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New treatment guidelines for asthma and COPD


Therapy recommendations for asthma and COPD updated

The German Respiratory League and the German Society for Pneumology (DGP) have presented new guidelines for the treatment of asthma and chronic obstructive pulmonary diseases (COPD). For example, in the case of asthma, a multitude of evidence-based recommendations for non-drug treatment (e.g. patient training, physiotherapy, rehabilitation), for dealing with typical asthma comorbidities and for asthma prevention have been added.

Asthma and COPD are widespread symptoms in which a cure based on the previous therapeutic options cannot be achieved. However, with the right therapy, the symptoms can be alleviated. With the adjustments to the respective treatment guidelines, the evidence-based new developments in diagnostics and therapy, which have been achieved since the publication of the last guidelines, are now to be taken into account, reports the German Respiratory League.

New findings in diagnostics and therapy

"With more than five million patients, asthma is one of the most common chronic diseases in Germany" and "more than ten percent of all children and adolescents and approximately five percent of all adults suffer from asthma," the respiratory league said on the adjustment of the treatment guidelines. Not only the new findings in the diagnosis and therapy of asthma, including the development of new drugs and therapy options, made a revision necessary, according to the DGP. "The reorientation and rethinking through the characterization of phenotypes of asthma, the new classification of the severity levels of asthma and the development of the step-by-step plans" are reasons for the revision.

Asthma is one of the most common chronic lung diseases

Although the prevalence of asthma in western countries has not increased in recent years, it has previously increased in many countries over decades (especially among children and adolescents), reports the DGP. Asthma remains one of the most common chronic diseases in Germany and the economic importance of asthma is very large. This guideline is an update of the guideline for the diagnosis and therapy of patients with asthma and replaces the version that was previously valid for the German-speaking countries.

New asthma treatment guidelines

In the new asthma guideline, the disease is defined as "a heterogeneous, multifactorial, mostly chronic inflammatory disease of the airways", which is usually characterized by hypersensitivity of the bronchi and / or a variable and partially reversible narrowing of the airways, reports the German The typical asthma symptoms are:

  • Shortness of breath,
  • Chest tightness,
  • Breathing noises
  • and cough with varying intensity.

Asthma often caused by allergies

According to the experts, a majority of those affected suffer from asthma as a result of an allergy to aeroallergens (especially plant pollen, mites, animal hair). But especially in adults, asthma can also be triggered by non-allergic triggers. The asthma diagnosis is based on the detection of the typical complaints based on the evidence of a narrowing of the bronchi by measuring the lung function.

Progress assessment sometimes necessary for diagnosis

If such a narrowing is completely reversible through inhalation of an anti-asthmatic medication, there is no doubt about the diagnosis of asthma, according to the specialist societies. On the other hand, if there is no narrowing and no measurable hypersensitivity of the bronchi, asthma is very unlikely. Sometimes, however, a final diagnosis can only be made through a course assessment.

Inhaled glucocorticoids are the basis of asthma therapy

In the treatment guideline, the basis of asthma therapy is inhaled glucocorticoids (ICS), which are supposed to effectively prevent the inflammatory processes underlying the asthma. "If this does not make it possible to control asthma, the treatment is supplemented by an inhaled long-acting beta2-mimetic (LABA), a medication that expands the bronchial tubes for up to 24 hours," reports the German Respiratory League. Relevant side effects are hardly to be feared by the inhaled use of the drugs mentioned.

Combination products with advantages for those affected

The experts explain that the long-term treatment with the medicines mentioned is supplemented by the administration of fast-acting bronchodilators that are inhaled only when necessary. An asthma treatment that is particularly easy for many patients consists of combination products consisting of an inhaled glucocorticoid and a long-acting beta2-mimetic. In the case of severe asthma, inhalation therapy must be supplemented by monoclonal antibodies that target and prevent the underlying inflammatory mechanisms.

New recommendations for non-drug therapy

A large number of evidence-based recommendations for non-drug asthma therapy, for dealing with typical asthma concomitant diseases (e.g. allergy, sleep disorders, smoking lung) and for asthma prevention (e.g. allergen avoidance) have also been added to the asthma guideline. In addition, new recommendations for the diagnosis and treatment of occupational asthma and for the management of asthma in pregnancy were incorporated.

New COPD treatment guidelines

So far, there is little data available on the epidemiology of COPD, but experts estimate the prevalence in the adult population in Germany and Austria at five to ten percent, according to the German Respiratory League. The new COPD guideline will replace the previous version from 2007 and should help "that COPD patients benefit from scientifically based, appropriate, economical and quality-assured methods of diagnosis, prevention and treatment", reports the DGP. The guideline is aimed at the pneumologically oriented specialists who care for patients with COPD in the field and in the hospital.

Shortness of breath and cough are warning signs

The specialist societies explain that the adaptation of the COPD treatment guidelines should support medical specialists in the diagnosis, follow-up and adequate therapy of their patients. In principle, the diagnosis should be considered in all patients who show symptoms such as shortness of breath, cough and / or expectoration. The diagnosis is confirmed by demonstrating that the obstruction in the lung function is not completely reversible.

New detection methods included in the guidelines

While the international GOLD guideline on COPD diagnosis only focuses on spirometry and forced expiratory one-second capacity (FEV1), the German guidelines also recommend taking into account body plethysmography and diffusion capacity. Simple criteria are also presented that enable a distinction to be made between asthma and COPD in the sense of pattern recognition.

Adaptation of drug COPD treatment

Furthermore, the new guideline provides for the classification of COPD patients in an ABCD scheme. The classification is based on the symptoms and the exacerbation history and should serve as the basis for drug therapy. Changed recommendations have also been made for drug treatment, which now essentially correspond to the international GOLD guideline. For example, the significant reduction in the importance of inhaled glucocorticoids (ICS) is of particular importance.

Too many COPD patients are given antibiotics

ICS are no longer indicated in initial therapy and should only be used if there is a suspicion that an asthmatic component is present, reports the German Respiratory League. In patients with pure COPD, ICS should only be provided at the earliest when the bronchodilator therapy has been exhausted. In addition, the authors of the German guideline believe that too many patients are currently being treated with antibiotics with regard to the treatment of COPD exacerbations. The guidelines therefore contain specific recommendations for the indications for antibiotic therapy. (fp)

Author and source information

Video: COPD Exacerbations (August 2020).