A new pharmacotherapy strategy for chronic obstructive pulmonary disease (COPD): Expert perspectives

Abstract

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy report is widely accepted as a global guide for chronic obstructive pulmonary disease (COPD) management. However, in our country, where time constraints often hinder comprehensive patient evaluation, pulmonologists face difficulties in applying the complex treatment recommendations of the GOLD guidelines. To date, no COPD treatment strategy report tailored to the specific realities of our country has been developed. Therefore, we aimed to create a COPD pharmacological treatment strategy report that facilitates rapid patient assessment and treatment planning. Our algorithm does not rely on COPD Assessment Test (CAT) scores or forced expiratory volume in one second (FEV1) values for patient evaluation. We recommend transitioning to long-acting beta-agonist (LABA) or long-acting muscarinic antagonist (LAMA) monotherapy as needed in selected cases. For patients on LAMA therapy, we advise the use of short-acting beta-agonists (SABA) as rescue medication only. For patients with a Modified Medical Research Council (mMRC) dyspnea score of >= 2 and a high risk of exacerbation, we recommend initiating triple therapy from the outset. Due to insufficient data, we excluded the use of eosinophils as a biomarker in treatment planning. Phosphodiesterase-4 inhibitors were omitted from our algorithm due to their unavailability in our country. For patients who have experienced at least two infectious exacerbations in the past year despite effective COPD treatment, we recommend daily azithromycin therapy during the winter months or three times a week as needed.