Implementing asthma management guidelines in public primary care clinics in Malaysia

AbstractImplementing asthma guideline recommendations is challenging in low- and middle-income countries. We aimed to explore healthcare provider (HCP) perspectives on the provision of recommended care. Twenty-six HCPs from six public primary care clinics in a semi-urban district of Malaysia were purposively sampled based on roles and experience. Focus group discussions were guided by a semi-structured interview guide and analysed thematically. HCPs had access to guidelines and training but highlighted multiple infrastructure-related challenges to implementing recommended care. Diagnosis and review of asthma control were hampered by limited access to spirometry and limited asthma control test (ACT) use, respectively. Treatment decisions were limited by poor availability of inhaled combination therapy (ICS/LABA) and free spacer devices. Imposed Ministry of Health programmes involving other non-communicable diseases were prioritised over asthma. Ministerial policies need practical resources and organisational support if quality improvement programmes are to facilitate better management of asthma in public primary care clinics.

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Asthma control and management among schoolchildren in urban Uganda: results from a cross-sectional study

Wellcome Open Research ◽

10.12688/wellcomeopenres.15460.1 ◽

2019 ◽

Vol 4 ◽

pp. 168 ◽

Cited By ~ 5

Author(s):

Harriet Mpairwe ◽

Pius Tumwesige ◽

Milly Namutebi ◽

Marble Nnaluwooza ◽

Tonny Katongole ◽

...

Keyword(s):

Asthma Control ◽

Asthma Management ◽

Cross Sectional Study ◽

P Value ◽

Asthma Diagnosis ◽

Sectional Study ◽

Asthma Control Test ◽

Cross Sectional ◽

Children With Asthma ◽

Control And Management

Background: Children from low- and middle-income countries have poor asthma control, mainly because of poor management. The extent of this problem in Uganda is not well known, but such information would be useful to guide policy and practice. We therefore conducted a cross-sectional study among schoolchildren with asthma in urban Uganda, to assess the level of asthma control and management. Methods: Schoolchildren aged 5-17 years were enrolled, asthma was diagnosed by the study medical team. Asthma control was assessed using the Asthma Control Test and the childhood Asthma Control Test. Data on previous asthma management was obtained using interviewer-led questionnaires. Data were analysed using multiple linear and multiple logistic regression. Results: We enrolled 561 children with asthma, of whom only 56% had ever had an asthma diagnosis. We categorised asthma as well-controlled (55.5%), partly-controlled (29.5%) and poorly-controlled (15.0%). Poor asthma control was associated with increasing age (adjusted regression coefficient [95% confidence interval], p-value: -1.07 [-1.20, -0.94], p<0.0001), concurrent allergic rhinitis (-1.33 [-2.28, -0.38], p=0.006), and city residence in early life (-1.99 [-3.69, -0.29], p=0.06). Regular use of inhaled asthma medication in the last 12 months was very low; 18.1% for salbutamol and 6.7% for inhaled corticosteroids. The main barriers to inhaled asthma medication use were lack of prescription (47.6%) and inaccurate diagnosis (38.8%). Increased inhaler use was associated with tertiary education of the fathers (adjusted odds ratio [95% confidence interval], p-value: 5.19 [2.39-11.28], p<0.0001), city residence in early life (4.66 [1.79-12.43], 0.002) and an asthma diagnosis prior to enrolment (11.39 [6.35-20.43], p<0.0001). Conclusions: This study confirms that children with asthma in Uganda generally have inadequate asthma control, which is attributable to poor asthma management. This could be improved through re-training of medical workers and patient education, and by increasing availability and affordability of essential asthma medications.

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Assessment of disease control in patients with asthma

Medicina ◽

10.3390/medicina45120121 ◽

2009 ◽

Vol 45 (12) ◽

pp. 943 ◽

Cited By ~ 1

Author(s):

Guoda Pilkauskaitė ◽

Kęstutis Malakauskas ◽

Raimundas Sakalauskas

Keyword(s):

Lung Function ◽

Asthma Control ◽

Control Level ◽

Asthma Management ◽

Control Test ◽

Uncontrolled Asthma ◽

Asthma Control Test ◽

Inhaled Steroids ◽

Asthma Patients ◽

Β2 Agonists

International guidelines indicate that the main criterion of asthma management is asthma control level. The aim of this study was to assess asthma control and its relation with age, gender, and lung function. Material and methods. A total of 106 family physicians and 13 pulmonologists and allergists took part in this study. Each doctor had selected 10–15 asthma patients and had sent invitations to them by post. On the visit day, the patients themselves filled in the Asthma Control Test. The doctors interviewed the patients and filled in a special questionnaire. Pulmonologists and allergists also assessed lung function by performing spirometry. According to the results of the Asthma Control Test, the disease control level was indicated as “totally controlled” (25 points), “well controlled” (24–20 points), and “uncontrolled” (19 points or less). Results. A total of 876 asthma patients were examined. Uncontrolled asthma was diagnosed to 56.2% of the patients, 36.5% of patients had well controlled and 7.3% totally controlled asthma. There was no significant difference in asthma control level comparing men and women. A correlation between asthma control level and age was found revealing poorer asthma control in older patients. Ninety-five percent of patients were treated with inhaled steroids; most of them had used inhaled steroids in combination with long-acting β2 agonists. It was found that lung function correlated with clinical symptoms of asthma, the demand of shortacting β2 agonists, and asthma control level. Conclusion. The study showed that uncontrolled asthma was diagnosed to more than half of the patients, despite most of them used inhaled steroids. Asthma control was worsening with the age of patients with asthma and it correlated with lung function. We suggest that periodical assessment of asthma control should help to optimize asthma management.

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Comparison of the Global Initiative for Asthma Guideline–based Asthma Control Measure and the Childhood Asthma Control Test in Evaluating Asthma Control in Children

Pediatrics & Neonatology ◽

10.1016/s1875-9572(10)60053-8 ◽

2010 ◽

Vol 51 (5) ◽

pp. 273-278 ◽

Cited By ~ 13

Author(s):

Hong-Ren Yu ◽

Chen-Kuang Niu ◽

Ho-Chang Kuo ◽

Ka-Yin Tsui ◽

Chih-Chiang Wu ◽

...

Keyword(s):

Asthma Control ◽

Childhood Asthma ◽

Control Measure ◽

Control Test ◽

Asthma Control Test ◽

Asthma Guideline ◽

Global Initiative For Asthma ◽

Global Initiative

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Validity of Asthma Control Test for Asthma Control Assessment in Chinese Primary Care Settings

CHEST Journal ◽

10.1378/chest.08-0967 ◽

2009 ◽

Vol 135 (4) ◽

pp. 904-910 ◽

Cited By ~ 33

Author(s):

Xin Zhou ◽

Feng-ming Ding ◽

Jiang-tao Lin ◽

Kai-sheng Yin

Keyword(s):

Primary Care ◽

Asthma Control ◽

Control Test ◽

Asthma Control Test ◽

Primary Care Settings

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Asthma Management Responsibility, Control, and Quality of Life Among Emerging Adolescents

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsz069 ◽

2019 ◽

Vol 45 (1) ◽

pp. 40-49

Author(s):

Mallory Netz ◽

David A Fedele ◽

Rachel Sweenie ◽

Dawn Baker ◽

Michael Light ◽

...

Keyword(s):

Quality Of Life ◽

Asthma Control ◽

Healthcare Providers ◽

Asthma Management ◽

Life Questionnaire ◽

Act Scores ◽

Asthma Control Test ◽

Significant Difference ◽

Related Quality

Abstract Objective To examine how asthma control is related to the association between the division of responsibility for asthma management and asthma-related quality of life among early adolescents. Methods Forty-nine youth aged 10–15 years (Mage = 12.25, 57.1% female) with a physician-verified asthma diagnosis completed the Standardized Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and Asthma Control Test (ACT). Youth and their caregivers also completed the Asthma Responsibility Questionnaire (ARQ). Higher ACT scores indicate better asthma control. Results There was a significant difference in ARQ scores between youth and caregivers (p < .001, d = .94). Youth reported sharing equal responsibility for asthma management with caregivers, while caregivers reported having more responsibility relative to youth. Greater youth-reported ARQ (p = .004) and greater ACT scores (p < .001) were associated with higher PAQLQ scores. ACT scores moderated the effect of youth-reported ARQ on PAQLQ scores (p = .043). For youth with lower ACT scores, higher youth-reported responsibility was associated with higher PAQLQ scores; while for youth with higher ACT scores, PAQLQ scores were high regardless of perceived responsibility. The interaction between caregiver ARQ scores and ACT scores was not significant. Conclusion This study suggests youth and caregivers report discrepant ARQ for asthma management tasks. Responsibility and level of asthma control are important factors for PAQLQ, with results indicating that fostering responsibility is an important factor, even among youth with poorly controlled asthma. Findings suggest that healthcare providers should assess family responsibility and help caregivers support adolescents in developing asthma management skills.

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Meeting the challenges of asthma management guidelines in public primary care clinics in Malaysia: a qualitative study

10.1183/13993003.congress-2021.pa1002 ◽

2021 ◽

Author(s):

Ai Theng Cheong ◽

Ping Yein Lee ◽

Shariff Ghazali Sazlina ◽

Hani Salim ◽

Norita Hussein ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Asthma Management ◽

Management Guidelines ◽

Primary Care Clinics

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The Role of Pharmacists in General Practice in Asthma Management: A Pilot Study

Pharmacy ◽

10.3390/pharmacy6040114 ◽

2018 ◽

Vol 6 (4) ◽

pp. 114 ◽

Cited By ~ 7

Author(s):

Louise Deeks ◽

Sam Kosari ◽

Katja Boom ◽

Gregory Peterson ◽

Aaron Maina ◽

...

Keyword(s):

General Practice ◽

Pilot Study ◽

Asthma Control ◽

Action Plan ◽

Asthma Management ◽

Asthma Control Test ◽

Appropriate Prescribing ◽

Device Use ◽

Practice Methods

Background: Asthma is principally managed in general practice. Appropriate prescribing and medication use are essential, so general practice pharmacists appear suitable to conduct asthma management consultations. This pilot study aimed to evaluate the asthma management role of a pharmacist in general practice. Methods: Analysis of an activity diary and stakeholder interviews were conducted to identify interventions in asthma management; determine whether asthma control changed following pharmacist input; and determine acceptability of asthma management review by a pharmacist in one general practice in Canberra, Australia. Results: Over 13 months, the pharmacist saw 136 individual patients. The most common activities were asthma control assessment; recommendations to adjust medication or device; counselling on correct device use; asthma action plan development and trigger avoidance. For patients with multiple consultations, the mean Asthma Control Test score improved from the initial to last visit (14.4 ± 5.2 vs. 19.3 ± 4.7, n = 23, p < 0.0001). Eight of the 19 (42%) patients moved from having poor to well-controlled asthma. Case studies and qualitative data indicated probable hospital admission avoidance and stakeholder acceptability of asthma management by a practice pharmacist. Conclusions: This pilot study demonstrated it is feasible, acceptable and potentially beneficial to have a general practice pharmacist involved in asthma management. Fuller evaluation is warranted.

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Disease control in patients with asthma and respiratory symptoms (wheezing, cough) during sleep

Asthma Research and Practice ◽

10.1186/s40733-020-00062-w ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Jonathan Doenges ◽

Elisabeth Kuckuck ◽

Werner Cassel ◽

Olaf Hildebrandt ◽

Andreas Weissflog ◽

...

Keyword(s):

Asthma Control ◽

Respiratory Symptoms ◽

Asthma Management ◽

Objective Evaluation ◽

Uncontrolled Asthma ◽

Asthma Control Test ◽

Asthmatic Patients ◽

Significant Difference ◽

Asthma Patients ◽

Act Score

Abstract Introduction The Global Initiative for Asthma (GINA)-defined criteria for asthma control include questions about daytime symptoms, limitation of activity, nocturnal symptoms, need for reliever treatment and patients’ satisfaction. Patients with nocturnal symptoms like wheezing and cough often suffer from lower sleep quality and impaired daytime performance. The lack of an appropriate method for standardized and objective monitoring of respiratory symptoms leads to difficulties in asthma management. The aim of this study is to present a new method for automated wheeze and cough detection during sleep and to assess the actual level of asthma control by the Asthma Control Test (ACT). Methods Respiratory symptoms like wheezing and cough were recorded with the LEOSound-Monitor for one night in 55 asthmatic patients in their individual domestic setting. Patients were asked to assess their level of asthma subjectively with the ACT. The study consisted of 37 women and 18 men, with a mean age of 41 years, and a mean BMI of 27 kg/m2. Most of the patients had been taking an ICS/LABA combination and would resort to a SABA as their rescue medication. Results 60% of the participants were classed as having controlled, and 40% were classed as having partially- or uncontrolled asthma. During sleep wheezing was found in 8 of the 55 asthma patients (14.5%) and coughing was found in 30 patients (54.5%). The median ACT score in wheezing-patients was 14, while in non-wheezing patients it was 21. Uncontrolled asthma was found in 6 of the 8 wheezing-patients. Coughing versus non-coughing patients did not show a significant difference in the ACT-score (20, 22 respectively). Conclusion Wheezing is a sign of uncontrolled asthma. The ACT-score in wheezing patients is worse compared to patients without wheezing. LEOSound proofed to be a useful tool in providing an objective evaluation of respiratory symptoms, like coughing and wheezing. In clinical practice, this may allow an improvement in asthma therapy.

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