Browsing by Author "Gaur, Vaibhav"
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Publication Experience of clinicians with dual bronchodilator therapy in COPD (EXPAND) in Nepal Authors(Nepalese Respiratory Society, 2023) Chokhani, Ramesh; Shrestha, Sanjeet Krishna; Bhattarai, Sharad; Mukhopadhyay, Aniruddha; Gaur, Vaibhav; Gogtay, JaideepAbstract: Introduction: Combination of bronchodilators, particularly long-acting muscarinic antagonists (LAMAs) and long-acting β2 agonists (LABAs) have become the mainstay of pharmacological therapy for COPD. COPD is now a common non communicable disease in Nepal. Objective: The study evaluated the current perception and experience of the clinicians in Nepal on diagnosis and management of COPD with focus on use of dual bronchodilator therapy. Method: This cross-sectional, observational survey evaluated experiences of clinicians (n=96; pulmonologist-13, physician-57, general practitioner-26) in Nepal on diagnosis, management trends, and current perceptions on the use of dual bronchodilator therapy in COPD management. Result: 93% of clinicians were practising in an urban setting for an average of 10 years and an average of 35% of their patients are of COPD. 61% of clinicians use mMRC with (34%) or without (27%) CAT score. 92% of clinicians perceived that most of their patients had 1 (32%) or >1 (59%) exacerbation/year. 54% of clinicians performed spirometry on all their patients with suspected COPD. 49% of clinicians measured blood EOS in their patients with severe COPD before adding ICS. 93% of clinicians preferred dual therapy (separate inhalers or a combination) for their COPD patients, but 83% of clinicians preferred LABA + LAMA in a single inhaler over inhalers given separately. 57% of clinicians preferred LABA + LAMA and 82% preferred the Tiotropium + Formoterol combination. 81% of clinicians stepped up or stepped down their treatment. 56% of patients were taking LABA + LAMA + ICS and 55% of clinicians co-prescribed ICS + LABA with LABA + LAMA. 80% of clinicians checked the inhalation technique at every visit and an average of 54% of their COPD patients were adherent (>80%) to the prescribed inhalation therapy. 78% of clinicians felt that dryness of mouth was the most common side effect of LABA + LAMA. 94% of clinicians believed that managing COPD better could improve cardiovascular outcomes in their patients with coexistent COPD. Conclusion: In the EXPAND survey, Formoterol + Tiotropium was preferred by most clinicians in Nepal amongst the LABA + LAMA combination. There is a good scope for improvement in the utilization of tools like spirometry, mMRC, CAT, and blood EOS in the daily practice of clinicians in Nepal.Publication Practice Pattern Survey for Paediatric Asthma in Nepal (SPAN)(Nepalese Respiratory Society, 2024) Ghimire, Amrit; Mukhopadhyay, Aniruddha; Gaur, Vaibhav; Gogtay, JaideepAbstract: Background: In Nepal, asthma is one of the most prevalent diseases affecting children and is a leading contributor to childhood morbidity. Objectives: We evaluated the current perceptions and experiences of pediatricians in Nepal regarding the diagnosis and management of pediatric asthma. Methods: A questionnaire-supported, observation-based, cross-sectional survey was conducted digitally among paediatricians from Nepal who routinely manage patients ≤12 years of age with asthma. A total of 121 paediatricians from different practice settings participated in the survey. Results: Of patients who visit paediatricians, 31.6% were under 5 years and 26.6% were between 5 and 12 years of age. 90.08% of paediatricians found an increasing trend in asthma cases in the last 5 years in Nepal. 64.46% of paediatricians agreed that dust and dust mites were the most common triggers. Diagnosis based solely on history and physical examination was used by 54.54% of paediatricians. 49.59% of paediatricians prioritized getting back to the normal routine as the criterion for achieving asthma control. 43% of paediatricians prescribed oral bronchodilators, 31.4% oral steroids, 54.5% only short-acting beta2-agonist (SABA), 66.1% combination of inhaled corticosteroids and long-acting beta2-agonist (ICS/LABA), 96.7% ICS/SABA, 46% only ICS, and 66.1% nebulization therapy to their patients with asthma. Nine out of 10 paediatricians agreed that an average of 34.01% of their patients were on add-on montelukast with inhalation therapy. Pressurized metered dose inhaler (pMDI) + spacer + facemask with bronchodilators was suggested by 63.63% of paediatricians to manage asthma attacks at home. The average adherence to inhalation therapy was 47.02%. During the first interaction, most paediatricians spent at least 15 minutes educating patients/parents about the disease and its treatment. 67.77% of paediatricians or their paramedics checked patients’ inhalation techniques on every visit. Most paediatricians considered tear-off pads about asthma (46.3%) and videos on asthma for patients (31.4%) as the best tools that can increase patient awareness of asthma and inhalation therapy. Conclusion: Only half of the participating paediatricians in Nepal follow the Global Initiative for Asthma (GINA) strategy reports to diagnose and manage their patients with asthma. pMDI + spacer with or without a face mask was the most preferred device. Patient education and awareness were critical, and most paediatricians educated their patients regularly.