Роль пикового инспираторного потока в подборе ингаляционной терапии у пациентов с хронической обструктивной болезнью легких

В фармакотерапии хронической обструктивной болезни легких (ХОБЛ) основополагающую роль играет ингаляционная терапия. Выбор подходящего ингаляционного устройства влияет на частоту ошибок в технике ингаляций, приверженность лечению и общую эффективность терапии. Дозированные порошковые ингаляторы (ДПИ) имеют внутреннее сопротивление устройства, которое необходимо преодолеть пациенту для его активации. Пиковый инспираторный поток (ПИП) представляет собой максимальную скорость воздушного потока, генерируемую пациентом во время вдоха, и измеряется в литрах в минуту. Достаточный ПИП является необходимым условием эффективного использования ДПИ у пациентов с ХОБЛ. Для большинства ДПИ оптимальным считается значение ПИП не менее 60 л/мин, в то время как при ПИП менее 30 л/мин лекарственное средство не сможет достичь нижних дыхательных путей. В то же время клиническая эффективность использования ДПИ при значениях ПИП от 30 до 60 л/мин может быть недостаточной, поэтому необходимо учитывать значение ПИП для подбора базисной терапии ХОБЛ. Принимая во внимание отсутствие портативных флоуметров у врачей, в условиях реальной клинической практики имеет значение выявление факторов риска субоптимального ПИП у пациентов с ХОБЛ. В группу риска по недостаточному значению ПИП для дальнейшего эффективного использования ДПИ входят пациенты с эмфиземой, легочной гиперинфляцией, пожилого возраста, женского пола, с низким ростом, ожирением и наличием сопутствующих заболеваний. В данном обзоре приведены основные сведения о методике измерения ПИП, предикторах субоптимального ПИП, предлагаются рекомендации по выбору ингаляционных устройств для пациентов с ХОБЛ в зависимости от значений ПИП.

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