Implementation of asthma guideline in Taiwan--the management in medical centers

The asthma guideline was published in Taiwan in 1995. In order to understand the implementation of the guidelines and patients' attitudes to inhaled corticosteroid (ICS), in 1999, we conducted two studies: one by reviewing medical records of 230 stable asthmatic patients cared for by 23 pulmonologists in four medical centers and another through aface-to-face questionnaire survey for 246 asthmatic patients at the outpatient clinics. The results revealed that oral bronchodilators were prescribed to 85.7% (197/230) of the patients, while inhaled beta2 agonists were prescribed to 66.1% (152/230) of the patients. Inhaled corticosteroids and oral corticosteroids were prescribed to 120 (52.2%) and 64 (27.8%) patients, respectively. Twenty-three (10%) patients were treated with oral corticosteroids without prescription of ICS. Only 25 (10.9%) patients had records of peak expiratory flow (PEF) every month. Thirty-eight (16.5%) patients sometimes measured PEF. The remaining 167 (72.6%) patients never measured PEF. The face-to-face questionnaire survey revealed that 56.5% (139/246) of the patients worried about adverse reactions of corticosteroids. Among them 40 (16.3%) patients were very worried about it. Only 101 of 189 (53.4%) patients currently using ICS took the daily doses according to doctor's orders. Seventy-four (39.2%) patients decreased the dose and 14 (7.4%) patients actually did not take ICS. In the 57 patients not treated with ICS, 13 (22.8%) patients answered that they would refuse to take ICS. In conclusion, the adherence to asthma guidelines is suboptimal for pulmonologists in the medical center. Poor adherence to asthma guidelines may be due to doctors' behavior and patients' attitudes.