medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-12-91-99medsovet-6335Research ArticleПУЛЬМОНОЛОГИЯ, ЛОРBRONCHOPULMONOLOGY, OTORHINOLARYNGOLOGYПрименение короткодействующих бронходилататоров у пациентов с хронической бронхообструктивной патологией на современном этапеThe use of short-acting bronchodilators in patients with chronic bronchoobstructive pathology at the present stagehttps://orcid.org/0000-0003-3385-2632ЗыковК. А.ZykovK. A.

заведующий кафедрой факультетской терапии и профболезней, 127473, Москва, ул. Делегатская, д. 20, стр. 1;

д.м.н., профессор РАН, заместитель директора по научной и инновационной работе, 115682; Москва, Ореховый бульвар, д. 28

Head of the Department of Faculty Therapy and Occupational Diseases, 20, Bldg. 1, Delegateskaya St., Moscow, 127473;

Dr. Sci. (Med.), Professor of the Russian Academy of Sciences, Deputy Director for Research and Innovation, 8, Orekhovy Boulevard, Moscow, 115682

kirillaz@inbox.ruhttps://orcid.org/0000-0001-8344-988XВикентьевВ. В.VikentyevV. V.

к.м.н., доцент, доцент кафедры факультетской терапии и профболезней, 

127473, Москва, ул. Делегатская, д. 20/1

Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Faculty Therapy and  Occupational Diseases, 

20, Bldg. 1, Delegateskaya St., Moscow, 127473

vvvikentiev@mail.ruhttps://orcid.org/0000-0003-4583-6330ГолобородоваИ. С.GoloborodovaI. V.

к.м.н., доцент, доцент кафедры факультетской терапии и профболезней, 

127473, Москва, ул. Делегатская, д. 20, стр. 1

Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Faculty Therapy and Occupational Diseases, 

20, Bldg. 1, Delegateskaya St., Moscow, 127473

giv55555@mail.ruhttps://orcid.org/0000-0002-9691-0265КопченовИ. И.KopchenovI. I.

к.м.н., доцент, доцент кафедры факультетской терапии и профболезней, 

127473, Москва, ул. Делегатская, д. 20, стр. 1

Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Faculty Therapy and Occupational Diseases,

20, Bldg. 1, Delegateskaya St., Moscow, 127473

iik976@mail.ruhttps://orcid.org/0000-0003-1555-1449БондарецО. В.BondarecO. V.

к.м.н., доцент, доцент кафедры факультетской терапии и  профболезней, 

127473, Москва, ул. Делегатская, д. 20, стр. 1

Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Faculty Therapy and Occupational Diseases, 

20, Bldg. 1, Delegateskaya St., Moscow, 127473

o.v.bondarets@gmail.comhttps://orcid.org/0000-0002-1286-3968ГусеваТ. Ф.GusevaT. F.

 к.м.н., доцент, доцент кафедры факультетской терапии и профболезней, 

127473, Москва, ул. Делегатская, д. 20, стр. 1

Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Faculty Therapy and Occupational Diseases, 

20, Bldg. 1, Delegateskaya St., Moscow, 127473

tguseva65@mail.ruhttps://orcid.org/0000-0002-5496-3481СоколовЕ. И.SokolovE. I.

академик РАН, д.м.н., профессор, профессор кафедры факультетской терапии и профболезней, 

127473, Москва, ул. Делегатская, д. 20, стр. 1

Acad. RAS, Dr. Sci. (Med.), Professor, Professor of the Department of Faculty Therapy and Occupational Diseases,

20, Bldg. 1, Delegateskaya St., Moscow, 127473

f.therapy@mail.ruМосковский государственный медико-стоматологический университет имени А.И. Евдокимова; Научно-исследовательский институт пульмонологииРоссияYevdokimov Moscow State University of Medicine and Dentistry; Research Institute for PulmonologyRussian FederationМосковский государственный медико-стоматологический университет имени А.И. ЕвдокимоваРоссияYevdokimov Moscow State University of Medicine and DentistryRussian Federation2021140920210129199Copyright © Зыков К.А., Викентьев В.В., Голобородова И.С., Копченов И.И., Бондарец О.В., Гусева Т.Ф., Соколов Е.И., 20212021Зыков К.А., Викентьев В.В., Голобородова И.С., Копченов И.И., Бондарец О.В., Гусева Т.Ф., Соколов Е.И.Zykov K.A., Vikentyev V.V., Goloborodova I.V., Kopchenov I.I., Bondarec O.V., Guseva T.F., Sokolov E.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/6335

Ингаляционные короткодействующие бронходилататоры (бета-агонисты и М-холинолитики) в течение длительного времени применяются у пациентов с бронхообструктивными заболеваниями, основными представителями которых являются хроническая обструктивная болезнь легких (ХОБЛ) и бронхиальная астма (БА). Учитывая тот факт, что большинство пациентов с ХОБЛ и БА принимают пролонгированные бронхолитики, встает вопрос о месте короткодействующих препаратов в современных схемах терапии бронхообструктивной патологии. Приведены данные о том, какая часть пациентов принимает короткодействующие бета-агонисты и М-холинолитики в реальной клинической практике, насколько целесообразно применять эти средства на фоне пролонгированных препаратов. В ходе российской части международного исследования POPE-study был проведен анализ характеристик амбулаторных пациентов с ХОБЛ. Было установлено, что подавляющее большинство пациентов в составе терапии имеют короткодействующие бронхолитики, а более 50% больных получают сочетание КДБА и КДХЛ, и в большинстве случаев это представлено комбинацией фенотерол + ипратропиум. Принимая во внимание, что большинство пациентов с ХОБЛ и  астмой получают пролонгированные бронходилататоры, важным с  практической точки зрения является вопрос об  эффективности применения короткодействующих препаратов на  фоне пролонгированных. В  статье обсуждаются эти аспекты терапии и приводятся свидетельства того, что применение КДБА и КДХЛ предоставляют возможность достижения дополнительной бронходилатации при применении на фоне пролонгированных бронхолитиков. Таким образом, симптоматическое применение КДБА и КДХЛ по потребности при бронхообструктивной патологии имеет достаточное обоснование даже при наличии в терапии пациента комбинации пролонгированных бронходилататоров. При этом необходимо учитывать увеличение вероятности развития побочных эффектов при таком режиме приема препаратов. В  статье также обсуждаются вопросы различных средств доставки короткодействующих бронхолитиков (небулайзеров и дозированных аэрозольных ингаляторов), приводятся данные об их сравнительной эффективности и безопасности. 

Inhaled short-acting bronchodilators (beta-agonists and M-anticholinergics) have been used for a long time in patients with bronchoobstructive diseases, the main representatives of which are chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA). Given the fact that most patients with COPD and BA are treated with long-acting bronchodilators, the question arises about the place of short-acting drugs in modern treatment algorithms for bronchoobstructive pathology. The data on how many patients take short-acting beta-agonists and M- anticholinergics in real-life clinical practice, and how appropriate it is to use these drugs on top of prolonged drugs are provided. The Russian part of the international POPE-study analyzed the characteristics of outpatients with COPD. It was found that the vast majority of patients have short-acting bronchodilators as part of their therapy, and more than 50% of patients receive a combination of SABA and SAAC, and in most cases this is represented by a combination of fenoterol + ipratropium. Taking into account that the majority of patients with COPD and asthma receive prolonged bronchodilators, important from a practical point of view is the question of the effectiveness of short-acting drugs on the background of prolonged ones. The article discusses these aspects of therapy and provides evidence that the use of SABA and SAAC provides an opportunity to achieve additional bronchodilatation when used against the background of prolonged bronchodilators. Thus, symptomatic use of SABA and SAAC on demand in bronchoobstructive pathology have sufficient justification even in the presence of a combination of prolonged bronchodilators in patient therapy. At the same time, it is necessary to take into account the increased probability of side effects with such drug regimen. The article also discusses the issues of different types of inhalation devices for short-acting bronchodilators (nebulizers and metered-dose aerosol inhalers), provides data on their comparative effectiveness and safety. 

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