medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-461medsovet-8601Research ArticleХРОНИЧЕСКИЕ ЗАБОЛЕВАНИЯ ЛЕГКИХCHRONIC PULMONARY DISEASESФенотипы и эндотипы тяжелой бронхиальной астмыSevere asthma phenotypes and endotypeshttps://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

Alexander 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 Federation2024241020240205259Copyright © 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/8601Введение

Введение. Тяжелая бронхиальная астма (ТБА) является гетерогенным заболеванием, при котором выявляются различные фенотипы и эндотипы. Частота фенотипов и эндотипов ТБА среди российских пациентов изучена недостаточно.

Цель

Цель. Оценить частоту различных фенотипов и эндотипов ТБА по сравнению с БА легкой и средней тяжести течения.

Материалы и методы

Материалы и методы. В поперечное одномоментное исследование включены 643 амбулаторных пациента с БА легкой и средней степени тяжести и 314 больных ТБА в возрасте 18-90 лет. Исследование функции легких выполняли методом спирометрии (спирограф 2120 Vitalograph, Великобритания). Оценка чувствительности к ингаляционным аллергенам осуществлялась с помощью кожных проб и/или уровней специфических IgE в крови. Содержание эозинофилов в периферической крови (ЭОЗ) определялось на автоматическом гемоанализаторе. Оксид азота выдыхаемого воздуха (FeNO) измерялся на хемилюминисцентном газоанализаторе (Logan 4100, Великобритания). Контроль БА и качество жизни пациентов оценивались при помощи русскоязычных версий теста ACQ-5 и респираторного вопросника госпиталя Святого Георгия.

Результаты

Результаты. Аллергический фенотип при ТБА диагностирован реже, чем при БА легкой и средней степени тяжести. У больных ТБА чаще, чем при нетяжелой БА, выявлялись аспириновая астма, гормонозависимая астма, астма с фиксированной бронхиальной обструкцией (ФО) и сочетанием с хронической обструктивной болезнью легких (ХОБЛ), а также астма с ожирением и поздним началом. У подавляющего числа больных ТБА имелось сочетание нескольких фенотипов, в среднем 3 фенотипа. Среди больных ТБА 94% имели хотя бы один маркер Т2-воспаления.

Выводы

Выводы. Наиболее частыми фенотипами ТБА являются аллергический, с ФО, ожирением, а также с сопутствующей ХОБЛ. Встречаемость фенотипов при тяжелой астме отличается от БА легкого и среднетяжелого течения. Подавляющее большинство пациентов с ТБА имеют сочетание нескольких фенотипов. Наиболее часто при ТБА отмечается Т2-эндотип заболевания.

Introduction

Introduction. Severe asthma is a heterogeneous disease with several phenotypes and endotypes. However, little is known about frequency of severe asthma phenotypes and endotypes in Russia.

Aim

Aim. To assess frequency of severe asthma phenotypes and endotypes compared with mild/moderate asthma.

Materials and methods

Materials and methods. Cross-sectional single center study included 643 adult outpatients with mild/moderate asthma and 314 patients with severe asthma (SA) aged 18-90 years. Spirometry and bronchodilator reversibility testing were carried out. Fractional exhaled nitric oxide (FeNO) was measured by a chemiluminescent analyzer (logan 4100, UK). Hypersensitivity to common inhalant allergen was assessed by skin prick and blood specific IgE level. Peripheral blood eosinophil counts were measured by automatic analyzer. Asthma control and asthma-related quality of life were assessed by using ACQ-5 and SGRQ.

Results

Results. Allergic phenotype was more frequent in patients with mild/moderate asthma than in those with SA, but aspirin- induced asthma, steroid-dependent asthma, asthma with persistent airflow limitation and concomitant COPD, asthma with late onset and obesity were more frequent in SA. The majority of patients with SA had several phenotypes (mean 3 phenotypes) and at least one marker of T2-high endotype.

Conclusion

Conclusion. The most frequent phenotypes of SA were allergic, with persistent airflow limitation, with concomitant obesity and COPD. Occurrence of asthma phenotypes differed between patients with SA and mild/moderate asthma. The majority of SA patients have T2-endotype.

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