Physicians’ Adherence to Asthma Guidelines: A Prospective Prescription Review from Tertiary Care Hospital, Malaysia

Raja Ahsan Aftab1, 2, *, Amer Hayat Khan1, Syed Azhar Syed Sulaiman1, Irfhan Ali3
1 Department of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, 11800 Penang, Malaysia
2 School Of Pharmacy, Taylor’s University, Subang Jaya, Selangor, Malaysia
3 Department of Respiratory Medicine, Penang General Hospital, Penang, Malaysia

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© 2018 Aftab et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia, Tel: 006-010-4322719;, Fax: 00604 657 0017, Email:


Aims and objective:

The aim of the current study is to evaluate adherence clinical practice guideline of asthma, to assess treatment outcomes of guideline adhering to pharmacotherapy and to calculate the cost of asthma treatment.


A prospective record viewing study was conducted at the respiratory clinic of Hospital Pulau Pinang, Penang, Malaysia from December 2012 to June 2013. A total of 180 prescriptions of patients from 6 doctors (30 prescriptions by each doctor) were evaluated against global initiative of asthma (GINA) guidelines. Treatment outcomes of asthma patients were evaluated based on lung function values. Direct assessment of cost was compared between the guidelines adhered and non-adhered scripts.


Of the total 180 asthmatic patients, 143 (78.9%) received guideline-adhered pharmacotherapy. A total of 158 (87.7%) patients reported successful treatment outcome, out of which, 124 (78.4%) patients received guideline-adhered pharmacotherapy. A statistical significant difference (p < 0.001) was observed among lung function values after patients’ first and second visit. An analysis indicated that patients aged > 46 years were found to have a significant association with treatment outcomes (OR=3.77, p=0.03). While comparing the cost of asthma treatment outcome, it was observed that the average cost of successfully treated patients who received guideline-adhered pharmacotherapy was RM 70.00 per patient (1US$ = RM 3.20) while patients reporting unsuccessful treatment outcome was RM 75.47 per patient.


A majority of asthma patients received guideline-adhered pharmacotherapy.

Keywords: Physicians’ adherence, Asthma clinical practice guideline, Asthma treatment outcomes, Asthma medication cost, Pharmacotherapy, GINA guidelines.