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

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 the 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 health 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.