ABSTRACT
BACKGROUND: Previous Thai surveys of asthma care have shown suboptimal management and poor control. Since then several editions of the Thailand National Asthma Guidelines have been distributed to help improve asthma control. A new survey was undertaken to see if any improvement in care had occurred. It examined patients' insights, attitudes and perceptions about their asthma and its treatment. METHODS: Asthma patients (>12 years) were randomly selected and participated in face-to-face interviews. Patients answered 53 questions exploring general health, diagnosis, symptoms, exacerbations, patient burden, disease management, treatment and attitudes. The Global Initiative for Asthma guidelines were used to assess asthma control. RESULTS: Data were obtained from 400 asthma patients from 8,177 screened households. This showed that 36% had had exacerbations in the previous year, 17% had been hospitalized and 35% had had an unscheduled emergency visit to hospital or a doctor's office or clinic. Work or school was missed by 44% due to asthma while a similar number had had an asthma episode that made them feel their life was in danger. Only 8% had good asthma control. Patients had low expectations with respect to asthma treatment and their understanding of how to use therapies was poor. Forty-four percent of participants reported day-time symptoms and about one-third (34%) of adults and adolescents in the survey reported night-time symptoms at least once a week in the previous 4 weeks. Asthma patients in Thailand rated their average productivity when asthma was at its worst at 48%, on a scale of 0 to 100%, which equates to a 36% decline in productivity. Rescue medication during the previous four weeks had been used by 44% of asthma patients while 54% had used a controller medication. Pill controller medication is the most used form among those reporting controller medication use (67%), whereas 57% reported taking an inhaler. Oral steroids had been used in the previous 12 months by 40% of patients with the average number for 3 day or longer at 24 times, while the median was about 4 times. CONCLUSIONS: Asthma had a profound impact on patients' wellbeing, despite the availability of effective treatments and evidence-based management guidelines. A large proportion of asthma patients overestimate their asthma control and have inappropriate concepts about asthma treatment. Gaining better insight into patient's attitudes about self-care is critical to improve asthma management.
Subject(s)
Anti-Asthmatic Agents/therapeutic use , Asthma/drug therapy , Health Knowledge, Attitudes, Practice , Quality of Life/psychology , Self Care/psychology , Adolescent , Adult , Asthma/physiopathology , Asthma/psychology , Child , Disease Management , Female , Health Surveys , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Nebulizers and Vaporizers/statistics & numerical data , Practice Guidelines as Topic , Thailand , Treatment OutcomeABSTRACT
OBJECTIVE: The present study assessed the validity and reliability of the Thai Mini AQLQ in the Easy Asthma Clinic, Srinagarind Hospital. MATERIAL AND METHOD: The present study used a cross sectional design, using an interview method by two trained-interviewers. The Thai Mini AQLQ consists of 15 items categorized into Symptoms, Activities, Emotions, Environment and Overall Scores. Scores range from 0 to 7 with higher scores meaning better quality of life. Cronbach's alpha was used to test for internal consistency reliability. Known group validation regarding asthma control was analyzed by the t-test and multiple regression, adjusting for age, gender and education. RESULTS: Of 168 patients recruited, 113 were controlled and, of these 55 were uncontrolled asthma patients, with an average age 53 +/- 13 years. Patients with controlled asthma reported significantly better scores in all domains compared with uncontrolled asthma: symptoms 6.6 +/- 0.54 vs. 4.7 +/- 1.14, p < 0.001; Activity 6.7 +/- 0.57 vs. 5.0 +/- 1.36, p < 0.001; emotion 6.4 +/- 0.91 vs. 4.6 +/- 1.67, p < 0.001; environment 5.3 +/- 1.10 vs. 4.1 +/- 1.24, p < 0.001 and overall scores 6.3 +/- 0.51 vs. 4.6 +/- 0.96, p < 0.001. Adjusting for age, gender and education using multiple regression, there was also a significant difference in all domains of Thai Mini AQLQ between the controlled and uncontrolled asthma patients. Internal consistency reliability was within the acceptable range (> 0.7) for all domains, except environment (overall 0.910; symptoms 0.855; activities 0.886; emotions 0.765 and environment 0.616). CONCLUSIONS: Thai Mini AQLQ has known to be reliable and valid. Further study on test-retest reliability and responsiveness to change are warranted.
