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

VK Jain; M Mishra; AK Singh

doi:10.4103/0972-6691.116615

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ORIGINAL ARTICLE

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

VK Jain, M Mishra, AK Singh
Department of Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur, Rajasthan, India

Date of Web Publication

17-Aug-2013

Correspondence Address:
V K Jain
KTR 3 and 4, Mahatma Gandhi Nagar, DCM, Ajmer Road, Jaipur - 302 021, Rajasthan
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0972-6691.116615

Abstract

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

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

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

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

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

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.

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