pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2023-33-1-44-50pulmo-4190Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESБронхолитическая терапия при хронической обструктивной болезни легких: что следует учитывать в клинической практике при выборе режима дозирования?Bronchodilator therapy in patients with chronic obstructive pulmonary disease: what should be considered in clinical practice when choosing a dosing regimen?https://orcid.org/0000-0003-4678-3904ТитоваО. Н.TitovaO. N.

Титова Ольга Николаевна – доктор медицинских наук, профессор, директор Научно-исследовательского института пульмонологии.

197022, Санкт-Петербург,  ул. Льва Толстого, 6–8; тел.: (812) 338-68-40

Olga N. Titova - Doctor of Medicine, Professor, Director of Research Institute of Pulmonology.

Ul. L’va Tolstogo 6/8, Saint-Petersburg, 197089; tel.: (812) 338-68-40

titova-on@mail.ruhttps://orcid.org/0000-0002-1166-9717КузубоваН. А.KuzubovaN. A.

Кузубова Наталия Анатольевна – доктор медицинских наук, заместитель директора по научной работе Научно-исследовательского института пульмонологии пульмонологии Первый Санкт-Петербургский ГМУ имени академика И.П. Павлова; заведующая Городским пульмонологическим центром Введенская городская клиническая больница.

197022, Санкт-Петербург, ул. Льва Толстого, 6–8; 191180, Санкт-Петербург, Лазаретный переулок, 4; тел.: (812) 338-66-06

Nataliya A. Kuzubova - Doctor of Medicine, Deputy Director for Research, Research Institute of Pulmonology, Academician I.P. Pavlov First St. Petersburg SMU; Head of the City Pulmonology Center, Saint-Petersburg SBIH “ Vvedenskaya City Clinical Hospital.

Ul. L’va Tolstogo 6/8, Saint-Petersburg, 197089; Lazaretnyy per. 32, Saint-Petersburg, 191180; tel.: (812) 338-66-06

kuzubova@mail.ruhttps://orcid.org/0000-0002-9270-3779КозыревА. Г.KozyrevA. G.

Козырев Андрей Геннадьевич – кандидат медицинских наук, ведущий научный сотрудник Научно-исследовательского института пульмонологии пульмонологии Первый Санкт-Петербургский ГМУ имени академика И.П. Павлова.

197022, Санкт-Петербург,  ул. Льва Толстого, 6–8; тел.: (812) 338-78-89

Andrey G. Kozyrev - Candidate of Medicine, Leading Researcher, Research Institute of Pulmonology, Academician I.P. Pavlov First St. Petersburg SMU.

Ul. L’va Tolstogo 6/8, Saint-Petersburg, 197089; tel.: (812) 338-78-89

kozyrev@bk.ruhttps://orcid.org/0000-0002-5033-280XШумиловА. А.ShumilovA. A.

Шумилов Алексей Александрович – кандидат медицинских наук, младший научный сотрудник Научно-исследовательского института пульмонологии Первый Санкт-Петербургский ГМУ имени академика И.П. Павлова; врач-пульмонолог Введенская городская клиническая больница

197022, Санкт-Петербург, ул. Льва Толстого, 6–8; 191180, Санкт-Петербург, Лазаретный переулок, 4; тел.: (812) 417-37-19

Aleksey А. Shumilov - Candidate of Medicine, Junior Researcher, Research Institute of Pulmonology, Academician I.P. Pavlov First St. Petersburg SMU; Pulmonologist, Saint-Petersburg SBIHV vedenskaya City Clinical Hospital.

Ul. L’va Tolstogo 6/8, Saint-Petersburg, 197089; Lazaretnyy per. 32, Saint-Petersburg, 191180; tel.: (812) 417-37-19

aleksey.a.shumilov@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова, Министерство здравоохранения Российской ФедерацииРоссияFederal State Budgetary Educational Institution of Higher Education Academician I.P. Pavlov First St. Petersburg State Medical University, Ministry of Healthcare of Russian FederationRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова, Министерство здравоохранения Российской Федерации; Санкт-Петербургское государственное бюджетное учреждение здравоохранения Введенская городская клиническая больницаРоссияFederal State Budgetary Educational Institution of Higher Education Academician I.P. Pavlov First St. Petersburg State Medical University, Ministry of Healthcare of Russian Federation; Saint-Petersburg State Budgetary Institution of Healthcare Vvedenskaya City Clinical HospitalRussian Federation2023100220233314450Copyright © Титова О.Н., Кузубова Н.А., Козырев А.Г., Шумилов А.А., 20232023Титова О.Н., Кузубова Н.А., Козырев А.Г., Шумилов А.А.Titova O.N., Kuzubova N.A., Kozyrev A.G., Shumilov A.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/4190

Применение бронхолитических препаратов длительного действия (ДД) составляет основу лечения хронической обструктивной болезни легких (ХОБЛ). Одной из задач бронхолитической терапии является уменьшение интенсивности утренних симптомов ХОБЛ, которые ассоциируются с более тяжелым течением заболевания и повышенным риском обострений.

Целью исследования явилась оценка клинической эффективности переключения больных ХОБЛ с выраженными утренними симптомами, получающих комбинации бронхолитических препаратов ДД с однократным режимом дозирования, на фиксированную двойную комбинацию М-холинолитического препарата аклидиния бромида (АБ) и β2-агониста адренорецепторов (БААР) формотерола фумарата (ФФ) c двукратным режимом дозирования.

Материалы и методы

Материалы и методы. Обследованы пациенты с ХОБЛ (n = 115), получавшие комбинации ДД БААР и М-холинолитических препаратов (но не АБ и ФФ), у которых, несмотря на лечение, сохранялись жалобы на выраженные симптомы при пробуждении в утреннее время (кашель, отделение мокроты, дистантные хрипы, одышка). После обследования пациентам назначалась терапия фиксированной комбинацией АБ (0,4 мг) и ФФ (0,012 мг) в виде дозированного порошкового ингалятора по 1 дозе 2 раза в сутки. Результаты оценивались при повторном обследовании через 6 мес. лечения.

Результаты

Результаты. Завершили лечение 90 пациентов с ХОБЛ. На фоне лечения у больных отмечено существенное уменьшение интенсивности кашля, количества мокроты, выраженности дистантных хрипов и одышки в утреннее время после пробуждения (–0,88, –0,38, –0,29, –0,58 балла по 4-балльной шкале соответственно; уменьшение на 0,44 балла в среднем; р < 0,001). Результат теста по оценке ХОБЛ уменьшился с 28 (24; 34) до 24 (20; 28) баллов (р = 0,011); дистанция при выполнении 6-минутного шагового теста возросла с 319 ± 72 до 354 ± 67 м (p < 0,001). При применении фиксированной комбинации АБ и ФФ серьезных нежелательных явлений не отмечено.

Заключение

Заключение. Назначение фиксированной двойной комбинации АБ и ФФ больным ХОБЛ сопровож далось значительным клиническим улучшением и хорошо переносилось. Выбор комбинации АБ и ФФ с двукратным режимом дозирования в течение 1 суток в особенности целесообразен для пациентов с утренними симптомами заболевания, сохраняющимися, несмотря на терапию иными комбинациями ДД бронхолитических препаратов с однократным режимом дозирования.

The use of long-acting bronchodilators is central to the chronic obstructive pulmonary disease (COPD) therapy. One of the goals of bronchodilation is to reduce the morning COPD symptoms that are associated with a more severe disease and an increased risk of exacerbations.

The aim of the study was to evaluate the clinical efficacy of switching COPD patients with severe morning symptoms who received combinations of long-acting bronchodilators QD to a fixed-dose combination of aclidinium bromide (AB) and formoterol fumarate (FF) BID.

Methods

Methods. We examined COPD patients treated with combinations of long-acting β2-agonists and M-anticholinergics (but not AB and FF), who continued to complain of severe symptoms in the morning despite the treatment. After examination, the patients were switched to the fixed-dose combination of AB 0.4 mg and FF 0.012 mg (AB/FF) BID in the form of a metered-dose powder inhaler. The patients were examined at baseline and at 6-month follow-up.

Results

Results. Of the 115 included COPD patients, 90 completed the study. After 6 months of treatment, they showed a significant decrease in the intensity of cough, sputum amount, severity of distant wheezing, and shortness of breath in the morning (–0.88, –0.38, –0.29, –0.58 on a 4-point scale, the mean score –0.44; p < 0.001). The result of the COPD Assessment test decreased from 28 (24; 34) to 24 (20; 28) (p = 0.011), the distance of a 6-minute walk increased from 319 ± 72 to 354 ± 67 m (p < 0.001). The fixed-dose combination of AB/FF did not cause serious adverse events.

Conclusion

Conclusion. The fixed-dose AB/FF combination in COPD patients resulted in a significant clinical improvement and was well tolerated. The AB/FF combination with twice daily dosing regimen is advisable for the patients with morning symptoms persisting despite therapy with other combinations of long-acting bronchodilators with once daily dosing regimen.

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