Therapeutic adherence of COPD patients according to levels of involvement in health education in their sites

Plaza, Vicente; Fernández, Carmen; Curto, Elena; Alonso-Ortiz, María Belén; Orue, Miren Itxaso; Vega, José M.; Cosío, Borja G.; Giner, Jordi

doi:10.1016/j.arbr.2020.09.006

Cited by 1 publication

(1 citation statement)

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“…In high-impact patients, it is imperative to verify the correct inhalation technique, adherence to treatment, the appearance of adverse effects and satisfaction with the inhalation device before proceeding with escalation of the inhalation device. 44 While this may seem obvious, the percentage of cases in which this assessment is either not made or not recorded is truly alarming. 17 , 18 , 45 In patients diagnosed with COPD who are given suitable treatment, with good inhalation technique, good tolerance to treatment, correct compliance and adequate satisfaction with the inhalation device and who, furthermore, persist with a high clinical impact, a change in treatment needs to be planned.…”

Section: Initial Stepping Up From Initial Treatmentmentioning

confidence: 99%

Step-Up and Step-Down Treatment Approaches for COPD: A Holistic View of Progressive Therapies

Lόpez-Campos¹,

Hernández²,

Ruiz-Duque³

et al. 2021

COPD

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Recent advances in inhaled drugs and a clearer definition of the disease have made the task of managing COPD more complex. Different proposals have been put forward which combine all the available treatments and the different clinical presentations in an effort to select the best therapeutic options for each clinical context. As COPD is a chronic progressive disease, the escalation of therapy has traditionally been considered the most natural way to tackle it. However, the notion of COPD as a constantly progressing disease has recently been challenged and, in specific areas, this points to the possibility of a deescalation in treatment. In this context, the clinician requires simple, specific recommendations to guide these changes in treatment in their daily clinical practice. To accomplish this, the first step must be a correct evaluation and an accurate initial preliminary diagnosis of the patient's condition. Thereafter, the first escalation in therapy must be introduced with caution as the disease progresses, since clinical trials are not designed with clinical decision-making in mind. During this escalation, three possibilities are open to change the current treatment for a different one within the same family, to increase non-pharmacological interventions or to increase the pharmacological therapies. Beyond that point, a patient with persistent symptoms represents a complex clinical scenario which requires a specialized approach, including the evaluation of different respiratory and non-respiratory comorbidities. Unfortunately, there are few de-escalation studies available, and these are mainly observational in nature. The debate on de-escalation in pharmacological treatment, therefore, involves two main discussion points: the withdrawal of bronchodilators and the withdrawal of inhaled steroids. Altogether, the scheme for modifying treatment must be more personalized than just adding molecules, and the therapeutic response and its conditioning factors should be evaluated at each step before proceeding further.

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