Abstract
Asthma control is often difficult to measure. The aim of this study was to compare physicians' personal clinical assessments of asthma control with the Global Initiative for Asthma (GINA) scoring. Physicians in the adult pulmonary clinics of a tertiary hospital in Oman first documented their subjective judgment of asthma control on 157 consecutive patients. Immediately after that and in the same proforma, they selected the individual components from the GINA asthma control table as applicable to each patient. The same classification of asthma control was achieved by physicians' clinical judgment and GINA classification in 106 cases (67.5%). In the other 32.5% (n = 51), the degree of control by clinical judgment was one level higher than the GINA classification. The agreement was higher for the pulmonologists (72%) as compared to non-pulmonologists (47%; P = 0.009). Physicians classified 76 patients (48.4%) as well-controlled by clinical judgment compared to 48 (30.6%) using GINA criteria (P <0.001). Conversely, they classified 34 patients (21.7%) as uncontrolled as compared to 57 (36.3%) by GINA criteria (P <0.001). In the 28 patients who were clinically judged as well-controlled but, by GINA criteria, were only partially controlled, low peak expiratory flow rate (PEFR) (46.7%) and limitation of activity (21.4%) were the most frequent parameters for downgrading the level of control. Using clinical judgment, physicians overestimated the level of asthma control and underestimated the uncontrolled disease. Since management decisions are based on the perceived level of control, this could potentially lead to under-treatment and therefore sub-optimal asthma control.
Highlights
Asthma control is often difficult to measure
Advances in knowledge - Subjective clinical judgment alone is likely to overestimate the degree of asthma control when compared to a guideline-based classification. - Overestimation of control often leads to under-treatment and the patients remain symptomatic. - This study highlights the need to adhere to the standard asthma management guidelines
This study showed that “usual” clinical judgment alone overestimates the degree of asthma control when compared to guideline-based classifications
Summary
Abstract: Objectives: Asthma control is often difficult to measure. The aim of this study was to compare physicians’ personal clinical assessments of asthma control with the Global Initiative for Asthma (GINA) scoring. Complete asthma control is possible in the majority of patients using the available therapies, worldwide studies have repeatedly shown that complete control is only achieved in a small number of patients.[1,2,3,4,5] This has been attributed to many factors related to both health care providers and patients.[4,6,7,8] Factors linked to health care providers include poor follow-up and instructions, incomplete and often subjective assessment, poor knowledge of inhaler technique, and underestimation of disease severity leading to inadequate treatment For their part, patients do not often comply well with the treatment, have an inadequate inhaler technique, or perceive the level of their asthma control inaccurately. The lack of standardised definitions for asthma control, and the discrepancy in assessments between the patients and their physicians are important contributory factors to the reported poor asthma control.[9]
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