ABSTRACT
Background: Treatment of COPD depends on disease severity, phenotype and exacerbation risk. Inhaled medications are the treatment of choice in COPD. We undertook this survey to find the most commonly prescribed inhalational medication in COPD as per the severity of the disease. Methods: It was a cross-sectional questionnaire-based survey of pulmonologists in real-world clinical practice settings conducted across India. Results: The participants included 806 pulmonologists across India. Seventy-five per cent of pulmonologists ranked symptom relief, reduction in the frequency of exacerbations and improvement in lung function as the most important treatment targets. In COPD patients falling under GOLD group A, the treatment choice by pulmonologists in descending rank order was fomroterol/glycopyrronium (32%), ipratropium (38%), and tiotropium (30%) and for gold group B, this was fomroterol/glycopyrronium (34%), followed by indacaterol/glycopyrronium (26%) and tiotropium/formoterol (40%). In the GOLD group E, triple therapy (formoterol/glycopyrronium/budesonide) was preferred by 41% of pulmonologists. In the frequent exacerbator, predominant emphysema, chronic bronchitis and concomitant asthma phenotype, 44%, 38%, 46% and 32% of pulmonologists ranked formoterol/ glycopyrronium/budesonide as their preferred 1st therapy, respectively. Among COPD patients with cardiovascular disease (CVD) comorbidity, 31% of pulmonologists selected formoterol/glycopyrronium/budesonide as 1st-preference drug therapy. Similar results were obtained for COPD patients with metabolic syndrome comorbidity. Conclusions: For the management of COPD patients, pulmonologists predominantly preferred a triple drug combination of formoterol/glycopyrronium/budesonide in GOLD group E and also in patients with cardiovascular and metabolic comorbidities. Fomroterol/glycopyrronium was the most preferred combination for GOLD group A and GOLD group B.
ABSTRACT
Background: Asthma is associated with high morbidity and mortality in India. This survey was undertaken to explore the perspectives of pulmonologists towards in-clinic management of patients with asthma. Methods: It was a cross-sectional survey of pulmonologists conducted across India. It was formulated to provide unbiased observations of real-world clinical practice focusing on methods of diagnosis of asthma and its treatment preferences. Results: The participants included 805 pulmonologists, with the majority primarily treating patients with asthma (62%), chronic obstructive pulmonary disease (19%) and allergic rhinitis (19%). More than 86% of pulmonologists consider clinical symptoms, history of childhood asthma, family history, and chronic allergic rhinitis for initial diagnosis. About 19-23% prefer spirometry alone or in combination with family history for confirmation of asthma. The preferred inhaled corticosteroids-long-acting bronchodilator (ICS-LABA) combination was budesonide-formoterol amongst 83% of pulmonologists. For both dry powder inhaler (DPI) and metered dose inhaler (MDI) devices, fine particle fraction per cent and delivered dose were ranked as the two most important attributes. Conclusions: Asthma is the most prevalent diagnosis among patients treated by pulmonologists on the basis of clinical presentation and medical history. The most commonly used pharmacotherapy for the treatment of asthma comprises ICS-LABA, with budesonide-formoterol being the preferred combination. Fine particle fraction per cent and magnitude of delivered dose influence the choice of asthma inhaler prescriptions the most.
ABSTRACT
The effect of chloroform soluble fraction (F-A) of twigs of Sarcostemma brevistigma on contractions induced by KCl, histamine, and acetylcholine in the isolated guinea pig ileum and taenia coli smooth muscles has been evaluated. F-A (19.5 microg/ml) significantly inhibited the contraction induced by 40 mM KCl to the extent of 87.6% in the isolated guinea pig ileum. In the isolated guinea pig ileum, F-A (64.3 and 59.2 microg/ml) significantly inhibited the contractions induced by acetylcholine and histamine to the extent of 85 and 83% respectively. In the isolated guinea pig taenia coli, F-A (65.2 microg/ml) significantly inhibited the contraction induced by 40 mM KCl to the extent of 96.0%. The inhibitory effect of F-A (40 microg/ml) on the isolated guinea pig taenia coli was reduced by Bay K 8644 (10(-6) M) to the extent of 61.6 from 73.6%. These results suggest that the F-A may exhibit smooth muscle relaxant activity by blocking the Ca2+ channels.