Date: {{$ActivityAssignDate}}

Dear Dr. {{ $doctorName }},


Subject: An observational, cross-sectional survey to understand the management paradigm of COPD as per disease severity with changing global recommendations (Global Initiative for Chronic Obstructive Lung Diseases 2024) and its relevance in the current Indian practice scenario


Chronic obstructive pulmonary disease (COPD) is a major health problem globally. These are indicated as different diseases with similar epidemiological features as well as pathophysiological mechanisms.1


COPD is a chronic respiratory disease characterized by progressive and irreversible airway obstruction and is one of the major causes of morbidity and mortality worldwide.1 The most commonly encountered risk factor for COPD, which is the fourth leading cause of death, is cigarette smoking, although in most countries, air pollution resulting from the burning of wood and other biomasses fuels has also been considered as a COPD risk factor.2


In India, there are 37.8 million cases, contributing to 17.8% of the global burden of COPD


It contributes to a disproportionate 27.3% of the global COPD deaths and 28.5% to the global COPD DALYs.


A meta‑analysis estimate of COPD in India is 55 million cases higher than the global burden study. As per the global burden of COPD study, India ranks number two globally


COPD is the second leading cause of death and DALYs in India (in terms of absolute numbers)


COPD is a chronic, incurable disease and requires lifelong management. Given the lack of any curative strategies, the main therapeutic goals in COPD are to prevent and control symptoms, attenuate the incidence and severity of exacerbations, improve health status and exercise capacity. Maintenance treatment with long-term bronchodilators (long-acting muscarinic antagonists [LABAs] and/or long-acting b2 -agonists [LABAs] are considered the basis of pharmacotherapy for COPD, as they improve


– lung function,


– reduce dyspnea


– increase exercise capacity


– prevent future exacerbations


The main strategy to be considered in the pharmacological treatment of COPD and asthma are bronchodilators; short-acting bronchodilators (β -agonist and anti- cholinergic) are given as first-line treatment and long-acting bronchodilators can be given in more symptomatic patients with greater functional impact.3,4


The goal of treatment in COPD is to: prevent exacerbations, reduce symptoms and decrease mortality. Clinicians commonly use various pharmacological treatments in the management of COPD to relieve symptoms, improve quality of life, enhance exercise tolerance, prevent and treat exacerbations.3,4


Airway mucus hypersecretion is one of the prominent features of severe respiratory diseases including asthma and COPD.7 Pharmacological approach for relieving mucus accumulation in airways currently involves several classes of agents, including mucolytics.

Tracheobronchial mucus contributes significantly to the symptoms of chronic obstructive pulmonary disease (COPD) and is a defining feature of the condition, Chronic mucus hypersecretion (CMH) is a major cause of airflow obstruction in COPD. It is associated with increased mortality, an accelerated decline of forced expiratory volume in one second (FEV1), reduced quality of life, and increased risk of exacerbations and hospitalizations.8


Mucolytics have gained importance as the drugs that can degrade the mucin polymers of mucus gel, and by reducing the viscosity and elasticity of mucus are thought to increase the mucus expulsion, either by ciliary movement or cough reflex. Acebrophylline has been widely used as an inexpensive oral treatment of asthma, and COPD.35 Previously, this drug known to have bronchodilation, however it also showed to have anti-inflammatory actions.36 Acebrophylline have been developed with the expectation that such drugs would have greater potency than theophylline, but with an improved side effect profile.3


Thus, Acebrophylline may prove beneficial in respiratory conditions including COPD but there is scarce evidence to support this. A variety of agents are used as add-on to inhalation therapy for bronchodilation, microkinetic properties. As per the severity and clinical condition of the disease. Hence, we designed this study to understand he management paradigm of COPD as per disease severity with changing global recommendations (Global Initiative for Chronic Obstructive Lung Diseases 2024) and its relevance in the current Indian practice scenario.

Yours truly,

Mr. Sandeep Sharma

Sr GM -Sales and Marketing

Sun Pharmaceutical Laboratories Limited

Sun Pharma


References


1. Alshabanat, A., Zafari, Z., Albanyan, O., Dairi, M., & FitzGerald, J. M. (2015). Asthma and COPD overlap syndrome (ACOS): a systematic review and meta-analysis. PloS one, 10(9), e0136065.


2. GOLD (Global Initiative for Chronic Obstructive Lung Disease) - global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease, revised. (2024). http://www.goldcopd.org pp. 1–100.


3. Pandey KK, Kalley V, Dhamija M. Novel strategy approach of doxofylline and acebrophylline for the management of respiratory disease. Indian Journal of applied research. 2019;9(3):PRINT ISSN - 2249-555X


4. Morales, OMG., Rojas-Reyes, MX., & Dennis, RJ. (2017). Oral xanthine derivatives (theophylline and doxofylline) for patients with stable chronic obstructive pulmonary disease (COPD). Cochrane Database of Systematic Reviews, (8).


5. Barnes, PJ. (2003). Theophylline: new perspectives for an old drug. Am J Respir Crit Care Med, 167, 813-8.


6. Page, CP. (2010). Doxofylline: a “novofylline”. Pulmonary pharmacology & therapeutics, 23(4), 231-234.


7. Shen Y, Huang S, Kang J, et al. Management of airway mucus hypersecretion in chronic airway inflammatory disease: Chinese expert consensus (English edition). Int J Chron Obstruct Pulmon Dis. 2018; 13:399-407. Published 2018 Jan 30. doi:10.2147/COPD.S144312


8. Tian PW, Wen FQ. Clinical significance of airway mucus hypersecretion in chronic obstructive pulmonary disease. J Transl Int Med 2015; 3:89.


9. Pappová L, Kazimierová I, Kocmálová M. Effect of inhaled and oral n-acetylcysteine on airway defense mechanism. European Pharmaceutical Journal. 2017;64(1): 17-21.