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

Background: GINA 2023 recommends leukotriene receptor antagonist (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 with poor levels of evidence [1]. However, the majority of patients with asthma symptoms (45.74%) rely on montelukast as first-line pharmacotherapy due to its availability and publicity [2]. Such over-reliance on montelukast appears to be a challenge for the implementation of guideline-based pharmacotherapy for asthma in Bangladesh.
Research question: Does over-reliance on montelukast affect the implementation of the “Asthma Right Care (ARC)” movement in Bangladesh?
We propose that measurement of the use, trend and changes in the use of montelukast before and during the introduction of Asthma Right Care (ARC) [3] in Bangladesh could be an important indicator of its impact.

Methodology: This will be implementation research deploying quasi-experimental pre-post with non-equivalent control group design. Two similar Upazilas in Bangladesh with approximately 230,000 population, located far apart, will be selected; one will have the ARC movement for one year (intervention group) and the other with usual practice (control group). Pre-post sales and use data from available pharmaceutical companies of both sites will be collected on the use of montelukast and other asthma medications.
• Primary outcome: use, trend and changes in the use of montelukast
• Secondary outcome: use of inhaled reliever (e.g., salbutamol) and controller medications

Questions to discuss: How should the ARC movement be organised in Bangladesh?

Funding: National and international interest groups.

Reference:
1. Reddel, H. K., Bacharier, L. B., Bateman, E. D., Brightling, C. E., Brusselle, G. G., Buhl, R., ... & Boulet, L. P. (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.
2. Chowdhury, L. A. M., Rana, T., & Azim, M. I. (2019). Intellectual capital efficiency and organisational performance: In the context of the pharmaceutical industry in Bangladesh. Journal of Intellectual Capital.
3. Vázquez, M. M. (2022). Shifting asthma management with Asthma Right Care communication tools.