TABLE 3.

Summary of India-specific issues related to OAD characteristics, management, SITT therapy and research requirement

OAD population characteristics	• India has a highly symptomatic and exacerbating OAD population comprising group B and D COPD patients, step 4/5 asthma patients, difficult-to-treat asthma patients and ACO patients • >20% of the global COPD-related mortality is in India • Sociodemographic divide in terms of the prevalence of asthma with higher prevalence in the rural areas compared to urban areas • Asthma patients tend to tolerate their symptoms and consider a certain amount of suffering as an inherent part of the disease process • The rate of COPD is higher among nonsmokers compared to smokers • High burden of NSCOPD (∼65%), especially in rural areas due to biomass exposure and indoor pollution • Risk factors, such as childhood lower respiratory tract infections, biomass exposure, history of tuberculosis and environmental pollution, are high • High nonadherence rate (27.2%) to inhalers among asthma patients
Gaps in diagnosis and management of OAD	• Significant gaps are reported in primary healthcare delivery and clinical approach in the management of OAD • Discrepancies in the diagnosis, lack of proper labelling (such as bronchial asthma or COPD) and appropriate management of the disease • Asthma management in India remains very poor, with a significant proportion of patients experiencing challenging symptoms and worsened quality of life • Many patients do not use their inhaler device correctly • Asthma management is negatively influenced by certain cultural and social beliefs among Indians • Despite guideline recommendations of inhalation therapy in asthma, oral therapy is still widely used
Choice of SITT	• Both SITT and open triple therapy are used in clinical practice • Physicians decide the choice (SITT versus open triple therapy) based on factors such as stable versus unstable OAD, titration flexibility of ICS dose, patient compliance and device options
Gaps in SITT adaptation	• SITT options in India are limited to twice-daily DPI formulations • SITT is not yet approved for asthma by the drug regulatory body in India
Need for research	• Threshold values for blood eosinophil count in Indian population needs to be evaluated • The effectiveness of SITT in patients with ACO and NSCOPD in India needs to be established • Data related to SITT in asthma in India are lacking • Indian guidelines related to management of OAD need to be frequently updated

OAD: obstructive airway disease; SITT: single-inhaler triple therapy; ACO: asthma–COPD overlap; NSCOPD: nonsmoker chronic obstructive pulmonary disease; ICS: inhaled corticosteroids; DPI: dry powder inhaler.