Resolution of the II online-teleconference "Management of a patient with asthma, COPD. Treatment in "Easy" style"

Almost 5000 health care specialists from all regions of Ukraine have registered to participate in Online Teleconference "Management of a patient with asthma, COPD. Treatment in "Easy" style" which was held on October 26, 2021 (Kyiv, Ukraine).

Within the framework of the event the leading experts of the country in the sphere of Pulmonology, Allergology and Therapy have shared their thoughts and practical experience in management of patients with asthma and chronic obstructive pulmonary disease. 

Eight reports were offered to the participants for review and discussion and they were dealing with the following issues:

• What are the prospects for use of inhaled glucocorticosteroids in treatment of COVID-19?
• What are the opportunities for use of inhaled glucocorticosteroids for rehabilitation of patients during POST-COVID period?
• What is the essence of approach to treatment of obstructive diseases in an “Easy” style and how does it ensure high efficiency of treatment?
• What does MART-therapy mean and how is it used for treatment of asthma? 
• Simplicity in treatment, why do global strategies in treatment of asthma and COPD emphasize that? 
• How do Ukrainian realities influence on control of asthma and COPD? What should the doctor take into account?
• Why does World Health Organization declare importance of reasonable price policy for medicines used for treatment of asthma and COPD? 

The first panel discussion with medical experts in the sphere of Pulmonology, Allergology and Therapy was devoted to discussion of capabilities of inhaled glucocorticosteroids in case of СOVID-19 and during POST-COVID period; the second panel discussion has offered insight into main principles of cooperation between specialists of the primary and secondary health care and methods for treatment of asthma and COPD. 

Conclusions and decisions based on discussion of reports:

1. Many countries of the world have noticed lack of high incidence of COVID-19 among patients with asthma. The patients with allergic diseases have a reduced level of expression of ACE-2 receptors in the cells of airways, so it prevents replication of SARS-CоV-2 virus in the respiratory epithelium. Such effect is explained by permanent use of inhaled glucocorticosteroids. The dose-related reduction of expression of ACE-2 receptors caused by use of inhaled glucocorticosteroids was clearly demonstrated. The protective action of inhaled glucocorticosteroids in case of COVID-19 decreasing the viral load is considered. The first study of use of dry powder budesonide 1600 mcg in case of mild COVID-19 demonstrates good clinical effect – reduction of hospital admissions by 90%, 2 days shorter period of symptoms, reduction of residual effects of СOVID-19 on the 14th and 28th day. From a perception that nosology of СOVID-19 has not been properly studied yet, it might be reasonable to add promising drugs and methods with proved clinical efficiency to the treatment pattern. 
2. The entire medical community is following the results of the study “PRINCIPLE”, which studies the efficiency of dry powder budesonide and covers 4700 patients with COVID-19, with particular attention. The previous results of the study are quite positive, as far as patients from budesonide group recovered 2.94 days earlier and had a solid recovery of health, fewer emergency visits and fewer hospitalizations. 
3. Use of inhaled glucocorticosteroids during COVID-19 for reduced risk of hospital admission and alleviation of symptoms has demonstrated first positive results and is a promising method for reduction of hospital admission and less COVID-19 morbidity. In Ukraine a dry powder budesonide is represented by the Easyhaler inhaler. 
4. Patients who have suffered acute COVID-19 may experience various lung ventilation disorders and a restrictive or obstructive type of ventilation disorders may be formed, it is often associated with the impairment of the diffuse capacity of the lungs. Every patient who, after recovery, has respiratory symptoms (cough, shortness of breath) should undergo a spirographic study to determine the type of ventilation disorders. If there is a bronchial obstruction in the background of clinical symptomatology it is recommended to use bronchodilators with a short-term or long-term effect. In addition, it is desirable to use inhaled glucocorticosteroids to eliminate autoimmune inflammation in bronchial regions in the post-COVID period, especially for those who have taken high doses of systemic corticosteroids in the acute period. Where appropriate, it is recommended that preference be given to nebulizer therapy as a way of administering drugs directly into the airways. 
5. About 60% of patients observe no control of asthma. The reason is use of short-range bronchial spasmolytics reducing the symptoms and fallibility of inhaled glucocorticosteroids. Fixed combination of formoterol and budesonide gives an opportunity to use one inhaler in two regimes: as a baseline therapy and treatment of symptoms (MART-regime, shortly). Fixed combination of formoterol and budesonide is considered as a preferred therapy, in conformity with international recommendations, due to high efficiency of MART-regime. It is important for the inhaler to be convenient for quick reduction of symptoms and affordable for many patients. Combination of formoterol and budesonide in the Easyhaler inhaler meets such criteria. 
6. Though clinical studies demonstrate that it is possible to control asthma symptoms, in actual clinical practice the disease is still poorly controlled and in many countries continues to pose a threat to public health. According to international recommendations GINA 2021, the use of an effective and simple treatment scheme that will shape the patient’s disposition to treatment is one of important factors. The next step is to make sure that the inhaler is used, which minimizes the number of critical mistakes while using and which simplifies the treatment scheme. Easyhaler inhaler with combination budesonide/formoterol meets such criteria. 
7. Use of reasonable and available pharmacoeconomic drugs is an important part of treatment of asthma and COPD as far as it is an important factor in development of high patient’s compliance. 
8. Since 2019 according to the international protocols the baseline therapy of asthma should be used only in combination of a short-range bronchial spasmolytic with an inhaled steroid. There is a program “Available drugs” in Ukraine which gives an opportunity to provide a patient with asthma with an inhaled glucocorticosteroid on favorable terms. Use of a dry powder inhaled glucocorticosteroids ensures better delivery of the active agent in comparison to the aerosolic one. Budesonide in the Easyhaler inhaler is the most available dry powder inhaler. A doctor has to choose a convenient and simple inhaler for a patient. 
9. It is recommended to use long-acting bronchial spasmolytic for treatment of Group A and B COPD. Formoterol confers bronchodilatation within 12 hours and it has proved its efficiency for reduction of symptoms in patients with COPD. It is important to use inhalers that assure delivery of the acting agent even for the patients with low inspiratory flow rate. 
10. The patients should minimize the number of errors using the inhaler. And usually they make fewer mistakes using multi-dose inhalers.
11. The capability of inhaler to deliver the entire dose to the lungs is very important for treatment of asthma and COPD. The inhalers with high internal resistance generate turbulent air flow which de-aggregates drug particles and delivers them to the airways. The inhaler has to provide permanent delivery of almost 100% dose of a drug even for the patients with low inspiratory flow rate (28 l/min and more).
12. The treatment result is one the most important psychological and emotional factors which influence the patient with asthma and COPD. It is essential to avoid factors decreasing the patient’s motivation for treatment, such as: high price, inconvenient treatment scheme, frequent occurrence of side effects. Use of modern strategies of pharmacotherapy, modern delivery methods and patient’s adherence will guarantee efficient treatment and a positive patient’s condition. Assurance of high clinical efficiency of treatment and positive condition of a patient and a doctor is called a treatment in an “Easy” style. 
13. Local practitioners are an important and meaningful part in treatment of patients with asthma or COPD. The family doctors may conduct diagnostics, treatment and therapy correction on their own or they may cooperate with a pulmonologist or allergologist. The modern principles of management of patients with asthma or COPD are the same both for general practitioners and narrow specialists. The family doctors should focus on use of combination of formoterol and inhaled glucocorticosteroids as a preferred therapy at any stage of asthma. Prescription of convenient and easy-to-use inhalers, such as Easyhaler, for example, and physician’s consideration of pharmacoeconomic accessibility for the patient will form a high commitment to treatment and will make sure that asthma and COPD are under control. 

You can download the text of the Resolution by this link.

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