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Year : 2013  |  Volume : 27  |  Issue : 1  |  Page : 38-41

Status of previously diagnosed cases of bronchial asthma in relation to diagnosis, treatment, control profile and asthma education reporting at a tertiary care hospital

Department of Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur, Rajasthan, India

Date of Web Publication17-Aug-2013

Correspondence Address:
V K Jain
KTR 3 and 4, Mahatma Gandhi Nagar, DCM, Ajmer Road, Jaipur - 302 021, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-6691.116615

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Background: The cases of bronchial asthma are mainly diagnosed and treated by primary and PG General Physician. Asthma is not adequately controlled due to poor approach to diagnosis, inadequate inhalation therapy and lack of knowledge of asthma among practitioners. Objective: To evaluate the previously diagnosed cases of bronchial asthma made by various practitioners in relation to their diagnosis, treatment, control profile and asthma education before reporting to tertiary care hospital. Materials and Methods: A prospective study of previously diagnosed cases of bronchial asthma was done from the period of July 2010 to December 2011. One hundred twenty patients over 18 years of age were studied reporting to our tertiary care medical teaching hospital. Results: Out of 120 cases, 77.5% (n = 93) were males and 22.5% (n = 27) females with maximum cases (94.2%) under 45 years of age. Majority of cases (52.5%) were diagnosed by Postgraduate (PG) General Physicians, followed by 30% by Graduate doctors and only 17.5% by Respiratory physicians. In 80% cases diagnosis was established on the basis of history and clinical findings, while spirometry was used in only 20% cases. Inhalation therapy was prescribed in all the cases by Respiratory physicians, in 90.5% by PG General Physicians and in only 8.3% by Graduate doctors. Overall only 20% (n = 24) cases had their asthma under control, of these 62.5% were treated by Respiratory physicians and 37.5% by PG General Physicians and in none by Graduate doctor. Asthma education of patients rendered by various physicians showed marked variability ranging from nil to 71.5%. It was nil in patients treated by Graduate doctors and poor in treated by PG General Physicians and not even satisfactory in those treated by Respiratory physicians. Conclusion: Majority of bronchial asthma cases are treated by PG General Physicians and Graduate doctors in the community. Spirometry for diagnosis of asthma was very much under used. Awareness of using inhalation therapy was very poor among Graduate doctors. Poor knowledge of asthma education at each level of practitioner is the major reason of poor asthma control.

Keywords: Bronchial asthma, compliance, control, diagnostic profile, prescription, spirometry, technique, treatment

How to cite this article:
Jain V K, Mishra M, Singh A K. Status of previously diagnosed cases of bronchial asthma in relation to diagnosis, treatment, control profile and asthma education reporting at a tertiary care hospital. Indian J Allergy Asthma Immunol 2013;27:38-41

How to cite this URL:
Jain V K, Mishra M, Singh A K. Status of previously diagnosed cases of bronchial asthma in relation to diagnosis, treatment, control profile and asthma education reporting at a tertiary care hospital. Indian J Allergy Asthma Immunol [serial online] 2013 [cited 2023 Mar 26];27:38-41. Available from: https://www.ijaai.in/text.asp?2013/27/1/38/116615

  Introduction Top

Asthma is a common, chronic inflammatory disorder of the airways, associated with pronounced health and economic consequences. [1] It has been identified as one of the five pressing global lung problems, [2] affecting about 300 million people world-wide. [3],[4] It could increase further by another 100 million by year 2025. [5] Recent Indian Council of Medical Research [ICMR] study concluded the prevalence of asthma in India in adults was 2.05%. [6] In proper asthma management, there are deficiencies in diagnosis, adequate treatment, compliance and technique of inhalation of drugs and asthma education, leading to poor control. [1],[7],[8],[9],[10],[11],[12],[13],[14] It has been observed that the majority of the asthma patients are being managed at the primary health-care level or by a family physician. [10] Lack of asthma knowledge in the medical fraternity, particularly at primary level leads to poor management of asthma. [11] Lack of knowledge of asthma guideline among various practitioner's is an important reason of poor diagnosis and control. [12],[13] Lack of knowledge of self-management of asthma among patients is the reason of poor asthma control and can be achieved by providing asthma education to physicians. [14] Therefore, the objectives of the present study were to evaluate the diagnosis, treatment status, asthma education of the patient, and control profile of previously diagnosed bronchial asthma cases made by various physicians in the community before reporting to our center.

  Materials and Methods Top

This prospective study was conducted in the Department of Respiratory Medicine of Mahatma Gandhi Medical College and Hospital, Jaipur from the period of July 2010 to December 2011. Patients over 18 years of age who were previously diagnosed and treated for asthma by their physicians were included in the study. A written consent was obtained from all of them. Patients with unstable cardiovascular status, severe respiratory distress, hemoptysis, and inability to perform spirometry were excluded from the study. These patients were evaluated regarding their previous level of diagnosis whether based on the clinical (history and examination) and or spirometry made by various physicians in the community before reporting to our hospital. They were also evaluated for their types of treatment, inhalation technique, compliance/adherence of therapy, asthma education by the practitioner, and level of asthma control. Detail history was taken, with the complete blood investigations, chest skiagram and spirometry with reversibility. Spirometry was performed using the ndd Medizinitechnik AG true flow TM Machine [European Respiratory Society (ERS) and American Thoracic Society approved (ATS)]. Baseline Forced Expiratory Volume in first second [FEV 1 ] was determined. Two puffs of Levosalbutamol (200 micro gram) were administered and after an interval of 15 minute, spirometry was repeated to determine reversibility. Diagnosis of asthma was considered on the increase in FEV 1 by more than 12% and 200 ml in comparison to baseline value (Global Initiative on Asthma). [1]

  Results Top

A total of 120 patients of bronchial asthma were studied from the period of July 2010 to December 2011. Maximum cases were males (77.5%) and the majority of the cases (>90%) were in the age group of 18-45 year in both genders with a mean age of 32 years [Table 1]. Diagnosis of bronchial asthma cases was made in 36 cases (30%) by Graduate doctors, 63 (52.5%) by PG General Physicians and 21 (17.5%) by Respiratory physicians [Table 2]. Spirometry was used for diagnosis of bronchial asthma, maximum [n = 9 (42.9%)] by Respiratory physicians, in only 15 cases (23.8%) by PG General Physicians and none by Graduate doctors [Table 3]. Over all inhalation therapy was advised in 81 (67.5%) cases, among these it was advised in all cases by Respiratory physicians, in 90.5% by PG General physicians and only in 8.3% cases by Graduate doctors [Table 4]. Adequate compliance of inhaled therapy by patients was reported in 31 cases (38.3%). Over all asthma was controlled in only 20% patients. Among asthma patients, those treated by Respiratory physicians 71.4% had their asthma under control while in only 14.3% treated by PG General physicians and none in treated by Graduate doctor [Table 5]. Asthma education to patients by various physicians regarding disease and treatment knowledge was little higher in Respiratory physicians (19%), followed by PG General Physicians (6.3%) and in none by Graduate doctor. Teaching of inhalation technique to patients was in 71.4% cases by Respiratory physicians, 17.5% by PG General Physicians, and in none by Graduate doctors. Education regarding adherence to the treatment by various practitioners that is respiratory physicians, PG General Physicians and Graduate doctors was 52.4%, 15.9% and none respectively [Table 6].
Table 1: Distribution of cases according to gender and age

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Table 2: Status of various physicians diagnosed asthma cases

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Table 3: Methodology of previously diagnosed asthma cases by different physicians

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Table 4: Inhalation versus oral treatment profile of asthma patients

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Table 5: Status of asthma control

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Table 6: Status of asthma education rendered by various practitioners to asthma patients

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  Discussion Top

Asthma has a major impact on patient quality of life. Control of asthma is generally suboptimal (up to 50%) in patients. [15],[16] Hence, it is essential that asthmatics should be offered appropriate, adequate inhalation pharmacotherapy and asthma education to control asthma. Quality of management of asthma has been improved by proper asthma education campaign for physicians and patients. [14],[17],[18],[19],[20],[21],[22],[23] Differences in asthma management among Respiratory physicians and General physicians were observed in various surveys. [24],[25],[26],[27],[28],[29] In our study, nearly half of the previously diagnosed cases were treated by PG General physicians, followed by one-third by Graduate doctors and only 17.5% by Respiratory physicians in the community. Spirometry was under used for diagnosing asthma by all the practitioners in the community. It was poorly advised by non-Respiratory physicians and even Respiratory physicians advised spirometry inadequately for diagnosing asthma. These observations indicate the lack of awareness regarding use of spirometery for diagnosis of asthma by various physicians as recommended. [1] Other studies also reported similar observations. [12],[13]

In the present study, inhaled therapy was very much under advised by Graduate physicians (8.3%) reflecting poor knowledge among them. Phin et al., reported wide variations in the treatment of childhood asthma among pediatricians, respiratory physicians and general practitioners in Australia. [30] Jobanputra et al., showed that 32% of patients with acute asthma managed by general practitioners in UK were given oral theophylline. [31] Similar results were found by Mobeireek et al., who assessed the prescriptions of medications for asthma in out-patient clinics in four hospitals in Riyadh. [13] Legorreta et al., [32] from the survey of outpatients in US, documented the disparity between the guidelines and asthma care practiced. In our study, asthma was controlled in only one-fifth cases, this was maximum (71.4%) in patients treated by Respiratory physicians and minimum in non-respiratory physicians, it is also supported by others. [1],[7],[8],[9] Asthma education given to patients by various physicians was also very poor especially at the level of graduate doctors and PG general physicians in our study, similar results were also reported in different studies. [7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17]

  Conclusion Top

In the community, majority of asthma cases are diagnosed and treated by non-respiratory physicians. Asthma education and practice of using spirometry for diagnosis of asthma is lacking by all types of practitioners. Therefore, asthma education and use of spirometry for diagnosis of asthma is a dire need for proper asthma management.

  References Top

1.Global Initiative on Asthma an update: 2010, chapter 1, page 2.  Back to cited text no. 1
2.Barnes PJ. Is immunotherapy for asthma worthwhile? N Engl J Med 1996;334:531-2.  Back to cited text no. 2
3.Chapman KR. Impact of ′mild′ asthma on health outcomes: Findings of a systematic search of the literature. Respir Med 2005;99:1350-62.  Back to cited text no. 3
4.Ehrs PO, Nokela M, Ställberg B, Hjemdahl P, Wikström Jonsson E. Brief questionnaires for patient-reported outcomes in asthma: Validation and usefulness in a primary care setting. Chest 2006;129:925-32.  Back to cited text no. 4
5.Global Initiative for Asthma (GINA): Burden report. Available from: http://www.ginasthma.com. [Last accessed on 2008 May 30].  Back to cited text no. 5
6.Published executive summary phase I and II by Indian Council of Medical Research; 2010. p. 1-52.  Back to cited text no. 6
7.Baiardini I, Braido F, Giardini A, Majani G, Cacciola C, Rogaku A, et al. Adherence to treatment: Assessment of an unmet need in asthma. J Investig Allergol Clin Immunol 2006;16:218-23.  Back to cited text no. 7
8.Horne R. Compliance, adherence, and concordance: Implications for asthma treatment. Chest 2006;130:65S-72.  Back to cited text no. 8
9.Jones A, Pill R, Adams S. Qualitative study of views of health professionals and patients on guided self-management plans for asthma. BMJ 2000;321:1507-10.  Back to cited text no. 9
10.Gellert AR, Gellert SL, Iliffe SR. Prevalence and management of asthma in a London inner city general practice. Br J Gen Pract 1990;40:197-201.  Back to cited text no. 10
11.Gorton TA, Cranford CO, Golden WE, Walls RC, Pawelak JE. Primary care physicians′ response to dissemination of practice guidelines. Arch Fam Med 1995;4:135-42.  Back to cited text no. 11
12.Henry RL, Fitzclarence CA, Henry DA, Cruickshank D. What do health care professionals know about childhood asthma? J Paediatr Child Health 1993;29:32-5.  Back to cited text no. 12
13.Mobeireek A, Gee J, Al-Mobeireek K, Al-Majed S, Al-Shemimri A, Abba A. Prescribing for asthma in the outpatient clinics in Riyadh: Does it follow the guidelines? Ann Saudi Med 1996;16:497-500.  Back to cited text no. 13
14.Clark NM, Gong M, Schork MA, Kaciroti N, Evans D, Roloff D, et al. Long-term effects of asthma education for physicians on patient satisfaction and use of health services. Eur Respir J 2000;16:15-21.  Back to cited text no. 14
15.Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical management of asthma in 1999: The asthma insights and reality in Europe (AIRE) study. Eur Respir J 2000;16:802-7.  Back to cited text no. 15
16.Hassan Mahboub BH, Santhakumar S, Soriano JB, Pawankar R. Asthma insights and reality in the United Arab Emirates. Ann Thorac Med 2010;5:217-21.  Back to cited text no. 16
17.Cabana MD, Slish KK, Evans D, Mellins RB, Brown RW, Lin X, et al. Impact of physician asthma care education on patient outcomes. Pediatrics 2006;117:2149-57.  Back to cited text no. 17
18.Levy M, Bell L. General practice audit of asthma in childhood. Br Med J (Clin Res Ed) 1984;289:1115-6.  Back to cited text no. 18
19.Ong LM, de Haes JC, Hoos AM, Lammes FB. Doctor-patient communication: A review of the literature. Soc Sci Med 1995;40:903-18.  Back to cited text no. 19
20.Stewart MA. Effective physician-patient communication and health outcomes: A review. CMAJ 1995;152:1423-33.  Back to cited text no. 20
21.Partridge MR, Hill SR. Enhancing care for people with asthma: The role of communication, education, training and self-management. 1998 world asthma meeting education and delivery of care working group. Eur Respir J 2000;16:333-48.  Back to cited text no. 21
22.Clark NM, Cabana MD, Nan B, Gong ZM, Slish KK, Birk NA, et al. The clinician-patient partnership paradigm: Outcomes associated with physician communication behavior. Clin Pediatr (Phila) 2008;47:49-57.  Back to cited text no. 22
23.Cegala DJ, Marinelli T, Post D. The effects of patient communication skills training on compliance. Arch Fam Med 2000;9:57-64.  Back to cited text no. 23
24.Doerschug KC, Peterson MW, Dayton CS, Kline JN. Asthma guidelines: An assessment of physician understanding and practice. Am J Respir Crit Care Med 1999;159:1735-41.  Back to cited text no. 24
25.Panaqui MA, De Guia ES. Hospital based physician assessment of knowledge, attitudes and practice in the diagnosis and management of asthma guidelines. Chest 2005;128:241s.  Back to cited text no. 25
26.Ahmed Y, Anjum Q, Qureshi F, Qureshi AF. Assessment of physicians understanding of asthma guidelines in a tertiary care hospital. J Pak Med Assoc 2004;54:530-1.  Back to cited text no. 26
27.Alicea E, Casal J, Nazario S, Rodríguez W. Asthma knowledge among internal medicine residents. P R Health Sci J 1999;18:19-21.  Back to cited text no. 27
28.Ayuk A, Iioh K, Obumneme-Anyim I, Iiechukwu G, Oguonu T. Practice of asthma management among doctors in south east Nigeria. Afr J Respir Med 2010;(2):14-7.  Back to cited text no. 28
29.Yuksel N, Ginther S, Man P, Tsuyuki RT. Underuse of inhaled corticosteroids in adults with asthma. Pharmacotherapy 2000;20:387-93.  Back to cited text no. 29
30.Phin S, Oates RK. Variations in the treatment of childhood asthma. Med J Aust 1993;159:662-6.  Back to cited text no. 30
31.Jobanputra P, Ford A. Management of acute asthma attacks in general practice. Br J Gen Pract 1991;41:410-3.  Back to cited text no. 31
32.Legorreta AP, Christian-Herman J, O′Connor RD, Hasan MM, Evans R, Leung KM. Compliance with national asthma management guidelines and specialty care: A health maintenance organization experience. Arch Intern Med 1998;158:457-64.  Back to cited text no. 32


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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