Differential treatment strategy in patients with different clinical phenotypes of chronic obstructive pulmonary disease

Aim. To optimize the treatment in patients with chronic obstructive pulmonary disease in primary care. Methods. The effectiveness of different strategies of long-term control treatment in 245 patients with chronic obstructive pulmonary disease depending on clinical phenotypes of the disease was evaluated. Three groups of patients were formed: patients from the 1 st group (70 patients, 33 - with predominant emphysema phenotype, 37 - with predominant bronchitis phenotype) were using long-acting anticholinergics, patients from the 2 nd group (110 patients, 52 - with predominant emphysema phenotype, 58 - with predominant bronchitis phenotype) - long-acting anticholinergics and inhaled corticosteroids, and patients from the 3 rd group (65 patients, 28 - with predominant emphysema phenotype, 37 - with predominant bronchitis phenotype) - long-acting anticholinergics together with inhaled corticosteroids and long-acting beta 2-agonists. The respiratory function, diffusing lung capacity and gas exchange parameters were assessed after 12 months of long-term control treatment. Results. The 2nd treatment strategy was more effective in patients with bronchitis phenotype, confirmed by the increase of forced expiratory volume at 1st second (FEV 1) value from 1.12±1.04 to 1.90±1.05 (р <0.05), and partial oxygen pressure (р аО 2) increase from 53.72±6.28 to 69.56±6.83 mmHg, as well as partial carbon dioxide pressure (р аCО 2) decrease from 55.71±8.34 to 52.34±8.16 mmHg. No significant changes in patients with emphysema phenotype were observed. The treatment strategy 3 was the most effective in patients with emphysema phenotype which was demonstrated by the increase of FEV 1 from 1.18±0.03 to 1.47±0.03, р аО 2 from 66.43±3.79 to 78.48±5.78 mmHg (р <0.05), diffusion capacity of carbon monoxide to alveolar volume ratio (DLCO/Va) increase from 35.32±11.34 to 44.12±12.2 (р <0.05) and decrease of р аО 2 from 50.21±3.68 to 43.43±5.47 mmHg. No significant improvement of gas exchange parameters in patients with bronchitis phenotype was registered. The treatment strategy 1 had no significant effect on respiratory function parameters. Conclusion. The differential strategies of long-term control treatment should be used depending on clinical phenotypes to optimize the treatment of chronic obstructive pulmonary disease.

chronic obstructive pulmonary disease, phenotypes, strategies of basic therapy