pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2015-25-2-143-150pulmo-546Research ArticleКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИCLINICAL GUIDELINESСогласованные рекомендации по применению антихолинергического препарата длительного действия тиотропия в терапии бронхиальной астмыConsensus report: indications for use of long-acting antimuscarinic tiotropium in the treatment of bronchial asthmaЧучалинА. Г.ChuchalinA. G.

д. м. н., профессор, директор ФГБУ "НИИ пульмонологии" ФМБА России, председатель правления РРО, главный внештатный специалист терапевт

MD, Professor, Academician of the Russian Science Academy, Director of Federal State Budget institution «Pulmonology Research Institute», Federal Medical and Biological Agency of Russia, the Chairman of the Russian Respiratory Society, Chief Therapeutist and Pneumologist of the Healthcare Ministry of Russian Federation; tel.: (495) 465-52-64;

chuchalin@inbox.ruАвдеевС. Н.AvdeevS. N.

д. м. н., профессор, зам. директора по научной работе, зав. клиническим отделом ФГБУ «НИИ пульмонологии» ФМБА России; тел. / факс: (495) 465-52-64;

MD, Professor, Head of Clinical Department, Federal State Federal Institution «Pulmonology Research Institute», Federal Medical and Biological Agency of Russia; tel.: (495) 465-52-64

serg_avdeev@list.ruАйсановЗ. Р.AisanovZ. R.

д. м. н., профессор, зав. отделом клинической физиологии и клинических исследований ФГБУ «НИИ пульмонологии» ФМБА России; тел.: (495) 965-34-66

MD, Professor, Head of Department of Clinical Physiology and Clinical Trials, Federal State Budget institution «Pulmonology Research Institute», Federal Medical and Biological Agency of Russia, tel.: (495) 965-34-66;

aisanov@mail.ruАрхиповВ. В.ArkhipovV. V.

д. м. н., проф. кафедры клинической фармакологии и пропедевтики внутренних болезней ГБОУ ВПО «Первый МГМУ им. И.М.Сеченова»; тел.: +7-985-190-17-00;

MD, Professor, State Institution "I.M.Sechenov First Moscow State Medical University", Healthcare Ministry of Russia; tel.: +7-985-190-17-00

1901700@gmail.comБелевскийА. С.BelevskiiA. S.

д. м. н., профессор кафедры ФДПО пульмонологии ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России, зав. лабораторией реабилитации и исследования качества жизни ФГБУ «НИИ пульмонологии» ФМБА России, главный внештатный специалист-пульмонолог Департамента здравоохранения Москвы; тел.: (495) 965-09-27: 

MD, Professor of Department of Pulmonology, Faculty of Postgraduate Physician Training, State Institution "N.I.Pirogov Russian National Research Medical University", Healthcare Ministry of Russia; tel.: (495) 963-24-67;

pulmobas@yandex.ruНенашеваН. М.NenashevaN. M.

д. м. н., профессор кафедры клинической аллергологии ГБОУ ДПО «Российская медицинская академия последипломного образования» Минздрава России; тел.: (499) 196-17-86;

MD, Professor of Chair of Clinical Allergology, State Budget Educational Institution of Аdditional Еducation "Russian Medical Postgraduate Academy", Healthcare Ministry of Russia, tel.: (499) 196-17-86;

1444031@gmail.com201524062015252143150Copyright © Чучалин А.Г., Авдеев С.Н., Айсанов З.Р., Архипов В.В., Белевский А.С., Ненашева Н.М., 20152015Чучалин А.Г., Авдеев С.Н., Айсанов З.Р., Архипов В.В., Белевский А.С., Ненашева Н.М.Chuchalin A.G., Avdeev S.N., Aisanov Z.R., Arkhipov V.V., Belevskii A.S., Nenasheva N.M.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/546

В Согласованных рекомендациях рассматриваются клиническая значимость и доказательная база тиотропия применительно к каждому из показаний для назначения тиотропия Респимат при бронхиальной астме (БА). Экспертный совет был сформирован из специалистов – пульмонологов и аллергологов в соответствии с их научным авторитетом в данной области. Доказательная база и проект Рекомендаций были подготовлены инициативной группой. Каждый пункт заключения обсуждался на Экспертном совете и принимался большинством голосов при открытом голосовании. После проведения Экспертного совета инициативной группой проведено редактирование проекта заключения в соответствии с полученными замечаниями и предложениями. Окончательный проект заключения был согласован со всеми членами Экспертного совета. Добавление к терапии тиотропия Респимат рекомендуется в следующих случаях: 1) при тяжелой и среднетяжелой БА, если не достигается полный контроль над заболеванием при терапии ступеней 3–5 (ингаляционные глюкокортикостероиды (иГКС) + #b2-агонисты длительного действия (ДДБА), в т. ч. в сочетании с системными ГКС и другими базисными препаратами, или монотерапия иГКС в высоких дозах); 2) при сочетании БА и ХОБЛ; 3) в качестве альтернативы ДДБА, когда имеются противопоказания к назначению, нежелательные эффекты или индивидуальная непереносимость ДДБА; 4) в качестве дополнительных показаний к назначению тиотропия Респимат пациентам с БА при курении, положительном бронходилатационном тесте с #b2-агонистом короткого действия, преобладании ночных симптомов.

Relevant indications for tiotropium Respimat in adult patients with bronchial asthma (BA) were reviewed. This consensus represents a collaborative effort of members of the Executive Group of Russian Respiratory Society. The Group consisted of clinicians, pharmacologists and researchers with recognized expertise in therapeutic field. The draft of the recommendations was prepared by initiative group. Each point of the recommendation was discussed during Executive group meeting and was accepted by vote of majority members. Final version of the consensus statement was approved by each member of Executive group. As concluded, tiotropium Respimat could be recommended for adult patients with bronchial asthma as: 1) add-on therapy in patients with severe and moderate severe non-controlled BA on GINA step 3–5 (ICS and LABA, including oral steroids or other controllers, or high doses ICS monotherapy); 2) add-on therapy in patients with asthma-COPD overlap syndrome (ACOS); 3) add-on therapy to ICS in case of side effects, contraindications for use or individual intolerance of LABA; 4) additional indications to consider use of tiotropium Respimat may include: smoking, positive SABA reversibility test, predominant nocturnal asthma symptoms.

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