Drug Prescribing Patterns For Asthma

Asthma is a common chronic inflammatory disorder. According to WHO estimates, 235 million people suffer from asthma worldwide; India has an estimated 15-20 million asthmatics. Asthma management guidelines recommend a stepwise approach to initiating and adjusting anti-asthmatic therapy to patients with asthma. However, prescription patterns of these medications vary among doctors in different disciplines and settings.

An in-app survey was conducted on the WhiteCoats app to determine the prescribing patterns doctors follow to treat asthma patients. A total of 123 doctors from varying specialities participated in the survey that comprised of eight questions.

The questions asked were as follows-

What do you most commonly prescribe as monotherapy for asthma treatment? Which combination do you mostly prescribe to asthma patients? Are inhaled corticosteroids commonly prescribed? Which is the preferred route of administration of asthma medications? What are the common comorbidities that you encounter while treating asthmatics? How does knowing the smoking history help manage asthma patients? In what situations do you prescribe antibiotics to asthma patients? Do you prescribe generic drugs?

Inhaled corticosteroids are the most effective controllers used in the treatment of asthma and the only drugs that can effectively suppress the characteristic inflammation in asthmatic airways, even in very low doses. It was found that around 42% of doctors commonly prescribe inhaled corticosteroids as a monotherapy to treat asthma followed by oral beta-2 agonist (22.76%), inhaled adrenergic (13%), xanthine derivative (9%) and others.

It was also found that all these were mostly prescribed in combination with either anti-allergic drugs, anti-histamines, anti-inflammatory, bronchodilators or anticholinergics. Inhaled corticosteroids are most commonly and effectively used as a long-term control medication for asthma, around 84% of doctors commonly prescribe it.

Around 94% of doctors, preferred ‘inhalational’ as the most preferred route of administration of asthma medications. The most common comorbidities that were encountered while treating asthma were allergies of different kinds, obesity, hypertension, diabetes, respiratory infections, viral infections etc. Smoking is one of the most common risk factors associated with asthma. It can cause asthma “flare-ups” to happen more often. Passive smoking can also trigger asthma symptoms.

However, knowing the smoking history will definitely help manage asthma patients in counselling them to quit smoking, understanding the difference between asthma and COPD, preventing acute exacerbations/other complications and many others.

Most of the doctors are bound to prescribe antibiotics during acute exacerbations, viral/ bacterial infections, lower respiratory tract infections and many more. However, guidelines do not recommend prescribing antibiotics to people with asthma. It was found that around 40% of doctors prescribe generic drugs.

In order to expect a consistent asthma treatment with minimal antibiotic use, it’s very important to prescribe patterns that are in concordance with the published guidelines.

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