ASSESSMENT OF PRESCRIPTION PATTERN AND

DRUG UTILIZATION OF ASTHMA MEDICATION IN

HOSPITALS OF RUPANDEHI DISTRICT

Presented by: Niraj Adhikari

B.pharma, 6th sem

07/17/2022 pharmaceutical seminar 5 1

 Content
• Introduction
• Materials and methods
• Results
• Discussion
• Conclusion
• Reference

07/17/2022 pharmaceutical seminar 5 2

 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.

07/17/2022 pharmaceutical seminar 5 3

 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.

07/17/2022 pharmaceutical seminar 5 4

 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.

07/17/2022 pharmaceutical seminar 5 5

 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.
07/17/2022 pharmaceutical seminar 5 6
 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.

07/17/2022 pharmaceutical seminar 5 7

 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.

07/17/2022 pharmaceutical seminar 5 8

 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.

07/17/2022 pharmaceutical seminar 5 9

 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.

07/17/2022 pharmaceutical seminar 5 10

 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.

07/17/2022 pharmaceutical seminar 5 11

 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.

07/17/2022 pharmaceutical seminar 5 12

 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.

07/17/2022 pharmaceutical seminar 5 13

 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

07/17/2022 pharmaceutical seminar 5 14

 Smoking history
Smoking history of patient

35
% smoking
65
non-smoking
%

07/17/2022 pharmaceutical seminar 5 15

 Gender
gender

45%
55% female
male

07/17/2022 pharmaceutical seminar 5 16

 Habitat
Habitat wise distribution of patient

50.00%
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Rupandehi Nawalparashi kapilvastu others

07/17/2022 pharmaceutical seminar 5 17

 Distribution of patient by occupation

occupation
25.00%
20.00%
15.00%
10.00%
5.00%
0.00% occupation
dr
y
e rs ess red e rs
an ak si n eti h
b u r ot
us em b rs/
h om e
al h o l d
im h
/ an jo
b
i ng
rm
fa

07/17/2022 pharmaceutical seminar 5 18

 Common triggering factors in patient

triggering factors
30.00%

25.00%

20.00%
triggering factors
15.00%

10.00%

5.00%

0.00%
dust smoke cold exer… others infec…

07/17/2022 pharmaceutical seminar 5 19

 Distribution of anti-asthmatic agents in
patient of crimson hospital
therapeutic agents (crimson hospital)
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00% therapeutic agents
(crimson hospital)
10.00%
5.00%
0.00%
i ds to rs
e n e o n
tics
ero i l a t ri n ati b io
o st o d ko bi nti
c h u m a
rti nc le co
o o
c br

07/17/2022 pharmaceutical seminar 5 20

 Distribution of anti-asthmatic agents in
patient of chauraha hospital
chauraha hospital
40%
35%
30%
25%
20%
15%
10%
5% chauraha hospital
0%
i ds o rs i st on tics
ro t n ti o
te i la ago
i n a bi
cos h od ant m
b
an
ti
rti n c e co
o o n
c br t rie
u ko
le

07/17/2022 pharmaceutical seminar 5 21

 Route of administration
crimson hospital
80%
70%
60%
50%
crimson hospital
40%
30%
20%
10%
0%
oral parenteral inhalation

07/17/2022 pharmaceutical seminar 5 22

 Contd…
chauraha hospital
70.00%

60.00%

50.00%

40.00% chauraha hospital

30.00%

20.00%

10.00%

0.00%
oral parenteral inhalation

07/17/2022 pharmaceutical seminar 5 23

 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.
07/17/2022 pharmaceutical seminar 5 24
 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 16.9
budesomide
6 Montelukast 3.65
7 Iprabromide 5.47
8 Antibiotics 10.04
9 Combination drugs 12.32
10 Others 3.65

07/17/2022 pharmaceutical seminar 5 25

 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 10.34
budesonide
6 Montelukast 5.17
7 Iprabromide 3.44
8 Antibiotics 12
9 Combination drugs 5.17
10 Others 15.51

07/17/2022 pharmaceutical seminar 5 26

 Combined vs monotherapy
crimson hospita therapy
100%
90%
80%
70%
60%
crimson hospita therapy
50%
40%
30%
20%
10%
0%
monotherapy combined therpy

07/17/2022 pharmaceutical seminar 5 27

 Contd…
chauraha hospital therapy
100%
90%
80%
70%
60%
chauraha hospital therapy
50%
40%
30%
20%
10%
0%
monotherapy combined therapy

07/17/2022 pharmaceutical seminar 5 28

 Drug therapy regimen
drug therapy regimen(crimson)
35.00%
30.00%
25.00%
20.00%
drug therapy reg-
15.00% imen(crimson)
10.00%
5.00%
0.00%
single two drug three four drug more
drug drug than four
drugs

07/17/2022 pharmaceutical seminar 5 29

 Contd…
DTR(chauraha hospital)
40.00%
35.00%
30.00%
25.00%
20.00%
DTR(chauraha hospital)
15.00%
10.00%
5.00%
0.00%
single two three four more
drug drugs drugs drugs than 4
drugs

07/17/2022 pharmaceutical seminar 5 30

 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.

07/17/2022 pharmaceutical seminar 5 31

 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.

07/17/2022 pharmaceutical seminar 5 32

 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.
07/17/2022 pharmaceutical seminar 5 33
 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%).
07/17/2022 pharmaceutical seminar 5 34
 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).
07/17/2022 pharmaceutical seminar 5 35
 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
07/17/2022 pharmaceutical seminar 5 36
 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).

07/17/2022 pharmaceutical seminar 5 37