Knowledge of asthma and its management in newly qualified doctors in Accra, Ghana

Abstract

This study assessed first-year doctors’ (House Officers) knowledge of asthma at the Korle-Bu Teaching Hospital. Seventy-two out of 80 doctors answered 32 questions on various aspects of asthma. Many of these doctors managed between one to three asthmatics per week. Few, however, did so by acceptable standards. In assessing the severity of asthma, 88% looked for cyanosis, 69% looked for pulsus paradoxicus and 63% looked for a fast pulse rate. Only 63% considered the measurement of peak expiratory flow useful. Ninety-four per cent used intravenous aminophylline, 82% intravenous hydrocortisone and 14% oxygen as the drug of choice for acute severe asthma. In moderate forms of acute asthma, 54% used salbutamol inhaler or intravenous aminophylline, 28% oxygen, 15% steroid inhaler and 14% oral prednisolone. Nebulized bronchodilators are not well known for use in either severe or moderate asthma and only 19-21% of doctors had prescribed their use. In chronic asthma, 55565% of respondents prescribed bronchodilators compared to 19-35% who gave anti-inflammatory drugs. These results reveal insufficient knowledge of the pathophysiology of asthma, the use of standard drugs in asthma therapy and international guidelines for the management of asthma. The results also show that the pragmatic constraints which exist in developing countries preclude the adoption of international guidelines without local modification.Introduction Asthma is now recognized to be due to chronic inflammation of the airways. There is evidence of inflammation even in patients with mild forms of the disease (1). This current view of the pathophysiology of the disease has altered the traditional methods of management. Internationally, the rationale of management is primarily to reduce inflammation. Anti-inflammatory drugs are generally preferred to bronchodilators in modern practice (2). The disease still has a significant morbidity and mortality which may increase worldwide despite the availability of potent drugs. Among the major factors which contribute to the morbidity and mortality of asthma are under-diagnosis and under-treatment by medical personnel and patients (3-5). Factors related to the availability of health care are also major contributors (6,7). In Third World countries where hospital facilities are inadequate and where current information about management may not be readily available, morbidity and mortality are expected to be even higher. Lack of knowledge of the pathophysiology of asthma has also contributed to the morbidity and mortality of the disease. To reduce mortality andparticular, education of health personnel and even of patients on principles of the management of asthma is essential (8). This need has, indeed, been emphasized in the international guidelines for assessment and treatment of asthma (2). In Ghana, bronchial asthma is well known and commonly encountered in clinical practice. However, very little systematic work has been done to establish its prevalence and the level of mortality. It is also important to determine the level of knowledge of practising doctors in Ghana of the disease and its management. The present study focuses on recently qualified doctors who, presumably, have current knowledge of the management of asthma from recent medical school training. A reason for choosing this group is that House Officers are first-in-line for the management of emergencies including asthma. Management problems are more likely to be associated with this group. Methods Seventy-two out of 80 House Officers (aged 25-32 years) at the Korle-Bu Teaching Hospital (KBTH) in Accra participated in this study. KBTH is the primary referral centre in Ghana. It has a bed capacityof 1700, and is the main hospital for training students from the University of Ghana Medical School. House Officers involved in this study had worked in the KBTH for up to 12 months after graduation from medical school. They included doctors trained at the University of Ghana Medical School, the School of Medical Sciences, Kumasi and a number from schools outside Ghana.Each respondent answered 32 questions on various aspects of asthma, including its management. Some of the questions demanded multiple responses to determine degree of knowledge.