Human Journals

Research Article
January 2024 Vol.:30, Issue:1
© All rights are reserved by Dr. Shirsam Deb et al.

Assessment of Prescribing Patterns of Drugs in COPD Patients with

Cor Pulmonale and Pulmonary Hypertension in A Teaching Hospital
Keywords: Chronic Obstructive Pulmonary Disease, Cor
Pulmonale, Pulmonary Hypertension, Right ventricular
hypertrophy.

ABSTRACT

Introduction: Chronic Obstructive Pulmonary Disease

Dr. Shirsam Deb*1, Dr. Vaishnavi Prasannan 2, Dr.
(COPD), a progressive ailment induced by pulmonary irritants,
Prabhu Das3 exhibits irreversible airway obstruction and inflammation.
COPD poses an independent risk for cardiovascular morbidity,
including right ventricular (RV) dysfunction and Cor
1 Pharm D, Acharya and BM Reddy College of
Pulmonale (CP) due to Pulmonary Hypertension (PH). This
Pharmacy, Bengaluru, India study aimed to scrutinize drug usage patterns in treating COPD
patients with exacerbations, CP, and PH, emphasizing
echocardiographic findings to refine diagnostic approaches.
2 Assistant professor, Department of Pharmacy Objectives: The primary objective was to assess drug
Practice, Acharya & BM Reddy College of Pharmacy, prescription patterns for COPD patients, focusing on alternative
medications. Additionally, the study aimed to explore
Bengaluru, India
echocardiographic findings among COPD patients.
Methodology: An observational study involved 40 in-patients
3 HOD/Chief Medical Officer (NFSG), Department of diagnosed with COPD, CP, and/or PH. Patient data, collected
from admission to discharge, underwent statistical analysis,
Pulmonology, ESIC-MC&PGIMSR, Rajajinagar, utilizing descriptive statistics and chi-square tests. Results:
Bengaluru, India Analysis revealed a prevalence of COPD among non-smoking
women over 50 years. PH was present in 35%, and CP
prevalence increased during exacerbations. Dyspnea was a
Submitted: 20 December 2023 predominant symptom. Drug prescriptions favored
Accepted: 25 December 2023 bronchodilators, corticosteroids, and antibiotics. Aspirin was a
frequently prescribed cardiovascular drug. Echocardiographic
Published: 30 January 2024 findings aided in identifying RV dysfunction and PH.
Conclusion: The study underscores COPD's predominance in
non-smoking women over 50, emphasizing the influence of age
on disease progression. Echocardiography facilitates the early
detection of PH and CP in COPD patients. Prescription patterns
mainly targeted symptom relief and exacerbation prevention,
with a preference for bronchodilators, corticosteroids, and
ijppr.humanjournals.com antibiotics. Recognition of RV dysfunction and PH in CP
patients may enhance treatment outcomes and life expectancy.
The findings contribute valuable insights for optimizing COPD
management strategies.
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INTRODUCTION

Global Initiative for Chronic Obstructive Lung Disease (GOLD 2022) guidelines define
Chronic Obstructive Pulmonary Disease (COPD) as a disease distinguished by irreversible
expiratory airflow limitation that is typically progressive and accompanied by an aberrant
[1,2]
inflammatory response of the lungs to noxious particles or gases. COPD is a commonly
progressing disorder usually brought on by pernicious lung irritants and is defined by a
completely irreversible airway obstruction and an inflammatory component. In men over the
age of 35 in India, the prevalence of chronic obstructive pulmonary disease is 5%, whereas in
[3]
women it is around 3.2 % COPD is in the limelight around the world as its high
prevalence, morbidity and mortality pose significant problems to the healthcare system.
According to the World Health Organization (WHO), the total number of deaths in the world
due to COPD is estimated to increase by more than 30% in the next 10 years and by 2030,
COPD will become the fourth leading cause of death worldwide. [3,4] COPD causes disability
and degrades the quality of life, as well as loss of productivity, increased hospital admissions,
increased healthcare costs, and early death. [5]

The key to managing COPD patients is pharmacotherapy which entails systemic, oral, and
inhalational therapy for the maintenance and relief of drugs. Long-acting bronchodilators
(long-acting β2 agonists) or LABA and (long-acting antimuscarinics) or LAMA, either alone
or in combination, are the cornerstone of pharmacological therapy for stable COPD patients
to ease symptoms, boosting exercise capacity, and enhancing the quality of life and
prognosis.

Acute exacerbations of COPD (AECOPD) are characterized by an increase in cough, sputum

[6]
output, purulence, and dyspnoea, as well as the worsening of COPD symptoms. The
primary goal of AECOPD management is to reduce the severity of the current exacerbation
[7]
while also preventing future exacerbations. Formerly published systematic reviews and
clinical guidelines on the case of AECOPD patients hospitalized have predominantly focused
on medical management, with hardly any consideration paid to physical therapy-specific
interactions. [8] Archiving current practice designs is a significant stage in the advancement of
best practice rules. [9]

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COPD related Pulmonary Hypertension

Pulmonary hypertension (PH) associated with lung disease can be defined as a resting mean
pulmonary artery pressure greater than 20mmHg. The development of PH is a notable
inconvenience of COPD. PH often arises when there is substantial airway obstruction and is
accompanied by prolonged hypoxemia, with chronic alveolar hypoxia being the most
[10]
prevalent pathophysiologic cause, however, other pathways have recently emerged. PH in
COPD is classified as Group 3 by the World Health Organization (WHO). [4,11]

Pulmonary Hypertension and Cor Pulmonale in COPD

COPD is a significant and independent risk factor for cardiovascular morbidity, including
right ventricular (RV) dysfunction and cor pulmonale due to pulmonary arterial hypertension.

Cor Pulmonale (CP) is described by WHO as "hypertrophy of the right ventricle caused by
disorders affecting the function and/or structure of the lungs, except when these pulmonary
abnormalities are caused by diseases principally affecting the left side of the heart, as in
congenital heart disease." In Cor pulmonale, PH is always the underlying pathogenic cause
causing right ventricular hypertrophy.

The reported prevalence ranges from 20% to 91% depending on the definition of pulmonary
hypertension, the severity of lung illness in the study group, and the technique of assessing
PASP. [12,13]

The prevalence of PH increases as COPD worsens, and the development of PH and Cor
pulmonale appears to have an impact on COPD patients' survival. [14]

Comorbidities have a substantial impact on the prognosis of chronic obstructive pulmonary

disease (COPD). Additionally, cardiovascular comorbidities are regarded as a leading cause
of hospitalization and mortality in COPD patients.

Drug usage or drug use measures are well-structured and valid quality assurance approaches.
These studies are designed to investigate drug usage and uncover pharmacological trends
based on current recommendations or guidelines for treating a certain ailment.

Aim and objective of the study: This study aimed to analyze the prescribing pattern of
drugs in COPD patients with Cor Pulmonale and Pulmonary hypertension and to determine

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the echocardiographic findings and the presence of symptoms associated with the diagnosis
of COPD patients admitted in the department of General Medicine of a teaching hospital.

PATIENTS AND METHODS:

Study Design: This was a prospective observational study.

Study Duration: 6 months of study, including planning, data collection, interpretation, and
thesis writing.

Study Centre: The study was conducted in the Department of General Medicine at ESI
PGIMSR, Rajajinagar, Bengaluru.

Study Population: The study was conducted in subjects drawn from the population admitted
in the General Medicine ward at ESI-MC & PGIMSR, Bengaluru, who had given informed
consent and assent forms.

Sample Size: The sample size was calculated using a prevalence of 12% in the
Department of General Medicine and was estimated to be 40.

Inclusion criteria:

a. Patients diagnosed with COPD with Cor pulmonale and/or Pulmonary hypertension
admitted as in-patient in the department of General Medicine.

b. Patients above 18 years of age.

Exclusion criteria:

a. Patients who tested COVID-19+VE at the time of admission.

b. Pregnant and lactating women.

Ethical approval: this study was approved by epic-medical college & primer
(No.532/L/11/12/Ethics/ESICMC&PGIMSR/Estt. Vol.-IV).

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Source of data:

Patient demographics and treatment details were collected from patients' case sheets
admitted in the in-patient department of General Medicine.

Study tool:

Self-designed data collection form: Data was collected by using a self-designed data
collection form, which consists of details like age, sex, lab data, disease condition,
echocardiography report, ECG report, symptoms, co-morbidities, drug therapy, and other
relevant information.

Study procedure:

Subjects for the study were identified by the investigators during the ward visits based on the
inclusion and exclusion criteria. The patients were explained the purpose of the study and
informed consent was obtained. Relevant data such as demographic details, medication
charts, etc., was recorded. The data thus obtained was entered in a Microsoft Excel sheet and
appropriate analysis was performed.

Statistical analysis:

All recorded data were entered using MS Excel software and analyzed using MS Excel.
Descriptive statistics such as mean and standard deviation were computed for quantitative
variables and frequencies and percentages were calculated for categorical variables.
Histograms and pie charts were applied to find the nature of data distribution.

Parameters Analysed:

The prescription pattern for patients with COPD diagnosed with Cor pulmonale and/or
Pulmonary hypertension was analyzed and it was correlated to the treatment provided for
symptomatic relief and to prevent exacerbations. The Doppler echocardiography and ECG
report of individual patients were obtained and the presence of right ventricular hypertrophy
was confirmed. The PASP values were correlated with the presence of comorbidities. The
symptoms were correlated with the presence of COPD, COPD patients with exacerbations
and cardiovascular complications.

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RESULTS

The study was conducted in subjects drawn from the population admitted to the General
Medicine ward at ESI-MC & PGIMSR, Bengaluru based on the inclusion criteria. A total of
40 study subjects were included in the study.

Gender Distribution

Out of 40 study subjects enrolled in the study, 19 (47.5%) were male and 21 (52.5%) were
female as enlisted in Table 1.

Age Distribution:

The maximum number of male patients were found to belong to the age group of 60-69 years,
9 (22.5%), and the maximum number of female patients were found to belong to the age
group of 50-59 years, 8 (20%) as enlisted in Table 1.

Table 1: Distribution of patients based on age group and gender

Total No of
Age Group Male Female
Patients
(Years)
n (%) n (%) n %
30-39 0 0% 0 (0%) 0 (0%)
40-49 2 5% 1 (2.5%) 3 (7.5%)
50-59 5 12.5% 8 (20%) 13 (32.5%)
60-69 9 22.5% 5 (12.5%) 14 (35%)
70-79 3 7.5% 6 (15%) 9 (22.5%)
80-89 0 0% 1 (2.5%) 1 (2.5%)
Total 19 21 40

Smoking Status:

Out of 40 COPD patients included in the study, 17 (42.5%) male patients were found to be
smokers and3 (7.5%) patients were non-smokers and out of 20 (50%) female patients all were
non-smokers as enumerated in Figure 1.

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Figure 1: Distribution of smoking status

Distribution of COPD Subjects Based on Ejection Fraction:

Ejection fraction was measured for 11 (27.5%) male patients, out of which 10 (25%) patients
were found to be in the normal range (52-72%) and 1 (2.5%) patient in the mildly abnormal
range (41-51%). Ejection fraction was measured for 14 (35%) female patients among which
11 (27.5%) patients were found to be in the normal range of 52-72%, 1 (2.5%) patient in the
mildly abnormal range (30-40%) and 2 (5%) patients in the moderately abnormal range (30-
40%) as enlisted in Figure 2.

Figure 2: Distribution of COPD patients based on ejection fraction

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Distribution of COPD Patients based on RVH as Found in ECG:

Out of the total COPD patients screened for ECG, 21 patients (52.5%) had the presence
of rightventricular hypertrophy as shown in Figure 3.

Figure 3: Distribution of COPD patients based on RVH as found in ECG

Distribution of COPD Patients Based on the Presence of Complications:

Out of 40 COPD patients, 14 (22%) patients were diagnosed with COPD with Cor
pulmonale, 14 patients (22%) with COPD with pulmonary hypertension, and 6 patients (10%)
as COPD with Cor pulmonale and pulmonary hypertension as seen in Figure 4.

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Figure 4: Distribution of COPD patients based on the presence of complications

Distribution Of COPD Patients with Acute Exacerbation and Complications:

Out of 40 patients who had a history of COPD, 15 (37.5%) patients were diagnosed as
AECOPD with Cor pulmonale, 9 (22.5%) patients with AECOPD with Pulmonary
hypertension, and 5 (12.5%) patients as AECOPD with Cor pulmonale and Pulmonary
hypertension as shown in Figure 5.

Figure 5: Distribution of COPD patients with acute exacerbation and complications

Distribution Of Comorbidities in COPD Patients:

Out of 40 COPD patients with Pulmonary hypertension and/or Cor pulmonale, Hypertension
(n=16,40%) was found to be the most common comorbidity followed by common
distribution between Type 2 DM (n= 12, 30%) Type I Respiratory failure (n= 12, 30%), atrial
flutter (n= 4, 10%), left midzone consolidation (n= 4, 10%) and hypertensive heart disease
(n= 1,2.5%) being the most least comorbidity found in patients as shown in Figure 6.

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Figure 6: Distribution of comorbidities in COPD patients

Distribution of Symptoms Among COPD Patients:

Out of 40 COPD patients, dyspnea (n=39, 98%) was found to be the most prevalent symptom
followed by cough (n=31, 78%), pedal edema (n=17, 42.5%), fever (n=16, 40%), chest pain
(n=9, 22.5%), wheezing (n=8, 20%), fatigue (n=6, 15%) and the least common symptom was
found to be puffiness and giddiness sharing common distribution in 1 patients (2.5%)
respectively as enlisted in table 2.

Table 2: Distribution of symptoms among COPD patients

Symptoms No Of Patients Percentage (%)
Dyspnea 39 98%
Cough 31 78%
Pedal edema 17 42.50%
Fever 16 40.00%
Chest pain 9 22.50%
Wheezing 8 20%
Fatigue 6 15%
Puffiness 1 2.50%
Giddiness 1 2.50%

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Distribution of Patients on Basis Of Dyspnea Grading:

Out of a total of 40 COPD patients, 39 were found to have dyspnea, with 18 patients (45%)
having Grade I Dyspnea, 3 patients (7.5%) having Grade II Dyspnea, 9 patients (22.5%)
having Grade III Dyspnea, and 8 patients (20%) having Grade IV Dyspnea, according to
mMRC Scale as enlisted in Table 3.

Table 3: Distribution of patients based on dyspnea grading

Dyspnea Grading (mMRC Scale) No Of Patients Percentages
Grade I 18 45%
Grade II 4 10%
Grade III 9 22.50%
Grade IV 8 20%

Distribution of Medications Prescribed for COPD Patients:

This study observed that bronchodilators (n=37, 92.5%) were the most frequent class of drug,
tied for first place with corticosteroids followed by antibiotics given to 28 patients (70%),
cardiovascular drugs (n=23, 57.5%), anti-inflammatory and diuretics shares a common
distribution of 17 patients (42.5%). Antitussives were given to 16 patients (40%), calcium
channel blockers (n=7, 17.5%), PDE-5 Inhibitors (n=6, 15%), antihypertensives (n=5, 12.5%)
and antidysrhythmic was given to least number of patients (n=2, 5%) as enlisted in Table 4.

Table 4: Distribution of medications prescribed for COPD patients

Class of drug No. Of patients received Percentage (%)
Bronchodilators 37 92.50%
Corticosteroids 37 92.50%
Antibiotics 28 70%
Cardiovascular drugs 23 57.50%
Anti Inflammatory 17 42.50%
Diuretics 17 42.50%
Antitussives 16 40%
Calcium channel blockers 7 17.50%
PDE-5 Inhibitors 6 15%
Antihypertensives 5 12.50%
Antidysrhythmic 2 5%

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Distribution Of COPD Patients Receiving Bronchodilators And Corticosteroids:

The most commonly prescribed class of drug was a combination of short-acting beta 2
agonists and anticholinergics (SABA+SAMA), with 37 patients (92.5%) receiving
levosalbutamol + Ipratropium bromide, followed by long-acting anticholinergics (LAMA)
and short-acting anticholinergics (SAMA) sharing an equal distribution, with tiotropium
bromide and ipratropium bromide. The combination of long-acting beta 2 agonist and
corticosteroid (LABA+ICS) is also equally distributed with methyl xanthines comprising
formoterol fumarate+budesonide (5%), and deriphyllin (5%) and Budesonide (92.5%) were
found to be the most commonly prescribed drug among corticosteroids followed by
methylprednisolone and hydrocortisone sharing an equal distribution of 32.5% as enlisted in
Table 5.

Table 5: Distribution of COPD patients receiving bronchodilatotrs and corticosteroids:

Group Of No Of
Drug Class Drugs Percentages
Drug Patients
SABA Salbutamol 1 2.50%
Levosalbutamol +
(SABA+SAMA) 37 92.50%
Ipratropium bromide
(LAMA) Tiotropium bromide 2 5%
Salmeterol + Fluticasone
(LABA+ICS) 1 2.50%
Bronchodilators propionate
Formoterol fumarate +
2 5%
Budesonide
(SAMA) Ipratropium bromide 2 5%
Methyl Theophylline 1 2.50%
Xanthines Deriphyllin 2 5%
Corticosteroids Budesonide 37 92.50%
- Methyl Prednisolone 13 32.50%
Hydrocortisone 13 32.50%

Distribution Of COPD Patients Receiving Antibiotics :

The most frequently prescribed medicine class was cephalosporin antibiotics, of which
ceftriaxone was prescribed to 28 patients (70%) and cefixime to 5 patients (5%). Macrolide
antibiotics were the second most frequently given class of drugs, with 55% of patients
receiving azithromycin. This was followed by penicillin antibiotics, beta-lactam antibiotics,

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and levofloxacin, which were provided to 30%, 7.5%, and 2.5% of patients, respectively as
enlisted in Table 6.

Table 6: Distribution of COPD patients receiving antibiotics

Class Of Drugs Drugs No Of Patients Percentages
Cephalosporin antibiotics Ceftriaxone 28 70%
Cefixime 2 5%
Macrolide antibiotics
Azithromycin 22 55%
Piperacillin and
Penicillin antibiotics 12 30%
Tazobactam
Beta-Lactam antibiotics Meropenem 3 7.50%
Fluoroquinolones Levofloxacin 1 2.50%

Distribution of Combination Drugs Used in COPD Patients:

Out of 40 prescriptions, levosalbutaml+Ipratropium bromide was found to be the most

commonly prescribed combination of drugs followed by monteleukast+levocetrizine given to
42.5% of patients, piperacillin + tazobactam to 30% of patients while acebrophylline +
monteleukast, ambroxol + acetylcysteine, and salmeterol + fluticasone propionate shares a
common distribution of 2.5% as enlisted in Table 7.

Table 7: Distribution of combination drugs used in COPD patients

No Of Patients
Combination Of Drugs Used In Patients (n=40) Percentages
Piperacillin and Tazobactam 12 30%
Levosalbutamol + Ipratropium bromide 37 92.50%
Salmeterol + Fluticasone propionate 1 2.50%
Monteleukast sodium + levocetrizine 17 42.50%
Acebrophyliine + Monteleukast 1 2.50%
Ambroxol + Acetylcysteine 1 2.50%

Distribution of Patients Based on Route of Administration:

Inhalation was determined to be the most generally favored route of administration (n=39,
97.5%) followed by injection (n=31, 77.5%) and oral (n=23, 57.5%) as shown in Figure 7.

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Figure 7: Distribution of patients based on the route of administration

DISCUSSION

The study included 40 patients, 19 (47.5% of the subjects) were male and 21 (52.5% of the
subjects) were female. Our research revealed that female patients suffer from COPD at a
higher rate than male patients, which may be attributable to occupational exposure and
epidemiological factors. The average length of stay (LOS) for COPD patients in the hospital
was 10.22 (±4.6) days, with 4 days being the shortest stay and 22 days being the longest. The
mean length of hospital stay was 4.5 days, which is similar to the study conducted by
Hoskins et al. (2000)[15].

The 40 COPD participants were categorized by smoking status, revealing that 42.5% of
males and 7.5% of females were smokers. Contrary to Avinash Teli et al.'s study (87%
smokers), our findings indicated a majority of non-smokers (57.5%). [16]

On obtaining the ECG report of all COPD patients from their case sheets, it was discovered
that right ventricular hypertrophy (RVH) was present in 21 (52.5%) of the patients. Our
findings correlate with the findings of D Radha Krishnan et al., where COPD subjects
diagnosed with Cor pulmonale had the presence of RVH in 30/100 cases (30%). [17]

The combination of levosalbutamol and ipratropium bromide (42.5%) was the most
recommended for individuals with RVH, followed by budesonide (42.5%).

Our study found a higher prevalence of Cor pulmonale in COPD patients with acute
exacerbations (37.5%) compared to those with COPD alone (35%). These results align with
Hang Fang et al., who reported a more frequent detection of Cor pulmonale in subjects with

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[18]
exacerbation (27.2%) compared to those without exacerbation (18.8%) . Additionally,
Pulmonary hypertension was more prevalent in COPD subjects (35%) than in AECOPD
subjects (22.5%), supporting Buklioska-llievska et al.'s findings, indicating a significantly
higher frequency of PH among COPD patients (33.3% vs. 0%) than those without COPD. [19]

In our study, COPD was most commonly associated with hypertension (40%), followed by
type 2 diabetes (30%) and type I respiratory failure (30%). Aiswarya et al., reported similar
findings, with hypertension being the most prevalent comorbidity (38.33%), followed by
diabetes mellitus (30%) [20]. Conversely, Avinash Teli et al., found that Cor pulmonale (15%)
was the most prevalent comorbid condition, followed by hypertension (10%) and diabetes
mellitus (3%).[16]

Dyspnea (98%) was the predominant symptom in our study, followed by cough (78%), pedal
edema (42.5%), and other less prevalent symptoms. Our results align with D. Radha
Krishnan et al., who reported dyspnea (100%) as the most prevalent symptom, followed by
cough (96%) [21].

Bronchodilators (n=37, 92.5%) were the most commonly prescribed class of drugs followed
by corticosteroids (n=37, 92.5%). Antibiotics (n=28, 70%) were the second most commonly
prescribed class of drugs.

In our study, commonly prescribed drug combinations included levo-salbutamol and

ipratropium bromide (92.5%), monteleukast and levocetrizine (42.5%), piperacillin and
tazobactam (30%), and salmeterol and fluticasone propionate (2.5%). These findings are
consistent with Amit Kumar et al., who reported a high prevalence of salbutamol and
ipratropium bromide combination (20.9%) and other common pairings[22].

Inhalation (97.5%) was the preferred route, followed by injection (77.5%) and oral
administration (57.5%), consistent with findings by DB Jyothi et al., [23].

After analyzing the prescriptions of 40 COPD subjects it was found that a total of 49 drugs
were prescribed to the patient population among which 31 (63.2%) drugs were prescribed
from the National List of Essential Medicines (NLEM) 2022.

CONCLUSION

In this study on Chronic Obstructive Pulmonary Disease (COPD), our findings emphasize

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notable gender disparities, with females exhibiting a higher COPD incidence possibly linked
to occupational exposures. Non-smokers constituted the majority of subjects, suggesting
cardiovascular comorbidities beyond age 50, potentially independent of smoking. Evaluation
of pulmonary function impairment and pulmonary hypertension revealed a spectrum of
severity, emphasizing the need for long-term prognosis assessment.

Right ventricular hypertrophy (RVH) was prevalent among patients diagnosed with Cor
pulmonale, highlighting its association with pulmonary hypertension. Dyspnea emerged as
the predominant symptom, indicating the significant impact of COPD on patients.
Bronchodilators and corticosteroids, particularly levosalbutamol plus ipratropium bromide
and budesonide, were the most frequently prescribed drugs, administered primarily through
inhalation.

Antibiotic prescriptions, notably cephalosporins and macrolides, lacked culture sensitivity

tests, suggesting potential irrational antibiotic use. Amlodipine, among calcium channel
blockers, was commonly recommended, aligning with previous research indicating its
positive effects on pulmonary hemodynamics in COPD.

Combinations like levosalbutamol and ipratropium bromide, montelukast and levocetirizine,

and piperacillin and tazobactam were frequently recommended, showcasing diverse treatment
approaches.

Prescriptions primarily focused on symptomatic relief, highlighting the symptomatic nature

of COPD management in our study. Left ventricular function remained unaffected in COPD
patients, as evidenced by normal LVEF values. Echocardiographic techniques efficiently
detected pulmonary hypertension and cor pulmonale, underscoring their utility in early
identification and subsequent treatment for improved life expectancy in affected individuals.

REFERENCES:

1. Jochmann A, Neubauer F, Miedinger D, Schafroth Török S, Tamm M, Leuppi J. General practitioner’s

adherence to the COPD GOLD guidelines: baseline data of the Swiss COPD Cohort Study. Swiss Med Wkly
[Internet]. 2010; Available from: http://dx.doi.org/10.4414/smw.2010.13053
2. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global Strategy for the
Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report. GOLD Executive
Summary. Am J Respir Crit Care Med [Internet]. 2017;195(5):557–82. Available from:
http://dx.doi.org/10.1164/rccm.201701-0218PP
3. Sawant MP, Padwal SL, Kale AS, Pise HN, Shinde RM. Study of drug prescription pattern among COPD
patients admitted to medicine in-patient department of tertiary care hospital. Int J Basic Clin Pharmacol.
[Internet]. 2017;6(9):2228. Available from: http://dx.doi.org/10.18203/2319-2003.ijbcp20173750

Citation: Dr. Shirsam Deb et al. Ijppr.Human, 2024; Vol. 30 (1): 96-113.
111
 ijppr.humanjournals.com

4. Ryan JJ, Thenappan T, Luo N, Ha T, Patel AR, Rich S, et al. The WHO classification of pulmonary
hypertension: A case-based imaging compendium. Pulm Circ [Internet]. 2012;2(1):107–21. Available from:
http://dx.doi.org/10.4103/2045-8932.94843
5. Daniel RA, Aggarwal P, Kalaivani M, Gupta SK. Prevalence of chronic obstructive pulmonary disease in
India: A systematic review and meta-analysis. Lung India [Internet]. 2021;38(6):506–13. Available from:
http://dx.doi.org/10.4103/lungindia.lungindia_159_21
6. Criner GJ, Bourbeau J, Diekemper RL, Ouellette DR, Goodridge D, Hernandez P, et al. Prevention of acute
exacerbations of COPD. Chest [Internet]. 2015;147(4):894–942. Available from:
http://dx.doi.org/10.1378/chest.14-1676
7. Adams SG, Melo J, Luther M, Anzueto A. Antibiotics are associated with lower relapse rates in outpatients
with acute exacerbations of COPD. Chest [Internet]. 2000;117(5):1345–52. Available from:
http://dx.doi.org/10.1378/chest.117.5.1345
8. Bach PB, Brown C, Gelfand SE, McCrory DC, American College of Physicians-American Society of
Internal Medicine, American College of Chest Physicians. Management of acute exacerbations of chronic
obstructive pulmonary disease: a summary and appraisal of published evidence. Ann Intern Med [Internet].
2001;134(7):600–20. Available from: http://dx.doi.org/10.7326/0003-4819-134-7-200104030-00016
9. Yohannes AM, Connolly MJ. A national survey: percussion, vibration, shaking and active cycle breathing
techniques used in patients with acute exacerbations of chronic obstructive pulmonary disease. Physiotherapy
[Internet]. 2007;93(2):110–3. Available from: http://dx.doi.org/10.1016/j.physio.2006.07.003
10. Chaouat A, Naeije R, Weitzenblum E. Pulmonary hypertension in COPD. Eur Respir J [Internet].
2008;32(5):1371–85. Available from: http://dx.doi.org/10.1183/09031936.00015608
11. McLaughlin VV, McGoon MD. Pulmonary arterial hypertension. Circulation [Internet].
2006;114(13):1417–31. Available from: http://dx.doi.org/10.1161/CIRCULATIONAHA.104.503540
12. Thabut G, Dauriat G, Stern JB, Logeart D, Lévy A, Marrash-Chahla R, et al. Pulmonary hemodynamics in
advanced COPD candidates for lung volume reduction surgery or lung transplantation. Chest [Internet].
2005;127(5):1531–6. Available from: http://dx.doi.org/10.1378/chest.127.5.1531
13. Weitzenblum E, Sautegeau A, Ehrhart M, Mammosser M, Pelletier A. Long-term oxygen therapy can
reverse the progression of pulmonary hypertension in patients with chronic obstructive pulmonary disease. Am
Rev Respir Dis [Internet]. 1985;131(4):493–8. Available from: http://dx.doi.org/10.1164/arrd.1985.131.4.493
14. Pulmonary Hypertension and Cor Pulmonale in COPD. Semin Respir Crit Care Med [Internet].
2003;24(3):263–72. Available from: http://dx.doi.org/10.1055/s-2003-41087
15. Wagenvoort CA, Mulder PGH. Thrombotic lesions in primary plexogenic arteriopathy. Chest [Internet].
1993;103(3):844–9. Available from: http://dx.doi.org/10.1378/chest.103.3.844
16. Teli A. A Study of Drug Utilization and Prescribing Patterns of Drugs in Chronic Obstructive Pulmonary
Disease Patients (IPD and OPD) in Tertiary Care Hospital. Acta Scientific Pharmacology. 2020;1:01-9
17. D. Radha Krishnan and Barama Srihari (2015). A study on the severity of right ventricular dysfunction in
correlation with the severity of Lung dysfunction in Chronic Obstructive Pulmonary Disease patients - COPD.
The American Journal of Science and Medical Research.1(4):112-119.doi:10.17812/ajsmr2015142. Available
from: http://ajsmrjournal.com/pdffiles/cimg145725_11.20%20RADHAKRISHNA%20112-119%20f.pdf
18. Fang H, Zhang M, Zhao C, Yao X, Wang H, Xia H, et al. Characteristics of length of stay and
cardiovascular pharmacotherapy advice among chronic obstructive pulmonary disease patients. Sci Prog
[Internet]. 2021;104(4):368504211066003. Available from: http://dx.doi.org/10.1177/00368504211066003
19. Buklioska-Ilievska D, Minov J, Kochovska-Kamchevska N, Prgova-Veljanova B, Petkovikj N, Ristovski V,
et al. Cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: Echocardiography
changes and their relation to the level of airflow limitation. Open Access Maced J Med Sci [Internet].
2019;7(21):3568–73. Available from: http://dx.doi.org/10.3889/oamjms.2019.848
20. Aiswarya, Suja, Krishnapriya, Unni PVS, Salim S. A study on prescription pattern and assessment of
smoking as a risk factor among COPD patients in a tertiary care hospital. Ind J Pharm Pr [Internet].
2022;15(2):90–6. Available from: http://dx.doi.org/10.5530/ijopp.15.2.17
21. D. Radha Krishnan and Barama Srihari (2015). A study on the severity of right ventricular dysfunction in
correlation with the severity of Lung dysfunction in Chronic Obstructive Pulmonary Disease patients - COPD.

Citation: Dr. Shirsam Deb et al. Ijppr.Human, 2024; Vol. 30 (1): 96-113.
112
 ijppr.humanjournals.com

The American Journal of Science and Medical Research.1(4):112-119.doi:10.17812/ajsmr2015142. Available

from: http://ajsmrjournal.com/pdffiles/cimg145725_11.20%20RADHAKRISHNA%20112-119%20f.pdf
22. Kumar A, Christine U, Surendranath GS. Prescribing Pattern of Drugs in the Management of Chronic
Obstructive Pulmonary Disease at an Indian Tertiary Care Teaching Hospital. Journal of Clinical and
Pharmaceutical Research. 2021 Jan 14:1-3. Available from:
https://scholar.googleusercontent.com/scholar?q=cache:rEZw7X9cMmoJ:scholar.google.com/&hl=en&as_sdt=
0,5
23. Jyothi DB, Prasad SV, Vangoori Y, Bharatha A. A prospective study on prescription pattern in chronic
obstructive pulmonary disease. Maedica (Buchar) [Internet]. 2020;15(1):37–44. Available from:
http://dx.doi.org/10.26574/maedica.2020.15.1.37

Citation: Dr. Shirsam Deb et al. Ijppr.Human, 2024; Vol. 30 (1): 96-113.
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