pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2014-0-6-73-82pulmo-496Research ArticleОБЗОРЫREVIEWАнтихолинергические препараты в лечении хронической обструктивной болезни легких: фокус на тиотропийAnticholinergics for therapy of chronic obstructive pulmonary disease: focus on tiotropiumСинопальниковА. И.Sinopal'nikovA. I.

д. м. н., профессор, зав. кафедрой пульмонологии ГБОУ ДПО "Российская медицинская академия последипломного образования" Минздрава России; тел.: (495) 263-53-72

MD, Professor, Head of Chair of Pulmonology, State Budget Educational Institution of Аdditional Еducation "Russian Medical Postgraduate Academy", Healthcare Ministry of Russia; tel.: (495) 263-53-72

aisyn@list.ruГБОУ ДПО "Российская медицинская академия последипломного образования" Минздрава России: 123995, Москва, ул. Баррикадная, 2 / 1РоссияState Institution of Аdditional Еducation "Russian Medical Postgraduate Academy", Healthcare Ministry of Russia: 2 / 1, Barrikadnaya ul., Moscow, 123995, Russia SummaryRussian Federation201428122014067382Copyright © Синопальников А.И., 20142014Синопальников А.И.Sinopal'nikov A.I.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/496

В последние несколько лет наблюдается лавинообразный рост числа новых лекарственных препаратов и их комбинаций, предлагаемых для лечения больных хронической обструктивной болезнью легких (ХОБЛ), что, с одной стороны, увеличивает терапевтические возможности, с другой – затрудняет выбор лучших из имеющихся. До настоящего времени бронходилататоры остаются ведущим направлением фармакотерапии ХОБЛ, а монотерапия антихолинергическими препаратами (АХП) или их комбинация с другими лекарственными средствами (β2-агонисты длительного действия, глюкокортикоиды, рофлумиласт) – едва ли не наиболее востребованный лечебный подход у данной категории больных. Подобное утверждение базируется главным образом на беспримерных доказательствах эффективности и безопасности применения тиотропия бромида (ТБ) – прототипа длительно действующих АХП, опыт успешного клинического применения которого составляет свыше 10 лет. Во многом именно репутацией ТБ стимулирован результативный поиск других длительно действующих АХП, которые в настоящее время являются одним из наиболее активно разрабатываемых и высокоэффективных классов лекарственных препаратов для лечения ХОБЛ. Очевидно, что у новых АХП база данных по оценке их клинической эффективности и безопасности ограничена, представлена исследованиями III фазы и потому не отражает в полной мере реальную популяцию больных ХОБЛ и не позволяет рассматривать их в качестве безусловной альтернативы ТБ. 

Recently, there is a progressive growth in new drugs and combinations for treatment of chronic obstructive pulmonary disease (COPD) that, on the one hand, promotes therapeutic opportunities but, on the other hand, impedes the best choice of the drug. Bronchodilators have been still the cornerstone of the pharmacotherapy of COPD. Anticholinergics as monotherapy or in combination with other drugs, such as long-acting beta-2-agonists, inhaled steroids, or roflumilast, are widespread therapeutic approach for these patients. A huge body of evidence has been accumulated about the safety and efficacy of long-acting anticholinergic tiotropium bromide which has been successfully used worldwide for more than 10 years. Longacting anticholinergics are one of the most actively developed and highly efficient drugs for management of COPD. There is limited evidence regarding clinical efficacy and safety of novel anticholinergics mostly obtained from phase III clinical trials which did not involve the real-life population of COPD patients; this fact prevents considering new long-acting anticholinergics as a definitive alternative for tiotropium bromide. 

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