pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2022-32-3-393-447pulmo-4109Research ArticleКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИCLINICAL GUIDELINESБронхиальная астма: федеральные клинические рекомендации по диагностике и лечениюFederal guidelines on diagnosis and treatment of bronchial asthmahttps://orcid.org/0000-0002-6808-5528ЧучалинА. Г.ChuchalinA. G.

д. м. н., профессор, академик Российской академии наук, заведующий кафедрой госпитальной терапии педиатрического факультета,

117997, Москва, ул. Островитянова, 1

председатель правления Российского респираторного общества

Doctor of Medicine, Professor, Academician of Russian Academy of Sciences, Head of Department of Hospital Internal Medicine, Pediatric Faculty, ul. Ostrovityanova 1, Moscow, 117997;

Chairman of the Executive Board of Russian Respiratory Society

pulmomoskva@mail.ruhttps://orcid.org/0000-0002-5999-2150АвдеевС. Н.AvdeevS. N.

д. м. н., профессор, академик Российской академии наук, заведующий кафедрой пульмонологии Института клинической медицины имени Н.В.Склифосовского, 119991, Москва, ул. Трубецкая, 8, стр. 2;

ведущий научный сотрудник, 115682, Москва, Ореховый бульвар, 28

Doctor of Medicine, Professor, Academician of Russian Academy of Sciences, Head of the Department of Pulmonology, N.V.Sklifosovsky Institute of Clinical Medicine, ul. Trubetskaya 8, build. 2, Moscow, 119991ж

Leading Researcher, Orehovyj bul’var 28, Moscow, 115682

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

д. м. н., профессор кафедры пульмонологии факультета дополнительного профессионального образования,

117997, Москва, ул. Островитянова, 1

Doctor of Medicine, Professor, Department of Pulmonology, 

ul. Ostrovityanova 1, Moscow, 117997

aisanov@mail.ruhttps://orcid.org/0000-0001-6050-724XБелевскийА. С.BelevskiyA. S.

д. м. н., профессор, заведующий кафедрой пульмонологии факультета дополнительного профессионального образования,

117997, Москва, ул. Островитянова, 1

Doctor of Medicine, Professor, Head of the Department of Pulmonology, Faculty of Postgraduate Physician Training, 

ul. Ostrovityanova 1, Moscow, 117997

pulmobas@yandex.ruВасильеваО. С.Vasil’evaO. S.

д. м. н., профессор, заведующая лабораторией экологозависимых и профессиональных легочных заболеваний, 

115682, Москва, Ореховый бульвар, 28

Doctor of Medicine, Professor, Head of Laboratory of Environmental and Occupational Pulmonary Diseases,

Orehovyj bul’var 28, Moscow, 115682

ovasil@mail.ruhttps://orcid.org/0000-0003-0547-3686ГеппеН. А.GeppeN. A.

д. м. н., профессор, заведующая кафедрой детских болезней института клинической медицины,

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

Doctor of Medicine, Professor, Head of Department of Pediatric Diseases, Therapeutic Faculty, 

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

geppe@mail.ruhttps://orcid.org/0000-0002-0877-6554ИгнатоваГ. Л.IgnatovaG. L.

д. м. н., профессор, заведующая кафедрой терапии института дополнительного профессионального образования, 454092, Челябинск, Воровского, 64;

руководитель Городского пульмонологического центра (Челябинск), главный пульмонолог Челябинска

Doctor of Medicine, Professor, Head of Department of Therapy, Institute of Postgraduate Physician Training,

ul. Vorovskogo 64, Chelyabinsk, 454092

Head of the City Pulmonology Center (Chelyabinsk); Chief pulmonologist of Chelyabinsk

iglign@mail.ruКняжескаяН. П.KnyazheskayaN. P.

к. м. н., доцент кафедры пульмонологии факультета дополнительного профессионального образования,

117997, Москва, ул. Островитянова, 1

Candidate of Medicine, Associate Professor at Department of of Pulmonology, Faculty of Postgraduate Physician Training, 

ul. Ostrovityanova 1, Moscow, 117997

Kniajeskaia@mail.ruhttps://orcid.org/0000-0002-2686-8284МалаховА. Б.MalakhovA. B.

д. м. н., профессор кафедры детских болезней,

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

Doctor of Medicine, Professor at Department of Pediatric Diseases, 

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

alexis4591m@mail.ruМещеряковаН. Н.MeshcheryakovaN. I.

к. м. н., доцент кафедры пульмонологии факультета дополнительного профессионального образования,

117997, Москва, ул. Островитянова, 1

Candidate of Medicine, Associate Professor, Department of Pulmonology, Faculty of Postgraduate Physician Training, 

ul. Ostrovityanova 1, Moscow, 117997

m_natalia1967@inbox.ruhttps://orcid.org/0000-0002-3162-2510НенашеваН. М.NenashevaN. M.

д. м. н., профессор кафедры клинической аллергологии,

125993, Москва, ул. Баррикадная, 2 / 1, стр. 1

Doctor of Medicine, Professor, Department of Clinical Allergology,

ul. Barrikadnaya 2/1, build. 1, Moscow, 123995

1444031@gmail.comhttps://orcid.org/0000-0001-9322-2689ФассаховР. С.FassakhovR. S.

д. м. н., профессор кафедры фундаментальных основ клинической медицины,

420008, Республика Татарстан, Казань, ул. Кремлевская, 18

Doctor of Medicine, Professor, Department of Basic Clinical Medicine, 

ul. Kremlyovskaya 18, Kazan, 420008, Tatarstan Republic

farrus@mail.ruhttps://orcid.org/0000-0002-2397-5172ХаитовР. М.KhaitovR. M.

д. м. н., профессор, академик Российской академии наук, научный руководитель, 127473, Москва, ул. Делегатская, 20, стр. 1;

заведующий кафедрой иммунологии и аллергологии, 115478, Москва, Каширское шоссе, 24, корп. 24

Head of the Department of Immunology and Allergology, ul. Delegatskaya 20/1, Moscow, 127473;

Doctor of Medicine, Professor, Academician of the Russian Academy of Sciences, Scientific Director, Kashirskoe shosse 24, Moscow, 115478

 

rkhaitov@mail.ruhttps://orcid.org/0000-0002-3556-969XИльинаН. И.Il’inaN. I.

д. м. н., профессор, заместитель директора по клинической работе,

115478, Москва, Каширское шоссе, 24, корп. 24

Doctor of Medicine, Professor, Deputy Director for Clinical Affairs, 

Kashirskoe shosse 24, Moscow, 115478

instimmun@yandex.ruhttps://orcid.org/0000-0003-3250-0694КурбачеваО. М.KurbachevaO. M.

д. м. н., профессор, заведующая отделением бронхиальной астмы,

115478, Москва, Каширское шоссе, 24, корп. 24

Doctor of Medicine, Professor, Head of the Department of bronchial asthma, 

Kashirskoe shosse 24, Moscow, 115478

kurbacheva@gmail.comhttps://orcid.org/0000-0002-7691-4584АстафьеваН. Г.AstafievaN. G.

д. м. н., профессор, заведующая кафедрой клинической иммунологии и аллергологии?

410012, Саратов, ул. Большая Казачья, 112

Doctor of Medicine, Professor, Head of the Department of Clinical Immunology and Allergology, 

ul. Bolshaya Kazachia 112, Saratov, 410012

meduniv@sgmu.ruhttps://orcid.org/0000-0001-8982-5292ДемкоИ. В.DemkoI. V.

д. м. н., профессор, заведующая кафедрой внутренних болезней № 2 с курсом постдипломного образования,

660022, Красноярск, ул. Партизана Железняка, 1

Doctor of Medicine, Professor, Head of Department of Internal Medicine No.2 with Postgraduate Physician Training Course, 

ul. Partizana Zheleznyaka 1, Krasnoyarsk, 660022

demko64@mail.ruФоминаД. С.FominaD. S.

доцент кафедры клинической иммунологии и аллергологии, 119991, Москва, ул. Трубецкая, 8, стр. 2;

к. м. н., врач аллерголог-иммунолог, руководитель центра аллергологии и иммунологии, 123182, Москва, ул. Пехотная, 3

Associate Professor, Department of Clinical Allergology аnd Immunology, ul. Trubetskaya 8, build. 2, Moscow, 119991;

Candidate of Medicine, Allergist and immunologist, Head of of diagnostic Division of Allergology аnd Immunology Center, Pekhotnaya ul. 3, Moscow, 123182 

daria_fomina@mail.ruhttps://orcid.org/0000-0002-2209-7531Намазова-БарановаЛ. С.Namazova-BaranovaL. S.

заведующая кафедрой факультетской педиатрии педиатрического факультета, 117997, Москва, ул. Островитянова, 1;

д. м. н., профессор, академик Российской академии наук, президент Союза педиатров России; руководитель Научно-исследовательского института педиатрии и охраны здоровья детей,  119333, Москва, ул. Фотиевой, 10, стр. 1

Head of Faculty Pediatrics Department, Pediatric Faculty, ul. Ostrovityanova 1, Moscow,117997;

Doctor of Medicine, Professor, Academician of the Russian Academy of Sciences, President of the Union of Pediatricians of Russia; Head of Pediatrics and Child Health Research Institute, ul. Fotievoy 10, buld. 1, Moscow, 119333;

Chief Pediatric Specialist in Preventive Medicine, Healthcare Ministry of Russia; Vice-President of the Global Pediatric Pulmonological Alliance

leyla.s.namazova@gmail.comhttps://orcid.org/0000-0003-3987-8112БарановА. А.BaranovA. A.

д. м. н., профессор, академик Российской академии наук, Почетный президент Союза педиатров России; главный внештатный специалист-педиатр Министерства здравоохранения Российской Федерации;

советник руководителя, 119333, Москва, ул. Фотиевой, 10, стр. 1

Doctor of Medicine, Professor, Academician of the Russian Academy of Sciences, Honorary President of the Union of Russian Pediatricians; Chief Pediatrician of Healthcare Ministry of Russia; Manager’s adviser,

ul. Fotievoy 10, buld. 1, Moscow, 119333

baranov@pediatr-russia.ruВишневаЕ. А.VishnevaE. A.

профессор кафедры факультетской педиатрии педиатрического факультета, 117997, Москва, ул. Островитянова, 1;

д. м. н., пресс-секретарь Союза педиатров России, заместитель руководителя по науке, 119333, Москва, ул. Фотиевой, 10, стр. 1

Professor, Faculty Pediatrics Department, Pediatric Faculty, ul. Ostrovityanova 1, Moscow, 117997;

Doctor of Medicine, Press secretary of the Union of Russian Pediatricians, Deputy Director for Science, ul. Fotievoy 10, buld. 1, Moscow, 119333

leyla.s.namazova@gmail.comНовикГ. А.NovikG. A.

д. м. н., профессор, заведующий кафедрой детских болезней имени профессора И.М.Воронцова факультета послевузовского и дополнительного профессионального образования,

194100, Санкт-Петербург, ул. Литовская, 2

Doctor of Medicine, Professor, Head of I.M.Vorontsov Pediatric diseases Department, Faculty of Postgraduate and Additional Professional Education, 

ul. Litovskaya 2, Saint Petersburg, 194100

ga_novik@mail.ruФедеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И.Пирогова» Министерства здравоохранения Российской ФедерацииРоссияPirogov Russian National Research Medical University (Pirogov Medical University), Ministry of Health of the Russian FederationRussian FederationФедеральное 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 агентстваРоссияFederal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); Federal Pulmonology Research Institute, Federal Medical and Biological Agency of RussiaRussian FederationФедеральное государственное бюджетное учреждение «Научно-исследовательский институт пульмонологии» Федерального медико-биологического агентстваРоссияFederal Pulmonology Research Institute, Federal Medical and Biological Agency of RussiaRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М.Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияFederal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Russian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Южно-Уральский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияSouth Ural State Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияRussian Medical Academy of Continuous Professional Education, Healthcare Ministry of Russian FederationRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Казанский (Приволжский) федеральный университет» Министерства науки и высшего образования Российской ФедерацииРоссияFederal State Autonomous Educational Institution of Higher Education “Kazan (Volga Region) Federal University” Ministry of Healthcare of the Russian FederationRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Московский государственный медико-стоматологический университет имени А.И.Евдокимова» Министерства здравоохранения Российской Федерации; Федеральное государственное бюджетное учреждение «Государственный научный центр “Институт иммунологии” Федерального медико-биологического агентства»РоссияFederal State Budgetary Educational Institution of the Higher Education “A.I.Yevdokimov Moscow State University of Medicine and Dentistry” of the Ministry of Healthcare of the Russian Federation; Federal Research Center “Institute of Immunology”, Federal Medical and Biological Agency of RussiaRussian FederationФедеральное государственное бюджетное учреждение «Государственный научный центр “Институт иммунологии” Федерального медико-биологического агентства»РоссияFederal Research Center “Institute of Immunology”, Federal Medical and Biological Agency of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Саратовский государственный медицинский университет имени В.И.Разумовского» Министерства здравоохранения Российской ФедерацииРоссияSaratov State Medical University named after V.I.Razumovsky, Healthcare Ministry of Russian FederationRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Красноярский государственный медицинский университет имени профессора В.Ф.Войно-Ясенецкого» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Educational Institution of Higher Education “Krasnoyarsk State Medical University named after Professor V.F.Voyno-Yasenetsky” of the Ministry of Health of the Russian FederationRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М.Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет); Государственное бюджетное учреждение здравоохранения «Городская больница № 52» Департамента здравоохранения МосквыРоссияFederal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); State Institution “City Hospital No.52”, Moscow Health DepartmentRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И.Пирогова» Министерства здравоохранения Российской Федерации; Научно-исследовательский институт педиатрии и охраны здоровья детей Федерального государственного бюджетного учреждения «Центральная клиническая больница Российской академии наук» Министерства науки и высшего образования Российской ФедерацииРоссияPirogov Russian National Research Medical University (Pirogov Medical University), Ministry of Health of the Russian Federation; Pediatrics and Child Health Research Institute of the “Central Clinical Hospital of the Russian Academy of Sciences”, Ministry of Education and Science of RussiaRussian FederationНаучно-исследовательский институт педиатрии и охраны здоровья детей Федерального государственного бюджетного учреждения «Центральная клиническая больница Российской академии наук» Министерства науки и высшего образования Российской ФедерацииРоссияPediatrics and Child Health Research Institute of the “Central Clinical Hospital of the Russian Academy of Sciences”, Ministry of Education and Science of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный педиатрический медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияFederal State budgetary Educational Institution of Higher Education “St. Petersburg State Pediatric Medical University” of the Ministry of Healthcare of the Russian FederationRussian Federation202214072022323Спецвыпуск393447Copyright © Чучалин А.Г., Авдеев С.Н., Айсанов З.Р., Белевский А.С., Васильева О.С., Геппе Н.А., Игнатова Г.Л., Княжеская Н.П., Малахов А.Б., Мещерякова Н.Н., Ненашева Н.М., Фассахов Р.С., Хаитов Р.М., Ильина Н.И., Курбачева О.М., Астафьева Н.Г., Демко И.В., Фомина Д.С., Намазова-Баранова Л.С., Баранов А.А., Вишнева Е.А., Новик Г.А., 20222022Чучалин А.Г., Авдеев С.Н., Айсанов З.Р., Белевский А.С., Васильева О.С., Геппе Н.А., Игнатова Г.Л., Княжеская Н.П., Малахов А.Б., Мещерякова Н.Н., Ненашева Н.М., Фассахов Р.С., Хаитов Р.М., Ильина Н.И., Курбачева О.М., Астафьева Н.Г., Демко И.В., Фомина Д.С., Намазова-Баранова Л.С., Баранов А.А., Вишнева Е.А., Новик Г.А.Chuchalin A.G., Avdeev S.N., Aisanov Z.R., Belevskiy A.S., Vasil’eva O.S., Geppe N.A., Ignatova G.L., Knyazheskaya N.P., Malakhov A.B., Meshcheryakova N.I., Nenasheva N.M., Fassakhov R.S., Khaitov R.M., Il’ina N.I., Kurbacheva O.M., Astafieva N.G., Demko I.V., Fomina D.S., Namazova-Baranova L.S., Baranov A.A., Vishneva E.A., Novik G.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/4109

Бронхиальная астма (БА) является гетерогенным заболеванием, при котором требуется выделение различных фенотипов и персонифицированный подход к терапии. При этом несмотря на широкий выбор терапевтических возможностей, у многих пациентов с БА не удается достичь контроля над заболеванием.

Методы

Методы. Целевой аудиторией данных клинических рекомендаций являются врачи общей практики, терапевты, педиатры, аллергологи-иммунологи, пульмонологи и врачи функциональной диагностики. Каждый тезис-рекомендация по проведению диагностических и лечебных мероприятий оценивается по шкалам уровней достоверности доказательств от 1 до 5 и шкале оценки уровней убедительности рекомендаций по категориям А, В, С. Клинические рекомендации содержат также комментарии и разъяснения к указанным тезисам-рекомендациям, алгоритмы по диагностике и лечению БА, справочные материалы.

Заключение

Заключение. По данным представленных клинических рекомендаций освещаются современные сведения об этиологии и патогенезе, классификации, клинических проявлениях, диагностике, лечении и профилактике БА. Клинические рекомендации одобрены Научно-практическим Советом Министерства здравоохранения Российской Федерации (2021). 

Bronchial asthma is a heterogeneous disease that requires identification of its phenotype and a personalized approach to therapy. At the same time, despite a wide range of therapeutic options, many patients with asthma cannot achieve control over the disease.

Methodology

Methodology. The target audience of these clinical recommendations are general practitioners, therapists, pediatricians, allergologists-immunologists, pulmonologists, and functional diagnostics doctors. Each thesis-recommendation about diagnostic and therapeutic procedures has been scored according to the scales of classes of recommendations from 1 to 5 and A, B, C scale of the levels of evidence. The clinical recommendations also contain comments and explanations to the theses, algorithms for the diagnosis and treatment of bronchial asthma, and reference materials.

Conclusion

Conclusion. The presented clinical guidelines cover current information about the etiology and pathogenesis, classification, clinical manifestations, diagnosis, treatment, and prevention of bronchial asthma. These guidelines were approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation in 2021. 

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