СLINICAL EFFICIENCY OF ROFLUMILAST AND OF PULMONARY REHABILITATION IN PATIENTS WITH CHRONIC OBSTRUCTIVE LUNG DISEASE AND METABOLIC SYNDROME

Background. Chronic obstructive pulmonary disease (COPD) has a leading position among the causes of morbidity, disability and mortality. In patients with COPD, metabolic syndrome (MS) is detected on average twice as often as in the population. According to some reports, roflumilast increases insulin sensitivity, the level of glucagon-like peptide-1 influences the level of glycated hemoglobin (HbA1c), which is important for patients with COPD and MS. Aim. To evaluate the clinical efficacy of treatment and of preventive measures in patients with COPD and MS using roflumilast and a pulmonary rehabilitation program (PRP). Materials and Methods. The study included 49 people diagnosed with COPD and MS (26 men, 23 women; average age 47.06±0.34 years). All patients underwent: spirometry, measurements of interleukin (IL)-6, IL-8, tumor necrosis factor-α (TNF-α), HbA1c, assessment of the severity of dyspnea, sputum and cough according to visual-analogue scales (VAS), assessment of quality of life (QOL) according to the SF-36 questionnaire at the beginning of the study and after 12 months. Pulmonary rehabilitation program (PRP) included smoking cessation recommendations, physical activity, and dietary recommendations. Patients received roflumilast at a dose of 500 µg once a day for 2 months, 2 times a year, in the autumn-spring period. Results. Patients with COPD and MS with intake of roflumilast and use of PRP showed significant positive dynamics in the subjective assessment of the severity of the main clinical symptoms - dyspnea, cough, sputum. Improvement in spirometric parameters after 12 months was not statistically significant (p=0.0688). The dynamics of the level of HbA1c was revealed - a decrease from 7.51±0.08 to 7.36±0.05%. There was also a significant decrease in the levels of IL-6, IL-8, TNF-α observed – their values were 10.08±0.08; 11.54±0.18 and 23.79±0.45, respectively. Reliable positive dynamics of all parameters of the SF-36 questionnaire was noted. Conclusion. The inclusion of roflumilast and PRP in the standard treatment protocol for COPD patients contributes to a positive dynamics in the severity of the main clinical symptoms of COPD, to a decrease in the activity of the systemic inflammatory response, and to an increase in the QOL of patients with COPD and MC.