Title Inhalacijska terapija opstruktivnih bolesti pluća Title (english) Inhaled therapy in obstructive lung diseases Author Franka Butković Mentor Marija Gomerčić Palčić (mentor)Committee member Sanja Popović-Grle (predsjednik povjerenstva)Committee member Marko Jakopović (član povjerenstva)Committee member Marija Gomerčić Palčić (član povjerenstva)Granter University of Zagreb Defense date and country 2021-09-11, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Inhalacijska terapija ima središnju ulogu u liječenju astme i KOPB-a. Mnoge su prednosti inhalacijske terapije u odnosu na sistemsku, uključujući brži nastup djelovanja i manje sistemskih nuspojava. Inhalacijski se lijekovi primjenjuju putem četiri osnovna tipa inhalacijskih uređaja: inhalera fiksnih doza (pMDI), koji se mogu koristiti s ili bez komorica (spacer), inhalera suhog praha (DPI), inhalera koji stvara finu maglicu (SMI) te nebulizatora. Na tržištu se nalazi veliki broj inhalera, a kliničar mora odabrati onaj koji najbolje odgovara njegovu pacijentu. Uspješnost inhalacijske terapije ovisi o adekvatnoj tehnici primjene inhalera te adherenciji samog pacijenta. Pacijenti s postavljenom dijagnozom KOPB-a i astme imaju učestalo greške u tehnici primjene te nisku adherenciju prema propisanoj inhalacijskoj terapiji. Navedenom se nastoji dokinuti pravilnom edukacijom pacijenata i kliničara te individualnim pristupom i uvažavanjem pacijentovih želja prilikom odabira inhalera. U inhalacijskoj se terapiji KOPB-a koriste kratko- i dugodjelujući bronhodilatatori (SABA, SAMA, LABA, LAMA), koji su zlatni standard u liječenju KOPB-a, inhalacijski kortikosteroidi (IKS) te njihove kombinacije (LAMA/LABA, IKS/LABA, IKS/LAMA/LABA). Prema GOLD smjernicama inicijalna se terapija u oboljelih od KOPB-a planira prema težini simptoma, stupnju dispneje i riziku od učestalih egzacerbacija, a u daljnjem se tijeku liječenja modificira ovisno o vodećoj teškoći u pacijenta – perzistentnoj dispneji ili egzacerbacijama. Cilj inhalacijske terapije astme je potpuna kontrola bolesti – simptoma i rizika od egzacerbacija i drugih nepoželjnih ishoda. Terapija astme sastoji se od lijeka za olakšanje simptoma (IKS/formoterol ili SABA) te lijekova za kontrolu bolesti čija su obavezna sastavnica IKS. Najnovije GINA smjernice predlažu dva terapijska puta koji se u potpunosti razlikuju prema lijeku za olakšanje simptoma, naglašavajući prednost puta u kojem je to IKS/formoterol zbog njegovog boljeg učinka na prevenciju egzacerbacija te smanjene sigurnosti SABA. Terapija za kontrolu astme inicijalno se određuje prema težini simptoma, a zatim se mijenja ovisno o postignutoj ili ne postignutoj kontroli simptoma (step up ili step down). Klasifikacija težine astme danas se radi retrogradno upravo prema terapiji kojom je postignuta potpuna kontrola bolesti.
Abstract (english) Inhaled therapy has a central role in both asthma and COPD management. There are many advantages of inhaled therapy compared to systemic therapy. The principal types of devices used to generate therapeutic aerosols are pressurized metered dose inhalers (pMDIs), dry powder inhalers (DPIs), soft mist inhalers (SMIs) and nebulizers. There is a wide range of inhaler devices on the market, among which the clinician chooses the one most suitable for their patient. Correct inhaler technique and adherence to therapy are of major importance for effective treatment of asthma and COPD. Asthma and COPD patients commonly make critical mistakes while using their inhalers, as well as show poor adherence to their therapy. Possible solutions to aforementioned problems are proper clinician and patient education and a personalized approach to inhaler choice. It is very important to include patients‘ preferences while making decisions about their inhaled therapy. Inhaled medications in COPD management include long- and short-acting bronchodilators (SABA, SAMA, LABA, LAMA), inhaled corticosteroids (ICS), and a number of their combinations (LAMA/LABA, ICS/LABA, ICS/LABA/LAMA). According to the GOLD guidelines, initial management of COPD is based on the symptom severity, the level of dyspnea, and the risk of exacerbations. In the follow up management, therapy regime can be modified according to the patient‘s leading problem – persistent dyspnea or exacerbations. The goal of asthma treatment is to achieve disease control, which means both symptom control and control of exacerbations and other adverse events. Two basic groups of medications are used to achieve that: reliever (ICS/formoterol or SABA) and controller medications. The latest GINA guidelines recommend two tracks in the choice of controller medication, which differ in the chosen reliever. The recommended track is the one where ICS/formoterol is used as a reliever, due to its more effective exacerbation prevention and a lack of safety with SABAs. Initial choice of controller medication is based on first presentation symptom severity. In the follow up management the treatment can be stepped up or down, depending on whether complete disease control was achieved. Asthma severity is assessed retrospectively according to the controller medication that was necessary to achieve the control of the disease.
Keywords
inhalacijska terapija
KOPB
astma
Keywords (english)
inhaled therapy
asthma
COPD
Language croatian URN:NBN urn:nbn:hr:105:770567 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2022-01-28 11:51:38
