Impact of objective airflow measurement on assessment of asthma severity and treatment appropriateness

  • Li Cher Loh
  • Choo Nea Khoo
Keywords: Asthma severity, spirometry, symptoms, Malaysia, under-treatment


Current 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.


National Institutes of Health: Global Initiative for Asthma: Pocket Guide for Asthma Management and Prevention. Report no. 95-3659B. Bethesda: National Institutes of Health, National Heart, Lung, and Blood Institute; 1998.

Stahl E. Correlation between objective measures of airway calibre and clinical symptoms in asthma: a systematic review of clinical studies. Respir Med. 2000 Aug;94(8):735-41.

Magadle R, Berar-Yanay N, Weiner P. The risk of hospitalization and near-fatal and fatal asthma in relation to the perception of dyspnea. Chest. 2002 Feb;121(2):329-33.

Clinical practice guidelines for management of adult asthma. Malaysian Thoracic Society, Academy of Medicine of Malaysia, Ministry of Health Malaysia, 2nd ed. 2002.

Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function testing. Eur Respir J. 2005 Jul;26(1):153-61.

Dekker FW, Schrier AC, Sterk PJ, et al. Validity of peak expiratory flow measurement in assessing reversibility of airflow obstruction. Thorax. 1992 Mar;47(3):162-66.

Liard R, Leynaert B, Zureik M, et al. Using Global Initiative for Asthma guidelines to assess asthma severity in populations. Eur Respir J. 2000 Oct;16(4):615-20.

Lai CK, De Guia TS, Kim YY, et al. Asthma control in the Asia-Pacific region: the Asthma Insights and Reality in AsiaPacific Study. J Allergy Clin Immunol. 2003 Feb;111(2):263-8.

Rabe KF, Vermeire PA, Soriano JB, et al. Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study. Eur Respir J. 2000 Nov;16(5):802-7.

Adachi M, Morikawa A, Ishihara K. [Asthma insights & reality in Japan (AIRJ)]. Arerugi. 2002 May;51(5):411-20.

Connolly CK, Alcock SM, Prescott RJ. Management and control of asthma as assessed by actual/best function and corticosteroid use 1980-1993/4. Eur Respir J. 1998 Oct;12(4):859-64.

Reddel HK, Jenkins CR, Marks GB, et al. Optimal asthma control, starting with high doses of inhaled budesonide. Eur Respir J. 2000 Aug;16(2):226-35.

How to Cite
LohL. C., & KhooC. N. (2012). Impact of objective airflow measurement on assessment of asthma severity and treatment appropriateness. Malaysian Family Physician, 13(3), 5. Retrieved from
Original Articles