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Table 3 shows overall pattern of drug use in paediatric patients. β2 agonists were the most common antiasthmatic drugs prescribed in 97.33% patients followed by corticosteroids (94.66%) and anticholinergics (58.66%) respectively. Magnesium sulphate was prescribed to inpatients only (24%). The next common drug class prescribed was antimicrobial agents (64%). Oxygen was prescribed in 18.67% patients. Other drugs prescribed were expectorants (30.66%), antipyretics and analgesics (24%), antacids and antireflux agents (22.66%) and antihistaminics (17.33%).

DISCUSSION

Conducting periodic studies of pattern of drug use in various hospital settings or patient populations is essential to critically analyze the current hospital drug policies and to make recommendations based on various guidelines to improve upon the current drug usage pattern in the future, if needed. It is more importantly required in resource poor countries like ours so as to ensure that the scarce resources are utilized in the best possible manner. There is always a variation in drug utilization among different countries and even among health institutions within a country and sometimes within the same institute at different point of time probably because of changing disease trends over a period of time.⁴ Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation⁵. There are about 334 million patients with asthma affecting all age groups, across the world⁶. A recent analysis using three different estimate models: Indian study on Epidemiology of Asthma, Respiratory symptoms and Chronic bronchitis (INSEARCH), Global Initiative for Asthma (GINA) and WHO survey suggests that 17-30 million patients suffer from asthma in India⁷. Asthma is known to be one of the major causes of morbidity and mortality in India, comprising 3-11% of adults and 3-5% of paediatric population⁸and its prevalence varies from place to place⁹. Global Initiative for Asthma (GINA) guidelines are the international guidelines available for the management of asthma. As per GINA guidelines, mainly two categories of drugs are used namely controllers (inhaled and systemic glucocorticoids and inhaled long acting beta agonists in combination used with inhaled corticosteroid, leukotriene modifiers, sustained-release theophylline, cromones, anti-IgE) and relievers (inhaled and oral beta-2 agonists, short acting anticholinergics, short acting theophylline). These drugs can be used alone or in conjunction with other antiasthmatic drugs⁵. Asthma cannot be cured, but clinical episodes can largely be prevented and controlled by proper management¹⁰. The goal of treatment as per GINA guidelines is to achieve good symptom control and to minimize future risk of exacerbations, fixed airflow limitation and side effects of treatment. It also identifies that fixed international guidelines may not work in many locations and hence it recommends that these guidelines be adapted according to local needs and availability of resources⁵. For effective implementation of any guideline it is important first to assess the current status of asthma care in the target region and this can be achieved by doing drug utilization study. This will help not only to understand the current prescribing trends but also to assess other factors like availability of preventive, diagnostic and curative resources and also affordability, compliance and knowledge of patients¹¹. Drug utilization research can thus be used to compare the observed patterns of drug use for the treatment of certain disease with current recommendations or guidelines.¹² In our study we have seen that Table 2 shows overall pattern of drug use in medicine patients. β2 -agonists were the most common antiasthmatic drugs prescribed in all the patients followed by corticosteroids (92.57%) and methylxanthines (85.71%) respectively. The next common drug class prescribed was antimicrobial agents (65.14%). Oxygen was prescribed in 7.43% patients. Other drugs prescribed were antacids and antireflux agents (28.57%), antihistaminics (20%), vitamins and minerals (15.43%), antidiabetics (9.71%), antihypertensives (9.14%) and antipyretics and analgesics (3.43%). The use of β2 agonists is in accordance with other studies by Kamath et al¹³ (100%), Pinal Patel et al⁸ (90% in urban patients and 84% in rural patients), Arumugam et al1⁰¹ (66%). Other studies by Pandey et al1⁰² (40%). Similar observations were seen in a study by Michael et al ¹⁶ (antacids-33.33%, multivitamins-24.83%) and Kamath et al¹³ (antireflux agents-26%, antihistaminics-30%, antidiabetics-15%, antihypertensives-12.5%). Table 3 shows overall pattern of drug use in paediatric patients. β2 agonists were the most common antiasthmatic drugs prescribed in 97.33%

patients followed by corticosteroids (94.66%) and anticholinergics (58.66%) respectively. Magnesium sulphate was prescribed to inpatients only (24%). The next common drug class prescribed was antimicrobial agents (64%). Oxygen was prescribed in 18.67% patients. Other drugs prescribed were expectorants (30.66%), antipyretics and analgesics (24%), antacids and antireflux agents (22.66%) and antihistaminics (17.33%). The most common antiasthmatic drugs prescribed in paediatric patients were β2 agonists (97.33%) followed by corticosteroids (94.66%). This finding is consistent with previous studies like Sayedda et al¹⁸ (β2 agonists- 100% in exacerbations, corticosteroids- 100% in persistent asthma), Garje et al97 (β2 agonists- 81%, corticosteroids- 93%) and Kumar et al²⁰ (β2 agonists- 83.6%, corticosteroids- 40.98%). Higher percentage of paediatric patients were prescribed anticholinergics (58.66%) (Table 3) as compared to medicine patients (Table 2) and this was mainly ipratropium bromide in combination with salbutamol. A significantly different finding from medicine patients was use of magnesium sulphate in 43.64% patients in paediatric IPD. It is recommended that magnesium sulphate may be used parenterally in severe exacerbations of asthma not responding to initial treatment⁵ thus indicating that these patients may be suffering from severe exacerbations. In a study done by Sayedda et al¹⁷, prescription of anticholinergics (32.4%) and magnesium sulphate (1.6%) was seen to be less as compared to the present study. This discrepancy could be because another bronchodilator aminophylline was also prescribed in their study. Aminophylline was not prescribed in paediatric patients of the present study. Similar to the results seen in medicine patients (Table 3), the use of leukotriene¹⁹ Inhibitors is minimal (5.33%) and consistent to results observed by Pandey et al 102(4.4%). Antimicrobial agents were prescribed to higher percentage (64%) of paediatric patients in present study which is again similar to the medicine patients (Table 3). Garje et al¹⁷ observed antibiotic prescription in 19% and Kumar et al96 observed it in 36.06% of paediatric patients. The higher use of antimicrobials may be due to the inadequate control of asthma symptoms predisposing the patients to infection and exacerbation. The other classes of drugs were expectorants (30.66%) which were prescribed to only paediatric patients in this study and antihistaminics (17.33%). This observation was in accordance with Kumar et al²⁰ (antitussives -39.34%, antihistaminics -21.31%). Many expectorants contain terbutaline which is a β2 agonist and hence it reflects increased prescription of drugs being used for bronchodilatation.

CONCLUSION

It was concluded from our study that Overall pattern of drug use showed that β2 agonists and corticosteroids were most common class of antiasthmatic drugs prescribed. A detailed drug utilization of antiasthmatic drugs indicated that the use of oral and nebulised salbutamol, injection hydrocortisone, nebulised budesonide and injection as well as oral theophylline was high in both IPD and OPD medicine patients. The use of oral and nebulised salbutamol, systemic steroids and nebulised budesonide was high only in paediatric IPD patients as compared to paediatric OPD patients. The use of theophylline was only in medicine patients while magnesium sulphate was prescribed to only paediatric patients.

REFERENCES