Assessment of treatment pattern of childhood asthma reporting to outpatients’ facility of a tertiary care hospital in Lucknow, North India: A cross-sectional study

Abstract

Problem considered: Global initiative for Asthma (GINA) guidelines recommend a stepwise approach to instituting and adjusting therapy for children with asthma. The objective of this study was to describe the physicians prescribing patterns of childhood asthma, in accordance with GINA guidelines. Methods: This hospital-based, cross-sectional study was conducted after institutional ethical clearance. Children aged 1–12 years with asthma were recruited after parental consent from the outpatients’ department (OPD). Drugs used for the treatment of acute exacerbation of asthma and for long-term control of asthma were assessed as per the GINA 2009 guidelines. Qualification together with identity of treating physician was kept anonymous. Results: From August 2008 to August 2011, 250 children were recruited. Out of them, 35.2% had mild intermittent, 37.2% had mild persistent, 20% had moderate persistent and 7.6% had severe persistent asthma. There were 94.4% children with acute exacerbation of asthma. For the management of current episode of acute exacerbation of asthma, SABA through oral route (77.3%) was preferred over inhalation (22.7%). Antibiotics (53.4%) and antitussives (52.1%) were prescribed in considerable proportions of exacerbations. The prescription pattern of controller drugs was not in line with the GINA guidelines, as it did not vary much across asthma severity categories. As compared to intermittent asthma, children with persistent asthma were prescribed as and when required salbutamol more (OR = 2.5; 95% CI = 1.15–5.51; p = 0.018). None of the prescriptions have any documentation of evaluation of either severity of asthma or level of control of asthma. Conclusion: Prescription pattern of drugs for asthma exacerbation and long-term control do not correspond to GINA guidelines recommendations. Operative strategies aimed at implementing existing guidelines into daily practice are urgently needed.