medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-18-20-28medsovet-7116Research ArticleХРОНИЧЕСКИЕ ЗАБОЛЕВАНИЯ ЛЕГКИХCHRONIC PULMONARY DISEASESНовые возможности терапии тяжелой бронхиальной астмыNew options for severe asthmahttps://orcid.org/0000-0001-6896-877XКрапошинаА. Ю.KraposhinaA. Yu.

Крапошина Ангелина Юрьевна, кандидат медицинских наук, доцент, доцент кафедры госпитальной терапии и иммунологии с курсом последипломного образования, Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого; врач-пульмонолог отделения пульмонологии, Краевая клиническая больница

660022, Красноярск, ул. Партизана Железняка, д. 1,

660022, Красноярск, ул. Партизана Железняка, д. 3а

Angelina Yu. Kraposhina, Cand. Sci. (Med.), Associate Professor, Department of hospital therapy and Immunology with Postgraduate Education Course, Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky;

Pulmonologist, Pulmonology Department, Regional Clinical Hospital

1, Partizan Zheleznyak St., Krasnoyarsk, 660022,

3а, Partizan Zheleznyak St., Krasnoyarsk, 660022

angelina-maria@inbox.ruhttps://orcid.org/0000-0002-9377-5213СобкоЕ. А.SobkoE. A.

Собко Елена Альбертовна, доктор медицинских наук, профессор, профессор кафедры госпитальной терапии и иммунологии с курсом последипломного образования, Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого; заведующая отделением аллергологии, Краевая клиническая больница

660022, Красноярск, ул. Партизана Железняка, д. 1,

660022, Красноярск, ул. Партизана Железняка, д. 3а

Elena A. Sobko, Dr. Sci. (Med.), Professor, Department of Hospital Therapy and Immunology with Postgraduate Education Course, Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky; Head of Allergology Department, Regional Clinical Hospital

1, Partizan Zheleznyak St., Krasnoyarsk, 660022,

3а, Partizan Zheleznyak St., Krasnoyarsk, 660022

sobko29@mail.ruhttps://orcid.org/0000-0001-8982-5292ДемкоИ. В.DemkoI. V.

Демко Ирина Владимировна, доктор медицинских наук, профессор, заведующая кафедрой госпитальной терапии и иммунологии с курсом последипломного образования, Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого; заведующая легочно-аллергологическим центром, Краевая клиническая больница

660022, Красноярск, ул. Партизана Железняка, д. 1,

660022, Красноярск, ул. Партизана Железняка, д. 3а

Irina V. Demko, Dr. Sci. (Med.), Professor, Head of Department of Hospital Therapy and Immunology with Postgraduate Education Course, Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky; Head of Pulmonary Allergology Сenter, Regional Clinical Hospital

1, Partizan Zheleznyak St., Krasnoyarsk, 660022,

3а, Partizan Zheleznyak St., Krasnoyarsk, 660022

demko64@mail.ruhttps://orcid.org/0000-0002-6649-8900КацерА. Б.KatserA. B.

Кацер Анна Борисовна, ординатор кафедры госпитальной терапии и иммунологии с курсом последипломного образования

660022, Красноярск, ул. Партизана Железняка, д. 1

Anna B. Katser, Intern, Department of  Hospital Therapy and Immunology with Postgraduate Education Course

1, Partizan Zheleznyak St., Krasnoyarsk, 660022

lesmotsfors@mail.ruhttps://orcid.org/0000-0001-7999-4113КазмерчукО. В.KazmerchukO. V.

Казмерчук Ольга Витальевна, ординатор кафедры госпитальной терапии и иммунологии с курсом последипломного образования

660022, Красноярск, ул. Партизана Железняка, д. 1

Olga V. Kazmerchuk, Intern, Department of Hospital Therapy and Immunology with Postgraduate Education Course

1, Partizan Zheleznyak St., Krasnoyarsk, 660022

olguna24@mail.ruhttps://orcid.org/0000-0002-9937-1025АбрамовЮ. И.AbramovYu. I.

Абрамов Юрий Игоревич, научный сотрудник кафедры госпитальной терапии и иммунологии с курсом последипломного образования

660022, Красноярск, ул. Партизана Железняка, д. 1

Yuriy I. Abramov, Research Associate, Department of Hospital Therapy and Immunology with Postgraduate Education Course

1, Partizan Zheleznyak St., Krasnoyarsk, 660022

yuriyab1997@gmail.comhttps://orcid.org/0000-0002-8832-811XЧубароваС. В.ChubarovaS. V.

Чубарова Светлана Владимировна, кандидат медицинских наук, доцент кафедры госпитальной терапии и иммунологии с курсом последипломного образования

660022, Красноярск, ул. Партизана Железняка, д. 1

Svetlana V. Chubarova, Cand. Sci. (Med.), Associate Professor, Department of Hospital Therapy and Immunology with Postgraduate Education Course

1, Partizan Zheleznyak St., Krasnoyarsk, 660022

svetachubarova@mail.ruКрасноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого; Краевая клиническая больницаРоссияKrasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky; Regional Clinical HospitalRussian FederationКрасноярский государственный медицинский университет имени профессора В.Ф. Войно-ЯсенецкогоРоссияKrasnoyarsk State Medical University named after Professor V.F. Voino-YasenetskyRussian Federation20221410202216182028Copyright © Крапошина А.Ю., Собко Е.А., Демко И.В., Кацер А.Б., Казмерчук О.В., Абрамов Ю.И., Чубарова С.В., 20222022Крапошина А.Ю., Собко Е.А., Демко И.В., Кацер А.Б., Казмерчук О.В., Абрамов Ю.И., Чубарова С.В.Kraposhina A.Y., Sobko E.A., Demko I.V., Katser A.B., Kazmerchuk O.V., Abramov Y.I., Chubarova S.V.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/7116

В обзоре приведены современные данные о новых возможностях терапии тяжелой бронхиальной астмы (БА). Распространенность тяжелой астмы составляет от 3 до 10%, но именно для лечения данной группы пациентов расходуется более 80% средств, выделяемых на лечение заболевания в целом. Пациенты c тяжелой БА составляют особую категорию, так как традиционная терапия, эффективная у большинства больных БА, не позволяет контролировать заболевание. Гетерогенность и многоликость заболевания диктуют необходимость разработки персонифицированного подхода, который невозможен без значительных финансовых и кадровых вложений. Понимание патогенетических путей, лежащих в основе развития воспаления при астме, явилось толчком к разработке таргетной терапии. Было разработано и одобрено пять генноинженерных иммунобиологических препаратов для пациентов с тяжелой аллергической и (или) эозинофильной БА. Выбор правильного лекарства должен зависеть от правильного диагноза тяжелой астмы, понимания эндотипа пациента и учета специфических для него факторов. Стоит отметить, что все одобренные биопрепараты и большинство находящихся в настоящее время в разработке сосредоточены на Т2-иммунном ответе. Безусловно, существует огромный пул пациентов, у которых регистрируется другой тип воспаления. И поэтому, несмотря на быстрое развитие знаний в области таргетной терапии БА, необходимы дальнейшая расшифровка и углубление знаний о патофизиологических механизмах, в частности не Т2-воспаления, а также анализ опыта применения существующих препаратов для четкого понимания показаний и оценки эффективности и безопасности существующих методов лечения.

 

 

The review provides current data on new options for the treatment of severe bronchial asthma. The prevalence of severe asthma ranges from 3% to 10%, but it is for the treatment of this group of patients that more than 80% of the funds allocated for the treatment of the disease as a whole are spent. Patients with severe bronchial asthma make up a special category, since traditional therapy, effective in most patients with bronchial asthma, does not allow controlling the disease. Heterogeneity and multivariate disease dictate the need to develop a personalized approach, which is impossible without significant financial and personnel investments. Understanding the pathogenetic pathways underlying the development of inflammation in asthma was the impetus for  the development of  targeted therapies. Five genetically engineered immunobiological drugs have been developed and approved for  patients with severe allergic and/or eosinophilic bronchial asthma. The choice of  the right medication should depend on the correct diagnosis of severe asthma, understanding the patient’s endotype, and accounting for patient-specific factors. It is worth noting that all approved biologics and most biologics currently in development focus on T2-immune response. To be sure, there is a huge pool of patients who register a different type of inflammation. And therefore, despite the rapid development of knowledge in the field of targeted therapy of bronchial asthma, further decoding and deepening of knowledge about the pathophysiological mechanisms, in particular non-T2 inflammation, as well as an analysis of the experience of using existing drugs to clearly understand the indications, as well as to assess the effectiveness and safety of existing treatments.

 

 

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