Knowledge about bronchial asthma management in primary health care physicians in Al-Khobar City, Saudi Arabia

Knowledge, attitude and practices of PHC physicians in Aseer region regarding management of acute asthma

Objectives

This study aims to explore knowledge, attitude and practices of physicians working at primary health care (PHC) in Abha, KSA, regarding assessment and management of acute bronchial asthma.

Subjects and Methods

This is a cross-sectional study that was conducted among PHC physicians in Abha, Khamis Mushayt and Ahad Rufeida cities, Aseer region KSA in 2018. A questionnaire that was constructed by the investigators was used to assess the knowledge, attitude and practices of PHC physicians regarding the diagnosis and management of patients with acute asthma. The questionnaire was distributed under the supervision of the first investigator. Data management was carried out using SPSS version 23.

Results

A total of 200 PHC physicians participated in this study. About two-thirds of them (63.5%) had good grade of knowledge regarding acute asthma management, whereas 44% had positive attitude toward acute asthma management. The main knowledge gaps were doses of drugs used in the management of acute severe asthma attack (36%), and diagnosis of acute severe asthma attack (51.5%). Physicians' main source of knowledge on asthma included textbooks (26%) and guidelines (61.5%). Physicians' practice grades were significantly higher among those with less experience in PHC (p = 0.011). Almost all PHC centers (PHCC) (98%) had oxygen and nebulizers, 72.5% had steroids, 71.5% had salbutamol, 50.5% had ipratropium and 41% had peak flow meter, whereas 73.5% had the Saudi Initiative for Asthma (SINA) guidelines.

Conclusion

This study revealed that knowledge of PHC physicians regarding the management of bronchial asthma was suboptimal, their attitude is not completely positive, and their adherence to asthma management guidelines is quite low. Some PHCCs were lacking important drugs and equipment for management acute asthma that should be provided. Well-structured training of PHCC doctors on SINA is mandatory to upgrade their knowledge, promote their attitude and improve their skills.

The diagnosis of asthma. Can physiological tests of small airways function help?

Asthma is a common, chronic, and heterogeneous disease with a global impact and substantial economic costs. It is also associated with significant mortality and morbidity and the burden of undiagnosed asthma is significant. Asthma can be difficult to diagnose as there is no gold standard test and, while spirometry is central in diagnosing asthma, it may not be sufficient to confirm or exclude the diagnosis. The most commonly reported spirometric measures (forced expiratory volume in one second (FEV₁) and forced vital capacity assess function in the larger airways. However, small airway dysfunction is highly prevalent in asthma and some studies suggest small airway involvement is one of the earliest disease manifestations. Moreover, there are new inhaled therapies with ultrafine particles that are specifically designed to target the small airways. Potentially, tests of small airways may more accurately diagnose early or mild asthma and assess the response to treatment than spirometry. Furthermore, some assessment techniques do not rely on forced ventilatory manoeuvres and may, therefore, be easier for certain groups to perform. This review discusses the current evidence of small airways tests in asthma and future research that may be needed to further assess their utility.

Assessment of family and internal medicine physicians knowledge and practice of bronchial asthma at Riyadh city

Background:

The prevalence of bronchial asthma (BA) is increasing in the Kingdom of Saudi Arabia. The knowledge and adherence to guidelines by physicians can play a major role in controlling asthma.

Aim:

To assess the knowledge and practice of family medicine and internal medicine physicians about BAat King Saudi University medical city in Riyadh, Kingdom of Saudi Arabia.

Methodology:

A cross-sectional survey study was conducted. All family and internal medicine physicians at King Khalid University Hospital were included. A total of 180 physicians participated. The questionnaire was developed according to the Global Initiative for Asthma (GINA) guideline to assess the knowledge and practice of physicians towards bronchial asthma, included questions (diagnosis, severity classification, management, and referral).

Results:

All participated physicians knowledge and practice level about BAwaslow; the average scores were around 50%. The comparison between family and internal medicine physicians' knowledge shows insignificant differences. The only exception is the management part; family medicine physicians show better results than internal medicine physicians. The years of experience and higher qualification show significant improvement in the level of the knowledge scores.

Conclusion:

The knowledge of physicians about the diagnosis, assessment of severity, management, and referral of BA was unsatisfactory. We recommend an adoption of a special asthma clinic for teaching, supervising, and managing purposes assigned to an expert consultant.

An online survey detected knowledge gaps and cost-saving opportunities in asthma maintenance treatment among allergists, pulmonologists, ENTs and primary care

Background

In April 2017 the Mexican Asthma Guidelines (GUIMA) were published. Before the launch, physicians’ knowledge was explored related to key issues of the guideline.

Methods

A SurveyMonkey® survey was sent out to board-certified physicians of 5 medical specialties treating asthma. Replies were analyzed per specialty against the GUIMA evidence-based recommendations. We present the treatment part here.

Results

A total of 364 allergists (ALLERG), 161 pulmonologists (PULM), 34 ENTs, 239 pediatricians (PED) and 62 general practitioners (GPs) replied to the survey and 247-83-14-135-37 respectively finished it. Spirometry is not routinely indicated when asthma is very probable by ALLERG 54%, PULM 47%, ENT 39%, PED 65%, GP 64%. A fictitious case proposed to the physicians with intermittent asthma was erroneously treated with ICS by ALLERG 9%, PULM 11%, ENT 28%, PED 10%, GP 11%. The mild persistent case received mistakenly ICS-LABA by ALLERG 25%, PULM 26%, ENT 33%, PED 27%, GP 23%. The first-line option for moderate persistent asthma was ICS(median dose) instead of ICS(low)+LABA for ALLERG 29%, PULM 25%, ENT 17%, PED 27%, GP 23% and in severe asthma maintenance treatment PULM20%, ALLERG-ENT-PED-GP 22-34% failed to indicate LABA. Concerning the guidelines’ recommendation to use one inhaler for maintenance & rescue in moderate-to-severe asthma, PULM45%, ALLERG-ENT-PED-GP 56-80% (p < 0.00001), erroneously indicated ICS-salmeterol could be used, instead of ICS-formoterol. Oral β2 or theophylline are no longer recommended, but PULM 37% and ALLERG-ENT-PED-GP 42-62% (p < 0.01) still indicate their use. In severe asthma 61-73% of physicians consider adding LTRA to the treatment; only PULM38%, OTHERS12-25% consider adding tiotropium (p < 0.001) and 3-17% consider adding omalizumab, both guideline recommended add-ons. As for asthma in pregnancy, most surveyed are not aware budesonide is the 1st line option ICS. Finally, 81-97% of the group-members recognized allergen immunotherapy, as a viable add-on, in line with GINA/GEMA/GUIMA recommendations.

Conclusions

An online survey could detect knowledge-gaps related to asthma treatment. Interestingly, surveyed physicians tended to over-treat the milder asthma cases, thus clearly leaving room for cost-savings. Caution should be taken in the promotion of the SMART (single-maintenance-and-reliever-treatment) approach, which can only be done with ICS-formoterol. Many physicians opt for other combinations not apt for this approach. Among all surveyed specialties there is ample room for improvement in mild and severe asthma management.

Implementation of GINA guidelines in asthma management by primary care physicians in Vietnam

Background

Asthma control is suboptimal in Vietnam. Lack of knowledge of primary care physicians (PCPs) for asthma management may potentially be one of the causes.

Purpose

The aim of this study was to assess the knowledge and practice of PCPs’ asthma management based on the Global Initiative for Asthma (GINA) guidelines (2015 update).

Methods

A cross-sectional study with convenience sampling was conducted among PCPs in an urban and rural area of Vietnam using questionnaires related to asthma patients daily practice: use of spirometry and the asthma control test (ACT), prescription of asthma medications, and frequency of consultations. Five asthma case scenarios were also used to ask participants to classify GINA-defined levels of asthma control and to choose the initial or adjusted treatment options based on the current situation. All scenarios are common in Vietnam, ie, three cases for adults, one case for children, and one case for pregnant women.

Results

Of the 327 completed questionnaires, 201 questionnaires could be analyzed. Most PCPs consulted their asthma patients on a weekly to monthly basis. Approximately 50% used spirometry for asthma care and only 25% used ACT. For asthma treatment, oral short-acting beta agonists and oral steroids were still commonly used and long-acting beta agonists alone were prescribed by 70%. Regarding GINA-defined levels of asthma control, 24% of the responders had ≥50% of correct answers, 21% had no correct answers, 2% had all five correct answers, and 20–42% had a correct answer for each of the five questions. Regarding treatment choice, 22% had ≥50% of correct answers, 14% had a wrong answer for all nine questions, and no respondent had a correct answer for ≥8 questions.

Conclusion

The percentage of PCPs in Vietnam who had implemented GINA 2015 was low. Some drugs with a high risk of side effects were still being prescribed. There is a need to improve both knowledge and daily practice. Additional studies should determine why these guidelines are not largely adopted by PCPs in Vietnam.