pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2013-0-1-68-76pulmo-56Research ArticleОБЗОРЫREVIEWФенотип хронической обструктивной болезни легких с частыми обострениями и современная противовоспалительная терапияPhenotype of chronic obstructive pulmonary disease with frequent exacerbations and current anti–inflammatory therapyАйсановЗ. Р.AisanovZ. R.

д. м. н., проф., зав. отделом клинической физиологии и клинических исследований 

105077, Москва, ул. 11–я Парковая, 32, корп. 4

aisanov@mail.ruКалмановаЕ. Н.KalmanovaE. N.

к. м. н., доцент кафедры госпитальной терапии педиатрического факультета 

117997, Москва, ул. Островитянова, 1

kalmanova@mail.ruСтуловаО. Ю.StulovaO. Yu.

зав. лабораторией 

105077, Москва, ул. 11–я Парковая, 32, корп. 4

olga.stulova@mail.ruФГБУ "НИИ пульмонологии"Russian FederationГБОУ ВПО РНИМУ им. Н.И.ПироговаRussian Federation201328022013016876Copyright © Айсанов З.Р., Калманова Е.Н., Стулова О.Ю., 20132013Айсанов З.Р., Калманова Е.Н., Стулова О.Ю.Aisanov Z.R., Kalmanova E.N., Stulova O.Y.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/56

Фенотип хронической обструктивной болезни легких с частыми обострениями и современная противовоспалительная терапия.

Phenotype of chronic obstructive pulmonary disease with frequent exacerbations and current anti–inflammatory therapy.

хроническая обструктивная болезнь легкихобостренияфенотипингибиторы фосфодиэстеразы–4chronic obstructive pulmonary diseaseexacerbationsphenotypephosphodiesterase–4 inhibitorsReferencesGlobal Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD. Updated 2013. http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013_Feb20.pdfGlobal Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD. Updated 2013. http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013_Feb20.pdfWorld Health Organization. Chronic Obstructive Pulmonary Disease Fact Sheet. 2012. www.who.int/mediacentre/factsheets/fs315World Health Organization. Chronic Obstructive Pulmonary Disease Fact Sheet. 2012. www.who.int/mediacentre/factsheets/fs315Celli B.R., Macnee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS / ERS position paper. Eur. Respir. J. 2004; 23 (6): 932–946.Celli B.R., Macnee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS / ERS position paper. Eur. Respir. J. 2004; 23 (6): 932–946.Donaldson G.C., Wedzicha J.A. COPD exacerbations. 1: Epidemiology. Thorax 2006; 61 (2): 164–168.Donaldson G.C., Wedzicha J.A. COPD exacerbations. 1: Epidemiology. Thorax 2006; 61 (2): 164–168.Pauwels R., Calverley P., Buist A.S. et al. COPD exacerbations: the importance of a standard definition. Respir. Med. 2004; 98 (2): 99–107.Pauwels R., Calverley P., Buist A.S. et al. COPD exacerbations: the importance of a standard definition. Respir. Med. 2004; 98 (2): 99–107.Seemungal T.A., Donaldson G.C., Bhowmik A. et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2000; 161 (5): 1608–1613.Seemungal T.A., Donaldson G.C., Bhowmik A. et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2000; 161 (5): 1608–1613.Hurst J.R., Perera W.R., Wilkinson T.M. et al. Systemic and upper and lower airway inflammation at exacerbation of chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2006; 173: 71–78.Hurst J.R., Perera W.R., Wilkinson T.M. et al. Systemic and upper and lower airway inflammation at exacerbation of chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2006; 173: 71–78.Wedzicha J.A., Seemungal T.A. COPD exacerbations: defining their cause and prevention. Lancet 2007; 370: 786–796.Wedzicha J.A., Seemungal T.A. COPD exacerbations: defining their cause and prevention. Lancet 2007; 370: 786–796.Perera W.R., Hurst J.R., Wilkinson T.M. et al. Inflammatory changes, recovery and recurrence at COPD exacerbation. Eur. Respir. J. 2007; 29 (3): 527–534.Perera W.R., Hurst J.R., Wilkinson T.M. et al. Inflammatory changes, recovery and recurrence at COPD exacerbation. Eur. Respir. J. 2007; 29 (3): 527–534.Miravitlles M., Guerrero T., Mayordomo C. et al. Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients: a multiplelogistic regression analysis. Respiration 2000; 67: 495–501.Miravitlles M., Guerrero T., Mayordomo C. et al. Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients: a multiplelogistic regression analysis. Respiration 2000; 67: 495–501.Hurst J.R., Vestbo J., Anzueto A. et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N. Engl. J. Med. 2010; 363: 1128–1138.Hurst J.R., Vestbo J., Anzueto A. et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N. Engl. J. Med. 2010; 363: 1128–1138.Soler–Cataluna J.J., Rodriguez–Roisin R. Frequent chronic obstructive pulmonary disease exacerbators: how much real, how much fictitious? COPD 2010; 7: 276–284.Soler–Cataluna J.J., Rodriguez–Roisin R. Frequent chronic obstructive pulmonary disease exacerbators: how much real, how much fictitious? COPD 2010; 7: 276–284.Tashkin D.P. Frequent exacerbations of chronic obstructive pulmonary disease – a distinct phenotype? N. Engl. J. Med. 2010; 363: 1183–1184.Tashkin D.P. Frequent exacerbations of chronic obstructive pulmonary disease – a distinct phenotype? N. Engl. J. Med. 2010; 363: 1183–1184.Seemungal T.A.R., Donaldson G.C., Paul E.A. et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1998; 157: 1418–1422.Seemungal T.A.R., Donaldson G.C., Paul E.A. et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1998; 157: 1418–1422.Quint J.K, Baghai–Ravary R., Donaldson G.C., Wedzicha J.A. Relationship between depression and exacerbations in COPD. Eur. Respir. J. 2008; 32: 53–60.Quint J.K, Baghai–Ravary R., Donaldson G.C., Wedzicha J.A. Relationship between depression and exacerbations in COPD. Eur. Respir. J. 2008; 32: 53–60.Soler J.J., Sanchez L., Roman P. et al. Risk factors of emergency care and admissions in COPD patients with high consumption of health resources. Respir. Med. 2004; 98: 318–329.Soler J.J., Sanchez L., Roman P. et al. Risk factors of emergency care and admissions in COPD patients with high consumption of health resources. Respir. Med. 2004; 98: 318–329.Soler J.J., Sanchez L., Latorre M. et al. The impact of COPD on hospital resources: the specific burden of COPD patients with high rates of hospitalization. Arch. Bronconeumol. 2001; 37: 375–381.Soler J.J., Sanchez L., Latorre M. et al. The impact of COPD on hospital resources: the specific burden of COPD patients with high rates of hospitalization. Arch. Bronconeumol. 2001; 37: 375–381.Soler–Cataluña J.J., Martinez–Garcia M.A., Roman Sanchez P. et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005; 60: 925–931.Soler–Cataluña J.J., Martinez–Garcia M.A., Roman Sanchez P. et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005; 60: 925–931.Esteban C., Quintana J.M., Aburto M. et al. Predictors of mortality in patients with stable COPD. J. Gen. Intern. Med. 2008; 23: 1829–1834.Esteban C., Quintana J.M., Aburto M. et al. Predictors of mortality in patients with stable COPD. J. Gen. Intern. Med. 2008; 23: 1829–1834.Soler–Cataluña J.J., Martinez–Garcia M.A., Sanchez L. et al. Severe exacerbations and BODE index: two independent risk factors for death in male COPD patients. Respir. Med.2009; 103: 692–699.Soler–Cataluña J.J., Martinez–Garcia M.A., Sanchez L. et al. Severe exacerbations and BODE index: two independent risk factors for death in male COPD patients. Respir. Med.2009; 103: 692–699.Alfageme I., Reyes N., Merino M. et al. The effect of airflow limitation on the cause of death in patients with COPD. Chron. Respir. Dis. 2010; 7: 135–145.Alfageme I., Reyes N., Merino M. et al. The effect of airflow limitation on the cause of death in patients with COPD. Chron. Respir. Dis. 2010; 7: 135–145.Dewan N.A., Rafique S., Kanwar B. et al. Acute exacerbation of COPD: factors associated with poor outcome. Chest 2000; 117: 662–671.Dewan N.A., Rafique S., Kanwar B. et al. Acute exacerbation of COPD: factors associated with poor outcome. Chest 2000; 117: 662–671.Bhowmik A., Seemungal T.A.R., Sapsford R.J., Wedzicha J.A. Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exac– erbations. Thorax 2000; 55: 114–120.Bhowmik A., Seemungal T.A.R., Sapsford R.J., Wedzicha J.A. Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exac– erbations. Thorax 2000; 55: 114–120.Miravitlles M., Marin A., Monso E. et al. Colour of sputum is a marker of bacterial colonization in COPD. Respir. Res. 2010; 11: 58.Miravitlles M., Marin A., Monso E. et al. Colour of sputum is a marker of bacterial colonization in COPD. Respir. Res. 2010; 11: 58.Burgel P.R., Nesme–Meyer P., Chanez P. et al. Cough and sputum production are associated with frequent exacerbations and hospitalizations in COPD subjects. Chest 2009; 135: 975–982.Burgel P.R., Nesme–Meyer P., Chanez P. et al. Cough and sputum production are associated with frequent exacerbations and hospitalizations in COPD subjects. Chest 2009; 135: 975–982.Patel I.S., Seemungal T.A.R., Wiks M. et al. Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations. Thorax 2002; 57: 759–764.Patel I.S., Seemungal T.A.R., Wiks M. et al. Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations. Thorax 2002; 57: 759–764.Tumkaya M., Atis S., Ozge C. et al. Relationship between airway colonization, inflammation and exacerbation frequency in COPD. Respir. Med. 2007; 101: 729–737.Tumkaya M., Atis S., Ozge C. et al. Relationship between airway colonization, inflammation and exacerbation frequency in COPD. Respir. Med. 2007; 101: 729–737.Wan E.S., DeMeo D.L., Hersh C.P. et al. Clinical predictors of frequent exacerbations in subjects with severe chronic obstructive pulmonary disease (COPD). Respir. Med. 2011; 105: 588–594.Wan E.S., DeMeo D.L., Hersh C.P. et al. Clinical predictors of frequent exacerbations in subjects with severe chronic obstructive pulmonary disease (COPD). Respir. Med. 2011; 105: 588–594.Decramer M., Gosselink R., Troosters T. et al. Muscle weakness is related to utilization of health care resources in COPD patients. Eur. Respir J. 1997; 10: 417–423.Decramer M., Gosselink R., Troosters T. et al. Muscle weakness is related to utilization of health care resources in COPD patients. Eur. Respir J. 1997; 10: 417–423.Donaldson G.C., Hurst J.R., Smith C.J. et al. Increased risk of myocardial infarction and stroke following exacerbation of chronic obstructive pulmonary disease. Chest 2010; 137: 1091–1097.Donaldson G.C., Hurst J.R., Smith C.J. et al. Increased risk of myocardial infarction and stroke following exacerbation of chronic obstructive pulmonary disease. Chest 2010; 137: 1091–1097.Miravitlles M. Cough and sputum production as risk factors for poor outcomes in patients with COPD. Respir. Med. 2011; 105: 1118–1128.Miravitlles M. Cough and sputum production as risk factors for poor outcomes in patients with COPD. Respir. Med. 2011; 105: 1118–1128.Martinez–Garcia M.A., Soler–Cataluña J.J., Donat Y. et al. Factors associated with bronchiectasis in chronic obstructive pulmonary disease patients. Chest 2011; 140: 1130–1137.Martinez–Garcia M.A., Soler–Cataluña J.J., Donat Y. et al. Factors associated with bronchiectasis in chronic obstructive pulmonary disease patients. Chest 2011; 140: 1130–1137.Patel I.S., Vlahos I., Wilkinson T.M.A. et al. Bronchiectasis, exacerbation indices, and inflammation in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2004; 170: 400–407.Patel I.S., Vlahos I., Wilkinson T.M.A. et al. Bronchiectasis, exacerbation indices, and inflammation in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2004; 170: 400–407.Bourbeau J., Ford G., Zackon H. et al. Impact on patients' health status following early identification of a COPD exacerbation. Eur. Respir. J. 2007; 30: 907–913.Bourbeau J., Ford G., Zackon H. et al. Impact on patients' health status following early identification of a COPD exacerbation. Eur. Respir. J. 2007; 30: 907–913.Doll H., Miravitlles M. Quality of life in acute exacerbations of chronic bronchitis and chronic obstructive pulmonary disease: a review of the literature. Pharmacoeconomics 2005; 23: 345–363.Doll H., Miravitlles M. Quality of life in acute exacerbations of chronic bronchitis and chronic obstructive pulmonary disease: a review of the literature. Pharmacoeconomics 2005; 23: 345–363.Donaldson G.C., Hurst J.R., Smith C.J. et al. Increased risk of myocardial infarction and stroke following exacerbation of chronic obstructive pulmonary disease. Chest 2010; 137: 1091–1097.Donaldson G.C., Hurst J.R., Smith C.J. et al. Increased risk of myocardial infarction and stroke following exacerbation of chronic obstructive pulmonary disease. Chest 2010; 137: 1091–1097.Bhowmik A., Seemungal T.A.R., Sapsford R.J., Wedzicha J.A. Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations. Thorax 2000; 55: 114–120.Bhowmik A., Seemungal T.A.R., Sapsford R.J., Wedzicha J.A. Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations. Thorax 2000; 55: 114–120.Suissa S., Dell'aniello S., Ernst P. Long–term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012; 67: 957–963.Suissa S., Dell'aniello S., Ernst P. Long–term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012; 67: 957–963.Calverley P.M., Rabe K.F., Goehring U.M. et al. Roflumilast in symptomatic chronic obstructive pulmonary disease: two randomised clinical trials. Lancet 2009; 374 (9691): 685–694.Calverley P.M., Rabe K.F., Goehring U.M. et al. Roflumilast in symptomatic chronic obstructive pulmonary disease: two randomised clinical trials. Lancet 2009; 374 (9691): 685–694.Fabbri L.M., Calverley P.M., Izquierdo–Alonso J.L. et al. Roflumilast in moderate–to–severe chronic obstructive pulmonary disease treated with longacting bronchodilators: two randomised clinical trials. Lancet 2009; 374 (9691): 695–703.Fabbri L.M., Calverley P.M., Izquierdo–Alonso J.L. et al. Roflumilast in moderate–to–severe chronic obstructive pulmonary disease treated with longacting bronchodilators: two randomised clinical trials. Lancet 2009; 374 (9691): 695–703.Bateman E.D., Rabe K.F., Calverley P.M. et al. Roflumilast with long–acting beta2–agonists for COPD: influence of exacerbation history. Eur. Respir. J. 2011; 38 (3): 553–560.Bateman E.D., Rabe K.F., Calverley P.M. et al. Roflumilast with long–acting beta2–agonists for COPD: influence of exacerbation history. Eur. Respir. J. 2011; 38 (3): 553–560.Rennard S.I., Calverley P.M., Goehring U.M. et al. Reduction of exacerbations by the PDE4 inhibitor roflumilast –the importance of defining different subsets of patients with COPD. Respir. Res. 2011; 12: 18.Rennard S.I., Calverley P.M., Goehring U.M. et al. Reduction of exacerbations by the PDE4 inhibitor roflumilast –the importance of defining different subsets of patients with COPD. Respir. Res. 2011; 12: 18.Grootendorst D.C., Gauw S.A., Verhoosel R.M. et al. Reduction in sputum neutrophil and eosinophil numbers by the PDE4 inhibitor roflumilast in patients with COPD. Thorax 2007; 62 (12): 1081–1087.Grootendorst D.C., Gauw S.A., Verhoosel R.M. et al. Reduction in sputum neutrophil and eosinophil numbers by the PDE4 inhibitor roflumilast in patients with COPD. Thorax 2007; 62 (12): 1081–1087.Wedzicha J.A., Rabe K.F., Martinez F.J. et al. Efficacy of roflumilast in the chronic obstructive pulmonary disease frequent exacerbator phenotype (e–publication on http://journal.publications.chestnet.org).Wedzicha J.A., Rabe K.F., Martinez F.J. et al. Efficacy of roflumilast in the chronic obstructive pulmonary disease frequent exacerbator phenotype (e–publication on http://journal.publications.chestnet.org).Postma D., Anzueto A., Calverley P. et al. A new perspective on optimal care for patients with COPD. Prim. Care Respir. J. 2011; 20 (2): 205–209.Postma D., Anzueto A., Calverley P. et al. A new perspective on optimal care for patients with COPD. Prim. Care Respir. J. 2011; 20 (2): 205–209.Rabe K.F., Wedzicha J.A. Controversies in treatment of chronic obstructive pulmonary disease. Lancet 2011; 378 (9795): 1038–1047.Rabe K.F., Wedzicha J.A. Controversies in treatment of chronic obstructive pulmonary disease. Lancet 2011; 378 (9795): 1038–1047.Agusti A., Vestbo J. Current controversies and future perspectives in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2011; 184: 507–513.Agusti A., Vestbo J. Current controversies and future perspectives in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2011; 184: 507–513.Hurst J.R., Vestbo J., Anzueto A. et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N. Engl. J. Med. 2010; 363 (12): 1128–1138.Hurst J.R., Vestbo J., Anzueto A. et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N. Engl. J. Med. 2010; 363 (12): 1128–1138.Singh S., Amin A.V., Loke Y.K. Long–term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease. Arch. Intern. Med. 2009; 169: 219–229.Singh S., Amin A.V., Loke Y.K. Long–term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease. Arch. Intern. Med. 2009; 169: 219–229.Quint J.K., Donaldson G.C., Hurst J.R. et al. Predictive accuracy of patient–reported exacerbation frequency in COPD. Eur. Respir. J. 2011; 37: 501–507.Quint J.K., Donaldson G.C., Hurst J.R. et al. Predictive accuracy of patient–reported exacerbation frequency in COPD. Eur. Respir. J. 2011; 37: 501–507.

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