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Are Our Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Adequately Treated? Are We in Line with Gold Guidelines?

Author(s): Padmaja Udaykumar, Fathima Farangipete

Background: Adherence to GOLD guidelines is inadequate in the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Evaluating the drug utilization pattern in these patients was the primary objective. Methods: We analyzed the prescriptions of hospitalized adult patients with AECOPD excluding those with bronchial asthma, cystic fibrosis and severe bronchiectasis. Anaemic status of these patients was assessed. Results: Eighty eligible patients with a mean age ± SD of 65.99 ± 10.7 years were included. Males (65%) outnumbered females. Mean ± SD duration of COPD was 5.9 ± 2.1 yrs. There were 78.75% smokers. Hypertension (n=37, 46.25%) and diabetes (n=25, 31.25%) were the frequent comorbidities. Inhalational drugs were administered to 76 (95%) patients, 72 (90%) received oral while 25 (31.2%) received parenteral medications. Β2-agonist Salbutamol accounted for 74 (97.3%) prescriptions of Inhalational agents, followed by anti-cholinergics (96%), Steroids (61.8%). Among oral medications, β-agonist accounted for 52.7% prescriptions (Terbutaline 97.3%). Antibiotics were prescribed to 66 (82.5%) patients, ceftriaxone 39 (59%) and combination of amoxicillin trihydrate clavulanic acid topped the list. Of parenteral steroids (n=22, 88%) Hydrocortisone (100 mg) was administered to all. Forty eight (61.8%) prescriptions consisted of inhalational steroids (budesonide). Of methylxanthines (67.5%), theophylline was the preferred choice in all. Anti-cholinergics (ipratropium bromide) were prescribed to 91.2% patients. Average number of drugs prescribed was 4.5/ patient. There was no statistical significance and relationship between number of drugs, duration of disease, hemoglobin levels, and comorbidities. Conclusion: The treatment protocol for AECOPD in our hospital is in accordance with the current GOLD guidelines. Adherence to GOLD guidelines is feasible in our setup and results appropriate and adequate treatment.

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