NOVI TERAPIJSKI PRISTUP KRONIČNOJ OPSTRUKTIVNOJ PLUĆNOJ BOLESTI ; NEW THERAPEUTIC APPROACH TO CHRONIC OPSTRUCTIVE PULMONARY DISEASE

Kronična opstruktivna plućna bolest (KOPB) progresivna je bolest karakterizirana ireverzibilnom opstrukcijom dišnih puteva. Najvažniji uzrok nastanka KOPB-a je dugotrajno izlaganje duhanskome dimu. Najvažniji postupak u dijagnostici opstrukcije dišnih puteva je spirometrija. S novim GOLD smjernicama iz 2017., spirometrijski pokazatelji opstrukcije, FEV1 i omjer FEV1/FVC isključeni su iz terapijskog algoritma bolesti te se terapijski algoritam temelji na simptomima i egzacerbacijama bolesti. Temelj liječenja KOPB-a predstavljaju bronhodilatacijski lijekovi u monoterapiji i dvojnoj bronhodilatacijskoj terapiji. Dokazana je korist dualne bronhodilatacijske terapije u odnosu na monoterapiju u liječenju stabilne bolesti, dok su ICS indicirani za manju skupinu bolesnika sa brojnim simptomima i učestalim egzacerbacijama, sa eozinofilijom sputuma i vrijednostima FEV1 ispod 50%, te bolesnicima s ACO, jer u većoj skupini bolesnika korist ICS-a ne nadmašuje potencijalne nuspojave. ; Chronic obstructive pulmonary disease (COPD) is characterized by irreversible obstruction of the respiratory tract. The most important cause of COPD is the long-term exposure to tobacco smoke. The most important procedure in the diagnosis of respiratory obstruction is spirometry. With the new 2017 GOLD guidelines, spirometric obstruction indicators, FEV1 and FEV1/FVC are excluded from the therapeutic algorithm of the disease, and the therapeutic algorithm is based on symptoms and exacerbations of the disease. The basis of COPD treatment is bronchodilatory medications in monotherapy and dual bronchodilation therapy. There was evidence of dual bronchodilation therapy compared to monotherapy in the treatment of stable disease, while ICS was indicated for a smaller group of patients with numerous symptoms and frequent exacerbations, spontaneous eosinophilia and FEV1 values below 50%, and patients with ACO, because in a larger group of patients the benefit of ICS does not outweigh the potential side effects.