Adapting International Asthma Management Guidelines to Regions of Turmoil: The Syrian Experience

Abstract

Background: Adherence to international asthma management guidelines is suboptimal even in developed countries.  In low resources settings, especially during periods of turmoil, asthma care becomes emergency-oriented, long-term Inhaled corticosteroids prescription is limited, and follow up is rare.  The current conditions in Syria have weakened the health system. It is not multisectoral and asthma management is not routinely included in primary care centers. There is a weak referral system to secondary care and specialists. Frequently, internal medicine general hospital outpatient clinics are the first contact. To our knowledge, no studies have evaluated asthma knowledge and management skills of internal medicine physicians and residents in regions of turmoil like present-time Syria. Purpose: The purpose of this study was to assess asthma knowledge and management skills of general internists and residents, barriers to adherence to international management guidelines, and means to improve compliance and outcome. Methods:  We developed and administered to general practitioners asthma management audit forms which were reviewed by a trainer pulmonologist for compliance with international management guidelines. When discrepancies were noted, onsite training was provided in weekly sessions. Follow up of care of asthma patients was done by mobile devices to track patients unable to return to the hospital clinic. Findings: Implementation of these strategies resulted in improved adherence to ICS dosing guidelines (P=0.002) and optimal technique for inhaler use by patients. Interpretation: We recommend that WHO programs for CRD include auditing of care by internists with onsite supervision and teaching and mobile follow up technology.  We believe these recommendations will be useful and add value to existing programs and will improve asthma care. Funding Statement: We declare no funding. Conflict of Interest: We declare no conflict of interest.  (We declare no conflict of interest, and no funding.) Ethics Approval Statement: Ethical approval was secured from hospital [Damascus General Hospital] institutional board, and patient consent forms were collected.