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Review
, 14, 1993-2002
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Diagnosis and Management of Chronic Obstructive Pulmonary Disease in Serbia: An Expert Group Position Statement

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Review

Diagnosis and Management of Chronic Obstructive Pulmonary Disease in Serbia: An Expert Group Position Statement

Marija Vukoja et al. Int J Chron Obstruct Pulmon Dis.

Abstract

In recent years, several national chronic obstructive pulmonary disease (COPD) guidelines have been issued. In Serbia, the burden of COPD is high and most of the patients are diagnosed at late stages. Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy is poorly implemented in real-life practice, as many patients are still prescribed inhaled corticosteroids (ICS)-containing regimens and slow-release theophylline. In this document, we propose an algorithm for treating COPD patients in Serbia based on national experts' opinion, taking into account global recommendations and recent findings from clinical trials that are tailored according to local needs. We identified four major components of COPD treatment based on country specifics: active case finding and early diagnosis in high-risk population, therapeutic algorithm for initiation and escalation of therapy that is simple and easy to use in real-life practice, de-escalation of ICS in low-risk non-exacerbators, and individual choice of inhaler device based on patients' ability and preferences. With this approach we aim to facilitate implementation of the recommendation, initiate the treatment in early stages, improve cost-effectiveness, reduce possible side effects, and ensure efficient treatment.

Keywords: COPD; guidelines; treatment.

Conflict of interest statement

MV has received honoraria for scientific advice and/or for lecturing from Boehringer Ingelheim, GlaxoSmithKline, and Novartis, outside the submitted work. IK has received honoraria for scientific advice and/or for lecturing from AstraZeneca, GlaxoSmithKline, Novartis, Boehringer Ingelheim, Teva, Chiesi, Menarini, outside the submitted work. ZL has received honoraria for lecturing from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Teva, Chiesi, outside the submitted work. BZ has received honoraria for scientific advice and/or for lecturing from AstraZeneca, Glaxo SmithKline, Novartis, Boehringer Ingelheim, Chiesi, Menarini, outside the submitted work. ADI has received honoraria for scientific advice and/or lecturing from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, outside the submitted work. IC has received honoraria for lecturing from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, outside the submitted work. MV has received honoraria for scientific advice and/or for lecturing from AstraZeneca, Glaxo SmithKline, Novartis, Boehringer Ingelheim, Teva, Chiesi outside the submitted work. VZ has received honoraria for scientific advice and/or for lecturing from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Teva, Chiesi, Novartis, outside the submitted work. SH has received honoraria for scientific advice and/or for lecturing from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Teva, Chiesi, Novartis, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Algorithm for initiation and escalation of therapy. *In case of presentation with exacerbation LAMA is preferred. **Eosinophils should be measured at the time of diagnosis and at least on one more separate occasion. Abbreviations: ICS, inhaled corticosteroids; LABA, long-acting beta2-agonist; LAMA, long-acting muscarinic antagonist.
Figure 2
Figure 2
Algorithm for diagnosis and initial treatment of asthma-COPD overlap (ACO). *Outside of exacerbations. Abbreviations: LABA, long-acting beta2-agonist; LAMA, long-acting muscarinic antagonist.
Figure 3
Figure 3
De-escalation of ICS in COPD. Abbreviations: ICS, inhaled corticosteroids; LABA, long-acting beta2-agonist; LAMA, long-acting muscarinic antagonist.

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