Is Clinical Judgment of Asthma Control Adequate? A prospective survey in a tertiary hospital pulmonary clinic
Journal Title: Sultan Qaboos University Medical Journal - Year 2013, Vol 13, Issue 1
Abstract
Objectives: Asthma control is often difcult to measure. Te aim of this study was to compare physicians’ personal clinical assessments of asthma control with the Global Initiative for Asthma (GINA) scoring. Methods: Physicians in the adult pulmonary clinics of a tertiary hospital in Oman frst documented their subjective judgment of asthma control on 157 consecutive patients. Immediately after that and in the same proforma, they selected the individual components from the GINA asthma control table as applicable to each patient. Results: Te same classifcation of asthma control was achieved by physicians’ clinical judgment and GINA classifcation in 106 cases (67.5%). In the other 32.5% (n = 51), the degree of control by clinical judgment was one level higher than the GINA classifcation. Te agreement was higher for the pulmonologists (72%) as compared to non-pulmonologists (47%; P = 0.009). Physicians classifed 76 patients (48.4%) as well-controlled by clinical judgment compared to 48 (30.6%) using GINA criteria (P <0.001). Conversely, they classifed 34 patients (21.7%) as uncontrolled as compared to 57 (36.3%) by GINA criteria (P <0.001). In the 28 patients who were clinically judged as well-controlled but, by GINA criteria, were only partially controlled, low peak expiratory flow rate (PEFR) (46.7%) and limitation of activity (21.4%) were the most frequent parameters for downgrading the level of control. Conclusion: Using clinical judgment, physicians overestimated the level of asthma control and underestimated the uncontrolled disease. Since management decisions are based on the perceived level of control, this could potentially lead to under-treatment and therefore sub-optimal asthma control.
Authors and Affiliations
Sawsan Baddar| Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman, Jayakrishnan B. | Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman, Omar Al-Rawas| Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman, Jojy George| Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman, Khalfan Al-Zeedy| Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
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