medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-18-49-54medsovet-7119Research ArticleХРОНИЧЕСКИЕ ЗАБОЛЕВАНИЯ ЛЕГКИХCHRONIC PULMONARY DISEASESДвойная бронхолитическая комбинация умеклидиния/вилантерола в терапии ХОБЛ: вопросы эффективности и безопасностиDouble broncholytic combination of umeclidnium/ vilanterol in COPD therapy: issues of efficacy and safetyhttps://orcid.org/0000-0002-1562-6386КняжескаяН. П.KnyazheskayaN. P.

Княжеская Надежда Павловна, кандидат медицинских наук, доцент, доцент кафедры пульмонологии

117997, Москва, ул. Островитянова, д. 1

Nadezhda P. Knyazheskaya, Cand. Sci.  (Med.), Associate Professor, Associate Professor of  the Department of  Pulmonology

1, Ostrovityanov St., Moscow, 117997

kniajeskaia@mail.ruhttps://orcid.org/0000-0003-3672-9242АнаевЭ. Х.AnaevE. Кh.

Анаев Эльдар Хусеевич, доктор медицинских наук, профессор кафедры пульмонологии факультета дополнительного профессионального образования

117997, Москва, ул. Островитянова, д. 1

Eldar Кh. Anaev, Dr. Sci. (Med.), Professor of the Department of Pulmonology, Faculty of Additional Professional Education

1, Ostrovityanov St., Moscow, 117997

el_anaev@hotmail.comhttps://orcid.org/0000-0001-6050-724XБелевскийА. С.BelevskiyA. S.

Белевский Андрей Станиславович, доктор медицинских наук, профессор, заведующий кафедрой пульмонологии факультета дополнительного профессионального образования

117997, Москва, ул. Островитянова, д. 1

Andrey S. Belevskiy, Dr. Sci. (Med.), Professor, Head of the Department of Pulmonology, Faculty of Additional Professional Education

1, Ostrovityanov St., Moscow, 117997

pulmobas@yandex.ruhttps://orcid.org/0000-0003-4913-087XМакароваМ. А.MakarovaM. A.

Макарова Марина Алексеевна, доцент кафедры пульмонологии

117997, Москва, ул. Островитянова, д. 1

Marina A. Makarova, Associate Professor of the Department of Pulmonology

1, Ostrovityanov St., Moscow, 117997

 

mma123@list.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation20221410202216184954Copyright © Княжеская Н.П., Анаев Э.Х., Белевский А.С., Макарова М.А., 20222022Княжеская Н.П., Анаев Э.Х., Белевский А.С., Макарова М.А.Knyazheskaya N.P., Anaev E.К., Belevskiy A.S., Makarova M.A.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/7119

Хроническая обструктивная болезнь легких (ХОБЛ) – заболевание, характеризующееся ограничением скорости воздушного потока, которое обратимо не полностью, обычно прогрессирует и связано с воспалительным ответом легких на патогенные частицы или газы, причем основной причиной является курение табака. ХОБЛ приводит к ряду значимых системных эффектов, которые могут усугублять течение болезни. Важно, что ХОБЛ можно предупреждать и лечить. Глобальная стратегия диагностики, лечения и профилактики ХОБЛ (GOLD) рассматривает ингаляционные бронхолитики длительного действия в качестве основы поддерживающей терапии. GOLD рекомендует применение как длительно действующих антихолинергических препаратов (ДДАХ), так и длительно действующих β2 -агонистов (ДДБА) у всех категорий больных, в т. ч. в качестве первой линии у лиц с выраженными симптомами и низким риском обострений. В рекомендациях GOLD 2020 г. отмечено, что пациенты с выраженными симптомами, без риска обострений нуждаются в максимальной бронходилатации. ДДАХ и ДДБА показаны для уменьшения выраженности и профилактики симптомов, что не исключает вероятность и профилактики обострений. Использование комбинированных бронхолитиков длительного действия позволяет уменьшать выраженность одышки и других симптомов заболевания, а также увеличивает толерантность к физической нагрузке. Отдельные компоненты имеют разные точки приложения: ДДАХ ингибируют воздействие ацетилхолина преимущественно на М1- и М3-мускариновые рецепторы, ДДБА стимулируют β2 -адренорецепторы, увеличивая содержание внутриклеточного циклического аденозина монофосфата и вызывая бронходилатацию. Оба класса препаратов потенцируют активность друг друга, увеличивая релаксирующее действие на гладкую мускулатуру бронхов.

Inhaled bronchodilators are the basis of pharmacological therapy of chronic obstructive pulmonary disease. Bronchodilation can be reached in two different ways: by stimulation of β2 -adrenoreceptors and inhibition of M3-cholinoreceptors. Combined long acting bronchodilators show additional effect on lung function and clinical outcomes of the disease. This article covers the issues of efficacy and safety of different combined bronchodilators. Chronic obstructive pulmonary disease (COPD) is a disease characterized by the limitation of air flow velocity, which is reversible incompletely. The restriction of air flow velocity is usually progressive and is associated with inflammatory response of the lungs to pathogenic particles or gases, with tobacco smoking being the main cause. COPD leads to a number of significant systemic effects that can worsen the course of the disease. It is important that COPD can be prevented and treated. The Global Strategy for the Diagnosis, Treatment and Prevention of Chronic Obstructive Pulmonary Disease  (GOLD) considers long-acting inhaled bronchodilators as the  basis for  long-term maintenance therapy of  chronic obstructive pulmonary disease. GOLD recommends the  use of  both long-acting anticholinergic drugs  (LAMA) and long-acting β2-agonists (LABA) in all categories of patients, including as the first line in people with severe symptoms and low risk of exacerbations. bronchodilators reduce the severity of shortness of breath and other symptoms of the disease, and also increase exercise tolerance. The individual components have different application points: LAMA inhibit the effect of acetylcholine mainly on M1- and M3-muscarinic receptors, LABA stimulate β2-adrenergic receptors, increasing the content of intracellular cAMP and causing bronchodilation. Both classes of drugs potentiate each other’s activity, increasing the relaxing effect on the smooth muscles of the bronchi.

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