No abstract

Objectives: to determine modifiable risk factors of exacerbations in chronic respiratory diseases with airways obstruction (i.e., asthma and COPD) in southern Vietnam. Methods: an environmental and health-related behavioural questionnaire was submitted to patients with both chronic respiratory symptoms and airways obstruction. An exacerbation was defined as any acute worsening in clinical symptoms requiring a change in treatment, in a patient receiving prophylactic therapy. Results: 235 patients were evaluated, including 131 (56%) chronic obstructive pulmonary disease (COPD) and 104 (44%) asthmatics. There were 75% males and 69% smokers. Occupational exposure accounted for 66%, mainly among construction and industry workers. Smoking was associated with more severe airways obstruction. Respiratory exacerbations were reported in 56/235 patients (24%). The risk of exacerbation was increased in patients with a lower education level, exposure to occupational pollutants, cumulative smoking ≥ 20 pack year, housing space < 10 m2, and poorly ventilated housing. Based on multivariate analysis, the risk of exacerbation remained significantly higher among patients with occupational exposure and low housing space per person. Conclusions: besides smoking cessation, more supportive policies, including improvement of occupational environment and housing design for better ventilation, are needed to prevent the severity of chronic respiratory diseases in Vietnam.

Context: Vietnam is one of the countries at the high alert of antibiotic resistance. Aims: To evaluate the compliance rate and changes in physicians’ prescribing patterns in patients with community-acquired pneumonia (CAP) before and after using the antibiotic order form (AOF) in a tertiary hospital. Methods: 120 inpatient medical records having antibiotic use and 115 patient medical records diagnosed with CAP at a Department of Respiratory Medicine during 3 months before and 3 months after using the AOF were retrospectively collected for assessment. Results: The compliance rate was 92%, and the average rate of filling in information fields was 58%. Comparison of prescribing behavior of CAP in control and intervention group showed that the rate of bacterial culture increased from 70% to 77% (p = 0.690), in which the rate of culture prior prescribing administration increased from 14% to 45% (p < 0.001), the initial antibiotic regimen with narrow-spectrum increased from 26% to 36% (p = 0.353), the proportion of patients improved clinically after 72 hours increased from 64% to 89% (p = 0.138), and the de-escalation decreased from 23% to 20% (p = 0.713). The treatment failure at hospital discharge decreased from 12% to 6% (p = 0.447). However, the length of treatment and the days of antibiotic treatment were not significantly different. Conclusions: The compliance rate was high, but the AOF filling rate was incomplete. Improving prescribing patterns and treatment efficacy in CAP patients is a suggestion to combine the AOF into multifaceted interventional efforts for specific patients.