Corticosteroids and Antibiotics Utilization in COPD Exacerbation: A Prospective Observational Study from a Tertiary Care Hospital

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, with exacerbations significantly impacting disease progression, hospitalization rates, and mortality risk. The GOLD 2025 guidelines emphasize the critical role of corticosteroids and antibiotics in managing COPD exacerbations, yet prescribing practices in rural Indian healthcare settings remain inadequately documented.
Objective: This study aimed to assess the prescribing patterns of corticosteroids and antibiotics among patients with COPD exacerbations at a tertiary care hospital in rural Maharashtra, India, and evaluate adherence to GOLD 2025 treatment guidelines.
Methods: A prospective observational study was conducted over six months (June to November 2025) at Vilasrao Deshmukh Government Medical College and Hospital, Latur, Maharashtra. Patients aged ≥40 years with clinically confirmed COPD exacerbations were enrolled. Data on demographic characteristics, corticosteroid utilization (type, route, dose, duration), antibiotic prescribing patterns (class, specific agents), and therapy combinations were collected using a structured proforma. Descriptive statistics were employed for data analysis.
Results: Among 50 enrolled patients, the majority were aged ≥60 years (76%), with a nearly equal gender distribution (48% male, 52% female). Corticosteroid therapy was administered to 86% (n=43) of patients, with dual therapy (44%) and triple therapy (40%) being the predominant regimens. Antibiotics were prescribed rationally, with penicillins (35%) and macrolides (31%) being the most commonly utilized classes. Azithromycin (56%) and amoxicillin-clavulanate (44%) were the most frequently prescribed specific agents. The prescribing patterns demonstrated substantial alignment with GOLD 2025 recommendations, though opportunities for improvement were identified in eosinophil-guided inhaled corticosteroid prescribing and antimicrobial stewardship.
Conclusion: This study reveals that corticosteroid and antibiotic prescribing practices at the study hospital largely adhere to GOLD 2025 guidelines, reflecting appropriate clinical management of COPD exacerbations. However, gaps persist in consistent documentation of blood eosinophil counts and optimization of inhaled corticosteroid therapy. Enhanced disease awareness initiatives, regular prescription audits, and strengthened antimicrobial stewardship programs are essential to further improve COPD management outcomes in resource-limited rural Indian settings.