Le Thi Tuyet Lan

Background/Objectives: Asthma action plans (AAPs) are recommended for patients’ self-management of asthma and should be adapted to a country’s situation. This study aimed to develop expert consensus on the optimal structure, content, and action of asthma action plans for Vietnamese settings to ensure feasibility, acceptance, and implementation. Methods: A Delphi consensus was conducted over two rounds. The proposed items were evaluated by a Vietnamese panel of pulmonologists, allergists, tuberculosis/lung disease specialists, and general practitioners. Structured online questionnaires with five-point Likert scales were used. Consensus was defined as >80% agreement and <10% strong disagreement. Results: A total of 26 and 21 participants completed round 1 and round 2, respectively. The 4-zone format of AAP was preferred (42.3%) over the 3-zone (38.5%) or 2-zone (19.2%) formats. The AAP should include some key statements for asthma, symptoms for self-monitoring, an objective asthma control questionnaire, actions for changes in maintenance medication, and instructions in emergency situations. AAP zones should be classified by symptom frequency and severity. Patient actions should be tailored to their treatment regimen (MART or ICS/LABA + SABA). The APP might not include peak expiratory flow monitoring and oral corticosteroid self-administration for both the MART and ICS/LABA + SABA regimens and might not add SABA together with ICS dose escalation for the ICS/LABA + SABA regimen. Conclusions: This study established an expert consensus on fundamental AAP structural elements and actions for the Vietnamese. The failure to achieve consensus on PEF monitoring tools and OCS for the self-management of asthma exacerbation reflects concerns about medication abuse, especially in Vietnamese healthcare settings.

Background/Objectives: Asthma action plans (AAP) are recommended for patients’ self-management of asthma and should be adapted countries’ situation. This study aimed to develop expert consensus on the optimal structure and content and action of asthma action plans for Vietnamese settings to ensure feasibility, acceptance and implementation. Methods: A Delphi consensus conducted over two rounds. The proposed items were evaluated by a Vietnamese panel of pulmonologists, allergist, tuberculosis/lung disease specialists and general practitioners. Structured online questionnaires with 5-point Likert scales were used. Consensus was defined as >80% agreement and < 10% strong disagreement. Results: 26 and 21 participants completed round 1 and round 2, respectively. 4-zone of AAP was preferred (42.3%) over 3-zone (38.5%) or 2-zone (19.2%). AAP should include some key statements for asthma, symptoms for self-monitoring, objective asthma control questionnaire, actions for changes of maintenance medication and instructions in emergency situations. AAP zones should be classified on symptom frequency and severity. Patient actions should be tailored to their treatment regimen (MART or ICS/LABA + SABA). APP might not include peak expiratory flow monitoring and oral corticosteroid self-administration for both MART and ICS/LABA + SABA regimen, and might not add SABA together with ICS dose escalation for ICS/LABA + SABA regimen. Conclusions: This study established an expert consensus on fundamental AAP structural elements and actions for the Vietnamese. The failure to achieve consensus on PEF monitoring tools and OCS for self-management of asthma exacerbation reflects concerns about medication abuse, especially in Vietnam healthcare settings.

Đặt vấn đề: Đợt cấp COPD là yếu tố tăng gánh nặng cho bệnh nhân và hệ thống y tế, gây suy giảm chức năng phổi và tăng nguy cơ tử vong. Mục tiêu nghiên cứu này là mô tả đặc điểm lâm sàng của bệnh nhân COPD và phân tích các yếu tố nguy cơ liên quan đến tần suất đợt cấp. Đối tượng, phương pháp: Nghiên cứu mô tả cắt ngang trên 258 bệnh nhân COPD tại phòng khám Hô hấp bệnh viện Quận 11 từ 01/2022 đến 09/2024. Bệnh nhân được chia thành hai nhóm: ít đợt cấp (0-1 đợt/năm) và nhiều đợt cấp (≥2 đợt/năm). Phân tích hồi quy logistic xác định các yếu tố nguy cơ liên quan đến đợt cấp. Kết quả: Phần lớn bệnh nhân là nam giới (95,3%), người Hoa (61,2%), thuộc GOLD 3 (72,5%) với FEV1 trung bình 45,8%. Nhóm nhiều đợt cấp có FEV₁ thấp hơn (41,6% so với 51,3%, p<0,001), tỷ lệ còn hút thuốc cao hơn (43,1% so với 23,7%, p=0,004) và nhiều bệnh đồng mắc hơn. Yếu tố nguy cơ mạnh nhất là suy tim (OR=46,60), bệnh tim thiếu máu cục bộ (OR=24,10), FEV₁ thấp (SMD=-1,42) và điểm CAT cao (SMD=1,02). Kết luận: Bệnh đồng mắc tim mạch và chức năng phổi kém là những yếu tố nguy cơ mạnh nhất của đợt cấp COPD. Cần đánh giá toàn diện bệnh nhân COPD, chú trọng sàng lọc và điều trị tích cực các bệnh đồng mắc tim mạch.

COPD patients with asthma features usually benefit from inhaled corticosteroids (ICS)-containing regimens, but their burden and diagnostic criteria remain to be established. The aims of this study were to estimate the proportion of patients with asthma features among patients with physician-diagnosed COPD and to investigate differences in clinical characteristics and current medications between COPD patients with asthma features and patients with COPD alone. A cross-sectional study was conducted at two respiratory out-patient clinics at the University Medical Center in Ho Chi Minh City and Bach Mai Hospital in Ha Noi, Vietnam. COPD patients with asthma features were identified by attending physicians following the approach recommended by the GINA/GOLD joint committee. Of the 332 patients screened, 300 were enrolled in the study. The proportion of COPD patients with asthma features was 27.3% (95% confidence interval (95% CI) 22.6–32.6%). COPD patients with asthma features were younger, with higher FEV₁ values, a greater proportion of positive bronchodilator reversibility tests, higher blood eosinophil count, and were more often treated with ICS/LABA (ICS/long-acting bronchodilator beta-2 agonist) than patients with COPD alone. The prevalence of COPD patients with asthma features is particularly high in Vietnam thus requiring appropriate action plans in clinical practice.

Symptoms control remains challenging for most patients with asthma. This study was conducted to evaluate the level of asthma symptoms control and lung function over 5 years of GINA (Global INitiative for Asthma) implementation. We included all patients with asthma who had been managed following GINA recommendations at the Asthma and COPD Outpatient Care Unit (ACOCU) of the University Medical Center in Ho Chi Minh City, Vietnam from October 2006 to October 2016. Of 1388 patients with asthma managed following GINA recommendations, the proportion of patients with well-controlled asthma significantly improved from 2.6% at baseline to 66.8% at month 3, 64.8% at year 1, 59.6% at year 2, 58.6% at year 3, 57.7% at year 4, and 59.5% at year 5 (p < 0.0001 for all comparisons). The proportion of patients with persistent airflow limitation significantly decreased from 26.7% at baseline to 12.6% at year 1 (p < 0.0001), 14.4% at year 2 (p < 0.0001), 15.9% at year 3 (p = 0.0006), 12.7% at year 4 (p = 0.0047), and 12.2% at year 5 (p = 0.0011). In patients with asthma managed according to GINA recommendations, asthma symptoms control and lung function improved after 3 months and the improvement was sustained over 5 years.

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

Chronic obstructive pulmonary disease (COPD) is a clinical syndrome encompassing a group of chronic, progressive, and debilitating respiratory conditions, that are characterized by incompletely reversible airflow limitation. Within the Asia-Pacific region, prevalence estimates have been derived using various protocols and study methods, and there is little data on the impact of COPD exacerbations. This study aimed to provide a comprehensive picture of the current prevalence and burden of COPD in this region. A population-based survey was conducted in nine Asia-Pacific territories between 01 February 2012 and 16 May 2012. Overall, 112,330 households were screened to identify eligible subjects (aged ≥40 years, with a physician diagnosis of COPD, chronic bronchitis or emphysema, or with identifiable symptoms of chronic bronchitis). Out of a sample of 69,279 individuals aged ≥40 years, 4,289 subjects with COPD were identified. Data were collected via face-to-face interviews or by fixed-line telephone, using a structured questionnaire. A total of 1,841 completed questionnaires were analyzed. The overall estimated COPD prevalence was 6.2%, with 19.1% of subjects having severe COPD. In the 12 months prior to the survey, nearly half of all subjects (46%) had experienced exacerbations, and 19% had been hospitalized as a result of their condition. When subjects were asked about the impact of their condition on employment, 23% said their condition kept them from working, and 42% felt that their condition limited their ability to work or their activities. Of those who reported taking prescription drugs, 20% did not know the name of the drugs they were taking. Prescription of oral corticosteroids was common, with 44% of subjects having used these during the previous year to manage their respiratory symptoms; in contrast, inhaler use was low (25%). Only 37% of subjects had taken a lung function test, and the majority (89%) of those tested did not know their test results. Across the Asia-Pacific territories surveyed, the prevalence of COPD is high, indicating a substantial socioeconomic burden. Our findings suggest that there is considerable room for improvement in the management of COPD, and highlight a need to enhance patient and physician education in the region.