Background
Indian COPD patients have variable pattern of risk exposure and response to treatment as compared with western patients.
Methods
Prospective interventional and observational study conducted after IRB approval in Pulmonary Medicine, MIMSR Medical College & Venkatesh chest hospital Latur during January 2014 to June 2017, included 600 symptomatic COPD cases diagnosed by GOLD guidelines (FEV1/FVC < 0.7) and FEV1 < 80% in all cases, eosinophilic predominance in sputum (4% or more), and having at least one exacerbation in last three years. All study cases received influenza vaccination before enrollment in study and received same treatment to all cases as ICS (inhaled corticosteroids) and LAMA (long acting antimuscarinic drug) combination (glycopyrronium bromide and salmeterol plus fluticasone in different dry powder inhalers). Statistical analysis was done by using Chi test and student’s t test.
Observations and analysis
In study cases, we documented 67% study cases were having eosinophilic predominance in sputum. We observed FEV1 improvement by 124 ± 10 ml in 24% cases and 56% cases having 24 ± 6 ml decline (p < .0001). Total 69% of study cases were showing symptomatic improvement and change in mMRC grade and CAT score (p < .001) Exacerbation was documented in 6% cases (36/600), of those 8 cases required ICU admission (p < .0001). There is no increase in asymptomatic hyperglycemia and pneumonia is observed in 2.5% study cases during 42 months study period.
Conclusion
Initiation of LAMA and ICS early in symptomatic COPD cases with FEV1 < 80% with eosinophilic predominance in sputum will have successful treatment outcome in form of good symptom control and decrease in exacerbation. Rationale for response is predominant nonsmoker class (heterogeneous class) in Indian COPD cases as compared with classically described neutrophilic phenotype and having varieties dusts exposure especially agricultural dust. We recommend preferable use of LAMA and ICS combination in Indian COPD cases debatable to existing COPD guidelines.