Russian guidelines for the management of COPD: algorithm of pharmacologic treatment

Abstract

The high prevalence of COPD together with its high level of misdiagnosis and late diagnosis dictate the necessity for the development and implementation of clinical practice guidelines (CPGs) in order to improve the management of this disease. High-quality, evidence-based international CPGs need to be adapted to the particular situation of each country or region. A new version of the Russian Respiratory Society guidelines released at the end of 2016 was based on the proposal by Global Initiative for Obstructive Lung Disease but adapted to the characteristics of the Russian health system and included an algorithm of pharmacologic treatment of COPD. The proposed algorithm had to comply with the requirements of the Russian Ministry of Health to be included into the unified electronic rubricator, which required a balance between the level of information and the simplicity of the graphic design. This was achieved by: exclusion of the initial diagnostic process, grouping together the common pharmacologic and nonpharmacologic measures for all patients, and the decision not to use the letters A–D for simplicity and clarity. At all stages of the treatment algorithm, efficacy and safety have to be carefully assessed. Escalation and de-escalation is possible in the case of lack of or insufficient efficacy or safety issues. Bronchodilators should not be discontinued except in the case of significant side effects. At the same time, inhaled corticosteroid (ICS) withdrawal is not represented in the algorithm, because it was agreed that there is insufficient evidence to establish clear criteria for ICSs discontinuation. Finally, based on the Global Initiative for Obstructive Lung Disease statement, the proposed algorithm reflects and summarizes different approaches to the pharmacological treatment of COPD taking into account the reality of health care in the Russian Federation.

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

“…Согласно российскому алгоритму терапии ХОБЛ [41,42], при старте терапии выбор препарата производится только в зависимости от выраженности симптомов у больного (рис. 3).…”

“…Figure 3. An algorithm of treatment of chronic obstructive pulmonary disease [41,42] Notes. *, Рredominantly non-infectious exacerbations (in patients with comorbid bronchial asthma or eosinophilic type of inflammation).…”

The Comparison of Inspiratory Muscle Training Effectiveness in COPD Patients with Obesity and Normal Weight

“…(1) Despite the success of medical treatment for COPD, many patients continue to notice symptoms of the disease, such as progressive dyspnea, cough, and poor exercise tolerance. (2) Muscle dysfunction in COPD, the most extensively studied systemic manifestation of the disease, can involve both respiratory and peripheral muscles. (3)(4)(5)(6) It is considered to be of multifactorial origin, with local and systemic factors interacting to modify, in different ways, the phenotype and function of any specific muscle.…”

Тренировка Дыхательной Мускулатуры У Пациентов С Хронической Обструктивной Болезнью Легких

“…Хроническая обструктивная болезнь легких (ХОБЛ) является актуальной проблемой современного здравоохранения в силу высокой распространенности, значительно ограничивает физическую активность пациентов, снижает качество их жизни, а обострения и ухудшения течения заболевания являются одной из основных причин госпитализации [5,20,28,1]. Несмотря на определенные успехи медикаментозного лечения ХОБЛ, многие больные продолжают отмечать симптомы заболевания, такие как прогрессирующая одышка, кашель, плохая переносимость физических нагрузок [6,30,4]. Известно, что у пациентов с выраженной ХОБЛ вследствие нарушения геометрии грудной клетки, действия системных факторов, развивается слабость дыхательной мускулатуры, включая диа-фрагму, межреберные мышцы и др.…”