ОСОБЕННОСТИ КЛИНИЧЕСКИХ ПРОЯВЛЕНИЙ И ОЦЕНКА ПРОВОДИМОЙ ТЕРАПИИ ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ НА ТРЕТЬЕМ УРОВНЕ ОКАЗАНИЯ МЕДИЦИНСКОЙ ПОМОЩИ В РЕСПУБЛИКЕ ТАТАРСТАН

Abstract

Objective: to identify clinical data and treatment methods for COPD patients on the third level of medical care, and assess their correlations with exacerbations, the fatigue syndrome, and patient adherence to treatment. Materials and methods. We examined 330 patients with diagnosed COPD. We collected case records, assessed drugs and routes of administration, established results of clinical and laboratory studies, smoking status, and compliance. Results. GOLD-III and type D spirometry disorders prevailed. Frequent exacerbations were typical for patients with high mMRC and CAT scores and low FEV1 values. The proportion of adherent patients was 29.4%. Patients with frequent exacerbations, decreased FEV1, and pronounced symptoms were more adherent to treatment. COPD patients received short-acting bronchodilators (85.5%), ICS/LABA (54.5%), and dual long-acting bronchodilators (18.8%). The fatigue syndrome was established using the FAS questionnaire in 61.9% of patients. Patients with significant levels of fatigue were predominantly of the older age, often with FEV1 of 50% or less of the due value, more pronounced clinical symptoms by the CAT and mMRC scale, two or more exacerbation episodes, and concomitant diseases. Conclusion. COPD patients treated on the third level had lower adherence to treatment, poor skills in inhalation technique and control, and they excessively used short-acting bronchodilators. The present study confirmed the expediency of simultaneous use of two classifications of COPD and the necessity to assess fatigue levels during management of COPD patients.