Asthma Control Limitations in Selected Primary Health Care Clinics

Primary health care services worldwide are currently experiencing many quality-related problems. Efforts to improve these services appear to be sporadic and unsatisfactory. Investigations have revealed (Sharma et Sharma 2007) that one of the main causes for this state of affairs can be identif ed as neglected or inadequate documentation of patient/case history. The health care provider (HCP) should be equipped to improve the quality of health care and to take the lead in assuaging the predicament. The present study was undertaken to assess the correlation between asthma control and patient-related case history notes as recorded via the HCP. The data were obtained retrospectively from the patient notes of all asthmatic patients (including children and pregnant women) who attended six selected clinics in the North West Province of South Africa (Dr Kenneth Kaunda Municipal District). The analysis of the data collected from the patient clinic books confirmed the suspicion of poor quality of documentation; although the documentation in certain categories rendered some positive results. When compared to the GINAr guidelines; none of the patients had been controlled properly and only a small number (18.4) had been controlled partly (GINA 2008). Asthma control may be enhanced when a standard template is developed for completion by the HCP. It is envisaged that this will ensure that vital information regarding asthma control is documented in order to contribute to satisfactory chronic disease control

Milestones in Asthma Management

Background: Asthma is an old and common disorder of respiratory function whose prevalence is increasing everywhere particularly in urban centres. This situation; coupled with the problem of suboptimal management has led to an increase in the morbidity of the disease and enormous economic losses through lost productivity and absenteeism from work and schools. There is therefore a need to review the evolution of the management of this disease with a view to drawing attention to currently recommended management guidelines. This should help to improve the outlook for the asthma patient and hopefully reduce the morbidity and mortality of this rampant disease.Methods: A review of the literature regarding the history of asthma and the evolution of its management was undertaken with the aid of textbooks; journal publications and the Internet via Google Pubmed. The history of asthma and the evolution of the management of asthma was surveyed with emphasis on major and spectacular developments particularly in respect of chronic asthma.Results: Asthma management started from the naming of the disorder; a description of its pathogenesis; pathology and attempts at the therapy of the disease with a variety of agents notably adrenaline; noradrenaline and cortisone. This was followed by the invention of various drug delivery systems and the discovery of salbutamol and cromoglycate. The invention of the bronchoscope led to the development of anti- inflammatory drugs like inhaled corticosteroids and leucotriene antagonists while the discovery of the synergy between salmeterol and fluticasone (an inhaled corticosteroid); made possible the development of combination therapy. Guidelines were devised to ensure the optimal management of the disease through the proper classification of the disease according to severity as well as the efficient utilization of available effective therapies.Conclusion: Although asthma management began in the pre-christian era; the most spectacular and revolutionary developments occurred during the last 55 years and include the discovery of various drug delivery systems; salbutamol; combination therapy and the development of asthma management guidelines