asthma clinics in primary healthcare centres in oman do they make a difference?

Objectives: This study aimed to determine the effect of newly established asthma clinics [ACs] on asthma management at primary healthcare centres [PHCs] in Oman

Methods: This retrospective crosssectional study was conducted between June 2011 and May 2012 in seven PHCs in the Seeb wilayat of Muscat, Oman. All >/=6-year-old asthmatic patients visiting these PHCs during the study period were included. Electronic medical records were reviewed to determine which clinical assessment and management components had been documented

Results: A total of 452 asthmatic patients were included in the study. The mean age was 35 +/- 21 years old [range: 6.95 years] and the majority [57%] were female. In total, 288 [64%] cases were managed at ACs and 164 [36%] were managed at general clinics [GCs]. Significant differences were noted in the documentation of cases managed at ACs compared to those at GCs, including history-taking information regarding signs and symptoms [91% versus 19%; P <0.001], trigger factors [79% versus 16%; P <0.001] and a history of atopy [81% versus 17%; P <0.001], smoking [61% versus 7%; P <0.001], asthma exacerbations [73% versus 10%; P <0.001] or previous admissions [63% versus 10%; P <0.001]. Furthermore, prescription rates of inhaled corticosteroids [72% versus 61%; P = 0.021] and short-acting Beta-agonists [93% versus 82%; P = 0.001] were significantly higher at ACs compared to GCs

Conclusion: Overall, the findings indicated that ACs have had a positive impact on asthma management at the studied PHCs

Is clinical judgment of asthma control adequate? A prospective survey in a tertiary hospital pulmonary clinic

Asthma control is often difficult to measure. The aim of this study was to compare physicians' personal clinical assessments of asthma control with the Global Initiative for Asthma [GINA] scoring. Physicians in the adult pulmonary clinics of a tertiary hospital in Oman first documented their subjective judgment of asthma control on 157 consecutive patients. Immediately after that and in the same proforma, they selected the individual components from the GINA asthma control table as applicable to each patient. The same classification of asthma control was achieved by physicians' clinical judgment and GINA classification in 106 cases [67.5%]. In the other 32.5% [n = 51], the degree of control by clinical judgment was one level higher than the GINA classification. The agreement was higher for the pulmonologists [72%] as compared to non-pulmonologists [47%; P = 0.009]. Physicians classified 76 patients [48.4%] as well-controlled by clinical judgment compared to 48 [30.6%] using GINA criteria [P <0.001]. Conversely, they classified 34 patients [21.7%] as uncontrolled as compared to 57 [36.3%] by GINA criteria [P <0.001]. In the 28 patients who were clinically judged as well-controlled but, by GINA criteria, were only partially controlled, low peak expiratory flow rate [PEFR] [46.7%] and limitation of activity [21.4%] were the most frequent parameters for downgrading the level of control. Using clinical judgment, physicians overestimated the level of asthma control and underestimated the uncontrolled disease. Since management decisions are based on the perceived level of control, this could potentially lead to under-treatment and therefore sub-optimal asthma control

Extent of subclinical pulmonary involvement in childhood onset systemic lupus erythematosus in the Sultanate of Oman

The aim of this study was to investigate the frequency of pulmonary function abnormalities in clinically asymptomatic children with Systemic Lupus Erythematosus and to determine the relationship of these abnormalities to clinical, laboratory, and immunological parameters as well as to disease activity. Forty-two children with childhood onset Systemic Lupus Erythematosus were included in this study Demographic, clinical, laboratory and immunological parameters, as well as disease activity were assessed. Pulmonary function tests [PFT] were performed routinely to screen for subclinical lung disease. Out of the 42 children, 19% [n=8] had clinical evidence of pulmonary involvement The patients with no clinical evidence of pulmonary involvement [n=34] represent the study cohort From our cohort of patients with no clinical evidence of pulmonary involvement 79% [n=27] had PFT abnormality; including 62% [n=21] had reduced FVC, 71% [n=24] had reduced FEV1, and 67% [n=12] had reduced DLCO Similarly, 56% [n=15] had a restrictive PFT pattern, and 2.6% [n=2] had an obstructive PFT pattern, while 33% [n=7] had an isolated impairment of diffusion capacity. Due to small sample size; it was not possible to find a statistically significant difference between the cohort of asymptomatic SLE patients with abnormal PFT findings [n=27] and those with normal PFT findings [n=7] in terms of clinical, laboratory, immunological or disease activity index score Subclinical lung disease, as demonstrated by abnormal PFT in patients with normal radiographs, may be common but should be interpreted with caution as an early sign of lung disease. Although PFT studies do not correlate well with pulmonary symptoms in patients with childhood onset SLE, they nevertheless provide objective quantification of the type and severity of the functional lesions