Knowledge-Practice Gaps in Guideline-Based Asthma Management Among Community Pharmacists in Sudan: A Cross-Sectional Study.

BACKGROUND: Asthma is a chronic, complex, and multifactorial respiratory disease affecting millions of people worldwide. Despite the availability of effective pharmacological therapies and evidence-based guidelines, asthma control remains suboptimal in many settings. Community pharmacists are well positioned to support asthma management through patient education, inhaler-technique assessment, adherence counselling, and referral when needed, roles increasingly emphasized in contemporary asthma guidelines. OBJECTIVES: This study aimed to assess community pharmacists' knowledge and practice regarding asthma management in Sudan, identify barriers to optimal care, and evaluate alignment with current asthma guideline recommendations. METHODOLOGY: This observational cross-sectional study was conducted among community pharmacists in Sudan between November 2025 and February 2026. Data were collected using an online structured questionnaire that assessed pharmacists' knowledge, practice, and perceived barriers related to asthma management. Descriptive statistics were used to summarize participants' characteristics and response patterns. Inferential analyses were performed using the Pearson Chi-square test to examine associations between knowledge and practice scores and selected pharmacists' characteristics. A P-value <0.05 was considered statistically significant. RESULTS: A total of 384 community pharmacists participated in the study. More than half were female (n = 210, 54.7%), and most held a Bachelor of Pharmacy degree (n = 308, 80.2%). The mean knowledge score was 6.63 ± 2.10 out of 9, while the mean practice score was 9.06 ± 3.26 out of 14. Knowledge score was significantly associated with years of professional experience (χ 2 = 12.851, P = 0.045). Practice score was significantly associated with pharmacists' qualifications (χ 2 = 9.671, P = 0.046) and years of experience (χ 2 = 14.204, P = 0.027). CONCLUSIONS: Community pharmacists demonstrated generally adequate knowledge of asthma management; however, their practice was only moderate, indicating a significant knowledge-practice gap in implementing current Global Initiative for Asthma (GINA) guideline recommendations. Targeted continuing professional development, practical guideline-based training, and structured asthma-care protocols are needed to strengthen pharmacists' contribution to asthma management and potentially improve the quality of patient care, adherence to treatment, and asthma control in Sudan.