Improvement in symptoms and pulmonary function of asthmatic patients due to their treatment according to the Global Strategy for Asthma Management (GINA)

Abstract

Background: Global Initiative Strategy for Asthma Management (GINA) is poorly applied in undeveloped and developing countries. The current study examined the effects of applying GINA guidelines on treatment efficacy in asthmatic patients in Iran.

Methods: Twenty four asthmatic patients (usual care group) were treated as usual and 26 patients (intervention group) according to the GINA for 2 months. Asthma symptom score, asthma severity, frequency of symptoms/week and wheezing were recorded at the beginning (first visit), one month after treatment (second visit), and at the end of the study (third visit). Pulmonary function tests (PFTs) were performed by spirometry, and the patients' use of asthma drugs and their symptoms were evaluated, at each visit.

Results: Asthma symptoms, frequency of symptoms/week, chest wheezing, and PFT values were significantly improved in the intervention group at the second and third visits compared to first visit (p < 0.001 for all measures). In addition, exercise induced cough and wheeze were significant improved in the third visit compared to the second visit in this group (p < 0.01 for both measures). In the second and third visits all symptoms were significantly lower, and PFT values higher, in the intervention group compared to the usual care group (p < 0.005 to p < 0.001). In the usual care group, there were only small improvements in some parameters in just the second visit (p < 0.01 for all measures). The use of asthma drugs was unchanged in the usual care group and significantly reduced in the intervention group (p < 0.01) by the end of the study.

Conclusion: Adoption of GINA guidelines improves asthma symptoms and pulmonary function in asthmatic patients in Iran.

Figure 1

Comparison of symptom score of usual care (a) and intervention (b) groups of asthmatic patients at the beginning (fine filled bars), middle (medium filled bars) and at the end (coarse filled bars) of a two month study period. Statistical difference in different parameter between three visits: NS; non significant difference, *; p < 0.05, **; p < 0.01, ***, p < 0.001.

Figure 2

Comparison of severity of asthma according to GINA guidelines, frequency of asthma symptoms/week and chest wheeze of usual care (a) and intervention (b) groups of asthmatic patients at the beginning (fine filled bars), middle (medium filled bars) and at the end (coarse filled bars) of a two month study. Statistical difference in different parameter between three visits: NS; non significant difference, *; p < 0.05, **; p < 0.01, ***, p < 0.001.

Figure 3

Comparison of pulmonary function tests of usual care (a) and intervention (b) groups of asthmatic patients at the beginning (fine filled bars), middle (medium filled bars) and at the end (coarse filled bars) of a two month study. FEV₁: forced expiratory volume in one second; FVC: forced vital capacity; PEF: peak expiratory flow; MMEF: maximal mid expiratory flow; MEF₇₅, MEF₅₀ and MEF₂₅: maximal expiratory flow at 75%, 50%, and 25% of the FVC respectively. All values of PFTs were quoted as percentage predicted. Statistical difference in different parameter between three visits: NS; non significant difference, *; p < 0.05, **; p < 0.01, ***, p < 0.001.