Perception and Usage Among Indian Physicians of Long Acting Dual Bronchodilators in COPD: PATTERN Study

Long-acting dual bronchodilators are indicated for a majority of COPD patients(pts). We aimed to understand their usage by Indian physicians (PY), as data on this is lacking. A self-reported questionnaire was administered to PY randomly selected across India. 321 PY participated in the survey. 93% PY reported that majority of their COPD pts had breathlessness mMRC grade 2 or more. 63% PY said that majority of their COPD pts had 1-2 exacerbations per year while another 15.9% felt that it was more than 2/year. First-line therapy used in the majority of symptomatic COPD pts were dual bronchodilators (43.5% PY), triple therapy (18.6% PY), short acting bronchodilator drugs (SABD; 17.8% PY) or ICS/LABA (15.8% PY). The preferred first-line maintenance therapy for patients at high risk of exacerbations was ICS/LABA/LAMA, LABA/LAMA or ICS/LABA (39.7%, 37% and 18% PY, respectively). Patient profiles believed to be suitable for LABA-LAMAs mainly included GOLD D (45.9% PY), GOLD B (44.4% PY) and GOLD C (32.30% PY) pts. 90% PY perceived tolerability of LABA-LAMA combinations to be good-excellent. 22% PY prescribed ICS-LABA in addition to a LABA-LAMA for more than 40% pts. Of them, 27.3% prescribed ICS/LABA to control symptoms, while 32.6% prescribed it due to greater confidence in ICS-LABA as compared to LABA-LAMA. In pts on long acting bronchodilators, 64% PY used SABD for breakthrough symptoms while 22.6% PY used them for additional symptom relief. 60.2% PY preferred pMDI+Spacer as inhaler device for COPD pts. Despite having highly symptomatic pts, dual long-acting bronchodilators are underused by Indian PY. A significant proportion use ICS/LABA with LABA/LAMA, which may be a safety concern.