Personalized medicine of chronic obstructive pulmonary disease.
Brief summary of the new guidelines of the Czech Pneumological and Phthisiological Society


Authors: V. Koblížek 1;  J. Chlumský 2;  V. Zindr 3;  K. Neumannová 4,5;  J. Zatloukal 4;  V. Sedlák 1;  J. Kociánová 6;  J. Zatloukal 7
Authors‘ workplace: Univerzita Karlova v Praze Lékařská fakulta a Fakultní nemocnice, Hradec Králové, Plicní klinika Přednosta: doc. MUDr. František Salajka, CSc. 1;  Univerzita Karlova v Praze1. lékařská fakulta a Thomayerova nemocnice, Praha, Pneumologická klinika Přednosta: prof. MUDr. Jiří Homolka, DrSc. 2;  Plicní ordinace, Karlovy Vary 3;  Univerzita Palackého, Olomouc Fakulta tělesné kultury, Katedra fyzioterapie Vedoucí: prof. MUDr. Jaroslav Opavský, CSc. 4;  Univerzita Palackého, Olomouc Fakulta tělesné kultury, Katedra přírodních věd v kinantropologii Vedoucí: prof. RNDr. Miroslav Janura, Dr. 5;  Plicní ordinace, Ostrava 6;  Univerzita Palackého, OlomoucLékařská fakulta a Fakultní nemocnice, Klinika plicních nemocí a tuberkulózy Přednosta: prof. MUDr. Vítězslav Kolek, DrSc. 7
Published in: Prakt. Lék. 2013; 93(4): 169-174
Category: In diferent

Overview

Introduction:
Chronic obstructive pulmonary disease (COPD) is a global problem with serious impacts on patients in the Czech Republic. The current view on COPD changes the diagnostic approach and optimal treatment recommendations.

Methods:
The Expert group of the Czech Pneumological and Phthisiological Society (CPPS) has drawn up draft guidelines on COPD. This document was discussed at the National Consensus Conference and subsequently presented at a series of local and national workshops. The final document was prepared for publication (full version in Czech, short version in English) in April and May 2013.

Diagnosis:
The basic diagnostic method is spirometry after inhaled bronchodilators. Detailed analysis of medical history (symptoms and exacerbations) provides additional important information. The wide spectrum of COPD symptoms can help with detection of the clinical subtypes of COPD (called phenotypes). CPPS describes six clinical phenotypes relevant for practical usage: emphysematic and bronchitic phenotypes, the phenotype of frequent exacerbations, phenotype of pulmonary cachexia and two overlapping phenotypes (COPD with asthma and COPD with bronchiectasis).

Treatment:
Treatment recommendations are divided into four steps. The first is to eliminate all risk of inhalation. Standard therapy, particularly inhaled bronchodilators, pulmonary rehabilitation, vaccination and treatment of comorbidities, is intended for all patients with confirmed diagnosis of COPD. Advanced diseases have a tendency to develop disease specific phenotypes, phenotypic targeted therapy is geared to specific types of disabilities. The final therapeutic step is to care for respiratory failure and terminal COPD.

Conclusion:
Effective treatment of COPD requires a personalized approach to the each patient.

Keywords:
COPD phenotypes – personalized medicine – national guidelines – treatment strategy


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