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

AimDelivering 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.MethodsAll children (5-17 years old), and adults (≥18 years old) with physician-diagnosed asthma or who had been given asthma treatment in the previous year were recruited between June 2019-January 2020. Data were collected from patients (face-to-face questionnaires) and extracted from their clinical records. Results1,280 patients were recruited (14.7% children). The majority (76%) of patients fell into the low household income group (<USD1196). Only 6.6% of adults and 4.3% of children had spirometry done at diagnosis. Based on GINA 2017 criteria, only 34.1% adults had ‘good’ asthma control, 36.5% and 29.4% had ‘partly’ and ‘uncontrolled’ asthma respectively. In children, 54.3% had good control, 31.9% partly controlled and 13.8% had uncontrolled asthma. 81.2% of adults and 66.5% of children reported using inhaled controller medication in the last 12-months. Only a third of adults (70.7%) and children (69.7%) had scheduled follow-up visits. About half of adults (54.7%) and children (53.7%) had a peak flow rate documented during at least one of the last three visits. More than 90% (adults and children) had received some form of asthma education, though the topics covered varied; the importance of an asthma diary and provision of an asthma action plan were least emphasised. Only 13.7% of adults reported being given an asthma action plan and 39% had an asthma diary; in children these proportions were 27.7% and 50% respectively. ConclusionAlthough 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. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest This research was commissioned by the UK National Institute for Health Research (NIHR) Global Health Research Unit on Respiratory Health (RESPIRE), using UK Aid from the UK Government to support global health research. References and Clinical Trial Registry Information