Impact of objective airflow measurement on assessment of asthma severity and treatment appropriateness
AbstractCurrent asthma treatment is directed by severity of symptoms and lung function. In Malaysia, spirometry is not widely available and therefore not used in most medical consultations. In 163 asthmatic patients [mean (95% CI) age: 41 (38-44) yrs; 29% male; 32% Malays, 32% Chinese, 34% Indians] who were being followed up in a State Hospital medical outpatient clinic and a large urban-based health clinic, we studied the effect on Global Initiative for Asthma (GINA) disease severity classification and the appropriateness of currently prescribed treatment when forced expiratory volume in one second (FEV1) was considered together with symptom severity. We showed that 52% of the patients were upgraded to a higher severity classification and 71% of the patients were ‘under-treated’. If based on ‘symptoms alone’ to assess severity, 39% of the patients were still ‘under-treated’. We concluded that the disease severity in many asthmatic patients might have been underestimated and therefore not adequately treated, because spirometry was not available or used to assess asthma severity. The use of spirometry should be advocated more widely among clinicians treating asthma in Malaysia.
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