pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2019-29-3-334-345pulmo-1177Research ArticleОБЗОРЫREVIEWОтмена ингаляционных глюкокортикостероидов у пациентов с хронической обструктивной болезнью легкихWithdrawal of inhaled corticosteroids in patients with chronic obstructive pulmonary diseasehttps://orcid.org/0000-0002-5999-2150АвдеевС. Н.AvdeevS. N.

д. м. н., член-корр. Российской академии наук, профессор, заведующий кафедрой пульмонологии, 119991, Москва, ул. Трубецкая, 8, стр. 2;

руководитель клинического отдела, 115682, Москва, Ореховый бульвар, 28

Doctor of Medicine, Professor, Corresponding Member of Russian Academy of Sciences, Head of Department of Pulmonology, ul. Trubetskaya 8, build. 2, Moscow, 119991;

Head of Clinical Division, Orekhovyy bul'var 28, Moscow, 115682

serg_avdeev@list.ruhttps://orcid.org/0000-0002-4044-674XАйсановЗ. Р.AisanovZ. R.

д. м. н., профессор кафедры пульмонологии,

117997, Москва, ул. Островитянова, 1

Doctor of Medicine, Professor, Department of Pulmonology,

ul. Ostrovityanova 1, Moscow, 117997

aisanov@mail.ruhttps://orcid.org/0000-0002-5671-3478АрхиповВ. В.ArkhipovV. V.

д. м. н., профессор кафедры клинической фармакологии и терапии, 

123995, Москва, ул. Баррикадная, 2, стр. 1

Doctor of Medicine, Professor, Department of Clinical Pharmacology and Therapy,

ul. Barrikadnaya 2/1, Moscow, 123995

arkhipov@gmx.ushttps://orcid.org/0000-0001-6050-724XБелевскийА. С.BelevskiyA. S.

д. м. н., профессор, заведующий кафедрой пульмонологии,

117997, Москва, ул. Островитянова, 1

Doctor of Medicine, Professor, Head of Department of Pulmonology,

ul. Ostrovityanova 1, Moscow, 117997

pulmobas@yandex.ruhttps://orcid.org/0000-0002-1620-7159ЛещенкоИ. В.LeshchenkoI. V.

д. м. н., профессор кафедры фтизиатрии, пульмонологии и торакальной хирургии,

620028, Екатеринбург, ул. Репина, 3

Doctor of Medicine, Professor, Department of Phthisiology, Pulmonology and Thoracic Surgery,

ul. Repina 3, Ekaterinburg, 620028

leshchenkoiv@mail.ruhttps://orcid.org/0000-0002-8264-6635ОвчаренкоС. И.OvcharenkoS. I.

д. м. н., профессор кафедры факультетской терапии № 1 лечебного факультета,

119991, Москва, ул. Трубецкая, 8, стр. 2

Doctor of Medicine, Professor, Department No.1 of General Internal Medicine, Medical Faculty,

ul. Trubetskaya 8, build. 2, Moscow, 119991

svetftk@mail.ruhttps://orcid.org/0000-0002-1908-5601ШмелевЕ. И.ShmelevE. I.

д. м. н., профессор, заведующий отделом дифференциальной диагностики туберкулеза легких и экстракорпоральных методов лечения,

107564, Москва, Яузская аллея, 2

Doctor of Medicine, Professor, Head of Division of Differential Diagnosis of Tuberculosis and Extracorporeal Therapeutic Methods,

Yauzskaya alleya 2, Moscow, 107564

eishmelev@mail.ruhttps://orcid.org/0000-0002-9850-9520MиравитлсМ.MiravitlsM.

доктор медицины, профессор,

Барселона

Doctor of Medicine, Professor, Pneumology Department,

Barcelona

mmiravitlles@vhebron.netФедеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М.Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет); Федеральное государственное бюджетное учреждение «Научно-исследовательский институт пульмонологии» Федерального медико-биологического агентстваРоссияI.M.Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia; Federal Pulmonology Research Institute, Federal Medical and Biological Agency of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И.Пирогова» Министерства здравоохранения Российской ФедерацииРоссияN N.I.Pirogov Federal Russian National Research Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияRussian Federal Academy of Continued Medical Education, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Уральский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияUral Federal State Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М.Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияI.M.Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное научное учреждение «Центральный научно-исследовательский институт туберкулеза»РоссияFederal Central Research Institute of Tuberculosis, Russian Academy of ScienceRussian FederationУниверситетская клиника Валь д'Эброн, Научно-исследовательский институт Валь д'Эброн (VHIR), Ciber de Enfermedades Respiratorias (CIBERES)ИспанияUniversity Hospital Vall d’Hebron/Vall d’Hebron Research Institute (VHIR), Ciber de Enfermedades Respiratorias (CIBERES)Spain201917082019293334345Copyright © Авдеев С.Н., Айсанов З.Р., Архипов В.В., Белевский А.С., Лещенко И.В., Овчаренко С.И., Шмелев Е.И., Mиравитлс М., 20192019Авдеев С.Н., Айсанов З.Р., Архипов В.В., Белевский А.С., Лещенко И.В., Овчаренко С.И., Шмелев Е.И., Mиравитлс М.Avdeev S.N., Aisanov Z.R., Arkhipov V.V., Belevskiy A.S., Leshchenko I.V., Ovcharenko S.I., Shmelev E.I., Miravitls M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/1177

Роль ингаляционных глюкокортикостероидов (иГКС) в терапии пациентов с хронической обструктивной болезнью легких (ХОБЛ) в со - временных клинических рекомендациях ограничена. Хотя оптимальное соотношение польза / риск и может быть достигнуто в специфических популяциях этих больных, однако в реальной клинической практике врачи зачастую не следуют клиническим рекомендациям и многие пациенты с ХОБЛ получают иГКС необоснованно. Наряду с отсутствием эффективности применение иГКС может быть связано с возможными рисками, которые могут превосходить потенциальную пользу от применения препаратов этого класса у больных ХОБЛ. Эти данные диктуют необходимость разработки простого и удобного алгоритма для врачей по отмене иГКС у пациентов, которым применение препаратов этого класса не показано. В настоящей статье анализируются исследования, посвященные эффективности и безопасности иГКС, а также доступные данные по отмене иГКС у пациентов с ХОБЛ. На основании актуальных данных международной группой экспертов разработан простой и удобный алгоритм по отмене иГКС у больных ХОБЛ.

According to current clinical guidelines, a role of inhaled corticosteroids (ICS) in the management of patients with COPD is limited. The optimal benefit/risk ratio could be achieved only in specific populations of patients with COPD. In a real life, physicians often do not follow clinical guidelines, and ICS are overprescribed. In addition to the lack of effectiveness, there are possible risks of ICS use. Regarding to this, there is a need to develop a simple and convenient algorithm for ICS withdrawal in the population of COPD patients who do not fit criteria for therapy with ICS. Clinical studies on efficacy and safety of ICS and available data on ICS withdrawal in patients with COPD are analyzed in this article. An international expert panel developed a simple and convenient algorithm for withdrawal of ICS in patients with COPD based on published data.

хроническая обструктивная болезнь легкихингаляционные препаратыингаляционные глюкокортикостероидыотмена ингаляционных глюкокортикостероидовбронходилататоры длительного действияалгоритм отмены ингаляционных глюкокортикостероидовchronic obstructive pulmonary diseaseinhaled drugsinhaled corticosteroidswithdrawal of inhaled corticosteroidslong-acting bronchodilatorsICS withdrawal algorithmСтатья опубликована при финансовой поддержке ООО «Берин - гер Ингельхайм». ООО «Берингер Ингельхайм» не несет ответственности за содержание статьи. Мнение ООО «Берингер Ингельхайм» может отличаться от мнения авторов статьи и редакцииReferencesGlobal Initiative for Chronic Obstructive Lung Disease. Global Strategy for Prevention, Diagnosis and Management of COPD. 2019 GOLD Reports. Available at: https://goldcopd.org/gold-reports/ (Accessed: December 11, 2018).Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Prevention, Diagnosis and Management of COPD. 2019 GOLD Reports. 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The authors declare that there are no conflicts of interest present.