Asthma is more than just occasional wheezing; it is a chronic inflammatory disease of the airways that causes variable respiratory symptoms and limits expiratory airflow 7 . Managing this condition effectively requires the right drugs, used in the right way. But how often does real-world medical practice align with established guidelines?
A revealing study conducted at a government hospital in Saudi Arabia sought to answer this exact question by evaluating the drug utilization pattern for bronchial asthma patients. This research provides a crucial snapshot of current prescription practices, highlighting both promising alignments with global standards and critical gaps that need addressing 1 .
The Why: The Importance of Drug Utilization Studies
Drug utilization studies are powerful tools in modern healthcare. The World Health Organization (WHO) emphasizes their use to assess the "marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences" 1 .
In essence, these studies act as a check-up for the healthcare system itself, ensuring that treatment patterns are reliable, effective, and rational against standard guidelines like the Global Initiative for Asthma (GINA) and the Saudi Initiative for Asthma (SINA) 1 7 . When medications are used inappropriately, it leads to reduced therapeutic effectiveness, increased adverse effects, and a higher financial burden on both families and the healthcare system 1 .
The Saudi Context: Asthma Control and the SINA Guidelines
Asthma is a significant public health issue in Saudi Arabia. A recent systematic review highlighted that the prevalence of uncontrolled asthma among Saudi adults ranges from 23.4% to as high as 68.1% 3 8 . In some studies, well-controlled asthma was reported in as few as 3% of patients 8 .
Uncontrolled asthma range in Saudi adults
Well-controlled asthma in some studies
Factors contributing to this lack of control include lower educational attainment, poor medication adherence, and lack of regular medical follow-up 8 . In response, the Saudi Thoracic Society developed the Saudi Initiative for Asthma (SINA) guidelines, now updated in 2024, to provide simple, up-to-date management protocols for healthcare workers across the kingdom 7 .
A Deep Dive into the Hospital Study
To understand how asthma is being treated on the ground, a retrospective study was conducted at a government hospital, analyzing 380 prescriptions from patients aged from 4 months to 79 years 1 4 .
Methodology: How the Prescriptions Were Analyzed
Researchers collected retrospective prescribing information for patients diagnosed with bronchial asthma. Each prescription was examined for the order, number, and therapeutic class of drugs, alongside assessments of poly-pharmacy and appropriateness. Prescriptions were then classified based on their relationship to the diagnosis 1 :
Appropriate
Prescribed drugs had a full relationship to the asthma diagnosis.
Partially Appropriate
Drugs were partially related to the diagnosis.
Inappropriate
No relationship between the prescribed drugs and the diagnosis.
Difficult to Comment
Diagnosis was missing or the prescription was not written clearly.
Key Findings: What the Data Revealed
The analysis of the 380 prescriptions yielded several key insights into prescription habits, as shown in the following data.
Most Frequently Prescribed Anti-Asthma Drug Classes 1
| Drug Class | Percentage | Example |
|---|---|---|
| Bronchodilators | 78.9% | Salbutamol |
| Steroids | 28.9% | Budesonide |
Prescription Composition 1
| Aspect | Finding |
|---|---|
| Average drugs per prescription | 3.18 ± 1.22 |
| Patients on combination therapy | 89.5% |
| Patients on a single drug | 10.5% |
| Prescriptions with >4 drugs (poly-pharmacy) | 13.1% |
Route of Drug Administration 1
Prescription Appropriateness 1
The Scientist's Toolkit: Essentials of Asthma Management
Understanding an asthma drug study requires familiarity with the primary tools and medications involved. The following table details key components of asthma pharmacotherapy and their functions.
Short-Acting Beta-Agonists (SABA)
Relieve acute asthma symptoms by quickly relaxing airway muscles 9 .
Inhaled Corticosteroids (ICS)
Foundation of treatment; reduce chronic airway inflammation to prevent attacks 7 .
Inhalational Route
Preferred method for delivering asthma drugs directly to the lungs, minimizing side effects 1 .
Beyond the Prescription: The Human Factor
A prescription is only the first step. For treatment to be effective, patients must use their inhalers correctly and adhere to their medication plan. Studies show that only 12.3% of asthmatic patients report appropriate use of their asthma drugs 2 .
Only 12.3%
of asthmatic patients report appropriate use of their asthma drugs 2
Key factors that enable proper use include:
- Sound knowledge of their asthma drugs
- Consultation with a specialist
- Good self-perceived health 2
Furthermore, patient education is critical. Healthcare providers must teach patients how to use inhalers correctly, advise on minimizing side effects (like rinsing the mouth after inhaled steroids), and acknowledge the frustrations of managing a chronic condition 6 .
The Future of Asthma Treatment
The field of asthma pharmacology is rapidly evolving. Research is moving towards personalized medicine, where treatments are tailored to a patient's specific biology and biomarkers 5 .
For instance, monoclonal antibodies like benralizumab can target specific parts of the immune system, such as eosinophils, in severe asthma cases 6 . Recent studies on such biologics have shown "game-changer" potential for reducing asthma attacks, representing the first new treatment approach in half a century .
A Breath of Hope
The hospital drug utilization study concludes that while the prescription pattern is mainly in accordance with standard guidelines, there are "some knowledge and technical gaps in prescription writing methodology" 1 4 . This suggests a promising foundation upon which to build.
Enhancing asthma control in Saudi Arabia requires a multifaceted approach: continuing physician education on SINA guidelines, empowering patients through better communication and education, and embracing new, targeted therapies. By closing these gaps, the simple, fundamental act of breathing can become easier for the many Saudis living with asthma.