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

Tan C, Wong B, Goh DY, Van Bever HP
Correspondence: Prof HugoVan Bever, paevbhps@nus.edu.sg

ABSTRACT
Introduction Asthma is the most common chronic disease in children in Singapore. More than 20 percent of children will have been diagnosed with asthma by the age of 15 years. Most children are seen in the primary care setting, thus it is of value to study the management practices, especially of general practitioners, with comparison to gold standards. The aims of the study were to investigate: (a) Methods of monitoring asthma control; (b) Practices in managing acute exacerbations; and (c) Choice of therapy in maintenance treatment.
Methods 2,100 questionnaires consisting of 35 questions were sent by post to general practitioners and various paediatric doctors throughout Singapore. 173 valid responses were received and results were compared to the 2006 Global Initiative for Asthma guidelines.
Results 76.3 percent of respondents were general practitioners. 89.1 percent did not use symptom score cards/diaries. 37.6 percent did not use peak-flow meters/spirometers. 83.8 percent used a short-acting beta-agonist in acute exacerbations, but only 41.0 percent used oral corticosteroids in outpatients. A significant number used long-acting beta-agonists (LABA) in combination with inhaled steroids (29.5–41.6 percent) or as monotherapy (5.8–8.7 percent) for maintenance treatment. 91.3 percent never used immunotherapy in practice.
Conclusion Greater usage of diaries/score cards can be encouraged along with objective peak flow/spirometry measurements. Management of acute exacerbations is appropriate but corticosteroids are under-prescribed by most doctors. LABA continues to be prescribed for maintenance despite a lack of established safety profile for infants, along with recommendations that they only be used selectively in patients poorly-controlled by medium-dosage inhaled corticosteroids.

Keywords: asthma, childhood asthma, corticosteroids, inhaled corticosteroids, long-acting beta-agonists
Singapore Med J 2009; 50(1): 54-61