Asthma medication in hospital od rupandehi district

1. ASSESSMENT OF PRESCRIPTION
PATTERN AND DRUG UTILIZATION
OF ASTHMA MEDICATION IN
HOSPITALS OF RUPANDEHI DISTRICT
Presented by: Niraj Adhikari
B.pharma, 6th sem
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2. Content
• Introduction
• Materials and methods
• Results
• Discussion
• Conclusion
• Reference
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3. Introduction
• Asthma is defined as the chronic bronchial
inflammation causing swelling and airways
constriction, resulting in breathing difficulties.
• Several factors such as aeroallergens, drugs,
chemicals, exercise, genetic
predisposition, cold and dry air, infections and
emotions can aggravate the symptoms and
precipitate the attacks.
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4. Contd…
• According to the latest WHO data published in
2017, asthmatic deaths in Nepal reached 3,317
or 2.03% of total deaths.
• The age adjusted death rate is 16.38 per
100,000 of population ranks Nepal number 26
in the world.
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5. Contd..
• Asthma is under diagnosed and under-treated,
creating a substantial burden to individuals and
families and possibly restricting individual’s
activities for a life-time.
• The primary goal is prevention of life-
threatening asthma by early detection and early
intervention.
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6. Contd..
• In order to improve patient’s health,
pharmaceutical care has to be implemented by
clinical pharmacist which includes activity like
monitoring patient’s symptoms, counseling about
their medications, helping to result drug related
problem.
• Previous studies have shown that there is
considerable room for improvement in adherence
to asthma medication treatment.
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7. Contd..
• Because poor adherence may reduce the
likelihood of achieving and maintaining good
asthma control, it is important that adherence to
prescribed asthma medication be addressed by the
health care providers during follow-up
consultation.
• Drug utilization studies are important tools to
assess current prescription practices against
standard guidelines and help in rationalizing the
management.
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8. Materials and methods
 Study design
• A prospective study was conducted for six
months. The ethical consideration of the study
was approved by NHRC and official unit of
Crimson Hospital and Chauraha Hospital.
• Patient with asthma was interviewed verbally
as well as prescription was viewed to fill the
patient profile form.
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9. Contd..
Study site
• The study was conducted in Crimson Hospital
and Chauraha Hospital of Rupandehi district,
Western Nepal.
• Sample size
• 111 patients were involved in our study who
confirmed to our predetermined exclusion and
inclusion criteria.
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10. Contd..
Inclusion criteria
• 1. Population of patients of either sex.
• 2. Population with all the age groups.
• 3. Patients with diagnosed asthma and
bronchial symptoms, who are willing to be
enrolled in the study with consent.
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11. Contd..
Exclusion criteria
• 1. Patient with other concomitant diseases
along with asthma (like, tuberculosis, cancer,
MI and leprosy).
• 2. Patients with mental illness.
• 3. Patients who refused to give their consent.
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12. Contd…
Result analysis
• The data was entered in MS excel, SPSS and
analyzed different parameters like mean, ± SD,
bar diagram, pie chart of distribution of age,
gender, religion, address, smoking history
along with the route, drug therapy regimen,
drugs used in prescription of the patient.
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13. Results
• 111 asthma prescriptions were included in our
study as per the inclusion and exclusion
criteria.
• The various parameter analyzed are as follows.
• 1) Age: patient were classified into 5 different
groups where patient age greater than 60 were
found to be most suffering age group.
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14. Table1: age distribution of patients
S.No Age group(in years) No. of patient
1 1-16 3
2 17-30 3
3 31-45 8
4 46-60 20
5 >60 77
Total 111
Mean 59.9
±SD ±14.13
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15. Smoking history
Smoking history of patient
smoking
non-smoking
65%
35%
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16. Gender
gender
female
male
55%
45%
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17. Habitat
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
Rupandehi Nawalparashi kapilvastu others
Habitat wise distribution of patient
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18. Distribution of patient by occupation
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
occupation
occupation
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19. Common triggering factors in patient
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
dust smoke cold exer… others infec…
triggering factors
triggering factors
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20. Distribution of anti-asthmatic agents in
patient of crimson hospital
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
therapeutic agents (crimson hospital)
therapeutic agents
(crimson hospital)
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21. Distribution of anti-asthmatic agents in
patient of chauraha hospital
0%
5%
10%
15%
20%
25%
30%
35%
40%
chauraha hospital
chauraha hospital
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22. Route of administration
0%
10%
20%
30%
40%
50%
60%
70%
80%
oral parenteral inhalation
crimson hospital
crimson hospital
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23. Contd…
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
oral parenteral inhalation
chauraha hospital
chauraha hospital
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24. Medications
• In crimson hospital
• The combination drug formeterol, glucocorticoids
and budesonide (16.9%) and salmeterol (16.9%)
were the most prescribed drugs which is given
below in table 2.
• In chauraha hospital
• The drug salbutamol (13.79%) and salmeterol
(13.79%) were most prescribed which is shown in
table 3.
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25. Table2: different medication used in
asthma patients in crimson hospital
s.n. Different drugs used %
1 cortocosteroids 9.1
2 Salmeterol 16.9
3 Salbutamol 10.04
4 Tiotropium bromide 11.87
5 Combo. Of formeterol, glucocorticoid and
budesomide
16.9
6 Montelukast 3.65
7 Iprabromide 5.47
8 Antibiotics 10.04
9 Combination drugs 12.32
10 Others 3.65
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26. Table3: different medication used in
asthma patient in chauhara hospital
s.n. Drugs used %
1 Corticosteroids 8.9
2 Salmeterol 13.79
3 Salbutamol 13.79
4 Tiotropium bromide 12
5 Combo. Of formeterol, glucocorticoid and
budesonide
10.34
6 Montelukast 5.17
7 Iprabromide 3.44
8 Antibiotics 12
9 Combination drugs 5.17
10 Others 15.51
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27. Combined vs monotherapy
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
monotherapy combined therpy
crimson hospita therapy
crimson hospita therapy
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28. Contd…
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
monotherapy combined therapy
chauraha hospital therapy
chauraha hospital therapy
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29. Drug therapy regimen
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
single
drug
two drug three drug four drug more than
four drugs
drug therapy regimen(crimson)
drug therapy
regimen(crimson)
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30. Contd…
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
single
drug
two
drugs
three
drugs
four
drugs
more
than 4
drugs
DTR(chauraha hospital)
DTR(chauraha hospital)
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31. Discussion
• The result of our study allowed us the
assessment of prescription pattern and drug
utilization of asthma medication in different
hospitals of Rupandehi district, Nepal.
• The main aim of the study was to assess
prescription pattern and drug utilization of
asthma medications.
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32. Contd..
• In our study, the total of 111 patients were
taken and it showed that the age group above
60 (69.36%) constituted the highest number of
asthmatic patient and lowest number in the
group below 30 where both the age group 1-16
and 17-30 were 2.7% and Mean ± SD is 59.9 ±
14.13.
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33. Contd..
• A similar type of study conducted at a tertiary
hospital in Dubai, United Arab Emirates, showed
a result with age group 0-10 (41.6%) followed by
above 70 (11.0%), 41-50 (10.4%), 31-40 (9.1%),
51-60 (8.4%), 61-70 (7.8%), 21-30 (7.8%) and
11-20 (3.9%).
• This is because our study was conducted from
March to August which are summer months and
we included patients with COPD in our study.
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34. Contd..
• A similar type of study conducted at BPKIHS,
Dharan, Nepal and showed result with less than
30 (27.2%) and above 50 (27.4%) followed by
42-49 (23.2%) and 30-39 (22.1%), and mean ±
SD is 40.4 ± 13.37.
• A similar type of study conducted at Nemmh
Chest Clinic in Ethiopia and the result showed
that 21.3% of them were employed followed by
farmer (16.7%), house wife (10.9%), merchant
(8%) and students (5.17%).
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35. Contd…
• A similar type of study conducted at Copenhagen
University Hospital, Denmark, showed a result
with current smokers (2467) followed by non-
smokers (2304) and ex-smokers (920).
• A similar type of study conducted at Dehradun
Hospital, showed results with methylxanthine
(80) followed by β-agonist (66), corticosteroids
(56), antihistaminics (28) and leukotriene
antagonists (14).
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36. Conclusion
• In our study, we found that the prescription of
bronchodilators was highest (41% in Crimson Hospital
and 35.6% in Chauraha Hospital) followed by
combination drug (26.5% in Crimson Hospital and
25.4% in Chauraha Hospital), corticosteroids (14.1% in
Crimson Hospital and 17% in Chauraha Hospital),
antibiotics (13.7% in Crimson Hospital and 13.5% in
Chauraha Hospital) and leukotriene antagonist (4.5% in
Crimson Hospital and 8.5% in Chauraha Hospital).
• Also, inhalational was the most prescribed route of
administratio
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37. Reference
• Mukesh et al.(2020) Assessment of
prescription pattern and drug utilization of
asthma medication in hospitals of rupandehi
district, world journal of pharmacy and
pharmaceutical science, 9(1), pp(929-945).
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