Possibilities to prevent acute exacerbation of chronic obstructive pulmonary disease using inhalational therapy. A Report of Expert Panel of Russian Respiratory Society

Abstract

An impact of acute exacerbation of COPD (AECOPD) on the course and the prognosis of chronic obstructive pulmonary disease depends on severity of the exacerbation. Moderate and severe exacerbations are considered as clinically significant events. Clinical studies investigating a role of inhalational therapy for the risk of AECOPD differed significantly in important parameters and the patients involved were not fully described in the real clinical practice. Tiotropium alone did not demonstrate any benefit over other inhalational therapies, such as inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) combinations and long-acting muscarinic antagonist (LAMA)/LABA combinations, for risk reduction of moderate to severe exacerbations. A benefit of tiotropium/olodaterol combination over tiotropium for the reduction of risk of clinically significant exacerbations was first shown in DYNAGITO study; patients’ groups in this study did not differ in a rate and a spectrum of adverse events including cardiovascular events. An efficient bronchodilating therapy should be administered to all patients with COPD as it could improve dyspnea and prevent exacerbations. Further escalation of treatment in patients with frequent exacerbations of COPD should be personalized according to clinical course and causes of AECOPD.

<p>Withdrawal of inhaled corticosteroids in COPD patients: rationale and algorithms</p>

“…This is a selective and far from complete list of approaches to withdrawal of unnecessary ICS, as defined in currently available clinical guidelines. The expert group held several working group meetings in order to formulate approaches to ICS withdrawal in COPD patients 66–68. The expert team reviewed available approaches to (and algorithms for) ICS withdrawal and switching to treatment regimens without ICS.…”

“…On the other hand, oversimplification of the approach by minimizing the number of the factors would not allow for all possible clinical situations to be covered. In view of the above, the working group tried to use an integrated approach to formulate a relatively simple algorithm that is based on consideration and integrated assessment of the most relevant factors (markers) influencing decision-making, such as a history of exacerbations, peripheral blood eosinophil count, presence of infection, and risk of community-acquired pneumonia 66–68…”

Withdrawal of inhaled corticosteroids in patients with chronic obstructive pulmonary disease

“…Экспертной группой проведены несколько заседаний по выработке подходов к отмене терапии иГКС у больных ХОБЛ [59][60][61]. Членами экспертной группы проанализированы имеющиеся на сегодняшний день подходы и алгоритмы отказа от иГКС-содержащей терапии и переключения на лечебные режимы, свободные от приема иГКС.…”

“…В то же время попытки упрощения подходов за счет использования минимального количества факторов, определяющих дальнейшую тактику, не позволяют дать рекомендации при разных вариантах развития клинических ситуаций. Специалисты рабочей группы попытались осуществить интегрированный подход и совместить простоту алгоритма с учетом и комплексной оценкой в определенной последовательности наиболее значимых факторов (маркеров), влияющих на принятие решений, таких как наличие обострений в анамнезе, количество эозинофилов в периферической крови, наличие инфекции и риск развития внебольничной пневмонии [59][60][61].…”

Outpatient pulmonology in contemporary national recommendations and research

“…ИГКС получали 85,8% больных в виде монотерапии или в составе фиксированных комбинаций с ДДБА. Фиксированные комбинации лекарственных препаратов имеют преимущество перед другими средствами [4,5] и снижают расходы на лечение ХОБЛ [11]. Терапевтическая тактика назначения ИГКС изменена у 10,5% больных в связи с обострением или другими причинами.…”