Introduction

• Globally estimated 384 million people are suffering from Chronic Obstructive Pulmonary Disease (COPD)  with a prevalence of 11.7%.¹ Current annual mortality is 3 million which might increase to 4.5 million by 2030.¹
• With increasing prevalence of smoking in developing countries, and aging populations in high-income countries, the prevalence of COPD is expected to rise over the next 30 years.¹
• Translating about 448,000 cases in Malaysia, prevalence of moderate to severe COPD estimated to be 4.7%²
• Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends the use of spirometer to evaluate the lung function of COPD patients.¹
• Guideline also suggests, pharmacologic treatments, and should be complemented by appropriate non-pharmacologic interventions for management of COPD.¹
• There is a paucity of recent data to understand the practice pattern of COPD by clinicians in Malaysia.

Aim

• The study aimed to evaluate doctors’ perception on demographics, diagnosis and monitoring, management, device usage and adherence among COPD patients in Malaysia.

Methods

• This was a questionnaire based survey with multiple choices answers.(Figure 1)
• Data was collected from randomly selected 144 doctors of different specialties practicing obstructive airway diseases in both government and private setup.
• The participants were from 10 different locations across Malaysia.
• The data collection took 1 month (November 2017) to complete.
• All forms are hand-filled by the doctors, duly undersigned.
• The data analysis was performed by SPSS version 2.2, supported at Chest Research Foundation (CRF), Pune.

Results

• 73% doctors saw at least 5 patients in their daily practice.
• Almost all patients were >40-years of age and more than 90% were smokers.
• Most of the doctors routinely used spirometry and clinical judgement to diagnose COPD and suggested a follow-up atleast every 3 months.

Half of the doctors considered patients’ exacerbation history while selecting the treatment for COPD patients.

• 85% of doctors routinely use spirometer and clinical examination to diagnose COPD (Fig 2).
• Maximum number of doctors preferred SABA/SAMA combination for Group-A, LABA/LAMA for Group-B and C, and LAMA+ICS/LABA for Group-D patients.
• 64% of doctors prescribed inhalation therapy to all their COPD patients.
• Pressurised Metered Dose Inhaler (Pmdi) with or without spacer was preferred by most doctors.
• Nebulization in clinic or at home, was one of the preferred options for Group-D patients by 24% of doctors; SABA/SAMA being most prescribed one.

• Among the non-pharmacological management, maximum doctors advised for smoking cessation, whereas least being dietetic advice (Fig 3).

• pMDI with or without spacer preferred by maximum doctors (Fig. 4).
• 64% of doctors prescribed inhalation therapy to their every COPD patients.
• 13% of doctors believe atleast >70% of their patients are still apprehensive to use inhalers.
• 64% doctors didn’t prefer to prescribe spacer along with inhaler.

• Only 22% doctors feel 70% of patients visiting them showed good (>80%) adherence to prescribed inhaled treatment (Fig. 5).
• All the doctors evaluated inhalation technique either at every visit (51%) or on suspecting wrong technique (49%) (Fig. 6).

Maximum (67%) doctors considered the number of daily doses most important for their patients, compared to per day cost or type of devices (Fig. 7).

• Poor technique was considered to be the biggest reason for non-adherence to COPD treatment (Fig. 8).

Conclusions

• Doctors in Malaysia followed GOLD recommendations for COPD management.
• pMDI with or without spacer is the most preferred device choice for patients with COPD in Malaysia.
• More doctors can adopt inhalation therapy in more number of their patients
• Regular device demonstration in each visit can improve the inhalation technique and possibly can increase adherence to the treatment

References

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline, updated 2018
2. Respirology. 2003;8(2):192-198