Medication profile and treatment response in acute exacerbation of chronic obstructive pulmonary disease: A prospective longitudinal observational study in a tertiary care hospital

OBJECTIVES: To evaluate the medication use profile, treatment outcomes, and postdischarge responsiveness and adherence in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MATERIAL AND METHODS: This prospective longitudinal observational study enrolled consenting adults hospitalized for AECOPD at a tertiary care hospital in Kolkata. Medication details (drug, route, dose, frequency, and duration) were recorded from admission to discharge. In-hospital and postdischarge outcomes, symptom burden (Chronic Obstructive Pulmonary Disease Assessment Test [CAT]), quality of life (St. George's Respiratory Questionnaire), and medication adherence (Medication Adherence Rating Scale-10) were evaluated. Data were analyzed using Jamovi statistical software. RESULTS: Fifty-one participants were enrolled (mean age: 62.9 years, 80.4% males). 76.4% had severe exacerbations (Rome criteria). In-hospital, 98% received parenteral antibiotics (median duration: 8 days), with dual therapy being the most common pattern. In addition, 88.2% received short-course systemic steroids. Bronchodilators, short-acting beta-2 agonists + short-acting muscarinic antagonists and long-acting beta-agonists (LABA) + inhaled corticosteroids (ICS) were initiated in 92.2% and 88.2% of participants, respectively. Following stabilization, 21.6% were started on long-acting muscarinic antagonists (LAMA) therapy in-hospital. Ventilatory support was required by 64.7%, and the in-hospital mortality rate was 23.5%. Admission CAT score was an independent predictor of mortality (adjusted odds ratios: 2.13, 95% confidence interval: 1.21-3.76, P = 0.009). At discharge, inhaled therapy was centered on LABA + ICS inhalers (84.6%), and in 71.8%, a LAMA-based inhaler was added. 43.5% participants required readmission within 6 months. Participants with correct inhaler technique and good medication adherence showed a significant increase from the 1st to the 6th month of follow-up (P < 0.05). CONCLUSIONS: AECOPD pharmacotherapy largely aligned with established guidelines. However, high readmission rates and initial poor inhaler technique highlight the need for prioritized strategies in medication adherence and device training.