Abstract
BackgroundInhaled corticosteroids (ICSs) are cornerstone therapy for persistent asthma. However, underutilization of ICSs is common and little is known about factors contributing toward this undesirable use.MethodsA cross-sectional study was conducted through interview and chart review among persistent asthmatic patients attending chest clinic of Tikur Anbessa Specialized Hospital from 1 May to 31 September 2014. A total of 131 eligible patients who attended the clinic during study period were included in the study. A multivariate logistic regression was used to examine the association between independent and dependent variables.ResultsOverall, extent of underutilization of ICSs was found to be 68%. Monthly income, comorbidity and types of ICSs products prescribed showed significant association with reported underutilization. Patients’ reported reasons for underutilization includes; unaffordability (44%), using only when symptoms exacerbate (21%), fear of side effects (10%), practitioners’ recommendation (10%) and unavailability of ICSs in the local market (7%). Physicians also stated unaffordability, fear of side effects and dependency, lack of local guideline for asthma management and unavailability of ICSs as the contributing factors.ConclusionIn this setting, extent of underutilization of ICSs was found to be high and seems the result of complex interaction of various factors. Financial problem combined with inconsistent availability of ICSs in the local market, patients’ poor knowledge of asthma and ICSs, negative attitude toward ICSs, absence of local guidelines for asthma management are found to be essential elements dictating an extent of ICSs use.
Highlights
Inhaled corticosteroids (ICSs) are cornerstone therapy for persistent asthma
The majority (73%) of study subjects were earning less than 1200 Ethiopian Birr (ETB) which is equivalent to $53.5 on monthly basis considering all sources of their income
The severity category of asthma was found to be distributed roughly equal among all categories: 34.4, 33.6 and 32.1% of the participants had mild persistent asthma, moderate persistent asthma and severe persistent asthma, respectively
Summary
Inhaled corticosteroids (ICSs) are cornerstone therapy for persistent asthma. Underutilization of ICSs is common and little is known about factors contributing toward this undesirable use. The incidence of asthma has increased dramatically in the past few decades. The historic perception of associating asthma with developed countries no longer exist as rapidly increasing number of people are being. Airway inflammations are a major factor in the pathophysiology of asthma and remain as a principal target of treatment. Asthma cannot be cured, appropriate management can ensure adequate control of the disease, reverse and even prevent disease process and enable people to have good quality of life [3]. Pharmacological therapy is a key part of asthma management.
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