Have we Made Progress in Treating COPD?

Od daleke 1965. kada je prvi puta dr. William Briscoe upotrijebio izraz kronična opstruktivna plućna bolest (KOPB) pa sve do danas, rasla su i mijenjala se saznanja o KOPB-u, a s njima i liječenje ove kronične i progresivne bolesti. Bronhodilatatori su i dalje osnova liječenja, a primjena kombinirane terapije ili najnovije trojne terapije namijenjena je bolesnicima s više simptoma i čestim egzacerbacijama. Daleko veće promjene je doživio sam terapijski pristup. U prošlosti se odluka o liječenju temeljila na stupnju opstrukcije za razliku od današnjeg pristupa, kada težimo personalizaciji u liječenju KOPB-a. Na raspolaganju nam stoje brojni novi lijekovi u različitim inhalatornim uređajima, čime možemo osigurati bolesniku s KOPB-om najbolji terapijski odabir u inhaleru koji najviše odgovara bolesnikovim potrebama. Osim farmakološkog napretka u liječenju KOPB-a, treba istaknuti i razvoj nefarmakoloških metoda liječenja, prije svega plućne rehabilitacije, kao sastavne i ravnopravne komponente u zbrinjavanju bolesnika s KOPB-om. Međutim, današnje liječenje usmjereno je ponajprije zbrinjavanju bolesnika sa značajnim simptomima bolesti. Nedostaju nam lijekovi koji bi mijenjali sam tijek bolesti, odnosno zaustavili daljnju progresiju bolesti. Ne postoje definirane opcije za rani KOPB. U tijeku su brojna istraživanja različitih lijekova za koje se očekuje da budu učinkovita. Međutim za sada niti jedna od ispitivanih opcija nije dovela do značajnijih pomaka. Koliko god nam se činilo da znamo sve o KOPB-u, još uvijek ne znamo dovoljno da bismo ga izliječili.The knowledge about COPD has grown and changed since 1965 when Dr. W. Briscoe first used the term chronic obstructive pulmonary disease (COPD). At the same time, knowledge about the treatment has grown as well. Bronchodilators are still the first-line therapy for COPD, while combination therapies, especially triple combination therapy, are reserved for more symptomatic patients and patients with frequent exacerbations. The therapeutic approach has undergone far greater changes. In the past, treatment recommendation was based primarily on the level of airflow limitation. The assessment system was refined, and today we have the A, B, C, and D groups that define the pharmacological treatment based on symptoms and exacerbation history only. Numerous new drugs are available for patients in a variety of inhaler devices, allowing us to provide COPD patients with the best therapeutic choice in the inhaler that is best for them. In addition to pharmacological advances in COPD treatment, it is necessary to emphasize the development of non-pharmacological methods, primarily pulmonary rehabilitation. However, the direction of treatment is aimed primarily at caring for patients with significant symptoms. We lack drugs that would change the course of COPD and stop further progression of the disease. In addition, there are no defined options for early COPD. Numerous studies of various drugs are expected to be effective, but none of the options examined led to significant progress so far. As much as we think we know everything about COPD, we still do not know enough to cure it