Adherence to the National Guidelines on the management of bronchial asthma: a cross-sectional study in Medical Clinics in Teaching Hospital, Karapitiya

Abstract

Introduction: In persistent asthma, the regular use of inhaled corticosteroids (ICS) on daily basis is the mainstay of therapy. As little is known about the use of ICS in the local set up, this study was planned to identify how the ICS are used, compliance of patients and factors that limit the correct use of ICS. Objectives: To describe the adherence to the guidelines; in prescribing and dose titration and to assess the correct technique of using inhaler device. Also to describe patient factors that limit adherence to guidelines. Methods: This is a descriptive cross-sectional study involving 106 Physician-diagnosed bronchial asthmatics attending medical clinics in Teaching Hospital, Karapitiya. Results: Patients were between the age of 12-93 years. 67% were between 41-70 years. 67.9% patients were prescribed appropriate optimal treatment according to the guidelines. 67% of patients showed a good compliance to the prescribed medications. The commonest reasons for poor compliance were unaffordability of drugs (56.75%) and improvement of symptoms as felt by the patients (18.9%). Compliance declined with the duration of follow up. 64.2% were following the correct inhaler technique. The most critical step in the inhaler technique was the 'breath holding for 10 seconds' (only 41.3% adhered to this). Males were significantly (chi-square test; =0.01) better in practicing the proper inhaler technique as compared to females. Conclusions: Majority of patients need ICS as the primary treatment with some requiring long acting bronchodilators. Programs to improve the knowledge of doctors would be beneficial to improve the adherence to the guidelines. Supplying ICS free of charge by the hospital, at least in the initial years, and continuous health education would improve the compliance to ICS. The inhaler technique should be checked at least in non-responders. When checking the inhaler technique special attention should be paid to the ability of holding breath after inhalation and females are the most vulnerable group. Changing over to metered dose inhaler with a spacer device should not be delayed in repeated failures of dry powder inhalers. DOI: 10.4038/gmj.v15i1.2389 Galle Medical Journal Vol.15(1) 2010 pp.8-13