Resolution of the Third Teleconference “Management of patients with asthma, COPD. Treatment in an “Easy” style. New opportunities of the Affordable Medicines Program”

Almost 4400 health care specialists have registered to participate in the Teleconference “Management of patients with asthma, COPD. Treatment in an “Easy” style. New opportunities of the Affordable Medicines Program”, November 8, 2022, Kyiv, Ukraine.

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

The special attention was paid to changes in the Affordable Medicines National Prescription Drugs Cost Reimbursement Program, updated recommendations on treatment of asthma, published data devoted to the impact of war on the patients.

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

• Extension of disease groups in the Affordable Medicines Program and updating of the Register of Medicines to be reimbursed based on the National Prescription Drugs Cost Reimbursement Program for patients with asthma and COPD. 
• Changes in prescription of medicines for treatment of asthma and COPD in medical information systems 
• Impact of war on the patients with asthma and COPD.
• New Ukrainian protocol for treatment of asthma in children. 
• Updated GINA recommendations in 2022 
• MART-STRATEGY – approach to treatment of asthma aimed at achievement of control 
• Why does the World Health Organization declare the importance of affordable price policy for medicines used for treatment of asthma and COPD?

The panel discussion with practical experts in the sphere of Pulmonology, Allergology and Therapy was devoted to discussion of possible updating of the Affordable Medicines National Prescription Drugs Cost Reimbursement Program, adapting of treatment of asthma and COPD to the conditions of war. 

Conclusions and decisions based on discussion of reports:

1. The Order of MoH of Ukraine dated 27.10.2022 № 1931 has approved the updated Register of medicines subject to reimbursement based on the program of state financial guarantees of public health services as of October 20, 2022. The documents is effective from October 31, 2022.
2. “Asthma” nosology was replaced with disease group “Chronicle diseases of lower respiratory airways”. It means that the doctor may prescribe Bufomix and Budesonide not only to patients with asthma but also with COPD. 
3. Combination medicinal products used for treatment of chronic diseases of lower respiratory airways were added to the register. I total 9 positions, 6 of them are subject to complete reimbursement. Special attention was paid to combination of budesonide/formoterol in low, middle and high doses. 
4. 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. 
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 2022, 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. 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. 
8. The patients should minimize the number of errors using the inhaler. And usually they make fewer mistakes using multi-dose inhalers. 
9. 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). 
10. 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. 
11. Primary 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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