Asian Journal of Pharmaceutical Research and Health Care

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Drug Prescription Pattern in Pediatric Patients of Bronchial Asthma Attending Outpatient Department in a Private Hospital


Affiliations
1 PhD Scholar, Department of Pharmacology, Smt. Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed University, Piparia, Vadodara − 391760, Gujarat, India and Assistant Lecturer, Department of Pharmacology, MGM Medical College, Aurangabad − 431003, Maharashtra,, India
2 Professor, Dean, Department of Pharmacology, Symbiosis Medical College for Women, Symbiosis International (Deemed) University, Pune − 412115, Maharashtra, India
3 Junior Resident II, Department of Pharmacology, Dr. V. M. Government Medical College, Solapur − 413003, Maharashtra, India
 

Bronchial asthma, being a chronic airway disease, requires long-term pharmacotherapy. Since, a wide range of antiasthmatic drugs are available, study of prescription pattern is essential to promote rational use of drugs. The aim of the study was to evaluate prescription pattern in paediatric patients of bronchial asthma in a private hospital. An observational, non-interventional cross-sectional study was conducted in paediatric outpatient department at a private hospital in Aurangabad after institutional ethical clearance. Asthmatic children of either gender or age group 1-17 years were enrolled and patients details such as demographic details, drugs used etc. were filled in the specially designed case record form. Data was presented in percentages. SPSS software version 20.0 was used to analyse data using statistical test ANOVA. ‘P’ value ≤ 0.05 was considered as significant. Out of total 300 children enrolled in the study, 43.33% children had intermittent asthma, 16.33% had mild persistent, 21.34% had moderate persistent and 19% had severe persistent asthma. Asthma in majority of the children (40%) was partly controlled. Maximum study population was males of 6-10 years of age. Most of the children received multiple anti-asthmatic drugs (66%) and prevalence of two drug combinations was the highest (46%). Average drugs per prescription were 2.7. Inhalational route was preferred. Most commonly encountered anti-asthmatic drugs were short acting beta 2 agonists (74.33%) followed by inhalational corticosteroids (56.33%). Inhalational corticosteroid usage was profound in children with persistent asthma. Encounter with antibiotics was found to be 18.33%. All the drugs were prescribed by their brand names. Inhaled and oral corticosteroids were prescribed more often in children with persistent asthma than children with intermittent asthma and differences were statistically significant (p=0.001). However, no statistically significant difference was observed among intermittent and persistent asthma in terms of prescription of drugs like salbutamol, levosalbutamol, levosalbutamol plus ipratropium bromide and salmeterol plus fluticasone. The findings of the study suggested a rational approach in providing anti-asthmatic pharmacotherapy to children. Health care professionals seemed to be well versed with the current treatment guidelines. Only matter of concern is prescribing with brand names. Promotion of educational strategies and programmer will incur awareness about benefits of prescribing generic drugs.


Keywords

Anti-Asthmatic Drugs, Asthma, Outpatient Department, Paediatrics, Prescription Pattern.
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  • Global Initiative for Asthma. Global strategy for asthma management and prevention. 2019. Available from www.ginasthma.org.

  • Network GA. The Global Asthma Report, Auckland, New Zealand; 2018.

  • International Study of bronchial Asthma and Allergies in Childhood (ISAAC). Worldwide variations in the prevalence of bronchial asthma symptoms. Euro. Respir. J. 1998; 12:315-35. https://doi.org/10.1183/09031936.98.12020315. PMid: 9727780.

  • Pal R, Dahal S, Pal S. Prevalence of bronchial asthma in Indian children. Indian J. Community Med. 2009; 34:310-16. https://doi.org/10.4103/0970-0218.58389. PMid: 20165624, PMCid: PMC2822191.

  • Naik PB, Ravikumar P. Study of prevalence of bronchial asthma in school children of 6-12 years of age in rural schools of Tumakuru district. Indian J. Allergy Asthma Immunol 2017; 31:56-60. https://doi.org/10.4103/ijaai.ijaai_35_16.

  • Dartnell J. Activities to improve hospital prescribing. Aust. Prescr. 2001; 24:29-31. https://doi.org/10.18773/austprescr.2001.033.

  • International consensus report on diagnosis and treatment of asthma. National Heart, Lung, and Blood. Institute, National Institutes of Health. Bethesda, Maryland 20892. Publication No. 92-3091, March 1992; Eur. Respir. J. 1992; 5(5):509-11.

  • World Health Organization. Expert Committee. Geneva: World Health Organization; 1977. Report of a WHO 1977. The Selection of Essential Drugs; p. 7-35. WHO Technical Report Series, No. 615.

  • World Health Organization Medicine Strategy, 2008-2013. Geneva: WHO; 2008.

  • Batta A, Madan N, Kalra BS, Arora S. Prescription audit, drug utilization pattern and adverse drug reaction monitoring in outpatients of orthopedics department of Tertiary Care teaching hospital: A pilot study. MAMC J. Med. Sci. 2019; 5:77-82. https://doi.org/10.4103/mamcjms.mamcjms_33_19.

  • Jain S, Upadhyaya P, Goyal J, et al. A systematic review of prescription pattern monitoring studies and their effectiveness in promoting rational use of medicines. Perspect. Clin. Res. 2015; 6(2):86-90. https://doi.org/10.4103/2229-3485.154005. PMid: 25878953, PMCid: PMC4394586.

  • Parthasarthi G, Hansen KN, Nahata MC. A Textbook of Clinical Pharmacy Practice: Essential Concepts and Skills. India: Orient Blackswan; 2004. p. 496.

  • Rasmussen F, Taylor DR, Flannery EM, et al. Risk factors for hospital admission for asthma from childhood to young adulthood: A longitudinal population study. J. Allergy Clin. Immunol. 2002; 110:220-27. https://doi.org/10.1067/mai.2002.125295. PMid: 12170261.

  • Ghai OP. Essential Pediatrics, published by interprint A-16, Narain all, New Delhi, India. 4th edition; 1998.

  • NIH. Guidelines for the Diagnosis and Management of Asthma. Bethesda: National Institutes of Health (NIH); Publication No. 97-4051 A, May 1997. p. 41.

  • Chen Y, Stewart P, Johansen H, McRae L, Taylor G. Sex difference in hospitalization due to asthma in relation to age. J. Clin. Epidemiol. 2003; 56:180-87. https://doi.org/10.1016/S0895-4356(02)00593-0.

  • Garje YA, Suman RK, Kumar R, Deshmukh YA, Patra V. Prescribing patterns and pharmacoeconomic analysis of drugs used in paediatric asthma patients at Tertiary Care hospital. World J. of Pharm Pharmaceutical Sci. 2014; 3(6):1448-65.

  • Shah RD, Burute SR, Ramanand SJ, Murthy MB, Shah ND, Kumbhar AV. Drug utilization study in patients with bronchial asthma of a Tertiary Care hospital in Western Maharashtra. Indian J. Allergy Asthma Immunol. 2019; 33:105-11. https://doi.org/10.4103/ijaai.ijaai_17_19.

  • Ahmed A, Tanveer M, Khan GM, Hanif K. Prescribing and utilization trends of anti-asthmatic drugs amongst children in a Tertiary Care Hospital in Lahore, Pakistan. J. Pharm Prac. and Comm. Med. 2017; 3(2):70-75. https://doi.org/10.5530/jppcm.2017.2.17.

  • Robinson CL, Baumann LM, Romero K, et al. Effect of urbanisation on asthma, allergy and airways inflammation in a developing country setting. Thorax 2011; 66(12):1051-57. https://doi.org/10.1136/thx.2011.158956. PMid: 21730351, PMCid: PMC5523938.

  • Tripathy JP, Bahuguna P, Prinja S. Drug prescription behavior: A cross-sectional study in public health facilities in two states of North India. Perspect. Clin. Res. 2018; 9:76-82. https://doi.org/10.4103/picr.PICR_75_17. PMid: 29862200, PMCid: PMC5950614.

  • Kumar VB, Thankachan TM, Amanapu A, Chandra DS, Krishnan SP. Study of prescribing pattern and impact of pharmaceutical care in bronchial asthmatic paediatric patients in a Tertiary Care teaching hospital. Indian J. Pharm. Pract. 2015; 8:42-48. https://doi.org/10.5530/ijopp.8.1.8.

  • Hassali MA, Wong ZY, Alrasheedy AA, Saleem F, Mohamad Yahaya AH, Aljadhey H. Does educational intervention improve doctors’ knowledge and perceptions of generic medicines and their generic prescribing rate? A study from Malaysia. SAGE Open Med. 2014; 2. https://doi.org/10.1177/2050312114555722. PMid: 26770747, PMCid: PMC4607233.

  • De Boeck K, Vermeulen F, Meyts I, Hutsebaut L, Franckaert D, Proesmans M. Coprescription of antibiotics and asthma drugs in children. Pediatrics. 2011; 127(6):1022-26. https://doi.org/10.1542/peds.2009-3068. PMid: 21606144.

  • Mangione-Smith R, Krogstad P. Antibiotic prescription with asthma medications: Why is it so common? Pediatrics. 2011; 127(6):1174-76. https://doi.org/10.1542/peds.2011-0894. PMid: 21606148.

  • Trivedi N, Acharya H, Barvaliya M, Tripathi C. Prescribing pattern in patients of asthma visiting outpatient departments of a Tertiary Care hospital: A cross-sectional, observational study. Int. J. Basic & Clin. Pharmac. 2017; 6(3):587-91. https://doi.org/10.18203/2319-2003.ijbcp20170818.

  • Karki S, Mohanty IR, Potdar PV, et al. Assessment of prescribing patterns of drugs used in adult asthma patients at a Tertiary Care hospital. Int. J. Curr. Res. Med. Sci. 2017; 3(6):169-75. https://doi.org/10.22192/ijcrms.2017.03.06.022.

  • Prasad A, Pradhan SP, Datta PP, Samajdar SS, Panda P. Drug prescription pattern for bronchial asthma in a Tertiary Care hospital in Eastern India. Natl. J. Physiol. Pharm. Pharmacol. 2015; 5:263-66. https://doi.org/10.5455/njppp.2015.5.2002201531.

  • Ullmann N, Caggiano S, Cutrera R. Salbutamol and around. Ital. J. Pediatr. 2015; 41(Suppl 2):A74. https://doi.org/10.1186/1824-7288-41-S2-A74. PMCid: PMC4707606.

  • Robertson CF, Price D, Henry R, Mellis C, Glasgow N, Fitzgerald D, et al. Short-course montelukast for intermittent asthma in children: A randomized controlled trial. Am. J. Respir. Crit. Care Med. 2007; 175:323-29. https://doi.org/10.1164/rccm.200510-1546OC. PMid:17110643.

  • Bisgaard H, Zielen S, Garcia-Garcia ML, Johnston SL, Gilles L, Menten J, et al. Montelukast reduces asthma exacerbations in 2- to 5-year-old children with intermittent asthma. Am. J. Respir. Crit. Care Med. 2005; 171(4):315-22. https://doi.org/10.1164/rccm.200407-894OC. PMid:15542792.


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  • Drug Prescription Pattern in Pediatric Patients of Bronchial Asthma Attending Outpatient Department in a Private Hospital

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Authors

Sukhmeen Kaur
PhD Scholar, Department of Pharmacology, Smt. Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed University, Piparia, Vadodara − 391760, Gujarat, India and Assistant Lecturer, Department of Pharmacology, MGM Medical College, Aurangabad − 431003, Maharashtra,, India
Bhagya M. Sattigeri
Professor, Dean, Department of Pharmacology, Symbiosis Medical College for Women, Symbiosis International (Deemed) University, Pune − 412115, Maharashtra, India
Prashant Mishra
Junior Resident II, Department of Pharmacology, Dr. V. M. Government Medical College, Solapur − 413003, Maharashtra, India

Abstract


Bronchial asthma, being a chronic airway disease, requires long-term pharmacotherapy. Since, a wide range of antiasthmatic drugs are available, study of prescription pattern is essential to promote rational use of drugs. The aim of the study was to evaluate prescription pattern in paediatric patients of bronchial asthma in a private hospital. An observational, non-interventional cross-sectional study was conducted in paediatric outpatient department at a private hospital in Aurangabad after institutional ethical clearance. Asthmatic children of either gender or age group 1-17 years were enrolled and patients details such as demographic details, drugs used etc. were filled in the specially designed case record form. Data was presented in percentages. SPSS software version 20.0 was used to analyse data using statistical test ANOVA. ‘P’ value ≤ 0.05 was considered as significant. Out of total 300 children enrolled in the study, 43.33% children had intermittent asthma, 16.33% had mild persistent, 21.34% had moderate persistent and 19% had severe persistent asthma. Asthma in majority of the children (40%) was partly controlled. Maximum study population was males of 6-10 years of age. Most of the children received multiple anti-asthmatic drugs (66%) and prevalence of two drug combinations was the highest (46%). Average drugs per prescription were 2.7. Inhalational route was preferred. Most commonly encountered anti-asthmatic drugs were short acting beta 2 agonists (74.33%) followed by inhalational corticosteroids (56.33%). Inhalational corticosteroid usage was profound in children with persistent asthma. Encounter with antibiotics was found to be 18.33%. All the drugs were prescribed by their brand names. Inhaled and oral corticosteroids were prescribed more often in children with persistent asthma than children with intermittent asthma and differences were statistically significant (p=0.001). However, no statistically significant difference was observed among intermittent and persistent asthma in terms of prescription of drugs like salbutamol, levosalbutamol, levosalbutamol plus ipratropium bromide and salmeterol plus fluticasone. The findings of the study suggested a rational approach in providing anti-asthmatic pharmacotherapy to children. Health care professionals seemed to be well versed with the current treatment guidelines. Only matter of concern is prescribing with brand names. Promotion of educational strategies and programmer will incur awareness about benefits of prescribing generic drugs.


Keywords


Anti-Asthmatic Drugs, Asthma, Outpatient Department, Paediatrics, Prescription Pattern.

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DOI: https://doi.org/10.18311/ajprhc%2F2020%2F25261