FACTORS INFLUENCE ON POOR ASTHMA CONTROL AMONG MEDICAL CLINIC PATIENTS SEEN AT TEACHING HOSPITAL BATTICALOA.

Objective: To identify the influencing factors of poor asthma control among adult asthmatic patient teaching hospital Batticaloa. Method: A cross sectional descriptive study conducted among 207 sample of asthmatic adult clients aged above 18 years who visited medical clinic teaching hospital, Batticaloa. Modified version of the 2007 NAEPP expert panel report guideline used to classified asthma control as well control and not well control by using four parameters: daytime symptoms, nighttime symptoms, interference with normal activity, and use of short-acting β2-agonists. Data were statistically analyzed using the Statistical Package of Social Science (SPSS v.20) software. Result: Analysis revealed that most of the patients (71%) are well controlling their asthma. Poor controlled patient (35%) told that weather is the triggering factor for their asthma. Patient who have regular clinic visit have well controlled their asthma. Most of the not well-controlled patient (72.8%) does not received health education. Inhaler usage and appropriate time of taking medication were statistically significant with not well-controlled asthma. Conclusion: Most of the Adult asthmatic patients well control their asthma symptoms. Clients under not well-controlled category not


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countries. Asthma is under diagnosed and under treated problem in all countries. It creates substantial burden to individuals and families and often restricts individuals' activities for a lifetime (2).
Asthma is a common chronic airway disorder characterized by periods of reversible airflow obstruction known as asthma attacks. Airflow is obstructed by inflammation and airway hyper reactivity (contraction of the small muscles surrounding the airways) in reaction to certain exposures. Exposures include exercise, infection, allergens (e.g., pollen), occupational exposures (e.g., chemicals), and airborne irritants (e.g., environmental tobacco smoke). Symptoms may include wheezing, coughing, shortness of breath, and chest tightness. It is not clear how to prevent asthma from developing and there is no cure. Yet the means to control and prevent exacerbations in persons who have asthma are well established in evidence-based clinical guidelines (8).
According to the latest WHO data published in May 2014 Asthma Deaths in Sri Lanka reached 2,953 or 2.33% of total deaths. The age adjusted Death Rate is 13.98 per 100,000 of population ranks Sri Lanka got twentieth place in the world (4). Sri Lanka health at glance 2008 reveal leading causes of hospital admissions due to respiratory system, excluding disease of upper respiratory tract on the year 2007 the rate was 8.7% (5). In Batticaloa district, 19 % of the people are suffering from chronic illnesses. In that, asthma prevalence is 2.8% in total population in Sri Lanka. (6) There is very limited data on asthma epidemiology from the developing world, including Sri Lanka. The expected outcome will bring out the asthma control in patient attending teaching hospital Batticaloa. It will be helpful to enhance their quality of life and the management who are suffering from asthma. No any studies performed in Batticaloa District, regarding factors influence on poor asthma control.
Methodology:-It is a cross-sectional descriptive study, which was carried out in Teaching hospital, Batticaloa. The study population considered of the asthmatic patients attending the medical clinic during the year of 2017. Asthmatic patient above 18 years old were included for the study, on the other hand asthmatic patients who under 18 years old and not supported to the study were excluded. A structured interviewer administered questionnaire (IAQ) was used to collect information.
Data collection:-Data collection was done by the researcher and his trained team, they assisted in filling the questionnaires. The participants were sensitized thoroughly about the purpose of the study. The interviewer administered questionnaire (IAQ) was prepared in English language and translated into Tamil language.

Data analysis:-
The data analysis done by using Statistical Package of Social Science (SPSS v.20). Following the guidelines in the NAEPP Expert Panel Report 3 (7), we classified asthma control as well controlled, not well controlled by using four parameters: daytime symptoms, nighttime symptoms, interference with normal activity, and use of short-acting β2agonists (SABA) ( Table 1). This is a modified version of the 2007 NAEEP guidelines because it does not include very poorly controlled option and pulmonary function measures. Results:- Figure 01 Prevalence of level of asthma control.    Figure 04 explain about the triggering factors of asthma among not well control asthmatic patients. 35% of them state their asthma trigger by weather condition on the other hand 33% of them told that allergens such as pets, mice, cockroaches, dust, mold and cleaning supplies are triggering their disease.
Figure 05 describe about spacer device usage related to age. Here more than 65 years old, only 6.8% of them are using spacer device while inhaling their medication. But others not using at all. Taking inhaler is extremely helpful to 75.9% well controlled people where 24.1% of them in not well-controlled group state that taking inhaler is extremely helpful and also taking inhaler is having statistically significant association with level of asthma control. Most (73.4%) of well controlled patient getting puff when they feel coughing but only 26.6% taking puff in not well controlled category. The point where they are taking the puff also having statistically significant association with level of asthma control.

Discussion:-
The purpose of this cross sectional descriptive study was to identify influencing factors among poor asthma control patients who were following medical clinic at teaching hospital Batticaloa. Inhaler usage and appropriate time of taking medication are having a statistically significant association with not well asthma control where other variables does not show any statistically significant relationship.
In our study showed that 29% of the patients with asthma had not well-controlled asthma.
Asthma self-management education is necessary to provide persons with asthma and caregivers with the knowledge and skills to control and manage asthma (8,9). In our study respondents reported that low self-management education was given by health care providers; only 27.1% of the respondents received education in not wellcontrolled asthma group rest of them (72.8%) were not received health education.
Jamaan M Al-Zahrani et al (14) state in their study most of the education was received from physician (68%) with much less education received from the asthma educators. Same finding was seen in our study too most of the patient get educated from doctors rather than other health care professionals.
In well-controlled group 80% said, that meeting doctor is extremely helpful to them same finding obtained the study conducted by Al-Jahdali and colleagues (15)in the emergency setting, the majority of patients (81.4%) had a regular follow-ups in the community care clinic for asthma management.

Conclusion:-
In this study population, 29% of them are not well controlling their asthma disease and most of them (2.8%) does not received health education from the health care providers.
Inhaler usage and appropriate time of taking medication have statistically significant relationship with not wellcontrolled asthma it shows that their education, inhaler usage and proper time of inhalation of medicine have impact on poor asthma control.
In our study when we consider about the outpatient department visit in last year in not well control category 42.4% of them visited 1-3 times and received medical care. Patients who attending regularly to consult doctor, 80% of well-controlled patient stated it is extremely helpful to them. This brought the finding that when patient Poor attendance to the doctor due to poor symptom perception, failure of the physician to adhere to treatment guidelines, insufficient adherence by children and parents and the presence of extremely severe, therapy-resistant disease have all been proposed as possible reasons for suboptimal asthma control (10,(11)(12)(13).

Recommendation:-
The health education programme has much effect on asthma control and symptom management. Therefore, we have to provide optimum knowledge not only in health sectors but also in schools. We have to conduct screening programme annually that is more effective in controlling symptoms and prevent from complications.