USING OF RISK PROGNOSTIC MODEL FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATIONS IN PERSONALIZED REHABILITATION PROGRAMS DEVELOPMENT

Abstract

COPD is one of the leading causes of death worldwide and a serious burden on the health system. Exacerbations are a critically important feature of COPD. In GOLD (2022), a strategy was proposed for clinical practice based on treatable traits, which include persistent dyspnea and exacerbations. Their assessment underlies the algorithm of pharmacological treatment, but there are many more pulmonary and extrapulmonary signs united by common pathogenetic mechanisms and the role of biomarkers, as well as behavioral/social risk factors that deserve individual attention and treatment. Thus, medical professionals need to take a proactive position in the search for individual treatable traits to reduce the risk of disease exacerbations and an unfavorable prognosis of life in COPD patients. Purpose. To assess the clinical efficiency of using of risk prognostic model for COPD exacerbations in personalized rehabilitation programs development. Materials and methods. 106 patients with COPD aged 18 to 80 years were examined. The examination of patients included an assessment of outpatient exacerbations and hospitalizations to medical organizations number, an assessment of COPD Assessment Test (CAT), a subjective assessment of the insomnia severity according to Insomnia Severity Index, an assessment of laboratory parameters IL-4, IL-6, IL-8, CRP, TNF-, surfactant protein D, melatonin in urine. Statistical data processing by STATGRAPHICS 18. Results. In according to GOLD (2023), 90 patients (84.9%) were classified as high risk of exacerbations group E. Using the original regression equation, the probability index of COPD exacerbation during 1 year of follow-up was calculated, which turned out to be high, i.e. 2 or more exacerbations of COPD were predicted during 1 year of follow-up (Prog_ex_COPD = 8,21831,13). As a prevention of possible COPD exacerbations, individual rehabilitation programs were applied during 1 year of follow-up: modification of therapy, personalized programs to optimize physical activity, vaccination against influenza and pneumococcal infection, course intake of melatonin. After 1 year of follow-up, the analysis of the assessed indicators in patients with COPD showed a significant positive trend (p˂0.05). The calculation of Prog_ex_COPD according to the original regression equation showed a low risk of COPD exacerbations with the number of exacerbations less than 2 times a year and was 3.62351.24. Conclusions. The developed risk prognostic model for COPD exacerbations has shown clinical efficacy and can be used in the management of COPD patients with frequent exacerbations. The addition of melatonin improves the quality of sleep, which has a positive effect on reducing the symptoms and exacerbations of COPD. For COPD patients with frequent exacerbations, it is advisable to develop individual rehabilitation programs to improve control, taking into account treatable traits.