“We see too many patients at a high level of disease evolution. It’s about moving the diagnosis to an early stage. We need to diagnose those who start to have symptoms: a 40-50 year old who has a history of exposure to smoke for at least 20- 30 years, for example. In particular, the proportion of women is increasing due to the increase in smokers. In Italy, 20-23% (of the over 14s, Editor’s note) are smokers, but there is an increase in women”. Claudio Micheletto, UOC director of pulmonology Integrated University Hospital of Verona, speaking this morning at a meeting on the new recommendations of the latest Gold report (Global initiative on obstructive lung diseases), the most important document for diagnosis, prevention and treatment of chronic obstructive pulmonary disease (COPD).
“Advance and proactivity of the therapeutic intervention were already present in the Gold report last year – points out Alberto Papi, full professor of respiratory diseases at the University of Ferrara – In proactivity, attention is paid to patients with a condition at risk of developing COPD due to particular conditions. This facilitates the identification of the patient and the activation of an early diagnostic path which does not leave the option of seeing patients when they are in the most severe forms, more difficult to treat. As is now consolidated, “we have an increase in effectiveness through early management. We can make people feel better. We must insist on prevention and early diagnosis”, reiterates Claudio Cricelli, president of the Italian Society of General Medicine and Treatment primary (Simg).
Chronic obstructive pulmonary disease – it was recalled during the event promoted in Verona by GSK – is characterized by persistent airflow limitation, generally has a progressive course and is associated with an increased chronic inflammatory response to harmful particles or gases in the airways and lungs. It typically affects over 40 years of age and mainly smokers or ex-smokers. In fact, smoking is the first cause of the disease. In addition to smoking history and age, other risk factors include exposure to occupational particles, genetic factors, and asthma. Lung function decline is a key clinical feature. Severity is highly variable and can be mild, moderate, severe, or very severe. Exacerbations, ie acute events of worsening of respiratory symptoms beyond the normal daily variations and symptoms of the disease are also important clinical features and affect patients in all degrees of disease severity.
“Exacerbations are the reason why the patient goes to the doctor – explains Paci -. They range from moderate to hospitalized ones that can be fatal, in the serious patient. Beyond the acute event, which upsets the patient’s life, above all because he is elderly, the whole history of the disease is affected. Exacerbations favor progression of the disease and, the more severe, worsen the quality of life and increase the risk of mortality. Exacerbations – he reiterates – are a fundamental event to be placed at the center of health and not only pharmacological action”.
“There are 2 particular aspects that are the challenge for the future – recalls Micheletto – Underdiagnosis, which is due to the fact that COPD has a delay in diagnosis due to the type of patient: a smoker who tries to stay away from doctors. In this case spirometry, the reference diagnostic test, would help. The second challenge is adherence to treatments, which affects all chronic diseases, but is particularly low in COPD. Inhalation therapy may not feel like oral therapy. Inserting more active ingredients in a single inhaler can have a positive impact both at a clinical and adherence level”, given that only one administration per day is enough.
Treatment with the most effective therapy at symptom onset results in better treatment and symptom control. “Today 5-8-15 years pass from clinical episodes before diagnosis: all wasted time”, underlines Paci. As noted at the event, the Gold report supports triple, but no longer recommends the Ics-Laba association in COPD. Moreover, studies show that triple therapy, compared to dual therapy, when indicated, reduces severe exacerbations by 35%.
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