Availability, affordability and access to essential medications for asthma and chronic obstructive pulmonary disease in three low- and middle-income country settings

Siddharthan, Trishul; Robertson, Nicole; Rykiel, Natalie; Underhill, Lindsay J.; Rahman, Nihaal; Kafle, Sujan; Mohan, Sakshi; Padalkar, Roma; McKeown, Sarah; Flores-Flores, Oscar; Quaderi, Shumonta; Alupo, Patricia; Kalyesubula, Robert; Kirenga, Bruce; Luo, Jianxun; Cárdenas, María Kathia; Gianella, Gonzalo; Miranda, J. Jaime; Checkley, William; Hurst, John R.; Pollard, Suzanne L.

doi:10.1371/journal.pgph.0001309

Cited by 4 publications

(14 citation statements)

References 31 publications

(41 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among them, montelukast was more frequent than others; it mainly exhibited promising findings in faster recovery and reduced inflammatory cytokines, indicating it may be a practical COVID‐19 therapeutic choice 24 . The pattern of respiratory drug prescribing was nearly similar to that of lower‐middle‐income countries such as Nepal, Peru, and Uganda, which suggested that prescribers used the usual pattern of respiratory drugs according to the country's economic conditions, even in COVID‐19 cases 28 . Gastrointestinal diseases are one of the most frequent problems in Bangladesh 29 ; therefore, antiulcerant medications might be given to maximum patients (84.34%).…”

Section: Discussionmentioning

confidence: 90%

“…24 The pattern of respiratory drug prescribing was nearly similar to that of lowermiddle-income countries such as Nepal, Peru, and Uganda, which suggested that prescribers used the usual pattern of respiratory drugs according to the country's economic conditions, even in COVID-19 cases. 28 Gastrointestinal diseases are one of the most frequent problems in Bangladesh 29 ; therefore, antiulcerant medications might be given to maximum patients (84.34%). Fever and body aches are also common symptoms of COVID-19 patients; this may be the reason for the frequent prescribing of paracetamol in this study.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Prescription patterns in an intensive care unit of COVID‐19 patients in Bangladesh: A cross‐sectional study

Rahman,

Islam,

Paul

et al. 2023

Health Science Reports

View full text Add to dashboard Cite

Background and AimsTo reduce death rates for critical patients hospitalized in intensive care units (ICUs), coronavirus (COVID‐19) lacks proven and efficient treatment methods. This cross‐sectional study aims to evaluate how physicians treat severe and suspected COVID‐19 patients in the ICU department in the absence of an established approach, as well as assess the rational use of the medication in the ICU department.MethodsBetween June 16, 2021, and December 10, 2022, a total of 428 prescriptions were randomly gathered, including both suspected (yellow zone) and confirmed (red zone) COVID‐19 patients. For data management, Microsoft Excel 2021 was utilized, while STATA 17 provided statistical analysis. To find associations between patients' admission status and demographic details, exploratory and bivariate analyses were conducted.ResultsOf the 428 patients admitted to the ICU, 228 (53.27%) were in the yellow zone and 200 (46.73%) were in the verified COVID‐19 red zone. The majority of patients were male (54.44%), and the age range from 41 to 60 was the most common (41.82%). No significant deviation was detected to the yellow and red groups' prescription patterns. A total of 4001 medicines (mean 9.35/patient) were prescribed. Antiulcerants, antibiotics, respiratory, analgesics, anticoagulants, vitamins and minerals, steroids, cardiovascular, antidiabetic drugs, antivirals, antihistamines, muscle relaxants, and antifungal treatments were widely prescribed drugs. Enoxaparin (67.06%) appeared as the most prescribed medicine, followed by montelukast (60.51%), paracetamol (58.41%), and dexamethasone (51.64%).ConclusionThe prescription patterns for the yellow and red groups were comparable and mostly included symptomatic treatment. Respiratory drugs constituted the most frequent therapeutic class. Polypharmacy should be taken under considerations. In ICU settings, the outcomes emphasize the need of correct diagnosis, cautious antibiotic usage, suitable therapy, and attentive monitoring.

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Prescription patterns in an intensive care unit of COVID‐19 patients in Bangladesh: A cross‐sectional study

Rahman,

Islam,

Paul

et al. 2023

Health Science Reports

View full text Add to dashboard Cite

show abstract

“…This is not surprising given the low availability of both monotherapies and combination inhaler therapies in this setting, with less than 50% availability in most health facilities and pharmacies 42. These medications are also largely unaffordable to these patients as it costs up to 3 days wages to afford the monthly cost of treating COPD 43. This highlights the need to find affordable treatment options for these patients, or policy-level interventions to subsidise inhaler costs in this setting.…”

Section: Discussionmentioning

confidence: 99%

“… 42 These medications are also largely unaffordable to these patients as it costs up to 3 days wages to afford the monthly cost of treating COPD. 43 This highlights the need to find affordable treatment options for these patients, or policy-level interventions to subsidise inhaler costs in this setting.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and phenotypes of a COPD cohort from referral hospital clinics in Uganda

Alupo,

Mugenyi,

Katagira

et al. 2024

BMJ Open Resp Res

Self Cite

View full text Add to dashboard Cite

IntroductionChronic obstructive pulmonary disease (COPD) is a heterogeneous condition with varied clinical and pathophysiological characteristics. Although there is increasing evidence that COPD in low-income and middle-income countries may have different clinical characteristics from that in high-income countries, little is known about COPD phenotypes in these settings. We describe the clinical characteristics and risk factor profile of a COPD population in Uganda.MethodsWe cross sectionally analysed the baseline clinical characteristics of 323 patients with COPD aged 30 years and above who were attending 2 national referral outpatient facilities in Kampala, Uganda between July 2019 and March 2021. Logistic regression was used to determine factors associated with spirometric disease severity.ResultsThe median age was 62 years; 51.1% females; 93.5% scored COPD Assessment Test >10; 63.8% modified medical research council (mMRC) >2; 71.8% had wheezing; 16.7% HIV positive; 20.4% had a history of pulmonary tuberculosis (TB); 50% with blood eosinophilic count >3%, 51.7% had 3 or more exacerbations in the past year. Greater severity by Global initiative for Chronic Obstructive Lung Disease (GOLD) stage was inversely related to age (aOR=0.95, 95% CI 0.92 to 0.97), and obesity compared with underweight (aOR=0.25, 95% CI 0.07 to 0.82). Regarding clinical factors, more severe airflow obstruction was associated with SPO2<93% (aOR=3.79, 95% CI 2.05 to 7.00), mMRC ≥2 (aOR=2.21, 95% CI 1.08 to 4.53), and a history of severe exacerbations (aOR=2.64, 95% CI 1.32 to 5.26).ConclusionPatients with COPD in this population had specific characteristics and risk factor profiles including HIV and TB meriting tailored preventative approaches. Further studies are needed to better understand the pathophysiological mechanisms at play and the therapeutic implications of these findings.

show abstract

“…Participants were randomly selected from study area censuses, regardless of respiratory symptoms, a prior diagnosis of COPD, St. George’s Respiratory Questionnaire (SGRQ) scores, or exacerbation history at baseline. We made a pragmatic choice not to require guideline-recommended maintenance therapy because of the extremely low availability and affordability of these therapies in these settings ( 17 ).…”

Section: Methodsmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease Self-Management in Three Low- and Middle-Income Countries: A Pilot Randomized Trial

Pollard,

Siddharthan,

Hossen

et al. 2023

Am J Respir Crit Care Med

Self Cite

View full text Add to dashboard Cite

Objectives Chronic obstructive pulmonary disease (COPD) disproportionately affects low- and middle-income countries. Health systems are ill prepared to manage the increase in COPD cases. Methods We performed a pilot effectiveness-implementation randomized field trial of a community health worker (CHW)-supported, 1-year self-management intervention in individuals with COPD grades B–D. The study took place in low-resource settings of Nepal, Peru, and Uganda. The primary outcome was the St. George’s Respiratory Questionnaire (SGRQ) score at 1 year. We evaluated differences in moderate to severe exacerbations, all-cause hospitalizations, and the EuroQol score (EQ-5D-3 L) at 12 months. Measurements and Main Results We randomly assigned 239 participants (119 control arm, 120 intervention arm) with grades B–D COPD to a multicomponent, CHW-supported intervention or standard of care and COPD education. Twenty-five participants (21%) died or were lost to follow-up in the control arm compared with 11 (9%) in the intervention arm. At 12 months, there was no difference in mean total SGRQ score between the intervention and control arms (34.7 vs. 34.0 points; adjusted mean difference, 1.0; 95% confidence interval, −4.2, 6.1; P = 0.71). The intervention arm had a higher proportion of hospitalizations than the control arm (10% vs. 5.2%; adjusted odds ratio, 2.2; 95% confidence interval, 0.8, 7.5; P = 0.15) at 12 months. Conclusions A CHW-based intervention to support self-management of acute exacerbations of COPD in three resource-poor settings did not result in differences in SGRQ scores at 1 year. Fidelity was high, and intervention engagement was moderate. Although these results cannot differentiate between a failed intervention or implementation, they nonetheless suggest that we need to revisit our strategy. Clinical trial registered with www.clinicaltrials.gov (NCT03359915).

show abstract

Availability, affordability and access to essential medications for asthma and chronic obstructive pulmonary disease in three low- and middle-income country settings

Cited by 4 publications

References 31 publications

Prescription patterns in an intensive care unit of COVID‐19 patients in Bangladesh: A cross‐sectional study

Prescription patterns in an intensive care unit of COVID‐19 patients in Bangladesh: A cross‐sectional study

Characteristics and phenotypes of a COPD cohort from referral hospital clinics in Uganda

Chronic Obstructive Pulmonary Disease Self-Management in Three Low- and Middle-Income Countries: A Pilot Randomized Trial

Contact Info

Product

Resources

About