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Introduction
Chronic obstructive pulmonary disease (COPD) is a widespread illness that affects the lungs, causing decreased airflow and lowered lung capacity. Protocols for treating COPD vary from one country to another. Generally, there is a reasonable consensus on the criteria for diagnosis and the initial treatment procedures, however, there are differences in the categorization of patients with COPD and the advanced treatment methods (Miravitlles et al., 2016). This review aims to highlight these differences in guidelines for COPD treatment by critically analyzing two scholarly articles on the topic.
Main body
The first scientific paper by Ferreira et al. is called “Optimal treatment sequence in COPD: Can a consensus be found?” The article analyzes treatment guidelines from four countries: Spain, Canada, the United States, and the United Kingdom. Chosen treatment protocols were discussed on a meeting of the GI DPOC-Grupo de Interesse na Doença Pulmonar Obstrutiva Crónica in December 2014 and through 2015 via emails (Ferreira et al., 2016). The purpose of this discussion is to develop a unified therapeutic scheme for COPD treatment.
Several recent studies on the subject are used as evidence for the best available treatment. Potential issues with particular therapy methods in different patient groups are identified. For example, the safety of long-acting bronchodilators in patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) is discussed (Ferreira et al., 2016). The authors attempt to create a unified list of treatment methods based on their meaningfulness, safety, and effectiveness.
The topic of discussion proceeds into the outlining of non-inhaled therapies based on their usefulness. Ferreira et al. (2016) review several drugs used in COPD treatment, they include “mucolytic agents, macrolides, PDE4i, xanthine derivatives, and immunostimulating agents” (p. 43). The next chapter provides an overview of comorbidities and their input to the problem. Ferreira et al. (2016) state that the exclusion of the patients with relevant comorbidities from clinical trials “prevented evidence-based clinical treatment guidelines in these patients” (p. 44). Potential negative impacts by comorbidities on COPD syndromes and treatment are analyzed and presented to readers.
The paper provides findings on the differences between COPD treatment guidelines in different countries and offers the middle-ground that would improve patient outcomes. However, Ferreira et al. (2016) conclude that there are “too many unknown variables, no reliable biomarkers to guide treatment, and a poor definition of clinically relevant COPD phenotypes” (p. 46). I think that the main strength of this article is that it reviews a variety of crucial obstacles in COPD treatment, and authors attempt to generalize their findings in the form of their recommendations. However, its weak point is that it does not draw a consensus and states the need for further research on the subject.
The second article that will be analyzed is “A review of national guidelines for the management of COPD in Europe” by Miravitlles et al. The guidelines were chosen from the following countries: Finland, Russia, Portugal, Italy, Spain, Sweden, the Czech Republic, the United Kingdom, France, Germany, and Poland. While the research method is similar to the first article, this paper provides a comparison of each COPD treatment guideline, yet does not attempt to synthesize an optimal solution.
The review begins with the stratification of patients and clinical phenotypes. Miravitlles et al. (2016) state that “most guidelines considered symptom severity” and “stratified patients based on the degree of airflow limitation” (p. 626). When analyzing the treatment methods, Miravitlles et al. (2016) found that “in the majority of guidelines, the criteria for the proper use of ICS were roughly similar” (p. 630), and “additional treatments were considered in all recommendations” (p. 631). Treatment goals in most countries were identified as aiming to decrease the severity of syndromes and increase the quality of life (Miravitlles et al., 2016). Moreover, this article considers comorbidities in the same fashion as the first paper and provides homogenous results.
The second part of the article discusses the reasons behind found similarities and variations of treatment. Miravitlles et al. (2016) conclude that they might be caused by “differences in national healthcare systems, differences in opinions regarding the cost-effectiveness of drugs, reimbursement issues, and availability of medications” (p. 632). They discuss the need for recognition of comorbidities in COPD treatment and the necessity for proper grouping of COPD patients.
By comparing these protocols, the authors attempt to find which parts of the COPD treatment process require additional research more than others. While referencing further evidence, Miravitlles et al. (2016) describe evidence from several studies that prove that more significant improvements in pulmonary function come from the most extensive treatment. They urge governmental healthcare organizations to integrate a consistent guideline for COPD treatment into practice.
This article concludes similar to the first one: it is vital to research the subject further to improve the number of positive outcomes. The guideline development must be updated as soon as any proven evidence suggests a potential upgrade of current therapies (Miravitlles et al., 2016). I perceive that the importance of this article lies in weighing in all benefits and risks of COPD treatment among countries, and it could provide necessary information for further research and development. However, it does not include a thorough analysis of each choice based on scientific evidence.
Conclusion
In conclusion, both articles attempt to assess the potential field for improvement in healthcare systems regarding COPD treatment. Since there is no globally accepted opinion on the matter, each article tries to find a way to improve patient outcomes by generating its guidelines or picking the best option based on its frequency. I would like to see more details on different patient stratification methods, and how positive outcomes in various countries correlate based on that factor. These articles signal a severe need for additional research on this disease.
References
- Ferreira, J., Drummond, M., Pires, N., Reis, G., Alves, C., & Robalo-Cordeiro, C. (2016). Optimal treatment sequence in COPD: Can a consensus be found?Revista Portuguesa de Pneumologia (English Edition), 22(1), 39–49. Web.
- Miravitlles, M., Vogelmeier, C., Roche, N., Halpin, D., Cardoso, J., Chuchalin A. G., Kankaanranta, H., Sandström, T., Śliwiński, P., Zatloukal, J., & Blasi, F. (2016). A review of national guidelines for management of COPD in Europe. European Respiratory Journal, 47, 625–637. Web.
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