Prescription of oral short-acting beta 2-agonist for asthma in non-resource poor settings: A national study in Malaysia

Chin, May Chien; Sivasampu, Sheamini; Khoo, Ee Ming

doi:10.1371/journal.pone.0180443

Cited by 11 publications

(7 citation statements)

References 22 publications

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“…Although in the present study, the proportion of patients who used inhaled corticosteroids (ICS), long-acting inhaled β 2 -agonist (LABA) and/or oral short-acting β 2 -agonist were non-significantly higher in the uncontrolled asthma than in the controlled asthma group, being on treatment has a significant association with uncontrolled asthma. Moreover, in our patient cohort, as common in low-income countries, short-acting β 2 -agonist (SABA) was the most frequent form of treatment even though it has lower efficacy and safety [48].…”

Section: Discussionmentioning

confidence: 99%

Asthma Control and Its Predictive Factors in Adult Asthma Patients

et al. 2019

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BackgroundAsthma is a highly prevalent condition that remains difficult to control, as its associated factors remain poorly understood. Thus, the primary aim of the present investigation was to determine the prevalence of uncontrolled asthma in hospital units in south Jordan and to evaluate the risk factors that may contribute to uncontrolled asthma.MethodsThis was a cross-sectional study involving 93 patients aged 40.5 ± 13.6 years that met the criteria of the Global Initiative for Asthma (GINA). Relevant patient data were collected via a questionnaire and through a review of medical records. The questionnaire comprised of sections pertaining to sociodemographic and clinical characteristics, as well as pharmacological asthma treatment, asthma severity and asthma control. Asthma severity was determined in line with the GINA guidelines, whereby the patients were classified into four groups (intermittent, mild persistent, moderate persistent or severe persistent). Moreover, based on the findings yielded by the asthma control questionnaire (ACQ), patients were divided into three levels, whereby those diagnosed with partly controlled and uncontrolled asthma were combined into one group, denoted as “poorly controlled asthma”, with “uncontrolled asthma” and “controlled asthma” as the remaining two groups. Atopy was defined as one or more positive reactions (A/H ratio > 1) on a skin prick test.ResultsAsthma control was achieved in 45.2% of the sample. Moreover, older age, severe asthma according to the GINA guidelines, longer duration of asthma, atopy, being on treatment for asthma and history of allergic rhinitis were identified as the main risk factors contributing to poorly controlled asthma. Multivariate analyses, however, revealed that only atopy to two or more allergens and having severe asthmatic attacks were statistically significantly associated with poorly controlled asthma, for which the odds ratio Mantel-Haenszel (ORMH) of 17.2 and 2.2 was obtained, respectively.ConclusionOur findings indicate that severe asthma and atopy to two or more allergens are the main risk factors for uncontrolled asthma. However, further studies with larger sample sizes are needed to confirm these results.

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Section: Discussionmentioning

confidence: 99%

Asthma Control and Its Predictive Factors in Adult Asthma Patients

et al. 2019

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“…Less than half of adult asthma patients had regular long-term follow-up [9][10][11] . In addition, studies have reported under-utilisation of controller medications 10,11 , while the use of oral short-acting beta-agonist was common among adults with poor asthma control in Malaysia [10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Barriers to implementing asthma self-management in Malaysian primary care: qualitative study exploring the perspectives of healthcare professionals

Lee

Cheong

Ghazali

et al. 2021

npj Prim. Care Respir. Med.

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Asthma self-management is a crucial component of asthma management. We sought to explore healthcare professionals’ (HCPs’) perceptions on barriers to asthma self-management implementation in primary care. We recruited 26 HCPs from six public primary care clinics in a semi-urban district of Malaysia in 2019. The analysis was done inductively. HCPs described barriers that resonated with the “COM-B” behaviour change framework. Capability-related issues stemmed from a need for specific self-management skills training. Opportunity-related barriers included the need to balance competing tasks and limited, poorly tailored resources. Motivation-related barriers included lack of awareness about self-management benefits, which was not prioritised in consultations with perceived lack of receptiveness from patients. These were compounded by contextual barriers of the healthcare organisation and multilingual society. The approach to implementation of asthma self-management needs to be comprehensive, addressing systemic, professional, and patient barriers and tailored to the local language, health literacy, and societal context.

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“…A high level of preventer prescription was also observed in this study whereby 89.8 percent of patients with poor control asthma were prescribed with inhaled corticosteroid or LABA or both. These levels of prescription were not far off the 100 percent standard targets and they were substantially higher than those in a national study done at both public and private primary care clinics in Malaysia [16]. In the latter study, 50.2 and 38.3 percent of 9241 asthmatic patients were prescribed with inhaled SABA and a preventer, respectively.…”

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confidence: 64%

Quality of asthma care at a university-based primary care clinic in Malaysia

Tohid

Azmi

et al. 2019

JHR

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Purpose The quality of asthma care may be affected if asthma management is overlooked, thus needing frequent clinical audits to identify areas for improvement. The purpose of this paper is to evaluate the quality of the process (e.g. documentation of asthma-specific information), the structure (e.g. availability of resources) and the outcome (e.g. proportion of patients prescribed with asthma medications) at a university-based primary care clinic. The associated clinical factors for non-documentation of asthma control at the last visit were also examined. Design/methodology/approach This retrospective study involved auditing medical records and the pharmacy data system of 433 adult patients with asthma to evaluate 18 quality indicators. The standard target for the indicators of process and structure was 80 percent and the standard target for the indicators of outcome was 100 percent. Findings All the indicators failed to reach the standard targets. Documentation of asthma-specific information and availability of resources were deficient. The non-documentation of asthma control was significantly associated with presence of acute complaint(s) unrelated to asthma, presence of other issues and number of the documented parameters for asthma control. Although the prescription rates of inhaled reliever and preventer were substandard, they were reasonably high compared to the targets. Research limitations/implications In this study, evaluation of the quality of care was limited by absence of asthma register, use of paper-based medical records and restricted practice capacity. Besides, the asthma-specific assessments and management were only audited at one particular time. Furthermore, the findings of this study could not be generalised to other settings that used other methods of record keeping such as patient-held cards and electronic medical records. Future studies should sample asthma patients from a register, evaluate more reliable quality indicators (e.g. over-prescription of short-acting β-2 agonist and underuse of inhaled corticosteroid) and assess asthma management over a duration of time. Practical implications This study provides quality information on all aspects of asthma care (process, structure and outcome) which can be a basis for clinical improvement. It is hoped that the study could assist the stakeholders to plan strategies for improvement of the asthma care. A more strategic and reliable system of documentation is needed, such as the use of a simple template or structured form, which should not jeopardise the provision of personalised and comprehensive care. With complete documentation, thorough investigational audits can be continuously performed to determine the quality of asthma care. Social implications This study could provide useful findings to guide healthcare providers in developing a more strategic model of asthma care that can ensure asthma patients to receive a personalised, comprehensive, holistic and continuous care. Through this approach, their physical and psychosocial well-being can be optimised. Originality/value Even though our healthcare has advanced, the quality of asthma care is still suboptimal which requires further improvement. However, it could be considered assuring due to high outcome levels of asthma care despite having limited resources and practice capacity.

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Prescription of oral short-acting beta 2-agonist for asthma in non-resource poor settings: A national study in Malaysia

Cited by 11 publications

References 22 publications

Asthma Control and Its Predictive Factors in Adult Asthma Patients

Asthma Control and Its Predictive Factors in Adult Asthma Patients

Barriers to implementing asthma self-management in Malaysian primary care: qualitative study exploring the perspectives of healthcare professionals

Quality of asthma care at a university-based primary care clinic in Malaysia

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