ABS007: Scoring system-a guide for general practitioners enabling proper selection of drugs in step care management of asthma

Abstract

Introduction:

In a population of 7 million asthma patients in Bangladesh, a maximum of only 0.1 million patients are receiving treatment from respiratory experts in the secondary or tertiary care setting. The remaining 6.9 million patients are receiving their treatment from general practitioners (GPs) in the primary care setting. The aim of this paper was to formulate a score by which primary care physicians can select the appropriate step for the patient.

Methods:

An extensive search together with personal experience was gathered to formulate a score system. Effectiveness of these criteria were assessed practically in 5 asthma orientation courses, where a total of 100 GPs applied these criteria on 200 different patients.

Results:

More than 90% GPs applied scoring successfully.

Conclusion:

This scoring system is found to be effective and cost effective in a PHC setting in developing countries.

Criteria scoring yes (1) no (0)

1. Do you have dyspnoea everyday?

2. Do you have nocturnal attacks of dyspnoea more than two times per month?

3. Have you suffered from dyspnoea, which was severe enough to necessitate- steroid tablets, Nebulizer therapy, and Aminophylline Injection or hospital admission?

4. Do you have persistent dyspnoea for last six months or more? OR are you taking steroid tablets for one year or more?

5. Is the patient's baseline (during asymptomatic stage) PEFR <60% of predicted value? (Not applicable for <T 5 yrs).

Score wise recommendation for step care management: Children≤5 Years >5 Years to Adults

Score···Recommended Score···Recommended

Step Step

0 Step-I 0 Step-I

1 Step-II 1 Step-II

2 Step-III 2 Step-III 3–6 Step-IV 3 Step-IV A 4 Step-IV B

5–7 Step-V

Conflict of interest and funding

None declared. Funded by Asthma Association, Bangladesh.