New algorithm for initial and subsequent therapy of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease, a leading cause of morbidity and mortality worldwide. In recent years, new approaches to the epidemiology, diagnosis, classification (categorization), phenotype assessment, and characterization and severity of exacerbations of COPD have emerged. Modern approaches to initial and subsequent drug therapy have changed significantly. This is largely due to the results of large studies conducted in recent years, demonstrating the high efficacy of triple fixed-dose combinations including inhaled glucocorticosteroids, long-acting β-agonists, and long-acting anticholinergics. The aim of this review was to highlight the latest advances in COPD treatment, taking into account the nuances of the pathophysiology of its subtypes, which will be crucial for reducing the symptoms of the disease. Due to the emergence of new drugs, there was a need to modify domestic algorithms for managing patients with COPD. Methods. For the first time, the biological agent dupilumab has been included in clinical guidelines; it is indicated for patients with COPD with signs of type 2 inflammation and symptoms of chronic bronchitis. The use of non-pharmacological therapies (smoking cessation, physical activity, and respiratory rehabilitation) and modern approaches to treating respiratory failure remain important. Conclusion. New additions to clinical guidelines emphasize the importance of early intervention, personalized treatment, and the diversity of COPD phenotypes, and also lay the foundation for a more effective and individualized COPD treatment model. The ability to control inflammation and improve lung function in COPD patients using modern therapeutic approaches can not only improve quality of life for patients but also potentially reduce the overall burden on the healthcare system.