pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2026-36-1-84-94pulmo-4748Research ArticleОБЗОРЫREVIEWБронхиальная астма и бронхоэктазы: опасная взаимосвязь?Bronchiectasis and asthma: a dangerous liaison?https://orcid.org/0000-0001-9928-926XГайнитдиноваВ. В.GainitdinovaV. V.

Гайнитдинова Вилия Вилевна – д. м. н., профессор кафедры пульмонологии Института клинической медицины имени Н.В.Склифосовского

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

+7(495)708-35-76

Viliya V. Gaynitdinova, Doctor of Medicine, Professor of Pulmonology Department, N.V.Sklifosovsky Institute of Clinical Medicine

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

tel.: (495) 708-35-76

ivv_08@mail.ruПанаринаИ. Н.PanarinaI. N.

Панарина Ирина Николаевна – врач-пульмонолог

127642, Москва, пр-д Шокальского, 8

тел.: (499) 479-95-39

Irina N. Panarina, Pulmonologist

proyezd Shokal’skogo 8, Moscow, 127642

tel.: (499) 479-95-39

irina.panarina2002@gmail.comhttps://orcid.org/0000-0002-5999-2150АвдеевС. Н.AvdeevS. N.

Авдеев Сергей Николаевич – д. м. н., профессор, академик Российской академии наук; директор Национального медицинского исследовательского центра по профилю «Пульмонология»; заведующий кафедрой пульмонологии Института клинической медицины имени Н.В.Склифосовского; руководитель клинического отдела; главный внештатный пульмонолог Министерства здравоохранения Российской Федерации

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

115682, Москва, Ореховый бульвар, 28

тел.: (495) 708-35-76

Scopus Author ID: 7003292838

Sergey N. Avdeev, Doctor of Medicine, Professor, Academician of Russian Academy of Sciences, Director of the National Medical Research Center for Pulmonology; Head of the Department of Pulmonology, N.V.Sklifosovsky Institute of Clinical Medicine; Head of Clinical Department; Chief Pulmonologist of the Ministry of Health of the Russian Federation

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

Orekhovyy bul’var 28, Moscow, 115682

tel.: (495) 708-35-76

Scopus Author ID: 7003292838

serg_avdeev@list.ruФедеральное 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 FederationГосударственное бюджетное учреждение здравоохранения города Москвы «Городская поликлиника № 218 Департамента здравоохранения города Москвы»РоссияMoscow City State Budgetary Healthcare Institution “City Polyclinic No.218, Moscow Department of Healthcare”Russian 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 агентства РоссииРоссияFederal 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 State Budgetary Institution “Pulmonology Scientific Research Institute” under Federal Medical and Biological Agency of Russian FederationRussian Federation2026180220263618494Copyright © Гайнитдинова В.В., Панарина И.Н., Авдеев С.Н., 20262026Гайнитдинова В.В., Панарина И.Н., Авдеев С.Н.Gainitdinova V.V., Panarina I.N., 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/4748

По данным исследований последних лет продемонстрировано, что сочетание бронхиальной астмы (БА) и бронхоэктазов (БЭ)  – частое явление, приводящее к более тяжелому течению БА с частыми обострениями. Механизмы, составляющие основу связи между этими двумя заболеваниями, до конца не установлены, однако они имеют общие клинические и иммунологические особенности, а также множество сопутствующих заболеваний.

Целью данного обзора являлись изучение и анализ результатов исследований, посвященных сочетанию БА и БЭ.

Материалы и методы

Материалы и методы. В базах данных PubMed, MedLine был проведен поиск литературы с использованием следующих ключевых терминов: «бронхоэктазы при бронхиальной астме», «связь между бронхиальной астмой и бронхоэктазами», «коморбидность при бронхиальной астме», «тяжелая бронхиальная астма», «лечение бронхиальной астмы и бронхоэктазов». Ограничения по времени публикаций не применялись.

Результаты

Результаты. БА и БЭ имеют общие симптомы, схожие коморбидные состояния и этиопатогенетические механизмы. При сочетании этих двух заболеваний формируется отдельный фенотип, который имеет клинические особенности и характеризуется более тяжелым течением БА. Для пациентов с фенотипом «БА + БЭ» характерны более тяжелая бронхиальная обструкция, частые обострения и более длительный период госпитализации по сравнению с пациентами, страдающими только БА. У пациентов с БА и хроническим риносинуситом отмечается особенно высокий риск развития БЭ. В последнее время БЭ рассматриваются как воспалительное, а не только инфекционное заболевание, что подчеркивает сложность их патофизиологии. Особый интерес представляют БЭ с высоким уровнем эозинофилов. Фенотип «БА + БЭ» отражает перекрест эозинофильного и нейтрофильного механизмов воспаления, которые приводит к ремоделированию дыхательных путей (ДП), при этом дисбиоз микробиоты усиливает это воспаление. Формируется «порочный круг» воспаления и повреждения ДП. Раннее выявление БЭ с помощью компьютерной томографии высокого разрешения у пациентов с тяжелой БА крайне важно для назначения адекватной терапии обоих заболеваний. Это позволяет улучшить контроль над симптомами, снизить частоту обострений и инфекций.

Заключение

Заключение. БЭ являются распространенным сопутствующим заболеванием у пациентов с БА. Сочетание этих двух заболеваний выделяется в отдельный фенотип с клиническими особенностями в виде более частых хронических инфекций и повышенной тяжести течения. При использовании тактики ведения пациентов с фенотипом «БА + БЭ» требуется индивидуальный подход для оптимизации лечения и эффективного решения этой сложной коморбидности.

Recent studies demonstrate that the combination of asthma and bronchiectasis is a common phenomenon, leading to a more severe course of asthma with frequent exacerbations. The mechanisms underlying the association between these two diseases are not well understood; however, they share common clinical and immunological features, as well as numerous comorbidities.

The aim of this review was to examine and analyze the results of studies focusing on concomitant asthma and bronchiectasis.

Methods

Methods. A literature search in the PubMed, MedLine databases was conducted using the following key terms: bronchiectasis in asthma, association between asthma and bronchiectasis, comorbidities in asthma, severe asthma, treatment of asthma and bronchiectasis. The publication date was not limited.

Results

Results. Asthma and bronchiectasis share overlapping symptoms, similar comorbid conditions, and etiopathogenetic mechanisms. The coexistence of these two diseases may form a characteristic phenotype with a more severe course of asthma. The “asthma + bronchiectasis” phenotype is characterized by more severe bronchial obstruction, frequent exacerbations, and longer hospitalizations as compared to asthma alone. Patients with asthma and chronic rhinosinusitis have an especially high risk of developing bronchiectasis. Recently, bronchiectasis has been viewed as an inflammatory, rather than purely infectious, disease, highlighting the complexity of its pathophysiology. Bronchiectasis with high eosinophil levels is of particular interest. The “asthma + bronchiectasis” phenotype reflects the overlap of eosinophilic and neutrophilic inflammatory mechanisms, leading to airway remodeling, while microbiota dysbiosis exacerbates this inflammation. This creates a vicious cycle of airway inflammation and damage. Early detection of bronchiectasis with high-resolution computed tomography in patients with severe asthma is essential for initiating appropriate therapy for both diseases. This approach improves symptom control and reduces the frequency of exacerbations and infections.

Conclusion

Conclusion. Bronchiectasis is a common comorbid condition in patients with asthma. The combination of these two diseases constitutes a distinct phenotype characterized by more frequent chronic infections and increased disease severity. Patients with the “asthma + bronchiectasis” phenotype require an individualized approach to optimize treatment and effectively address this complex comorbidity.

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