Assessment of asthma control status and management Adequacy among adult asthmatic patients on chronic Follow-up at jimma medical center: the focus of Clinical inertia

Abstract

Background: Asthma is a chronic inflammatory disorder and requires pharmacologic management. However, health care providers often fail to initiate or intensify therapy appropriately for patients with asthma during visits. Such behavior is defined as clinical inertia. Objective: To assess asthma control status and asthma management adequacy; the focus of clinical inertia among adult asthmatic patients on chronic follow-up at JMC from Dec 2021 to May 2022. Methods: Hospital-based prospective observational study was conducted in Jimma Medical Center from Dec 2021 to May 2022. All asthmatic patients who fulfilled the inclusion criteria were enrolled in the study consecutively and followed for two months. Data were entered into Epi Data 4.6.and exported to the statistical package for social sciences (SPSS) version 25.0 for analysis. Logistic regressions were used to identify independent predictors of outcomes and the strength of association between the variables. The adjusted odds ratio was used to measure the strength of association and a p-value < 0.05 was used as a cut point to declare statistical significance. Results: Of 148 patients, a total of 135 patients’ data were analyzed. The mean (standard deviation (SD)) age of the patients was 52.03 (±15.75) years. More than half (54.1%) of the study participants were male. The mean (SD) duration since diagnosis of asthma for these participants was 16.04 years (±16.67). About two-thirds of the study participants (65.9%) had uncontrolled asthma at the first visit and most of the study participants (58.5%) had uncontrolled asthma at the second visit of the follow-up. Most of the study participants (68.9%) at the first visit and (70.4%) at the second visit had clinical inertia. Smoker [AOR; 5.92, 95%CI (1.02, 34.51), P<0.048], non- adherence to medication [AOR; 8.45, 95% CI (2.47, 28.82),P<0.001] and asthma duration of 5-10 years[AOR; 0.15, 95%CI(0.03,0.81),P<0.027] were identified as associated factors to uncontrolled asthma. Comorbidity [AOR;3.35,95% CI (1.15,9.81),P<0.027],asthma duration of 5 to 10 years [AOR,7.58 95% CI (1.51,38.05),,P<0.014)],moderate persistent asthma [AOR;6.91,95% CI (2.46,19.42,P<0.00]and severe persistent asthma[AOR; 10.84,95%CI (1.1,107.0,P<0.041] were contributing factors for clinical inertia. Conclusions: About three-fifths of study participants had poor asthma control and the burden of clinical inertia in our study was high at both visits. Smoking, non-adherence and duration asthma of 5-10 years were identified as contributing factors to uncontrolled asthma. Stakeholders' intervention to avoid clinical inertia is necessary to improve asthma treatment outcomes.