pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2016-26-2-231-237pulmo-706Research ArticleОБЗОРЫREVIEWКлинические симптомы и качество жизни пациентов с хронической обструктивной болезнью легких: субъективно оцениваемые показатели или факторы, определяющие прогноз?Symptoms and quality of life in patients with chronic obstructive pulmonary disease: are there patient_defined outcomes or predictive factors?АвдеевС. Н.AvdeevS. N.

д. м. н., профессор, руководитель клинического отдела ФГБУ «НИИ пульмонологии» ФМБА России; тел. / факс: (495) 465-52-64;

MD, Professor, Head of Clinical Division, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia; tel. / fax: (495) 465-52-64; 

serg_avdeev@list.ruФГБУ «НИИ пульмонологии» ФМБА России: 105077, Москва, ул. 11-я Парковая, 32, корп. 4РоссияFederal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia; 32, build. 4, 11th Parkovaya str., Moscow, 105077, RussiaRussian Federation201624062016262231237Copyright © Авдеев С.Н., 20162016Авдеев С.Н.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/706

Современные препараты для терапии хронической обструктивной болезни легких (ХОБЛ), в первую очередь, длительно действующие бронходилататоры позволяют уменьшить выраженность симптомов у пациентов. Однако у данной категории больных клинически значимая одышка сохраняется в 50–70 % случаев, несмотря на проводимую терапию. Выявление пациентов на ранних стадиях ХОБЛ – достаточно сложная клиническая проблема. Между тем уже на ранних стадиях заболевания необходимо назначать активную терапию, поскольку у таких больных уже отмечается снижение физической выносливости и физической активности, а также наблюдается наиболее быстрая потеря легочной функции. Относительно недавно были созданы фиксированные комбинации длительно действующего β2-агониста (ДДБА) и длительно действующего антихолинергических препарата (ДДАХП), позволяющие совместно назначать данные препараты с помощью 1 ингалятора. По результатам исследования продемонстрировано, что эффективность терапии комбинацией ДДБА / ДДАХП превосходит таковую при монотерапии их компонентами. Одним из новых комбинированных препаратов ДДБА / ДДАХП является препарат Спиолто® Респимат® (тиотропия бромид / олодатерол). В нескольких крупных исследованиях (TONADO-1 и -2, ОTEMTO-1 и -2) продемонстрировано существенное улучшение качества жизни и уменьшение одышки у больных ХОБЛ при терапии тиотропием / олодатеролом. Показано, что терапия комбинацией тиотропия бромид / олодатерол является высокоэффективной уже на ранних стадиях ХОБЛ.

Novel medications for therapy of chronic obstructive pulmonary disease (COPD), primarily long-acting bronchodilators, could reduce severity of symptoms. Nevertheless, 50% to 70% of patients continue to experience significant dyspnea despite the therapy. Early diagnosis of COPD is a quite difficult clinical problem, whereas an active treatment is usually required at early-stage disease because of decreasing physical tolerance and, importantly, rapidly declining pulmonary function. Novel fixed combinations of long-acting beta-2-agonists (LABA) and long-acting muscarinic antagonists (LAMA) deliver both the drugs in a single inhaler. These combinations have been shown to be more effective compared to monotherapy with the components. One of new LABA/LAMA combinations is tiotropium/olodaterol combination (Spiolto Respimat). Several large clinical trials (TONADO 1 and 2, ОTEMTO 1 and 2) demonstrated significant improvement in quality of life and dyspnea in patients with COPD taking the tiotropium/olodaterol combination. This combined drug was highly effective in early-stage COPD.

хроническая обструктивная болезнь легкихдлительно действующие бронходилататорыкомбинированная терапияранняя диагностикаранняя терапиятиотропия бромидолодатеролchronic obstructive pulmonary diseaselong-acting bronchodilatorsearly diagnosisearly-stage therapytiotropium bromideolodaterolReferencesGlobal Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO workshop report. The 2016 report is available on www.goldcopd.comGlobal Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO workshop report. The 2016 report is available on www.goldcopd.comHogg J.C., McDonough J.E., Suzuki M. Small airway obstruction in COPD: new insights based on micro-CT imaging and MRI imaging. Chest. 2013; 143: 1436–1443.Hogg J.C., McDonough J.E., Suzuki M. Small airway obstruction in COPD: new insights based on micro-CT imaging and MRI imaging. Chest. 2013; 143: 1436–1443.Decramer M., Janssens W., Miravitlles M. Chronic obstructive pulmonary disease. Lancet. 2012; 379: 1341–1351.Decramer M., Janssens W., Miravitlles M. Chronic obstructive pulmonary disease. Lancet. 2012; 379: 1341–1351.Buist A.S., McBurnie M.A., Vollmer W.M. et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007; 370: 741–750.Buist A.S., McBurnie M.A., Vollmer W.M. et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007; 370: 741–750.Chuchalin A.G., Khaltaev N., Antonov N.S. et al. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. Int. J. COPD. 2014; 9: 963–974.Chuchalin A.G., Khaltaev N., Antonov N.S. et al. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. Int. J. COPD. 2014; 9: 963–974.Hoyert D.L., Xu J. Deaths: preliminary data for 2011. Natl. Vital. Stat. Rep. 2012; 61: 1–51.Hoyert D.L., Xu J. Deaths: preliminary data for 2011. Natl. Vital. Stat. Rep. 2012; 61: 1–51.Mannino D.M., Homa D.M., Akinbami L.J. et al. Chronic obstructive pulmonary disease surveillance – United States, 1971 – 2000. MMWR Surveill. Summ. 2002; 51 (SS06): 1–16.Mannino D.M., Homa D.M., Akinbami L.J. et al. Chronic obstructive pulmonary disease surveillance – United States, 1971–2000. MMWR Surveill. Summ. 2002; 51 (SS06): 1–16.Kessler R., Partridge M.R., Miravitlles M. et al. Symptom variability in patients with severe COPD: a pan-European cross-sectional study. Eur. Respir. J. 2011; 37: 264–272.Kessler R., Partridge M.R., Miravitlles M. et al. Symptom variability in patients with severe COPD: a pan-European cross-sectional study. Eur. Respir. J. 2011; 37: 264–272.Kim Y.J., Lee B.K., Jung C.Y. et al. Patient’s perception of symptoms related to morning activity in chronic obstructive pulmonary disease: the SYMBOL study. Korean J. Intern. Med. 2012; 27: 426–435.Kim Y.J., Lee B.K., Jung C.Y. et al. Patient’s perception of symptoms related to morning activity in chronic obstructive pulmonary disease: the SYMBOL study. Korean J. Intern. Med. 2012; 27: 426–435.Joshi M., Joshi A., Bartter T. Symptom burden in chronic obstructive pulmonary disease and cancer. Curr. Opin. Pulm. Med. 2012; 18: 97–103.Joshi M., Joshi A., Bartter T. Symptom burden in chronic obstructive pulmonary disease and cancer. Curr. Opin. Pulm. Med. 2012; 18: 97–103.Bárbara C., Moita J., Cardoso J. et al. The importance of dyspnoea in the diagnosis of chronic obstructive pulmonary disease − a descriptive analysis of a stable cohort in Portugal (SAFE Trial). Rev. Port. Pneumol. 2011; 17: 131–138.Bárbara C., Moita J., Cardoso J. et al. The importance of dyspnoea in the diagnosis of chronic obstructive pulmonary disease – a descriptive analysis of a stable cohort in Portugal (SAFE Trial). Rev. Port. Pneumol. 2011; 17: 131–138.Miravitlles M., Worth H., Soler Cataluña J.J. et al. Observational study to characterise 24-hour COPD symptoms and their relationship with patient-reported outcomes: results from the ASSESS study. Respir. Res. 2014; 15: 122.Miravitlles M., Worth H., Soler Cataluña J.J. et al. Observational study to characterise 24-hour COPD symptoms and their relationship with patient-reported outcomes: results from the ASSESS study. Respir. Res. 2014; 15: 122.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.Nishimura K., Izumi T., Tsukino M., Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest. 2002; 121: 1434–1340.Nishimura K., Izumi T., Tsukino M., Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/12006425" \o "Chest." Chest. 2002; 121: 1434–1340.Steer J., Norman E.M., Afolabi O.A. et al. Dyspnoea severity and pneumonia as predictors of in-hospital mortality and early readmission in acute exacerbations of COPD. Thorax. 2012; 67: 117–121.Steer J., Norman E.M., Afolabi O.A. et al. Dyspnoea severity and pneumonia as predictors of in-hospital mortality and early readmission in acute exacerbations of COPD. Thorax. 2012; 67: 117–121.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.Watz H., Waschki B., Meyer T., Magnussen H. Physical activity in patients with COPD. Eur. Respir. J. 2009; 33: 262–272.Watz H., Waschki B., Meyer T., Magnussen H. Physical activity in patients with COPD. Eur. Respir. J. 2009; 33: 262–272.Vaes A.W., Garcia-Aymerich J., Marott J.L. et al. Changes in physical activity and all-cause mortality in COPD. Eur. Respir. J. 2014; 44: 1199–1209.Vaes A.W., Garcia-Aymerich J., HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=Marott%20JL%5BAuthor%5D&cauthor=true&cauthor_uid=25063247" Marott J.L. et al. Changes in physical activity and all-cause mortality in COPD. Eur. Respir. J. 2014; 44: 1199–1209.Curtis J.R., Patrick D.L. The assessment of health status among patients with COPD. Eur. Respir. J. 2003; 21 (Suppl. 41): 36s–45s.Curtis J.R., Patrick D.L. The assessment of health status among patients with COPD. Eur. Respir. J. 2003; 21 (Suppl. 41): 36s–45s.Reardon J.Z., Lareau S.C., ZuWallack R. Functional status and quality of life in chronic obstructive pulmonary disease. Am. J. Med. 2006; 119 (10A): S32–S37.Reardon J.Z., Lareau S.C., ZuWallack R. Functional status and quality of life in chronic obstructive pulmonary disease. Am. J. Med. 2006; 119 (10A): S32–S37.Beeh K.M., Beier J. The short, the long and the "ultra-long": why duration of bronchodilator action matters in chronic obstructive pulmonary disease. Adv. Ther. 2010; 7: 150–159.Beeh K.M., Beier J. The short, the long and the "ultra-long": why duration of bronchodilator action matters in chronic obstructive pulmonary disease. Adv. Ther. 2010; 7: 150–159.Tashkin D.P. Is a long-acting inhaled bronchodilator the first agent to use in stable chronic obstructive pulmonary disease? Curr. Opin. Pulm. Med. 2005; 11: 121–128.Tashkin D.P. Is a long-acting inhaled bronchodilator the first agent to use in stable chronic obstructive pulmonary disease? Curr. Opin. Pulm. Med. 2005; 11: 121–128.Tashkin D.P., Ferguson G.T.Combination bronchodilator therapy in the management of chronic obstructive pulmonary disease. Respir. Res. 2013; 14: 49.Tashkin D.P., Ferguson G.T.Combination bronchodilator therapy in the management of chronic obstructive pulmonary disease. Respir. Res. 2013; 14: 49.Sutherland E.R., Cherniack R.M. Management of chronic obstructive pulmonary disease. N. Engl. J. Med. 2004; 350: 2689–2697.Sutherland E.R., Cherniack R.M. Management of chronic obstructive pulmonary disease. N. Engl. J. Med. 2004; 350: 2689–2697.Авдеев С.Н. Выбор оптимальной терапии при ранних стадиях хронической обструктивной болезни легких. Справочник поликлинического врача. 2009; 11: 27–31.Avdeev S.N. A choice of the optimal therapy in early-stage chronic obstructive pulmonary disease. Spravochnik poliklinicheskogo vracha. 2009; 11: 27–31 (in Russian).Rennard S., Decramer M., Calverley P.M. et al. Impact of COPD in North America and Europe in 2000: subjects’ perspective of Confronting COPD International Survey. Eur. Respir. J. 2002; 20: 799–805.Rennard S., Decramer M., Calverley P.M. et al. Impact of COPD in North America and Europe in 2000: subjects’ perspective of Confronting COPD International Survey. Eur. Respir. J. 2002; 20: 799–805.Green M. How big are the bronchioles? St. Thomas Hosp. Gaz. 1965; 63: 136–139.Green M. How big are the bronchioles? St. Thomas Hosp. Gaz. 1965; 63: 136–139.Pinto-Plata V.M., Celli-Cruz R.A., Vassaux C. et al. Differences in cardiopulmonary exercise test results by American Thoracic Society / European Respiratory Society – Global initiative for chronic obstructive lung disease stage categories and gender. Chest. 2007; 132; 1204–1211.Pinto-Plata V.M., Celli-Cruz R.A., Vassaux C. et al. Differences in cardiopulmonary exercise test results by American Thoracic Society / European Respiratory Society – Global initiative for chronic obstructive lung disease stage categories and gender. Chest. 2007; 132; 1204–1211.Pitta F., Troosters T., Spruit M.A. et al. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2005; 171: 972–977.Pitta F., Troosters T., Spruit M.A. et al. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2005; 171: 972–977.Tantucci C., Modina D. Lung function decline in COPD. Int. J. COPD. 2012; 7: 95–99.Tantucci C., Modina D. Lung function decline in COPD. Int. J. COPD. 2012; 7: 95–99.Авдеев С.Н., Трушенко Н.В. Двойная бронходилатация – новая парадигма длительно терапии хронической обструктивной болезни легких. Практическая пульмонология. 2015; 3: 24–32.Avdeev S.N., Trushenko N.V. Dual brochodilation is a novel paradigm of the basic therapy of chronic obstructive pulmonary disease. Prakticheskaya pul'monologiya. 2015; 3: 24–32 (in Russian).Muruganandan S., Jayaram L. Profile of a fixed-dose combination of tiotropium/olodaterol and its potential in the treatment of COPD. Int. J. COPD. 2015; 10: 1179–1189.Muruganandan S., Jayaram L. Profile of a fixed-dose combination of tiotropium/olodaterol and its potential in the treatment of COPD. Int. J. COPD. 2015; 10: 1179–1189.Buhl R., Maltais F., Abrahams R. et al. Tiotropium and olodaterol fixed-dose combination versus mono-components in COPD (GOLD 2–4). Eur. Respir. J. 2015; 45: 969–979.Buhl R., Maltais F., Abrahams R. et al. Tiotropium and olodaterol fixed-dose combination versus mono-components in COPD (GOLD 2–4). Eur. Respir. J. 2015; 45: 969–979.Singh D., Ferguson G.T., Bolitschek J. et al. Tiotropium + olodaterol shows clinically meaningful improvements in quality of life. Respir. Med. 2015; 109: 1312–1319.Singh D., Ferguson G.T., Bolitschek J. et al. Tiotropium + olodaterol shows clinically meaningful improvements in quality of life. Respir. Med. 2015; 109: 1312–1319.Ferguson G.T., Flezar M., Korn S. et al. Efficacy of tiotropium/olodaterol in patients with chronic obstructive pulmonary disease by initial disease severity and treatment intensity: a post hoc analysis. Adv. Ther. 2015; 32: 523–536.Ferguson G.T., Flezar M., Korn S. et al. Efficacy of tiotropium/olodaterol in patients with chronic obstructive pulmonary disease by initial disease severity and treatment intensity: a post hoc analysis. Adv. Ther. 2015; 32: 523–536.Singh D., Ferguson G.T., Bolitschek J. et al. Tiotropium + olodaterol fixed-dose combination shows clinically meaningful improvements in quality of life versus placebo. Poster PA2958 presented at the European Respiratory Society International Congress, Amsterdam, the Netherlands, 26−30 September 2015.Singh D., Ferguson G.T., Bolitschek J. et al. Tiotropium + olodaterol fixed-dose combination shows clinically meaningful improvements in quality of life versus placebo. Poster PA2958 presented at the European Respiratory Society International Congress, Amsterdam, the Netherlands, 26−30 September 2015.

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