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 published new guidelines for the treatment of asthma and chronic obstructive pulmonary disease (COPD). For example, in asthma, a variety of evidence-based recommendations for non-drug treatment (including patient education, physiotherapy, rehabilitation), dealing with typical comorbidities and asthma prevention have been re-launched.

Asthma and COPD are common medical conditions where healing based on previous treatment options is not achievable. However, with the right therapy, the symptoms can be alleviated. With the adaptation of the respective treatment guidelines, the evidence-based new developments in diagnostics and therapy, which have been achieved since the publication of the last guidelines, should now be taken into account, reports the German respiratory league.

New treatment guidelines for asthma and COPD presented. (Image: WavebreakmediaMicro / fotolia.com)

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 about five percent of all adults suffer from asthma", according to the respiratory league communication on the adaptation of treatment guidelines. Not only the new findings in the diagnosis and treatment of asthma, including the development of new drugs and treatment options made a recast according to the DGP necessary. "The reorientation and rethinking through the characterization of phenotypes of asthma, the new classification of the severity of asthma and the structure of the 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 increased in many countries for 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 valid until now for the German-speaking countries.

New Asthma Treatment Guide

In the new asthma guideline, the disease is defined as "a heterogeneous, multifactorial, mostly chronic inflammatory disease of the respiratory tract", which is characterized by hypersensitivity of the bronchi and / or a variable and partially reversible narrowing of the respiratory tract, reports the German Atemwegsliga.Typische asthma symptoms are mainly:

• shortness of breath,
• chest tightness,
• Breathing noises
• and cough with varying intensity.

Asthma is often allergic

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

Assessment sometimes required for diagnosis

If such a narrowing by inhalation of an antiasthmatic drug is completely reversible, there is no doubt about asthma diagnosis, according to the specialist societies. If, on the other hand, there is no constriction and no measurable hypersensitivity of the bronchi, asthma is very unlikely. Occasionally, however, a final diagnosis can only be made through a course assessment.

Inhaled glucocorticoids based on asthma therapy

The basis of asthma therapy is the guideline for the treatment of inhaled glucocorticoids (ICS), which are intended to effectively prevent the inflammatory processes underlying asthma. "If this prevents asthma control, the treatment is supplemented by an inhaled long-acting beta-2-mimetic (LABA), a bronchial medicine that can be used for up to 24 hours," reports the German respiratory league. Relevant side effects are hardly to be feared by inhalation of the medicines mentioned.

Combination preparations with benefits for those affected

The long-term treatment with the mentioned remedies is complemented by the administration of fast-acting bronchodilators, which are inhaled only when needed, explain the experts. A particularly simple asthma treatment for many patients consists of combination preparations consisting of an inhaled glucocorticoid and a long-acting beta2-mimetic. In severe asthma, however, inhalative therapy must be supplemented with monoclonal antibodies that are directed against the underlying inflammatory mechanisms and prevent them.

New recommendations for non-drug therapy

Also included in the Asthma Guideline are a variety of evidence-based recommendations for non-drug asthma therapy, dealing with typical companion asthma (for example, allergy, sleep disorders, smoker's lungs) and asthma prevention (such as allergen avoidance). In addition, new recommendations have been incorporated to diagnose and treat occupational asthma and manage asthma during pregnancy.

Chronic obstructive pulmonary disease is also known as smoker's cough, but it does not only affect smokers. (Image: bilderzwerg / fotolia.com)

New COPD treatment guidelines

Although only a few data are available on the epidemiology of COPD, experts estimate that the prevalence in the adult population in Germany and Austria is between five and ten percent, according to the German respiratory leaflet. The new COPD guideline will replace the previous version from 2007 and help to "ensure that COPD patients benefit from science-based, appropriate, cost-effective and quality-assured diagnostic, prevention and treatment procedures," reports the DGP. The guideline is addressed to the pneumologically oriented medical specialists who care for patients with COPD in the in-patient area and in the hospital.

Shortness of breath and cough are warnings

By adapting the COPD treatment guideline, specialists are to be supported in the diagnosis, follow-up and adequate treatment of their patients, the medical societies explain. Basically, the diagnosis should be considered in all patients who show symptoms such as breathlessness, coughing and / or sputum. The diagnosis is confirmed by evidence of non-reversible obstruction in lung function.

New detection methods included in the guidelines

While the international GOLD guideline on COPD diagnosis focuses exclusively on spirometry and forced expiratory one-second capacity (FEV1), the German guidelines also recommend consideration of body plethysmography and diffusion capacity. Also, simple criteria are presented that allow a distinction between asthma and COPD in terms of pattern recognition.

Adaptation of the drug COPD treatment

Furthermore, the new guideline provides for a classification of COPD patients into an ABCD scheme. The classification is based on the symptoms and the exacerbation history and should serve as a basis for drug therapy. Modified recommendations have also been issued for drug treatment, which are now essentially in line with the international GOLD guideline. Of particular importance is, for example, the significant reduction in the value of inhaled glucocorticoids (ICS).

Too many COPD patients receive antibiotics

ICS are therefore no longer indicated in the initial therapy and should only be used when there is a suspicion that an asthmatic component is present, reports the German respiratory league. In patients with pure COPD ICS are earmarked at the earliest when the bronchodilator therapy is exhausted. In addition, the authors of the German guideline consider that too many patients are being treated with antibiotics for the treatment of COPD exacerbations. Therefore, specific recommendations for the indication for antibiotic therapy should be included in the guidelines. (Fp)