Problems And Strategies In Asthma Management

ObjectivesTo investigate the problems in asthma management and the compliance of guideline-based therapy, to evaluate the effect of hospital initiative management on asthma control and pulmonary function, and to explore the correlation of clinical characteristic between allergic rhinitis and bronchial asthma and the strategies for asthma patients with rhinitis.MethodsPART1: 320 asthma patients were given questionnaires which include the education background, income, insurance status, as well as the previous treatment and the reason of non-compliance. After the healthy education, the patients were divided into two groups according to the initial management, the guideline-based group and the non-guideline-based group, with treatment only in asthma attack. One year later, all patients in guideline-based group were divided into two groups, compliance group and non compliance group according to compliance. The education, income and insurance condition were compared between guideline-based group and the non-guideline-based group. The asthma control and pulmonary function were compared between compliance group and non compliance group.PART2: 40 moderate asthma patients enrolled successively were divided into 2 groups, hospital initiative management group (A) and patient self management group (B), and received the asthma treatment with hospital initiative management or patient self management for 1 year. The compliance, control condition, pulmonary function and Saint George respiratory score were compared between two groups.PART3: The questionnaire survey of 140 bronchial asthma patients from the city of Qingdao was conducted. Their age, severity, diagnosis and treatment status of allergic rhinitis were investigated in details. All patients with asthma were randomized into three groups, A group just received asthma treatment, in which patients were without allergic rhinitis .B group also just received asthma treatment, in which patients were accompanied with allergic rhinitis. C group was added the allergic rhinitis treatment in period of treating bronchial asthma, in which patients were accompanied with allergic rhinitis.ResultsPART1: 216 patients havenot insist on the ICS therapy, the main reasons for low compliance of ics were fear about the adverse effect and bad impression of ics. In comparing with non-guideline-based group and non-compliance group, the education and income condition were superior in the guideline-based group and compliance group, but the insurance condition was similar between compliance group and non-compliance group(P>0.01). The PEF and acute attack were impoved after treatments with significant differences between compliance group and non compliance group (P<0.05).PART2: After one year management, there were 19 patients in proceeding of the standard treatment, 13 total control, 6 partial control and 1 uncontrolled in Group A, while there were 11 patients in proceeding of the standard treatment, 6 total control, 8 partial control and 6 uncontrolled in Group B. To compare with Group B, The satisfaction degree(9.3±0.801), FEV1((2.56±0.30)L) and PEF ((6.26±0.39)L/s) were elevated while SGRQ (21.55±6.35)was decreased in Group A (P<0.01).PART3: There were 98 patients with allergic rhinitis accompanying with bronchial asthma, After treatment, PEF in the patients of C group ((520.38±116.04)L/min)was significantly higher than that in B group((430.47±100.48)L/min) (P<0.05, C vs B),but didn't show significantly difference compared that in A group((540.14±122.04)L/min) (P>0.05).ConclusionsInadequate knowledge of asthma is main obstacle in maintaining good compliance to therapy in asthma patients. The therapy strategies were influenced by education, income and insurance condition. The asthma control and pulmonary function were improved by guideline-based treatment. The asthma control and pulmonary function can be improved by hospital initiative management, so it is helpful to promote this management model in China via a close cooperation between general hospital and community hospital.The morbidity of bronchial asthma combining with allergic rhinitis is high. It was very important to add the allergic rhinitis treatment in period of treating bronchial asthma.