Open AccessDifferential treatment strategy in patients with different clinical phenotypes of chronic obstructive pulmonary disease
Author(s) -
Elena Lapteva
Publication year - 2013
Publication title -
kazanskij medicinskij žurnal
Language(s) - English
Resource type - Journals
eISSN - 2587-9359
pISSN - 0368-4814
DOI - 10.17816/kmj1902
Subject(s) - medicine , chronic bronchitis , phenotype , bronchitis , pulmonary function testing , gastroenterology , diffusing capacity , lung , lung function , biology , gene , biochemistry
Aim. To optimize the treatment in patients with chronic obstructive pulmonary disease in primary care.Methods. The effectiveness of different strategies of long-term control treatment in 245 patients with chronic obstructive pulmonary disease depending on clinical phenotypes of the disease was evaluated. Three groups of patients were formed: patients from the 1st group (70 patients, 33 - with predominant emphysema phenotype, 37 - with predominant bronchitis phenotype) were using long-acting anticholinergics, patients from the 2nd group (110 patients, 52 - with predominant emphysema phenotype, 58 - with predominant bronchitis phenotype) - long-acting anticholinergics and inhaled corticosteroids, and patients from the 3rd group (65 patients, 28 - with predominant emphysema phenotype, 37 - with predominant bronchitis phenotype) - long-acting anticholinergics together with inhaled corticosteroids and long-acting beta2-agonists. The respiratory function, diffusing lung capacity and gas exchange parameters were assessed after 12 months of long-term control treatment.Results. The 2nd treatment strategy was more effective in patients with bronchitis phenotype, confirmed by the increase of forced expiratory volume at 1st second (FEV1) value from 1.12±1.04 to 1.90±1.05 (р 0.05), and partial oxygen pressure (раО2) increase from 53.72±6.28 to 69.56±6.83 mmHg, as well as partial carbon dioxide pressure (раCО2) decrease from 55.71±8.34 to 52.34±8.16 mmHg. No significant changes in patients with emphysema phenotype were observed. The treatment strategy 3 was the most effective in patients with emphysema phenotype which was demonstrated by the increase of FEV1 from 1.18±0.03 to 1.47±0.03, раО2 from 66.43±3.79 to 78.48±5.78 mmHg (р 0.05), diffusion capacity of carbon monoxide to alveolar volume ratio (DLCO/Va) increase from 35.32±11.34 to 44.12±12.2 (р 0.05) and decrease of раО2 from 50.21±3.68 to 43.43±5.47 mmHg. No significant improvement of gas exchange parameters in patients with bronchitis phenotype was registered. The treatment strategy 1 had no significant effect on respiratory function parameters.Conclusion. The differential strategies of long-term control treatment should be used depending on clinical phenotypes to optimize the treatment of chronic obstructive pulmonary disease.