Monitoring and Management of Childhood Asthma in Asian Countries A Questionnaire Study

BACKGROUND : A recent study by the International Study of Asthma and Allergies in Childhood has shown that asthma symptom prevalence is still increasing in parts of Asia. As such, it is important to know how well asthma is being managed. Practices of physicians in India, China, Sri Lanka, Australia, Singapore, Indonesia, Philippines, and Taiwan in monitoring and treating childhood asthma were examined. METHODS : A 6-page standardized questionnaire was sent to physicians via post. The questionnaire is made up of 3 parts, including (1) methods of monitoring of childhood asthma, (2) practices in managing acute asthma exacerbations, and (3) choice of therapy in maintenance treatment. RESULTS : Our study reflects mostly the practices of physicians who practice in urban regions. Of respondents, 41.4% were general pediatricians, whereas 26.3% were general practitioners. A small fraction of physicians used score cards or diaries to monitor asthma, ranging from 0% (Philippines and Australia) to 15.9% (India). Only 8.1% (Sri Lanka) to 52.0% (Australia) use either a peak flow meter and/or spirometry to monitor asthma. However, for frequency of use, 35% (China) to 94% (Indonesia) never or seldom make use of a peak flow meter, and 33% (China) to 97.6% (Indonesia) never or seldom use spirometry for monitoring. Most physicians treat acute asthma appropriately with short-acting bronchodilators. For maintenance treatment, an inhaled corticosteroid was the most frequently chosen first-choice therapy. However, a significant fraction of physicians chose a long-acting β-agonist monotherapy as a first-choice treatment for asthma maintenance. For infants, the percentage ranged from 1.4% (Australia) to 76.3% (Indonesia); in preschoolers, 1.8% (Australia) to 43.3% (Indonesia); and in older children, 0% (Philippines) to 28.8% (Indonesia). These results may be related to the overall affluence of each nation. CONCLUSIONS : There is much room for improvement in increasing physicians' awareness to guidelines for more effective management of pediatric asthma in Southeast Asia, especially regarding the high use of long-acting β-agonist monotherapy, even in young children.