pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLCpulmo-2622Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESТерапия больных с тяжелым обострением бронхиальной астмыTherapy of patients with severe asthma exacerbationКаролиН. А.KaroliN. A.РебровА. П.RebrovA. P.ПутинскийС. А.ChushinskyS. A.Саратовский государственный медицинский университет; Областная клиническая больницаРоссия200303092021056370Copyright © Кароли Н.А., Ребров А.П., Путинский С.А., 20212021Кароли Н.А., Ребров А.П., Путинский С.А.Karoli N.A., Rebrov A.P., Chushinsky S.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/2622

Цель работы — оценить эффективность применения β2-агонистов короткого действия при помощи ДИ и спейсера в комплексной терапии тяжелого обострения бронхиальной астмы (ТОБА).Проанализирована эффективность и безопасность высокодозовой терапии β2-агонистами короткого действия при помощи ДИ и спейсера у 15 больных с ТОБА, средний возраст которых составил 40,7±1,2 года. Для оценки эффективности применяемой схемы терапии оценивали ряд клинических и функциональных параметров. Врачом по 3-балльной шкале оценивались выраженность "свистящих хрипов", интенсивность кашля, участие вспомогательной мускулатуры в акте дыхания, наличие парадоксального пульса, а также измерялись пиковая скорость выдоха (ПСВ), частота сердечных сокращений (ЧСС), частота дыхательных движений (ЧДЦ), артериальное давление (АД); пациент также оценивал выраженность одышки по 3-балльной шкале.Применение β2-агонистов короткого действия через дозированный ингалятор и спейсер является эффективным и безопасным методом терапии больных с ТОБА.

The aim of this study was to evaluate an efficacy of short-acting β2-agonists used via a dosing inhaler and a spacer in therapy of severe asthma exacerbation (SAE).Efficacy and safety of high-dose therapy with short-acting β2-agonists v'a a dosing inhaler and a spacer was analyzed in 15 SAE patients, the average age was 0.7±1.2 yrs. The efficacy of the treatment was evaluated with several clinical and functional parameters. Using a 3-ball scale a doctor assessed wheeze and cough intensities, accessory muscle use, pulsus paradoxus. Peak expiratory flow rate (PEF), heart beat rate (HBR), respiratory frequency (RF), and arterial blood pressure were also measured. A patient also assessed his dyspnoe with the 3-ball scale.The therapy with short-acting β2-agonists via a dosing inhaler and a spacer is an effective and safe method for treatment of SAE patients.

ReferencesРебров А.П., Кароли И.А., Гладенина Л.А., Стешенко Р.Н. Качество диагностики астматического статуса и его лечения. Пульмонология 1999; 4: 57-62.Ребров А.П., Кароли И.А., Гладенина Л.А., Стешенко Р.Н. Качество диагностики астматического статуса и его лечения. Пульмонология 1999; 4: 57-62.Ребров А.П., Кароли Н.А. Анализ качества лечения больных с тяжелым обострением бронхиальной астмы. В кн.: Якушин С.С. (ред.) Актуальные вопросы в клинике внутренних болезней. М.: Медицина; 2001. 265-271.Ребров А.П., Кароли Н.А. Анализ качества лечения больных с тяжелым обострением бронхиальной астмы. В кн.: Якушин С.С. (ред.) Актуальные вопросы в клинике внутренних болезней. М.: Медицина; 2001. 265-271.Чучалин А.Г., Третьяков А.В. Астматический статус. В кн.: Чучалин А.Г. (ред.) Бронхиальная астма, т.2: М.: Агар; 1997; 151-159.Чучалин А.Г., Третьяков А.В. Астматический статус. В кн.: Чучалин А.Г. (ред.) Бронхиальная астма, т.2: М.: Агар; 1997; 151-159.Чучалин А.Г. Тяжелая бронхиальная астма. Рус. мед. журн. 2000; 12: 482-486.Чучалин А.Г. Тяжелая бронхиальная астма. Рус. мед. журн. 2000; 12: 482-486.Callahan C.W. Wet nebulization in acute asthma. The last refrain? Chest 2000; 117: 1226-1228.Callahan C.W. Wet nebulization in acute asthma. The last refrain? Chest 2000; 117: 1226-1228.Canada asthma consensus report. 1999.Canada asthma consensus report. 1999.Gates C., Rowe В.И. Holding chambers versus nebulizers for beta-agonist treatment of acute asthma. Cochrane Library 2000; Issue 3.Gates C., Rowe В.И. Holding chambers versus nebulizers for beta-agonist treatment of acute asthma. Cochrane Library 2000; Issue 3.Chen Y., Dales R., Krewski D. Asthma and risk of hospitalization in Canada. Chest 2001; 119: 708-713.Chen Y., Dales R., Krewski D. Asthma and risk of hospitalization in Canada. Chest 2001; 119: 708-713.Chou K.J., Cunningham S.J., Crain E.F. Metered-dose inhalers with spacers vs nebulizers for pediatric asthma. Arch. Pediatr. Adolesc. Med. 1995; 149: 201-205.Chou K.J., Cunningham S.J., Crain E.F. Metered-dose inhalers with spacers vs nebulizers for pediatric asthma. Arch. Pediatr. Adolesc. Med. 1995; 149: 201-205.Colacone A., Afilalo М ., Wolkove N., Kreisman H. A comparison of albuterol administered by metered dose inhaler (and holding chamber) or wet nebulizer in acute asthma. Chest 1993; 104: 8354-8361.Colacone A., Afilalo М ., Wolkove N., Kreisman H. A comparison of albuterol administered by metered dose inhaler (and holding chamber) or wet nebulizer in acute asthma. Chest 1993; 104: 8354-8361.FitzGerald M . Acute asthma. Brit. Med. J. 2001; 323: 841-845.FitzGerald M . Acute asthma. Brit. Med. J. 2001; 323: 841-845.Ford J.G., Meyee I.FI., Sternfels P. et al. Patterns and predictors of asthma-related emergency department use in Harlem. Chest 2001; 120: 1129-1135.Ford J.G., Meyee I.FI., Sternfels P. et al. Patterns and predictors of asthma-related emergency department use in Harlem. Chest 2001; 120: 1129-1135.Gibbs M .A., Camargo C.A.Jr., Rowe B.H., Silverm an R.A. Therapeutic controversies in severe acute asthma. Ac. Emerg. Med. 2000; 7: 800-815.Gibbs M .A., Camargo C.A.Jr., Rowe B.H., Silverm an R.A. Therapeutic controversies in severe acute asthma. Ac. Emerg. Med. 2000; 7: 800-815.Global initiative for asthma. NHLB/WHO Workshop Report. National Heat, Lung and Blood Institute, Publication № 95-3659, 1995.Global initiative for asthma. NHLB/WHO Workshop Report. National Heat, Lung and Blood Institute, Publication № 95-3659, 1995.Hodder R.V., Callcutt L.E., Leetch J.A. Metered dose inhaler is superior to wet nebulization for emergency treatment of acute, severe asthma. Chest. 1988; 94 (suppl): 52S.Hodder R.V., Callcutt L.E., Leetch J.A. Metered dose inhaler is superior to wet nebulization for emergency treatment of acute, severe asthma. Chest. 1988; 94 (suppl): 52S.Idris A.H., McDermott M .F., Raucci J.C. et al. Emergency department treatment of severe asthma. Metered-dose inhaler plus holding chamber is equivalent in effectiveness to nebulizer. Ibid. 1993; 103: 665-672.Idris A.H., McDermott M .F., Raucci J.C. et al. Emergency department treatment of severe asthma. Metered-dose inhaler plus holding chamber is equivalent in effectiveness to nebulizer. Ibid. 1993; 103: 665-672.Inwald D., Roland М., Kuitert I. et al. Oxygen treatment for acute severe asthma. Brit. Med. J. 2001; 323: 98-100.Inwald D., Roland М., Kuitert I. et al. Oxygen treatment for acute severe asthma. Brit. Med. J. 2001; 323: 98-100.Karpel J.P., Aldrich Т.К., Prezant D.J. et al. Emergency treatment of acute asthma with albuterol metered-dose inhaler plus holding chamber: how often should treatments be administered? Chest 1997; 112: 348-356.Karpel J.P., Aldrich Т.К., Prezant D.J. et al. Emergency treatment of acute asthma with albuterol metered-dose inhaler plus holding chamber: how often should treatments be administered? Chest 1997; 112: 348-356.Kerem E., Levinson H., Schuh S. et al. Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma. J. Pediatr. 1993; 123: 313-317.Kerem E., Levinson H., Schuh S. et al. Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma. J. Pediatr. 1993; 123: 313-317.Lin Y.Z., Hsieh К.И. Metered dose inhaler and nebuliser in acute asthma. Arch. Dis. Childh. 1995; 72: 214-218.Lin Y.Z., Hsieh К.И. Metered dose inhaler and nebuliser in acute asthma. Arch. Dis. Childh. 1995; 72: 214-218.Mandelberg A., Chen E., Noviski N., Priel I.E. Nebulized wet aerosol treatment in emergency department — is it essential? Comparison with large spacer device for metered-dose inhaler. Chest 1997; 112: 1501-1505.Mandelberg A., Chen E., Noviski N., Priel I.E. Nebulized wet aerosol treatment in emergency department — is it essential? Comparison with large spacer device for metered-dose inhaler. Chest 1997; 112: 1501-1505.National asthma education and prevention program. Expert panel report II: Guidelines for the diagnosis and management of asthma. Bethesda, MD: National Institute of Health: 1997.National asthma education and prevention program. Expert panel report II: Guidelines for the diagnosis and management of asthma. Bethesda, MD: National Institute of Health: 1997.National Heat, Lung and Blood Institute Data fact sheet. Asthma statistics. 1999.National Heat, Lung and Blood Institute Data fact sheet. Asthma statistics. 1999.Raim ondi A., Schottlender J., Lombardi D., Molfino N.A. Treatment of acute severe asthma with inhaled albuterol delivered via jet nebulizer, metered dose inhaled with spacer, or dry powder. Chest. 1997; 112: 24-28.Raim ondi A., Schottlender J., Lombardi D., Molfino N.A. Treatment of acute severe asthma with inhaled albuterol delivered via jet nebulizer, metered dose inhaled with spacer, or dry powder. Chest. 1997; 112: 24-28.Rodrigo C., Rodrigo G. Salbutamol treatment of acute severe asthma in the ED: MDI versus hand-held nebulizer. Am. J. Emerg. Med. 1998; 16: 637-642.Rodrigo C., Rodrigo G. Salbutamol treatment of acute severe asthma in the ED: MDI versus hand-held nebulizer. Am. J. Emerg. Med. 1998; 16: 637-642.Soler М ., Imhof E., Perruchoud A.P. Severe acute asthma. Pathophysiology, clinical assesessment, and treatment. Respiration 1990; 57: 114-121.Soler М ., Imhof E., Perruchoud A.P. Severe acute asthma. Pathophysiology, clinical assesessment, and treatment. Respiration 1990; 57: 114-121.Turner M.O., Noertjojo K., Vedal S. et al. Risk factors for nearfatal asthma. Am. J. Respir. Crit. Care Med. 1998; 157; 1804-1809.Turner M.O., Noertjojo K., Vedal S. et al. Risk factors for nearfatal asthma. Am. J. Respir. Crit. Care Med. 1998; 157; 1804-1809.Weiss K.B., Gergen P.J., Hodgson T.A. An economic evolution of asthma in the United States. N. Engl. J. Med. 1992; 326: 862-866.Weiss K.B., Gergen P.J., Hodgson T.A. An economic evolution of asthma in the United States. N. Engl. J. Med. 1992; 326: 862-866.

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