Monitoring and treatment practices of childhood asthma in Singapore: a questionnaire study

Area of Science:

• Pediatric Pulmonology
• General Practice Research
• Healthcare Management

Background:

• Asthma is Singapore's most prevalent childhood chronic disease, affecting over 20% of children by age 15.
• Primary care physicians manage most pediatric asthma cases, necessitating an evaluation of their practices against established guidelines.
• Key areas for investigation include asthma control monitoring, acute exacerbation management, and maintenance therapy selection.

Purpose of the Study:

• To assess current asthma control monitoring methods used by Singaporean doctors.
• To evaluate the practices for managing acute asthma exacerbations in children.
• To examine the selection of maintenance therapies for pediatric asthma.

Main Methods:

• A survey of 2,100 questionnaires was distributed to general practitioners and pediatric specialists across Singapore.
• 173 valid responses were analyzed and compared against the 2006 Global Initiative for Asthma guidelines.
• The study focused on monitoring techniques, acute care, and maintenance treatment choices.

Main Results:

• Most respondents (76.3%) were general practitioners; 89.1% did not use symptom score cards/diaries, and 37.6% lacked peak-flow meters/spirometers.
• While 83.8% used short-acting beta-agonists for exacerbations, only 41.0% prescribed oral corticosteroids for outpatients.
• Long-acting beta-agonists (LABA) were frequently used in maintenance therapy, sometimes as monotherapy (5.8-8.7%), and immunotherapy was rarely employed (91.3%).

Conclusions:

• Enhanced utilization of asthma diaries and objective measurements like peak flow/spirometry is recommended.
• Acute exacerbation management is generally appropriate, but oral corticosteroid under-prescription was noted.
• Maintenance therapy with LABA is prevalent despite safety concerns in infants and guidelines recommending selective use.