The concept of controlling chronic obstructive pulmonary disease
Yu.G. Belotserkovskaya, A.I. Sinopalnikov, A.G. Romanovskikh, I.P. Smirnov
Russian Medical Academy of Continuous Professional Education, Moscow, Russia
Given the significant heterogeneity of the disease, the treatment of chronic obstructive pulmonary disease (COPD) should be individualized, taking into account the different clinical characteristics and severity of the condition of each patient. That is why experts proposed a new concept for controlling COPD. Clinical COPD control may be a new step in determining the status of a patient after assessing the phenotype, severity of the disease, severity of symptoms, taking into account the degree of impaired respiratory function, associated diseases, prognostic parameters. The concept of COPD control is interpreted as maintaining the situation with the minimal clinical impact of disease symptoms in combination with a stable course characterized by a low risk of exacerbations over a long period of time adapted to the severity of the disease. Different clinical criteria for controlling require further research to confirm a high level of correlation with different clinical outcomes in a controlled or uncontrolled course of COPD. The authors of the concept suggest using the possibilities of drug therapy to correct the level of control. Modifying the amount of therapy based on the level of control implies periods of increasing the volume of therapy due to the addition of drugs of another class with insufficient control and periods of ongoing therapy with a good level of control. It is also possible to reduce the amout of therapy by canceling inhaled glucocorticosteroids in patients whose disease remains controlled for a certain period of time. The amount of bronchodilation therapy in COPD is not recommended to be reduced, since this is progressive disease and full normalization of the functional respiratory parameters is impossible. Such an approach would help to correct the treatment of each patient, avoiding both insufficient and excessive medication effects, and achieve the best possible course of the disease with a minimum amount of therapy.
About the Autors
Corresponding author: Yuliya G. Belotserkovskaya, PhD, Associate Professor at the Department of Pulmonology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; e-mail: email@example.com; ORCID: https://orcid.org/0000-0003-1224-1904; Address: 2/1, Build. 1, Barrikadnaya Street, Moscow 123995, Russian Federation