Trends in asthma therapy in Hong Kong, 1987-1992

Abstract

To audit the clinical practice in drug treatment of bronchial asthma in Hong Kong, two questionnaire surveys were conducted in 1987 and 1992. The questionnaire was adapted from the 1984 European Audit. The response rate was 40% (248 of 615 mailings) in 1987 and 32% (207 of 652 mailings) in 1992. A total of 86% and 87% of responders were general practitioners (GP), respectively, and the others were chest physicians (CP). For treatment of acute severe asthma in adults, parenteral aminophylline was the first drug used by GP in 1987, whereas inhaled β-agonist was used in 1992. Parenteral steroid was more often used by both GP and CP in 1992. In children, inhaled β-agonist was always the first choice and parenteral steroid ranked higher in 1992, overtaking parenteral aminophylline. For maintenance therapy of chronic asthma in adults, inhaled β-agonist ranked first in both surveys. Inhaled steroid has become much more popular with GP, ranking second in 1992, overtaking oral bronchodilators. With CP, inhaled steroid was already ranking second in 1987, and it was used as the first drug, as frequently as inhaled β-agonist, in 1992. In children, in 1987, inhaled β-agonist was the first drug of choice, and prophylactic drugs ranked lower than oral bronchodilators with both GP and CP. In 1992, cromoglycate and inhaled steroids were much more often used, so much so that among CP, inhaled steroid ranked first, just ahead of inhaled β-agonist. The dose of metered-dose β-agonist most commonly recommended by both GP and CP was 5-10 puffs per day in both 1987 and 1992, but there was a trend to recommend less (0-5 puffs) by CP in 1992. Powder inhalers were more widely used by GP in 1992. Hyposensitization was not commonly practiced, but there was an increase in its use in 1992. In summary, there has been a change in therapeutic attitudes among doctors in Hong Kong over the survey interval of 4 1/4 years. Anti-inflammatory drugs and the inhalational route of administration are used much more often now, even among primary care physicians, in keeping with international recommendations.