Poor adherence and reasons for nonadherence to the asthma guidelines among pediatricians in Korea

Background: Information is limited regarding adherence to the asthma guidelines in Asia, especially for children. Objective: The aim of the study was to estimate adherence to the asthma guidelines, and investigate reasons for nonadherence. Methods: We conducted a cross-sectional questionnaire survey on the primary care pediatricians practicing in Incheon, Korea. Results: Surveys were returned by 81 of 131 eligible primary care pediatricians for a response rate of 61.8%. Almost all respondents (98.8%) had heard of the asthma guidelines, and most (93.8%) had read or received education about them. The classification of asthma severity was well understood with the accuracy of 85.7%. Correct responses for treatments were 51.3% for intermittent, 68.5% for mild persistent and 56.9% for moderate persistent asthma. For severe persistent asthma, the accuracy was high (85.7%). Only 21.5% of the respondents reported routine use of office peak flow measurement for patients with moderate or severe persistent asthma for diagnosis, and fewer (10.3%) used spirometry. A written action plan was reported to be given to only 5.2% of patients with asthma. The principal barrier to adherence was the presence of external barriers (lack of time, equipment, supporting staff etc.). Different barriers were prominent for different types of guideline components. Conclusions: There is poor adherence to the asthma guidelines in several aspects of their recommendations. Tailored interventions that address the current state of barriers need to be designed and implemented.