Aisanov Zaurbek, Avdeev Sergey, Arkhipov Vladimir, Belevskiy Andrey, Chuchalin Alexander, Leshchenko Igor, Ovcharenko Svetlana, Shmelev Evgeny, Miravitlles Marc
Department of Pulmonology, N.I. Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia.
Clinical Department, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia.
Int J Chron Obstruct Pulmon Dis. 2018 Jan 8;13:183-187. doi: 10.2147/COPD.S153770. eCollection 2018.
The high prevalence of COPD together with its high level of misdiagnosis and late diagnosis dictate the necessity for the development and implementation of clinical practice guidelines (CPGs) in order to improve the management of this disease. High-quality, evidence-based international CPGs need to be adapted to the particular situation of each country or region. A new version of the Russian Respiratory Society guidelines released at the end of 2016 was based on the proposal by Global Initiative for Obstructive Lung Disease but adapted to the characteristics of the Russian health system and included an algorithm of pharmacologic treatment of COPD. The proposed algorithm had to comply with the requirements of the Russian Ministry of Health to be included into the unified electronic rubricator, which required a balance between the level of information and the simplicity of the graphic design. This was achieved by: exclusion of the initial diagnostic process, grouping together the common pharmacologic and nonpharmacologic measures for all patients, and the decision not to use the letters A-D for simplicity and clarity. At all stages of the treatment algorithm, efficacy and safety have to be carefully assessed. Escalation and de-escalation is possible in the case of lack of or insufficient efficacy or safety issues. Bronchodilators should not be discontinued except in the case of significant side effects. At the same time, inhaled corticosteroid (ICS) withdrawal is not represented in the algorithm, because it was agreed that there is insufficient evidence to establish clear criteria for ICSs discontinuation. Finally, based on the Global Initiative for Obstructive Lung Disease statement, the proposed algorithm reflects and summarizes different approaches to the pharmacological treatment of COPD taking into account the reality of health care in the Russian Federation.
慢性阻塞性肺疾病（COPD）的高患病率及其高误诊率和诊断延迟情况决定了制定和实施临床实践指南（CPG）以改善该疾病管理的必要性。高质量、基于证据的国际CPG需要根据每个国家或地区的具体情况进行调整。2016年底发布的俄罗斯呼吸学会指南新版本基于慢性阻塞性肺疾病全球倡议组织的提议，但根据俄罗斯卫生系统的特点进行了调整，其中包括COPD药物治疗算法。所提议的算法必须符合俄罗斯卫生部的要求才能纳入统一的电子分类器，这要求在信息水平和图形设计的简洁性之间取得平衡。这是通过以下方式实现的：排除初始诊断过程，将所有患者的常见药物和非药物措施归为一组，以及为了简单明了而决定不使用字母A - D。在治疗算法的所有阶段，都必须仔细评估疗效和安全性。如果疗效不足或出现安全性问题，可以进行升级或降级治疗。除非出现严重副作用，支气管扩张剂不应停用。同时，算法中未体现吸入性糖皮质激素（ICS）的撤药情况，因为大家一致认为，尚无足够证据确立ICS撤药的明确标准。最后，基于慢性阻塞性肺疾病全球倡议组织的声明，所提议的算法反映并总结了考虑到俄罗斯联邦医疗保健实际情况的COPD药物治疗的不同方法。
