Guidance on the diagnosis and management of asthma among adults in resource limited settings

Bruce J Kirenga, Jeremy I Schwartz, Corina de Jong, Thys van der Molen, Martin Okot-Nwang

Abstract

Background: Optimal management of asthma in resource limited settings is hindered by lack of resources, making it difficult for health providers to adhere to international guidelines. The purpose of this review is to identify steps for asthma diagnosis and management in resource limited settings.

Methods: Review of international asthma guidelines and other published studies on diagnosis and management of asthma.

Results: We establish that clinical diagnosis of asthma can be made if recurrent respiratory symptoms especially current wheeze or wheeze in the last 12 months are present. Presence of a trigger, other allergic diseases, personal or family history of asthma; clinical improvement and increase in the peak flow and forced expiratory volume in one second of ≥12% after salbutamol administration increases the likelihood of asthma. At diagnosis severity grading, patient education, removal or reduction of trigger should be done. Follow up 2-6 weeks and assessment of control during therapy is essential. Therapy should be adjusted up or down depending on control levels. Patients should be instructed to increase the frequency of their bronchodilators and/or steroids therapy when they start to experience worsening symptoms.

Conclusion: Good quality asthma care can be achieved in resource limited settings by use of clinical data and simple tests.

Keywords: Asthma, diagnosis, treatment, management and resource limited settings.