medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-302medsovet-7883Research ArticleХРОНИЧЕСКИЕ ЗАБОЛЕВАНИЯ ЛЕГКИХCHRONIC PULMONARY DISEASESКомбинированная терапия бронхообструктивной патологии: два решения одной проблемыCombined therapy of broncho-obstructive pathology: two solutions to one problemhttps://orcid.org/0000-0001-5028-5276ВизельА. А.VizelA. A.

Визель Александр Андреевич, доктор медицинских наук, профессор, заведующий кафедрой фтизиопульмонологии

420012, Казань, ул. Бутлерова, д. 49

SPIN-код: 5918-5465;

Author ID: 195 447

Alexander A. Vizel, Dr. Sci. (Med.), Professor, Head Department

49, Butlerov St., Kazan, 420012

lordara@inbox.ruhttps://orcid.org/0000-0002-8855-8177ВизельИ. Ю.VizelI. Yu.

Визель Ирина Юрьевна, доктор медицинских наук, профессор РАЕ, доцент кафедры фтизиопульмонологии

420012, Казань, ул. Бутлерова, д. 49

SPIN-код: 6000-3813;

Author ID: 246946

Irina Yu. Vizel, Dr. Sci. (Med.), Professor of RAE, Associate Professor of the Department of Phthisiopulmonology

49, Butlerov St., Kazan, 420012

tatpulmo@mail.ruКазанский государственный медицинский университетРоссияKazan State Medical UniversityRussian Federation2023151120230202835Copyright © Визель А.А., Визель И.Ю., 20232023Визель А.А., Визель И.Ю.Vizel A.A., Vizel I.Y.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/7883

Хронические бронхообструктивные заболевания легких: бронхиальная астма (БА) и хроническая обструктивная болезнь легких (ХОБЛ) – являются серьезной проблемой и экономическим бременем для практического здравоохранения. Цель научного обзора – отследить эволюцию взглядов на применение бронхолитиков и ингаляционных кортикостероидов (ИГКС) при этих заболеваниях и проанализировать современные подходы к лечению, основанные на отечественных и международных рекомендательных документах. Лечение ХОБЛ направлено на два патогенетических компонента – воспаление бронхов и формирование эмфиземы. Основой базисной терапии остается применение бронхолитиков длительного действия двух классов. Применение бронхолитиков длительного действия при лечении БА направлено прежде всего на купирование хронического воспаления дыхательных путей. Основой базисной терапии БА является применение ингаляционных глюкокортикостероидов. В настоящее время как при БА, так и при ХОБЛ рекомендованы одинаковые комбинации бронхолитиков и ИГКС. Одно направление основано на применении ИГКС с формотеролом, препаратом 12-часового действия и быстрым началом, при котором препарат может применяться по потребности. Второе направление основано на постоянном приеме ИГКС/ДДБА только на регулярной основе, но с возможностью применять бронхолитики по потребности. При этом чаще применяются ИГКС с высокой аффинностью. Важным компонентом лечения являются приверженность врачебным назначениям и доступность препаратов разных типов для пациентов в реальной клинической практике. В настоящее время в России созданы условия для реализации лечения пациентов как с БА, так и ХОБЛ с частыми обострениями и эозинофилией на основании импортозамещения современными препаратами.

Chronic broncho-obstructive pulmonary diseases – bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) – are a serious clinical problem and an economic burden for practical healthcare. The purpose of the scientific review is to track the evolution of views on the use of bronchodilators and inhaled corticosteroids (ICS) in these diseases and to analyze modern approaches to treatment based on domestic and international guidelines. COPD treatment is aimed at two pathogenetic components – inflammation of the bronchi and the formation of emphysema. The basis of basic therapy remains the use of long-acting bronchodilators of two classes. Treatment of asthma is directed primarily at chronic inflammation of the airways using long-acting bronchodilators. The basis of basic therapy for asthma is the use of inhaled glucocorticosteroids. Currently, the same combinations of bronchodilators and ICS are recommended for both asthma and COPD. One direction is based on the use of ICS with formoterol, a 12-hour drug with a fast onset, in which the drug can be used on demand. The second direction is based on the constant use of ICS/LABA only on a regular basis, but with the ability to use bronchodilators on demand. In this case, ICS with high affinity are more often used. An important component of treatment is adherence to medical prescriptions and the availability of different types of drugs for patients in real clinical practice. At present, conditions have been created in Russia for the implementation of both the treatment of patients with asthma and the treatment of patients with COPD with frequent exacerbations and eosinophilia based on import substitution with modern drugs.

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