Prescribing for asthma in the outpatient clinics in Riyadh: Does it follow the guidelines?

In order to reduce the significant morbidity and mortality associated with asthma, current guidelines recommend the use of anti-inflammatory therapy in a step-wise approach. To obtain information on how physicians are treating asthma, we evaluated prospectively 243 newly seen asthmatics in the outpatient clinics in four hospitals in Riyadh. The patients were assessed by five pulmonologists who confirmed the diagnosis, established the severity, recorded the medications patients were taking, and the specialty of the prescribing physician. The inhaler technique was checked and changes made in the treatment were also recorded. The medications prescribed were ss agonists (inhaled 69%, oral 25%0, steroids (inhaled 33%, systemic 8%), cough mixtures (30%), antibiotics (26%), theophylline (21%), and miscellaneous 16%. Over half of the patients (55%) were taking ss agonists regularly. The most frequent changes made were as follows: adding steroids (inhaled 56%, systemic 27%, or increasing the inhaled dose 16%), starting inhaled ss agonists (28%) and discontinuining theophylline (9%). The GPs were the group least inclined to prescribe inhaled steroids (P < 0.0001). The inhaler technique was poor in 53% of the patients. We conclude that in treating asthma, physicians are still relying more on bronchodilator and symptomatic therapy rather than anti-inflammatory therapy. There is also evidence to suggest overuse of antibiotics. Wide dissemination of the guidelines may alter the prescribing habits, and as many asthamtics are managed by GPs, this group in particular should be targeted.