Raja Ahsan AFTAB, Amer Hayat KHAN, Syed Azhar SYED SULAIMAN, Irfhan ALI, Azmi HASSALI, Fahad SALEEM

An assessment of adherence to asthma medication guidelines: findingsfrom a tertiary care center in the state of Penang, Malaysia

Background/aim: Multiple asthma guidelines have been developed to reduce asthma mortality, morbidity, and cost associated with asthma worldwide. In Malaysia, within this context, it is relatively unknown to what extent doctors adhere to the asthma guidelines. This study aimed to assess guideline adherence and calculate the cost of adhered and nonadhered prescriptions by medical doctors in a public tertiary health care facility. Materials and methods: A cross-sectional study was carried out at Hospital Pulau Pinang, Malaysia. One hundred and eighty patients, a total of 30 patients per doctor, were enrolled to assess guideline adherence. The patients were followed for a second visit to assess their lung function. The costs of adhered and nonadhered prescriptions were calculated. Results: One hundred and forty-three patients (79%) received guideline (Global Initiative for Asthma 2011)-adhering pharmacotherapy. In the majority of patients (n = 133, 73.9%) asthma control was classified as partially controlled. There was no significant association observed between patient asthma control and patient demographics; however, there was a significant difference (P < 0.001) between lung function values from the first and second visits. The cost of adhered prescription was higher (70.1 Malaysian ringgit) than that of nonadhered prescription (13.74 Malaysian ringgit). Conclusion: Fair levels of guideline adherence were observed. Emphasis should be placed on identifying appropriate cost-effective medication regimens based on patient asthma control and constant feedback from patients.

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1. Price D, Thomas M. Breaking new ground: challenging existing asthma guidelines. BMC Pulm Med 2006; 6: 6.
2. Bahadori K, Doyle-Waters MM, Marra C, Lynd L, Alasaly K, Swiston J, FitzGerald JM. Economic burden of asthma: a systematic review. BMC Pulm Med 2009; 9: 24.
3. Russels B. European Lung White Book. Brussels, Belgium: Respiratory Society and the Lung Foundation; 2003.
4. Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. New Engl J Med 1992; 326: 862- 866.
5. Laumann JM, Bjornson DC. Treatment of Medicaid patients with asthma: comparison with treatment guidelines using disease-based drug utilization review methodology. Ann Pharmacother 1998; 32: 1290-1294.
6. Donahue JG, Weiss ST, Livingston JM, Goetsch MA, Greineder DK, Platt R. Inhaled steroids and the risk of hospitalization for asthma. JAMA-J Am Med Assoc 1997; 277: 887-891.
7. Lai CK, Kim YY, Kuo SH, Spencer M, Williams AE. Cost of asthma in the Asia-Pacific region. European Respiratory Review 2006; 15: 10-16.
8. Zainudin BMZ. Guideline for Management of Adult Asthma. Kuala Lumpur, Malaysia: Academy of Medicine of Malaysia; 1996. Available online at http://www.acadmed.org.my/index. cfm?&menuid=28.
9. Chapman KR, Ernst P, Grenville A, Dewland P, Zimmerman S. Control of asthma in Canada: failure to achieve guideline targets. Can Respir J 2001; 8: 35A.
10. Legorreta AP, Christian-Herman J, OConnor RD, Hasan MM, Evans R, Leung KM. Compliance with national asthma management guidelines and specialty care: a health maintenance organization experience. Arch Intern Med 1998; 158: 457-464.
11. Taylor DM, Auble TE, Calhoun WJ, Mosesso VN Jr. Current outpatient management of asthma shows poor compliance with international consensus guidelines. Chest 1999; 116: 1638-1645.
12. Sun YH, Eun BW, Sim SY, Cho KH, Ryoo E, Cho DY, Son DW, Tchah H, Jeon IS. Poor adherence and reasons for nonadherence to the asthma guideline among pediatricians in Korea. Asian Pac J Allergy Immunol 2010; 28:147-154.
13. Kitch BT, Paltiel AD, Kuntz KM, Dockery DW, Schouten JP, Weiss ST, Fuhlbrigge AL. A single measure of FEV1 is associated with risk of asthma attacks in long-term follow-up. Chest 2004; 126: 1875-1882.
14. Roorda RJ, Gerritsen J, Vanaalderen WMC, Schouten JP, Veltman JC, Weiss ST, Knol KM. Follow-up of asthma from childhood to adulthood: influence of potential childhood risk factors on the outcome of pulmonary function and bronchial responsiveness in adulthood. J Allergy Clin Immunol 1994; 93: 575-584.
15. Balkrishnan R, Norwood GJ, Anderson A. Outcomes and cost benefits associated with the introduction of inhaled corticosteroid therapy in a Medicaid population of asthmatic patients. Clin Ther 1998; 20: 567-580.
16. Jaques PA, Kim CS. Measurement of total lung deposition of inhaled ultrafine particles in healthy men and women. Inhal Toxicol 2000; 12: 715-731.
17. Tal A1, Simon G, Vermeulen JH, Petru V, Cobos N, Everard ML, de Boeck K. Budesonide/formoterol in a single inhaler versus inhaled corticosteroids alone in the treatment of asthma. Pediatr Pulmonol 2002; 34: 342-350.