Hesse I F
Department of Medicine, University of Ghana Medical School, Accra.
Respir Med. 1995 Jan;89(1):35-9. doi: 10.1016/0954-6111(95)90068-3.
This study assessed first-year doctors' (House Officers) knowledge of asthma at the Korle-Bu Teaching Hospital. Seventy-two out of 80 doctors answered 32 questions on various aspects of asthma. Many of these doctors managed between one to three asthmatics per week. Few, however, did so by acceptable standards. In assessing the severity of asthma, 88% looked for cyanosis, 69% looked for pulsus paradoxicus and 63% looked for a fast pulse rate. Only 63% considered the measurement of peak expiratory flow useful. Ninety-four percent used intravenous aminophylline, 82% intravenous hydrocortisone and 74% oxygen as the drug of choice for acute severe asthma. In moderate forms of acute asthma, 54% used salbutamol inhaler or intravenous aminophylline, 28% oxygen, 15% steroid inhaler and 14% oral prednisolone. Nebulized bronchodilators are not well known for use in either severe or moderate asthma and only 19-21% of doctors had prescribed their use. In chronic asthma, 55-65% of respondents prescribed bronchodilators compared to 19-35% who gave anti-inflammatory drugs. These results reveal insufficient knowledge of the pathophysiology of asthma, the use of standard drugs in asthma therapy and international guidelines for the management of asthma. The results also show that the pragmatic constraints which exist in developing countries preclude the adoption of international guidelines without local modification.
本研究评估了科勒-布教学医院一年级医生（住院医师）对哮喘的了解程度。80名医生中有72人回答了32个关于哮喘各个方面的问题。这些医生中许多人每周治疗1至3名哮喘患者。然而，很少有人按照可接受的标准进行治疗。在评估哮喘严重程度时，88%的人观察发绀情况，69%的人观察奇脉，63%的人观察脉搏加快情况。只有63%的人认为测量呼气峰值流速有用。94%的人将静脉注射氨茶碱、82%的人将静脉注射氢化可的松和74%的人将氧气作为急性重症哮喘的首选药物。在中度急性哮喘中，54%的人使用沙丁胺醇吸入器或静脉注射氨茶碱，28%的人使用氧气，15%的人使用类固醇吸入器，14%的人使用口服泼尼松龙。雾化支气管扩张剂在重症或中度哮喘中的应用并不广为人知，只有19%至21%的医生曾开过此类药物。在慢性哮喘中，55%至65%的受访者开了支气管扩张剂，而开抗炎药的比例为19%至35%。这些结果表明，医生对哮喘病理生理学、哮喘治疗中标准药物的使用以及哮喘管理国际指南的了解不足。结果还表明，发展中国家存在的实际限制因素使得在没有本地化修改的情况下无法采用国际指南。
