Implementation of asthma guidelines in health centres of several developing countries

Nine selected out-patient clinics caring for asthma patients in Algeria, Guinea, Ivory Coast, Kenya, Mali, Morocco, Syria, Turkey and Vietnam.

Prospective enrolment of consecutive patients considered by the practitioner to have asthma with evaluation of adherence of the practitioner with recommended standard case management, including proportion of patients confirmed to have asthma, proportion in whom severity was correctly graded and proportion in whom treatment with inhaled corticosteroids corresponded to severity grade.

Of 499 consecutive patients, 456 (91%) were enrolled and evaluated. The diagnosis was confirmed in 263 (58%). Agreement between the practitioner and the guidelines in assigning grade of severity was moderate overall (kappa = 0.42). It was higher for assignment of grade using symptoms (K = 0.51), but poor for assignment of grade using peak expiratory flow (PEF) rate (kappa = 0.29), with practitioners tending to underestimate the severity. Agreement between the practitioners' assessment of severity and treatment with inhaled corticosteroids was poor (kappa = 0.18), with underutilisation of inhaled corticosteroids.

Practitioners caring for asthma patients in this study tended to underutilise the PEF rate in assessing their patients and underutilised treatment of patients with inhaled corticosteroids.