New concept and algorithm for the management of patients with chronic obstructive pulmonary disease
S. N. Avdeev,
I. V. Leshchenko,
Z. R. Aisanov on behalf of the chronic obstructive pulmonary disease Federal guideline development and revision working group
https://doi.org/10.18093/0869-0189-2023-33-5-587-594
Abstract
Currently, chronic obstructive pulmonary disease (COPD) is a global problem and one of the leading causes of death worldwide. COPD therapy includes pharmacological and non-pharmacological approaches that can significantly reduce clinical symptoms and decrease the frequency of exacerbations of the disease. Methods. The updates of guidelines for the diagnosis and treatment of COPD is expected to have a significant impact on patients with COPD in clinical practice. Simplification of the treatment algorithms and inclusion of triple therapy will help clinicians provide appropriate and timely treatment to patients with COPD with a focus on reducing the risk of future exacerbations. Recognition of mortality reduction as a treatment goal in COPD supports the increased use of triple therapy, the only pharmacologic intervention shown to improve survival in patients with COPD. Conclusion. Although further guidance and clarification are needed in some areas, such as the use of blood eosinophil count in treatment decisions and the implementation of post-hospitalizaton treatment protocols, the recent guideline updates will help clinicians address current gaps in patient care.
About the Authors
S. N. Avdeev
Federal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); Federal State Budgetary Institution “Pulmonology Scientific Research Institute” under Federal Medical and Biological Agency of Russian Federation
Russian Federation
Competing Interests:
Russian Federation
Sergey N. Avdeev, Doctor of Medicine, Professor, Academician of Russian Academy of Sciences, Vice-Rector for Research and Innovation, Head of the Department of Pulmonology, N.V.Sklifosovsky Institute of Clinical Medicine, Federal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); Leading Researcher, Federal State Budgetary Institution “Pulmonology Scientific Research Institute” under Federal Medical and Biological Agency of Russian Federation; Director, National Medical Research Center for the profile “Pulmonology”, Chief Freelance Pulmonologist of the Ministry of Health of the Russian Federation
ul. Trubetskaya 8, build. 2, Moscow, 119991; Orekhovyy bul’var 28, Moscow, 115682
tel.: (499)246-75-18
Competing Interests:
The authors declare no conflict of interest.
I. V. Leshchenko
Federal State Budgetary Educational Institution of Higher Education “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, Federal State Budgetary Educational Institution of Higher Education “Ural Federal State Medical University”, Healthcare Ministry of Russia; Chief Researcher, 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; Scientific Director, Limited Liability Company “Novaya bol’nitsa” Clinical Association, Chief Freelance Pulmonologist, Healthcare Ministry of the Sverdlovsk Region, Honored Doctor of the Russian Federation
ul. Repina 3, Ekaterinburg, 620028; ul. 22-go Parts’ezda 50, Ekaterinburg, 620039; ul. Zavodskaya 29, Ekaterinburg, 620109
tel.: (343) 246-44-75
Competing Interests:
The authors declare no conflict of interest.
Z. R. Aisanov
Federal State Autonomous Educational Institution of Higher Education “N.I.Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation
Russian Federation
Competing Interests:
Russian Federation
Zaurbek R. Aisanov, Doctor of Medicine, Professor, Professor, Department of Pulmonology, Faculty of Additional Professional Education
ul. Ostrovityanova 1, Moscow, 117997
tel.: (495) 965-34-66
Competing Interests:
The authors declare no conflict of interest.
References
1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2023 Report. Available at: https://goldcopd.org/2023-gold-report-2/
2. Ministry of Health of the Russian Federation [Chronic obstructive pulmonary disease: Clinical guidelines]. Available at: https://spulmo.ru/upload/kr/HOBL_2023_draft.pdf (in Russian).
3. Aisanov Z.R., Avdeev S.N., Arkhipov V.V. et al. [National clinical guidelines on diagnosis and treatment of chronic obstructive pulmonary disease: a clinical decision-making algorithm]. Pul'monologiya. 2017; 27 (1): 13–20. DOI: 10.18093/0869-0189-2017-27-1-13-20 (in Russian).
4. Aisanov Z., Avdeev S., Arkhipov V. et al. Russian guidelines for the management of COPD: algorithm of pharmacologic treatment. Int. J. Chron. Obstruct. Pulmon. Dis. 2018; 13: 183–187. DOI: 10.2147/copd.s153770.
5. Sestini P., Renzoni E., Robinson S. et al. Short-acting beta 2 agonists for stable chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2002; (4): CD001495. DOI: 10.1002/14651858.cd001495.
6. Schermer T., Smeenk F., van Weel C. Referral and consultation in asthma and COPD: an exploration of pulmonologists' views. Neth. J. Med. 2003; 61 (3): 71–81. Available at: https://pubmed.ncbi.nlm.nih.gov/12765227/
7. Karner C., Cates C.J. Long-acting beta2-agonist in addition to tiotropium versus either tiotropium or long-acting beta2-agonist alone for chronic obstructive pulmonary disease. Cochrane Database Syst .Rev. 2012; 4 (4): CD008989. DOI: 10.1002/14651858.cd008989.pub2.
8. Van der Molen T., Cazzola M. Beyond lung function in COPD management: effectiveness of LABA/LAMA combination therapy on patient-centered outcomes. Prim. Care Respir. J. 2012; 21 (1): 101–108. DOI: 10.4104/pcrj.2011.00102.
9. Mahler D.A., Decramer M., D`Urzo A. et al. Dual bronchodilatation with QVA149 reduces patient reported dyspnea in COPD: the BLAZE study. Eur. Respir. J. 2014; 43 (6): 1599–1609. DOI: 10.1183/09031936.00124013.
10. Singh D., Agusti A., Martinez F.J. et al. Blood eosinophils and chronic obstructive pulmonary disease: a Global Initiative for Chronic Obstructive Lung Disease Science Committee 2022 review. Am. J. Respir. Crit. Care Med. 2022; 206 (1): 17–24. DOI: 10.1164/rccm.202201-0209pp.
11. Calzetta L., Ritondo B.L., de Marco P. et al. Evaluating triple ICS/LABA/LAMA therapies for COPD patients: a network meta-analysis of ETHOS, KRONOS, IMPACT, and TRILOGY studies. Expert Rev. Respir. Med. 2021; 15 (1): 143–152. DOI: 10.1080/17476348.2020.1816830.
12. Cazzola M., Rogliani P., Laitano R. et al. Beyond dual bronchodilation – triple therapy, when and why. Int. J. Chron. Obstruct. Pulmon. Dis. 2022; 17: 165–180. DOI: 10.2147/copd.s345263.
13. Yu A.P., Guérin A., Ponce de Leon D. et al. Therapy persistence and adherence in patients with chronic obstructive pulmonary disease: multiple versus single long-acting maintenance inhalers. J. Med. Econ. 2011; 14 (4): 486–496. DOI: 10.3111/13696998.2011.594123
14. Lipson D.A., Barnhart F., Brealey N. et al. Once-daily single-inhaler triple versus dual therapy in patients with COPD. N. Engl. J. Med. 2018; 378 (18): 1671–1680. DOI: 10.1056/nejmoa1713901.
15. Ferguson G.T., Rabe K.F., Martinez F.J. et al. Triple therapy with budesonide/glycopyrrolate/formoterol fumarate with co-suspension delivery technology versus dual therapies in chronic obstructive pulmonary disease (KRONOS): a double-blind, parallel-group, multicentre, phase 3 randomised controlled trial. Lancet Resp. Med. 2018; 6 (10): 747–758. DOI: 10.1016/s2213-2600(18)30327-8.
16. Papi A., Vestbo J., Fabbri L. et al. Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial. Lancet. 2018; 391 (10125): 1076–1084. DOI: 10.1016/s0140-6736(18)30206-x.
17. Singh D., Papi A., Corradi M. et al. Single inhaler triple therapy versus inhaled corticosteroid plus long-acting β2-agonist therapy for chronic obstructive pulmonary disease (TRILOGY): a double-blind, parallel group, randomised controlled trial. Lancet. 2016; 388 (10048): 963–973. DOI: 10.1016/s0140-6736(16)31354-x.
18. Chong J., Poole P., Leung B., Black P.N. Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2011; (5): CD002309. DOI: 10.1002/14651858.cd002309.pub3.
19. Donath E., Chaudhry A., Hernandez-Aya L.F., Lit L. A meta-analysis on the prophylactic use of macrolide antibiotics for the prevention of disease exacerbations in patients with Chronic Obstructive Pulmonary Disease. Respir. Med. 2013; 107 (9): 1385–1392. DOI: 10.1016/j.rmed.2013.05.004.
20. Albert R.K., Connett J., Bailey W.C. et al. Azithromycin for prevention of exacerbations of COPD. N. Engl. J. Med. 2011; 365 (8): 689–698. DOI: 10.1056/nejmoa1104623.
21. Cazzola M., Calzetta L., Page C. et al. Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis. Eur. Respir. Rev. 2015; 24 (137): 451–461. DOI: 10.1183/16000617.00002215.
22. Poole P., Black P.N., Cates C.J. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2012; (8): CD001287. DOI: 10.1002/14651858.cd001287.pub4.
23. Zeng Z., Yang D., Huang X., Xiao Z. Effect of carbocisteine on patients with COPD: a systematic review and meta-analysis. Int. J. Chron. Obstruct. Pulmon. Dis. 2017; 12: 2277–2283. DOI: 10.2147/COPD.S140603.
24. Dal Negro R., Wedzicha J., Iversen M. et al. Effect of erdosteine on the rate and duration of COPD exacerbations: the RESTORE study. Eur. Respir. J. 2017; 50 (4): 1700711. DOI: 10.1183/13993003.00711-2017
25. White P., Thorntoh H., Pinnock H. et al. Overtreatment of COPD with inhaled corticosteroids – implications for safety and costs: cross-sectional observational study. PLoS One. 2013; 8 (10): e75221. DOI: 10.1371/journal.pone.0075221.
26. Rossi A., Guerriero M., Corrado A. OPTIMO/AIPO Study Group. Withdrawal of inhaled corticosteroids can be safe in COPD patients at low risk of exacerbation: a real-life study on the appropriateness of treatment in moderate COPD patients (OPTIMO). Respir. Res. 2014; 15 (1): 77. DOI: 10.1186/1465-9921-15-77.
27. Magnussen H., Disse B., Rodriguez-Roisin R. et al. Withdrawal of inhaled glucocorticoids and exacerbations of COPD. N. Engl. J. Med. 2014; 371 (14): 1285–1294. DOI: 10.1056/nejmoa1407154.
28. Chapman K.R., Hurst J.R., Frent S.M. et al. Long-term triple therapy De-escalation to Indacaterol/Glycopyrronium in COPD Patients (SUNSET): a randomized, double-blind, triple-dummy clinical trial. Am. J. Respir. Crit. Care Med. 2018; 198 (3): 329–339. DOI: 10.1164/rccm.201803-0405oc.
29. Stoller J.K., Panos R.J., Krachman S. et al. Oxygen therapy for patients with COPD: current evidence and the long-term oxygen treatment trial. Chest. 2010; 138 (1): 179–187. DOI: 10.1378/chest.09-2555.
30. Sculley J.A., Corbridge S.J., Prieto-Centurion V. et al. Home oxygen therapy for patients with COPD: time for a reboot. Respir. Care. 2019; 64 (12): 1574–1585. DOI: 10.4187/respcare.07135.
31. Ergan B., Nava S. Long-term oxygen therapy in COPD patients who do not meet the actual recommendations. COPD. 2017; 14 (3): 351–366. DOI: 10.1080/15412555.2017.1319918.
32. Jacobs S.S., Krishnan J.A., Lederer D.J. et al. Home oxygen therapy for adults with chronic lung disease: an official American Thoracic Society clinical practice guideline. Am. J. Respir. Crit. Care Med. 2020; 202 (10): e121–141. DOI: 10.1164/rccm.202009-3608st.
33. Chuchalin A.G., Avdeev S.N., Aisanov Z.R. et al. [Federal guidelines on diagnosis and treatment of chronic obstructive pulmonary disease]. Pul'monologiya. 2022; 32 (3): 356–392. DOI: 10.18093/0869-0189-2022-32-3-356-392 (in Russian).
34. Avdeev S.N. [Non invasive ventilation in patients with chronic obstructive pulmonary disease in a hospital and at home]. Pul'monologiya. 2017; 27 (2): 232–249. DOI: 10.18093/0869-0189-2017-27-2-232-249 (in Russian).
35. Nagata K., Horie T., Chohnabayashi N. et al. Home high-flow nasal cannula oxygen therapy for stable hypercapnic COPD: a randomized clinical trial. Am. J. Respir. Crit. Care Med. 2022; 206 (11): 1326–1335. DOI: 10.1164/rccm.202201-0199OC.
Supplementary files
Review
For citations:
Avdeev S.N., Leshchenko I.V., Aisanov Z.R. New concept and algorithm for the management of patients with chronic obstructive pulmonary disease. PULMONOLOGIYA. 2023;33(5):587-594. (In Russ.) https://doi.org/10.18093/0869-0189-2023-33-5-587-594
Views:
3738
Email this article 