{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T02:44:27Z","timestamp":1782787467239,"version":"3.54.5"},"reference-count":29,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Glenmark Pharmaceuticals Ltd."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ARM"],"abstract":"<jats:p>Background: Acute exacerbation of obstructive airway disease (AEOAD) is a major cause of hospitalization, morbidity, and premature mortality in India. Hospitalized patients for the same are predominantly treated with short-acting bronchodilators, which require frequent administration and are associated with systemic adverse effects. Despite the availability of nebulized long-acting muscarinic antagonists (LAMAs) with quick onset of action, such as glycopyrronium, their role in acute care remains unclear in India. Methods: A pan-India expert opinion-building initiative was conducted among 220 pulmonologists across Tier I\u2013II cities through 13 structured advisory meetings between April 2025 and July 2025. The final expert perspectives were then categorized into recurrent insights, raised in 75% or more meetings, and variable insights, raised in &lt;75% of all meetings. Results: Experts reported that AEOAD management commonly involved initial stabilization with SABA\/SAMA followed by transition to triple therapy with nebulized glycopyrronium, formoterol, and budesonide. Nebulized glycopyrronium was perceived to provide rapid and sustained bronchodilation with fewer cardiovascular side effects compared to short-acting agents. Benefits were reported in patients with frequent exacerbations, high sputum burden, and bronchiectasis. Operational advantages included reduced dosing frequency and nursing workload. Experts also noted potential improvements in hospital stay and readmissions; however, these observations were based on clinical experience rather than controlled data. Conclusions: Indian pulmonologists agreed that early initiation of nebulized glycopyrronium (with formoterol and budesonide) in hospitalized AEOAD may improve symptom control, lower exacerbation burden, reduce reliance on short-acting bronchodilators and corticosteroids, and shorten hospital stays.<\/jats:p>","DOI":"10.3390\/arm94040043","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:55:11Z","timestamp":1782780911000},"page":"43","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Utilization Patterns of Nebulized Glycopyrronium in Patients Hospitalized for Acute Exacerbations of Obstructive Airway Disease (AEOAD)\u2014Indian Expert Perspectives"],"prefix":"10.3390","volume":"94","author":[{"given":"Arjun","family":"Khanna","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine, School of Medicine, Amrita Vishwa Vidyapeetham, Faridabad 121002, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradyut","family":"Waghray","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine SVS Medical College, Mahbubnagar 509001, Telangana, India"},{"name":"Kunal Institute of Medical Specialties Pvt Ltd., Hyderabad 500004, Telangana, India"},{"name":"SR., Pulmonology Apollo Hospitals Hyderabad, Hyderabad 500033, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0510-5509","authenticated-orcid":false,"given":"Ashok Kr","family":"Singh","sequence":"additional","affiliation":[{"name":"Pulmonary & Critical Care Medicine Regency Hospital, Kanpur 208005, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinay","family":"Mehta","sequence":"additional","affiliation":[{"name":"Global Medical Affairs, Glenmark Pharmaceuticals, Ltd., Mumbai 400099, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Rithik","sequence":"additional","affiliation":[{"name":"Global Medical Affairs, Glenmark Pharmaceuticals, Ltd., Mumbai 400099, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sagar","family":"Bhagat","sequence":"additional","affiliation":[{"name":"Global Medical Affairs, Glenmark Pharmaceuticals, Ltd., Mumbai 400099, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saiprasad","family":"Patil","sequence":"additional","affiliation":[{"name":"Global Medical Affairs, Glenmark Pharmaceuticals, Ltd., Mumbai 400099, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanmant","family":"Barkate","sequence":"additional","affiliation":[{"name":"Global Medical Affairs, Glenmark Pharmaceuticals, Ltd., Mumbai 400099, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"46","DOI":"10.4103\/ijrc.ijrc_31_18","article-title":"The Prevalence of Obstructive Airway Disease by Spirometric Indices in Nonsmoker Patients with Catheter-Diagnosed Coronary Artery Disease","volume":"8","author":"Agrawal","year":"2019","journal-title":"Indian J. Respir. Care"},{"key":"ref_2","unstructured":"World Health Organisation (2025, August 19). Noncommunicable Diseases, Rehabilitation and Disability. Chronic Respiratory Diseases Programme. Available online: https:\/\/www.who.int\/teams\/noncommunicable-diseases\/ncds-management\/chronic-respiratory-diseases-programme."},{"key":"ref_3","unstructured":"World Health Organisation (2020, December 25). Chronic Obstructive Pulmonary Disease (COPD). Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/chronic-obstructive-pulmonary-disease-(copd)."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S438","DOI":"10.5005\/jaypee-journals-10071-24667.165","article-title":"To Study the Burden of COPD among the Patients Admitted in Critical Care Units from Partner Hospitals under Smart-ICU Network Across India","volume":"28","author":"Dasari","year":"2024","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_5","unstructured":"(2020). Exceptional Surveillance of Chronic Obstructive Pulmonary Disease in Over 16s: Diagnosis and Management (NICE Guideline NG115), National Institute for Health and Care Excellence (NICE)."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e567","DOI":"10.7861\/clinmed.2021-0649","article-title":"Management of acute exacerbations of airways disease: Advice for the non-respiratory physician","volume":"21","author":"Elsey","year":"2021","journal-title":"Clin. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"00722-2022","DOI":"10.1183\/23120541.00722-2022","article-title":"High use of short-acting \u03b22-agonists in COPD is associated with an increased risk of exacerbations and mortality","volume":"9","author":"Janson","year":"2023","journal-title":"ERJ Open Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1111\/all.16538","article-title":"Adverse Outcomes Associated with Short-Acting Beta-Agonist Overuse in Asthma: A Systematic Review and Meta-Analysis","volume":"80","author":"Tsao","year":"2025","journal-title":"Allergy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1186\/s13643-018-0860-0","article-title":"Short-acting bronchodilators for the management of acute exacerbations of chronic obstructive pulmonary disease in the hospital setting: Systematic review","volume":"7","author":"Kopsaftis","year":"2018","journal-title":"Syst. Rev."},{"key":"ref_10","unstructured":"Venkatesan, P. (2025). GOLD COPD report: 2026 update. Lancet Respir. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"673","DOI":"10.2147\/COPD.S35990","article-title":"Once-daily glycopyrronium bromide, a long-acting muscarinic antagonist, for chronic obstructive pulmonary disease: A systematic review of clinical benefit","volume":"7","author":"Ulrik","year":"2012","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1164\/rccm.201710-1986OC","article-title":"Identification of Diagnostic Criteria for Chronic Hypersensitivity Pneumonitis. An International Modified Delphi Survey","volume":"197","author":"Morisset","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s13643-024-02738-3","article-title":"How Delphi studies in the health sciences find consensus: A scoping review","volume":"14","author":"Schifano","year":"2025","journal-title":"Syst. Rev."},{"key":"ref_14","first-page":"8","article-title":"Evaluating the role of nebulized glycopyrronium in hospitalized patients with exacerbations of obstructive airway disease: Transitioning from hospital care to discharge","volume":"42","author":"Bhojwani","year":"2025","journal-title":"Lung India"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.tcm.2016.04.001","article-title":"Chronic obstructive pulmonary disease and sudden cardiac death: A systematic review","volume":"26","author":"Berg","year":"2016","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_16","first-page":"PA2478","article-title":"Clinical Assessment of Glycopyrronium in COPD phenotypes and ACOS: Prospective, case control, observational study","volume":"54","author":"Korukonda","year":"2019","journal-title":"Eur. Respir. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"A1835","DOI":"10.1016\/j.chest.2021.07.1649","article-title":"Glycopyrronium-Based Triple (ics\/laba\/lama) Nebulization in Patients Hospitalized with Acute Exacerbating Obstructive Airway Disease: Drug Utilization Study in India","volume":"160","author":"Panigrahi","year":"2021","journal-title":"Chest"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"A361","DOI":"10.1016\/j.chest.2021.12.391","article-title":"Nebulized broncodilator utilization in hospitalized obstructive airway disease patients: An indian multicentre drug utilization study","volume":"161","author":"Patel","year":"2022","journal-title":"Chest"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/2049-6958-9-50","article-title":"COPD: Maximization of bronchodilation","volume":"9","author":"Nardini","year":"2014","journal-title":"Multidiscip. Respir. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"963","DOI":"10.5005\/jp-journals-10071-24806","article-title":"Comparison of Nebulized Glycopyrronium with a Combination of Salbutamol and Ipratropium on Ventilatory Parameters in Critically Ill Mechanically Ventilated Patients of Chronic Obstructive Pulmonary Disease: An Observational Study","volume":"28","author":"Kumar","year":"2024","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e17863","DOI":"10.2196\/17863","article-title":"Health-Related Effects of Home Nebulization With Glycopyrronium on Difficult-to-Treat Asthma: Post-Hoc Analyses of an Observational Study","volume":"9","author":"Talwar","year":"2020","journal-title":"Interact. J. Med. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1038\/s41533-021-00255-7","article-title":"Impact of baseline clinical features on outcomes of nebulized glycopyrrolate therapy in COPD","volume":"31","author":"Tashkin","year":"2021","journal-title":"npj Prim. Care Respir. Med."},{"key":"ref_23","first-page":"193","article-title":"Health-Related Quality of Life Improvements in Moderate to Very Severe Chronic Obstructive Pulmonary Disease Patients on Nebulized Glycopyrrolate: Evidence from the GOLDEN Studies","volume":"5","author":"Ferguson","year":"2018","journal-title":"Chronic Obstr. Pulm. Dis. J. COPD Found."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.chest.2023.11.013","article-title":"Guidance on Mitigating the Risk of Transmitting Respiratory Infections During Nebulization by the COPD Foundation Nebulizer Consortium","volume":"165","author":"Biney","year":"2024","journal-title":"Chest"},{"key":"ref_25","first-page":"e104894","article-title":"A Study on the Use of Nebulized Glycopyrronium in Hospitalized Patients With Exacerbations of Obstructive Airway Disease","volume":"18","author":"Khanna","year":"2026","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"56","DOI":"10.3329\/taj.v34i2.58556","article-title":"Compari-son of Bronchodilator Response of Nebulized Salbutamol with Nebulized Salbutamol and Ipratropium Bromide in Patients with Acute Exacerbation of Advanced COPD","volume":"34","author":"Hasan","year":"2022","journal-title":"J. Teach. Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s41030-017-0041-7","article-title":"Ipratropium\/Salbutamol Comparator Versus Originator for Chronic Obstructive Pulmonary Disease Exacerbations: USA Observational Cohort Study Using the Clinformatics\u2122 Health Claims Database","volume":"3","author":"Thomas","year":"2017","journal-title":"Pulm. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/S0885-3924(01)00378-5","article-title":"Ffpmanzca Nebulized Glycopyrrolate for Drooling in a Motor Neuron Patient","volume":"23","author":"Strutt","year":"2002","journal-title":"J. Pain Symptom Manag."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e155","DOI":"10.1097\/PHM.0000000000000669","article-title":"The Effect of Nebulized Glycopyrrolate on Posterior Drooling in Patients with Brain Injury: Two Cases of Different Brain Lesions","volume":"96","author":"Lee","year":"2017","journal-title":"Am. J. Phys. Med. Rehabil."}],"container-title":["Advances in Respiratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2543-6031\/94\/4\/43\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T02:10:56Z","timestamp":1782785456000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2543-6031\/94\/4\/43"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":29,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["arm94040043"],"URL":"https:\/\/doi.org\/10.3390\/arm94040043","relation":{},"ISSN":["2543-6031"],"issn-type":[{"value":"2543-6031","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]}}}