Kamalaporn Harutai, Chawalitdamrong Pongpan, Preutthipan Aroonwan
a Division of Pulmonology, Department of Pediatrics, Ramathibodi Hospital, Faculty of Medicine , Mahidol University , Bangkok , Thailand.
J Asthma. 2018 Apr;55(4):402-415. doi: 10.1080/02770903.2017.1338724. Epub 2017 Jul 11.
Childhood asthma is a substantial health burden in Thailand. Due to a lack of pediatric respiratory specialists (pediatric pulmonologists and allergists; RS), most Thai children are cared for by general pediatricians (pediatric primary care providers (PCP)).
We investigated whether current practices of Thai pediatricians complied with asthma guidelines and compared practices (diagnosis and treatments) provided by PCP and RS.
A cross-sectional study was conducted using electronic surveys including four case scenarios of different asthma phenotypes distributed to Thai pediatricians. Asthma diagnosis and management were evaluated for compliance with standard guidelines. The practices of PCP and RS were compared.
From 800 surveys distributed, there were 405 respondents (51%). Most respondents (81%) were PCP, who preferred to use clinical diagnosis rather than laboratory investigations to diagnose asthma. For acute asthmatic attacks, 58% of the pediatricians prescribed a systemic corticosteroid. For uncontrolled asthma, 89% of the pediatricians prescribed at least one controller. For exercise-induced bronchospasm, 55% of the pediatricians chose an inhaled bronchodilator, while 38% chose a leukotriene receptor antagonist (LTRA). For virus-induced wheeze, 40% of the respondents chose an LTRA, while 15% chose inhaled corticosteroids (ICS). PCP prescribed more oral bronchodilators (31% vs. 18%, p = 0.02), antibiotics (20% vs. 6%, p < 0.001), and antihistamines (13% vs. 0%, p = 0.02) than RS for the management of an acute asthmatic attack.
Most of the Thai pediatricians' practices toward diagnosis and treatment of acute asthmatic attack and uncontrolled asthma conform to the guidelines. PCP prescribed more oral bronchodilators, antibiotics, and antihistamines than RS.
儿童哮喘给泰国带来了沉重的健康负担。由于缺乏儿科呼吸专科医生（儿科肺病学家和过敏症专科医生；RS），大多数泰国儿童由普通儿科医生（儿科初级保健提供者（PCP））照料。
我们调查了泰国儿科医生目前的做法是否符合哮喘指南，并比较了PCP和RS提供的做法（诊断和治疗）。
采用电子调查问卷进行横断面研究，向泰国儿科医生分发包含四种不同哮喘表型病例场景的问卷。评估哮喘诊断和管理是否符合标准指南。比较PCP和RS的做法。
在分发的800份调查问卷中，有405名受访者（51%）。大多数受访者（81%）是PCP，他们更倾向于使用临床诊断而非实验室检查来诊断哮喘。对于急性哮喘发作，58%的儿科医生开具了全身用糖皮质激素。对于未控制的哮喘，89%的儿科医生至少开具了一种控制药物。对于运动诱发性支气管痉挛，55%的儿科医生选择吸入性支气管扩张剂而38%选择白三烯受体拮抗剂（LTRA）。对于病毒诱发的喘息，40%的受访者选择LTRA，15%选择吸入性糖皮质激素（ICS）。在急性哮喘发作的管理方面，PCP比RS开具更多的口服支气管扩张剂（31%对18%，p = 0.02）、抗生素（20%对6%，p < 0.001）和抗组胺药（13%对0%，p = 0.02）。
大多数泰国儿科医生对急性哮喘发作和未控制哮喘的诊断和治疗做法符合指南。PCP比RS开具更多的口服支气管扩张剂、抗生素和抗组胺药。
