A COMPARATIVE STUDY ON PRESCRIPTION PATTERNS

OF COPD PRE AND POST COVID

In partial fulfillment for the award of the degree of
Doctor of Pharmacy
Research supervisor:
Dr. Manda Anusha, Assistant professor,
Department of pharmacy practice
St Pauls college of pharmacy.
Co-guide:
Dr. Leela Prasanna, Clinical pharmacist, KIMS Hospitals Kondapur
Submitted by:-
Mr. S.Jayanth kumar (256517882011)
Ms.Enara Bawani (256518882007)
Ms.Adiba Nousheen (256521883001)
Ms.Jannapala Anusha (256518882010)
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 ACKNOWLEDGMENT

This dissertation would not have been possible without the guidance and the help of several individuals
who are in one way or another have contributed and extended their valuable assistance in the preparation
and completion of this study.

It gives us great Pleasure in expressing our gratitude to all those who have supported us and had their
contributions in making this thesis possible.

"I would like to extend my sincere appreciation to Osmania University for their valuable affiliation with
St. Pauls College of Pharmacy. Their support and collaboration have played a significant role in
enriching my educational experience.

I am grateful for the opportunities and resources made available to me through this affiliation, which
have contributed to my growth and success. Thank you for being an integral part of my academic
journey."
 ACKNOWLEDGMENT

This dissertation would not have been possible without the guidance and help of
several individuals who in one way or another contributed and extended their valuable assistance in the
preparation and completion of this study.
We take this opportunity to express our gratefulness to Mr. K. Sudhir, Chairman, Mr. T. Raghava Reddy,
Secretary, Dr. M. Kiranmai, Professor and Principal, Dr. Are Anusha, Associate Professor, Head of the
department, Department of pharmacy practice, St.Pauls college of pharmacy, Hyderabad for providing the
necessary facilities to carry out this project work with great ease and precision.
We express our gratitude to our guide, Dr. Manda Anusha, Assistant Professor, St. Paul's college of
pharmacy for her advice, support, constant encouragement and boosting our morale throughout the course
of research. We would like to thank the staff of St. Pauls college of pharmacy for their co-operation.

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 ACKNOWLEDGMENT

We wholeheartedly thank the management and staff of KIMS Hospital, Kondapur for their cooperation and
everlasting support without which our study would not be possible.

We are extremely grateful to Dr. V Sudheer, Regional Medical Director, Dr. Sai pardhu, Chief Medical
Information Officer and Medical Admin, Dr. Leela Prasanna, Clinical pharmacist, KIMS, Kondapur for their
ready helping hand and encouragement.

With great sense of gratitude, we would like to thank all patients and Nursing staff for their valuable
cooperation throughout the research study for its successful completion.
 CONTENT

S.NO CONTENT SLIDE NO

1 5
Introduction
2 7
Literature survey
3 9
Aims and objectives
4 10
Justification
5 11
Materials & methods
6 14-31
Results & discussion
7 32
Conclusion
8 33
References
5
 INTRODUCTION
 Chronic Obstructive pulmonary disease(COPD) is a disabling respiratory disease characterized by airflow
obstruction and associated symptoms (including breathing difficulties caused by shortness of breath and
wheezing, airway hyperactivity, chronic cough, sputum production, exercise intolerance and poor quality of
life).
 The chronic airflow obstruction that is characteristic of COPD is caused by a mixture of small airway disease
(chronic bronchitis) and destruction of lung parenchyma (emphysema), the relative contribution of which
vary from patients to patients
 The major risk factor for COPD is tobacco smoking. However, other factors such as exposure to air
pollutants, may increase oxidative stress and inflammation in the lungs and contribute to development of
COPD.
 COPD can be diagnosed with symptoms, physical examination ,spirometry, chest x-ray or CT scan, blood
tests like ABG.
 Treatment can be intensified in stages, depending on the seriousness of the disease. Bronchodilators
(selective β2-agonists, anticholinergic antimuscarinic agents, and methylxanthines); glucocorticoids; and
other forms of drug (vaccines,antibiotics,1-antitrypsin,augmentation therapy, mucolytic agents, vitamins,
immunoregulators, antitussives, and vasodilators) are currently recommended for the management of COPD.

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Pharmacotherapy is used to alleviate symptoms, decrease the incidence and duration of acute
exacerbations, delay disease development and death, promote fitness, and increase exercise resistance in
patients with stable COPD

In terms of patient quality of life and cost-effectiveness, most of these treatment choices prove to be
beneficial. Smoking abstinence, rehabilitation, and long-term oxygen treatment are also well recognized as
treatments that will help COPD patients.

It is necessary to identify the common risk factors as well as aggressive treatment for COPD with
Bronchodilators and Corticosteroids as it have been recommended to help reduce exacerbation of COPD.

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 LITERATURE SURVEY
1.Zainabath Sazmi et al. Conducted a Prospective observational study to evaluate prescribing pattern of
Corticosteroids and bronchodilators in COPD patients and to determine the type of therapy, study was in
general medicine and pulmonology department in yenepoya medical College Hospital, Mangalore,
Population included in the study is 39, In patients and out Patients of both the sex of the above 18 years
with or without comorbidities were included. The Study showed the combination of Salbutamol and
Ipratropium bromide was most frequently prescribed drug followed by antibiotics, concluded that
combination is preferred in the treatment over monotherapy.

2.Shiva Kumar et al. Conducted a Prospective observational Study on prescribing pattern of drugs in
COPD in tertiary care teaching hospital, population included in the study is 163, study Includes COPD
patients of either sex with or without comorbidities and age between 18- 80 years. The study showed the
symptomatic treatment was given for COPD patients; Combinational therapy was preferred over
Monotherapy.

3.Mukesh Kumar et al. Conducted a prospective observational study to evaluate the current
prescription pattern of COPD management using data generated in a tertiary care hospital, site of study is
department of TB&chest with the Department of pharmacology, Mahaveer Medical college &Research
Centre, Moradabad, population included in the study is 74, the study Included the patients with a
diagnosis of COPD visiting TB& Chest department. The study showed the prescribing trend observed in 8
the study
appear to be in concordance with the current GOLD guidelines for the management of COPD patients.

4.Mahadeo et al. Conducted a prospective observational study on prescription pattern among COPD
patients admitted in Medicine ward of a tertiary care hospital, site of study is department of pharmacology
govt. medical college and Hospital Ambajogai, Maharashtra. Population included in the study is 284, study
included patients of all age groups suffering from COPD as the primary diagnosis and admitted in the
medicine ward. The study shows that average number of drugs prescribed were higher than WHO norms,
antibiotic was commonly used, and drugs prescribed with brand names were higher than the generic names.

5.Vijay Prasad et al. Conducted a prospective observational study on prescription pattern in chronic
obstructive pulmonary disease, study conducted in the department of pharmacology Govt medical college
Madhya Pradesh, population included in the study is 400, the study includes patients with mild, moderate,
and severe COPD attending the outpatient department of Medicine. The study shows data from the analysis
suggest the adherence to GOLD guidelines does not have a perceivable impact on symptom prevalence,
exacerbation rate or lung function.

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 AIMS AND OBJECTIVES
AIM:-
To study the prescribing pattern in COPD patients.

OBJECTIVES:
 To assess the comorbid conditions of COPD patients
 To assess the prescription patterns of drugs such as corticosteroids, bronchodilators and antimicrobial
therapy in patients
 To assess the monotherapy or combinational therapy of COPD patients

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 JUSTIFICATION

COPD is a chronic pulmonary disease. As Covid affected the people mostly the pulmonary system, it

requires the use of an appropriate prescription for the diseases affecting pulmonary system. So, there is a

need to assess the prescription patterns after Covid to analyze the change in the treatment. So we assessed

the prescription patterns of COPD before and after Covid.

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 METHODS AND MATERIALS
 STUDY SITE:

KIMS Hospital, Kondapur, Hyderabad

 STUDY DESIGN AND PERIOD: -

This was a Ambispective observational study. This study was carried out for a period of six months.

 STUDY CRITERIA: -

 Inclusion criteria-

o Subjects who are diagnosed with COPD.

o Known case of COPD

o Previous history of COVID 19

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  Exclusion criteria-
o Subjects below the age of 18 years.
o Subjects with Pregnancy and lactation.

 SOURCE OF DATA: -
All data is documented in suitable data collection forms.

 PLAN OF WORK:-

o Preparation of data collection form

o Collection of data in data collection form such as age, gender, diagnosis, comorbidities, treatment.

o Differentiating the treatment into different categories, based on category and monotherapy/
combinational therapy in patients.

o Assessing the prescribing pattern in COPD patients.

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 RESULTS

•Post COVID
•Gender COPD Subjects
Tot wise COPD distribution 60
56

TABLE-1: Gender wise distribution of people 50

50

S.No Gender Pre COVID Post COVID Total

40

30
1 Male 50 (33%) 56 (37%) 106 (70%) 25

20 19

2 Female 25 (17%) 19 (13%) 44 (30%)

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Total 75 (50%) 75 (50%) 150 (100%) 0

Pre Post

Male Female

Figure-1: Gender wise distribution of patients

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Age wise COPD distribution

Table 2: Age wise distribution of COPD people

AGE (years) Pre COVID Post COVID

18-30 0 0
31-40 2 2
41-50 0 1
51-60 9 12
61-70 29 28
71-80 28 27
>81 7 5
Total 75 75

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 Length of stay of patients
TABLE-3: Length of stay of COPD patients in Hospital.
Length of stay
S.N Length Pre Post Total
o of stay COVID COVID
1 0-3 21 26 47 (31%) 4
32 3%
days 21%
47 0-3 days
31%
4-7 days
2 4-7 35 32 67 (45%)
8-10 days
days 11-15 days
3 8-10 17 15 32 (21%) 67
45%
days
4 11-15 02 02 4 (3%)
days
Total 75 75 150
(100%)
Figure-2: Length of stay of COPD patients in Hospital.

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 Comorbidities in COPD patients
Subjects with COPD as Comorbidity COPD
60
TABLE-4: Patients with COPD as Comorbidity 50 47 49

S. Comorbid Pre Post Total 40

No ity COVID COVID 30 28 26

1 Yes 47 49 96 20

10

2 No 28 26 54 0
Pre COVID Post COVID

Yes No

Subjects with other comorbidities Figure-3:Patients with COPD as Comorbidity

TABLE-5: Patients with Comorbidities other than COPD Other Combordities

70 63
S.No Combordi Pre Post Total 60
49
ties COVID COVID 50
40
1 Yes 49 63 112 30 26
20 12
10
2 No 26 12 38 0
Pre COVID Post COVID

Yes No
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Figure-4: Patients with Comorbidities other than COPD
 Monotherapy in Patients
TABLE-6: Monotherapy of drugs used in COPD patients.
Drugs Pre COVID Post COVID

Antibiotics 71 58

Bronchodilators 24 10

Steroids 71 71

Monotherapy
80
71 71 71
70
60 58
50
40
30 24
20
10
10
0
Pre COVID Post COVID

Antibiotics Bronchodilators Steriods

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Figure-5: Monotherapy of drugs used in COPD patients.
 Combinational therapy in patients
TABLE-7: Combinational therapy used in COPD people.
Drugs Pre COVID Post COVID

Antibiotics 58 58

Bronchodilators 74 74

Steroids 66 56

80 74 Combinational therapy 74
70 66
60 58 58 56
50
40
30
20
10
0
Pre COVID Post COVID
Antibiotics Bronchodilators Steriods
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Figure-6: Combinational therapy used in COPD patients.
 Antibiotics

TABLE-8: Use of antibiotics in management of COPD pre and post covid

Antimicr Ceph Quinol Beta Tetrac Lincos Macrol Oxazol Amino Carbap Azoles Total
obials alosp ones lactam yclines amides ides idinon glycosi enems
orins es des
Pre 62 16 55 03 16 38 03 07 24 12 236
COVID

Post 62 09 34 16 06 19 06 03 16 05 176
COVID

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 Antibiotics
70

62 62
60
55

50

40 38
34

30
24

20 19
16 16 16 16
12
10 9
6 6 7
5
3 3 3
0
Cephalosporins Quinolones Beta lactams Tetracyclines Macrolides Lincosamides OxazolidinonesAminoglycosides Carbapenem Azoles

Pre Post

Fig-7 Use of antibiotics in management of COPD pre and post covid

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 Bronchodilators and steroids

TABLE-9: Use of bronchodilators and steroids in management of COPD pre and post covid

Duol Form Acebr Derip Acet Amb Salbu Terb Bude Hydro Prednis Methylp Total
Drug in onide ophyll hylli yl roxol tamol utalin sonid cortis olone rednisol
s in ne cyste e e one one
ine

66 61 41 28 45 21 06 16 40 47 15 52 438
Pre
66 54 59 19 54 19 01 17 70 43 31 17 450
Post

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 Bronchodilators and steroids
80

70

60

50

40

30

20

10

0
in e
lli
n ne e xo
l ol e e e e e
uol nid y ly li e in o m l in nid son l on l on
D o ph h st br ta uta so r ti so so
rm ro r ip lcy Am lb
u
rb de co dni dni
Fo e b
De et
y Sa Te Bu o e e
Ac Ac dr Pr lp
r
Hy th
y
e
M

Pre Post
Fig-8 Use of bronchodilators and steroids in management of COPD pre and post covid 23
 Length of stay and treatment in Pre COVID Patients
TABLE-10: Length of stay in pre covid COPD patients using medication.
Drugs 0-3 days 4-7 days 8-10 days 11-15 days
Cephalosporins 17 29 14 2

Quinolones 2 8 6 0
*Beta lactams 11 30 12 2
Tetracyclines 1 2 0 0
Lincosamides 1 10 4 1
*Macrolides 12 19 5 2
Oxazolidinones 0 2 1 0
Aminoglycosides 2 1 3 1
Carbapenems 6 10 7 1
Antivirals 3 12 6 1
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P Value-<0.05
Drugs 0-3 days 4-7 days 8-10 days 11-15 days
Budesonide 13 20 6 1
Hydrocortisone 14 23 9 1
*Prednisolone 3 12 0 0
*Methylprednisolon 12 22 16 2
e
Duolin 19 31 14 2
Formonide 15 28 16 2
Acebrophylline 11 18 11 1
Deriphylline 6 14 6 2
Acetylcysteine 11 20 13 1
Ambroxol 5 10 5 1
Salbutamol 1 3 2 0
Terbutaline 5 7 3 1
25
P Value-<0.05
 Length of stay and treatment in Post COVID Patients
TABLE-11: Length of stay in post covid COPD patients using medication
Drugs 0-3 days 4-7 days 8-10 days 11-15 days
*Cephalosporins 24 26 10 2
Quinolones 1 6 1 1
*Beta lactams 9 12 9 2
Tetracyclines 6 6 2 1
Lincosamides 1 3 1 0
Macrolides 6 8 4 1
*Oxazolidinones 0 3 1 2
Aminoglycoside 0 1 1 1
s
*Carbapenems 2 8 4 1
Antivirals 1 7 1 0
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P Value-<0.05
Drugs 0-3 days 4-7 days 8-10 days 11-15 days
Budesonide 25 28 15 2
Hydrocortisone 18 16 7 2
Prednisolone 11 15 3 2
Methylprednisolone 4 9 4 0
*Duolin 25 27 13 1
Formonide 17 27 9 1
Acebrophylline 21 24 13 1
Deriphylline 8 8 3 0
Acetylcysteine 20 22 10 2
Ambroxol 7 8 3 1
Salbutamol 0 1 0 0
Terbutaline 5 8 4 0

P Value-<0.05
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Pre Covid treatment of COPD with Mono and Combinational therapy in
patients
TABLE-12: Use of mono and combinational therapy in pre Covid COPD patients

COPD *Mono Mono Mono Combinational Combinational Combinational

Antibiotics Bronchodilat Steroids Antibiotics Bronchodilator steroids
ors s
Yes 45 17 47 36 48 40
No 26 7 24 22 26 26

P Value-<0.05

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Post Covid treatment of COPD with Mono and Combinational therapy in patients
TABLE-13:Use of Mono and combinational therapy in post Covid COPD patients

COPD Mono Mono Mono Combinational Combinational *Combination

Antibiotics Bronchodilators Steroids Antibiotics Bronchodilator al steroids
s
Yes 23 3 26 19 28 20
No 35 7 45 39 46 36

P Value-<0.05

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 DISCUSSION
 This is an Ambispective observational study “A COMPARATIVE STUDY ON PRESCRIPTION
PATTERN OF COPD PRE AND POST COVID’ ’This was a hospital-based study conducted on a total of
150 patients. The data was collected for 150 patients using data collection form, where 75 were taken as
pre covid COPD and the other 75 as post covid COPD.

 Out of 150 patients, 106 (70%) were Males and 44(30%) were Females. A maximum number of COPD
patients were from the age group 60-80 with minimum years being 31-40 to be diagnosed with COPD.
Subjects with COPD as comorbidity is total 96, subjects with other Comorbidities are 112. Length of stay
of patients is maximum in between 4-7 days during Pre COVID

 In our study, according to the data collected from both pre and post COVID COPD patients we have
noticed that the first line treatment was followed before covid but same was not followed after covid.
Second line treatment was mostly followed after covid along with increased use of combinational therapy
than monotherapy.

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 It was noticed that Cephalosporin antibiotic was administered primarily, while the second most prescribed
drug included combinational short acting beta 2agonist followed by other drugs in pre COVID. In our
study the combination used mostly to treat COPD patients consist of long-Acting Beta Agonists +Inhaled
Corticosteroids which is recommended by GOLD guide lines.

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 CONCLUSION
 Overall, we can see the treatment is according to guidelines but before covid they used mostly first line
therapy and mono therapy which reduced the length of stay of patients. After covid second line
treatment and combinational therapy is mostly used which reduced the length of stay of patients.
 Before covid the number of drugs were more because of mono therapy and after covid combinational
therapy is used much so the number of drugs are less

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 REFERENCES
 Zainabath Sazmi, Sanjiv Karale, Sharanya S Rao, Amrutha Sathyan, Assessment of Prescribing Pattern of
Corticosteroids and Bronchodilators in the Management of COPD Patients 10.5530/ijopp.15.3.33
 Shiv Kumar, G. Madhuri, Anju Wilson, Tigi S George, Study of Prescribing Pattern of Drugs in Chronic
Obstructive Pulmonary Disease in Tertiary Care Teaching Hospital, 10.5530/ijopp.12.3.36
 DB JYOTHI, S VIJAY PRASAD, Yakaiah VANGOORI, Ambadasu BHARATHA, A Prospective Study on
Prescription Pattern in Chronic Obstructive Pulmonary Disease, MAEDICA – a Journal of Clinical Medicine
2020; 15(1): 37-44
 Mahadeo P. Sawant, Sudhir L. Padwal*, Anand S. Kale, Harshal N. Pise, Rucha M. Shinde, Study of drug
prescription pattern among COPD patients admitted to medicine in-patient department of tertiary care hospital,
Sawant MP et al. Int J Basic Clin Pharmacol. 2017 Sep;6(9):2228-2232
 Maqusood M, Khan FA, Kumar M. A Study of Prescription Pattern in the Management of COPD in a Tertiary
Care Hospital Ann. Int. Med. Den. Res. 2016;2(3):159-63.

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DATA COLLECTION FORM

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ETHICAL CERTIFICATE

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PUBLICATIONS

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