De-escalation of therapy in a patient with chronic obstructive pulmonary disease: A clinical observation

Current clinical guidelines for chronic obstructive pulmonary disease assign a significant role to the combination of a long-acting muscarinic antagonist / a long-acting β2-agonist (LAMA / LABA). The combined use of LAMA / LABA improves symptoms, quality of life, reduces the frequency of exacerbations, hospitalizations and mortality. Despite the existence of various guide-lines for the pharmacological treatment of COPD, there is a significant discrepancy between the recommendations and the actual practice of prescribing inhaled corticosteroids (ICS), especially in low-risk groups, where triple therapy is often overly prescribed. The purpose of this clinical observation is to demonstrate the de-escalation of triple therapy (ICS / LAMA / LABA) to a dual bronchodilation (LAMA / LABA) in a patient with COPD. Based on the dynamics of clinical, instrumental and laboratory parameters of the patient, the absence of indications for the appointment of ICS has been proven. The appointment of combined double therapy indacaterol / glycopyrronium bromide 110/50 mcg inhalation 1 time/day is justified. The positive effect dual bronchodilation therapy (indacatero / glycopyrronium bromide) has been demonstrated the symptoms and quality of life of the patient. The absence of adverse events against the background of taking indacaterol / glycopyrronium bromide and the convenience of using the Breezhaler® inhaler were established. Based on the above, conclusions are drawn: a thorough assessment of the indications for the appointment of ICS in stable patients with chronic obstructive pulmonary disease is necessary; the use of a combination of indacaterol / glycopyrronium bromide in one device 1 time per day provides better adherence to treatment; the inhaler Breezhaler® ensures optimal delivery of a dose of the drug to the lungs.