medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-453medsovet-8600Research ArticleХРОНИЧЕСКИЕ ЗАБОЛЕВАНИЯ ЛЕГКИХCHRONIC PULMONARY DISEASESСтабильность фенотипов тяжелой бронхиальной астмыStability of severe asthma phenotypeshttps://orcid.org/0000-0003-1544-4336СергееваГ. Р.SergeevaG. R.

Сергеева Галина Раисовна - к.м.н., доцент кафедры пульмонологии.

191015, Санкт-Петербург, ул. Кирочная, д. 41

Galina R. Sergeeva - Cand. Sci. (Med.), Associate Professor of the Department of Pulmonology, North-Western State Medical University named after I.I. Mechnikov.

41, Kirochnaya St., St Petersburg, 191015

sergeevagr@mail.ruhttps://orcid.org/0000-0002-8574-6869ЕмельяновА. В.EmelyanovA. V.

Емельянов Александр Викторович - д.м.н., профессор, заведующий кафедрой пульмонологии.

191015, Санкт-Петербург, ул. Кирочная, д. 41

Aleksandr V. Emelyanov - Dr. Sci. (Med.), Professor, Head of the Department of Pulmonology, North-Western State Medical University named after I.I. Mechnikov.

41, Kirochnaya St., St Petersburg, 191015

emelav@inbox.ruСеверо-Западный государственный медицинский университет имени И.И. МечниковаРоссияNorth-Western State Medical University named after I.I. MechnikovRussian Federation2024241020240206068Copyright © Сергеева Г.Р., Емельянов А.В., 20242024Сергеева Г.Р., Емельянов А.В.Sergeeva G.R., Emelyanov A.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/8600Введение

Введение. Тяжелая бронхиальная астма (ТБА) является гетерогенным заболеванием, при котором выявляются различные фенотипы. Их стабильность изучена недостаточно.

Цель

Цель. Оценить стабильность различных фенотипов ТБА у взрослых пациентов в ходе проспективного исследования.

Материалы и методы

Материалы и методы. В течение 5 лет наблюдались 117 взрослых амбулаторных пациентов с тяжелой аллергической астмой, 51 пациент - с аспириновой ТБА, 59 больных - ТБА с фиксированной обструкцией и 35 пациентов с сочетанием ТБА и хронической обструктивной болезни легких (ХОБЛ), 65 больных - с гормонозависимой ТБА и 89 пациентов, переносивших частые (2 и более в год) обострения ТБА. Выполнялись спирометрия с оценкой обратимости обструкции (спирограф 2120 Vitalograph, Великобритания), оценка атопического статуса (кожные пробы или специфические IgE в сыворотке крови). Содержание эозинофилов в периферической крови (ЭОЗ) определялось импедансным методом на автоматическом гемоанализаторе. Оксид азота выдыхаемого воздуха (FeNO) измерялся на хемилюминисцентном газоанализаторе (Logan 4100, Великобритания). Контроль БА и качество жизни (КЖ) пациентов оценивались при помощи русскоязычных версий теста ACQ-5 и респираторного вопросника госпиталя Святого Георгия. Визиты пациентов проводились каждые 3-6 мес. Статистический анализ проводился с использованием параметрических и непараметрических методов.

Результаты

Результаты. В ходе 5-летнего наблюдения стабильность аспириновой ТБА и сочетания тяжелой астмы с ХОБЛ составила 100%. Стабильность аллергической ТБА отмечена в 81% случаев. Фенотип с фиксированной бронхиальной обструкцией был устойчив у 86% больных. Гормонозависимая тяжелая астма была стабильна в 55%. Частые обострения ТБА через 5 лет сохранялись у 28% пациентов.

Выводы

Выводы. Наиболее стабильными фенотипами ТБА являлись аспириновый и сочетание с ХОБЛ. Менее устойчивы были тяжелая аллергическая, гормонозависимая бронхиальная астма и фенотип с фиксированной бронхиальной обструкцией. Наименее стабильным был фенотип ТБА с частыми обострениями.

Introduction

Introduction. Severe asthma (SA) is a heterogeneous disease with several phenotypes. There are lack of data about its stability.

Aim

Aim. To assess stability of SA phenotypes in adult patients during 5 years follow-up.

Materials and methods

Materials and methods. Prospective study included 117 adult outpatients with allergic SA, 51 severe asthmatics with aspirin- induced disease, 59 patient with persistent airflow limitation (PAL) and 35 patients with SA and concomitant COPD, 65 steroid-dependent severe asthmatics and 89 patients with SA and frequent (>2 per year) exacerbations. Spirometry and bronchodilator reversibility testing were carried out; fractional exhaled nitric oxide (FeNO) was measured; hypersensitivity to common inhalant allergens (skin prick and blood specific IgE testing) and peripheral blood eosinophil counts were estimated. Asthma control and asthma-related quality of life were assessed by using ACQ-5 and SGRQ questionnaire.

Results

Results. During 5-year prospective study stability of aspirin-induced SA and SA with COPD was 100%. Allergic phenotype was stable in 81% of SA cases and in patients with changed atopic status we revealed worsening of symptoms and accelerated lung function decline. Stability of SA phenotype with PAL without COPD was 86% and steroid-dependent SA was stable in 55% of cases. After 5 years of treatment frequent exacerbations remained in 28% of severe asthmatics.

Conclusion

Conclusion. The most stable phenotypes of SA were aspirin-induced and asthma with concomitant COPD. Less stable were allergic SA, steroid-dependent SA and phenotype with persistent airflow limitation. The least stable was SA phenotype with frequent exacerbations.

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