Introduction

• Globally estimated 384 million people are suffering from 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
• In Nepal COPD possessed 43% of the non-communicable disease burden, and 2.56% of hospitalizations.²
• Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommended the use of spirometer to evaluate the lung function of COPD patients.¹
• Guideline suggested, pharmacologic treatments should be complemented by appropriate non-pharmacologic interventions for management of COPD.¹
• There was a paucity of recent data to understand the practice pattern of COPD by clinicians in Nepal.

Aim

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

Methods

• This was a questionnaire based survey with multiple choices (Fig. 1).
• A total of 18 questions were branched out into categories of demographics, diagnosis, management, use of devices and adherence.
• Data was collected from randomly selected 171 physicians practicing obstructive airway diseases.
• The participants were from 135 different locations across 45 towns in Nepal.
• The data collection took 2 months (September and October 2017) to complete.
• All forms were 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

•  81.87% doctors encountered at least 5 COPD patients in their daily practice (Fig. 2).
• Almost all patients were >40-years of age (Fig. 3).
• 47.18% COPD patients were female.

How Many Patients Do You Encounter with COPD in Your Daily Practice?

The Highest Number of Your COPD Patients Belong to Which Age Band?

• 75.74% of doctors routinely used spirometry and clinical judgment to diagnose COPD (Fig. 4).
• Almost all doctors called their patients every 3 months for follow up.
• 96.43% doctors found at least 70% of their patients were smokers (Fig 5).

How Do You Routinely Diagnose COPD in Your Practice?

What Percentage of Your Patients with COPD Never Smoked?

Figure 5: Percentage of never smoked COPD patients  

• Symptoms of COPD was prioritized by most doctors over lung function and exacerbation history, for selecting treatment options for their patients (Fig. 6).
• Approximately, 54.74% of doctors preferred to prescribe short-acting bronchodilators to GOLD Group-A patients.
• LABA/LAMA and ICS/LABA combinations were preferred choice by 28.57% and 25.51% doctors respectively for GOLD Group-B patients.
• 53.57% and 78.18% doctors preferred LABA+LAMA/ICS combination for both GOLD Groups-C and D patients respectively.

Which of the following do you prioritize while selecting a treatment for patients with COPD?

Which of The Following Non-Pharmacological Treatments Do You Routinely Offer to Your Patients with COPD?

• Smoking cessation advised is widely offered by most doctors as a non-pharmacological treatment to COPD patients (Fig. 7).
• 40.12% of doctors prescribed inhalation therapy to each of their COPD patients.
• 46.34% doctors said they don’t prescribe spacer with pMDI.
• Only 41.57% doctors regularly checked their patient’s inhalation technique on every visit (Fig. 8).

How Often Do You/Your Assistant/Other Healthcare Professional Evaluate the Inhalation Technique of Your COPD Patients?

Of the Following Devices, Which One Do You Prefer to Prescribe to Maximum Patients with COPD?

• 72.67% doctors preferred dry powder inhaler devices (Fig. 9).
• 85.03% doctors preferred nebulized SABA/SAMA at home for severe COPD patients.

In Your Experience, for Every 10 Patients That Visit You, How Many Show Good Adherence (>80%) to the Prescribed Inhaled Treatment?

In Your Opinion, What is the Biggest Reason of Non-Adherence to the COPD Treatment?

• Only 21.56% doctors believed that >70% of their patients had good adherence (>80%) to the treatment (Fig. 10).
• Poor technique and high cost of therapy were considered as the biggest reasons for non-adherence to COPD treatment (Fig. 11).

Conclusions

• There was a high burden of COPD among females as-well-as non-smokers in Nepal.
• Doctors were following GOLD recommendations for the treatment of COPD.
• DPIs were the most preferred device nevertheless, in the patients who were using pMDIs, the use of spacer can be increased.
• Evaluation of inhalation technique in every visit can be improved the adherence level among COPD patients.

References

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline, updated 2018.
2. International Journal of COPD 2012:7 253–257.