medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2018-15-96-100medsovet-2677Research ArticleШкола пульмонологаPulmonologist schoolФиксированные комбинации бронходилататоров в лечении больных ХОБЛ: проблема выбораFixed-dose combinations of bronchodilators in the treatment of patients with COPD: problem of choiceСинопальниковА. И.SinopalnikovA. I.

Синопальников Александр Игоревич – доктор медицинских наук, профессор, завкафедрой пульмонологии.

Москва

Moscow

ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy of Continuing Postgraduate Education, Federal State Budgetary Educational Institution of Further Professional Education of the Ministry of Health of RussiaRussian Federation20181110201801596100Copyright © Синопальников А.И., 20182018Синопальников А.И.Sinopalnikov A.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2677

Хроническая обструктивная болезнь легких (ХОБЛ) – заболевание, характеризующееся прогрессирующим со временем и не обратимым полностью ограничением воздушного потока, что наряду с выраженностью клинических симптомов и частотой повторно переносимых обострений относится к числу его ключевых характеристик [1, 2]. Основным «инструментом» в достижении терапевтических целей согласно современным рекомендациям – GOLD [1], GesEPOC [3], NICE [4], РРО [5] и др. – являются бронходилататоры. Фиксированные комбинации ДДБА/ДДХБ обеспечивают оптимальную бронходилатацию и играют первостепенную роль в предотвращении обострений ХОБЛ.

Chronic Obstructive Pulmonary Disease (COPD) is a disease characterized by air flow limitation that progresses over time and is not fully reversible, which, along with the severity of clinical symptoms and the frequency of relapses, is one of its key characteristics [1, 2]. The main “tool” in achieving therapeutic goals in accordance with current guidelines GOLD [1], GesEPOC [3], NICE [4], PPO [5], etc. - are bronchodilators. Fixed-dose combinations of long acting beta-2 agonists/long acting anticholinergic agents provide optimal bronchodilation and play a primary role in preventing exacerbations of COPD.

хроническая обструктивная болезнь легкихфиксированные комбинации ДДБА/ДДХБвилантерол/умеклидинийchronic obstructive pulmonary diseasefixed-dose combinations of LABA/LAACvilantherol/umeclidiniumReferencesGlobal Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of COPD, 2018. Available from: http://goldcopd.org/gold-2018-global-strategy-diagnosis-management-prevention-copd/.Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of COPD, 2018. Available from: http://goldcopd.org/gold-2018-global-strategy-diagnosis-management-prevention-copd/.Lopez-Campos JL. Treatment strategies in chronic obstructive pulmonary disease: a proposal for standardization. Arch Bronconeumol, 2010, 46: 617-620.Lopez-Campos JL. Treatment strategies in chronic obstructive pulmonary disease: a proposal for standardization. Arch Bronconeumol, 2010, 46: 617-620.Miravitlles M, Soler-Cataluna JJ, Calle M, et al. Spanish guidelines for management of chronic obstructive pulmonary disease (GesEPOC) 2017: pharmacological treatment of stable phase. Arch Bronconeumol, 2017, 53: 324-335.Miravitlles M, Soler-Cataluna JJ, Calle M, et al. Spanish guidelines for management of chronic obstructive pulmonary disease (GesEPOC) 2017: pharmacological treatment of stable phase. Arch Bronconeumol, 2017, 53: 324-335.COPD: NICE guideline DRAFT (July 2018). Available from: http://www.nice.org.uk.COPD: NICE guideline DRAFT (July 2018). Available from: http://www.nice.org.uk.Aisanov Z, Avdeev S, Arkhipov V, et al. Russian guidelines for the management of COPD: algorithm of pharmacologic treatment. Int J COPD, 2018, 13: 183-187.Aisanov Z, Avdeev S, Arkhipov V, et al. Russian guidelines for the management of COPD: algorithm of pharmacologic treatment. Int J COPD, 2018, 13: 183-187.Williams DM, Rubin BK. Clinical pharmacology of bronchodilator medications. Respir Care, 2018, 63: 641-654.Williams DM, Rubin BK. Clinical pharmacology of bronchodilator medications. Respir Care, 2018, 63: 641-654.Johnson M, Rennard S. Alternative mechanisms for long-acting beta(2)-adrenergic agonists in COPD. Chest, 2001, 120: 258-270.Johnson M, Rennard S. Alternative mechanisms for long-acting beta(2)-adrenergic agonists in COPD. Chest, 2001, 120: 258-270.Hanania NA, Moore RH. Anti-inflammatory activities of beta2-agonists. Curr Drug Targets Inflamm Allergy, 2004, 3: 271-277.Hanania NA, Moore RH. Anti-inflammatory activities of beta2-agonists. Curr Drug Targets Inflamm Allergy, 2004, 3: 271-277.Bennett WD, Almond MA, Zeman KL, et al. Effect of salmeterol on mucociliary and cough clearance in chronic bronchitis. Pulm Pharmacol Ther, 2006, 19: 96-100.Bennett WD, Almond MA, Zeman KL, et al. Effect of salmeterol on mucociliary and cough clearance in chronic bronchitis. Pulm Pharmacol Ther, 2006, 19: 96-100.Profita M, Giorgi RD, Sala A, et al. Muscarinic receptors, leukotriene B4 production and neutrophilic inflammation in COPD patients. Allergy, 2005, 60: 1361-1369.Profita M, Giorgi RD, Sala A, et al. Muscarinic receptors, leukotriene B4 production and neutrophilic inflammation in COPD patients. Allergy, 2005, 60: 1361-1369.Cazzola M, Molimard M. The scientific rationale for combining long-acting beta-2-agonists and muscarinic antagonists in COPD. Pulm Pharmacol Ther, 2010, 23: 257-267.Cazzola M, Molimard M. The scientific rationale for combining long-acting beta-2-agonists and muscarinic antagonists in COPD. Pulm Pharmacol Ther, 2010, 23: 257-267.Miravitlles M, Baek S, Vithlani V, Lad R. Optimal bronchodilation for COPD patients: are all long-acting β2-agonist/long-acting muscarinic antagonists the same? Tuberc Respir Dis, 2018, 81: 198-215.Miravitlles M, Baek S, Vithlani V, Lad R. Optimal bronchodilation for COPD patients: are all long-acting β2-agonist/long-acting muscarinic antagonists the same? Tuberc Respir Dis, 2018, 81: 198-215.Price D, Ǿstrem A, Thomas M, Welte T. Dual bronchodilation in COPD: lung function and patient-reported outcomes – a review. Int J COPD, 2017, 12: 141-168.Price D, Ǿstrem A, Thomas M, Welte T. Dual bronchodilation in COPD: lung function and patient-reported outcomes – a review. Int J COPD, 2017, 12: 141-168.Rodrigo GJ, Price D, Anzueto A, et al. LABA/ LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis. Int J COPD, 2017, 12: 07-922.Rodrigo GJ, Price D, Anzueto A, et al. LABA/ LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis. Int J COPD, 2017, 12: 07-922.Horita N, Goto A, Shibata Y, et al. Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive disease (COPD). Cochrane Database Syst Rev, 2017, 2: CD012066.Horita N, Goto A, Shibata Y, et al. Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive disease (COPD). Cochrane Database Syst Rev, 2017, 2: CD012066.Miravitlles M, Anzueto A. A new two-step algorithm for the treatment of COPD. Eur Respir J, 2017, 49: 1602200.Miravitlles M, Anzueto A. A new two-step algorithm for the treatment of COPD. Eur Respir J, 2017, 49: 1602200.Feldman GJ, Sousa AR, Lipson DA, et al. Comparative efficacy of once-daily umeclidinium/vilanterol and tiotropium/olodaterol therapy in symptomatic chronic obstructive pulmonary disease: a randomized study. Adv ther, 2017, 34: 2518-2533.Feldman GJ, Sousa AR, Lipson DA, et al. Comparative efficacy of once-daily umeclidinium/vilanterol and tiotropium/olodaterol therapy in symptomatic chronic obstructive pulmonary disease: a randomized study. Adv ther, 2017, 34: 2518-2533.Calzetta L, Rogliani P, Matera MG, Cazzola M. A Systematic review with meta-analysis of dual bronchodilation with LAMA/LABA for the treatment of stable COPD. Chest, 2016, 149: 11811196.Calzetta L, Rogliani P, Matera MG, Cazzola M. A Systematic review with meta-analysis of dual bronchodilation with LAMA/LABA for the treatment of stable COPD. Chest, 2016, 149: 11811196.Kerwin E, Ferguson GT, Sanjar S, et al. Dual bronchodilation with indacaterol maleate/glycopyrronium bromide compared with umeclidinium bromide/vilanterol in patients with moderate-to-severe COPD: results from two randomized, controlled, cross-over studies. Lung, 2017, 195: 739-747.Kerwin E, Ferguson GT, Sanjar S, et al. Dual bronchodilation with indacaterol maleate/glycopyrronium bromide compared with umeclidinium bromide/vilanterol in patients with moderate-to-severe COPD: results from two randomized, controlled, cross-over studies. Lung, 2017, 195: 739-747.Navarrete BA et al. Umeclidinium/Vilanterol Versus Tiotropium/Olodaterol in Maintenance-Naïve Patients with Moderate Symptomatic Chronic Obstructive Pulmonary Disease: A Post Hoc Analysis. Pulm Ther, 2018, June 20.Navarrete BA et al. Umeclidinium/Vilanterol Versus Tiotropium/Olodaterol in Maintenance-Naïve Patients with Moderate Symptomatic Chronic Obstructive Pulmonary Disease: A Post Hoc Analysis. Pulm Ther, 2018, June 20.https://www.astrazeneca.com/content/astraz/media-centre/press-releases/2018/astrazenecaprovides-update-on-aeristo-phase-iiib-trial-forbevespi-aerosphere-in-chronic-obstructive-pulmonary-disease23082018.html.https://www.astrazeneca.com/content/astraz/media-centre/press-releases/2018/astrazenecaprovides-update-on-aeristo-phase-iiib-trial-forbevespi-aerosphere-in-chronic-obstructive-pulmonary-disease23082018.html.

The authors declare that there are no conflicts of interest present.