Prescription pattern of inhalational medications for chronic obstructive pulmonary disease in India: insights from cross-sectional survey of pulmonologists across India

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.