Tuesday , May 11 2021

You can live well with HOBP



Chronic Obstructive Pulmonary Disease (HOBP) affects 251 million people worldwide; of them, about 10% are Mexican.

COPD is a common disease that can be prevented and treated, with persistent respiratory symptoms and airflow constraints due to airway and / or alveolar abnormalities that potentially and slowly lead to death and increases in Mexico, positioning itself in one of the first causes of mortality.

It is estimated that currently around 64 million people in the world live with HOBP.

This disease affects both men and women, who have more incidents in men, but are more deadly in women than in breast cancer.

It is usually caused by significant exposure to harmful particles or gases such as tobacco and wood smoke, indoor air pollution, the use of biomass fuels for cooking and as a heating medium, outdoor air pollution, exposure to chemical products and dust (steam, irritants and gases on workplace).

Dr. Gabriel Escobedo Arenas, a pulmologist at the Medical Center La Raza from the IMSS, commented that a frequent respiratory disorder whose symptoms cough with flegma, chronic cough, difficulty breathing, beeping, chest tightness, tiredness, sleep loss, decreased packaging and cognitive function, in extreme cases, weight loss, gradually reducing the quality of life of patients and those around the person.

However, the expert emphasized that, if the first level of spirometry is first detected, a study that measures the amount of air in the lungs can be prevented and treated. "The first thing, he said, is to quit smoking, so the patient is offered inhaled bronchodilators, such as tiotropium, the first anticholinergic antidepressant that has been for more than a decade the most effective, safer and safe medicine in the treatment of HOBP."

He argued that, despite this, there are those who continue with persistent symptoms, so they have a greater risk of exacerbations (crises), episodes of instability that increase disease progression and complicate his prognosis. "There are several reasons why they occur, including not treating the patient with appropriate medication, not using the inhalation device properly, or having a therapeutic abandonment. In either case, the outcome is the same: the work of remission, a greater number of medical emergency cases, hospitalization and premature death[i].

Only in 2017 HOBP was one of the 10 leading causes of death among Mexicans over the age of 50, while cost studies in public health institutions indicate that for each hospital reception due to exacerbation, the cost per patient fluctuates between $ 140,000 and $ 400,000 per year , regardless of salary compensation and other related resources. Therefore, from the moment the patient presents one or more hospitalization because of his cause, it is necessary for the physician to initiate or, if necessary, modify the therapeutic scheme with a combination of two bronchodilators: LAMA + LABA instead of monotherapy, as indicated by the recent update of the GOLD 2019 guidelines.

In this regard, dr. Ricardo Lemus Rangel, an adult pulmonologist at CMN La Raza, said that due to the benefits of healthcare workers and patients, it has launched an innovative double bronchodilator last year, a rapid and prolonged action that combines the benefits of tiotropium (LAMA) and olodaterol, beta2-agonists and anergy LABA), which aims to reduce symptoms, improve tolerance and health, and reduce risk in terms of preventing progression of the disease, prevent exacerbation and reduce mortality and delay the constant or final use of oxygen.

Various studies have shown that the combination of fixed doses of tiotropium + olodaterol provides more benefits from the function of the lungs and quality of life of both drugs separately, in addition to offering greater efficiency than a combination of inhaled corticosteroid (ICS) + a LABA, so that it is the only one of its categorized GOLD standards in primary treatment or maintenance of HOBP. "This double bronchodilator reduces the difficulty of breathing and the use of lifesaving medicines, which allows those who are affected to walk, work, play and even exercise, making them functional and independent."

Although the HOBP evolution could have been delayed by timely and adequate therapeutic intervention, the expert agreed that the lack of adherence was the main reason for failure. For example, 6 out of 10 patients do not use properly prescribed inhalants, which increases the risk of complications. In this sense, he explained that the combination of tiotropium + olodaterol has the advantage of being administered by an easy-to-use inhalation device (Respimat) that produces a cloud of fine particles so that, with one stroke, the active substance arrives directly at the site of action.

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