Respirology (2004) 9, 373–378 Blackwell Science, LtdOxford, UKRESRespirology1323-77992004 Blackwell Science Asia Pty LtdMay 200492373378Original Article Asthma in ThailandW Boonsawat et al. Correspondence: Watchara Boonsawat, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. Email: watcha_b@kku.ac.th Received 28 January 2003; revised and accepted for publication 8 January 2004. ORIGINAL ARTICLE Survey of asthma control in Thailand Watchara BOONSAWAT, 1 Poonkasem CHAROENPHAN, 2 Sumalee KIATBOONSRI, 2 Somkiat WONGTIM, 3 Vilaiwan VIRIYACHAIYO, 4 Chaicharn POTHIRAT 5 AND Nikom THANOMSIENG 6 1 Department of Medicine, Khon Kaen University, 2 Department of Medicine, Ramathibodi Hospital, 3 Department of Medicine, Chulalongkorn University, 4 Department of Medicine, Songkhla Nakarin University, 5 Department of Medicine, Chiang Mai University and 6 Faculty of Public Health, Khon Kaen University, Thailand Survey of asthma control in Thailand BOONSAWAT W, CHAROENPHAN P, KIATBOONSRI S, WONGTIM S, VIRIYACHAIYO V, POTHIRAT C, THANOMSIENG N. Respirology 2004; 9: 373–378 Objective: The aim of the study was to determine whether asthma management in Thailand is suc- ceeding in achieving the levels of control, specified in national and international asthma guidelines. Methodology: Adults with asthma in Bangkok, Chiang Mai, Songkhla, and Khon Kaen were inter- viewed, and we have reported on their asthma severity, morbidity, control, perception of asthma, and healthcare use. Results: A total of 466 asthma sufferers were interviewed. The burden of asthma was high, with 14.8% of respondents being hospitalized for their asthma in the past year. One-quarter of those sur- veyed had lost workdays as a result of their asthma, and most patients felt that their lifestyle was lim- ited. The majority of respondents had intermittent asthma (62.9%), 10.5% had mild persistent asthma, 17.6% had moderate persistent asthma, and 9.0% had severe persistent asthma; increasing severity was significantly associated with increased emergency healthcare use (P < 0.00001). Asthma sufferers greatly underestimated the severity of their condition. Only 36.0% used reliever medication, and use of inhaled corticosteroids was low at 6.7%. Understanding of the inflammatory basis of asthma was poor. Few patients underwent lung function tests or took peak flow meter readings. Conclusions: The burden of asthma is high in Thailand, and guidelines are not being followed. Encouraging greater use of inhaled corticosteroids will be an important step towards improving asthma control. Key words: asthma, control, management, Thailand. INTRODUCTION Asthma has become a major public health concern worldwide. 1 Recent advances in science and medicine have improved our understanding of asthma, but its prevalence appears to be increasing. 2,3 Furthermore, morbidity and mortality are still significant, and this is believed to be partly a result of under-use of pre- ventative treatment. 4 The Global Initiative for Asthma (GINA) guidelines, which aim to improve asthma care, were produced in 1995 by the National Heart, Lung and Blood Institute and the World Health Organization. 1 Two large-scale surveys of asthma management in Europe (Asthma Insights and Reality in Europe; AIRE) 5 and the USA (Asthma in America; AIA) 6 were undertaken several years after the publication of the guidelines. However, both reported disappointing data that showed asthma control in these regions falls far short of the goals defined for asthma management. 5,6 In two studies conducted in Bangkok and Khon Kaen as part of the International Study of Asthma and Allergy in Childhood (ISAAC) programme, the 12- month prevalence of wheezing in school-age children was reported to be around 10–13%. 7,8 However, there is a lack of published data reporting the prevalence of adult asthma in Thailand. Asthma management guidelines for Thailand were published in 1994–1995, 9 and revised in 1997–1998 following GINA recommendations. 10 The guidelines emphasize the role of airway inflammation in the