# Study Questionnaire — Survey Questionnaire Version 01 (Date: 14/10/2026)

**CREST Pvt. Ltd. — Confidential**

**Study title:** Physicians' Perceptions of the Impact of an Extended-Dose Pack versus Regular Pack on Adherence to Inhaled Maintenance Medication in Asthma and COPD: A Cross-Sectional Survey

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## Section 1: Basic Demographics / Doctor Details

- **Name:** ______
- **Qualification** (single choice): MBBS / MD (Chest) / DM (Pulmo / DNB / DCH) / MD (Med) / DNB (Med) / Any other (specify): ______
- **Years of Practice:** ______
- **Practice setting** (multi-select): Private Clinic / Private Hospital / Govt. Hospital / Other (please specify): ______
- **Specialization** (single choice): Chest Physician / Consulting Physician / Other (specify): ______
- **City:** ______
- **State** (dropdown): all Indian states and union territories

## Section 2: Physician Practice Profile

1. On an average, how many patients do you see per month? ______
2. Approximately how many **asthma** patients do you manage per month?
   - New patients: ___
   - Follow-up/old patients: ___
3. Approximately how many **COPD** patients do you manage per month?
   - New patients: ___
   - Follow-up/old patients: ___

## Section 3: Foracort Prescribing Pattern

4. Approximately what proportion of your **asthma** patients receive Formoterol/Budesonide? ___ %
5. Approximately what proportion of your **COPD** patients receive Formoterol/Budesonide? ___ %
6. For how long have you been prescribing the Extended-Dose Pack to your patients with asthma and/or COPD? (single choice)
   - [ ] Less than 6 months
   - [ ] 6 months to less than 1 year
   - [ ] More than 1 year
7. Among your patients receiving Formoterol/Budesonide, approximately what proportion do you prescribe (each column must total 100%):

   > Regular Pack: Formoterol/Budesonide 200 & 400 mcg – Rotacaps (pack of 30) and MDI (120 doses).
   > Extended-Dose Pack: Formoterol/Budesonide 200 & 400 mcg – Rotacaps (pack of 60) and MDI (180 doses).

| Pack type | Product | Pack info | Asthma | COPD |
|---|---|---|---|---|
| Regular Pack | Formoterol/Budesonide 200 & 400 mcg pMDI | 120 doses (unit dose cost same for 120 and 180 dose packs) | ___% | ___% |
| Regular Pack | Rotacap | Pack of 30 (unit dose cost same for 30 and 60 dose pack) | ___% | ___% |
| Extended-Dose Pack | Formoterol/Budesonide 200 & 400 mcg pMDI | 180 doses (unit dose cost same for 120 and 180 dose packs) | ___% | ___% |
| Extended-Dose Pack | Rotacap | Pack of 60 (unit dose cost same for 30 and 60 dose pack) | ___% | ___% |
| **Total** | | | **100%** | **100%** |

## Section 4: Physician Assessment of Adherence

8. Based on your clinical experience, approximately what proportion of patients are adherent to their prescribed treatment? (Estimate out of 100 patients.)

   *Note: A patient is considered "adherent" if the physician believes the patient takes at least 75% of the prescribed inhaled maintenance medication doses during a typical month of treatment.*

   > Regular Pack: Formoterol/Budesonide 200 & 400 mcg – Rotacaps (pack of 30) and MDI (120 doses).
   > Extended-Dose Pack: Formoterol/Budesonide 200 & 400 mcg – Rotacaps (pack of 60) and MDI (180 doses).

| Pack type | Product | Asthma | COPD |
|---|---|---|---|
| Regular Pack | Formoterol/Budesonide 200 & 400 mcg pMDI (120 doses) | ___ / 100 | ___ / 100 |
| Regular Pack | Rotacap (pack of 30) | ___ / 100 | ___ / 100 |
| Extended-Dose Pack | Formoterol/Budesonide 200 & 400 mcg pMDI (180 doses) | ___ / 100 | ___ / 100 |
| Extended-Dose Pack | Rotacap (pack of 60) | ___ / 100 | ___ / 100 |

9. Compared with patients receiving the regular pack, adherence among patients receiving the extended-dose pack is: (single choice)
   - [ ] Much better
   - [ ] Somewhat better
   - [ ] No difference
   - [ ] Somewhat worse
   - [ ] Much worse
   - [ ] Unable to assess

## Section 5: Reasons for Non-adherence

10. In your opinion, what are the key barriers to adherence to inhaled maintenance therapy of formoterol/budesonide in your asthma and COPD patients? (multi-select)
    - [ ] Side effects
    - [ ] Lack of understanding of the need for regular treatment
    - [ ] Delay in refill due to poor accessibility
    - [ ] Perception that medication is not required when symptoms improve
    - [ ] Fear/concerns about long-term medication
    - [ ] Cost
    - [ ] Difficulty remembering to take doses
    - [ ] Inhaler technique difficulties
    - [ ] Patient lifestyle/work-related factors
    - [ ] Other (specify): ______

## Section 6: Patient Characteristics Associated with Adherence

11. Which patients, in your opinion, are most likely to benefit from an Extended-dose pack? (multi-select)
    - [ ] Elderly patients
    - [ ] Difficulty accessing the pharmacy for a refill (e.g., remote location)
    - [ ] Patients with frequent exacerbations
    - [ ] Patients frequently forgetting doses
    - [ ] Patients taking multiple medications
    - [ ] Patients with poor disease awareness
    - [ ] All patients requiring long-term maintenance therapy
    - [ ] Busy lifestyle / working professional
    - [ ] Frequent travellers
    - [ ] Caregiver-dependent patients
    - [ ] Other: ______

## Section 7: Physician Perspective on the Extended-Dose Pack

12. What do you consider the main advantages / disadvantages of the Extended-Dose Pack compared to the Regular Pack?
    - Advantages: ______
    - Disadvantages: ______

13. Overall, how would you rate the Extended-Dose Pack compared with the Regular Pack with respect to the following? (Likert scale per row: Strongly disagree / Disagree / Neither agree nor disagree / Agree / Strongly agree)

    1. Using an Extended-Dose Pack is more convenient for patients
    2. Using an Extended-Dose Pack reduces the frequency of medication refills
    3. Using an Extended-Dose Pack improves medication adherence
    4. Using an Extended-Dose Pack helps in maintaining treatment continuity
    5. Using an Extended-Dose Pack improves patient satisfaction
    6. Using an Extended-Dose Pack helps achieve better disease control
    7. Using an Extended-Dose Pack is more cost-beneficial for patients because it reduces the frequency of doctor visits
    8. Using an Extended-Dose Pack may be detrimental because it can delay follow-up visits with the doctor
    9. Patients are reluctant to bear the higher initial purchase amount
    10. Higher chance of damage to Rotacaps due to humidity in the extended-dose pack

    > Note: In the source PDF, rows 9 and 10 appear without the rating options (the page appears cut off); they are presumably meant to use the same 5-point scale.