Vnitr Lek 2013, 59(6):505-514

Chronic obstructive pulmonary disease in the light of new guidelines - brief summary of phenotypically oriented guidelines for non-pulmonary physicans

V. Koblížek^1,*, J. Chlumský², V. Zindr³, K. Neumannová^4,5, J. Zatloukal⁴, V. Sedlák¹, J. Kociánová⁶, J. Zatloukal⁷, B. Novotná¹

¹ Plicní klinika Lékařské fakulty UK a FN Hradec Králové, přednosta doc. MUDr. František Salajka, CSc.

² Pneumologická klinika 1. lékařské fakulty UK a Thomayerovy nemocnice Praha, přednosta prof. MUDr. Jiří Homolka, DrSc.

³ Plicní ordinace Karlovy Vary

⁴ Katedra fyzioterapie Fakulty tělesné kultury UP v Olomouci, vedoucí katedry prof. MUDr. Jaroslav Opavský, CSc.

⁵ Katedra přírodních věd v kinantropologii Fakulty tělesné kultury UP v Olomouci, vedoucí katedry prof. RNDr. Miroslav Janura, Dr.

⁶ Plicní ordinace Ostrava

⁷ Klinika plicních nemocí a tuberkulózy Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Vítězslav Kolek, DrSc.

Introduction:
COPD is a global health and social problem. Morbidity and mortality increases in the Czech Republic. There are currently several global statements and strategies.

Methods:
The Czech Pneumological and Phthisiological Society (CPFS) at the end of 2011 mandated the Section of bronchial obstruction in drafting national guidelines concerning the stable COPD. Subsequently, this document was discussed during the National Consensus Conference (COPD forum) in November 2012 and presented at series of local workshops and national conferences. National guidelines has been subject to a review and eventually posted on the website for another round of comments.

Diagnosis:
A modern approach to COPD is a view of the patient through the pulmonary function, symptoms, exacerbation rates and the presence of specific phenotypes. CPFS identified six clinically relevant phenotypes: frequent exacerbators, COPD and asthma overlap, COPD and bronchiectasis overlap, emphysematic phenotype, bronchitic phenotype and phenotype of pulmonary cachexia.


Treatement:
Treatment recommendations can be divided into four elementary steps: the first step is the Elimination of all risks factors. The second one is the Standard therapy including in particular inhaled bronchodilators, pulmonary rehabilitation, and treatment of severe comorbidities. The third step is the Targeted therapy centered on clinical phenotypes of COPD. The final fourth step is the treatment of respiratory insufficiency and palliative care of the terminal COPD.

Conclusion:
The optimal treatment of COPD requires a personalized approach to the patient.

Keywords: COPD phenotypes; personalized medicine; national guidelines

Received: May 7, 2013; Published: June 1, 2013  Show citation