Values and Preferences of Patients and Caregivers Regarding the Management of Moderate-to-Severe Asthma: A Systematic Review and Qualitative Evidence Synthesis

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BACKGROUND: Understanding patient values and preferences can inform optimal care of moderate-to-severe asthma. OBJECTIVE: To systematically synthesize studies addressing the values and preferences of patients with moderate-to-severe asthma and their caregivers toward the management of asthma. METHODS: As part of updating the American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma, and Immunology (AAAAI/ACAAI) Joint Task Force on Practice Parameters severe asthma guidelines, we searched MEDLINE, Embase, PsycINFO, and CINAHL from inception to June 1, 2025, for studies addressing the values and preferences of patients with moderate-to-severe asthma or their caregivers. Paired reviewers independently screened citations, extracted data, and assessed risk of bias. We used iterative thematic content analysis to qualitatively synthesize findings and the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Quantitative Research (GRADE-CERQual) approach to rate the confidence of the evidence. We prospectively registered our review in PROSPERO (CRD42024572812). RESULTS: Synthesizing 88 studies enrolling 9,593 patients and 274 caregivers, we identified 5 key themes: (1) Patients and their caregivers place high value on avoiding potential adverse effects of asthma treatment (high confidence). Patients probably place high value toward (2) avoiding severe asthma exacerbations, (3) having autonomy in the administration of advanced therapies, such as biologics, and (4) are probably more willing to accept treatment if provided counselling by clinicians knowledgeable in asthma (moderate confidence). (5) Patients may place a high value on asthma treatments that are practical and logistically simple to implement (low confidence). CONCLUSIONS: We identified 5 key themes on the values and preferences of patients with moderate-to-severe asthma and their caregivers to inform optimal clinical care, practice guidelines, and future research.

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