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:
Of different specialties
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
Sources
1. Aaron, SD, Donaldson, GC, Whitmore, GA, et al. Time course and pattern of COPD exacerbation onset. Thorax 2012; 67(3): 238–243.
2. Bakke PS, Ronmark E, Eagan T, et al. Recommendations for epidemiological studies on COPD. Eur Respir J 2011; 38(6): 1261–1277.
3. Burgel PR, Paillasseur JL, Cailland D, et al. Clinical COPD phenotypes: a novel approach using principal component and cluster analyses. Eur Respir J 2010; 36(3): 531–539.
4. Casaburi R, Kukafka D, Cooper CB, et al. Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD. Chest 2005; 127(3): 809–817.
5. Celli BR. Update on the management of COPD. Chest 2008; 133(6): 1451–1462.
6. Celli BR, Thomas NE, Anderson JA, et al. Effect of pharmacotherapy on the rate of decline of lung fuction in chronic obstructive pulmonary disease: results from the TORCH study. Am J Respir Crit Care Med 2008; 178(4): 332–338.
7. Česká pneumologická a ftizeologická společnost. Doporučený postup pro diagnostiku a léčbu stabilní CHOPN [online]. 2013-01-02 [cit. 2013-04-05]. Dostupný z: http://www.pneumologie.cz/aktualne/doc/Standard%20verze%2021.1.pdf.
8. de Lucas-Ramos P, Izquierdo-Alonso JL, Rodriguez-Gonzalez JM, et al. Chronic obstructive pulmonary disease as a cardiovascular risk factor. Results of a case-control study (CONSISTE study). Int J Chron Obstr Pulmon Dis 2012; 7: 679–686.
9. Decramer M, Celli BR, Kesten S, et al. Effect of tiotropium on outcomes in patiens with moderate chronic obstructive pulmonary disease (UPLIFT) a prespecified subgroup analysis of a randomised controlled trial. Lancet 2009; 374(9696): 1171–1178.
10. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease [online]. 2013-01-02 [cit. 2013-3-2]. Dostupné z: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013_Feb20.pdf.
11. Gonem S, Raj V, Wardlaw J, et al. Phenotyping airways disease: an A to E approach. Clin Exp Allergy 2012; 42(12): 1664–1683.
12. Han MK, Agusti A, Calverley PM, et al. Chronic obstructive pulmonary disease phenotype. The future of COPD. Am J Respir Crit Care Med 2010; 182(5): 598–604.
13. Institute of Medical Information Services. Tuberculosis and respiratory diseases 2011 [online]. 2012-01-11 [cit. 2013-02-03]. Dostupné z: http://www.uzis.cz/katalog/zdravotnicka-statistika/tuberkuloza-respiracni-nemoci.
14. Izquierdo-Alonso JL, Rodriguez-Gonzálezmoro JM, de Lucas-Ramos P, et al. Prevalence and characteristics of three clinical phenotypes of chronic obstructive pulmonary disease (COPD). Respir Med 2013; 107(5): 724–731.
15. Jones P, Adamek L, Nadeau G, Banik N. Comparisons of health status scores with MRC grades in a primary care COPD population: implications for the new GOLD 2011 classification. Eur Respir J 2012 Dec 20. [Epub ahead of print] doi: 10.1183/09031936.001 25612.
16. Kamal AH, Maguire JM, Wheeler JL, et al. Dyspnea review for the paliative care professional: treatment goals and therapeutic options. J Palliat Med 2012; 15(1): 106–114.
17. Lamprecht B, McBurnie MA, Vollmer WM, et al. COPD in never smokers: results from the population-based burden of obstructive lung disease study. Chest 2011; 139(4): 752–763.
18. Lange P, Marott JL, Vestbo J, et al. Prediction of the clinical course of chronic obstructive pulmonary disease, using the new GOLD classification: a study of the general population. Am J Respir Crit Care Med 2012; 186(10): 975–981.
19. Lanken PN, Terry PB, DeLisser HM, et al. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 2008; 177(8): 912–927.
20. Laube BL, Janssens HM, Jongh FHC, et al. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J 2011; 37(6): 1308–1331.
21. Mahler DA, D'Urzo A, Bateman ED, et al. Concurrent use of indacaterol plus tiotropium in patients with COPD provides superior bronchodilatation compared with tiotropium alone: a randomised, double-blind comparison. Thorax 2012; 67(9): 781–788.
22. Malý M, Zvolský M, Rozborilová E, Vondra V. Respiratory Mortality in Czech and Slovak Republics in the year 2011. Stud Pneumol Phtiseol 2013; 73(2): v tisku..
23. Mapel DW, Marton J. Prevalence of renal and hepatobiliary disease, laboratory abnormalities, and potentially toxic medication exposures among persons with COPD. Int J Chron Obstr Pulmon Dis 2013; 8: 127–134.
24. Miravitlles M, Soler-Cataluña JJ, Calle M, et al. Spanish COPD Guidelines (GesEPOC): pharmacological treatment of stable COPD. Spanish Society of Pulmonology and Thoracic Surgery. Arch Bronchoconeumol 2012; 48(7): 247–257.
25. Miravitlles M, Calle M, Soler-Cataluña JJ. Clinical phenotypes of COPD. Identification, definition and implications for quidelines. Arch Bronchoconeumol 2012; 48(3): 86–98.
26. Nava S, Sturani C, Hartl S, et al. End-of-life decision – making in respiratory intermediate care units: a European survey. ERS TASK FORCE. Eur Respir J 2007; 30(1): 156–164.
27. National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease (updated) Clinical guidelines CG101 [online]. 2013-03-02 [cit. 2013-04-02]. Dostupný na: http://www.nice.org.uk/CG101.
28. Nici L, ZuWallack R. An official American Thoracic Society workshop report: the Integrated Care of The COPD Patient. Proc Am Thorac Soc 2012; 9(1): 9–18.
29. Nishimura M, Makita H, Nagai K, et al. Annual change in pulmonary function and clinical phenotype in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2012; 185(1): 44–52.
30. Pasteur MC, Bilton D, Hill AT, et al. British Thoracic Society guideline for non-CF bronchiectasis. Thorax 2010; 65(Suppl 1): i1–i59.
31. Pauwels RA, Rabe KF. Burden and clinical features of chronic obstructive pulmonary disease (COPD). Lancet 2004; 364(9434): 613–620.
32. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J 2005; 26(5): 948–968.
33. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update for the ACP, ACCP, ATS and ERS. Ann Intern Med 2011; 155(3): 179–191.
34. Rabe KF. Roflumilast for the treatment of chronic obstructive pulmonary disease. Expert Rev Resp Med 2010; 4(5): 543–555.
35. Sode B, Dahl M, Nordestgaard BG. Myocardial infarction and other co-morbidities in patients with chronic obstructive pulmonary disease: a Danish nationwide study of 7.4 million individuals. Eur Heart J 2011; 32(19): 2365–2375.
36. Stridsman C, Lindberg A, Skär L. Fatigue in chronic obstructive pulmonary disease: a qualitative study of people´s experiences. Scand J Caring Sci 2013 Mar 20. [Epub ahead of print] doi: 10.1111/scs.12033.
37. Torres JP, Marín JM, Casanova C, et al. Lung cancer in patiens with chronic obstructive pulmonary disease. Incidence and predicting factors. Am J Respir Crit Care Med 2011; 184(8): 913–919.
38. Uronis HE, Currow DC, Abernethy AP. Palliative management of refractory dyspnea in COPD. Int J Chron Obstr Pulmon Dis 2006; 1(3): 289–304.
39. Vanfleteren LE, Spruit MA, Groenen M, et al. Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013; 187(7): 728–735.
40. Vondra V. Úmrtnost na CHOPN v letech 1996–2005 se zdvojnásobila. Stud Pneumol Phtiseol 2007; 73(2): 75.
Labels
General practitioner for children and adolescents General practitioner for adultsArticle was published in
General Practitioner
2013 Issue 4
Most read in this issue
- The female and the male brain
- Chloroquine retinopathy: case report and recommendations for screening
- Dengue fever
- Nutritional imunology: modulation of immunity by components of nutrition