pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2020-30-3-330-343pulmo-1312Research ArticleКЛИНИЧЕСКАЯ ФАРМАКОЛОГИЯCLINICAL PHARMACOLOGYИнгаляционные глюкокортикостероиды в лечении хронической обструктивной болезни легкихInhalation glucocorticosteroids in the treatment of chronic obstructive pulmonary diseaseАвдеевС. Н.AvdeevS. N.

Авдеев Сергей Николаевич – доктор медицинских наук, профессор, член-корр. Российской академии наук, заведующий кафедрой пульмонологии.

119991, Москва, ул. Трубецкая, 8, стр. 2; 115682, Москва, Ореховый бульвар, 28; тел.: (495) 395-63-93

Sergey N. Avdeev - Doctor of Medicine, Professor, Corresponding Member of Russian Academy of Sciences, Head of Department of Pulmonology, I.M.Sechenov FMSMU, Healthcare Ministry of Russia (Sechenov University); Head of Clinical Division, FPRI, Federal Medical and Biological Agency of Russia

Ul. Trubetskaya 8, build. 2, Moscow, 119991; Orekhovyy bul'var 28, Moscow, 115682; tel.: (495) 395-63-93

serg_avdeev@list.ruАйсановЗ. Р.AisanovZ. R.

Айсанов Заурбек Рамазанович – доктор медицинских наук, профессор кафедры пульмонологии.

117997, Москва, ул. Островитянова, 1; тел.: (495) 965-34-66

Zaurbek R. Aisanov - Doctor of Medicine, Professor, Department of Pulmonology.

aisanov@mail.ruАрхиповВ. В.ArkhipovV. V.

Архипов Владимир Владимирович – доктор медицинских наук, профессор кафедры клинической фармакологии и терапии.

125993, Москва, ул. Баррикадная, 2 / 1, стр. 1; тел.: (499) 252-21-04

Vladimir V. Arkhipov - Doctor of Medicine, Professor, Department of Clinical Pharmacology and Therapy.

Ul. Barrikadnaya 2/1, Moscow, 123995; tel.: (499) 252-21-04

arkhipov@gmx.usБелевскийА. С.BelevskiyA. S.

Белевский Андрей Станиславович – доктор медицинских наук, профессор, заведующий кафедрой пульмонологии.

117997, Москва, ул. Островитянова, 1; тел.: (495) 963-24-67

Andrey S. Belevskiy - Doctor of Medicine, Professor, Head of Department of Pulmonology, Faculty of Postgraduate Physician Training.

Ul. Ostrovityanova 1, Moscow, 117997; tel.: (495) 963-24-67

pulmobas@yandex.ruЛещенкоИ. В.LeshchenkoI. V.

Лещенко Игорь Викторович – доктор медицинских наук, профессор кафедры фтизиатрии, пульмонологии и торакальной хирургии.

Igor' V. Leshchenko - Doctor of Medicine, Professor, Department of Phthisiology, Pulmonology and Thoracic Surgery.

leshchenkoiv@mail.ruОвчаренкоС. И.OvcharenkoS. I.

Овчаренко Светлана Ивановна – доктор медицинских наук, профессор кафедры факультетской терапии № 1 лечебного факультета.

119991, Москва, ул. Трубецкая, 8, стр. 2; тел.: (499) 248-45-23

Svetlana I. Ovcharenko - Doctor of Medicine, Professor, Department of General Internal Medicine No.1, Medical Faculty.

svetftk@mail.ruЕмельяновА. В.Emel'yanovA. V.

Емельянов Александр Викторович – доктор медицинских наук, профессор, заведующий кафедрой пульмонологии.

620028, Екатеринбург, ул. Репина, 3; тел.: (812) 970-71-88

Aleksandr V. Emel'yanov - Doctor of Medicine, Professor, Head of Department of Pulmonology.

emelav@inbox.ruДемкоИ. В.DemkoI. V.

Демко Ирина Владимировна – доктор медицинских наук, профессор, заведующая кафедрой внутренних болезней № 2 с курсом постдипломного образования.

660022, Красноярск, ул. Партизана Железняка, 1; тел.: (913) 507-84-08

Irina V. Demko - Doctor of Medicine, Professor, Head of Department No.2 of Internal Medicine and Postgraduate Physician Training Course.

Ul. Partizana Zheleznyaka 1, Krasnoyarsk, 660022; tel.: (913) 507-84-08

demko64@mail.ruИгнатоваГ. Л.IgnatovaG. L.

Игнатова Галина Львовна – доктор медицинских наук, профессор, заведующая кафедрой терапии Института дополнительного профессионального образования

454092, Челябинск, Воровского, 64; тел.: (351) 742-66-40

Galina L. Ignatova - Doctor of Medicine, Professor, Head of Department of Therapy, Institute of Postgraduate Physician Training.

Ul. Vorovskogo 64, Chelyabinsk, 454092; tel.: (351) 742-66-40

iglign@mail.ruТрофименкоИ. Н.TrofimenkoI. N.

Трофименко Ирина Николаевна – доктор медицинских наук, доцент кафедры клинической аллергологии и пульмонологии.

664049, Иркутск, мкр Юбилейный, 100; тел.: (9148) 77-80-96

Irina N. Trofimenko - Doctor of Medicine, Associate Professor, Department of Clinical Allergology and Pulmonology.

tin11@mail.ruШмелевЕ. И.ShmelevE. I.

Шмелев Евгений Иванович – доктор медицинских наук, профессор, заведующий отделом дифференциальной диагностики.

107564, Москва, Яузская аллея, 2; тел.: (499) 785-90-08

Evgeny I. Shmelev - Doctor of Medicine, Professor, Head of Department of Differential Diagnostics.

Yauzskaya alleya 2, Moscow, 107564; tel.: (499) 785-90-08

eishmelev@mail.ruФедеральное 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 агентстваРоссия.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.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 образовательное учреждение высшего образования «Уральский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияI.I.Mechnikov State North-West Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Красноярский государственный медицинский университет имени профессора В.Ф.Войно-Ясенецкого» Министерства здравоохранения Российской ФедерацииРоссияV.F.Voyno-Yasenetskiy Krasnoyarsk State Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Южно-Уральский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияSouth Ural State Medical University, Healthcare Ministry of RussiaRussian FederationИркутская государственная медицинская академия последипломного образования – филиал Федерального государственного бюджетного образовательного учреждения дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияIrkutsk State Medical Academy of Postgraduate Education – Branch Campus of Irkutsk State Medical Academy of Postgraduate TrainingRussian FederationФедеральное государственное бюджетное научное учреждение Центральный научно-исследовательский институт туберкулезаРоссияFederal Central Research Institute of Tuberculosis, Russian Academy of ScienceRussian Federation202001082020303330343Copyright © Авдеев С.Н., Айсанов З.Р., Архипов В.В., Белевский А.С., Лещенко И.В., Овчаренко С.И., Емельянов А.В., Демко И.В., Игнатова Г.Л., Трофименко И.Н., Шмелев Е.И., 20202020Авдеев С.Н., Айсанов З.Р., Архипов В.В., Белевский А.С., Лещенко И.В., Овчаренко С.И., Емельянов А.В., Демко И.В., Игнатова Г.Л., Трофименко И.Н., Шмелев Е.И.Avdeev S.N., Aisanov Z.R., Arkhipov V.V., Belevskiy A.S., Leshchenko I.V., Ovcharenko S.I., Emel'yanov A.V., Demko I.V., Ignatova G.L., Trofimenko I.N., Shmelev E.I.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/1312

Основными задачами терапии хронической обструктивной болезни легких (ХОБЛ) являются уменьшение выраженности симптомов заболевания и снижение риска обострений. В статье обсуждается роль локального и системного воспаления в патогенезе ХОБЛ, а также различные механизмы фармакологического влияния на него. Рассмотрены подходы к назначению базисной терапии пациентам с ХОБЛ, рекомендуемые различными национальными и глобальными руководствами (клинические рекомендации Российского респираторного общества, критерии Глобальной стратегии по лечению хронической обструктивной болезни легких (Global Initiative for Chronic Obstructive Lung Disease – GOLD), руководство Национального института совершенствования здравоохранения Великобритании (National Institute for Health and Clinical Excellence – NICE)), а также рекомендации по периодичности пересмотра терапии. В настоящее время в мире разрабатываются и регистрируются т. н. тройные комбинации – фиксированные комбинации двойных бронхолитических препаратов с ингаляционными глюкокортикостероидами, при этом их место и значение в лечении ХОБЛ вызывает многочисленные дискуссии. В работе обсуждается роль фиксированных тройных комбинаций при снижении частоты обострений ХОБЛ, воздействии на функциональные и пациент-репортированные исходы, приведены рекомендации по применению тройных комбинаций у пациентов с ХОБЛ с учетом соотношения польза / риск.

The main objectives of chronic obstructive pulmonary disease (COPD) therapy are to reduce the severity of symptoms and the risk of exacerbations. The article discusses the role of local and systemic inflammation in the pathogenesis of COPD as well as various mechanisms of pharmacological influence on it. Approaches to prescribing basic therapy for patients with COPD, recommended by various national and global guidelines (clinical recommendations of the Russian respiratory society, criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), guidelines of the National Institute for Health and Clinical Excellence (NICE)), as well as recommendations on the therapy frequency review are considered. Currently, so-called triple combinations – fixed combinations of double bronchodilators with inhaled glucocorticosteroids – are being developed and registered in the world, and their place and significance in the treatment of COPD raise many discussions. The paper discusses the role of fixed triple combinations in reducing the incidence of COPD exacerbations, the impact on functional and patient-reported outcomes, and provides recommendations for the use of triple combinations in patients with COPD, taking into account the benefit/risk ratio.

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