Search

Background: In Malaysia, asthma is common but often neglected. Achieving good asthma control and optimal asthma care is a challenge in primary care setting. Aim: To establish an asthma cohort in six public primary care clinics and assess the level of asthma control and care delivered in these clinics. Methods: Children (5-17 years old) and adults (18 years and over) with physician-diagnosed asthma or given asthma treatment in the previous year were recruited. We assessed asthma control, use of spirometry at diagnosis, peak flow monitoring, scheduled reviews, action plan ownership and asthma education as indicators of asthma care. Asthma control was assessed according to GINA global guideline 2017. Results: 1280 patients were recruited; 86% adults and 15% children. Only 37% had good asthma control, 36% were partly controlled and 27% were poorly controlled. Other findings are: 6% had spirometry testing at diagnosis, 71% had scheduled reviews and 61% had a peak flow documented during at least one of the last three visits. Although most (92%) had received some asthma education when asked, only 16% of patients had been given a written asthma action plan. Among those with poorly controlled asthma, only 82% were on an inhaled controller in the last 12 months and 67% were reviewed regularly. Conclusion: Asthma care remains suboptimal and a quality improvement programme in asthma care is needed. Funding: NIHR RESPIRE Global Health Research Unit and is written on behalf of the RESPIRE collaborators.

Background: Asthma self-management skills in Malaysia are reportedly poor despite evidence of self-management improved asthma outcomes. We aimed to explore asthma patients’ views and experiences of self-management. Methods: Adults with asthma were purposively selected from an urban primary healthcare clinic in Klang District, Malaysia. Individual in-depth interviews were conducted. Audio-recordings were transcribed verbatim and analysed thematically. Results: 24 participants within the age range of 22-69 years from diverse ethnicity, socioeconomic background and asthma duration were recruited. Influenced by the hot/cold concept of disease, asthma self-management practices involved food, rubs or apparel used to ‘warm up’ or ‘cool down’. Self-management skills were based on an interplay between personal experience, self-beliefs, family influence and health care practitioner’s advice; asthma action plans were poorly understood and modified for use. Confidence in self-management improved when perceived positive outcomes were achieved, irrespective of whether self-management strategy is appropriate or not. Participants expressed a strong desire for better support from health care practitioners on asthma self-management. Conclusion: Asthma self-management practices were learnt experientially based on personal experiences and beliefs guided by sociocultural influences and advice from health care practitioners, family and friends. There is a need for better patient-health care practitioner partnerships to develop self-management skills. Funder: NIHR RESPIRE Global Health Research Unit and is written on behalf of the RESPIRE collaboration.