Title: New Approaches to the Initial Treatment of Chronic Obstructive Pulmonary Disease: What we have to know for right management ?

Biography:

Alizamin Sadigov is a professor doctor with more than 30 tears of work experience in nursing, education, and research have graduated from Atlantic international university(AIU) in a doctorate and have received Ph.D. and MHSs degrees.Have graduated from Saint Petersburg medical university and have received a Medical Doctor degree. He also have two honored degrees: FCCP(Fellow at American College of chest physicians)and ATSF(Fellow at American Thoracic Society). He is the head of the pulmonary medicine department at the hospital clinic of a medical university.

Abstract

As we know that chronic obstructive pulmonary disease(COPD) is very complex ,because it is the result of interactions between several environmental factors and there is also we do not forgot the importance of genetic background. The clinical presentation, chronic bronchitis ,dyspnea, exacerbations, is not the same from one patient to another. When we look at the pathology, and the anatomic features, some patients are mostly bronchial, others are mostly emphysematous , and the comorbidities ,anxiety, cardiovascular comorbidities, osteoporosis, cancer ,are very different from one patient to another. As result of these suggestions not all patients are the same, and as a result it is very important that to provide patients with a personalized approach. Several years ago, GOLD guidelines has supported the approach as treating the disease ,but now this guidelines supports approach the need to treat the patient. We have to consider the significantly impact of COVID-19 infection to the COPD management .particularly, the diagnostic challenges of disease related to impossibility of use of spirometry as functional test for diagnosis of COPD. There is significantly limitation of the use of this tool for assessment of lung function related to this procedure is high aerosol generating .And once did spirometry ,we can classified the patient in terms of lung function impairment .But for the last year ,patients with suspected COPD have not been having spirometry. We have the new GOLD guidelines ,which was released in November 2020.Based on new GOLD document we will categorize the patients by symptoms, and exacerbation history. It is important the initiation of the treatment of patients with COPD by assessing of the symptoms and exacerbation history and we have to firstly try the use of single LABA or LAMA at the beginning of the diseases treatment and if the patients remains symptomatic ,it would be an element of trying a LAMA/LABA combination, because this combination is better choice for symptomatic patients. And, going back to the pharmacological treatment with which you initiate therapy for these patients ,one important message of the table on treatment initialization in the GOLD document is that never initiate with triple therapy with LABA/LAMA/ICS combination. And if the patient is very symptomatic ,dual bronchodilation can be a very good option for treatment initiation. And for the D patients ,again, if we initiate with only one bronchodilator it should be a LAMA, because these are the best preventions of exacerbations. And the use of inhaled corticosteroids (ICS) in patients with exacerbation history with consideration of the level of blood eosinophilia and accordingly new GOLD guidelines we can use of ICS just in D patients. However , there are some risks that can be associated with ICS ,such as pneumonia, and some systemic effects, osteoporosis for example, or diabetes, et cetera that have been associated with these drugs. In summary, the problem with this disease is that it is very heterogeneous. We definitely have to personalize care ,which is not that complex. For each patient we need to assess-lung function, symptoms , exacerbations-and then choose the right treatment .And before choose medication, we need to implement all the non-pharmacological components first. There are most important in this topic the discussion of smoking education, vaccination, activity, et cetera. And then for the treatments, the message is to start with bronchodilators ,and then there are some patients in whom ICS may be of use ,so we need to reassess the patient very regularly.