Prescription Patterns and Adherence to GOLD 2021 Guidelines for Chronic Obstructive Pulmonary Disease Management in Pakistan: A Cross-Sectional Study.
6 affiliations
- 1Department of Pharmacy Quaid-i-Azam University Islamabad Pakistan.
- 2Department of Clinical Pharmacy and Pharmacology, Rak College of Pharmacy RAK Medical and Health Sciences University Ras Al Khaimah United Arab Emirates.
- 3Department of Pharmacy The First Affiliated Hospital of Xi'an Jiaotong University Xi'an China.
- 4Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy Health Science Center Xi'an Jiaotong University Xi'an China.
- 5Department of Pharmaceutical Sciences Pak-Austria Fachhochshule: Institute of Applied Haripur Pakistan.
- 6Department of Statistics Government College Women University Sialkot Pakistan.
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.
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BibTeX
@article{kanwal2026prescription,
title = {{Prescription Patterns and Adherence to GOLD 2021 Guidelines for Chronic Obstructive Pulmonary Disease Management in Pakistan: A Cross-Sectional Study.}},
author = {Hafsa Kanwal and Syed Sikandar Shah and Areeg Anwer Ali and Amjad Khan and Umm-E-Kalsoom and Saima Mushtaq and Mahwish Rabia and Yu Fang},
journal = {Health science reports},
year = {2026},
month = nov,
doi = {10.1002/hsr2.73477},
url = {https://europepmc.org/article/MED/43011774},
note = {CC BY},
}
RIS
TY - JOUR
TI - Prescription Patterns and Adherence to GOLD 2021 Guidelines for Chronic Obstructive Pulmonary Disease Management in Pakistan: A Cross-Sectional Study.
AU - Hafsa Kanwal
AU - Syed Sikandar Shah
AU - Areeg Anwer Ali
AU - Amjad Khan
AU - Umm-E-Kalsoom
AU - Saima Mushtaq
AU - Mahwish Rabia
AU - Yu Fang
PY - 2026
DA - 2026/11/10
JO - Health science reports
DO - 10.1002/hsr2.73477
UR - https://europepmc.org/article/MED/43011774
AB - 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.
SN - 2398-8835
ER -