pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2021-31-4-418-438pulmo-2403Research ArticleКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИCLINICAL GUIDELINESРекомендации Европейского респираторного общества по диагностике и лечению хронического кашля у взрослых и детейEuropean Respiratory Society guidelines on the diagnosis and treatment of chronic cough in adults and childrenMoriceА. H.MoriceA. H.

Alyn H. Morice

Группа респираторных исследований

Халл

Alyn H. Morice 

Respiratory Research Group

Hull

MillqvistЕ.MillqvistE.

Eva Millqvist 

Кафедра внутренних болезней, респираторной медицины и аллергологии, Университетская больница Сальгренска

Гётеборг

Eva Millqvist 

Dept of Internal Medicine/Respiratory Medicine and Allergology

Gothenburg

BieksieneK.BieksieneK.

Kristina Bieksiene 

Кафедра пульмонологии

Каунас

Kristina Bieksiene 

Dept of Pulmonology

Kaunas

BirringS. S.BirringS. S.

Surinder S. Birring 

Факультет естественных наук и медицины, Королевский колледж Лондона,

Отделение респираторной медицины, Больница Королевского колледжа

Лондон

 

Surinder S. Birring 

Faculty of Life Sciences and Medicine, King’s College London

Dept of Respiratory Medicine, King’s College Hospital

London

DicpinigaitisP.DicpinigaitisP.

Peter Dicpinigaitis 

Бронкс Нью-Йорк

Peter Dicpinigaitis

Bronx

RibasCh. D.RibasCh. D.

Christian Domingo Ribas 

Пульмонологическая служба, Корпорасьо Санитария Парк Таули 

Медицинский факультет, Автономный университет Барселоны

Сабадель, Барселона

 

Christian Domingo Ribas 

Pulmonary Service, Corporació Sanitària Parc Taulí;

Dept of Medicine, Universitat Autònoma de Barcelona (UAB)

Sabadell, Barcelona

https://orcid.org/0000-0002-2240-7923BoonM. H.BoonM. H.

Michele Hilton Boon 

Отделение социальных и медицинских наук MRC / CSO

Глазго

Michele Hilton Boon 

MRC/CSO Social and Public Health Sciences Unit

Glasgow

https://orcid.org/0000-0002-3445-4612KantarА.KantarA.

Ahmad Kantar 

Бергамо

Ahmad Kantar 

Pediatric Cough and Asthma Center, Istituti Ospedalieri Bergamaschi

Bergamo

LaiK.LaiK.

Kefang Lai 

Отделение клинических исследований, Главная государственная лаборатория респираторных заболеваний, Институт респираторного здоровья Гуанчжоу, Первая дочерняя больница Медицинского университета Гуанчжоу

Представитель Китайского торакального общества

Гуанчжоу

Kefang Lai 

Dept of Clinical Research, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University

Representing the Chinese Thoracic Society

Guangzhou

McGarveyL.McGarveyL.

Lorcan McGarvey

Центр экспериментальной медицины, Школа медицины, стоматологии и биомедицинских наук

Белфаст

Lorcan McGarvey 

Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences

Belfast

RigauD.RigauD.

David Rigau 

Барселона

David Rigau 

Barcelona

SatiaI.SatiaI.

Imran Satia 

Кафедра медицины, Пульмонологическое отделение, Университет Макмастера

Манчестерский университет, Отделение инфекций, иммунитета и респираторной медицины, Целевой фонд NHS Манчестерского университета

Гамильтон, Онтарио, Манчестер, Соединенное Королевство

Imran Satia 

Dept of Medicine, Division of Respirology, McMaster University

University of Manchester Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Science Centre

Hamilton, Manchester

SmithJ.SmithJ.

Jacky Smith 

Отделение инфекций, иммунитета и респираторной медицины, Целевой фонд NHS Манчестерского университета

Манчестер

Jacky Smith 

Division of Infection, Immunity and Respiratory Medicine, Manchester University NHS Foundation Trust

Manchester

https://orcid.org/0000-0002-4630-9922SongW.-J.SongW.-J.

Woo-Jung Song 

Лаборатория по изучению чувствительности дыхательных путей и кашля, Отделение аллергии и клинической иммунологии, Медицинский центр Асан, Медицинский колледж Университета Ульсана

Представитель Азиатско-Тихоокеанской ассоциации по аллергии, бронхиальной астме и клинической иммунологии

Сеул, 

Woo-Jung Song 

Airway Sensation and Cough Research Laboratory, Dept of Allergy and Clinical Immunology, Asan Medical Center University of Ulsan College of Medicine

Representing the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI)

Seoul

 

ToniaT.ToniaT.

Thomy Tonia 

Берн

Thomy Tonia 

Bern

Van den BergJ. W.K.Van den BergJ. W.K.

Jan W. K. van den Berg 

Отделение респираторной медицины

Зволле

Jan W.K. van den Berg 

Dept of Respiratory Medicine

Zwolle

Van ManenM. J.G.Van ManenM. J.G.

Mirjam J.G. van Manen 

Отделение респираторной медицины

Роттердам

Mirjam J.G. van Manen

Dept of Respiratory Medicine

Rotterdam

ZacharasiewiczA.ZacharasiewiczA.

Angela Zacharasiewicz 

Педиатрическое отделение

Вена

Angela Zacharasiewicz

Dept of Pediatrics

Vienna

Медицинская школа Халл-Йорка; Университет ХаллаВеликобританияHull York Medical School; University of HullUnited KingdomГётеборгский университетШвецияSahlgrenska University Hospital; University of GothenburgSwedenЛитовский университет медицинских наукЛитваLithuanian University of Health SciencesLithuaniaЦентр изучения человека и прикладных физиологических наук, Школа фундаментальных и медицинских биологических наук; Королевский колледж Лондона; Больница Королевского колледжаВеликобританияCentre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences; King’s College London; King’s College HospitalUnited KingdomМедицинский колледж Альберта Эйнштейна, Медицинский центр МонтефиореСоединённые Штаты АмерикиAlbert Einstein College of Medicine; Montefiore Medical CenterUnited StatesКорпорасьо Санитария Парк Таули; Автономный университет БарселоныИспанияCorporació Sanitària Parc Taulí; Universitat Autònoma de Barcelona (UAB)SpainУниверситет ГлазгоВеликобританияUniversity of GlasgowUnited KingdomПедиатрический центр кашля и бронхиальной астмы, Институт при больнице Бергамо, Университетские и исследовательские больницыИталияUniversity and Research HospitalsItalyИнститут респираторного здоровья Гуанчжоу, Первая дочерняя больница Медицинского университета Гуанчжоу; Китайское торакальное обществоКитайGuangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University; Chinese Thoracic SocietyChinaКоролевский университет БелфастаВеликобританияQueen’s University BelfastUnited KingdomИбероамериканский Кохрейновский центрИспанияIberoamerican Cochrane CentreSpainУниверситет Макмастера; Манчестерский университетКанадаMcMaster University; University of ManchesterCanadaМанчестерский университетВеликобританияUniversity of ManchesterUnited KingdomМедицинский колледж Университета; Азиатско-Тихоокеанская ассоциация по аллергии, бронхиальной астме и клинической иммунологииЮжная КореяUniversity of Ulsan College of Medicine; Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI)Korea, Republic ofБернский университетШвейцарияUniversity of BernSwitzerlandБольница Хустполи ИсалаНидерландыHoestpoli Isala hospitalNetherlandsМедицинский центр Университета имени Эразма РоттердамскогоНидерландыErasmus University Medical CenterNetherlandsКлиническая больница Венского университета, больница ВильгельминенАвстрияTeaching Hospital of the University of Vienna; Wilhelminen HospitalAustria202131072021314418438Copyright © Morice А.H., Millqvist Е., Bieksiene K., Birring S.S., Dicpinigaitis P., Ribas C.D., Boon M.H., Kantar А., Lai K., McGarvey L., Rigau D., Satia I., Smith J., Song W., Tonia T., van den Berg J.W., van Manen M.J., Zacharasiewicz A., 20212021Morice А.H., Millqvist Е., Bieksiene K., Birring S.S., Dicpinigaitis P., Ribas C.D., Boon M.H., Kantar А., Lai K., McGarvey L., Rigau D., Satia I., Smith J., Song W., Tonia T., van den Berg J.W., van Manen M.J., Zacharasiewicz A.Morice A.H., Millqvist E., Bieksiene K., Birring S.S., Dicpinigaitis P., Ribas C.D., Boon M.H., Kantar A., Lai K., McGarvey L., Rigau D., Satia I., Smith J., Song W., Tonia T., van den Berg J.W., van Manen M.J., Zacharasiewicz A.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/2403

В рекомендации включены последние достижения в понимании патофизиологии хронического кашля (ХК), его диагностики и лечения. Кашлевая гиперчувствительность явилась объединяющим термином, с помощью которого описывается исключительная чувствительность пациентов к внешним раздражителям, таким как холодный воздух, запахи, дым и отбеливатели. Таким образом, симптомы у взрослых с ХК получили ясное физиологическое объяснение, основанное на афферентной гиперчувствительности блуждающего нерва. Существуют различные излечимые черты этой патологии – кашлевой вариант бронхиальной астмы / эозинофильный бронхит, которые отвечают на терапию противовоспалительными препаратами; некислотный рефлюкс, поддающийся терапии прокинетическими препаратами, а не препаратами для уменьшения желудочной кислотности. Альтернативной стратегией борьбы с кашлем становится снижение гиперчувствительности за счет нейромодуляции. У пациентов с кашлем, устойчивым к другим методам лечения, очень эффективен морфин в низких дозах. Также рекомендуются габапентин и прегабалин, но их применение ограничивается нежелательными явлениями. Возможно, наиболее многообещающими фармакологическими разработками являются препараты, при воздействии которых снижается нейрональная гиперчувствительность, блокирующая возбудимость афферентных нервов, например, за счет ингибирования рецепторов аденозинтрифосфорной кислоты (P2X3). Наконец, очень эффективной может быть кашель-контролирующая терапия при условии проведения ее опытным врачом. Дети – это не маленькие взрослые, у них следует стремиться выявить первопричину кашля. Например, среди детей раннего возраста распространена аспирация инородных тел. Частой причиной влажного кашля у детей является затяжной бактериальный бронхит, что ранее было малоизвестно. Излечения в этих случаях можно добиться с помощью терапии антибактериальными препаратами (АБП) (выбор АБП, доз и продолжительности применения еще предстоит определить). У детей следует использовать специальный педиатрический алгоритм.

These guidelines incorporate the recent advances in chronic cough pathophysiology, diagnosis and treatment. The concept of cough hypersensitivity has allowed an umbrella term that explains the exquisite sensitivity of patients to external stimuli such a cold air, perfumes, smoke and bleach. Thus, adults with chronic cough now have a firm physical explanation for their symptoms based on vagal afferent hypersensitivity. Different treatable traits exist with cough variant asthma (CVA)/eosinophilic bronchitis responding to anti-inflammatory treatment and non-acid reflux being treated with promotility agents rather the anti-acid drugs. An alternative antitussive strategy is to reduce hypersensitivity by neuromodulation. Low-dose morphine is highly effective in a subset of patients with cough resistant to other treatments. Gabapentin and pregabalin are also advocated, but in clinical experience they are limited by adverse events. Perhaps the most promising future developments in pharmacotherapy are drugs which tackle neuronal hypersensitivity by blocking excitability of afferent nerves by inhibiting targets such as the ATP receptor (P2X3). Finally, cough suppression therapy when performed by competent practitioners can be highly effective. Children are not small adults and a pursuit of an underlying cause for cough is advocated. Thus, in toddlers, inhalation of a foreign body is common. Persistent bacterial bronchitis is a common and previously unrecognised cause of wet cough in children. Antibiotics (drug, dose and duration need to be determined) can be curative. A paediatric-specific algorithm should be used.

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