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Prescription Patterns and Adherence to GOLD 2021 Guidelines for Chronic Obstructive Pulmonary Disease Management in Pakistan: A Cross‐Sectional Study

Year: 2026

Type: article

Abstract: ABSTRACT Background and Aims Global Initiative for chronic obstructive lung disease (GOLD) offers evidence‐based recommendations for the management of COPD, but compliance with the guidelines amongst physicians in LMC countries is varied. The objective of this study was to determine the prescribing pattern of inhaled COPD medications in Pakistan and to evaluate the adherence of pulmonologists with the GOLD 2021 guidelines and to assess all the factors that would affect the adherence. Methods This cross‐sectional observational study was undertaken at secondary health care facilities Rawalpindi and Islamabad between the period of April–September, 2022. Spirometry, COPD Assessment Test (CAT) and Modified Medical Research Council (mMRC) scores were used to classify outpatients ≥ 40 years old who had COPD confirmed by spirometry into GOLD 2021 ABCD groups. Pharmacological regimens recommended by GOLD were compared with prescribed regimens. Adherence was rated as appropriate, overtreatment or undertreatment. Demographic and clinical variables were correlated with adherence using chi‐square and t‐test. Results Among 400 patients (mean age 61.8 ± 10.0 years; 74.8% male), Group B was most frequent (40.3%), followed by C (24.0%), A (23.8%), and D (12.0%). Overall, 57.0% (228/400; 95% CI: 52.1–61.9%) received guideline‐concordant therapy, while 43.0% (172/400; 95% CI: 38.1–47.9%) were inappropriately managed. The 80 patients were considered to be overtreated and 92 patients were considered to be undertreated among the inappropriate prescriptions. Cardiovascular comorbidity was associated with treatment inappropriateness (OR, 1.57; 95% CI, 1.05–2.34; p = 0.026), and male sex was also significantly associated with inappropriate prescribing (OR, 2.36; 95% CI, 1.44–3.85; p = 0.001). Conclusion More than two‐fifths of patients received pharmacological treatment that was not concordant with GOLD 2021 recommendations. Both overtreatment and undertreatment were observed. Strengthening spirometry‐based assessment, clinician education, and access to appropriate inhaled therapies may improve guideline‐concordant COPD management in Pakistan.

Source: Health Science Reports

DOI: 10.1002/hsr2.73477