| | Patient number 1: a 52-year-old woman diagnosed with asthma in childhood and prescribed regular corticosteroids for inhalation twice a day. She is very skeptical of both the asthma medication and the asthma diagnosis. She stops taking her asthma medication when she feels well. Presently, she has not taken it for the last four months. The medication was only used for two weeks after the last appointment at the asthma/COPD clinic. Thereafter, she felt well and stopped using the inhaler. In preparation for today´s appointment with the nurse at the asthma/COPD clinic at the primary healthcare center, she has taken the medication. The appointment is a follow-up, as the last spirometry showed an obstructive curve. The asthma control test, 18, which is a symptom scoring assessment, shows 15. This is to be interpreted as poor disease control, though she says she feels very well. She does not believe in asthma medication or the asthma diagnosis. Rather, she believes that there is a problem with her back, which a chiropractor, in fact, told her was the case |
| | Patient number 2: a 52-year-old woman with a medical history of asthma and an allergy. Patient number 2 works as a hairdresser and loves jewelry and clothing. She is a worrier and very skeptical about and hesitant to use inhaled corticosteroids. As she believes that the body is self-healing, she prefers acupuncture to medication to get her body in balance. She is now visiting the nurse at the primary health care center because she has suffered from troublesome chest tightness and respiratory symptoms for the last six months; this has forced her to seek emergency care several times. She believes that there is something wrong with her heart, not with her respiratory airways. However, medical examinations show that her symptoms were not related to her heart but more likely to her airways. The patient is very worried and anxious. She does not believe she has asthma any longer because acupuncture healed her. For that reason, she has not used any asthma medication for years, and she has not shown up at the follow-up consultations at the asthma/COPD clinic at the primary healthcare center. Instead, she has sought health care for her heart problems |
| | Patient number 3: a 63-year-old man, and a former smoker, diagnosed with COPD three years ago. He has worked as a welder for most of his working life. He has tried to use the available protective equipment as his workplace. He says he is fine. Patient number 3 was present at his father's death, which was a traumatic experience for him because his father had a very hard time breathing. Patient number 3 cannot cope as before, but he reasons that he is no longer young—63 years old. He cannot exercise but thinks it is enough with his work and some gardening. He has been prescribed short-acting-beta2-agonist and long-acting-antimuscarinic-antagonists (LAMAs) for inhalation use. When he refilled the prescription of the LAMAs, he received another inhalator. He was annoyed that he was prescribed a cheaper medication∗ without training about the correct inhalation technique, explaining that it was typical for the healthcare system to prescribe the cheapest one. Thereafter, his respiratory symptoms, mucus secretion, breathlessness, and fatigue increased. Eventually, he was hospitalized for COPD exacerbation. Now, he is visiting the primary healthcare center for a follow-up. He is provoked by the fact that he was prescribed a cheaper and low-quality medication stating, “They do not care about the patient; it's just about making money”. He is also questioning the value of visiting the primary healthcare center |
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