Physicians' Knowledge and Attitude Towards Childhood Asthma Exacerbations in Damietta Governorate

Abstract

Acute asthma exacerbations can occur in patients across the spectrum of disease severity including patients considered to have “mild” asthma and most asthma exacerbations require immediate care and close observation for deterioration as it can be severe enough to lead to emergency department (ED) visits or hospital admissions, and even death. Despite advances in asthma management, acute exacerbations continue to occur and impose considerable morbidity on patients and constitute a major burden on health care resources. The social and economic burden of asthma exacerbations relates to the direct costs of health care use and the indirect costs associated with lost productivity In spite of the great efforts to improve asthma care over the past decade, a majority of patients have not benefited from advances in asthma treatment as the majority of asthma children are managed by general or family physicians all over the world. Clinicians who are treating asthmatic patients should be prepared to treat an asthma exacerbation, recognize the signs and symptoms of severe and life-threatening exacerbations, and be familiar with the risk factors for asthma-related death. Because infants are at greater risk for respiratory failure, clinicians should also be familiar with special considerations in the assessment and treatment of infants experiencing asthma exacerbations. In this work we aimed to assess the current situation as regard to clinician's management of pediatric acute asthma exacerbations in Damietta Governorate. This was achieved through a self-administered questionnaire aiming at assessment of three important aspects which are; physician’s knowledge, practice and attitude towards childhood asthma exacerbation management and guide lines. This questionnaire was applied to 216 physicians who deal with childhood acute asthma exacerbations; 158 physicians were general practitioners (73%), 40 physicians were residents (18.5%) and 18 physicians were pediatric specialists (8%). Physician’s knowledge, practice and attitude were assessed through special designed questionnaire by professional community medicine staff. In this study we found that the physicians who had good knowledge about asthma exacerbations diagnosis and management were 24.1% while those had good practices were 19.5%. Asthma exacerbation definition had different spectrums, the majority of studied physicians defined it as worsening of asthma symptoms requiring increased use of SABA (80.1%) and about75% agreed that it required systemic steroids and most of them (88.4%) agreed ER visit is required for asthma exacerbation management. Studied physicians depended mainly on clinical manifestations for initial assessment and grading of asthma exacerbations; the awareness of using lung function tests was18.5%, while who used it in asthma exacerbations were 4.6%. Moreover, 46.8% of studied physicians chose winter as a season of asthma exacerbations and 52.3% of them chose ED as a site of treatment for most of asthma exacerbation patients. As regard to studied Physician’s attitudes towards patient education about asthma, 93.1% of them agreed that patient education should include how to use medication, 71.8% of them agreed that patient education should include how to recognize allergen triggers. 91.7% of them thought that patient should be educated how to recognize and report asthma symptoms and only 42.1% who thought that patient should be educated how to use PEFM .