Introduction: The fixed dose combinations used in chronic obstructive pulmonary disease (COPD) patients need their rationale evaluation. If there is no added benefit; then it amounts economic burden on the society, reduced compliance, and unsuccessful therapy. This study evaluated the effectiveness of three regimens of dry powder inhaled preparations including tiotropium 18 μg once a day; tiotropium 18 μg plus formoterol 12 μg once a day, and tiotropium 18 μg once a day plus formoterol 12 μg twice a day in moderate COPD patients. Materials and Methods: A randomized, double-blind, placebo-controlled, active drug controlled parallel design study was conducted in 42 moderate COPD patients without any other comorbidity. Three (R1, R2, and R3) regimens were evaluated in patients to assess the appropriate evidence-based pharmacotherapy regimen. The forced expiratory volume in 1 s (FEV ₁ ), forced vital capacity (FVC), Borg's scale of dyspnea, and vital signs (blood pressure and pulse rate) were measured on serial time points for 24 h. Results: The trough FEV ₁ values of R1, R2, and R3 in liters were 1.836 ± 0.51, 1.886 ± 0.47, and 1.805 ± 0.37, respectively and did not show any statistical difference. No statistical significance was observed in FVC (liters), FEV ₁ % predicted, ∆FEV ₁ (liters), ∆FEV ₁ % predicted, ∆FVC % predicted, and ∆ FVC (liters) except in 24 h FVC percentage predicted values where P - value for R3 is in the range between 0.05 and 0.1 over R1. Conclusions: Study shows that tiotropium alone once a day is the evidence based and rationale pharmacotherapy in moderate COPD. There is no advantage or statistical significance of adding long acting β₂ agonists (LABA) such as formoterol to tiotropium either for 12 h (once daily) or 24 h (twice daily).

Objective: Patients' understanding and perceptions of antibiotic use and resistance are crucial for the public health. This study aimed to explore the awareness of antibiotic utilization in 12 aspects among Bahraini patients attending health centers and community pharmacies and to find the associations of their awareness. Materials and Methods: A cross-sectional survey study with questionnaire interviews was conducted in Bahraini patients attending five health centers or four community pharmacies during January - June 2013. All data were analyzed using descriptive statistics and a Chi-squared test was performed with a significance level set at 0.05. Results: A total of 306 patients (156 in health centers and 150 in community pharmacies) participated in the study. Female respondents (57.2%) were nearly equal to the male. Most were adults aged 16-29 (47.7%) and educated at the university or school levels (88.2%). The majority were aware of the use for colds and relevant resistance, including 10 other aspects. Approximately 35% misconceived the medicine intake in terms of concomitant use with milk, daily doses, stopping time and reusability. Patients' education was associated with six aspects of awareness, that is, decision on antibiotic prescribing, drug administration, treatment duration, drug resistance, reusability, and perceived side-effects (all P < 0.05). Conclusion: Bahraini patients are mostly aware of 12 antibiotic aspects despite some misconceptions. The public awareness and their expectations warrant further studies on a large scale to understand their self-medication and demand for antibiotic prescriptions.

Background: Drug-related problems (DRPs) potentially contribute to morbidity, mortality and financial indicators. There is increasing evidence that participation and interventions of clinical pharmacists in health care have a positive influence on clinical practice. Objectives: The main focus of this study was to identify DRPs, evaluate clinical pharmacy services and document pharmacist's interventions. Materials and Methods: A 3 months prospective observational study from October, 2014 to January, 2015 was carried out on 80 asthmatic patients admitted to pulmonology unit at Northwest general hospital and research center, Peshawar, Pakistan. The drug therapy details of the patients were collected from inpatient treatment charts using a predesigned questionnaire. The DRPs were identified, and clinical interventions made by pharmacists were documented. Results: A total of 37 patients (61.25%) presenting 91 DRPs were identified, including potential drug-drug interactions 39 (48.75%), drug selection 27 (33.75%), drug use process 12 (15%), drug monitoring 5 (6.25%), adverse drug reactions 5 (6.25%) and dosing 3 (3.75%). Clinical interventions documented by pharmacist were drug information response 21 (26.25%), patient education and counseling 14 (17.5%), change/clarify medication order 11 (13.5%), proper storage and cost effectiveness 10 (12.5%), medication error/brand duplication 7 (8.75%), change of drug/dosage 3 (3.75%), dose calculation in special population 3 (3.75%) and discharge plan 2 (2.5%). Of 91 interventions, the pharmacists contacted the consultants for 24 (30%) interventions, postgraduate medical officers/registrars 34 (42.5%), nursing staff 21 (26.25%) and the patients/attendant 12 (15%). 15 (18.75%) interventions were approved by concerned prescribers. Conclusion: To minimize the risks of DRPs and prevent their occurrence, drug therapy requires pharmacist's timely and effective interventions at all levels.

According to an estimate by 2020 Muslim population, will be almost a quarter of the world population. Pharmaceuticals business sector estimates "Halal Pharmaceuticals" to be multimillion dollars industry. Keeping in view the religious preference of Muslim consumers, many developing and developed countries have taken initiative to establish "halal certification centers" and "halal certification guidelines." However, till to date it is hard to find any contents in medicine or pharmacy curriculums that aims to develop understanding among pharmacy and medical graduates about the halal and non-halal (haram) animal sources, processing and manufacturing techniques and halal excipients. The current article will aim, to summarize, the concept of halal and non-halal sources of medicines or drugs in the light of recommendation from "Quran and Hadith." By adding basic contents in pharmacy and medicine curriculum, future graduates will be in a position to distinguish between the non-halal and halal sources of medicine and alternates. Thus, empowering medical and pharmacy graduates will assist them understanding the needs of Muslim patients' needs in the line with the Islamic regulations outlined in Quran.