pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2013-0-3-5-19pulmo-188Research ArticleПЕРЕДОВАЯ СТАТЬЯEDITORIALХроническая обструктивная болезнь легких: обостренияAcute exacerbation of chronic obstructive pulmonary diseaseАвдеевС. Н.AvdeevS. N.

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serg_avdeev@list.ruФГБУ "НИИ пульмонологии" ФМБА РоссииRussian Federation20132806201303519Copyright © Авдеев С.Н., 20132013Авдеев С.Н.Avdeev S.N.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/188

Хроническая обструктивная болезнь легких: обострения.

Acute exacerbation of chronic obstructive pulmonary disease.

хроническая обструктивная болезнь легкихобострениефенотипытерапияReferencesGlobal Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI / WHO workshop report. Last updated 2013. www.goldcopd.orgGlobal Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI / WHO workshop report. Last updated 2013. www.goldcopd.orgHurst J.R., Vestbo J., Anzueto A. et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N. Engl. J. Med. 2010; 363: 1128–1138.Hurst J.R., Vestbo J., Anzueto A. et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N. Engl. J. Med. 2010; 363: 1128–1138.Stanford R.H., Shen Y., McLaughlin T. Cost of chronic obstructive pulmonary disease in the emergency department and hospital: an analysis of administrative data from 218 US hospitals. Treat. Respir. Med. 2006; 5: 343–349.Stanford R.H., Shen Y., McLaughlin T. Cost of chronic obstructive pulmonary disease in the emergency department and hospital: an analysis of administrative data from 218 US hospitals. Treat. Respir. Med. 2006; 5: 343–349.O'Donnell D.E., Parker C.M. COPD exacerbations: Pathophysiology. Thorax 2006; 61: 354–361.O'Donnell D.E., Parker C.M. COPD exacerbations: Pathophysiology. Thorax 2006; 61: 354–361.Donaldson G.C., Seemungal T.A.R., Bhowmik A., Wedzi, cha J.A. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002; 57: 847–852.Donaldson G.C., Seemungal T.A.R., Bhowmik A., Wedzi, cha J.A. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002; 57: 847–852.Seemungal T.A.R., Donaldson G.C., Paul E.A. et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1998; 151: 1418–1422.Seemungal T.A.R., Donaldson G.C., Paul E.A. et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1998; 151: 1418–1422.Miravitlles M., Murio C., Guerrero T. et al. Pharmacoeconomic evaluation of acute exacerbations of chronic bronchitis and COPD. Chest 2002; 121: 1449–1455.Miravitlles M., Murio C., Guerrero T. et al. Pharmacoeconomic evaluation of acute exacerbations of chronic bronchitis and COPD. Chest 2002; 121: 1449–1455.Celli B.R., Barnes P.J. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Eur. Respir. J. 2007; 29: 1224–1238.Celli B.R., Barnes P.J. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Eur. Respir. J. 2007; 29: 1224–1238.Zielinski J., MacNee W., Wedzicha J. et al. Causes of death in patients with COPD and chronic respiratory failure. Monaldi Arch. Chest Dis. 1997; 52: 43–47.Zielinski J., MacNee W., Wedzicha J. et al. Causes of death in patients with COPD and chronic respiratory failure. Monaldi Arch. Chest Dis. 1997; 52: 43–47.Seneff M.G., Wagner D.P., Wagner R.P. et al. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. J.A.M.A. 1995; 274: 1852–1857.Seneff M.G., Wagner D.P., Wagner R.P. et al. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. J.A.M.A. 1995; 274: 1852–1857.Connors A.F. Jr, Dawson N.V., Thomas C. et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am. J. Respir. Crit. Care Med. 1996; 154: 959–967.Connors A.F. Jr, Dawson N.V., Thomas C. et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am. J. Respir. Crit. Care Med. 1996; 154: 959–967.Wouters E.F. The burden of COPD in The Netherlands: results from the Confronting COPD survey. Respir. Med. 2003; 97 (Suppl. C): S51– S59.Wouters E.F. The burden of COPD in The Netherlands: results from the Confronting COPD survey. Respir. Med. 2003; 97 (Suppl. C): S51– S59.Gunen H., Hacievliyagil S.S., Kosar F. et al. Factors affecting survival of hospitalised patients with COPD. Eur. Respir. J. 2005; 26: 234–241.Gunen H., Hacievliyagil S.S., Kosar F. et al. Factors affecting survival of hospitalised patients with COPD. Eur. Respir. J. 2005; 26: 234–241.Kong G.K., Belman M.J., Weingarten S. Reducing length of stay for patients hospitalized with exacerbation of COPD by using a practice guideline. Chest 1997; 111: 89–94.Kong G.K., Belman M.J., Weingarten S. Reducing length of stay for patients hospitalized with exacerbation of COPD by using a practice guideline. Chest 1997; 111: 89–94.Han M.K., Agusti A., Calverley P.M. et al. COPD phenotypes: The future of COPD. Am. J. Respir. Crit. Care Med. 2010; 182: 598–604.Han M.K., Agusti A., Calverley P.M. et al. COPD phenotypes: The future of COPD. Am. J. Respir. Crit. Care Med. 2010; 182: 598–604.Suissa S., Dell'aniello S., Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012; 67: 957–963.Suissa S., Dell'aniello S., Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012; 67: 957–963.van Eeden S.F., Sin D.D. Chronic obstructive pulmonary disease: a chronic systemic inflammatory disease. Respiration 2008; 75: 224–238.van Eeden S.F., Sin D.D. Chronic obstructive pulmonary disease: a chronic systemic inflammatory disease. Respiration 2008; 75: 224–238.Harvey M.G., Hancox R.J. Elevation of cardiac troponins in exacerbation of chronic obstructive pulmonary disease. Emerg. Med. Australasia 2004; 16: 212–215.Harvey M.G., Hancox R.J. Elevation of cardiac troponins in exacerbation of chronic obstructive pulmonary disease. Emerg. Med. Australasia 2004; 16: 212–215.Donaldson G.C., Hurst J.R., Smith C.J. et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest 2010; 137: 1091–1097.Donaldson G.C., Hurst J.R., Smith C.J. et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest 2010; 137: 1091–1097.McAllister D.A., Maclay J.D., Mills N.L. et al. Diagnosis of myocardial infarction following hospitalisation for exacerbation of COPD. Eur. Respir. J. 2012; 39: 1097–1103.McAllister D.A., Maclay J.D., Mills N.L. et al. Diagnosis of myocardial infarction following hospitalisation for exacerbation of COPD. Eur. Respir. J. 2012; 39: 1097–1103.Chang C.L., Robinson S.C., Mills G.D. et al. Biochemical markers of cardiac dysfunction predict mortality in acute exacerbations of COPD. Thorax 2011; 66: 764–768.Chang C.L., Robinson S.C., Mills G.D. et al. Biochemical markers of cardiac dysfunction predict mortality in acute exacerbations of COPD. Thorax 2011; 66: 764–768.Rodriguez,Roisin R. Toward a consensus definition for COPD exacerbation. Chest 2000; 117: 398S–401S.Rodriguez,Roisin R. Toward a consensus definition for COPD exacerbation. Chest 2000; 117: 398S–401S.Steer J., Gibson J., Bourke S.C. The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease. Thorax 2012; 67: 970–976.Steer J., Gibson J., Bourke S.C. The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease. Thorax 2012; 67: 970–976.Papi A., Bellettato C.M., Braccioni F. et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am. J. Respir. Crit. Care Med. 2006; 173: 1114–1121.Papi A., Bellettato C.M., Braccioni F. et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am. J. Respir. Crit. Care Med. 2006; 173: 1114–1121.Veeramachaneni S.B., Sethi S. Pathogenesis of bacterial exacerbations of COPD. COPD 2006; 3: 109–115.Veeramachaneni S.B., Sethi S. Pathogenesis of bacterial exacerbations of COPD. COPD 2006; 3: 109–115.Rosell A., Monso E., Soler N. et al. Microbiologic determinants of exacerbation in chronic obstructive pulmonary disease. Arch. Intern. Med. 2005; 165: 891–897.Rosell A., Monso E., Soler N. et al. Microbiologic determinants of exacerbation in chronic obstructive pulmonary disease. Arch. Intern. Med. 2005; 165: 891–897.Sethi S., Sethi R., Eschberger K. et al. Airway bacterial concentrations and exacerbations of chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2007; 176: 356–361.Sethi S., Sethi R., Eschberger K. et al. Airway bacterial concentrations and exacerbations of chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2007; 176: 356–361.Sethi S., Evans N., Grant B.J.B., Murphy T.F. New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N. Engl. J. Med. 2002; 347: 465–471.Sethi S., Evans N., Grant B.J.B., Murphy T.F. New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N. Engl. J. Med. 2002; 347: 465–471.Murphy T.F., Brauer A.L., Grant B.J., Sethi S. Moraxella catarrhalis in chronic obstructive pulmonary disease: burden of disease and immune response. Am. J. Respir. Crit. Care Med. 2005; 172: 195–199.Murphy T.F., Brauer A.L., Grant B.J., Sethi S. Moraxella catarrhalis in chronic obstructive pulmonary disease: burden of disease and immune response. Am. J. Respir. Crit. Care Med. 2005; 172: 195–199.Murphy T.F., Brauer A.L., Sethi S. et al. Haemophilus haemolyticus: a human respiratory tract commensal to be distinguished from Haemophilus influenzae. J. Infect. Dis. 2007; 195: 81–89.Murphy T.F., Brauer A.L., Sethi S. et al. Haemophilus haemolyticus: a human respiratory tract commensal to be distinguished from Haemophilus influenzae. J. Infect. Dis. 2007; 195: 81–89.Murphy T.F., Brauer A.L., Eschberger K. et al. Pseudomonas aeruginosa in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2008; 177: 853–60.Murphy T.F., Brauer A.L., Eschberger K. et al. Pseudomonas aeruginosa in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2008; 177: 853–60.Anzueto A. The pathogenesis of acute infection in COPD. Breathe 2009; 5: 311–315.Anzueto A. The pathogenesis of acute infection in COPD. Breathe 2009; 5: 311–315.Seemungal T., Harper,Owen R., Bhowmik A. et al. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2001; 164: 1618–1623.Seemungal T., Harper,Owen R., Bhowmik A. et al. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2001; 164: 1618–1623.Bhowmik A., Seemungal T.A., Sapsford R.J. et al. Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations. Thorax 2000; 55: 114–120.Bhowmik A., Seemungal T.A., Sapsford R.J. et al. Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations. Thorax 2000; 55: 114–120.Seemungal T.A., Donaldson G.C., Bhowmik A. et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2000; 161: 1608–1613.Seemungal T.A., Donaldson G.C., Bhowmik A. et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2000; 161: 1608–1613.Rohde G., Wiethege A., Borg I. et al. Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalisation: a case-control study. Thorax 2003; 58: 37–42.Rohde G., Wiethege A., Borg I. et al. Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalisation: a case-control study. Thorax 2003; 58: 37–42.Nichol K.L., Baken L., Nelson A. Relation between influenza vaccination and outpatient visits, hospitalization, and mortality in elderly persons with chronic lung disease. Ann. Intern. Med. 1999; 130: 397–403.Nichol K.L., Baken L., Nelson A. Relation between influenza vaccination and outpatient visits, hospitalization, and mortality in elderly persons with chronic lung disease. Ann. Intern. Med. 1999; 130: 397–403.Donaldson G.C., Seemungal T., Jeffries D.J. et al. Effect of temperature on lung function and symptoms in chronic obstructive pulmonary disease. Eur. Respir. J. 1999; 13: 844–849.Donaldson G.C., Seemungal T., Jeffries D.J. et al. Effect of temperature on lung function and symptoms in chronic obstructive pulmonary disease. Eur. Respir. J. 1999; 13: 844–849.Lyon J.L., Stoddard G., Ferguson D. et al. An every other year cyclic epidemic of infants hospitalized with respiratory syncytial virus. Pediatrics 1996; 97: 152–153.Lyon J.L., Stoddard G., Ferguson D. et al. An every other year cyclic epidemic of infants hospitalized with respiratory syncytial virus. Pediatrics 1996; 97: 152–153.Meerhoff T.J., Paget J.W., Kimpen J.L. et al. Variation of respiratory syncytial virus and the relation with meteorological factors in different winter seasons. Pediatr. Infect. Dis. J. 2009; 28: 860–866.Meerhoff T.J., Paget J.W., Kimpen J.L. et al. Variation of respiratory syncytial virus and the relation with meteorological factors in different winter seasons. Pediatr. Infect. Dis. J. 2009; 28: 860–866.Schwartz J. Air pollution and daily mortality: a review and a meta-analysis. Environ. Res. 1994; 64: 36–52.Schwartz J. Air pollution and daily mortality: a review and a meta-analysis. Environ. Res. 1994; 64: 36–52.Zanobetti A., Schwartz J., Dockery D.W. Airborne particles are a risk factor for hospital admissions for heart and lung disease. Environ. Hlth Perspect. 2000; 108: 1071–1077.Zanobetti A., Schwartz J., Dockery D.W. Airborne particles are a risk factor for hospital admissions for heart and lung disease. Environ. Hlth Perspect. 2000; 108: 1071–1077.Sunyer J., Saez M., Murillo C. et al. Air pollution and emergency room admission for chronic obstructive pulmonary disease: a 5-year study. Am. J. Epidemiol. 1993; 137: 701–705.Sunyer J., Saez M., Murillo C. et al. Air pollution and emergency room admission for chronic obstructive pulmonary disease: a 5-year study. Am. J. Epidemiol. 1993; 137: 701–705.Bafadhel M., McKenna S., Terry S. et al. Acute exacerbations of chronic obstructive pulmonary disease. Identification of biologic clusters and their biomarkers. Am. J. Respir. Crit. Care Med. 2011; 184: 662–671.Bafadhel M., McKenna S., Terry S. et al. Acute exacerbations of chronic obstructive pulmonary disease. Identification of biologic clusters and their biomarkers. Am. J. Respir. Crit. Care Med. 2011; 184: 662–671.Aaron S.D., Donaldson G.C., Whitmore G.A. et al. Time course and pattern of COPD exacerbation onset. Thorax 2012; 67: 238–243.Aaron S.D., Donaldson G.C., Whitmore G.A. et al. Time course and pattern of COPD exacerbation onset. Thorax 2012; 67: 238–243.Siefkin A.D. Optimal pharmacologic treatment of the critically ill patients with obstructive airways disease. Am. J. Med. 1996; 100 (Suppl. 1A): 54S–61S.Siefkin A.D. Optimal pharmacologic treatment of the critically ill patients with obstructive airways disease. Am. J. Med. 1996; 100 (Suppl. 1A): 54S–61S.Parker C.M., Voduc N., Aaron S.D. et al. Physiological changes during symptom recovery from moderate exacerbations of COPD. Eur. Respir. J. 2005; 26: 420–428.Parker C.M., Voduc N., Aaron S.D. et al. Physiological changes during symptom recovery from moderate exacerbations of COPD. Eur. Respir. J. 2005; 26: 420–428.Rodriguez,Roisin R. COPD exacerbations: management. Thorax 2006; 61: 535–544.Rodriguez,Roisin R. COPD exacerbations: management. Thorax 2006; 61: 535–544.McCrory D.C., Brown C.D. Anticholinergic bronchodilators versus beta2-sympathomimetic agents for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2003; (1): Art. №: CD003900. DOI: 10.1002/14651858.CD003900.McCrory D.C., Brown C.D. Anticholinergic bronchodilators versus beta2-sympathomimetic agents for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2003; (1): Art. №: CD003900. DOI: 10.1002/14651858.CD003900.Cuvelier A., Muir J.F., pour le groupe multicentrique. Apport de la nebulisation dans les exacerbations des bronchopneumopathies chroniques obstructives: place des anticholinergiques. Ann. Fr. Anesth. Reanim. 1998; 17 (Suppl. 2): 48–51.Cuvelier A., Muir J.F., pour le groupe multicentrique. Apport de la nebulisation dans les exacerbations des bronchopneumopathies chroniques obstructives: place des anticholinergiques. Ann. Fr. Anesth. Reanim. 1998; 17 (Suppl. 2): 48–51.Karpel J.P. The use of anticholinergic drugs in acute exacerbations of chronic obstructive pulmonary disease. In: Gross N.J., ed. Anticholinergic therapy in obstructive airways disease. London: Franklin Scientic Publications; 1993. 145–154.Karpel J.P. The use of anticholinergic drugs in acute exacerbations of chronic obstructive pulmonary disease. In: Gross N.J., ed. Anticholinergic therapy in obstructive airways disease. London: Franklin Scientic Publications; 1993. 145–154.Bach P.B., Brown C., Gelfand S.E., McCrory D.C. Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence. Ann. Intern. Med. 2001; 134: 600–620.Bach P.B., Brown C., Gelfand S.E., McCrory D.C. Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence. Ann. Intern. Med. 2001; 134: 600–620.O'Donnell D.E., Aaron S., Bourbeau J. et al. State of the Art Compendium: Canadian Thoracic Society DE recommendations for the management of chronic obstructive pulmonary disease. Can. Respir. J. 2004; 11 (Suppl. B): 7B–59B.O'Donnell D.E., Aaron S., Bourbeau J. et al. State of the Art Compendium: Canadian Thoracic Society DE recommendations for the management of chronic obstructive pulmonary disease. Can. Respir. J. 2004; 11 (Suppl. B): 7B–59B.COPD Guideline Working Group of the South African Thoracic Society. Guideline for the management of Chronic Obstructive Pulmonary Disease (COPD): 2004 Revision. S. Afr. Med. J. 2004; 94: 559–575.COPD Guideline Working Group of the South African Thoracic Society. Guideline for the management of Chronic Obstructive Pulmonary Disease (COPD): 2004 Revision. S. Afr. Med. J. 2004; 94: 559–575.Willaert W., Daenen M., Bornans P. et al. What is the optimal treatment strategy for chronic obstructive pulmonary disease exacerbations? Eur. Respir. J. 2002; 19: 928–935.Willaert W., Daenen M., Bornans P. et al. What is the optimal treatment strategy for chronic obstructive pulmonary disease exacerbations? Eur. Respir. J. 2002; 19: 928–935.Guerin C., Chevre A., Dessirier P. et al. Inhaled fenoterolipratropium bromide in mechanically ventilated patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1999; 159: 1036–1042.Guerin C., Chevre A., Dessirier P. et al. Inhaled fenoterolipratropium bromide in mechanically ventilated patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1999; 159: 1036–1042.Авдеев С.Н., Нуралиева Г.С., Батын С.З. и др. Эффективность комбинированной терапии ингаляционными β2-агонистами и антихолинергическими препаратами при тяжелом обострении хронической обструктивной болезни легких: рандомизированное контролируемое исследование. Пульмонология 2007; 3: 56–65.Авдеев С.Н., Нуралиева Г.С., Батын С.З. и др. Эффективность комбинированной терапии ингаляционными β2-агонистами и антихолинергическими препаратами при тяжелом обострении хронической обструктивной болезни легких: рандомизированное контролируемое исследование. Пульмонология 2007; 3: 56–65.Davies L., Angus R.M., Calverley P.M. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomized controlled trial. Lancet 1999; 354: 456–460.Davies L., Angus R.M., Calverley P.M. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomized controlled trial. Lancet 1999; 354: 456–460.Maltais F., Ostinelli J., Bourbeau J. et al. Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Am. J. Respir. Crit. Care Med. 2002; 165: 698–703.Maltais F., Ostinelli J., Bourbeau J. et al. Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Am. J. Respir. Crit. Care Med. 2002; 165: 698–703.Niewoehner D.E., Erbland M.L., Deupree R.H. et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. N. Engl. J. Med. 1999; 340: 1941–1947.Niewoehner D.E., Erbland M.L., Deupree R.H. et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. N. Engl. J. Med. 1999; 340: 1941–1947.Thompson W.H., Nielson C.P., Carvalho P. et al. Controlled trial of oral prednisone in outpatients with acute COPD exacerbation. Am. J. Respir. Crit. Care Med. 1996; 154: 407–412.Thompson W.H., Nielson C.P., Carvalho P. et al. Controlled trial of oral prednisone in outpatients with acute COPD exacerbation. Am. J. Respir. Crit. Care Med. 1996; 154: 407–412.Aaron S.D., Vandemheen K.L., Hebert P. et al. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. N. Engl. J. Med. 2003; 348: 2618–2625.Aaron S.D., Vandemheen K.L., Hebert P. et al. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. N. Engl. J. Med. 2003; 348: 2618–2625.Leuppi J.D., Schuetz P., Bingisser R. et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: The REDUCE randomized clinical trial. J.A.M.A. 2013; 309: 2223–2231.Leuppi J.D., Schuetz P., Bingisser R. et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: The REDUCE randomized clinical trial. J.A.M.A. 2013; 309: 2223–2231.Bafadhel M., McKenna S., Terry S. et al. Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease. A randomized placebo-controlled trial. Am. J. Respir. Crit. Care Med. 2012; 186: 48–55.Bafadhel M., McKenna S., Terry S. et al. Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease. A randomized placebo-controlled trial. Am. J. Respir. Crit. Care Med. 2012; 186: 48–55.Авдеев С.Н., Суточникова О.А., Белевский А.С., Чуча, лин А.Г. Применение небулизированного будесонида при тяжелом обострении хронической обструктивной болезни легких. Рандомизированное контролируемое исследование. Пульмонология 2003; 5: 81–88.Авдеев С.Н., Суточникова О.А., Белевский А.С., Чуча, лин А.Г. Применение небулизированного будесонида при тяжелом обострении хронической обструктивной болезни легких. Рандомизированное контролируемое исследование. Пульмонология 2003; 5: 81–88.Gunen H., Hacievliyagil S.S., Yetkin O., Gulbas G. The role of nebulised budesonide in the treatment of acute exacerbations of COPD. Eur. Respir. J. 2007; 30: 399–400.Gunen H., Hacievliyagil S.S., Yetkin O., Gulbas G. The role of nebulised budesonide in the treatment of acute exacerbations of COPD. Eur. Respir. J. 2007; 30: 399–400.Baker E.H., Janaway C.H., Philips B.J. et al. Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Thorax 2006; 61: 284–289.Baker E.H., Janaway C.H., Philips B.J. et al. Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Thorax 2006; 61: 284–289.Woodhead M., Blasi F., Ewig S. et al. European Respiratory Society; European Society of Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections. Eur. Respir. J. 2005; 26: 1138–1180.Woodhead M., Blasi F., Ewig S. et al. European Respiratory Society; European Society of Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections. Eur. Respir. J. 2005; 26: 1138–1180.O'Donnell D.E., Hernandez P., Kaplan A. et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease – 2008 update – highlights for primary care. Can. Respir. J. 2008; 15 (Suppl. A): 1A–8A.O'Donnell D.E., Hernandez P., Kaplan A. et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease – 2008 update – highlights for primary care. Can. Respir. J. 2008; 15 (Suppl. A): 1A–8A.Anthonisen N.R., Manfreda J., Warren C.P. et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann. Intern. Med. 1987; 106: 196–204.Anthonisen N.R., Manfreda J., Warren C.P. et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann. Intern. Med. 1987; 106: 196–204.Celli B.R., MacNee W.; ATS / ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS / ERS position paper. Eur. Respir. J. 2004; 23: 932–946.Celli B.R., MacNee W.; ATS / ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS / ERS position paper. Eur. Respir. J. 2004; 23: 932–946.Weis N., Almdal T. C-reactive protein – can it be used as a marker of infection in patients with exacerbation of chronic obstructive pulmonary disease. Eur. J. Intern. Med. 2006; 17: 88–91.Weis N., Almdal T. C-reactive protein – can it be used as a marker of infection in patients with exacerbation of chronic obstructive pulmonary disease. Eur. J. Intern. Med. 2006; 17: 88–91.Dev D., Sankaran E.W.R., Cunnife J. et al. Value of C-reactive protein in exacerbation of chronic obstructive pulmonary disease. Respir. Med. 1998; 92: 664–667.Dev D., Sankaran E.W.R., Cunnife J. et al. Value of C-reactive protein in exacerbation of chronic obstructive pulmonary disease. Respir. Med. 1998; 92: 664–667.Авдеев С.Н., Баймаканова Г.Е., Зубаирова П.А. Возможности С-реактивного белка в диагностике бактериальной инфекции и пневмонии у больных с обострением хронической обструктивной болезни легких. Урал. мед. журн. 2008; 13: 19–24.Авдеев С.Н., Баймаканова Г.Е., Зубаирова П.А. Возможности С-реактивного белка в диагностике бактериальной инфекции и пневмонии у больных с обострением хронической обструктивной болезни легких. Урал. мед. журн. 2008; 13: 19–24.Wilson R., Jones P., Schaberg T. et al. Antibiotic treatment and factors influencing short and long term outcomes of acute exacerbations of chronic bronchitis. Thorax 2006; 61: 337–342.Wilson R., Jones P., Schaberg T. et al. Antibiotic treatment and factors influencing short and long term outcomes of acute exacerbations of chronic bronchitis. Thorax 2006; 61: 337–342.Sethi S., Murphy T.F. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N. Engl. J. Med. 2008; 359: 2355–2365.Sethi S., Murphy T.F. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N. Engl. J. Med. 2008; 359: 2355–2365.Козлов Р.С., Сивая О.В., Кречикова О.И. и др. Динамика резистентности Streptococcus pneumoniae к антибиотикам в России за период 1999–2009 гг. (Результаты многоцентрового проспективного исследования ПеГАС). Клин. микробиол. и антимикроб. химиотер. 2010; 12 (4): 329–341.Козлов Р.С., Сивая О.В., Кречикова О.И. и др. Динамика резистентности Streptococcus pneumoniae к антибиотикам в России за период 1999–2009 гг. (Результаты многоцентрового проспективного исследования ПеГАС). Клин. микробиол. и антимикроб. химиотер. 2010; 12 (4): 329–341.Llor C., Moragas A., Hernandez S. et al. Efficacy of antibiotic therapy for acute exacerbations of mild to moderate COPD. Am. J. Respir. Crit. Care Med. 2012; 186: 716–723.Llor C., Moragas A., Hernandez S. et al. Efficacy of antibiotic therapy for acute exacerbations of mild to moderate COPD. Am. J. Respir. Crit. Care Med. 2012; 186: 716–723.Rogers D.F. Mucoactive agents for airway mucus hypersecretory diseases. Respir. Care 2007; 52: 1176–1193.Rogers D.F. Mucoactive agents for airway mucus hypersecretory diseases. Respir. Care 2007; 52: 1176–1193.Rogers D.F., Barnes P.J. Treatment of airway mucus hypersecretion. Ann. Med. 2006; 38: 116–125.Rogers D.F., Barnes P.J. Treatment of airway mucus hypersecretion. Ann. Med. 2006; 38: 116–125.Hogg J.C., Chu F.S., Tan W.C. et al. Survival after lung volume reduction in chronic obstructive pulmonary disease: insights from small airway pathology. Am. J. Respir. Crit. Care Med. 2007; 176: 454–459.Hogg J.C., Chu F.S., Tan W.C. et al. Survival after lung volume reduction in chronic obstructive pulmonary disease: insights from small airway pathology. Am. J. Respir. Crit. Care Med. 2007; 176: 454–459.Авдеев С.Н., Баймаканова Г.Е., Зубаирова П.А. Эффективность терапии карбоцистеином при обострении ХОБЛ. Пульмонология 2012; 6: 96–102.Авдеев С.Н., Баймаканова Г.Е., Зубаирова П.А. Эффективность терапии карбоцистеином при обострении ХОБЛ. Пульмонология 2012; 6: 96–102.Zuin R., Palamidese A., Negrin R. et al. High dose N-Acetylcysteine in patients with exacerbations of chronic obstructive pulmonary disease. Clin. Drug Invest. 2005; 25: 401–408.Zuin R., Palamidese A., Negrin R. et al. High dose N-Acetylcysteine in patients with exacerbations of chronic obstructive pulmonary disease. Clin. Drug Invest. 2005; 25: 401–408.Kane B., Decalmer S., O'Driscoll B.R. Emergency oxygen therapy: from guideline to implementation. Breathe 2013; 9: 247–254.Kane B., Decalmer S., O'Driscoll B.R. Emergency oxygen therapy: from guideline to implementation. Breathe 2013; 9: 247–254.Bone R.C., Pierce A.K., Johnson R.L. Controlled oxygen administration in acute respiratory failure in chronic obstructive pulmonary disease: a reappraisal. Am. J. Med. 1978; 65: 896–902.Bone R.C., Pierce A.K., Johnson R.L. Controlled oxygen administration in acute respiratory failure in chronic obstructive pulmonary disease: a reappraisal. Am. J. Med. 1978; 65: 896–902.Mehta S., Hill N.S. Noninvasive ventilation. Am. J. Respir. Crit. Care Med. 2001; 163: 540–577.Mehta S., Hill N.S. Noninvasive ventilation. Am. J. Respir. Crit. Care Med. 2001; 163: 540–577.Meduri G.U., Conoscenti C.C., Menashe P., Nair S. Noninvasive face mask ventilation in patients with acute respiratory failure. Chest 1989; 95: 865–870.Meduri G.U., Conoscenti C.C., Menashe P., Nair S. Noninvasive face mask ventilation in patients with acute respiratory failure. Chest 1989; 95: 865–870.Авдеев С.Н., Чучалин А.Г. Неинвазивная вентиляция легких при острой дыхательной недостаточности у больных хронической обструктивной болезнью легких. Тер. арх. 2000; 3: 59–65.Авдеев С.Н., Чучалин А.Г. Неинвазивная вентиляция легких при острой дыхательной недостаточности у больных хронической обструктивной болезнью легких. Тер. арх. 2000; 3: 59–65.Brochard L., Mancebo J., Wysocki M. et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N. Engl. J. Med. 1995; 333: 817–822.Brochard L., Mancebo J., Wysocki M. et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N. Engl. J. Med. 1995; 333: 817–822.Kramer N., Meyer T.J., Meharg J. et al. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am. J. Respir. Crit. Care Med. 1995; 151: 1799–1806.Kramer N., Meyer T.J., Meharg J. et al. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am. J. Respir. Crit. Care Med. 1995; 151: 1799–1806.Авдеев С.Н., Третьяков А.В., Григорьянц Р.А. и др. Исследование применения неинвазивной вентиляции легких при острой дыхательной недостаточности на фоне обострения хронического обструктивного заболевания легких. Анестезиол. реаниматол. 1998; 3: 45–51.Авдеев С.Н., Третьяков А.В., Григорьянц Р.А. и др. Исследование применения неинвазивной вентиляции легких при острой дыхательной недостаточности на фоне обострения хронического обструктивного заболевания легких. Анестезиол. реаниматол. 1998; 3: 45–51.Laghi F., D'Alfonso N., Tobin M.J. Pattern of recovery from diaphragmatic fatigue over 24 hours. J. Appl. Physiol. 1995; 79: 539–546.Laghi F., D'Alfonso N., Tobin M.J. Pattern of recovery from diaphragmatic fatigue over 24 hours. J. Appl. Physiol. 1995; 79: 539–546.Gladwin M.T., Pierson D.J. Mechanical ventilation of the patient with severe chronic obstructive pulmonary disease. Intens. Care Med. 1998; 24: 898–910.Gladwin M.T., Pierson D.J. Mechanical ventilation of the patient with severe chronic obstructive pulmonary disease. Intens. Care Med. 1998; 24: 898–910.Fagon J.Y., Chastre J., Gibert C. Acute respiratory failure in chronic obstructive pulmonary disease. Bacterial infection as a precipitating factor. In: Derenne J.-P., Whitelaw W.A., Similowski T., eds. Acute respiratory failure. New York: Marcel Dekker Inc.; 1995. 337–389.Fagon J.Y., Chastre J., Gibert C. Acute respiratory failure in chronic obstructive pulmonary disease. Bacterial infection as a precipitating factor. In: Derenne J.-P., Whitelaw W.A., Similowski T., eds. Acute respiratory failure. New York: Marcel Dekker Inc.; 1995. 337–389.Brochard L., Rauss A., Benito S. et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am. J. Respir. Crit. Care Med. 1994; 150: 896–903.Brochard L., Rauss A., Benito S. et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am. J. Respir. Crit. Care Med. 1994; 150: 896–903.Esteban A., Alia I., Gordo F. et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am. J. Respir. Crit. Care Med. 1997; 156: 459–465.Esteban A., Alia I., Gordo F. et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am. J. Respir. Crit. Care Med. 1997; 156: 459–465.Nava S., Ambrosino N., Clini E. et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial. Ann. Intern. Med. 1998; 128: 721–728.Nava S., Ambrosino N., Clini E. et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial. Ann. Intern. Med. 1998; 128: 721–728.Allan P.F., Osborn E.C., Chung K.K., Wanek S.M. Highfrequency percussive ventilation revisited. J. Burn. Care Res. 2010; 31: 510–520.Allan P.F., Osborn E.C., Chung K.K., Wanek S.M. Highfrequency percussive ventilation revisited. J. Burn. Care Res. 2010; 31: 510–520.Ravez P, Richez M, Godart G. et al. Effect of intermittent high-frequency intra-pulmonary percussive breathing onmucus transport. Eur. J. Respir Dis 1986; 69 (Suppl. 146): 285–289.Ravez P, Richez M, Godart G. et al. Effect of intermittent high-frequency intra-pulmonary percussive breathing onmucus transport. Eur. J. Respir Dis 1986; 69 (Suppl. 146): 285–289.Toussaint M., Guillet M.,C., Paternotte S. et al. Intrapulmonary effects of setting parameters in portable intrapulmonary percussive ventilation devices. Respir. Care 2012; 57: 735–742.Toussaint M., Guillet M.,C., Paternotte S. et al. Intrapulmonary effects of setting parameters in portable intrapulmonary percussive ventilation devices. Respir. Care 2012; 57: 735–742.Vargas F., Bui H.N., Boyer A. et al. Intrapulmonary percussive ventilation in acute exacerbations of COPD patients with mild respiratory acidosis: A randomised controlled trial. Crit. Care 2005; 9: R382–R389.Vargas F., Bui H.N., Boyer A. et al. Intrapulmonary percussive ventilation in acute exacerbations of COPD patients with mild respiratory acidosis: A randomised controlled trial. Crit. Care 2005; 9: R382–R389.Antonaglia V., Lucangelo U., Zin W.A et al. Intrapulmonary percussive ventilation improves the outcome of patients with acute exacerbation of chronic obstructive pulmonary disease using a helmet. Crit. Care Med. 2006; 34: 1–6.Antonaglia V., Lucangelo U., Zin W.A et al. Intrapulmonary percussive ventilation improves the outcome of patients with acute exacerbation of chronic obstructive pulmonary disease using a helmet. Crit. Care Med. 2006; 34: 1–6.Kempainen R.R., Milla C., Dunitz J. et al. Comparison of settings used for high-frequency chest-wall compression in cystic fibrosis. Respir. Care 2010; 55: 695–699.Kempainen R.R., Milla C., Dunitz J. et al. Comparison of settings used for high-frequency chest-wall compression in cystic fibrosis. Respir. Care 2010; 55: 695–699.Krishnan J., Ridge A., Walker Harris V. et al. Treating exacerbations of asthma or chronic obstructive pulmonary disease (COPD) with high frequency chest wall oscillation (HFCWO) in hospitalized patients. In: European. Respir. Congress; 2010. 3869.Krishnan J., Ridge A., Walker Harris V. et al. Treating exacerbations of asthma or chronic obstructive pulmonary disease (COPD) with high frequency chest wall oscillation (HFCWO) in hospitalized patients. In: European. Respir. Congress; 2010. 3869.Goktalay T., Akdemir S., Coskun A. et al. Evaluation of contribution of high frequency chest wall oscillation treatment to medical treatment in patients with acute exacerbations of COPD. In: European. Respir. Congress; 2011. 1245.Goktalay T., Akdemir S., Coskun A. et al. Evaluation of contribution of high frequency chest wall oscillation treatment to medical treatment in patients with acute exacerbations of COPD. In: European. Respir. Congress; 2011. 1245.

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