Prescriber adherence to asthma treatment guidelines and its impact on symptom control in Ethiopia: a mixed-methods study

Abstract

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.