This cross-sectional, observational survey evaluated diagnosis, management trends and current perceptions and experiences of clinicians [(CLs); n=96; pulmonologist-13, physician-57, general practitioner-26] in Nepal on use of dual bronchodilator therapy in COPD management.

93% of CLs were practising in urban setting for an average of 10 years and average 35% of their patients are of COPD. 61% of CLs use mMRC with (34%) or without (27%) CAT score. 92% of CLs perceived that majority of their patients had 1 (32%) or >1 (59%) exacerbation/year. 54% of CLs performed spirometry in all their patients with suspected COPD. 49% of CLs measured blood EOS in their patients with severe COPD before adding ICS. 93% of CLs preferred dual therapy (separate inhalers or a combination) for their COPD patients. 57% of CLs preferred LABA+LAMA and 82% preferred Tiotropium+Formoterol combination. 83% of CLs preferred LABA+LAMA in a single inhaler over inhalers given separately. 81% of CLs stepped-up or stepped down their treatment. 56% of patients were taking LABA+LAMA+ICS and 55% of CLs co-prescribed ICS+LABA with LABA+LAMA. 80% of CLs checked inhalation technique at every visit and an average 54% of their COPD patients were adherent (>80%) to the prescribed inhalation therapy. 78% of CLs felt that dryness of mouth was the most common side effect of LABA+LAMA. 94% of CLs believed that managing COPD better could improve cardiovascular outcomes in their patient with coexistent COPD.

In EXPAND survey, Formoterol+Tiotropium was preferred by most CLs in Nepal amongst LABA+LAMA combination. There is a good scope for improvement in utilisation of tools like spirometry, mMRC, CAT and blood EOS in daily practice of CLs in Nepal.