Implementation of GINA guidelines in asthma management by primary care physicians in Vietnam

Figures & data

Table 1 Framework of evaluation of knowledge and treatment strategy based on the GINA 2015 guidelines

	Questions related to:
	Assessment of level of control	Initial treatment	Adjusted treatment
Case 1: adult with partly controlled asthma	×	×	×
Case 2: adult with uncontrolled asthma	×	×	×
Case 3: adult with controlled asthma	×		×
Case 4: children with uncontrolled asthma	×	×
Case 5: pregnant woman with partly controlled asthma	×		×

Abbreviation: GINA, Global Initiative for Asthma.

Table 2 Characteristics of the study participants (n=201)

Characteristic	n (%)
Province
Ho Chi Minh City	58 (29)
Tien Giang	143 (71)
Specialty
General practitioners/internists	164 (82)
Family physicians	37 (18)
Gender
Male	86 (46)
Female	102 (54)
Age group (years)
24–40	37 (18.4)
41–50	78 (38.8)
>50	86 (42.8)
Years of practice
1–10	87 (43)
11–20	53 (26)
>20	57 (28)
Unknown	4 (2)

Table 3 Use of spirometry and ACT and frequency of consultations and prescribing medication in asthma care

	n (%)
Use of spirometry in practice
Yes	100 (49.8)
No	83 (41.3)
No answer	18 (9)
Use of asthma control test in practice
Yes	49 (24.4)
No	115 (57.2)
No answer	37 (18.4)
Frequency of seeing asthma patients
Daily	17 (8.5)
Weekly	65 (32.3)
Monthly	47 (23.4)
Few times per year	62 (30.8)
Unanswered	10 (5.0)
Frequency of prescribing asthma medications
Daily	15 (7.5)
Weekly	58 (28.9)
Monthly	49 (24.4)
Few times per year	59 (29.4
Unanswered	20 (10)

Abbreviation: ACT, asthma control test.

Table 4 Asthma medications prescribed to patients in practice

Asthma medication	Not prescribed	A few patients	Some patients	Most patients	All patients	Unanswered
Oral medications
Oral SABA	25 (12.4)	43 (21.4)	48 (23.9)	45 (22.4)	7 (3.5)	33 (16.4)
Oral steroid	9 (4.5)	47 (23.4)	68 (33.8)	46 (22.9)	6 (3)	25 (12.4)
Oral theophylline	50 (24.9)	48 (23.9)	48 (23.9)	23 (11.4)	0 (0)	32 (15.9)
Antileukotriene	52 (25.9)	32 (15.9)	45 (22.4)	20 (10)	4 (2.0)	48 (23.9)
Mucolytic	12 (6)	44 (21.9)	53 (26.4)	49 (24.9)	14 (7)	29 (14.4)
Inhaler medications
ICS	17 (8.5)	35 (17.4)	52 (25.9)	59 (29.4)	16 (8)	22 (10.9)
Inhaled SABA	18 (9)	27 (13.4)	66 (32.8)	58 (28.9)	11 (5.5)	21 (10.4)
Inhaled ICS + LABA	31 (15.4)	34 (16.9)	56 (27.9)	34 (16.9)	14 (7)	32 (15.9)
Inhaled anticholinergic	47 (23.4)	35 (17.4)	50 (24.9)	17 (8.5)	10 (5)	42 (20.9)
Oral or inhaler medications
LABA (inhaler or oral)	28 (13.9)	31 (15.4)	63 (31.3)	36 (17.9)	10 (5)	33 (16.4)

Note: Data presented as n (%).

Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting beta agonist; SABA, short-acting beta agonist.

Table 5 Results of assessment of asthma control based on the five case scenarios

Case scenario	Correct, n (%)	Incorrect, n (%)	No answer/unknown, n (%)
Case 1: adult, partly controlled asthma	43 (21)	119 (59)	39 (19)
Case 2: adult, uncontrolled asthma	77 (38)	91 (45)	33 (16)
Case 3: adult, controlled asthma	84 (42)	83 (41)	34 (17)
Case 4: children, uncontrolled asthma	83 (41)	71 (35)	47 (23)
Case 5: pregnant woman, partly controlled asthma	40 (20)	123 (61)	38 (19)

Table 6 Choice of initial and adjusted treatment of participants based on five case scenarios

Treatment	Correct, n (%)	Incorrect, n (%)	No answer/unknown, n (%)
Initial treatment
Case 1: question 1B: start treatment for adult with partly controlled asthma	45 (22.4)	156 (77.6)	0 (0)
Case 2: question 2B: start treatment for adult with uncontrolled asthma	102 (50.7)	98 (48.8)	1 (0.5)
Case 4: question 4B: start treatment for children with uncontrolled asthma	106 (52.7)	90 (44.8)	5 (2.5)
Adjusted treatment
Case 1: question 1C: adjust treatment for adult with partly controlled asthma on low-dose ICS	58 (28.9)	137 (68.2)	6 (3)
Case 2: question 2C: adjust treatment for adult with uncontrolled asthma on l ow-dose ICS	97 (48.3)	96 (47.)	8 (4)
Case 2: question 2D: adjust treatment for adult with uncontrolled asthma on a combination ICS/LABA	43 (21.4)	154 (76.6)	4 (2)
Case 3: question 3B: adjust treatment for adult with controlled asthma on low-dose ICS	47 (23.4)	152 (75.6)	2 (1)
Case 3: question 3C: adjust treatment for adult with controlled asthma on combination ICS/LABA	52 (25.9)	141 (70.1)	8 (4)
Case 5: question 5B: adjust treatment for pregnant woman with partly controlled asthma on low-dose ICS	24 (11.9)	173 (86)	6 (3)

Abbreviations:; ICS, inhaled corticosteroid; LABA, long-acting beta agonist.

Figure 1 Distribution of correct answers in asthma control and asthma treatment and the combined total score.

Notes: (A) Distribution of correct answers to the five questions on classification of asthma control; (B) distribution of correct answers to the nine asthma treatment questions; and (C) distribution of correct answers to all 14 questions related to the five case scenarios.

Table 7 Difference in mean score between age groups, years of experience, province, and specialty regarding asthma control and asthma treatment

Parameters	Age groups (years)				Years of experience				Province			Specialty
	24–40, n=37	41–50, n=78	>50, n=86	P	1–10, n=77	11–20, n=46	>20, n=54	P	HCMC, n=58	TG, n=143	P	GPs/INs, n=164	FPs, n=37	P
Mean score (SD) of five asthma control questions	1.8 (1.5)	1.6 (1.2)	1.6 (1.2)	0.67	1.8 (1.3)	1.7 (1.4)	1.7 (1.2)	0.74	1.8 (1.5)	1.5 (1.2)	0.2	1.6 (1.2)	1.5 (1.4)	0.65
Mean score (SD) of three initial treatment questions	0.5 (0.7)	0.9 (0.9)	1.4 (0.8)	0.03	0.9 (0.9)	0.9 (0.7)	0.9 (0.9)	0.99	0.5 (0.6)	1.0 (0.9)	0.00	0.9 (0.9)	0.5 (0.6)	0.01
Mean score (SD) of six adjusted treatment questions	1.2 (1.5)	2.1 (1.3)	2.3 (1.4)	0.00	1.8 (1.5)	2.3 (1.2)	2.1 (1.4)	0.24	1.1 (1.2)	2.4 (1.3)	0.00	2.1 (1.4)	1.3 (1.3)	0.00
Mean score (SD) of all nine treatment questions	1.7 (1.8)	2.9 (1.8)	3.3 (1.9)	0.00	2.7 (2.1)	3.1 (1.8)	3.0 (1.9)	0.47	1.6 (1.5)	3.4 (1.8)	0.00	3.1 (1.9)	1.86 (1.5)	0.00
Mean score (SD) of all 14 asthma questions	3.5 (2.0)	4.5 (2.5)	4.8 (2.3)	0.02	4.6 (2.5)	4.8 (2.3)	4.8 (2.1)	0.81	3.4 (2.0)	4.9 (2.3)	0.00	4.7 (2.4)	3.4 (1.9)	0.00

Note: Bold represents statistically significant values (P<0.05).

Abbreviations: FPs, family physicians; GPs, general practitioners; HCMC, Ho Chi Minh City; INs, internists; SD, standard deviation; TG, Tien Giang.