Türkan TATLICIOĞLU

Kronik obstrüktif akciğer hastalığı (KOAH) ve geleceği

Kronik obstrüktif akciğer hastalığı (KOAH), tüm dünya ülkelerinde mortalitesi, morbiditesi ve prevalansı oldukça yüksek ve giderek artmakta olan önemli bir sağlık sorunudur. Ancak hastalığın gelişmesinde önemli neden olarak bilinen sigara tüketiminin dünya genelinde kontrole alınamayacağı gerçeği, hastalığın progresif ve irreversibl olarak yanlış algılanması gibi nedenlerle uzun yıllar ihmal edilmiş bir hastalıktır. Son yıllarda KOAH’ın küresel bir sağlık sorunu ve giderek artan sosyoekonomik yüke neden olduğunun farkına varılmasıyla hastalık tıbbi ve bilimsel çevrelerin ve ilaç sanayiinin ilgi odağı haline gelmiştir. Hastalığın daha iyi anlaşılması ve tedavisinde sağlanan önemli gelişmelerle, günümüzde KOAH hastalarına daha iyimser yaklaşılmakta, hastalık daha iyi tanımlanmakta, daha iyi tedavi edilmektedir. Ne var ki KOAH’ın henüz tam anlaşılamadığı bir gerçektir ve nasıl tanımlanacağı ve tedavi edileceği tartışmaları halen sürmektedir. Sigara dışında KOAH’ın gelişmesinden sorumlu risk faktörleri, hastalığın patogenezi, kliniği, fenotipleri, komorbiditeleri ve tedavisi konusunda bilgilerimiz oldukça eksiktir. Günümüz KOAH tedavisinde uzun etkili antikolinerjikler ve beta-2 agonistlerin, inhale steroidlerin ve pulmoner rehabilitasyon gibi kronik akciğer hastalığında yaşam boyu uygulanması gereken ilaç dışı tedavilerin tedavinin ana bileşenleri olarak uygulamaya girmesi önemli gelişmelerdir. Ancak KOAH’ın ağır sosyoekonomik yükü karşısında, mevcut tedavilerin tüm kapsamlarıyla kullanılması yanında, hastalığın klinik seyrini değiştirebilecek yeni tedaviler ve daha etkin sigara bıraktırma stratejileri geliştirilmelidir. KOAH’ın patobiyolojisini, kliniğini anlamaya çalışırken ve tedavi yaklaşımlarının yararlarını değerlendirirken, yeni ve etkin paradigmalara da gereksinim vardır. Gelecekte KOAH fizyopatolojisi konusundaki bilgilerimizi tüm boyutlarıyla kullanan yeni tedavi paradigmalarının geliştirilmesi büyük önem kazanacaktır. Böylece hastalık daha iyi tedavi edilebilecek ve tedavilerin yararları daha iyi değerlendirilebilecektir.

Chronic obstructive pulmonary disease (COPD) and its future

Chronic obstructive pulmonary disease (COPD) is an important health problem in all countries of the world with its high and steadily increasing mortality, morbidity and prevalence. The disease has long been ignored due to the fact that smoking which is known as an important factor in the development of the disease could not be taken under control throughout the world and due to misperceptions that the disease is progressive and irreversible. In recent years with the understanding that COPD is a global health problem and that it creates increasing socioeconomic burden, the disease became the focus of scientific circles and pharmaceutical industry. Together with better understanding of the disease and the significant advances in its treatment, COPD patients are being approached more optimistically, while the disease is being defined and treated more comprehensively. Yet, it is a fact that COPD has not yet been fully understood and discussions regarding how to define and treat the disease are ongoing. Our knowledge about the risk factors other than smoking responsible from development of COPD, the pathogenesis of the disease, its clinical course, phenotypes, comorbidities and treatment is limited. Currently we have important advances in the treatment of COPD such as the use of long acting anticholinergics and beta-2-agonists, inhaled steroids and non-pharmaceutical treatments like pulmonary rehabilitation that have to be in use throughout the life time of the patient as main components of therapy. However, in response to severe socioeconomic burden of the disease, in addition to using the available treatment options in full scope there needs to be new therapeutic possibilities that could modify the disease course as well as more effective smoking cessation strategies. We also need new and effective paradigms while trying to understand the pathobiology and the clinical course of COPD and evaluating the benefits of treatment approaches. In future, the development of new treatment paradigms that can make comprehensive use of our knowledge about COPD pathophysiology will gain utmost importance. Thus, the disease will be better treated while treatment effects will be better assessed.

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