Treatment — light: patients with COPD without disability ask to be given drugs

Patients with chronic obstructive pulmonary disease (COPD) have asked the government to provide them with medicines free of charge and in full. Currently, drugs are provided only if they have a disability, which is no less than moderate to severe conditions. The appeal was sent to the Cabinet of Ministers by the All-Russian Union of Patients. The organization warns that without continuous treatment, the condition of people with a lower degree of illness worsens, and stronger drugs and hospitalization cost the state more than COPD treatment. Sergey Avdeev, the chief freelance pulmonologist at the Ministry of Health, confirmed that patients with mild illness are not allowed free medicines, so they have to be treated at their own expense. But patients with a moderate course do not always receive the status of a disabled person, as it depends on the decision of the medical and social expertise, he complained.

Therapy without status

Drugs for the treatment of chronic obstructive pulmonary disease (COPD) are given free of charge to patients only if they have a disability, the All-Russian Union of Patients drew attention. The organization proposed to expand access to preferential therapy — to issue it without reference to the status of "disabled", the organization's letter was sent to the government (Izvestia has it).

According to the patient organization, as of May 1, 2023, 2.5% of all people with disabilities in the country (more than 11 million people) received this status due to respiratory diseases. And one third of this share (84 thousand people) are patients with COPD.

"Patients acquire the right to receive preferential medications from the budgets of federal and regional benefits upon obtaining the status of "disabled", when a return to normal professional activity is rarely possible," the document emphasizes. — People with severe stage of the disease (53% of patients) lose an average of eight to nine years of life expectancy. Within five years after the first exacerbation, only 40% remain alive."

In his appeal, the VSP noted that "now every second patient with COPD is hospitalized," which also requires budgetary funds. And this could be avoided if a significant proportion of patients received effective drug therapy on time and free of charge, they believe. At the same time, the organization emphasized that modern drugs have a positive therapeutic effect in 75-85% of cases.

The direct cost of COPD treatment per year is 25-40 thousand rubles or more, Sergey Avdeev, chief freelance specialist of the pulmonologist of the Ministry of Health, told Izvestia. The main therapy for COPD patients with and without disabilities is two- and three-component inhaled combination drugs.

— Patients without the status of "disabled" are forced to purchase medicines at their own expense, he admitted. — Not everyone has the opportunity to pay for treatment out of pocket. But it is not doctors who make the decision to recognize a patient as disabled, but specialists at the Bureau of medical and social expertise. Most often, they assign this status to patients when they have respiratory failure and other complications characteristic of COPD. That is, not at an early stage, but with a moderate and severe course of the disease.

Sergey Avdeev complained that disability is not awarded to all people with a moderate condition in the same way — some of these patients remain without this status during ITU inspections.

Such patients are most often disabled with severe and very severe course of the disease, said medical lawyer Irina Gritsenko.

— In general, it is possible to get a disability, but it needs to be addressed. Documents for the disability commission can be submitted by the medical institution where the patient is being monitored. But sometimes they shy away from it. Then patients need to apply with a written application and a request to send documents to the ITU," the expert said.

Izvestia has sent a request to the government on whether the patient organization's proposal will be considered and whether it is planned to change the system of dispensing medicines for them.

What is the danger of COPD

More than 800,000 patients with COPD have been registered in Russia, but the real number may reach 10-11 million people, the VSP letter says. At the same time, Russia is one of the leaders in the proportion of patients with severe exacerbations of COPD who have a high risk of mortality.

"Almost 80% of patients have serious exacerbations within one year," the letter says. — Three years after the first severe exacerbation of COPD, 50% of patients die. With two moderate exacerbations per year, the risk of death increases by 80%."

The most common cause of death in patients with COPD (39%) is cardiovascular diseases, especially with moderate severity of the disease.

"The risk of myocardial infarction doubles within five days after a moderate exacerbation of the disease," the VSP said. — The risk of cardiovascular complications is ten times higher after a severe exacerbation of the disease for 30 days, and subsequently twice as high for a year after a severe exacerbation. Patients who had delayed the appointment of three-component therapy for a year after complications were 60% more likely to have repeated exacerbations compared to those who were prescribed such therapy within a month."

According to the Central Research Institute of Healthcare Organization and Informatization of the Ministry of Health, mortality from COPD is higher than from hypertension, stomach, pancreatic, breast cancer, chronic hepatitis C or HIV and is comparable to mortality from cardiovascular, oncological diseases and diabetes mellitus.

Providing free treatment to patients with COPD without disability, the VSP believes, will increase the life expectancy of Russians and reduce the mortality rate of people of working age. And they propose to finance additional measures to support patients with COPD through excise taxes on tobacco products.

"The smoking situation is changing in the world. The increase in its prevalence leads to a significant increase in the rate of COPD among women compared with men. The increase in the number of women with this disease, taking into account the downward trend in the age of those affected, threatens the realization of their reproductive potential," explained the choice of a funding source in the VSP.

The co-chairman of the VSP, Yuri Zhulev, stressed that the patient organization expects the Ministry of Health to work out in detail the necessary set of measures for the prevention and treatment of COPD patients, including the issue of drug provision. Izvestia sent a request to the agency about whether measures are being developed to expand access to free therapy for patients with COPD.

"The appeal of the public organization will be carefully considered upon its receipt by the ministry," the press service of the Ministry of Health reported in response to a request from the editorial board.

They also recalled that providing patients with drugs, medical products and specialized therapeutic nutrition is the responsibility of the regional Ministries of health and health departments.

"Funds for the exercise of these powers are provided in the form of subventions from the federal budget," the press service of the Ministry of Health added. — At the same time, the most serious patients, recognized as disabled, have the right to be provided with medicines included in the list of vital and essential.

Thus, they emphasized, particularly severe patients suffering from COPD and recognized as disabled have the right to receive medicines as part of a set of social services for the entire list of vital and essential drugs (VED) at the expense of the federal budget.

— Also, the regional authorities, within the framework of the territorial program of state guarantees, establish a list of medicines that are dispensed free of charge or with a 50% discount for outpatient treatment, the ministry's press service noted.

The regions also have the right to include COPD in the state guarantee program and provide patients with preferential drugs in an amount not less than that established by the list of VED, they emphasized.