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Data Collection Form


An observational survey study to analyze management of Asthma

(To be filled only by physician)


  1. As per your clinical practice, what is the approximate number of patients newly diagnosed with asthma every month? *

  2. What are the common complaints or signs-symptoms observed in patients with asthma? (Please tick all the applicable options) *
  3. What is the approximate percentage of patients having comorbidities in patients with asthma, as per observation in your practice? (Please fill the approximate percentage) *
    4. Name Percentage (%)

    %

  4. What are the common comorbidities observed in patients with asthma? (Please tick all the applicable options) *
  5. What is the approximate percentage of patients with asthma having cardio-vascular co-morbidity, as observed in your practice?*

  6. What is the approximate break up of patients in percentage based on severity of asthma, as observed in your practice? *
    7. Percentage

    %

    %

    %

    100%

  7. Which are the preferred medications in patients classified as mild asthma based on severity of asthma, as observed in your practice? (Tick all applicable) *
  8. Which are the preferred medications in patients classified as moderate asthma based on severity of asthma, as observed in your practice? (Tick all applicable) *
  9. Which are the preferred medications in patients classified as severe asthma based on severity of asthma, as observed in your practice? (Tick all applicable) *
  10. How would you rate the below medications for asthma in terms of FEV1 Improvement from baseline? *
    11. Parameter Strongly recommended Recommended Neutral
  11. How would you rate the below medications for asthma in terms of Improvement in annual moderate /severe exacerbation rates from baseline? *
    12. Parameter Strongly recommended Recommended Neutral
  12. What is the approximate number of patients with asthma requiring Acebrophylline per month, as per your practice? *

  13. How would you rate the role of Acebrophylline for patients with asthma as per the disease severity? *
    14. Parameter Strongly recommended Recommended Neutral
  14. Do you prefer Acebrophylline in patients with exacerbations, as per your clinical practice? *

  15. What is the approximate duration for which acebrophylline is prescribed in your patients with asthma? *

  16. How would you rate the role of Acebrophylline for patients with asthma in addition to below mentioned medications? *
    17. Parameter Strongly recommended Recommended Neutral
  17. Do you believe that acebrophylline is a better choice in patients with asthma & CV - comorbidities, as per observations in your clinical practice? *

  18. What is the approximate percentage of patients with asthma requiring Inhaled corticosteroids (ICS) + Long-Acting Beta-Agonists (LABA) per month, combinations as per your practice? *

  19. Which Long-Acting Beta-Agonists (LABAs) agent do you prefer the most in your clinical practice? *

  20. What criteria's do you use for choosing a Long-Acting Beta-Agonists (LABAs) agent in your patient with Asthma? *

  21. Kindly share the approximate break up of usage of Inhaled corticosteroids (ICS) + Long Acting Beta-Agonists (LABAs) combination as per patient profile in patients with Asthma, in your clinical practice? *
    22. Condition Percentage

    %

    %

    100%
  22. Kindly share the approximate break up of usage of Inhaled corticosteroids (ICS) + Long Acting Beta-Agonists (LABAs) combination as per disease condition in patients with Asthma, as per your clinical practice? *
    23. Stage Percentage

    %

    %

    %

    100%
  23. Which of the following below parameters do you consider for selecting the Inhaled corticosteroids (ICS) + Long Acting Beta-Agonists (LABAs) combination in patients with asthma, as per your practice? (Tick all applicable) *
    Parameter
  24. How would you rate the below ICS + LABA combinations in terms of efficacy in patients with asthma, as per observations in your clinical practice? *
    25. ICS + LABA Strongly recommended Recommended Neutral
  25. What are the criteria for selecting the specific ICS+ LABA combinations as per observations in your practice? (Kindly tick all applicable) *
  26. Which is your preferred ICS + LABA combinations in terms of efficacy & safety in asthma patients with below comorbid conditions/ specific patient profiles? *
    27. ICS + LABA Cardio-vascular co-morbidity COPD Renal impairment
  27. How would you rate the below ICS + LABA combinations in terms of safety in patients with asthma, as per observations in your clinical practice? *
    28. ICS + LABA Strongly recommended Recommended Neutral
  28. What is the approximate number of patients with asthma requiring Long-Acting Beta-Agonists (LABA) + Long acting muscarinic antagonists (LAMA) combinations per month, as per your practice? *

  29. Kindly share the approximate break up of usage of Long-Acting Beta-Agonists (LABA) + Long acting muscarinic antagonists (LAMA) combinations as per patient profile in patients with Asthma, in your clinical practice? *
    30. Condition Percentage

    %

    %

    100%

  30. What are the criteria for selecting the specific LAMA+ LABA combinations as per observations in your practice? (Kindly tick all applicable) *