The Gaps Between the Guidelines & Practices of Pediatricians for Managing Asthma at Tertiary Care Centers in Pakistan.

Abstract

Objectives: We wanted to find out the practices of pediatricians in tertiary care hospitals regarding the management of asthma in children and compare them with evidence-based, best-standard practice guidelines. This was necessary because only a few studies have focused on the huge gap between evidence-based guidelines and practices of pediatricians for managing asthma in children. Methods: The parents of 234 children (4-18 years), accompanying the asthmatic children were asked questions regarding the management of their children on a prescribed performa. The validated performa included questions regarding the epidemiology, various management options, pharmacotherapy, and about follow-up. The study venues were tertiary care hospitals. It was convenient sampling with a sample size calculated as 196 using OpenEpi version 3. The data was entered in SPSS-27 and analyzed by measuring frequencies of various parameters against the evidence-based recommendations, expressed in percentages. Results: Of the 234 children, 2/3 (67.5%) were males. The (81.2%) were prescribed oral reliever drugs in acute attacks. Only 19.7% of children were advised of any controller medicine. The doctors assessed the level of asthma control mainly by symptoms (94%) while objective/structured assessment with peak flow metery/spirometry or asthma control test was done only in 4% and 2% of children, respectively. The doctors provided minimal education to the parents regarding the Inhaler/spacer technique (6.5%), care of the equipment (7.5%), use of peak flow meter/recording the results (7.5%), or a written asthma action plan for emergency (2.1%). Almost all children (90%) were instructed to avoid triggers. The chronicity of the disease and the need for prolonged treatment were explained to 57% and 50% of parents, respectively. Conclusions: The management of asthma in children is far from the evidence-based best standard practices.