Knowledge, practice pattern and attitude toward asthma management amongst physicians from Nepal, Malaysia, Lebanon, Myanmar and Morocco

<b>Objective:</b> This survey aimed to understand the physicians’ practice pattern and challenges faced while treating their patients with asthma in five countries-Malaysia, Nepal, Myanmar, Morocco and Lebanon. <b>Methods:</b> Questionnaire-based data was gathered from internal medicine doctors (209), general practitioners (206), chest physicians (152) and pediatricians (58) from 232 locations from across the five countries. <b>Results:</b> Of the 816 physicians, 374 physicians encountered at least 5 asthma patients daily. Approximately, 38% physicians always used spirometry for diagnosis and only 12% physicians always recommended Peak flow meter (PFM) for home-monitoring. Salmeterol/fluticasone (71%) followed by formoterol/budesonide (38%) were the most preferred ICS/long-acting beta₂-agonists (LABA); Salbutamol (78%) was the most preferred reliever medication. 60% physicians said &gt;40% of their patients were apprehensive to use inhalers. 72% physicians preferred a pressurized metered-dose inhaler (pMDI) to a dry powder inhaler (DPI) with only a third of them using a spacer with the pMDI. 71% physicians believed that using similar device for controller and reliever can be beneficial to patients. Skipping medicines in absence of symptoms (64%), incorrect inhaler technique (48%) and high cost of medication (49%) were considered as major reasons for non-adherence by most physicians. Incorrect inhaler technique (66%) and nonadherence (59%) were considered the most common causes of poor asthma control. <b>Conclusions:</b> There are opportunities to improve the use of diagnostic and monitoring tools for asthma. Non-adherence, incorrect inhaler technique and cost remain a challenge to achieve good asthma control. Asthma education, including correct demonstration of inhaler, can potentially help to improve inhaler adherence.

**研究目标**：本调查旨在了解马来西亚、尼泊尔、缅甸、摩洛哥及黎巴嫩五国医师在诊疗哮喘患者时的临床实践模式与面临的各类挑战。
**研究方法**：本次研究通过问卷调查的方式，从上述五国232个医疗地点招募内科医师209名、全科医师206名、胸科医师152名及儿科医师58名，收集相关研究数据。
**研究结果**：在816名受访医师中，374名医师每日接诊至少5名哮喘患者。约38%的医师始终使用肺量计（spirometry）进行哮喘诊断，仅12%的医师始终推荐使用峰流速仪（Peak flow meter, PFM）开展家庭监测。沙美特罗/氟替卡松（71%）及福莫特罗/布地奈德（38%）为临床最常选用的吸入性糖皮质激素/长效β₂受体激动剂（ICS/long-acting beta₂-agonists, LABA）类药物；沙丁胺醇（78%）则为最常用的缓解类药物。60%的医师表示，超过40%的患者对吸入器使用存在顾虑。72%的医师更偏好使用压力定量气雾剂（pressurized metered-dose inhaler, pMDI）而非干粉吸入器（dry powder inhaler, DPI），其中仅三分之一的医师在使用pMDI时会搭配储雾罐。71%的医师认为，为控制用药与缓解用药选用相同装置可使患者获益。多数医师认为，症状缓解后自行停药（64%）、吸入器使用技术不当（48%）以及药物费用高昂（49%）是导致患者用药不依从的主要原因。而吸入器使用技术不当（66%）与用药不依从（59%）则被视为哮喘控制不佳的最常见诱因。
**研究结论**：目前哮喘诊疗领域仍存在优化诊断与监测工具使用的空间。用药不依从、吸入器使用技术不当以及药物费用高昂，仍是实现良好哮喘控制的核心挑战。通过哮喘教育（包括正确演示吸入器使用方法），或可有效提升患者的吸入器用药依从性。