MANAGEMENT OF PATIENTS WITH COPD: ROLE OF EVALUATION OF DISEASE IN REAL CLINICAL PRACTICE

COPD is a multicomponent disease characterized by a significant heterogeneity of the clinical presentation and by progression of the inflammatory process in lungs. The main goal in management of the disease is to minimize its severity. Traditionally, the severity of the disease is evaluated by restriction of the airflow rate measured by the forced expiratory volume in one second (FEV1), so treatment and management of COPD patients was largely based on the evaluation of spirometry. However, since COPD is a multicomponent disease, structural and functional changes occur not only in lungs but in other organs too. Thus, limitation of the airflow rate alone does not reflect severity of COPD. Despite the fact that FEV1 parameter is of important prognostic value, it weakly correlates with severity of the clinical symptoms of the disease. Typically, patients seek medical help when the symptoms begin to significantly influence their daily life (when patients are forced to correct their way of life to avoid these symptoms). These symptoms reflect the daily workload imposed on patients by COPD and have a real influence on the quality of their life. Indeed, symptoms of COPD are more closely related to the determined by health quality of life than to the obstruction of the airways, because the patient's quality of life is more affected by symptoms of COPD, than by obstruction of the lower airways. This article presents evaluation of the disease at the outpatient visit, which takes into account not only the degree of severity of bronchial obstruction (degree of impairment of bronchial patency) on the basis of the results the spirometric test, but also the clinical characteristics of the patient: expressiveness of clinical symptoms on mMRC scale and the CAT questionnaire.