Abstract
Background: COPD is a major global phenomenon. Currently in the world there are several parallel, not entirely compatible, medical statements, guidelines and strategies.
Description: This is a official statement of the Czech Pneumological Phthiseological Society (CPFS) prepared by Expert COPD working group. This guideline relates to stable COPD.
Methods: This guideline is based on a targeted literature update from Jan 2005 to December 2012 to evaluate the evidence and update the previous CPFS clinical practice guideline. Diagnosis: The hallmark of the modern approach to COPD is a view of the patient through the prism of lung function (LLN of FEV1/VC, TLCO, KCO, RV), symptoms, occurrence of acute exacerbations and identifications of clinical phenotype(s).
CPFS identifies six clinically relevant phenotypes: frequent exacerbator, COPD-asthma overlap, COPD - bronchiectasis overlap, emphysematic phenotype , bronchitic phenmotype and pulmonary cachexia phenotype. Treatment: Treatment recommendations can be divided into four steps. 1st step - Risk exposure elimination: DOWNWARDS ARROW smoking and ETS, DOWNWARDS ARROW home and occupational risks. 2nd step - Mandatory therapy: inhaled bronchodilators, regular aerobic physical activity, pulmonary rehabilitation, education, inhalation training, comorbidity treatment, vaccinations. 3rd step - Phenotypic treatment: PDE4i, ICS+LABA,LVRS, BVR, AAT substitution, physiotherapy, mucolytic, ATB. 4th step - Care for respiratory insufficiency and terminal COPD: LTOT, lung transplantation,high intenstity-NIV, palliative care.
Conclusion: Optimal treatment of patients with COPD requires individualized and multidisciplinary approach to the patient's symptoms, clinical phenotypes, needs and wishes. Czech COPD guidelines reflects these requirements.