This document analyzes defects in asthma management based on a study of patients in Egypt. It finds that 13.8% of cases were misdiagnosed as asthma. General practitioners made up 41.3% of those managing asthma patients but had the highest rate of misdiagnosis at 22.1%. Guidelines for diagnosis, classification, and management were not properly followed in the majority of cases. Non-compliance was highest in patients treated by general practitioners at 100% compared to 85.5% for chest specialists. The main reasons for non-compliance were issues with inhaler therapy and corticosteroid therapy. Treatment failure occurred in nearly half of cases.

3. Table (1-A): Patient’s distribution by clinicians and clinical possibility (n.870)‏ ** P < 0.001 100.0 870 (100%)‏ 100.0 398 (45.7%)‏ 99.9 180 (20.7%)‏ 100.0 292 (33.6%)‏ Total 86.2** 13.8** 750 120 77.9** 22.1** 310 88 87.7** 12.2** 158 22 96.6** 3.4** 282 10 Correct ???? %  No. %  No. %  No. %  No. Total G.Ps Other specialities Chest speciality Item

5. Table (2): Ventilatory functions (n.750)‏ ** P < 0.001 100.0 750 (99.9%)‏ 100 310 (41.3%)‏ 9.9 158 (21.0%)‏ 99.9 282 (37.6%)‏ Total 10.8** 89.2** 81 669 0 100 0 310 12.0** 87.9** 19 139 21.9** 78.0** 62 220 Done Not done %  No. %  No. %  No. %  No. Total G.Ps Other specialities Chest speciality Item

6. Table (3): Diagnosis and classification according to GINA guidelines (n.750)‏ ** P < 0.001 99.9 750 (99.9%)‏ 100 310 (41.3%)‏ 100.0 158 (21.0%)‏ 100.0 282 (37.6%)‏ Total 8.5** 91.4** 64 686 0 100 0 310 10.8** 89.2** 16 142 17.0** 83.0** 48 234 Possible Not possible %  No. %  No. %  No. %  No. Total G.Ps Other specialities Chest speciality Item

7. Table (4): Compliance in management according to GINA guidelines (n.750)‏ ** P < 0.001 99.9 750 (99.9%)‏ 100 310 (41.3%)‏ 100.0 158 (21.0%)‏ 100.0 282 (37.6%)‏ Total 6.9** 93.0** 52 698 0 100 0 310 7.5** 92.4 12 146 14.2** 85.8** 40 242 Complying Not complying %  No. %  No. %  No. %  No. Total G.Ps Other specialities Chest speciality Item

8. Table (5): Compliance in management according to Egyptian guidelines (n. 750)‏ ** P < 0.001 99.9 750 (99.9%)‏ 100 310 (41.3%)‏ 100.0 158 (21.0%)‏ 100.0 282 (37.6%)‏ Total 6.9** 93.0** 52 698 0 180 0 310 7.6** 92.4 12 146 14.2** 85.8** 40 242 Complying Not complying %  No. %  No. %  No. %  No. Total G.Ps Other specialities Chest speciality Item

9. Table (6): Main items of non-compliance (n.698)‏ * P < 0.05 ** P < 0.001 100.0 698 (100%)‏ 100.0 310 (44.4%)‏ 100.0 146 (20.9%)‏ 99.9 242 (34.7%)‏ Total 40.2* 34.8* 25.0** 281 243 174 30.3 25.8 43.9** 94 80 136 51.4 41.1 - 7.5** 75 60 11 46.3 42.5 11.1** 112 103 27 Inhalation therapy Corticoid therapy Both %  No. %  No. %  No. %  No. Total G.Ps Other specialities Chest speciality Item

10. Table (7): Duration of treatment by clinicians (n.750)‏ ** P < 0.001 between patients managed by chest specialists and other patients, who also showed the same difference when less and more than three months duration were compared. 49.2** 50.7** 87.3** 12.7^^ 90.0** 10.0** 74.0** 25.9** 99.9 750 100.0 310 100.0 158 99.9 282 Total 36.8 14.6 22.6 5.5 20.4 276 110 170 41 153 76.8 7.1 6.1 5.2 4.8 238 22 19 16 15 13.9 19.6 53.8 7.6 5.1 22 31 85 12 78 5.6 20.23 23.4 4.6 46.1 16 57 66 13 130 < 1 month 1 - < 2 month 2 - < 3 month 3 - < 4 month 4 or more months %  No. %  No. %  No. %  No. Total G.Ps Other specialities Chest speciality Item

11. Table (8): Cause of non-compliance (n. 906)#. # More than one cause may be encountered in one patient. ** P < 0.001 99.9 906 (100%)‏ 100.0 34.4 (38.4%)‏ 99.8 221 (24.4%)‏ 99.9 337 (37.2%)‏ Total # 31.0 26.8 19.2 19.1 3.8 281 243 174 173 35 27.6 22.9 38.6** 6.3** 4.6 94 80 136 22 16 33.9 27.1 4.9** 30.3** 3.6 75 60 11 67 8 33.2 30.5 8.0** 24.9** 3.3 112 103 27 84 11 Inhalation phobia Corticoid phobia Both Cost Others %  No. %  No. %  No. %  No. Total G.Ps Other specialities Chest speciality Item

12. Table (9): Analysis of inhalation non-compliance (n.436)# # More than one cause may be encountered in one patient. ** P < 0.001 99.8 436 (99.9%)‏ 99.8 116 (26.6%)‏ 99.8 195 (30.9%)‏ 100.0 185 (42.4%)‏ Total # 33.2** 11.0** 15.8** 39.6** 145 49 69: 44 25 173 64.6** 12.9** 3.4** 18.9** 75 15 4: 2 2 22 22.9** 8.8** 18.5** 49.6** 31 12 25: 16 9 67 21.1** 11.9** 21.6** 45.4** 39 22 40: 26 14 84 Corticoid inhalation Non-corticoid inhalation Both: One vehicle > One vehicle Cost %  No. %  No. %  No. %  No. Total G.Ps Other specialities Chest speciality Item

13. Table (10): Analysis of corticoid non-compliance (n.395)# # More than one cause may be encountered in one patient. ** P < 0.001 99.9 395 (100%)‏ 100.0 94 (23.8%)‏ 99.8 126 (30.4%)‏ 99.9 181 (45.8%)‏ Total # 25.8 21.5 8.8** 43.8** 102 85 35: 22 13 173 36.2** 23.4** 17.0** 23.4** 34 22 16: 10 6 2.2 24.1** 13.3** 6.6** 55.8** 29 16 8: 5 3 67 21.5** 25.9** 6.1** 46.4** 39 22 11: 7 4 84 Corticoid inhalation Non-corticoid inhalation Both: One vehicle > One vehicle Cost %  No. %  No. %  No. %  No. Total G.Ps Other specialities Chest speciality Item

15. Table (12): Responsibility of management failure (n.570)‏ ** P < 0.001 99.9 570 (99.9%)‏ 99.9 288 (50.5%)‏ 99.9 117 (20.5%)‏ 100.0 165 (28.9%)‏ Total # 65.6** 18.4** 15.9 374 105 91 51.7** 22.9** 25.3 14.9 66 73 70.9** 18.8** 10.2 83 22 12 86.1 10.3 3.6 142 17 6 Patient’s factor Physician’s factor Both %  No. %  No. %  No. %  No. Total G.Ps Other specialities Chest speciality Item