In centers that use lower limit of normal (LLN), the FEV1/VC LLN threshold should be used. The prevalence of COPD in Serbia is underestimated.3C5 High smoking prevalence, exposure to biomass fuels, and poor air quality all increase the risk of COPD in Serbia. side effects, and ensure efficient treatment. strong class=”kwd-title” Keywords: COPD, treatment, guidelines Introduction With an estimated prevalence of 12% and 3 million deaths annually, chronic obstructive pulmonary disease (COPD) is a major health problem worldwide.1,2 In Serbia, self-reported prevalence of COPD is 5% in females and 3.7% in males.3 This is a large underestimation, as active case finding in symptomatic high-risk Serbian population showed a prevalence of 22% in general practice4 and related results were obtained using patient questionnaires.5 According to the recent Phenotypes of COPD in Central and Eastern Europe (POPE) study, non-exacerbators are the most frequent COPD phenotype in Serbia.6 Global Initiative for Chronic Obstructive Lung Disease (Platinum) recommendations are poorly reflected in real-life practice, while more than half of these individuals receive inhaled corticosteroids (ICS) and many of them receive slow-release theophylline.6,7 Although intended to be global, multiple barriers preclude implementation of GOLD strategy worldwide, including availability of medicines and diagnostic methods and country-specific regulatory affairs. This has been further hampered from the increasing difficulty of COPD phenotypes and algorithms that are hard to follow in occupied outpatient settings. The need for context-specific implementation and tailoring recommendations according to local needs have been progressively recognized and resulted in several national guidelines and position statements in the last years including Russian,8 Spanish,9 Czech,10 Saudi Arabian,11 Canadian,12 and French.13 With this paper, we present recommendations for treatment of COPD in Serbia. Strategy The development of these recommendations was based on national COPD experts opinions and opinions from a panel of pulmonologists. First, a field survey on current medical practice was performed using available epidemiological studies from the region and data from your national registry.4,5,7,14 Second, an extensive review of the literature including GOLD strategy and the guidelines from various national societies was performed for the period of the last 6 years since the last national guideline was published.15 Only the medications available in Serbia were discussed. Three rounds of expert meetings (two face-to-face meetings and one video conference) were held during the following 6-month period to discuss treatment algorithms. Both the medical rationale and local applicability of the algorithms were evaluated. Disagreements were resolved by consensus. In the absence of consensus, a final decision was made by a simple majority rule. We offered specialists’ opinion statement rather than a formal guideline, as the primary aim was to develop locally applicable recommendations and there was no formal grading of the evidence. We recognized four major parts for treating COPD individuals based on country Methoctramine hydrate specifics: 1) active case getting and early analysis in high-risk populace, 2) restorative algorithm for initiation and escalation of therapy that is simple and easy to use inside a real-life scenario, 3) de-escalation of ICS in low-risk non-exacerbators, and 4) individual choice of inhaler device based on individuals’ ability and preferences. Recommendations Active case getting We recommend active case getting in individuals 40 years of age with 10 pack/years smoking who have symptoms of cough, wheezing or exertional dyspnea. The analysis should be made if FEV1/FVC is definitely 70% measured quarter-hour after four puffs of 100 mcg salbutamol. In centers that use Methoctramine hydrate lower limit of normal (LLN), the FEV1/VC LLN threshold should be used. The prevalence of COPD in Serbia is definitely underestimated.3C5 High smoking prevalence, exposure to biomass fuels, and poor air quality all increase the risk of COPD in Serbia. Relating to a health examinations survey, despite enforcement of tobacco control, 35% of the adult populace are smokers.16 Active case finding enables timely diagnosis and offers a window of opportunity for early intervention and prevention of functional decrease. High-quality spirometry should be performed according to the American Thoracic Society-European Respiratory Society (ATS/ERS) criteria and staff carrying out spirometry adequately qualified.17,18 National spirometry programs endorsed from the ERS have been available yearly since 2014. When.We identified four major components of COPD treatment based on country specifics: active case getting and early analysis in high-risk populace, therapeutic algorithm for initiation and escalation of therapy that is simple and easy to use in real-life practice, de-escalation of ICS in low-risk non-exacerbators, and individual choice of inhaler device based on individuals’ ability and preferences. 12% and 3 million deaths annually, chronic obstructive pulmonary disease (COPD) is definitely a major health problem worldwide.1,2 In Serbia, self-reported prevalence of COPD is 5% in females and 3.7% in males.3 This is a large underestimation, as active case finding in symptomatic high-risk Serbian population showed a prevalence of 22% in general practice4 and related results were obtained using patient questionnaires.5 According to the recent Phenotypes of COPD in Central and Eastern Europe (POPE) study, non-exacerbators are the most frequent COPD phenotype in Serbia.6 Global Initiative for Chronic Obstructive Lung Disease (Platinum) recommendations are poorly reflected in real-life practice, while more than half of these individuals receive inhaled corticosteroids (ICS) and many of them receive slow-release theophylline.6,7 Although intended to be global, multiple barriers preclude implementation of GOLD strategy worldwide, including availability of medicines and diagnostic methods and country-specific regulatory affairs. This has been further hampered from the increasing difficulty of COPD phenotypes and algorithms that are hard to follow in occupied outpatient settings. The need for Methoctramine hydrate context-specific implementation and tailoring recommendations according to local needs have been progressively recognized and resulted in several national guidelines and position statements in the last years including Russian,8 Spanish,9 Czech,10 Saudi Arabian,11 Canadian,12 and French.13 With this paper, we present recommendations for treatment of COPD in Serbia. Strategy The development of these recommendations was based on national COPD experts opinions and opinions from a panel of pulmonologists. First, a field survey on current medical practice was performed using available epidemiological studies from the region and data from your national registry.4,5,7,14 Second, an extensive review of the literature including GOLD strategy and the guidelines from various national societies was performed for the period of the last 6 years since the last national guideline was published.15 Only the medications available in Serbia were discussed. Three rounds of expert meetings (two face-to-face meetings and one video conference) were held during the following 6-month period to discuss treatment algorithms. Both the medical rationale and local applicability of the algorithms were evaluated. Disagreements were resolved by consensus. In the absence of consensus, a final decision was made by a simple majority rule. We offered specialists’ opinion statement rather than a formal guideline, as the primary aim was to develop locally applicable recommendations and there was no formal grading of the evidence. Methoctramine hydrate We recognized four major parts for treating COPD individuals based on country specifics: 1) KIT active case getting and early analysis in high-risk populace, 2) restorative algorithm for initiation and escalation of therapy that is simple and easy to use inside a real-life scenario, 3) de-escalation of ICS in low-risk non-exacerbators, and 4) individual choice of inhaler device based on individuals’ ability and preferences. Recommendations Active case getting We recommend active case getting in individuals 40 years of age with 10 pack/years smoking who have symptoms of cough, wheezing or exertional dyspnea. The analysis should be made if FEV1/FVC is definitely 70% measured quarter-hour after four puffs of 100 mcg salbutamol. In centers that use lower limit of normal (LLN), the FEV1/VC LLN threshold should be used. The prevalence Methoctramine hydrate of COPD in Serbia is definitely underestimated.3C5 High smoking prevalence, exposure to biomass fuels, and poor air quality all increase the risk of COPD in Serbia. Relating to a health examinations survey, despite enforcement of tobacco control, 35% of the adult populace are smokers.16 Active case finding enables timely diagnosis and offers a window of opportunity for early intervention and prevention of functional decline. High-quality spirometry should be performed according to the American Thoracic Society-European Respiratory Society (ATS/ERS) criteria and staff performing spirometry adequately trained.17,18 National spirometry courses endorsed by the ERS have been available yearly since 2014. When reported, a postbronchodilator value of FEV1 (postbd FEV1) should be used.19 Algorithm of initiating and escalating COPD treatment Non-pharmacological treatment All patients should receive non-pharmacological measures including smoking cessation counseling, vaccination, and rehabilitation. Many cases of COPD are preventable by avoidance or early cessation of smoking.20 Influenza vaccination reduces lower respiratory tract infections, COPD exacerbations, and mortality in COPD patients.21,22 Pneumococcal vaccine reduces pneumococcal disease.