Prescribing for Asthma in the Outpatient Clinics in Riyadh: Does it Follow the Guidelines?

Abstract

In order to reduce the significant morbidity and mortality associated with asthma, current guidelines recommend the use of anti-inflammatory therapy in a step-wise approach. To obtain information on how physicians are treating asthma, we evaluated prospectively 243 newly seen asthmatics in the outpatient clinics in four hospitals in Riyadh. The patients were assessed by five pulmonologists who confirmed the diagnosis, established the severity, recorded the medications patients were taking, and the specialty of the prescribing physician. The inhaler technique was checked and changes made in the treatment were also recorded. The medications prescribed were 6 agonists (inhaled 69%, oral 25%), steroids (inhaled 33%, systemic 8%), cough mixtures (30%), antibiotics (26%), theophylline (21%), and miscellaneous 16%. Over half of the patients (55%) were taking 6 agonists regularly. The most frequent changes made were as follows: adding steroids (inhaled 56%, systemic 27%, or increasing the inhaled dose 16%), starting inhaled 6 agonists (28%) and discontinuing theophylline (9%). The GPs were the group least inclined to prescribe inhaled steroids (P < 0.0001). The inhaler technique was poor in 53% of the patients. We conclude that in treating asthma, physicians are still relying more on bronchodilator and symptomatic therapy rather than anti-inflammatory therapy. There is also evidence to suggest overuse of antibiotics. Wide dissemination of the guidelines may alter the prescribing habits, and as many asthmatics are managed by GPs, this group in particular should be targeted.

Impact of ‘mild’ asthma on health outcomes: findings of a systematic search of the literature

“…57 Of asthma patients diagnosed as mild, many are treated inadequately, not according to guidelines. 13,27,35,39,[58][59][60][61][62][63][64] Ferrante and colleagues 58 reported that a high number of mild asthma patients were not taking any medication. Of those using medication, more than 50% were under-treated with steroids and more than 25% were undertreated with b 2 -agonists.…”

“…Of those using medication, more than 50% were under-treated with steroids and more than 25% were undertreated with b 2 -agonists. 59 Maintenance therapy results were worst in Italy where 76% of mild asthma patients were on inadequate concentrations of inhaled steroids compared with 24% in Slovakia and 9% in Norway. 60 Indeed, use of controller medication was about half as common in the mild intermittent class as in the other classes.…”

Prescribing Pattern of Asthma Therapy among Children with Asthma at Qassim Region, Saudi Arabia

“…Over half of the patients (55%) were using six agonists on a regular basis. Adding steroids (inhaled 56%, systemic 27%, or increasing the inhaled dosage 16%), beginning inhaled 6 agonists (28%), and stopping theophylline were the most common modifications undertaken (9%) [21]. From this study, it has been noted that an abrupt shift in prescribing xanthophylline derivatives (salbutamol, etc.)…”

Impact of Asthma Education Program on Asthma Knowledge of General Practitioners

“…13 Similar results were found in a recent local study by Mobaireek et al, who assessed the prescribing of medications for asthma in outpatient clinics in four large hospitals in Riyadh City. 14 Two approaches have been attempted in order to improve the quality of asthma care. The first consists of establishing unified clinical guidelines for the diagnosis and management of asthma.…”