The evidence is clear on the best ways to manage asthma, but ignorance about the treatment guidelines and the implementation thereof is resulting in patients not accessing potential life-saving care. Globally, asthma is one of the most common lung diseases and is characterised by the recurrence of symptoms such as wheezing, shortness of breath, chest tightness and coughing. The severity of the disease varies from person to person and, while an asthma attack may only cause mild symptoms in one person, it can be deadly.
"The evidence is very clear. A patient's asthma can be well controlled when health care workers follow the treatment guidelines, which are based on the best available evidence," says Dr Michael Pather, with the Division of Family Medicine and Primary Care at Stellenbosch University's Faculty of Medicine and Health Sciences (FMHS).
Asthma cannot be cured, but it can be effectively treated. Research shows that with proper treatment nearly all asthma patients can achieve and maintain good asthma control, enabling them to participate in everyday activities.
His research, which looked at the quality of care for asthma patient in the Western Cape, found the standard of care at primary level to be inadequate, mainly because health care workers were not following treatment guidelines.
"These guidelines are widely available, but we found they weren't being incorporated into patients' care regimens," he says, whose research also investigated the causes behind the non-use of guidelines. He also investigated methods that could be implemented in order to improve the uptake of treatment guidelines.
Through educational drives where doctors and nurses were schooled in the guidelines, Pather was able to make a significant improvement in the implementation of guidelines, which could translate in a higher level of asthma control in patients, although this was not assessed in the study. However, despite this advance, He believes there is still a lot of room for improvement.
He identified further challenges to the quality care for asthma patients through his research, including the high number of patients that health care staff at primary care level have to attend to daily, the high prevalence of smoking in the Western Cape, and poor inhaler technique among patients. Many patients also have more than one disease, making treatment more complex as certain medications can interfere with asthma.
"There is also no asthma register in existence. If you know how many asthma patients there are in clinics around the Western Cape, you can improve the quality of care." He also advocates audits and ongoing evaluation of the level of care patients receive in the primary care facilities.
"We have good guidelines, but it will only translate into good patient care if health care practitioners are aware of it and are able to put it into practice on patients sitting in their consultation rooms," he concludes.
