Оптимізація менеджменту ризиків загострень та передчасної смерті в пацієнтів із хронічним обструктивним захворюванням легень (огляд літератури)

Data analysis of numerous studies was carried out and trends and directions in the management of patients with сhronic obstructive pulmonary disease (COPD) were analysed. Studying the characteristics of factors contributing to disease development без коми allows us to understand that the smoking epidemic, the aging of the world population and the lack of disease-modifying therapy will lead to a further increase in mortality from COPD. Each COPD exacerbation increases both the risk and frequency of subsequent exacerbations, and the development of local or systemic changes and complications has also been established. Not only severe but also moderate COPD exacerbations (those that do not require hospitalization and could be treated on an outpatient basis) also increased the risk of subsequent exacerbations and death. The degree of increase in risk was proportional to the number of exacerbations per year. Thus, two moderate exacerbations per year increased the risk of death by 80 % (hazard ratio — 1.80 (95 % confidence interval (CI): 1.19—2.70)), while increased frequency of exacerbations to 5 increased the hazard ratio to 2.33 (95 % CI: 1.45—3.76).The effectiveness of the treatment of patients with COPD and the dependence of the latter on various factors were evaluated. Based on the received data, the specialists have concluded that the presence of one severe or two or more moderate COPD exacerbations during one year indicates a high risk of exacerbations in the future and is associated with an increased risk of premature death. Therefore, a high-risk group patient requires special attention when choosing the tactics of his management. This is reflected both in international and national consensus documents. A single-inhaler triple therapy (specifically a fixed combination of budesonide/glycopyrronium/formoterol), administered within the first 30 days after an exacerbation, is currently the only pharmacotherapeutic option that has been proven to reduce mortality in COPD patients.