medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-16-52-59medsovet-6460Research ArticleАКТУАЛЬНОЕ В ПУЛЬМОНОЛОГИИКомбинированная терапия ингаляционными глюкокортикостероидами и длительно действующими β2-агонистами больных бронхиальной астмой: проблема выбораCombined therapy with inhaled glucocorticosteroids and long-acting β2-agonists in patients with bronchial asthma: the problem of choicehttps://orcid.org/0000-0002-1990-2042СинопальниковА. И.SinopalnikovA. I.

Синопальников Александр Игоревич, д.м.н., профессор, заведующий кафедрой пульмонологии

125993, Россия, Москва, ул. Баррикадная, д. 2/1, стр. 1

Alexander I. Sinopalnikov, Dr. Sci. (Med.), Professor, Head of the Department of Pulmonology

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993, Russia

aisyn@list.ruРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuous Professional EducationRussian Federation2021291020210165259Copyright © Синопальников А.И., 20212021Синопальников 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/6460

Бронхиальная астма (БА) остается одним из наиболее распространенных хронических заболеваний органов дыхания. Очевидная гетерогенность БА лежит в основе концепции фенотип-специфической или пациент-ориентированной терапии. Однако в реальной клинической практике БА продолжает рассматриваться как достаточно однородное патологическое состояние, и при ее лечении в подавляющем большинстве случаев сохраняется эмпирической подход, основу которого составляют ингаляционные глюкокортикостероиды (ИГКС), как правило, в комбинации с длительно действующими β2-агонистами (ДДБА). Поскольку данная группа лекарственных средств весьма представительна, перед врачом стоит вопрос о выборе оптимального препарата. Основой доказательной медицины является иерархическая классификация, где систематические обзоры, метаанализы и рандомизированные клинические исследования рассматриваются как наивысший уровень доказательств. Поскольку рандомизированные клинические исследования проводятся в тщательно отобранных высоко селективных популяциях пациентов, они в малой степени соответствуют больным, встречающимся в повседневной клинической практике. В отличие от них, прагматичные рандомизированные клинические исследования позволяют оценить клиническую эффективность исследуемого средства в большой, специально не отбираемой популяции, куда оказываются включенными и пациенты с сопутствующими заболеваниями. В этом контексте Солфордское исследование легких (SLS) представляет особый интерес. Оно было проведено до регистрации нового комбинированного препарата, содержащего современный ИГКС флутиказона фуроат и ДДБА вилантерол. Результаты SLS свидетельствовали не только о том, что применение флутиказона фуроата и вилантерола обеспечивает лучший контроль БА по сравнению с продолжающейся обычной терапией (ИГКС ± ДДБА) больных с симптоматическим течением заболевания, но и приводит к последовательному улучшению суррогатных параметров качества жизни.

Bronchial asthma remains one of the most common chronic respiratory diseases. The apparent heterogeneity of BA underlies the concept of phenotype-specific or patient-centered therapy. However, in real clinical practice, BA continues to be regarded as a rather homogeneous pathological condition and its treatment in the vast majority of cases retains an empirical approach, the basis of which are inhaled glucocorticosteroids, usually in combination with long-acting beta2-agonists. Since this group of drugs is very representative, the physician is faced with the question of choosing the optimal drug. The basis of evidence-based medicine is a hierarchical classification, where systematic reviews, meta-analyses, and randomized clinical trials are considered the highest level of evidence. Because randomized clinical trials are conducted in carefully selected highly selected patient populations, they have little relevance to patients encountered in everyday clinical practice. In contrast, pragmatic randomized clinical trials assess the clinical efficacy of the investigational agent in a large, unselected population in which patients with comorbidities are included. In this context, the Salford Lung Study (SLS) is of particular interest. It was conducted before the registration of a new combination drug containing the modern ICS fluticasone furoate and the long-acting beta2-agonist vilanterol. The SLS results indicated not only that the use of fluticasone furoate with vilanterol provides better control of BA compared to continued "conventional therapy" (ICS ± LABAs) in symptomatic patients, but also leads to a consistent improvement in the surrogate parameters of quality of life.

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