Greek Guidelines for the Management of COPD, a Proposal of a Holistic Approach Based on the needs of the Greek Community (original) (raw)
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Recommendations for the pharmacological treatment of COPD: questions and answers
Jornal Brasileiro De Pneumologia, 2017
The treatment of COPD has become increasingly effective. Measures that range from behavioral changes, reduction in exposure to risk factors, education about the disease and its course, rehabilitation, oxygen therapy, management of comorbidities, and surgical and pharmacological treatments to end-of-life care allow health professionals to provide a personalized and effective therapy. The pharmacological treatment of COPD is one of the cornerstones of COPD management, and there have been many advances in this area in recent years. Given the greater availability of drugs and therapeutic combinations, it has become increasingly challenging to know the indications for, limitations of, and potential risks and benefits of each treatment modality. In order to critically evaluate recent evidence and systematize the major questions regarding the pharmacological treatment of COPD, 24 specialists from all over Brazil gathered to develop the present recommendations. A visual guide was developed for the classification and treatment of COPD, both of which were adapted to fit the situation in Brazil. Ten questions were selected on the basis of their relevance in clinical practice. They address the classification, definitions, treatment, and evidence available for each drug or drug combination. Each question was answered by two specialists, and then the answers were consolidated in two phases: review and consensus by all participants. The questions answered are practical questions and help select from among the many options the best treatment for each patient and his/her peculiarities.
COPD patients’ characteristics, usual care, and adherence to guidelines: the Greek UNLOCK study
International Journal of Chronic Obstructive Pulmonary Disease, 2019
Purpose: GOLD guidelines classify COPD patients into AD groups based on health status as assessed by COPD Assessment Test (CAT) or mMRC tools and exacerbations and recommend single or dual long-acting bronchodilators as maintenance therapy, with additional inhaled corticosteroids (ICS) if the disease remains uncontrolled. We aimed to classify primary care COPD patients into AD groups, assess usual treatment and adherence to guidelines, potential mismatches between CAT-and mMRC-based classification and described symptoms within groups. Patients and methods: A total of 257 primary care COPD patients were enrolled between 2015 and 2016 in Greece. Physicians used structured interviews to collect cross-sectional data including demographics, symptoms, CAT, mMRC scores, and medications. Patients were classified into AD groups based on CAT and mMRC, and prevalence of symptoms and medication was estimated within AD groups. Interviews with physicians were also performed to explore additional issues about treatment and adherence to guidelines. Results: Mean (SD) age was 65 (12.3) years with 79% males. The majority of patients reported uncontrolled symptoms (91% and 61% with 10CATor10 CAT or 10CATor2 mMRC scores, respectively). Thirty-seven percentage had $2 exacerbations in the past year. Group B was the largest followed by Groups D, A, and C. Patients were classified as more severe by CAT than by mMRC. In all groups, the majority were treated with combined long-acting beta agonist/ICS (.50%). When patients were asked to report their main symptoms, dyspnea and cough were the most important symptoms mentioned, and there was a great variation between the AD groups. However, Groups A-C reported mainly morning symptoms, whereas Group D suffered symptoms all day. Physicians reported a significant number of barriers to implementing guidelines, eg, frequent lack of guideline updates, access to diagnostic procedures, and prescription-reimbursement issues. Conclusion: Our study confirms poor adherence to guidelines regarding treatment with an overuse of ICS and important barriers to implementation. A mismatch in classification occurs depending on the tool used, which can mislead clinicians in their choice of treatment.
Romanian clinical guideline for diagnosis and treatment of COPD
Journal of International Medical Research
Chronic obstructive pulmonary disease (COPD) is a disease with increasing prevalence and burden for health systems worldwide. Every country collects its own epidemiological data regarding COPD prevalence, morbidity and mortality while taking steps to educate the population and medical community to improve early detection and treatment. The rising COPD prevalence creates a need for comprehensive guidelines. In 2012 and 2017–2018, the Romanian Society of Pneumology (SRP) organised national inquiries for COPD, while lung physicians in Romania began receiving education regarding the correct algorithms for COPD diagnosis and therapy. During 2019, a Romanian clinical guideline for diagnosis and treatment of COPD was published, and a condensed version of key points from this guideline are presented herein. COPD is diagnosed based on the presence of three major components: relevant exposure history, respiratory symptoms, and airway limitation that is not fully reversible. Clinical evaluatio...
The clinical and integrated management of COPD
Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG / World Association of Sarcoidosis and Other Granulomatous Disorders, 2014
COPD is a chronic disease of the respiratory system characteriz ed by persistent and partially re-versible airflow obstruction, to which variably contribute remodeling of bronchi (chronic bronchitis), bronchi-oles (small airway disease) and lung parenchyma (pulmonary emphysema). COPD can cause important sys-temic effects and be associated with complications and comorbidities. The diagnosis of COPD is based on the presence of respiratory symptoms and/or a history of exposure to risk factors, and the demonstration of airflow obstruction by spirometry. GARD of WHO has defined COPD "a preventable and treatable disease". The in-tegration among general practitioner, chest physician as well as other specialists, whenever required, assures the best management of the COPD person, when specific targets to be achieved are well defined in a diagnostic and therapeutic route, previously designed and shared with appropriateness. The first-line pharmacologic treat-ment of COPD is represen...
2021
Additional file 1: Figure S1: Pipeline of the different stages of this cross-sectional observational study. Figure S2: Summary of the demographic features and vital sign measurements of the study sample. Table S1: Summary statistics on CAT questionnaire. Table S2: Summary of COPD exacerbations within the last 12 months. Figure S3: Classification of subjects based on months since initial COPD diagnosis. Table S3: Subject allocation based on gender or body mass index and ABCD assessment. Table S4: List of the comorbid conditions present in COPD patients. Figure S4: COPD severity (stage) based on FEV1 preBD% of predicted. Figure S5: Colourmaps depicting the combination of principal treatments used by the study participants per group of the ABCD assessment tool, and their compliance to each of them. Table S5: Use of other pharmacological agents, for symptomatic treatment, besides the main treatment options for the chronic management of COPD (LAMA, LABA, ICS). Table S6: Distribution of v...
A review of national guidelines for management of COPD in Europe
The European respiratory journal, 2016
The quality of care can be improved by the development and implementation of evidence-based treatment guidelines. Different national guidelines for chronic obstructive pulmonary disease (COPD) exist in Europe and relevant differences may exist among them.This was an evaluation of COPD treatment guidelines published in Europe and Russia in the past 7 years. Each guideline was reviewed in detail and information about the most important aspects of patient diagnosis, risk stratification and pharmacotherapy was extracted following a standardised process. Guidelines were available from the Czech Republic, England and Wales, Finland, France, Germany, Italy, Poland, Portugal, Russia, Spain and Sweden. The treatment goals, criteria for COPD diagnosis, consideration of comorbidities in treatment selection and support for use of long-acting bronchodilators, were similar across treatment guidelines. There were differences in measures used for stratification of disease severity, consideration of...
The pharmacoepidemiology of COPD: Recent advances and methodological discussion
The European respiratory journal, 2003
Mortality rates from chronic obstructive pulmonary disease (COPD) vary across Europe. However, the continuing elevated prevalence rates of current smoking among males and the increasing trend observed in females in the last decades predicts an increase of COPD mortality in many countries in the coming years. The real prevalence of COPD within a given population may vary widely depending upon the tools used for its identification: reported respiratory symptoms, medical diagnosis and abnormal lung function. Even when the diagnosis is based on an objective tool like spirometry, largely variable prevalence rates are found within the same population. In view of the different criteria endorsed by different scientific societies, it is clear that further research is needed to reach a standardised criterion for airways obstruction. Patients underestimate their own morbidity and may therefore be undertreated. The cost of COPD, largely driven by exacerbations, is expected to increase considerably in the future, reflecting the previous smoking habits of an ageing population. The impressive prevalence in current smokers v45 yrs of age in most countries highlights the need to improve the quality of prevention; early detection and screening programmes may be useful in this population of smokers.
COPD exacerbations and hospitalizations in Greece
Conclusion: Comorbidities, disease severity, and compliance with treatment were identified as the most notable risk factors for exacerbations, hospitalizations, and ICU admissions. Read this original research and sign up to receive International Journal of Chronic Obstructive Pulmonary Disease here: https://www.dovepress.com/articles.php?article\_id=24947
Multidisciplinary Respiratory Medicine, 2014
COPD is a chronic pathological condition of the respiratory system characterized by persistent and partially reversible airflow obstruction, to which variably contribute remodeling of bronchi (chronic bronchitis), bronchioles (small airway disease) and lung parenchyma (pulmonary emphysema). COPD can cause important systemic effects and be associated with complications and comorbidities. The diagnosis of COPD is based on the presence of respiratory symptoms and/or a history of exposure to risk factors, and the demonstration of airflow obstruction by spirometry. GARD of WHO has defined COPD "a preventable and treatable disease". The integration among general practitioner, chest physician as well as other specialists, whenever required, assures the best management of the COPD person, when specific targets to be achieved are well defined in a diagnostic and therapeutic route, previously designed and shared with appropriateness. The first-line pharmacologic treatment of COPD is represented by inhaled long-acting bronchodilators. In symptomatic patients, with pre-bronchodilator FEV1 < 60% predicted and ≥ 2 exacerbations/year, ICS may be added to LABA. The use of fixed-dose, single-inhaler combination may improve the adherence to treatment. Long term oxygen therapy (LTOT) is indicated in stable patients, at rest while receiving the best possible treatment, and exhibiting a PaO 2 ≤ 55 mmHg (SO 2 < 88%) or PaO 2 values between 56 and 59 mmHg (SO 2 < 89%) associated with pulmonary arterial hypertension, cor pulmonale, or edema of the lower limbs or hematocrit > 55%. Respiratory rehabilitation is addressed to patients with chronic respiratory disease in all stages of severity who report symptoms and limitation of their daily activity. It must be integrated in an individual patient tailored treatment as it improves dyspnea, exercise performance, and quality of life. Acute exacerbation of COPD is a sudden worsening of usual symptoms in a person with COPD, over and beyond normal daily variability that requires treatment modification. The pharmacologic therapy can be applied at home and includes the administration of drugs used during the stable phase by increasing the dose or modifying the route, and adding, whenever required, drugs as antibiotics or systemic corticosteroids. In case of patients who because of COPD severity and/or of exacerbations do not respond promptly to (Continued on next page)