COVID-19 как фактор риска развития и ухудшения течения бронхиальной астмы

Бронхиальная астма (БА) является одним из наиболее распространенных хронических заболеваний органов дыхания во всем мире. В России распространенность БА среди взрослого населения составляет 6,9%. Его патогенез связан с комплексным взаимодействием генетических, экологических и иммунных факторов, среди которых важную роль играют острые респираторные вирусные инфекции (ОРВИ). Эти патогены способны повреждать эпителий дыхательных путей, запуская хроническое воспаление, индуцировать T2-иммунный ответ с гиперпродукцией интерлейкина-4 (ИЛ), ИЛ-5 и ИЛ-13. Пандемия COVID-19, вызванная новой коронавирусной инфекцией SARS-CoV-2, актуализировала вопрос о долгосрочных последствиях инфекции, включая риск развития новых случаев астмы и ухудшения течения уже диагностированной БА. Вирусиндуцированное воспаление дыхательных путей, опосредованное иммунными механизмами 2-го типа (T2-воспаление), может играть ключевую роль в патогенезе астмы в постковидном периоде. В поддержку этой гипотезы недавние ретроспективные исследования показали, что у взрослых пациентов риск обострения астмы, требующего усиления поддерживающей терапии, может сохраняться в среднем в течение 6–14 мес. после COVID-19. Полученные результаты свидетельствуют о том, что значительная часть пациентов с астмой может столкнуться с потерей контроля над астмой после COVID-19, что может привести к повышенному долгосрочному риску тяжелого обострения (требующего госпитализации) и смертности. На настоящий момент данных о долгосрочных эффектах SARS-CoV-2 на иммунные пути, регулирующие T2-воспаление, роли интерлейкина-13 (ИЛ) в персистенции постковидных респираторных симптомов, эффективности биологической терапии (например, анти-ИЛ-13/ИЛ-4) для профилактики астмы после COVID-19, а также о влиянии COVID-19 на долгосрочный риск тяжелых обострений и смертности недостаточно. Данный обзор интегрирует результаты молекулярных, иммунологических и клинических исследований, предлагая комплексный взгляд на проблему.

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