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New opportunities for prevention of exacerbations of chronic obstructive pulmonary disease. Russian Respiratory Society Expert Opinion

https://doi.org/10.18093/0869-0189-2017-27-1-108-113

Abstract

Combination therapy with long-acting β2-agonists (LABA) and long-acting muscarinic antagonists (LAMA) can reduce symptoms of chronic obstructive pulmonary disease (COPD) and the risk of future exacerbations. To date, the only fixed combination of long-acting bronchodilators, indacaterol/glycopyrronium, has demonstrated a significant reduction in dyspnea and in the risk of moderate and severe exacerbations of COPD in clinical trials when compared with the combination of salmeterol/fluticasone. Addition of inhaled steroids (ICS) to long-acting bronchodilators is recommended for patients with recurrent COPD exacerbations, especially in those with asthma-COPD overlap syndrome or history of elevated blood or sputum eosinophil levels. It is recommended to consider phenotype-specific therapy including roflumilast, N-acetylcysteine, and macrolides, in patients who continue to exacerbate despite being treated with LABA/LAMA or LABA/LAMA/ICS combinations. Withdrawal of inhaled corticosteroids is possible in patients with the low risk of exacerbation and in those with severe adverse events during ICS treatment. ICS should be withdrawn in a single step in patients with no repeated exacerbations during 12 months and with moderate bronchial obstruction (FEV1 ≥ 50% predicted). Stepwise withdrawal of ICS during 3 month with continuous dual bronchodilator therapy is recommended in COPD patients with severe bronchial obstruction (FEV1 ˂ 50% predicted) without frequent exacerbations in the previous year.

About the Authors

S. N. Avdeev
Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia
Russian Federation
Doctor of Medicine, Professor, Corresponding Member of Russian Academy of Sciences, Head of Clinical Division


Z. R. Aisanov
Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia
Russian Federation
Doctor of Medicine, Professor, Head of Division of Clinical Physiology and Clinical Trials


A. S. Belevskiy
N.I.Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia
Russian Federation
Doctor of Medicine, Professor, Head of Department of Pulmonology, Faculty of Postgraduate Physician Training


A. A. Vizel'
N.I.Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia
Russian Federation
Doctor of Medicine, Professor, Head of Department of Phthisiology and Pulmonology


S. K. Zyryanov
N.I.Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia; City Clinical Hospital No.24, Moscow Healthcare Department
Russian Federation
Doctor of Medicine, Professor, Head of Department of General and Clinical Pharmacology, N.I.Pirogov Russian National Research Medical University, Healthcare Ministry of Russia; Deputy Director for Therapy, City Clinical Hospital No. 24, Moscow Healthcare Department


G. L. Ignatova
South Ural State Medical University, Healthcare Ministry of Russia
Russian Federation
Doctor of Medicine, Professor, Head of Department of Therapy, Faculty of Postgraduate Physician Training


N. P. Knyazheskaya
N.I.Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia
Russian Federation
Candidate of Medicine, Associate Professor, Department of Pulmonology, Faculty of Postgraduate Physician Training


I. V. Leshchenko
Ural State Medical University, Healthcare Ministry of Russia
Russian Federation
Doctor of Medicine, Professor, Department of Phthisiology, Ural State Medical University, Healthcare Ministry of Russia; Chief Pulmonologist of Sverdlovsk region and Ekaterinburg


S. I. Ovcharenko
I.M.Sechenov First Moscow State Medical University, Healthcare Ministry of Russia
Russian Federation
Doctor of Medicine, Professor, Department of General Internal Medicine No.1, Medical Faculty


A. I. Sinopal'nikov
Russian State Academy of Continued Medical Education, Healthcare Ministry of Russia
Russian Federation
Doctor of Medicine, Professor, Head of Department of Pulmonology, Russian State Academy of Continued Medical Education, Healthcare Ministry of Russia; Vice-President of Interregional Association on Clinical Microbiology and Antimicrobial Chemotherapy


I. E. Stepanyan
Federal Central Research Institute of Tuberculosis, Russian Medical Science Academy
Russian Federation
Doctor of Medicine, Professor, Leading Researcher, Division of Differential Diagnosis of Pulmonary Tuberculosis and Extracorporeal Therapeutic Methods


V. I. Trofimov
Academician I.P.Pavlov First Saint-Petersburg State Medical University, Healthcare Ministry of Russia
Russian Federation
Doctor of Medicine, Professor, Head of M.V.Chernorutskiy Department of Hospital Internal Medicine with Course in Allergology and Immunology


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Review

For citations:


Avdeev S.N., Aisanov Z.R., Belevskiy A.S., Vizel' A.A., Zyryanov S.K., Ignatova G.L., Knyazheskaya N.P., Leshchenko I.V., Ovcharenko S.I., Sinopal'nikov A.I., Stepanyan I.E., Trofimov V.I. New opportunities for prevention of exacerbations of chronic obstructive pulmonary disease. Russian Respiratory Society Expert Opinion. PULMONOLOGIYA. 2017;27(1):108-113. (In Russ.) https://doi.org/10.18093/0869-0189-2017-27-1-108-113

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ISSN 0869-0189 (Print)
ISSN 2541-9617 (Online)