scholarly journals COPD Pharmacological Management Update

2020 ◽  
Author(s):  
Stefan-Marian Frent
Keyword(s):  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Pharmacological Management ◽  
Pharmacological Agents ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Therapeutic Decisions ◽  
Public Health Challenge ◽  
Blood Eosinophils

Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality worldwide. Although it is considered both preventable and treatable, COPD still represents an important public health challenge. The classes of pharmacological agents widely used for the maintenance treatment are bronchodilators (SABA, SAMA, LABA, LAMA) and inhaled corticosteroids (ICS). While it is largely accepted that inhaled bronchodilators, which are effective and well tolerated in patients with stable disease, are the cornerstone of the pharmacological management of COPD, there is an ongoing debate regarding the role of inhaled corticosteroids. This is also reflected in the last versions of the GOLD recommendations, which suffered dramatic changes in the recent years. The trend for personalized medicine led to the search for biomarkers which could guide the therapeutic decisions. Recent studies demonstrated that blood eosinophils can reasonably predict the ICS relative efficacy in preventing COPD exacerbations and thus could inform the disease management.

scholarly journals Reassessing the Role of Eosinophils as a Biomarker in Chronic Obstructive Pulmonary Disease

2019 ◽  
Vol 8 (7) ◽  
pp. 962 ◽  
Author(s):  
Tinè ◽  
Biondini ◽  
Semenzato ◽  
Bazzan ◽  
Cosio ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Real Life ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Exacerbation Risk ◽  
Blood Eosinophils

Blood eosinophils measurement, as proxy for tissue eosinophils, has become an important biomarker for exacerbation risk and response to inhaled corticosteroids (ICS) in Chronic Obstructive Pulmonary Disease (COPD). Its use to determine the pharmacological approach is recommended in the latest COPD guidelines. The potential role of blood eosinophils is mainly based on data derived from post-hoc and retrospective analyses that showed an association between increased blood eosinophils and risk of exacerbations, as well as mitigation of this risk with ICS. Yet other publications, including studies in real life COPD, do not confirm these assumptions. Moreover, anti-eosinophil therapy targeting interleukin (IL)-5 failed to reduce exacerbations in COPD patients with high blood eosinophils, which casts significant doubts on the role of eosinophils in COPD. Furthermore, a reduction of eosinophils might be harmful since COPD patients with relatively high eosinophils have better pulmonary function, better life quality, less infections and longer survival. These effects are probably linked to the role of eosinophils in the immune response against pathogens. In conclusion, in COPD, high blood eosinophils are widely used as a biomarker for exacerbation risk and response to ICS. However, much is yet to be learned about the reasons for the high eosinophil counts, their variations and their controversial effects on the fate of COPD patients.

Current opportunities of inhaled corticosteroid therapy in patients with chronic obstructive pulmonary disease

2021 ◽  
Vol 31 (1) ◽  
pp. 75-87
Author(s):  
I. V. Leshchenko ◽  
A. S. Meshcheryakova
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Fixed Combination ◽  
Chronic Obstructive ◽  
Delivery Device ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Long Acting ◽  
Blood Eosinophils

Chronic obstructive pulmonary disease (COPD) is the leading cause of death in the structure of respiratory diseases. The problem of rational pharmacotherapy of COPD have attracted attention of the medical scientific society for many years. The understanding of the pathogenesis of the disease has deepened and approaches to the therapy have changed. Some COPD patients need regular fixed-combination therapy: long-acting bronchodilators (LABD) and inhaled corticosteroids (ICS) in order to prevent exacerbations and reduce the severity of symptoms of the disease. Blood eosinophils count is one of criteria for choosing regular therapy. The appearance of fixed triple combinations of ICS/LABD increased the effectiveness of COPD therapy, and a new delivery device for fixed combination of budesonide/formoterol makes it possible to use ICS successfully in the most severe patients.

scholarly journals Issues of triple therapy of chronic obstructive pulmonary disease. Comments to the algorithm. A resolution of expert panel, June 13, 2018, Vladivostok

2019 ◽  
Vol 29 (3) ◽  
pp. 365-374
Author(s):  
S. N. Avdeev ◽  
V. A. Nevzorova ◽  
L. M. Kudelya ◽  
N. M. Kondrashova ◽  
G. I. Sukhanova ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Patient Adherence ◽  
Chronic Obstructive ◽  
Primary Concern ◽  
Small Airways ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Increased Risk

Minimizing the risk of exacerbations of chronic obstructive pulmonary disease (COPD) along with symptoms control are the most important therapeutic tasks in COPD. The effective solution of this problem is still being discussed. The prevention of COPD exacerbations is of social and economic importance and should be the primary concern in the treatment of this disease. Unresolved problems in the treatment of COPD are low patient compliance to therapy and side effects of medication. According to recent guidelines, in case of persistent COPD exacerbations with patients receiving long-acting bronchodilators (LABA), the use of inhaled corticosteroids (ICS) must be considered; this reduces the incidence of moderate and severe COPD exacerbations, especially if a patient has a history of bronchial asthma or blood and/or sputum eosinophilia. Availability of LABA/LAMA and ICS/LABA fixed combinations in Russia provides two possible options to administer a free triple combination consisting of a single LAMA plus ICS/LABA or ICS plus LAMA/LAMA. According to multiple trials, the use of fixed combinations could provide twice improvement in the patient adherence to the therapy, which therefore leads to higher efficiency. The main complaint about ICS with COPD patients is an increased risk of pneumonia as well as the development of systemic adverse reactions typical for corticosteroids. However, the use of extra-fine ICS could significantly reduce the risk of pneumonia compared with fine-particle inhalators and also increases the effectiveness of therapy as the pathological process in COPD mainly involves the small airways.

scholarly journals Inhalation glucocorticosteroids in the treatment of chronic obstructive pulmonary disease

2020 ◽  
Vol 30 (3) ◽  
pp. 330-343
Author(s):  
S. N. Avdeev ◽  
Z. R. Aisanov ◽  
V. V. Arkhipov ◽  
A. S. Belevskiy ◽  
I. V. Leshchenko ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive Lung Disease ◽  
Clinical Excellence ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Patient Reported ◽  
The Impact

The main objectives of chronic obstructive pulmonary disease (COPD) therapy are to reduce the severity of symptoms and the risk of exacerbations. The article discusses the role of local and systemic inflammation in the pathogenesis of COPD as well as various mechanisms of pharmacological influence on it. Approaches to prescribing basic therapy for patients with COPD, recommended by various national and global guidelines (clinical recommendations of the Russian respiratory society, criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), guidelines of the National Institute for Health and Clinical Excellence (NICE)), as well as recommendations on the therapy frequency review are considered. Currently, so-called triple combinations – fixed combinations of double bronchodilators with inhaled glucocorticosteroids – are being developed and registered in the world, and their place and significance in the treatment of COPD raise many discussions. The paper discusses the role of fixed triple combinations in reducing the incidence of COPD exacerbations, the impact on functional and patient-reported outcomes, and provides recommendations for the use of triple combinations in patients with COPD, taking into account the benefit/risk ratio.

scholarly journals Role of Type2 Inflammatory Biomarkers in Chronic Obstructive Pulmonary Disease

2020 ◽  
Vol 9 (8) ◽  
pp. 2670
Author(s):  
Keiji Oishi ◽  
Kazuto Matsunaga ◽  
Toshihiro Shirai ◽  
Keita Hirai ◽  
Yasuhiro Gon
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Stable State ◽  
Epidemiologic Studies ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Blood Eosinophils ◽  
The Relationship

Airway inflammation in chronic obstructive pulmonary disease (COPD) is typically thought to be driven by Type1 immune responses, while Type2 inflammation appears to be present in definite proportions in the stable state and during exacerbations. In fact, some COPD patients showed gene expression of Type2 inflammation in the airway, and this subset was associated with the inhaled corticosteroid (ICS) response. Interestingly enough, the relationship between COPD and diseases associated with Type2 inflammation from the perspective of impaired lung development is increasingly highlighted by recent epidemiologic studies on the origin of COPD. Therefore, many researchers have shown an interest in the prevalence and the role of existent Type2 biomarkers such as sputum and blood eosinophils, exhaled nitric oxide fraction, and atopy, not only in asthma but also in COPD. Although the evidence about Type2 biomarkers in COPD is inconsistent and less robust, Type2 biomarkers have shown some potential when analyzing various clinical outcomes or therapeutic response to ICS. In this article, we review the existent and emerging Type2 biomarkers with clinically higher applicability in the management of COPD.

scholarly journals The role of infectious pathogens in exacerbation of chronic obstructive pulmonary disease in Dakahlia Governorate

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Elsayed Ahmed Fahmy ◽  
Heba Wagih Abdelwahab ◽  
Heba Elsayed Eldegla ◽  
Mohammed Khairy Fahmy Elbadrawy
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Negative Impact ◽  
Fungal Growth ◽  
Atypical Mycobacteria ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations

Abstract Background Exacerbations of chronic obstructive pulmonary disease (COPD) represent important events in the management of COPD because of its negative impact on health status and disease progression. The etiology of acute exacerbations of chronic obstructive pulmonary disease (COPDAE) is heterogeneous and still under discussion. So, this study was planned to investigate the role of infectious pathogens (fungi and atypical mycobacteria in addition to the well-known bacteria) in patients with COPD exacerbation in our locality. Results This observational cross-sectional study was conducted on 100 patients with acute exacerbation of COPD. Sputum specimens were collected for mycobacterial and fungal examination in addition to routine sputum bacteriology. All sputum samples were negative for typical and atypical mycobacteria whereas sputum samples of 18 patients (18%) were negative for fungi. Mixed fungal growth was found in 19 patients (19%). Candida was isolated from 67 patients (67%), Aspergillus was isolated from 27 patients (27%), Alternaria was isolated from 3 patients (3%), and other fungi were isolated from 4 patients (4%). As regards sputum bacteriology, sputum samples of 49 patients (49%) have bacterial growth. Streptococcus pneumoniae was isolated from 16 samples (16%) and represents the most frequent bacterial isolate in this study. Conclusion The present study indicates that typical and atypical mycobacteria have no role in COPD exacerbations in our locality. However, fungi and bacteria may have a role in COPD exacerbations.

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