Abstract
Background and objective: To evaluate the awareness/knowledge and clinical practice for the treatment of atypical asthma among respiratory specialists and primary care practitioners (PCPs) in China.Methods: A total number of 1,997 physicians participated in the survey via WeChat. The questionnaire included six main items: physician demographic characteristics, awareness, diagnosis, medical prescription, assessment/education, and proposal.Results: Cough variant asthma (CVA) was recognized by 97.51% of physicians (1,166 respiratory specialists and 799 PCPs), followed by chest tightness variant asthma (CTVA, 83.72%) and occult asthma (73.54%). Specialists were more likely to follow diagnostic recommendations than PCPs (P < 0.01); however, 34.15% of physicians reported the utility of bronchodilation tests, airway provocation tests, and peak expiratory flow monitoring. A total of 91.70% and 92.01% of physicians prescribed inhaled corticosteroids (ICS) or ICS plus long-acting beta-agonists (LABA) for CVA and CTVA, respectively. Physicians prescribed an ICS or ICS/LABA for 4 (2–8) or 8 (4–12) weeks for CVA and 4 (2–8) or 5 (4–12) weeks for CTVA, and the prescription durations were significantly shorter for PCPs than for specialists (P < 0.01). Further, 52.42% and 35.78% reported good control of CVA and CTVA, respectively, with significantly lower control rates for PCPs than for specialists (P < 0.01). Additionally, specialists exhibited better assessment and educational habits than PCPs.Conclusion: While atypical asthma was identified by most specialists and PCPs, there remains a gap between management in real clinical practice and guideline recommendations, especially for PCPs. Further training of PCPs and clinical studies of atypical asthma are required to improve practice.
Highlights
Asthma is a global health problem that affects ∼334 million people worldwide, with an expected increase to 400 million worldwide by 2025, imposing a substantial burden on the healthcare system [1, 2]
Of the physicians who indicated that they were aware of cough variant asthma (CVA), chest tightness variant asthma (CTVA) and occult asthma were reported by 97.51%, 83.72%, and 73.54% of the physicians, respectively
The proportion of specialists who were aware of CVA was higher than that of primary care practitioners (PCPs) (99.66% vs. 94.37%, P < 0.001)
Summary
Asthma is a global health problem that affects ∼334 million people worldwide, with an expected increase to 400 million worldwide by 2025, imposing a substantial burden on the healthcare system [1, 2]. In 1979, Corrao et al first reported CVA, with cough as the only or main symptom [4]; in 1992, the Zhong et al team reported occult asthma [5]; and in 2013, Shen et al reported CTVA, with chest tightness as the only or main symptom [6] These types of atypical asthma have been listed in asthma guideline in China [7, 8]. Inhaled corticosteroids (ICS) or a combination of ICS and long-acting beta-agonists (ICS/LABA) resulted in a good response in patients with these asthma types compared with those with classic asthma [11, 12] These studies have aided physicians in understanding atypical asthma, reducing the rate of misdiagnosis and improving treatment outcomes. To evaluate the awareness/knowledge and clinical practice for the treatment of atypical asthma among respiratory specialists and primary care practitioners (PCPs) in China
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