USE OF INDIVIDUAL PREDICTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATIONS IN OBESE PATIENTS DURING DISPENSARY OBSERVATION

Abstract

COPD is one of the main public health problems. 40.0% of all COPD patients tolerate at least 1 moderate or severe exacerbation within a year, and up to 16.0% - 2 or more. GOLD (2022) proposed for clinical practice a strategy based on "treatable traits," the key of which are exacerbations and persistent shortness of breath, but there are other numerous pulmonary and extrapulmonary features, the definition and consideration of which is useful when leaving individual management algorithms for patients with COPD. Purpose. To evaluate the clinical effectiveness of the use of individual prediction of COPD exacerbations in obese patients during clinical observation. Materials and methods. 106 people diagnosed with COPD between the ages of 18 and 80 were examined. The patient examination included an assessment of the number of outpatient exacerbations and hospitalizations to medical organizations over the past 12 months, a BMI calculation, a comprehensive assessment of COPD symptoms with CAT, the functional status of patients, and an assessment of biochemical blood parameters. Results. According to the examination results and BMI calculation, 80 patients (75.5%) were overweight (55 patients) or obese of various degrees (grade 1 obesity - 21 patients, grade 2 - 1 patient and grade 3 - 3 patients). According to GOLD (2023), all patients were classified as "high risk of exacerbations" - group E. The probability index of COPD exacerbation was calculated over the next 12 months using regression analysis. To prevent predicted exacerbations of COPD, individual treatment and rehabilitation programs were developed for patients, designed for use for 12 months of follow-up: treatment modification, personalized programs for optimizing physical activity, dietary recommendations, vaccination against influenza and pneumococcal infection, course therapy with melatonin, consultation with an endocrinologist. At the end of 12 months, compliance with the recommendations of the index of the probability of exacerbation of COPD for the next 12 months was low. Conclusions. In patients with frequent exacerbations of COPD, in order to achieve disease control, it is advisable to develop individual treatment and rehabilitation programs within the framework of clinical observation, given the "treatable signs," the correction of which has a significant positive effect on the course of COPD, achievement of control and prognosis of the disease.