Primary care management of asthma –findings from the Klang Asthma Cohort Study in Malaysia

Abstract

<b>Aim:</b> Delivering optimal asthma care is a challenge in primary care setting. This study aimed to examine current asthma care provided to patients attending six public primary care clinics in the Klang District, Malaysia. <b>Methods:</b> All children (5-17years old), and adults (≥18years old) with physician-diagnosed asthma or who had been given asthma treatment in the previous year were recruited between June2019-January2020. <b>Results:</b> 1, 280 patients were recruited (15% children). The majority (76%) fell into the low household income group (&lt;USD1196). Only 7% of adults and 4% of children had spirometry done at diagnosis. Based on GINA 2017 criteria, 34% adults had good asthma control, 37% and 29% had partly and uncontrolled asthma. In children, 54% had good control, 32% partly controlled and 14% had uncontrolled asthma. 81% of adults and 67% of children reported using inhaled controller in the last 12-months. Only a third of adults (71%) and children (70%) had scheduled follow-up visits. More than 90% (adults and children) had received some form of asthma education, however asthma diary and provision of an asthma action plan (AAP) were least emphasised. Only 14% of adults reported being given AAP and 39% had an asthma diary; in children these proportions were 28% and 50% respectively. <b>Conclusion:</b> Although many patients having used controller medication in 12-months’, most do not have good control suggesting failure to step-up treatment and/or poor adherence. Supported self-management for asthma remains under-utilised. Interventions need to target practices, healthcare professionals and patients to improve asthma management.