A comment on the drug utilization pattern in chronic obstructive pulmonary disease.

Dear Editor,

I read the article “Study of Drug Utilization Pattern for Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Patients Attending a Government Hospital in Kerala, India” published in the Journal of Family Medicine and Primary Care July 2014.[1] I was disillusioned to find that instead of discussing the “drug utilization pattern” mentioned in the title of the article, the authors have discussed the “prescription pattern” of drugs as prescribed by the treating physicians in said hospital. In Table 2 of the article, we find a list of drugs that were prescribed to the patients, and alongside it the percentage of times each drug was prescribed. Any account of how the patients were consuming those drugs, whether any drugs were altered depending upon availability, or if any doses were missed, wasn’t available. Similarly, Table 3 mentions the names of antibiotics prescribed along with the frequency of prescription and gives no further information. The discussion section also focuses entirely on the frequency of prescription of different drugs for chronic obstructive pulmonary disease (COPD) as seen in different studies. The patient's perspective on drug utilization is totally missing from the study, and the title of the study seems misleading.

The demographic profile of the study population shows that most of the patients were of lower socioeconomic status. However, from such data alone it would be wrong to conclude that people belonging to the lower socioeconomic strata will have increased prevalence of COPD. To draw such a conclusion, we need to first know the details of the distribution of the entire target population by socioeconomic status and then calculate prevalence rates for COPD in the different socioeconomic strata, and analyze those data statistically.[2]

Also, in the discussion of comorbid conditions, the authors have only discussed the rates of alcoholism, diabetes, and hypertension in various studies, compared to the present study. How the prescription pattern for the patients with these comorbidities differed from those without the comorbidities is not mentioned anywhere. The detailed discussion of active or passive smoking, occupational exposure to dust, use of biofuels, indoor air pollution, and tuberculosis would have been more enlightening in the context of COPD would have been more useful.