Does over-reliance on montelukast affect the implementation of the “Asthma Right Care (ARC)” movement in Bangladesh?

Background: GINA 2023 recommends (montelukast) as an alternative controller option in step 2 for asthma patients 12+ years and as an add-on therapy along with inhaled ICS-LABA in steps 3 & 4 1. However, as per IQVIA Medical Research Data (IMRD), in Bangladesh, the majority of patients with asthma symptoms (45.74%) rely on montelukast as first-line pharmacotherapy due to its availability as an OTP drug 2. Such over-reliance on montelukast appears a challenge for the implementation of guideline-based pharmacotherapy for asthma in Bangladesh. We propose to assess the effect of Montelukast use as both controller and reliever therapy in asthma treatment in comparison to Asthma Right Care (ARC)3 in Bangladesh. Methodology: A case-control study will be done in two hospitals; in one, management of asthma will be according to the Asthma Right Care movement (ARC) at the initial and at 12th month (intervention) and the other -montelukast user (no intervention). Use of SABA, or other asthma medications: confounding variables. Asthmatics ≥12 years attending the OPD at a given period will be sampled randomly until the calculated sample size is met., Primary outcome variables: frequency of exacerbations and the number of hospitalisations. The variation will be determined by regression analysis. The causes behind the over-reliance on montelukast in asthma treatments are secondary outcomes Funding: we will apply for funding from the Ministry of Health, BMRC, and other national and international funding agencies. Reference: Reddel, H. K. et al. (2022). Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes. American Journal of Respiratory and Critical Care Medicine, 205(1), 17-35. Chowdhury, L. A. M. et al. (2019). Intellectual capital efficiency and organisational performance: In the context of the pharmaceutical industry in Bangladesh. Journal of Intellectual Capital. Vázquez, M. M. (2022). Shifting asthma management with Asthma Right Care communication tools.