Biomedical Papers, 2013 (vol. 157), issue 2

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2013, 157(2):189-201 | 10.5507/bp.2013.039

Chronic Obstructive Pulmonary Disease: Official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society; a novel phenotypic approach to COPD with patient-oriented care

Vladimir Koblizeka, Jan Chlumskyb, Vladimir Zindrc, Katerina Neumannovad,e, Jakub Zatloukald, Jaroslav Zakf, Vratislav Sedlaka, Jana Kocianovag, Jaromir Zatloukalh, Karel Hejduki, Sarka Pracharovaa
a Pulmonary Department, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
b Department of Respiratory Medicine, Thomayer Hospital, Prague
c Chest Clinic, Karlovy Vary
d Department of Physiotherapy, Faculty of Physical Culture, Palacky University Olomouc
e Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc
f Ludwig Institute for Cancer Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
g Chest Clinic, Ostrava
h Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine and Dentistry, Palacky Unversity Olomouc and University Hospital Olomouc
i Institute of Biostatistics Analyses, Masaryk University, Brno

Background: COPD is a global concern. Currently, several sets of guidelines, statements and strategies to managing COPD exist around the world.

Methods: The Czech Pneumological and Phthisiological Society (CPPS) has commissioned an Expert group to draft recommended guidelines for the management of stable COPD. Subsequent revisions were further discussed at the National Consensus Conference (NCC). Reviewers' comments contributed to the establishment of the document's final version.

Diagnosis: The hallmark of the novel approach to COPD is the integrated evaluation of the patient's lung functions, symptoms, exacerbations and identifications of clinical phenotype(s). The CPPS defines 6 clinically relevant phenotypes: frequent exacerbator, COPD-asthma overlap, COPD-bronchiectasis overlap, emphysematic phenotype, bronchitic phenotype and pulmonary cachexia phenotype.

Treatment: Treatment recommendations can be divided into four steps. 1st step = Risk exposure elimination: reduction of smoking and environmental tobacco smoke (ETS), decrease of home and occupational exposure risks. 2nd step = Standard treatment: inhaled bronchodilators, regular physical activity, pulmonary rehabilitation, education, inhalation training, comorbidity treatment, vaccination. 3rd step = Phenotype-specific therapy: PDE4i, ICS+LABA, LVRS, BVR, AAT augmentation, physiotherapy, mucolytic, ABT. 4th step = Care for respiratory insufficiency and terminal COPD: LTOT, lung transplantation, high intensity-NIV and palliative care.

Conclusion: Optimal treatment of COPD patients requires an individualised, multidisciplinary approach to the patient's symptoms, clinical phenotypes, needs and wishes. The new Czech COPD guideline reflects and covers these requirements.

Keywords: COPD, clinical phenotypes, individualized care, guideline, personalized medicine

Received: April 28, 2013; Accepted: May 20, 2013; Published: May 24, 2013


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