Perspectives of pharmacological therapy of chronic obstructive pulmonary disease: opportunities of dual bronchodilation and a role of inhaled steroids. Expert Council Consensus

Abstract

The most important symptoms of chronic obstructive pulmonary disease are dyspnea, cough and sputum production. According to results of several studies, 50% – 70% of COPD patients under regular therapy continue to experience dyspnea. Dyspnea has a great prognostic importance, it often correlates to exacerbation rate and the patients’ survival. Symptom reduction is one of the key outcomes of therapy of COPD. Measuring tools for assessment dyspnea are imperfect as dyspnea is a subjective feature. Nevertheless, available quantitative tools allow assessment symptom severity in COPD patients. Such tools (modified Medical Research Council scale and COPD Assessment Test – САТ) should be adopted to a medical care level (primary, secondary or tertiary care). Long-acting bronchodilators are the essential component of treatment COPD independently on COPD phenotype. COPD phenotype should be diagnosed before administration of combined drugs containing inhaled steroids (ICS). Long-term therapy with ICS is appropriate for the following groups of patients: overlap COPD and asthma phenotype; high risk of exacerbations (FEV1 < 50% pred., > 2 non-infectious exacerbations or > 1 hospitalization related to non-infectious exacerbation during the previous year); patients with sputum eosinophilia > 3% and / or blood eosinophilia > 300 cells × ml -1 with consideration of the disease severity. A physician should consider a risk of adverse events of ICS. ICS should not be administered to COPD patients with FEV1 > 50% pred. or having < 2 acute exacerbations or no one hospitalization related to acute exacerbation of COPD during the previous year. ICS could be withdrawn if their administration did not match these criteria. Patients with persistent symptoms under monotherapy with long-acting bronchodilators, ICS / long-acting b2-agonists and who do not match the criteria for treatment with ICS should be treated with indacaterol / glycopyrronium combination.