A syndromic approach to assess diagnosis and management of patients presenting with respiratory symptoms to healthcare facilities in Vietnam

Abstract

BackgroundThe aim of the study was to establish syndromic diagnoses in patients presenting with respiratory symptoms to healthcare facilities in Vietnam and to compare the diagnoses with the facility-level clinical diagnoses and treatment decisions.MethodsA representative sample of patients, aged≥5 years, presenting with dyspnoea, cough, wheezing, and/or chest tightness to health facilities in four provinces of Vietnam were systematically evaluated. Eight common syndromes were defined using data obtained.ResultsWe enrolled 977 subjects at 39 facilities. We identified fixed airflow limitation (FAL) in 198 (20.3%) patients and reversible airflow limitation (RAL) in 26 (2.7%) patients. Patients meeting the criteria for upper respiratory tract infection (URTI) alone constituted 160 (16.4%) patients and 470 (48.1%) did not meet the criteria for any of the syndromes. Less than half of patients with FAL were given long-acting bronchodilators. A minority of patients with either RAL or FAL with eosinophilia were prescribed inhaled corticosteroids. Antibiotics were given to more than half of all patients, even among those with URTI alone.ConclusionThis study identified a substantial discordance between prescribed treatment, clinician diagnosis and a standardised syndromic diagnosis among patients presenting with respiratory symptoms. Increased access to spirometry and implementation of locally-relevant syndromic approaches to management may help to improve patient care in resource-limited settings.

Stepped treatment algorithm using budesonide-formoterol for chronic respiratory diseases: A single arm interventional study

“…Hence, many patients with CRD may have been missed. A recent cross-sectional survey showed more than 20% of patients with respiratory symptoms who attended district health facilities in Vietnam had either fixed or reversible airflow limitation [ 25 ], and would have potentially benefited from the treatment algorithm of this study. Other studies have also shown that misdiagnosis of COPD and asthma is common [ 26 , 27 ].…”

Peak Flow and Mini-spirometry in the Diagnosis of Obstructive Airway Diseases

“…tuberculosis, HIV/AIDS-associated lung diseases, and parasitic or fungal lung diseases), so clinicians tend to place greater reliance on clinical findings and often use a syndromic approach to diagnosis and initial management. 61 This comes at the cost of precision but is based on the assumption (valid in most LMICs) that under-diagnosis and undertreatment of asthma is more likely 62 than the overdiagnosis and overtreatment often seen in high income countries. 19,63 Although acknowledging that poor access to lung function testing is a common barrier to asthma diagnosis in LMICs, GINA does not recommend that diagnosis should be solely based on syndromic clinical patterns.…”

A study of the moving rate of positive results for use in a patient‐based real‐time quality control program on a procalcitonin point‐of‐care testing analyzer

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