Background:This study aims at simplifying the practical patient management and offers some general indications for pharmacotherapeutic choice by the implementation of (Global Initiative for Chronic Lung Disease) guidelines. This study was designed to evaluate the clinical and economic consequences of salmeterol/fluticasone (SF), formoterol/budesonide (FB), and formoterol/fluticasone (FF) in severe and very severe chronic obstructive pulmonary disease (COPD) patients.Objectives:The aim was to find out the most cost-effective drug combination between the three combinations (SF/FB/FF) in COPD patients.Materials and Methods:A prospective observational comparative study (cost-effectiveness analysis), in which 90 severe (30 ≤ forced expiratory volume in 1 s [FEV1] <50% predicted) and very severe (FEV1 < 30% predicted) COPD patients (outpatients/inpatients) who are prescribed with any one of the following combinations (SF/FB/FF) were selected. In our study, we have divided 90 COPD patients into three groups (Group I, Group II, and Group III) each group consisting of 30 patients. Group I was prescribed with medication SF, Group II with medication FB, and Group III with medication FF. We used five different parameters such as spirometry test (mean FEV1 initial and final visit), number of symptom-free days (SFDs), number of moderate and severe exacerbations, Number of days of hospitalization and direct, indirect, and total cost to assess the cost-effectiveness of SF/FB/FF. Comparison of cost and effects was done during the period of 6 months of using SF/FB/FF.Results:The average FEV1 for Group I, Group II, and Group III subjects at initial visit was 33.47%, 33.73%, and 33.20% and was increased to 36.60%, 35.8%, and 33.4%, respectively. A 3% increment in FEV1 was reported for Group I subjects (SF) and was highly significant statistically (t = −8.833, P = 0.000) at 95% CI. For Group II subjects (FB), a 2% increment in FEV1 was reported and was highly significant statistically (t = −9.001, P = 0.000) at 95% CI. For Group III (FF) subjects 0.2% increment in FEV1. The overall mean total cost for Group I, Group II, and Group III subjects during the 6 months period was found to be Rs. 29,725/-, Rs. 32,602/- and Rs. 37,155/-. Incremental cost-effectiveness of FB versus SF was Rs. 37,781/- per avoided exacerbation and Rs. 661/-per SFD.Conclusion:This study highlights the favorable therapeutic performance of combined inhaled bronchodilators and corticosteroids (SF/FB/FF), thus suggesting that healthcare costs would be also affected positively. Results from our study showed that SF and FB were the most effective strategies in the treatment of COPD, with a slight clinical superiority of SF. The FF strategy was not much effective (i.e. associated with fewer outcomes and higher costs).

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According to World Health Organization (WHO), respiratory tract infections kill 2.6 million children every year worldwide so, it is recognized as the leading cause of morbidity and mortality. Respiratory tract diseases are quite prevalent & more dangerous to the people with weak immune system function. The study was carried out for a period of 90 to 100 days in Rajiv Gandhi Institute of Medical Sciences (RIMS), Kadapa. Antibiotics are prescribed based on symptoms and laboratory investigations. It is a single centered, prospective observational study. Subjects of both genders who indicated with any one antibiotic or its combination are taken in our study and patients who had co morbid pathological conditions also included. Pediatrics, pregnant women and surgical cases were excluded from the study.60 patients (Ambulatory patients) were collected. 36 were male and 24 were female. 20 patients were found to be Literates and 40 patients were Illiterates. 38 patients belong to Lower class, 17 patients belong to Middle class and 5 patients belong to Upper class. 9 patients belong to 15-30 years of age group, 21 patients belong to 31-45 years of age group, 16 patients belong to 46-60 years of age. Ceftriaxone is prescribed in 24 patients, Azithromycin is prescribed in 17 patients, Levofloxacin is prescribed in 7 patients, Ceftriaxone + Augmentin is prescribed in 12 patients.Drug utilization studies used to analyze the different aspects of the use of drugs and to implement ways of improving therapeutic quality. In the present study, pneumonia diagnosed patients (12 patients) received antibiotic combination regimen, while other common respiratory disease patients (48 patients) received single antibiotic during treatment. All the prescribed antibiotics belong to broad spectrums that are effective against most of causative organisms such as Streptococcus, Staphylococcus, Mycoplasma, Klebsiella, Hemophilus etc. In our study, it was also found that, physicians prescribed correct drug in correct dose at correct time through right route of administration for right duration of treatment, it clearly implies that most of the prescriptions found to be Rational.

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