Relation between Morbidity and Current Treatment in Patients who present with Acute Asthma to Polyclinics

NC Tan, S Goh, H Leong, CJ Ng, V Thai, WF Siew, S Emmanuel, TK Lim
Correspondence: T K Lim, mdclimkt@nus.edu.sg

ABSTRACT
Background It has been suggested that resources for asthma intervention should be focused mainly on patients in the community who experience a high burden of disease. These are who patients who have acute exacerbations which require urgent treatment.
Aim To assess the morbidity and identify deficiencies in the treatment of patients who present for urgent treatment of acute exacerbations to primary care clinics.
Patients Adult patients who received urgent treatment for acute exacerbation of bronchial asthma
Setting 4 primary care polyclinics.
Methods A cross-sectional survey of consecutive patients which related regular preventive treatment to current asthma activity. Poor asthma control was defined as step 2 or higher (American National Asthma Education and Prevention Program, report II, 1997) or > or = 2 emergency room visits in 6 months.
Results There were 116 patients of whom 53% were women. The mean (SD) age was 45(15) years and duration of current exacerbation 3 (3) days. The acute symptoms were successfully treated in 93% of patients. Quick relief medication was used regularly in 91% and inhaled corticosteroids (ICS) in 55%. Oral salbutamol was prescribed in 14% of patients. The asthma was poorly controlled in 54%. In the poorly controlled group 33% were not on regular ICS treatment and 64% were not receiving "add on" medication.
Conclusion Patients treated for acute asthma in primary care clinics: (1) were older and had less acutely severe exacerbations than those who presented to emergency rooms, (2) over half had poorly controlled asthma and (3) a third of patients with poor asthma control were inadequately treated.

Keywords: asthma, treatment, guidelines, morbidity
Singapore Med J 2000; 41(6): 259-263