Primary care management of asthma in Malaysia: findings of the Klang Asthma Cohort Study

Background: In Malaysia, asthma is common but often neglected. Achieving good asthma control and optimal asthma care is a challenge in primary care setting. Aim: To establish an asthma cohort in six public primary care clinics and assess the level of asthma control and care delivered in these clinics. Methods: Children (5-17 years old) and adults (18 years and over) with physician-diagnosed asthma or given asthma treatment in the previous year were recruited. We assessed asthma control, use of spirometry at diagnosis, peak flow monitoring, scheduled reviews, action plan ownership and asthma education as indicators of asthma care. Asthma control was assessed according to GINA global guideline 2017. Results: 1280 patients were recruited; 86% adults and 15% children. Only 37% had good asthma control, 36% were partly controlled and 27% were poorly controlled. Other findings are: 6% had spirometry testing at diagnosis, 71% had scheduled reviews and 61% had a peak flow documented during at least one of the last three visits. Although most (92%) had received some asthma education when asked, only 16% of patients had been given a written asthma action plan. Among those with poorly controlled asthma, only 82% were on an inhaled controller in the last 12 months and 67% were reviewed regularly. Conclusion: Asthma care remains suboptimal and a quality improvement programme in asthma care is needed. Funding: NIHR RESPIRE Global Health Research Unit and is written on behalf of the RESPIRE collaborators.