Background:

Asthma is a chronic inflammatory disease of the respiratory system characterized by wheezing, shortness of breath, and chest tightness. Although effective medications are available to control symptoms and prevent exacerbations, optimal outcomes depend largely on adherence to evidence-based treatment guidelines.

Objectives:

This study aimed to evaluate prescriber adherence to the Global Initiative for Asthma (GINA) guidelines, assess its impact on asthma symptom control, and identify challenges and barriers influencing guideline adherence.

Design:

A sequential explanatory cross-sectional study supplemented with qualitative interviews was employed.

Methods:

The study was conducted from May 16 to August 30, 2023. Quantitative data were obtained through structured medical chart abstraction, followed by semi-structured interviews to explore barriers to guideline adherence. Data were analyzed using SPSS version 25, and associations between independent variables and asthma control were examined using ordinal logistic regression. Statistical significance was set at p < 0.05.

Result:

Findings revealed that patients managed by prescribers not adhering to GINA guidelines had 72% lower odds of achieving symptom control (AOR = 0.28, 95% CI: 0.12–0.65, p = 0.003). Positive predictors of symptom control included monthly income of 5501–7000 ETB (AOR = 2.12, 95% CI: 1.02–4.40), mild persistent asthma compared with severe asthma (AOR = 2.63, 95% CI: 1.00–6.89), and use of low- or medium-dose budesonide plus formoterol inhalations daily (AOR = 8.26, 95% CI: 3.26–29.1, p = 0.001; AOR = 10.3, 95% CI: 3.27–32.6, p < 0.001, respectively). Conversely, married (AOR = 0.49, 95% CI: 0.25–0.98, p = 0.045) and divorced patients (AOR = 0.39, 95% CI: 0.19–0.81, p = 0.012), those prescribed medium-dose beclomethasone with salbutamol (AOR = 0.18, 95% CI: 0.07–0.45, p < 0.001), and patients with poor medication adherence (AOR = 0.36, 95% CI: 0.22–0.61, p < 0.001) showed significantly lower odds of symptom control. Qualitative findings highlighted barriers such as the extensiveness of the GINA guidelines, limited availability of recommended medications, and insufficient prescriber knowledge and training.

Conclusion:

Prescribers’ non-adherence significantly compromised asthma control. Strengthening guideline implementation requires improving medication accessibility, training healthcare providers, and enhancing awareness to optimize asthma management.

Plain language summary

Prescriber adherence to treatment guidelines for the management of asthma symptom and how its impact on symptom control

Asthma is a common long-term disease that causes inflammation in the airways and cause to breathing problems such as shortness of breath, wheezing, and chest tightness. Medicines are often prescribed to control these symptoms and prevent future asthma attacks. This study aimed to find out whether physicians are following the Global Initiative for Asthma (GINA) treatment guidelines and how their adherence affects asthma symptom control among patients. It also explored the reasons why some providers do not fully follow the guidelines. The study used both quantitative and qualitative methods. From May 16 to August 30, 2023, researchers reviewed patient medical charts to collect important information and conducted interviews with healthcare providers to understand barriers to using the GINA guidelines. Data were analyzed using SPSS version 25, and relationships between variables were tested using ordinal logistic regression, with a significance level of p < 0.05. The findings showed that patients treated by physicians who did not follow the GINA guidelines were 72% less likely to have good symptom control of their asthma symptoms (AOR = 0.28, 95% CI: 0.12–0.65, p = 0.003). Better asthma control was linked with: Having a moderate monthly income (5501–7000 ETB) compared with higher income (>7001 ETB), having mild persistent asthma rather than severe asthma, and using budesonide plus formoterol inhalers daily, either in low or medium doses. Poorer asthma control was observed among: Married and divorced patients compared to single individuals, those using beclomethasone plus salbutamol inhalers, patients not adhering to their medications, and those treated by non-adherent prescribers .Interviews with prescribers revealed that poor adherence to the GINA guidelines was mainly due to: The complexity and length of the guidelines, limited access to recommended medications, and lack of training and awareness among prescribers.