Inhaled corticosteroids administration/withdrawal as a therapeutic continuum for patients with chronic obstructive pulmonary disease in real clinical practice
S. N. Avdeev,
Z. R. Aisanov,
V. V. Arkhipov,
A. S. Belevskiy,
A. A. Vizel,
I. V. Demko,
A. V. Emelyanov,
A. A. Zaycev,
G. L. Ignatova,
N. P. Kniajeskaia,
L. M. Kudelya,
I. V. Leshchenko,
S. I. Ovcharenko,
A. I. Sinopalnikov,
I. N. Trofimenko,
V. D. Fedotov,
R. F. Khamitov https://doi.org/10.18093/0869-0189-2023-33-1-109-118
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressing disease. Each exacerbation impairs the patient’s prognosis and increases burden for the healthcare system. The most common maintenance treatment options for COPD include long-acting bronchodilators – β2-agonists (LABA) and long-acting antimuscarinic agents (LAMA), and inhaled glucocorticosteroids (ICS), in fixed/opened double and triple combinations. Triple therapy in subjects with exacerbation history is the most effective way to prevent negative outcomes of the disease. It can reduce the frequency of exacerbations, slow down the disease progression, improve quality of life, and reduce mortality in the long run. On the other hand, the response to triple therapy may change over the time depending on airways inflammation level, infection activity, and exacerbation frequency. Current COPD guidelines propose different indications for therapy escalation and de-escalation (ICS addition/withdrawal) for more personalized and safe treatment. At the same time, many practical issues of this process are still unclear, e.g. how often treatment regimens should be reviewed and what escalation/de-escalation criteria should be prioritized. The authors strongly believe that COPD therapy should adapt a holistic treatment approach (continuum) with quick responses to any changes in the patient’s condition.
The aim of our work was to create an algorithm for ICS administration/ withdrawal for COPD patients on long-acting dual bronchodilators maintenance therapy and to establish a therapeutic continuum that takes into account exacerbation history, symptoms severity, blood eosinophilia level, and concomitant asthma.
Conclusion. This instrument can be a useful and convenient tool for long-term patient management when access to specialized medical care might be restricted. It takes into account the main current recommendations for COPD management and is easy to apply in real clinical practice.
Keywords
chronic obstructive pulmonary disease (COPD),
inhaled corticosteroids (ICS),
COPD maintenance therapy,
COPD triple therapy,
single inhaler triple therapy,
COPD exacerbations,
ICS-containing COPD therapy,
COPD prescribing algorithm,
COPD therapeutic continuum
Supporting agencies: The authors declare that this work has not been funded
About the Authors
S. N. Avdeev
Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University); Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia
Russian Federation
Competing Interests:
Russian Federation
Sergey N. Avdeev - Doctor of Medicine, Professor, Academician of Russian Academy of Sciences, Head of the Department of Pulmonology, N.V. Sklifosovsky ICM, Institution of Higher Education I.M. Sechenov First MSMU (Sechenov University), Leading Researcher, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia
Ul. Trubetskaya 8, build. 2, Moscow, 119991; Orekhovyy bul’var 28, Moscow, 115682; tel.: (495) 708-35-76
Competing Interests:
reports giving lectures for Boehringer Ingelheim, LLC AstraZeneca Pharmaceuticals, LLC Chiesi Pharmaceuticals
Z. R. Aisanov
Pirogov Russian National Research Medical University (Pirogov Medical University), Healthcare Ministry of Russia
Russian Federation
Competing Interests:
Russian Federation
Zaurbek R. Aisanov - Doctor of Medicine, Professor, Department of Pulmonology.
Ul. Ostrovityanova 1, Moscow, 117997; tel.: (495) 965-34-66
Competing Interests:
reports giving lectures for Boehringer Ingelheim, Teva, GSK, LLC Chiesi Pharmaceuticals
V. V. Arkhipov
Russian Federal Academy of Continued Medical Education, Healthcare Ministry of Russia
Russian Federation
Competing Interests:
Russian Federation
Vladimir V. Arkhipov - Doctor of Medicine, Professor, Department of Clinical Pharmacology and Therapy.
Ul. Barrikadnaya 2/1, Moscow, 123995; tel.: (499) 252-21-04
Competing Interests:
reports giving lectures for Boehringer Ingelheim, GSK, LLC Chiesi Pharmaceuticals
A. S. Belevskiy
Pirogov Russian National Research Medical University (Pirogov Medical University), Healthcare Ministry of Russia
Russian Federation
Competing Interests:
Russian Federation
Andrey S. Belevskiy - Doctor of Medicine, Professor, Head of Department of Pulmonology, Faculty of Postgraduate Physician Training, Pirogov RNRMU (Pirogov Medical University), Head of Laboratory of Pulmonary Rehabilitation and Respiratory Health Research.
Ul. Ostrovityanova 1, Moscow, 117997; tel.: (495) 963-24-67
Competing Interests:
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A. A. Vizel
Kazan’ State Medical University, Healthcare Ministry of Russia
Russian Federation
Competing Interests:
Russian Federation
Alexander A. Vizel - Doctor of Medicine, Professor, Head of Department of Phthisiopulmonology and Pulmonology; Author ID: 195447.
Ul. Butlerova 49, Kazan’, 420012, Tatarstan Republic; tel.: (987) 296-25-99
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I. V. Demko
Federal State Budgetary Educational Institution of Higher Education Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky, Ministry of Health of the Russian Federation
Russian Federation
Competing Interests:
Russian Federation
Irina V. Demko - Doctor of Medicine, Professor, Head of Department of Internal Medicine No.2 with Postgraduate Physician Training Course.
Ul. Partizana Zheleznyaka 1, Krasnoyarsk, 660022; tel.: (913) 507-84-08
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A. V. Emelyanov
North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of the Russian Federation
Russian Federation
Competing Interests:
Russian Federation
Alexander V. Emelyanov - Doctor of Medicine, Professor, Head of Department of Pulmonology.
Ul. Kirochnaya 41, Saint-Petersburg, 191015; tel.: (812) 970-71-88
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A. A. Zaycev
Main Military Clinical Hospital named after academician N.N. Burdenko, Ministry of Defense of the Russian Federation; Federal State Budgetary Educational Institution of Higher Education Moscow State University of Food Production, Ministry of Science and Higher Education
Russian Federation
Competing Interests:
Russian Federation
Andrey A. Zaicev - Doctor of Medicine, Professor, Chief Pulmonologist, Main MCH named after academician N.N. Burdenko, Ministry of Defense of the Russian Federation, Head of the Department of Pulmonology (with a course in Allergology), Medical Institute of Continuing Education, MSU FP; Author ID: 217005
Gospital’naya pl. 3, Moscow, 105229; Volokolamskoye shosse 11, Moscow, 125080; tel.: (495) 263-55-55
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G. L. Ignatova
South Ural State Medical University, Healthcare Ministry of Russia
Russian Federation
Competing Interests:
Russian Federation
Galina L. Ignatova - Doctor of Medicine, Professor, Head of Department of Therapy, Institute of Postgraduate Physician Training, South USMU; Chief Pulmonologist, Ural FD.
Ul. Vorovskogo 64, Chelyabinsk, 454092; tel.: (351) 742-66-40
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N. P. Kniajeskaia
Pirogov Russian National Research Medical University (Pirogov Medical University), Healthcare Ministry of Russia
Russian Federation
Competing Interests:
Russian Federation
Nadezhda P. Kniajeskaia - Candidate of Medicine, Associate Professor, Department of Pulmonology, Faculty of Postgraduate Physician Training.
Ul. Ostrovityanova 1, Moscow, 117997; tel.: (495) 963-24-67
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L. M. Kudelya
Novosibirsk State Medical University, Healthcare Ministry of Russia; State budgetary healthcare institution of the Novosibirsk region State Novosibirsk Regional Clinical Hospital
Russian Federation
Competing Interests:
Russian Federation
Lyubov M. Kudelya - Doctor of Medicine, Professor, Department of Internal Diseases named after Academician L.D. Sidorova, Novosibirsk SMU, Healthcare Ministry of Russia, Head оf Pulmonology Department, State budgetary healthcare institution of the Novosibirsk region SNRCH, Chief Pulmonologist of the Novosibirsk region.
Krasnyy pr. 52, Novosibirsk, 630091; Ul. Nemirovicha-Danchenko 130, Novosibirsk, 630087; tel.: (383) 315-97-07
Competing Interests:
reports giving lectures for LLC AstraZeneca Pharmaceuticals, LLC Chiesi Pharmaceuticals
I. V. Leshchenko
Ural Federal State Medical University, Healthcare Ministry of Russia; Ural Federal Research Institute of Phthisiology and Pulmonology – a Branch of National Medical Research Center for Phthisiology, Pulmonology and Infectious Diseases, Healthcare Ministry of Russia; Limited Liability Company Novaya bol’nitsa Clinical Association
Russian Federation
Competing Interests:
Russian Federation
Igor V. Leshсhenko - Doctor of Medicine, Professor, Department of Phthisiology and Pulmonology, UF SMU; Chief Researcher, UFRI of Phthisiology and Pulmonology – A Branch of National Medical Research Center for Phthisiology, Pulmonology and Infectious Diseases; Scientific Director, Limited Liability Company “Novaya bol’nitsa” Clinical Association, Chief Freelance Pulmonologist, Honored Doctor of the RF.
Ul. Repina 3, Ekaterinburg, 620028; ul. 22-go Parts’ezda 50, Ekaterinburg, 620039; ul. Zavodskaya 29, Ekaterinburg, 620109; tel.: (343) 246-44-75
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S. I. Ovcharenko
Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University)
Russian Federation
Competing Interests:
Russian Federation
Svetlana I. Ovcharenko - Doctor of Medicine, Professor, Department No.1 of General Internal Medicine, N.V. Sklyphosovsky Institute of Clinical Medicine.
Ul. Trubetskaya 8, build. 2, Moscow, 119991; tel.: (499) 248-56-67
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A. I. Sinopalnikov
Russian Federal Academy of Continued Medical Education, Healthcare Ministry of Russia
Russian Federation
Competing Interests:
Russian Federation
Alexander I. Sinopalnikov - Doctor of Medicine, Professor, Head of Department of Pulmonology.
Ul. Barrikadnaya 2/1, Moscow, 123995; tel.: (499) 728-83-69
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I. N. Trofimenko
Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Federal State Budgetary Educational Institution of Further Professional Education Russian Medical Academy of Continuing Professional Education, Healthcare Ministry of the Russian Federation
Russian Federation
Competing Interests:
Russian Federation
Irina N. Trofimenko - Doctor of Medicine, Head of the Department of Clinical Allergology and Pulmonology.
Mkr Yubilejnyy 100, Irkutsk, 664079; tel.: (9148) 77-80-96
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V. D. Fedotov
Federal Budgetary Scientific Institution Nizhny Novgorod Research Institute for Hygiene and Occupational Pathology, Federal Service for Supervision of Consumer Rights Protection and Human Welfare
Russian Federation
Competing Interests:
Russian Federation
Vasily D. Fedotov - Candidate of Medicine, Senior Researcher, Clinical Department.
Ul. Semashko 20, Nizhny Novgorod, 603105; tel.: (831) 438-91-36
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R. F. Khamitov
Kazan’ State Medical University, Healthcare Ministry of Russia
Russian Federation
Competing Interests:
Russian Federation
Rustem F. Khamitov - Doctor of Medicine, Professor, Head of the Department of Internal Medicine.
Ul. Butlerova 49, Kazan’, 420012, Tatarstan Republic; tel.: (843) 236-06-52
Competing Interests:
reports giving lectures for Sandoz, R-Farm, LLC Chiesi Pharmaceuticals
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For citations:
Avdeev S.N., Aisanov Z.R., Arkhipov V.V., Belevskiy A.S., Vizel A.A., Demko I.V., Emelyanov A.V., Zaycev A.A., Ignatova G.L., Kniajeskaia N.P., Kudelya L.M., Leshchenko I.V., Ovcharenko S.I., Sinopalnikov A.I., Trofimenko I.N., Fedotov V.D., Khamitov R.F. Inhaled corticosteroids administration/withdrawal as a therapeutic continuum for patients with chronic obstructive pulmonary disease in real clinical practice. PULMONOLOGIYA. 2023;33(1):109-118. (In Russ.) https://doi.org/10.18093/0869-0189-2023-33-1-109-118
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