Implementation of GINA guidelines in asthma management by primary care physicians in Vietnam

Abstract

Background: Asthma control is suboptimal in Vietnam. Lack of knowledge of primary care physicians (PCPs) for asthma management may potentially be one of the causes. Purpose: The aim of this study was to assess the knowledge and practice of PCPs’ asthma management based on the Global Initiative for Asthma (GINA) guidelines (2015 update). Methods: A cross-sectional study with convenience sampling was conducted among PCPs in an urban and rural area of Vietnam using questionnaires related to asthma patients daily practice: use of spirometry and the asthma control test (ACT), prescription of asthma medications, and frequency of consultations. Five asthma case scenarios were also used to ask participants to classify GINA-defined levels of asthma control and to choose the initial or adjusted treatment options based on the current situation. All scenarios are common in Vietnam, ie, three cases for adults, one case for children, and one case for pregnant women. Results: Of the 327 completed questionnaires, 201 questionnaires could be analyzed. Most PCPs consulted their asthma patients on a weekly to monthly basis. Approximately 50% used spirometry for asthma care and only 25% used ACT. For asthma treatment, oral short-acting beta agonists and oral steroids were still commonly used and long-acting beta agonists alone were prescribed by 70%. Regarding GINA-defined levels of asthma control, 24% of the responders had ≥50% of correct answers, 21% had no correct answers, 2% had all five correct answers, and 20-42% had a correct answer for each of the five questions. Regarding treatment choice, 22% had ≥50% of correct answers, 14% had a wrong answer for all nine questions, and no respondent had a correct answer for ≥8 questions. Conclusion: The percentage of PCPs in Vietnam who had implemented GINA 2015 was low. Some drugs with a high risk of side effects were still being prescribed. There is a need to improve both knowledge and daily practice. Additional studies should determine why these guidelines are not largely adopted by PCPs in Vietnam.