Thai pediatricians' current practice toward childhood asthma

ABSTRACT

Background: Childhood asthma is a substantial health burden in Thailand. Due to a lack of pediatric respiratory specialists (pediatric pulmonologists and allergists; RS), most Thai children are cared for by general pediatricians (pediatric primary care providers (PCP)). Objectives: We investigated whether current practices of Thai pediatricians complied with asthma guidelines and compared practices (diagnosis and treatments) provided by PCP and RS. Methods: A cross-sectional study was conducted using electronic surveys including four case scenarios of different asthma phenotypes distributed to Thai pediatricians. Asthma diagnosis and management were evaluated for compliance with standard guidelines. The practices of PCP and RS were compared. Results: From 800 surveys distributed, there were 405 respondents (51%). Most respondents (81%) were PCP, who preferred to use clinical diagnosis rather than laboratory investigations to diagnose asthma. For acute asthmatic attacks, 58% of the pediatricians prescribed a systemic corticosteroid. For uncontrolled asthma, 89% of the pediatricians prescribed at least one controller. For exercise-induced bronchospasm, 55% of the pediatricians chose an inhaled bronchodilator, while 38% chose a leukotriene receptor antagonist (LTRA). For virus-induced wheeze, 40% of the respondents chose an LTRA, while 15% chose inhaled corticosteroids (ICS). PCP prescribed more oral bronchodilators (31% vs. 18%, p = 0.02), antibiotics (20% vs. 6%, p < 0.001), and antihistamines (13% vs. 0%, p = 0.02) than RS for the management of an acute asthmatic attack. Conclusions: Most of the Thai pediatricians' practices toward diagnosis and treatment of acute asthmatic attack and uncontrolled asthma conform to the guidelines. PCP prescribed more oral bronchodilators, antibiotics, and antihistamines than RS.

Keywords:

• Childhood asthma
• asthma guidelines
• asthma practice
• general pediatricians
• pediatric respiratory specialists

Declaration of interest

This study was partly supported by a research grant from the Investigator Initiated Studies Program of Merck, Sharp & Dohme Corp. Opinions expressed in this paper are the authors' opinions, and do not necessarily represent those of Merck, Sharp & Dohme Corp.

The authors (Assistant Professor Harutai Kamalaporn, Dr. Pongpan Chawalitdamrong, and Professor Aroonwan Preutthipan) have no conflicts of interest.

Acknowledgements

The authors gratefully acknowledge Prof. Teerachai Chantarojsiri, Mahidol University and Prof. Allan Coates, University of Toronto for their supervisions and editing assistance.