Outpatient Management of Bronchial Asthma: A Comparative Analysis Between Guideline-Directed Management and Usual Management

Abstract

Background: Bronchial asthma is a common controllable disease that causes a serious economic and social burden. The Global Initiative for Asthma (GINA) was developed to help guide clinicians in appropriate management of asthma. Despite the existence of published guidelines, common practice in many primary care clinics follows usual care based on clinical gestalt. This study aims to determine if there is a statistically significant difference in outcomes between patients receiving guideline-directed therapy when compared to those receiving usual clinician therapy.

Methods: A total of 300 patients were included in this study. Among them, 139 patients received guideline-directed medical therapy (GDMT group) and 161 received usual medical therapy (UMT group). Logistic regression models were utilized to determine if there was a significant difference in outcomes for patients comparing number of exacerbations and number of hospitalizations.

Results: More patients in GDMT group suffered from recorded exacerbations in the prior year with 43.9% having one, 3.6% having two, and 0.7% having three, compared to the frequencies of exacerbations in the UMT group (29.2%, 1.9%, and 1.2%, respectively) (P < 0.05). Cumulative number of hospitalizations due to asthma exacerbations in the prior year was also higher in GDMT group compared to the UMT group (one in 5.8% GDMT vs. 3.1% UMT; two in 0.0% GDMT vs. 0.6% UMT) without statistically significant difference (P = 0.349).

Conclusions: Primary care providers’ adherence to the 2018 GINA guidelines for asthma treatment did not offer benefit to patient outcomes, such as number of exacerbations or hospitalizations, compared to the usual medical care of bronchial asthma. Patient-tailored care may offer reduction in the rates of exacerbations and hospitalization.

J Clin Med Res. 2020;12(6):362-368
doi: https://doi.org/10.14740/jocmr4208