A syndromic approach to assess diagnosis and management of patients presenting with respiratory symptoms to healthcare facilities in Vietnam

Wan-Chun Huang; Gregory J Fox; Ngoc Yen Pham; Thu Anh Nguyen; Van Giap Vu; Quy Chau Ngo; Viet Nhung Nguyen; Stephen Jan; Joel Negin; Thi Tuyet Lan Le; Guy B Marks

doi:10.1183/23120541.00572-2020

A syndromic approach to assess diagnosis and management of patients presenting with respiratory symptoms to healthcare facilities in Vietnam

ERJ Open Res. 2021 Mar 1;7(1):00572-2020. doi: 10.1183/23120541.00572-2020. eCollection 2021 Jan.

Authors

Wan-Chun Huang^{1

2

3}, Gregory J Fox^{1

4}, Ngoc Yen Pham¹, Thu Anh Nguyen¹, Van Giap Vu⁵, Quy Chau Ngo⁵, Viet Nhung Nguyen⁶, Stephen Jan⁷, Joel Negin⁸, Thi Tuyet Lan Le⁹, Guy B Marks^{1

2}

Affiliations

¹ Woolcock Institute of Medical Research, Hanoi, Vietnam.
² South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.
³ Division of Thoracic Medicine, Dept of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
⁴ Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁵ Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam.
⁶ National Tuberculosis Control Program of Vietnam, Hanoi, Vietnam.
⁷ Health Economics and Process Evaluation Program, George Institute for Global Health, Sydney, Australia.
⁸ School of Public Health, University of Sydney, Sydney, Australia.
⁹ Society of Asthma and Allergy & Clinical Immunology, Ho Chi Minh City, Vietnam.

Abstract

Background: The aim of the study was to establish syndromic diagnoses in patients presenting with respiratory symptoms to healthcare facilities in Vietnam and to compare the diagnoses with facility-level clinical diagnoses and treatment decisions.

Methods: A representative sample of patients aged ≥5 years, presenting with dyspnoea, cough, wheezing, and/or chest tightness to healthcare facilities in four provinces of Vietnam were systematically evaluated. Eight common syndromes were defined using data obtained.

Results: We enrolled 977 subjects at 39 facilities. We identified fixed airflow limitation (FAL) in 198 (20.3%) patients and reversible airflow limitation (RAL) in 26 (2.7%) patients. Patients meeting the criteria for upper respiratory tract infection (URTI) alone constituted 160 (16.4%) patients and 470 (48.1%) did not meet the criteria for any of the syndromes. Less than half of patients with FAL were given long-acting bronchodilators. A minority of patients with either RAL or FAL with eosinophilia were prescribed inhaled corticosteroids. Antibiotics were given to more than half of all patients, even among those with URTI alone.

Conclusion: This study identified a substantial discordance between prescribed treatment, clinician diagnosis and a standardised syndromic diagnosis among patients presenting with respiratory symptoms. Increased access to spirometry and implementation of locally relevant syndromic approaches to management may help to improve patient care in resource-limited settings.