Study of asthma management practices among general practitioners and physicians in and around Pune city.

Abstract

Since significant number of cases of bronchial asthma are first seen by general practitioners (GPs) and physicians, the present study was undertaken to assess the asthma management practices among GPs and physicians in and around Pune city of Maharashtra. It was a prospective study in which 40 GPs and 30 physicians were personally administered a questionnaire dealing with use of diagnostic methods and management plan in chronic asthma. Spirometry was used for diagnosis by 16 physicians (53.3%) and 7 GPs (17.5%) and peak flow meter by 1 GP (2.5%) and 5 physicians (16.6%). Nine GPs (22.5%) and 12 physicians (40%) preferred inhalation therapy solely. Twenty-six GPs (65%) and 20 physicians (66.6%) preferred combination of inhalation and oral therapy. Thirty-two GPs (80%) and 11 physicians (36.6%) were using inhaled short acting beta2-agonists on regular basis. Thirty-seven GPs (92.5%) and 25 physicians (83.3%) were prescribing inhaled and oral bronchodilators together. Twenty-nine physicians (96.6%) and 12 GPs (30%) were prescribing inhaled corticosteroids on regular basis. Twenty-two GPs (55%) and 12 physicians (40%) were prescribing inhaled and oral steroids concurrently. Twenty-two GPs (55%) were prescribing inhaled and oral steroids as on required basis. Thirty-two GPs (80%) and 20 physicians (66.6%) did not explain the importance of inhaled steroids to their patients. Single dose dry powder inhaler was prescribed by 24 GPs (60%) and 27 physicians (90%), metered dose inhaler was prescribed by 9 GPs (22.5%) and 12 physicians (40%). Spacer was prescribed by 4 GPs (10%) and 6 physicians (20%). Inhalation technique for metered dose inhaler was incorrect in 22 GPs (61.2%) and 6 physicians (20%) and for single dose dry powder inhaler it was incorrect in 15 GPs (35%) and 2 physicians (6.6%). None of the GPs and only 5 physicians (16.6%) were monitoring their patients as per GINA guidelines. Four GPs (10%) and 7 physicians (23.3%) delivered asthma education in the form of only verbal communication. Overall management skills of physicians were better than GPs. However, they need to be educated about more frequent use of spirometry or peak flow meter in confirmation of diagnosis, increasing use of inhalation therapy, emphasising the role of inhaled steroids to patients and providing optimal asthma education to all patients. There is an urgent need to educate GPs in almost all aspects of asthma management.