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An multicentric, observational retrospective, cross-sectional survey study to assess the Prescription pattern of ACEbrophylline in Asthma

(To be filled only by physician)

Physician Details

@if(isset(session()->get('doctor')['vCentralCode']))

Name *

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Name *

@endif

Registration No. *

Qualification *

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Speciality *

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Speciality *

@endif

Affiliation *

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City *

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City *

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State *

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State *

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Inclusion Criteria:

Patients who have been initiated on Acebrophylline at baseline
Asthma diagnosis as per treating physician’s discretion
Male or female outpatients > 18 years of age

Exclusion Criteria:

Exclusion of patients as per discretion of treating physician

Demographic Data

Initials *

Serial No *

Gender *

Male Female Other

Age(in Years) *

Name of clinic/hospital*

Date of data collection *

General Examination Findings

Weight (kgs) *

Heart Rate (beats/min) *

BP (mm Hg) *

Comorbidities if any

Conditions³	YES or NO	Condition since how long
Conditions³	YES or NO	Years	Months
Hypertension	Yes No
Diabetes mellitus	Yes No
Metabolic syndrome	Yes No
Dyslipidemia	Yes No
Anemia⁴	Yes No
COPD	Yes No
Chronic ischemic heart disease	Yes No
Sleep disorders	Yes No
Chronic Kidney Disease	Yes No
Mention others if any

Current Asthma medications/Treatment regimen *

Kindly tick the ongoing medications in this patient

Asthma medications before baseline treatment*	Tick multiple if applicable *	If yes, which molecule? *
No treatment
ICS
ICS+LABA
SABA
Phosphodiesterase inhibitors
Acetyl cysteine

Appropriate reasons for prescribing the Acebrophylline *

Kindly tick the appropriate reasons for prescribing the Acebrophylline in this patient

Attributes*	Tick all the applicable appropriate attributes/ reasons for prescribing the above Acebrophylline in this patient *
Efficacy in terms of symptom control
Efficacy in terms of improvement of FEV₁
Efficacy in terms of exacerbation reduction
Tolerability
Faster onset of action
Presence of Co-morbidities

Follow-up for these patients

At 1 months At <3 months

Other Class of Drug given along with above therapy *

Class of Drug	Generic Name	Dose	Duration
Short-Acting Beta-Agonists (SABAs)
Inhaled corticosteroids (ICS)
Long Acting Beta-Agonists (LABAs) + Inhaled corticosteroids (ICS)
Acetylcysteine
Leukotriene receptor antagonists (LTRA)
Mention others if any

Any other comments

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An multicentric, observational retrospective, cross-sectional survey study to assess the Prescription pattern of ACEbrophylline in Asthma

Physician Details

Inclusion Criteria:

Exclusion Criteria:

Demographic Data

General Examination Findings

Details Of Diagnosis

Comorbidities if any

Current Asthma medications/Treatment regimen *

Appropriate reasons for prescribing the Acebrophylline *

Other Class of Drug given along with above therapy *