Corticosteroid Use in Bronchial Asthma: Prescription Patterns of Doctors in South-East Nigeria

Abstract

Background: There have been varying applications of corticosteroid use in asthma management despite guideline recommendations. Aim: To investigate the pattern of corticosteroid use in bronchial asthma management by doctors in South east of Nigeria and assess how factors such as cadres, years of practice and practice setting affect their corticosteroid prescription.

Methods: A cross-sectional study of participants enrolled by multistage sampling of hospitals was done in three states in the south-east of Nigeria. Structured questionnaires were used to obtain information on knowledge and attitude on corticosteroid use among different cadres of doctors with varying years of practice.

Results: A total of 283 doctors were interviewed over an eight-month period of which 61.1% (173) and 38.9% (110) were from tertiary and non-tertiary/private health facilities respectively. The male: female ratio was 1.5:1. The majority of participants were resident doctors (50.2%), while 21.1%, 18.4% and 8.8% were house officers, medical officers and consultants respectively. Corticosteroid prescriptions were made more for acute than for chronic stable state asthma management. The factors that most affected whether corticosteroids were prescribed or not were: the cadre and the number of years of practice of the doctors. Of those who did not use corticosteroids at all, 36.7%, 2.5%, 3.6% and 4.0% respectively were house officers, registrars, senior registrars, medical officers and consultants, (p < 0.001). When assessed by the number of years of practice, corticosteroid use as maintenance therapy, especially as inhalation therapy (ICS), in stable-state chronic asthma, was prescribed by 3.8%, 5.7%, 6.2%, 30%, 0% and 0% of doctors who had respectively practiced for 1-5years; 6-10 year, 11-15 years, 16-20 years, 21-25 years, > 25 years, (χ2=36.6 p=0.05); with least prescriptions by doctors with longest years of practice.

Conclusions: The use of corticosteroids as asthma maintenance therapy, is low among doctors in the region and is associated with the cadre and the number of years of practice.