New clinical guidelines for COPD – a paradigm shift: A review

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Abstract

Chronic obstructive pulmonary disease is now one of the most common noncommunicable diseases and the main causes of morbidity, disability and mortality in the world. In recent years, new approaches to epidemiology, diagnosis, classification (categorization), evaluation of phenotypes, as well as characterization and assessment of the severity of сhronic obstructive pulmonary disease exacerbations have emerged. Modern approaches to starting and subsequent drug therapy have changed significantly. This is largely due to the results of recently conducted major clinical trials, demonstrated high efficacy of triple fixed combinations, including inhaled glucocorticosteroids, long-acting beta-agonists and long-acting anticholinergic drugs. The use of non-medication methods (smoking cessation, physical activity and respiratory rehabilitation) and modern approaches to the treatment of respiratory failure and antibiotic therapy remain important. In terms of their significance, all these updates have a significant impact on real clinical practice and can be considered as a novel paradigm of the approaches to the diagnosis and management of this disease.

About the authors

Sergey N. Avdeev

Sechenov First Moscow State Medical University (Sechenov University); Research Institute of Pulmonology

Author for correspondence.
Email: serg_avdeev@list.ru
ORCID iD: 0000-0002-5999-2150

акад. РАН, д-р мед. наук, проф., зав. каф. пульмонологии Института клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет), зав. отд. ФГБУ «НИИ пульмонологии»

Russian Federation, Moscow; Moscow

Igor V. Leshchenko

Ural State Medical University; Ural Research Institute of Phthisiopulmonology – branch of the National Medical Research Center for Phthisiopulmonology and Infectious Diseases

Email: leshchenkoiv@yandex.ru
ORCID iD: 0000-0002-1620-7159

д-р мед. наук, проф. каф. фтизиатрии и пульмонологии ФГБОУ ВО УГМУ, гл. науч. сотр. научно-клинического отд. Уральского НИИ фтизиопульмонологии – филиала ФГБУ «НМИЦ ФПИ»

Russian Federation, Yekaterinburg; Yekaterinburg

Zaurbek R. Aisanov

Pirogov Russian National Research Medical University

Email: aisanov@mail.ru

д-р мед. наук, проф. каф. пульмонологии фак-та дополнительного профессионального образования ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»

Russian Federation, Moscow

Vladimir V. Arkhipov

Russian Medical Academy of Continuous Professional Education

Email: arkhipov@gmx.us
ORCID iD: 0000-0002-5671-3478

д-р мед. наук, проф. каф. клинической фармакологии и терапии ФГБОУ ДПО РМАНПО

Russian Federation, Moscow

Andrey S. Belevskiy

Pirogov Russian National Research Medical University

Email: pulmobas@yandex.ru
ORCID iD: 0000-0001-6050-724X

д-р мед. наук, проф., зав. каф. пульмонологии фак-та дополнительного профессионального образования ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»

Russian Federation, Moscow

Svetlana I. Ovcharenko

Sechenov First Moscow State Medical University (Sechenov University)

Email: svetftk@mail.ru
ORCID iD: 0000-0002-8264-6635

д-р мед. наук, проф. каф. факультетской терапии №1 Института клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)

Russian Federation, Moscow

Alexander V. Emelyanov

Mechnikov North-Western State Medical University

Email: emelav@inbox.ru
ORCID iD: 0000-0002-8574-6869

д-р мед. наук, проф., зав. каф. пульмонологии ФГБОУ ВО «СЗГМУ им. И.И. Мечникова»

Russian Federation, Saint Petersburg

Alexander I. Sinopalnikov

Russian Medical Academy of Continuous Professional Education

Email: aisyn@list.ru
ORCID iD: 0000-0002-1990-2042

д-р мед. наук, проф., зав. каф. пульмонологии ФГБОУ ДПО РМАНПО

Russian Federation, Moscow

Evgene I. Shmelev

Central Research Institute of Tuberculosis

Email: eishmelev@mail.ru
ORCID iD: 0000-0002-1908-5601

д-р мед. наук, проф., зав. отд. дифференциальной диагностики туберкулеза легких и экстракорпоральных методов лечения ФГБНУ ЦНИИТ

Russian Federation, Moscow

Alexander G. Chuchalin

Pirogov Russian National Research Medical University

Email: pulmomoskva@mail.ru
ORCID iD: 0000-0002-6808-5528

акад. РАН, д-р мед. наук, проф., зав. каф. госпитальной терапии педиатрического фак-та ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»

Russian Federation, Moscow

References

  1. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024. Available at: http://www.goldcopd.org/ Accessed: 29.12.2023.
  2. Halpin DMG, Celli BR, Criner GJ, et al. The GOLD Summit on chronic obstructive pulmonary disease in low- and middle-income countries. Int J Tuberc Lung Dis. 2019;23(11):1131-41. doi: 10.5588/ijtld.19.0397
  3. Diab N, Gershon AS, Sin DD, et al. Underdiagnosis and Overdiagnosis of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2018;198(9):1130-9. doi: 10.1164/rccm.201804-0621CI
  4. World Health Organization. The top 10 causes of death. Available at: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Accessed: 12.12.2023.
  5. Концевая А.В., Муканеева Д.К. Баланова Ю.А., и др. Экономический ущерб от болезней органов дыхания и хронической обструктивной болезни легких в Российской Федерации в 2016 году. Пульмонология. 2019;29(2):159-66 [Kontsevaya AV, Mukaneyeva DK, Balanova YA, et al. Economic burden of respiratory diseases and chronic obstructive pulmonary disease in Russian Federation, 2016. Pulmonologiya. 2019;29(2):159-66 (in Russian)]. doi: 10.18093/0869-0189-2019-29-2-159-166
  6. Skajaa N, Laugesen K, Horváth-Puhó E, Sørensen HT. Comorbidities and mortality among patients with chronic obstructive pulmonary disease. BMJ Open Respir Res. 2023;10(1):e001798. doi: 10.1136/bmjresp-2023-001798.
  7. Айсанов З.Р., Чучалин А.Г., Калманова Е.Н. Хроническая обструктивная болезнь легких и сердечно-сосудистая коморбидность. Кардиология. 2019;59(8S):24-36 [Aisanov ZR, Chuchalin AG, Kalmanova EN. Chronic obstructive pulmonary disease and cardiovascular comorbidity. Kardiologiia. 2019;59(8S):24-36 (in Russian)]. doi: 10.18087/cardio.2572
  8. Giezeman M, Sundh J, Athlin Å, et al. Comorbid Heart Disease in Patients with COPD is Associated with Increased Hospitalization and Mortality – A 15-Year Follow-Up. Int J Chron Obstruct Pulmon Dis. 2023;18:11-21. doi: 10.2147/COPD.S378979
  9. Celli BR, Fabbri LM, Aaron SD, et al. An Updated Definition and Severity Classification of Chronic Obstructive Pulmonary Disease Exacerbations: The Rome Proposal. Am J Respir Crit Care Med. 2021;204(11):1251-8. doi: 10.1164/rccm.202108-1819PP
  10. Rothnie KJ, Müllerová H, Smeeth L, Quint JK. Natural History of Chronic Obstructive Pulmonary Disease Exacerbations in a General Practice-based Population with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2018;198(4):464-71. doi: 10.1164/rccm.201710-2029OC
  11. Farne HA, Cates CJ. Long-acting beta2-agonist in addition to tiotropium versus either tiotropium or long-acting beta2-agonist alone for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015;(10):CD008989. doi: 10.1002/14651858.CD008989.pub3
  12. van der Molen T, Cazzola M. Beyond lung function in COPD management: effectiveness of LABA/LAMA combination therapy on patient-centred outcomes. Prim Care Respir J. 2012;21(1):101-8. doi: 10.4104/pcrj.2011.00102
  13. Mahler DA, Decramer M, D'Urzo A, et al. Dual bronchodilation with QVA149 reduces patient-reported dyspnoea in COPD: the BLAZE study. Eur Respir J. 2014;43(6):1599-609. doi: 10.1183/09031936.00124013
  14. Singh D, Agusti A, Martinez FJ, et al. Blood Eosinophils and Chronic Obstructive Pulmonary Disease: A Global Initiative for Chronic Obstructive Lung Disease Science Committee 2022 Review. Am J Respir Crit Care Med. 2022;206(1):17-24. doi: 10.1164/rccm.202201-0209PP
  15. Calzetta L, Ritondo BL, de Marco P, et al. Evaluating triple ICS/LABA/LAMA therapies for COPD patients: a network meta-analysis of ETHOS, KRONOS, IMPACT, and TRILOGY studies. Expert Rev Respir Med. 2021;15(1):143-52. doi: 10.1080/17476348.2020.1816830
  16. Cazzola M, Rogliani P, Laitano R, et al. Beyond Dual Bronchodilation – Triple Therapy, When and Why. Int J Chron Obstruct Pulmon Dis. 2022;17:165-80. doi: 10.2147/COPD.S345263
  17. Yu AP, Guérin A, Ponce de Leon D, et al. Therapy persistence and adherence in patients with chronic obstructive pulmonary disease: multiple versus single long-acting maintenance inhalers. J Med Econ. 2011;14(4):486-96. doi: 10.3111/13696998.2011.594123
  18. Chong J, Poole P, Leung B, Black PN. Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011;(5):CD002309. doi: 10.1002/14651858.CD002309.pub3
  19. Albert RK, Connett J, Bailey WC, et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011;365(8):689-98. doi: 10.1056/NEJMoa1104623
  20. Cazzola M, Calzetta L, Page C, J et al. Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis. Eur Respir Rev. 2015;24(137):451-61. doi: 10.1183/16000617.00002215
  21. White P, Thornton H, Pinnock H, et al. Overtreatment of COPD with inhaled corticosteroids – implications for safety and costs: cross-sectional observational study. PLoS One. 2013;8(10):e75221. doi: 10.1371/journal.pone.0075221
  22. Rossi A, Guerriero M, Corrado A; OPTIMO/AIPO Study Group. Withdrawal of inhaled corticosteroids can be safe in COPD patients at low risk of exacerbation: a real-life study on the appropriateness of treatment in moderate COPD patients (OPTIMO). Respir Res. 2014;15(1):77. doi: 10.1186/1465-9921-15-77
  23. Magnussen H, Disse B, Rodriguez-Roisin R, et al. Withdrawal of inhaled glucocorticoids and exacerbations of COPD. N Engl J Med. 2014;371(14):1285-94. doi: 10.1056/NEJMoa1407154
  24. Stoller JK, Panos RJ, Krachman S, et al. Long-term Oxygen Treatment Trial Research Group. Oxygen therapy for patients with COPD: current evidence and the long-term oxygen treatment trial. Chest. 2010;138(1):179-87. doi: 10.1378/chest.09-2555
  25. Sculley JA, Corbridge SJ, Prieto-Centurion V, et al. Home Oxygen Therapy for Patients With COPD: Time for a Reboot. Respir Care. 2019;64(12):1574-85. doi: 10.4187/respcare.07135
  26. Ergan B, Nava S. Long-Term Oxygen Therapy in COPD Patients Who Do Not Meet the Actual Recommendations. COPD. 2017;14(3):351-66. doi: 10.1080/15412555.2017.1319918
  27. Jacobs SS, Krishnan JA, Lederer DJ, et al. Home Oxygen Therapy for Adults with Chronic Lung Disease. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020;202(10):e121-41. doi: 10.1164/rccm.202009-3608ST
  28. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. Am J Respir Crit Care Med. 1995;152(5 Pt. 2): S77-121.
  29. Авдеев С.Н. Неинвазивная вентиляция легких у пациентов с хронической обструктивной болезнью легких в стационаре и домашних условиях. Пульмонология. 2017;27(2):232-49 [Avdeev SN. Non-invasive ventilation in patients with chronic obstructive pulmonary disease in a hospital and at home. Pulmonologiya. 2017;27(2):232-49 (in Russian)]. doi: 10.18093/0869-0189-2017-27-2-232-249
  30. Nagata K, Horie T, Chohnabayashi N, et al. Home High-Flow Nasal Cannula Oxygen Therapy for Stable Hypercapnic COPD: A Randomized Clinical Trial. Am J Respir Crit Care Med. 2022;206(11):1326-35. doi: 10.1164/rccm.202201-0199OC
  31. Авдеев С.Н., Лещенко И.В., Айсанов З.Р. Новая концепция и алгоритм ведения больных с хронической обструктивной болезнью легких. Пульмонология. 2023;5:587-94 [Avdeev SN, Leshchenko IV, Aisanov ZR. A new concept and algorithm for the management of patients with chronic obstructive pulmonary disease. Pulmonologiya. 2023;5:587-94 (in Russian)]. doi: 10.18093/0869-0189-2023-33-5-587-594

Supplementary files

Supplementary Files
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2. Fig. 1. Diagnostic criteria and categorization of COPD [1].

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3. Fig. 2. New classification of severity of COPD exacerbations [9].

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4. Fig. 3. Algorithm of COPD therapy [31].

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