More than 570,000 adults live with asthma in Portugal and one in three asthma patients do not have the diagnosis recorded in the clinical file in primary health care, indicates a study presented today in Lisbon.
According to the study, the first on asthma in Portugal, which will be presented at the Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), 70% of patients with no record of diagnosis have not had treatment in the last 12 months, which shows the “need for measures to improve access to diagnosis and monitoring of the disease”.
“We identified a considerable number of people who are probably being followed up (…) privately or elsewhere, and their treating doctors don’t have the diagnosis recorded,” Jaime Correia de Sousa, one of the coordinators of the Epi-Asthma study, which covered 38 primary health care units, explained to Lusa.
The specialist acknowledged that there has been “a great effort” on the part of the Directorate-General for Health – through the National Asthma Control Programme – and even on the part of other organizations to improve the registry and that, although it is getting smaller, “there is still some stigma in assuming the diagnosis, especially in children”.
Jaime Correia de Sousa pointed to problems of “low literacy [among the population] in respiratory health”, explaining: “people don’t want to assume that there is a chronic disease, treating it only when they have symptoms”.
This attitude, according to the specialist, means that many patients don’t have their disease under control, and asthma is considered under control “when you haven’t had any symptoms for the last four weeks”.
Poor control of the disease is also due to patients’ low adherence to medication – “people feel better and stop using it” – and unlearning of the inhalation technique – “they learn, but then they start to take it easy and start using too little of the product, because if they don’t inhale properly it won’t reach the bronchi”.
Jaime Correia de Sousa recalled that the clinical manifestations of the disease are seasonal and can vary greatly throughout the year and that the simple application of a questionnaire makes it possible to see whether or not the disease is under control.
He argued that not only is greater patient literacy needed, but also more attention from health professionals “to proactively monitor these patients”. “The attitude towards respiratory diseases is still very passive,” she said.
He recalled that there are already performance indicators in Family Health Units (USF) for respiratory diseases, which could begin to increase the attention of professionals to improve the periodic surveillance of these patients, as well as registration, for example by creating a specific area for respiratory diseases in the primary health care computer system.
He admitted underdiagnosis, but said that this criterion would only be analyzed later: “we know there is, but in this study we only measured under-registration”.
He also considered that a lot of the passivity in relation to diseases like asthma is because “it’s not seen as a worrying disease”, because “people hardly die of asthma in Portugal”.
“Those who die are people who already have many comorbidities and the elderly,” he recalled, stressing: “Despite everything, we have a reasonable quality of care, both in terms of asthma hospitalizations and asthma mortality. (…) We treat a lot, but it could be much better.”
He added: “There are diseases that have a low mortality rate, but which drag on for many years throughout life with a high morbidity rate.”
The coordinator of the study pointed out that asthma can trigger other serious health problems if it is not controlled, and gave the following example: “a person who has asthma and who has an exacerbation of their asthma and who has other illnesses, (…) can have a harmful outcome that they wouldn’t have if their asthma was well controlled”.
As for the organization of responses in the National Health Service, he advocated the creation of a referral network for severe asthma that would allow for multidisciplinary and more differentiated responses in just a few hospitals.
Epi-Asthma toured the country in a van with the aim of determining the prevalence of asthma according to the severity of the disease, as well as characterizing the profile of asthma patients. It was promoted by AstraZeneca, in collaboration with the Center for Research in Health Technologies and Services (CINTESIS), of the Faculty of Medicine of the University of Porto, and the Institute for Research in Life and Health Sciences (ICVS), of the University of Minho, and had the scientific sponsorship of the Portuguese Association of General and Family Medicine (APMGF), the Portuguese Society of Allergology and Clinical Immunology (SPAIC) and the Portuguese Society of Pneumology (SPP).