57% used spirometry (a lung function test) to diagnose asthma. Many relied on symptom history, family history, or trigger exposure instead. This aligns with China’s healthcare system, where severe patients are often referred to specialists.

2. Doctors Know Coexistent Disease Is Worse—But Treat It Like a Single Condition

  • 91%+ of physicians agreed that patients with both asthma and AR have more severe symptoms (e.g., worse sleep, work/school disruption) and higher healthcare use (unplanned visits, hospital stays) than those with just one condition.
  • Yet a surprising 96% believed patients were “well managed” if only one condition improved—even though global guidelines (from the Allergic Rhinitis and its Impact on Asthma, or ARIA) stress treating both together.

3. Guidelines Are Known—but Not Always Used

  • 71% of doctors said their preferred treatment for coexistent asthma-AR was a combination of inhaled corticosteroids (ICS) and intranasal steroids (INS)—exactly what ARIA recommends to treat both upper (nose) and lower (lungs) airways.
  • But only 50% used guidelines to guide treatment decisions. Instead, personal clinical experience (63%) and patient affordability (55%) mattered more. For example:
    • 80% of doctors used oral leukotriene receptor antagonists (LTRAs)—a pill—because patients preferred it over inhalers or nasal sprays.
    • 32% worried that treating both conditions required “too much medication,” and 34% delayed inhaled steroids for children (despite guidelines supporting their safe use).

4. Asthma Control Is Assessed Differently for Patients with Coexistent Disease

Global and Chinese guidelines (from the Global Initiative for Asthma, or GINA, and the Chinese Thoracic Society) recommend evaluating asthma control using four markers:

  1. Daytime symptoms
  2. Night-time awakenings
  3. Reliever medication use (e.g., short-acting beta-agonists, or SABAs)
  4. Activity limitation

While most doctors monitored symptom frequency for both asthma-only and coexistent patients, they were less likely to use other key markers for those with both conditions:

  • Night-time awakenings: Used by 74% of doctors for asthma-only patients vs. 55% for coexistent patients.
  • Lung function tests: 58% for asthma-only vs. 32% for coexistent.
  • Reliever use: 22% for asthma-only vs. 11% for coexistent.

This means patients with coexistent asthma-AR may not get the thorough checks needed to ensure both conditions are controlled.

The Gap Between Knowledge and Practice

The biggest takeaway from ASPAIR? Chinese physicians understand the burden of coexistent asthma-AR—but struggle to translate that knowledge into guideline-aligned care. Here’s why:

  • Time and Patient Preferences: Doctors see high volumes of patients (averaging 113 asthma patients monthly) and often prioritize what’s practical—like oral medications—over guideline-recommended inhalers/sprays.
  • Affordability: 55% of doctors cited cost as a barrier to using preferred treatments (e.g., ICS/INS combinations), which may be more expensive for patients.
  • Misconceptions: Nearly all doctors thought improving one condition was enough to “manage” both—even though AR and asthma are linked (AR worsens asthma control, and vice versa).

What This Means for Patients

Coexistent asthma-AR is more than just “two diseases”—it’s a united airway condition that requires holistic treatment. The ASPAIR study shows Chinese doctors need more support to:

  1. Use guidelines consistently: Integrate ARIA/GINA recommendations into daily practice (e.g., using spirometry, checking all control markers).
  2. Address patient preferences: Educate patients on why inhalers/sprays are more effective than oral pills for long-term control.
  3. Treat both conditions together: Shift the mindset from “managing one disease” to “managing the whole patient.”

About the Study

The ASPAIR study was led by:

  • David Hinds (Real World Evidence & Epidemiology, GSK, USA)
  • Bhumika Aggarwal (Respiratory, GSK Singapore)
  • Xin Du (Respiratory Therapeutic Area, GSK China)
  • Aruni Mulgirigama (Respiratory Franchise, GSK UK)
  • Sumitra Shantakumar (Real World Evidence and Epidemiology, GSK Singapore)

It was funded by GlaxoSmithKline (Study No. 206753) and published in the Chinese Medical Journal in 2019.

References

  1. Li L, Guo Y, Chen Z, et al. Epidemiology and the control of disease in China, with emphasis on the Chinese Biobank Study. Public Health. 2012;126:210–213. doi:10.1016/j.puhe.2011.11.012
  2. Wang XD, Zheng M, Lou HF, et al. An increased prevalence of self-reported allergic rhinitis in major Chinese cities from 2005 to 2011. Allergy. 2016;71:1170–1180. doi:10.1111/all.12874
  3. Lin J, Wang W, Chen P, et al. Prevalence and risk factors of asthma in mainland China: the CARE study. Respir Med. 2018;137:48–54. doi:10.1016/j.rmed.2018.02.010
  4. Lin J, Su N, Liu G, et al. The impact of concomitant allergic rhinitis on asthma control: a cross-sectional nationwide survey in China. J Asthma. 2014;51:34–43. doi:10.3109/02770903.2013.840789
  5. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008. Allergy. 2008;63(Suppl 86):8–160. doi:10.1111/j.1398-9995.2007.01620.x
  6. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. 2018. Available at: ginasthma.com

The full study is available at the Chinese Medical Journal: doi.org/10.1097/CM9.0000000000000229

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