An evaluation of Chronic Obstructive Pulmonary Disease (COPD) management within the healthcare System of Pakistan: Insights from a Cross-Sectional analysis of GOLD Guidelines implementation

Abstract

Abstract Background: Recognizing the significance of standardized treatment guidelines in managing COPD, this study aimed to explore prescription patterns in the treatment of chronic obstructive pulmonary disease (COPD). The primary objectives were to assess the extent to which pulmonologists adhere to these guidelines and to pinpoint any factors that may influence physician adherence. Methodology: The research was conducted from April to September 2022 in various healthcare facilities within the twin cities of Pakistan. COPD outpatients were categorized into different risk groups (ABCD) in accordance with the 2021 GOLD strategy. In the context of COPD management, physicians' clinical practices were evaluated by examining both the patients' disease status and the treatment regimens prescribed to determine the degree of adherence to established guidelines. Results: The study included 182 patients, mostly (73.6%) were male with the age mean ± SD 61.16 ± 11.004 years. All patients were Asian Pakistani (100%); 102 (56.0%) patients lived in urban areas, and 80 (44.0%) in rural areas. The most prescribed treatment was the combination long-acting beta agonist (LABA) (27.5%), followed by combination therapy LAMA + LABA (in different inhalers) ((21.4%), LAMA (17.0%), and LABA + ICS (13.7%).The most inappropriate therapies were in Group A (56.09%) followed by a7.5% in Group C. Patients with cardiovascular comorbidities had a .479 (95% CI, .264-.868) times higher risk of receiving an inappropriate therapy (p = 0.015). Conclusions: Pulmonologist compliance with the GOLD guidelines falls short of the desired level and necessitates enhancement. Among the influential factors contributing to the inadequacy of COPD treatments, cardiovascular comorbidities and the inclusion of low-risk Groups A and B are notable, as they carry an elevated risk of overtreatment. Furthermore, it is noteworthy that LABA, while being the most frequently prescribed therapy, is not aligned with the guideline's recommendations to a substantial extent.