Management of Asthma at Private Pharmacies in India

In India 37 to 64 percent of people buying medications at pharmacies are doing so without prescriptions and a similar situation occurs in many countries. Therefore, it is important to study this issue in order to align such practices with public health goals. Asthma and other respiratory conditions are growing in India and as many as 50 million Indians may be affected by the former.

This study investigated types of medications that pharmacy attendants in Chennai, India recommended to customers for a standard set of asthma symptoms, as well as studying characteristics of pharmacy consultations, advice dispensed and likelihood of referral to a physician. Data were gathered by having four simulated clients approach 52 shops and request medications for either a pediatric patient or for themselves.

Key Findings:

  • Only 7 percent of shops refused to sell medications without a prescription and instead recommended a visit to a physician. An additional 17 percent dispensed medication and advised medical attention. Another 19 percent advised medical attention if the medicine was ineffective, or if symptoms worsened or continued.
  • Overall, attendants recommended 40 unique combinations of medication classes. Among the most common were aminopenicillins or other antibiotics, methylxanthines, and oral corticosteroids.
  • Many products were cut from larger packages and did not contain information about dosing, expiration dates, or active ingredients. Sixty-five percent of attendants provided instruction on timing of taking medication; 27 percent mentioned side effects, but in every case it was to assure the client that there were none; 6 percent gave information about changing dosage if the medication was ineffective.
  • The most effective anti-asthma drugs, inhaled anti-inflammatories and beta2-agonists, were never recommended in this study.

The author concludes that individuals presenting with mild, persistent asthma to retail pharmacies mostly received neither appropriate advice nor appropriate medications. Frequently, clients received potentially harmful medications such as steroids and antibiotics. Recently, studies conducted on attendant performance after training using Good Pharmacy Practice guidelines have shown that such training can considerably improve quality of services offered to clients. In particular, such interventions can increase early detection of patients with tuberculosis and reduce unnecessary dispensing of antibiotics to patients with other respiratory problems that do not require antibiotics.