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Original Research (Original Article) 


Nasser Saeed Alqahtani et al, 2019;3(8):686–693.

International Journal of Medicine in Developing Countries

The pattern of utilizing anti-asthma medications from a physician’s perspective and factors affecting the disease, in Najran City, Saudi Arabia

Nasser Saeed Alqahtani1, Norah Hussain Al Mardhamah1*, Wejdan Nasser Al maqbul2, Abdulaziz Ahmad Alzahrany3, Rawan Ariman Alosaimi4, Hadi Abdullah Al Sleem1, Fahad Ahmed Alkanfari1, Nermean Abdullah Balharith1, Nouf Mubarak Al Mardhamah1, Aljouharah Mohammed Alanazi1, Nujoud Hamad Almoqati1

Correspondence to: Norah Hussain Al Mardhamah

*Najran University, Najran, Saudi Arabia.

Email: nhm-2- [at] hotmail.com

Full list of author information is available at the end of the article.

Received: 25 January 2019 | Accepted: 05 February 2019


ABSTRACT

Background:

Prevalence and burden of bronchial asthma have increased throughout time; it could even lead to fatal complications in many of the affected individuals. Optimum care for asthma requires collaborative work between physicians, health-providing facilities, patients, and their families. Misutilization of anti-asthma medications is one of the obstacles to achieving asthma control. This study examines the pattern of utilizing anti-asthma medications at primary healthcare centers from the physician’s perspective whereby determining the most influencing factors for the disease.


Methodology:

This was a cross-sectional study conducted in September 2018 in Najran city, enrolling all physicians (n = 134) working in primary health care centers, outpatient clinics, emergency departments of hospitals, and private polyclinic centers. An interview-administered questionnaire was used for the study.


Results:

More than 92% of asthmatic patients received medication as either a reliever or controller. It is reported that short-acting beta2-agonist agents had the highest (90.30%) use in short-term treatments, while corticosteroid (inhalant) had the highest medication (42.54%) in long-term treatments. Concerning the influence on utilizing anti-asthma medications, it is noted that physician-related factors have a good effect (78.06%) and workplace-related factors have the fair effect (62.23%), while patient-related factors have a bad effect (55.73%). Five demographic factors of primary physicians factors (age, medical specialty, workplace, healthcare facility, and experience duration) were shown to be important (<0.05) in the assessment of pattern of utilizing anti-asthma medications at primary healthcare.


Conclusion:

The study has further strengthened the important role of primary healthcare in the optimum management of bronchial asthma. This can be reached by enabling the primary physicians to be more confident with anti-asthma medications, arranging patient-centered counseling, and providing well equipment practice, including medications and requirements for health education.


Keywords:

Bronchial asthma, medications, utilizing, primary health care, physicians.


Introduction

Bronchial asthma is a chronic inflammatory disease of the airway. Nearly 235 million people worldwide have asthma and 383,000 deaths happened due to asthma in 2015. It is the most common chronic disease among children and prevalent among all age groups. Locally, the prevalence in Saudi Arabia ranged from 8% to 25% among children [1,2]. Despite well understanding the nature of the disease and the major advances in treatment, the prevalence and burden of asthma have all increased and death still continues to happen [3]. There are many barriers to achieving and maintaining asthma control that has been admitted. For example, insufficient knowledge of health care providers, organizational restrains, misconceptions about the disease and medications, non-adherence, or not using medications appropriately are the best-studied ones [4]. It is found that most of the patient with asthma was unaware of anti-asthmatic medications. It was also noticed that prescribed medicines usually were distributed without giving enough instructions [3]. Many studies were done to assess the utilization patterns of asthma medications and showed irrational use. One of the major problems seems to be the under-using of controller medications [57]. In asthma, adherence rates are particularly challenging and found to be 40% in the USA and ranging from 60% to 70% in France, UH, Germany, and Italy [8]. Improvement of asthma care outcomes requires collaborative work between physicians, health providing facilities, patients, and their families. This study examines the pattern of utilizing anti-asthma medications at primary healthcare centers from the physician’s perspective and determines the most influencing factors associated with the disease.


Subjects and Methods

This study is a cross-sectional study conducted throughout September 2018 in Najran city, which is a city in the southwestern part of Saudi Arabia. It is the capital of Najran Province. The health services are provided by many sectors (governmental and private) at different levels. The study population consists of all physicians who were providing primary health services in Najran City, Saudi Arabia at primary health care centers, outpatient clinics, emergency departments of hospitals, and private polyclinic centers during the study period and those who accepted to participate in the study. By using the simple random technique, all primary physicians’ data were obtained and the sample size was composed of 134 observations. Data were collected through an interviewer-administered questionnaire. It consisted of two main parts; the first part included socio-demographic information specified by gender, age, nationality, marital status, job title, medical specialty, qualification degree, workplace, healthcare facility, and experience duration, while the second part was about the physicians’ perspective concerning the most influencing factors on utilization of anti-asthma medications at primary healthcare (physicians related, patients related, and workplace-related factors) and consisted of 28 items and has been designed according to five-scale, where answers are given as numerical weights that present the answer degree to every statement, so it would be as follows: Always = 5, Usually = 4, Sometimes = 3, Rare = 2, and Never = 1. Based on the physicians’ perspective concerning the most influencing factors, the scoring system was categorized into good if score % > 70%, fair if score % between 70% and 60%, and poor if the score % < 60.

To ascertain the suitability of the questionnaire for research purposes, it was presented to a group of academic and professional arbitrators for validating the questionnaire, including each paragraph of the questionnaire. Cronbach’s alpha method has been used to calculate the reliability of the questionnaire (0.924), which was considered a highly reliable measurement for the study. The Statistical Package for Social Sciences (SPSS v.21) was used, with the use of necessary statistical methods to achieve the objectives of the study. A p value less than or equal to 0.05 was considered to be statistically significant. Participant’s confidentiality has been kept as well by securing the collected data in a safe place and all data were ensured to be used only for this study. An ethical approval letter has been obtained from the research committee in Najran University—Faculty of medicine on June 5, 2018.


Results

All physicians (n = 134) working in the primary health care facilities in the study were included. They all completed the interview-administered questionnaire, and the demographic variables are shown in Table 1. Figures 1 and 2 show the pattern of utilizing anti-asthma medication at primary healthcare from the physician’s perspective; it reports that short-acting beta2-agonist agents had the highest (90.30%) used medication in short-term treatments, while corticosteroid (Inhalant) had the highest (42.54%) used medication in long-term treatments. Theophylline has never been used in both treatments.

Table 2 demonstrates that arithmetic mean of all the paragraphs of the physician-related factors affecting the utilizing of anti-asthma medications at a primary health care center was 3.90, with a standard deviation of 0.748 and a relative weight of 78.06%. The paragraph “I prescribe medications for the asthmatic patient by evidence-based guideline” was the first ranked, with a relative weight of 83.73%, and while the paragraph “I focus on non-pharmacological options before prescribing medications to the asthmatic patient” was the last ranked, with a relative weight of 69.7%.

Table 3 explains that the arithmetic mean of all the paragraphs of the patient-related factors affecting the utilizing of anti-asthma medications at primary health care was 2.79, with a standard deviation of 0.675 and a relative weight of 55.73%. The paragraph “I find the asthmatic patient has true conceptions about the prescribed medications” was the last ranked, with a relative weight of 37.2%, and the paragraph “I find the asthmatic patient has self-management plan” was the penultimate ranked, with a relative weight of 53.88%.

Table 4 results show that from the physicians’ perspective, 62.23% of workplaces at primary health care have the fair effect (>60%) on utilizing anti-asthma medications at primary health care.

Table 1. Demographic characteristics of participants (n = 134).

Demographic variables Count Percent
Gender Male 65 48.5
Female 69 51.5
Age <30 years 6 4.5
30–40 years 76 56.7
41–50 years 44 32.8
>50 years 8 6.0
Nationality Saudi 3 2.2
Non-Saudi 131 97.8
Marital status Single 3 2.2
Married 131 97.8
Job Title General practitioner 75 56.0
Senior registrar 42 31.3
Consultant 17 12.7
Medical Specialty General medicine 59 44.0
Emergency medicine 9 6.7
Family medicine 29 21.6
General internal medicine 5 3.7
General pediatric medicine 32 23.9
Qualification degree Bachelor 59 44.0
Diploma 8 6.0
Master 16 11.9
Ph.D. 6 4.5
Board 45 33.6
Workplace MOH 98 73.1
University health services 10 7.5
Military health services 9 6.7
Private health services 17 12.7
Healthcare facility PHC-center 73 54.5
Hospital-outpatient clinic 37 27.6
Hospital-emergency department 20 14.9
Polyclinic 4 3.0
Experience duration <5 years 10 7.5
5–10 years 71 53.0
11–20 years 45 33.6
>20 years 8 6.0

Discussion

To achieve optimum care for bronchial asthma, it could be concluded that we have to utilize the medications either in short- or long-term at any time when the disease is progressing. This study has examined the pattern of utilizing anti-asthma medication at a primary healthcare center from the physician’s perspective and the most influencing factors affecting the disease. Our finding shows more than 92% of bronchial asthma patients received medication either as a reliever or as a controller. This finding is higher in comparison with other studies which were 47.4% at the chest clinic and 32.2% of the patients at the emergency department received asthma therapy prescriptions [10]. In the United States, around 40% of asthmatic patients used long-term control medications [11]. The high utilization rate of anti-asthma medications can be assumed as an activity parameter of primary care practice in dealing with asthma care. In the short-term treatment of bronchial asthma, results show high using (>90%) of short-acting beta2-agonist agents. This finding is further reinforced by a similar study conducted in Saudi population [2] and previous studies in other countries [12,13]. Using corticosteroid as reliever therapy shows 16.42%, 11.19%, and 4.48% inhaled, injectable, and oral, respectively. An anticholinergic agent is one of the lowest utilized therapies. About 5.97% of asthmatic patient use expectorants as short-term therapy. Apart from inhaled short-acting beta2-agonists, these findings are not aligning with the latest evidence or recommendations in the short-term treatment of bronchial asthma. Although the effectiveness of anticholinergic and oral corticosteroid is approved [14], they were underused. While expectorants and monoclonal antibodies are unproven treatment, they were used in relieving asthma symptoms. In the long-term treatment of bronchial asthma, a study shows high using (42.5%) of inhaled corticosteroid. This finding was reinforced by two similar studies from Saudi Arabia and India [2,13]. About one-third of patients use beta2 agonist/corticosteroid combinations and leukotriene receptor antagonist each group independently. Despite no role for inhaled short-acting beta2-agonists alone in long-term treatment and approved role of long-acting beta2-agonists [8], around 35.1% use inhaled short-acting beta2-agonists alone as controller agent compared to 17.16% use of inhaled long-acting beta2-agonists. Concerning the most influencing factors on utilizing anti-asthma medications, it is interesting to note that physician-related factors have a good effect (78.06%) and workplace-related factors have a fair effect (62.23%). While patient-related factors have a bad effect (55.73%) which can be justified where more than two-thirds of patients have misconceptions about the prescribed medications and around half of them have no self-management plan. Contradiction with earlier finding; Farber and Oliveria examined the impact of receiving basic asthma education and a written asthma management plan as an intervention on anti-asthma medications [15]. They reported that the intervention improved the use of long-acting asthma controller medications compared to the control group. Other study confirmed that a theory-based educational program had a good effect on self-management behaviors among asthma patients [16]. For more probing; this study shows 83.73% of primary physicians prescribe anti-asthma medications by evidence-based guideline, but this is not consisting of some unproven utilizations of anti-asthma medications in this study. On the other hand, in 2002, a similar study conducted in Tabuk City, Saudi Arabia reported that 39% of primary physicians adhered to the standard guidelines in the treatment of bronchial asthma [17].

Figure 1. Pattern of utilizing anti-asthma medications at primary healthcare from the physician’s perspective (short-term and long-term treatment).

Figure 2. Physicians’ perspective concerning the most influencing factors on utilizing anti-asthma medications at primary health care.

Majority of participants (83.13%) demonstrated the proper use of medications for the asthmatic patient, but they found 59.70% of patients use them in an improper way. This variability between figures should include inquiry on how that demonstration was going. About three-fourths of participants showed availability of asthmatic medications at their workplace and 63.73% mentioned policies and regulations to make prescribing them easier. This has further strengthened the engagement of primary healthcare in the management of bronchial asthma. These findings have correlated with current guidelines that state the majority of asthma cases do not require specialist intervention [18]. Five demographic factors of primary physicians (age, medical specialty, workplace, healthcare facility, and experience duration) were shown to be important (<0.05) in the assessment of pattern of utilizing anti-asthma medications at primary healthcare.


Conclusion

This study highlights the important role of primary healthcare in the optimum management of bronchial asthma. Therefore, this can be reached by; enabling the primary physicians to be more confident and updated in dealing with anti-asthma medications, arranging a patient-centered counseling session, and providing well-equipped practice, including anti-asthma medications and requirements for health education.

Table 2. The physician-related factors affecting the utilizing of anti-asthma medications at primary health care.

Dimensions Mean Standard deviation Rel. weight (%) Paragraph order
I feel confidence in prescribing medications for the asthmatic patient 3.82 1.003 76.42 10
I prescribe medications for an asthmatic patient by an evidence-based guideline 4.19 1.049 83.73 1
I keep updated with new doses and modalities of medications for the asthmatic patient 4.04 1.140 80.75 3
I don’t prescribe medications for an asthmatic patient unless I confirm a diagnosis 3.63 0.986 72.54 12
I focus on nonpharmacological options before prescribing medications to the asthmatic patient 3.49 1.285 69.70 13
I follow the stepwise approach in prescribing medications for the asthmatic patient 4.01 1.058 80.15 5
I consider asthmatic patient’s concerns regarding medications 3.99 1.011 79.70 6
I respect the preference of asthmatic patient regarding medications 3.83 0.880 76.57 9
I discuss asthmatic patient about the role of triggers in the inhibition of medications efficacy 3.96 0.900 79.10 7
I explain for the asthmatic patient the side effects of medications and how to overcome them 4.03 0.892 80.60 4
I demonstrate the proper use of medications for asthmatic patient and the risk of not using properly 4.16 0.857 83.13 2
I review using medications for asthmatic patient in every visit 3.88 0.958 77.61 8
I reassess triggers exposure and medications using before taking action in prescribing medications for the asthmatic patient 3.74 0.980 74.78 11
3.90 0.748 78.06

Paragraph order: ascending order by the mean and relative weight.

Relative weight = Mean * 0.2 * 100%.

Table 3. The patient-related factors affecting the utilizing of anti-asthma medications at primary health care.

Dimensions Mean Standard deviation Rel. weight (%) Paragraph order
I find the asthmatic patient is well educated about the disease and its medications 2.80 0.972 55.97 6
I find the asthmatic patient has true conceptions about the prescribed medications 1.86 0.894 37.2 9
I find the asthmatic patient refuses the prescribed medications 2.73 0.886 54.63 7
I find the asthmatic patient has good compliance with prescribed medications 2.91 0.921 58.21 4
I find the asthmatic patient uses the prescribed medications in a proper way 2.99 0.876 59.70 2
I find the asthmatic patient enrolls in regular follow-up 2.88 0.893 57.61 5
I find the asthmatic patient identifies himself/herself in controlled status 2.98 0.827 59.55 3
I find the asthmatic patient has a self-management plan 2.69 0.998 53.88 8
I find the asthmatic patient has a good family and social support 3.24 0.967 64.78 1
2.79 0.675 55.73

Paragraph order: ascending order by the mean and relative weight.

Relative weight = Mean * 0.2 * 100%.

Table 4. The workplace-related factors affecting the utilizing of anti-asthma medications at primary health care.

Dimensions Mean Standard deviation Rel. weight (%) Paragraph order
My work environment has positively affected prescribing medications for the asthmatic patient 2.84 1.244 56.8 7
My work approves protocol/guideline in prescribing medications for the asthmatic patient 3.09 1.514 61.79 3
My work arranges staff training about prescribing medications for the asthmatic patient 3.01 1.412 60.15 4
My work regulates policies to make prescribing medications for the asthmatic patient easier 3.19 1.293 63.73 2
In my workplace, medications for the asthmatic patient are available 3.69 1.172 73.73 1
In my workplace, health educator has an active role in prescribing medications for the asthmatic patient 2.98 1.387 59.70 5
In my workplace, the pharmacist has an active role in prescribing medications for an asthmatic patient 2.98 1.443 59.55 6
3.11 1.054 62.23

Paragraph order: ascending order by the mean and relative weight.

Relative weight = Mean * 0.2 * 100%.

Table 5. Association between the pattern of utilizing anti-asthma medications at primary healthcare and demographics data of primary physicians.

N Mean Standard deviation Test value p-value
Gender
Male 65 3.42 0.413 0.531 0.596
Female 69 3.36 0.826
Nationality
Saudi 3 3.53 0.302 0.390 0.697
Non-Saudi 131 3.38 0.663
Age
<30 6 4.05 0.333 3.798 0.012
30–40 76 3.33 0.656
40–50 44 3.30 0.664
>50 8 3.82 0.392
Job title
General Practitioner 75 3.37 0.666 1.309 0.274
Senior Registrar 42 3.33 0.713
Consultant 17 3.62 0.406
Medical specialty
General medicine 59 3.44 0.681 3.019 0.020
Emergency medicine 9 3.60 0.395
Family medicine 29 3.08 0.796
General internal medicine 5 3.97 0.618
General pediatric medicine 32 3.41 0.408
Qualification degree
Bachelor 59 3.31 0.692 2.254 0.067
Diploma 8 3.34 0.421
Master 16 3.10 1.069
Ph.D. 6 3.32 0.265
Board 45 3.60 0.405
Workplace
MOH 98 3.25 0.671 5.947 0.001
University health services 10 3.84 0.454
Military health services 9 3.64 0.413
Private health services 17 3.77 0.475
Healthcare facility
PHC-center 73 3.23 0.749 4.446 0.005
Hospital-outpatient clinic 37 3.56 0.347
Hospital-emergency department 20 3.50 0.603
Polyclinic 4 4.10 0.414
Experience duration
<5 years 10 3.99 0.278 5.045 0.002
5–10 years 71 3.29 0.649
11–20 years 45 3.33 0.678
>20 years 8 3.82 0.392

List of Abbreviations

SPSS Statistical Package for Social Sciences

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The research was approved by the institutional review board of Najran University, Najran, Saudi Arabia date: 5/6/2018.


Author details

Nasser Saeed Alqahtani1, Norah Hussain Al Mardhamah1, Wejdan Nasser Al maqbul2, Abdulaziz Ahmad Alzahrany3, Rawan Ariman Alosaimi4, Hadi Abdullah Al Sleem1, Fahad Ahmed Alkanfari1, Nermean Abdullah Balharith1, Nouf Mubarak Al Mardhamah1, Aljouharah Mohammed Alanazi1, Nujoud Hamad Almoqati1

  1. Najran University, Najran, Saudi Arabia
  2. King Khalid Hospital, Najran, Saudi Arabia
  3. Ibn Sina National College, Jeddah, Saudi Arabia
  4. Jordan University, Amman, Jordan

References

  1. World Health Organization. Asthma. 2017 [cited 2018 Dec 8]. Available from: www.who.int/en/news-room/fact-sheets/detail/asthma
  2. Rafeeq MM, Murad HA. Evaluation of drug utilization pattern for patients of bronchial asthma in a government hospital of Saudi Arabia. Nigerian J Clin Prac. 2017;20(9):1098–105. https://doi.org/10.4103/njcp.njcp_378_16
  3. Kumar S, Kala M, Saleem TM, Gauthaman K. Drug utilization and prescription monitoring of asthma patients. J Young Pharm. 2009;1(2):180. https://doi.org/10.4103/0975-1483.55753
  4. DocGo. 2018 [cited Dec 5]. Available from: GINA-2018-report-V1.3-002%20(1).pdf
  5. Fahmy SA, Abu-Gharbieh E, Hamidi S. Patterns of prescribing and utilization of asthma medications in a tertiary hospital in Dubai, United Arab Emirates. Trop J Pharm Res. 2016;15(5):1061–8. https://doi.org/10.4314/tjpr.v15i5.23
  6. Rabe KF, Adachi M, Lai CK, Soriano JB, Vermeire PA, Weiss KB, et al. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy Clin Immunol. 2004;114(1):40–7. https://doi.org/10.1016/j.jaci.2004.04.042
  7. Janson C, De Marco R, Accordini S, Almar E, Bugiani M, Carolei A, et al. Changes in the use of anti-asthmatic medication in an international cohort. Eur Respir J. 2005;26(6):1047–55. https://doi.org/10.1183/09031936.05.00031905
  8. Cerveri I, Locatelli F, Zoia MC, Corsico A, Accordini S, de Marco R. International variations in the asthma treatment compliance. The results of the European Community Respiratory Health Survey (ECRHS). Eur Respir J. 1999;14:288–94. https://doi.org/10.1034/j.1399-3003.1999.14b09.x
  9. Kirenga JB, Okot-Nwang M. The proportion of asthma and patterns of asthma medications prescriptions among adult patients in the chest, accident and emergency units of a tertiary health care facility in Uganda. Afr Health Sci. 2012;12(1):48–53.
  10. Center for Disease Control fact sheet: Asthma Stats National Center for Environmental Health Division of Environmental Hazards and Health Effects; Use of long-term control medication among persons with active asthma [website]. Available from: https://www.cdc.gov/asthma/default.htm
  11. Sayadeda K, Ansari NA, Ahmed QS, Upadhyay P, Dey S, Madhwar A. Drug utilization study of antiasthmatic drugs in a pediatric age group in a tertiary care teaching hospital, Bareilly, UP–India. Int J Univ Pharm Biosci. 2013;2(3):145–56.
  12. Thamby SA, Juling P, Xin BT, Jing NC. Retrospective studies on medication utilization patterns of asthmatics in a Government hospital in Kedah, Malaysia. Int Curr Pharm J. 2012;1(11):353–60. https://doi.org/10.3329/icpj.v1i11.12060
  13. Patel Pinal D, Patel RK, Patel NJ. Analysis of prescription pattern and drug utilization in asthma therapy. Int Res J Pharm. 2012;3(7):257–60.
  14. Pollart SM, Compton RM, Elward KS. Management of acute asthma exacerbations. Am Fam Physician. 2011;84(1):40–7.
  15. Farber HJ, Oliveria L. Trial of an asthma education program in an inner-city pediatric emergency department. Pediatr Asthma Allergy Immunol. 2004;17(2):107–15. https://doi.org/10.1089/0883187041269913
  16. Chiang LC, Huang JL, Yeh KW, Lu CM. Effects of a self-management asthma educational program in Taiwan based on PRECEDE-PROCEED model for parents with asthmatic children. J Asthma. 2004;41(2):205–15. https://doi.org/10.1081/JAS-120026078
  17. Al-Kabbaa AF, Al-Shamrani KM, Salih MA. Does the management of bronchial asthma by family physicians meet standards of the national protocol? J Fam Community Med. 2002;9(3):21–5.
  18. Small I. The majority of asthma cases can be managed in primary care. Guidelinesinpractice. [cited 2012 Jul]. Available from: https://www.guidelinesinpractice.co.uk/respiratory/the-majority-of-asthma-cases-can-be-managed-in-primary-care/335790.article


How to Cite this Article
Pubmed Style

Alqahtani NS, Almardhamah NH, Almaqbul WN, Alzahrany AA, Alosaimi RA, Sleem HAA, Alkanfari FA, Balharith NA, Mardhamah NMA, Alanazi AM, Almoqati NH. The pattern of utilizing anti-asthma medications from a physician's perspective and factors affecting the disease, in Najran City, Saudi Arabia. IJMDC. 2019; 3(8): 686-693. doi:10.24911/IJMDC.51-1548375157


Web Style

Alqahtani NS, Almardhamah NH, Almaqbul WN, Alzahrany AA, Alosaimi RA, Sleem HAA, Alkanfari FA, Balharith NA, Mardhamah NMA, Alanazi AM, Almoqati NH. The pattern of utilizing anti-asthma medications from a physician's perspective and factors affecting the disease, in Najran City, Saudi Arabia. http://www.ijmdc.com/?mno=27852 [Access: July 23, 2019]. doi:10.24911/IJMDC.51-1548375157


AMA (American Medical Association) Style

Alqahtani NS, Almardhamah NH, Almaqbul WN, Alzahrany AA, Alosaimi RA, Sleem HAA, Alkanfari FA, Balharith NA, Mardhamah NMA, Alanazi AM, Almoqati NH. The pattern of utilizing anti-asthma medications from a physician's perspective and factors affecting the disease, in Najran City, Saudi Arabia. IJMDC. 2019; 3(8): 686-693. doi:10.24911/IJMDC.51-1548375157



Vancouver/ICMJE Style

Alqahtani NS, Almardhamah NH, Almaqbul WN, Alzahrany AA, Alosaimi RA, Sleem HAA, Alkanfari FA, Balharith NA, Mardhamah NMA, Alanazi AM, Almoqati NH. The pattern of utilizing anti-asthma medications from a physician's perspective and factors affecting the disease, in Najran City, Saudi Arabia. IJMDC. (2019), [cited July 23, 2019]; 3(8): 686-693. doi:10.24911/IJMDC.51-1548375157



Harvard Style

Alqahtani, N. S., Almardhamah, . N. H., Almaqbul, . W. N., Alzahrany, . A. A., Alosaimi, . R. A., Sleem, . H. A. A., Alkanfari, . F. A., Balharith, . N. A., Mardhamah, . N. M. A., Alanazi, . A. M. & Almoqati, . N. H. (2019) The pattern of utilizing anti-asthma medications from a physician's perspective and factors affecting the disease, in Najran City, Saudi Arabia. IJMDC, 3 (8), 686-693. doi:10.24911/IJMDC.51-1548375157



Turabian Style

Alqahtani, Nasser Saeed, Norah Hussain Almardhamah, Wejdan Nasser Almaqbul, Abdulaziz Ahmad Alzahrany, Rawan Ariman Alosaimi, Hadi Abdullah Al Sleem, Fahad Ahmed Alkanfari, Nermean Abdullah Balharith, Nouf Mubarak Al Mardhamah, Aljouharah Mohammed Alanazi, and Nujoud Hamad Almoqati. 2019. The pattern of utilizing anti-asthma medications from a physician's perspective and factors affecting the disease, in Najran City, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (8), 686-693. doi:10.24911/IJMDC.51-1548375157



Chicago Style

Alqahtani, Nasser Saeed, Norah Hussain Almardhamah, Wejdan Nasser Almaqbul, Abdulaziz Ahmad Alzahrany, Rawan Ariman Alosaimi, Hadi Abdullah Al Sleem, Fahad Ahmed Alkanfari, Nermean Abdullah Balharith, Nouf Mubarak Al Mardhamah, Aljouharah Mohammed Alanazi, and Nujoud Hamad Almoqati. "The pattern of utilizing anti-asthma medications from a physician's perspective and factors affecting the disease, in Najran City, Saudi Arabia." International Journal of Medicine in Developing Countries 3 (2019), 686-693. doi:10.24911/IJMDC.51-1548375157



MLA (The Modern Language Association) Style

Alqahtani, Nasser Saeed, Norah Hussain Almardhamah, Wejdan Nasser Almaqbul, Abdulaziz Ahmad Alzahrany, Rawan Ariman Alosaimi, Hadi Abdullah Al Sleem, Fahad Ahmed Alkanfari, Nermean Abdullah Balharith, Nouf Mubarak Al Mardhamah, Aljouharah Mohammed Alanazi, and Nujoud Hamad Almoqati. "The pattern of utilizing anti-asthma medications from a physician's perspective and factors affecting the disease, in Najran City, Saudi Arabia." International Journal of Medicine in Developing Countries 3.8 (2019), 686-693. Print. doi:10.24911/IJMDC.51-1548375157



APA (American Psychological Association) Style

Alqahtani, N. S., Almardhamah, . N. H., Almaqbul, . W. N., Alzahrany, . A. A., Alosaimi, . R. A., Sleem, . H. A. A., Alkanfari, . F. A., Balharith, . N. A., Mardhamah, . N. M. A., Alanazi, . A. M. & Almoqati, . N. H. (2019) The pattern of utilizing anti-asthma medications from a physician's perspective and factors affecting the disease, in Najran City, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (8), 686-693. doi:10.24911/IJMDC.51-1548375157