pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2016-26-5-591-603pulmo-768Research ArticleОБЗОРЫREVIEWПРОФИЛАКТИКА ОБОСТРЕНИЙ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЕГКИХPREVENTION OF ACUTE EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASEАвдеевС. Н.AvdeevS. N.

д. м. н., профессор, член-корр. РАН, руководитель клинического отдела

MD, Professor, Associate Member of Russian Academy of Science, Head of Clinical Division

serg_avdeev@list.ruФГБУ «НИИ пульмонологии» ФМБА России: 105077, Россия, 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 Federation201620122016265591603Copyright © 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/768

Характерной чертой течения хронической обструктивной болезни легких (ХОБЛ) является развитие обострений. Обострение ХОБЛ является одной из самых частых причин обращения больных за неотложной медицинской помощью. Частое развитие обострений у больных ХОБЛ приводит к длительному (до нескольких недель) ухудшению показателей функции дыхания и газообмена, более быстрому прогрессированию заболевания, значимому снижению качества жизни больных и сопряжено с существенными экономическими расходами на лечение. С помощью современной терапии возможно значительно снизить риск развития обострений ХОБЛ. Влияние поддерживающей терапии на обострения зависит от разных факторов, таких так причины обострений (например, инфекции, спонтанное усиление воспаления, бронхоспазм и т. п.), тяжести заболевания (обычно снижение риска обострений на фоне терапии более выражено у тяжелых пациентов), фенотипа ХОБЛ и т. п. Необходимо подчеркнуть, что результаты исследований по снижению риска обострений также зависят от многих факторов: популяции пациентов, включенных в исследование; количества обострений у них до включения в исследование; определения обострений; длительности исследования и т. д. Эффективность различных методов терапии по снижению риска обострений в разных исследованиях составляет от 15 до 50 %, хотя ни один из методов сегодня не позволяет полностью избавить пациента с ХОБЛ от обострений. Условно все виды терапии, направленные на снижение риска обострений, можно разделить на фармакологические и нефармакологические. Для улучшения качества ведения пациентов с ХОБЛ необходим поиск более целенаправленных (или таргетных) фармакологических способов профилактики обострений, даже с учетом уже доступных препаратов.

Acute exacerbation is a typical event in the natural course of chronic obstructive pulmonary disease (COPD). Acute exacerbation of COPD (AECOPD) is one of the most frequent causes for seeking the emergency aid by patients. Frequent AECOPD could deteriorate lung function and gaz exchange, cause more rapid progression of the disease and significant worsening of the patient's quality of life for long time (up to several weeks). AECOPD is associated with severe economic burden. Current therapeutic approaches can greatly reduce the risk of AECOPD. Effect of the basic therapy on exacerbation rate are related to such factors as the exacerbation cause (infection, spontaneous deterioration of inflammation, bronchoconstriction, etc.), severity of the disease (usually, therapy can decrease the risk of exacerbation in more severe patients), COPD phenotype, etc. Results  of clinical trials aimed at the reduction of exacerbation rate are also related to many of factors such as patients' population involved in the study, the previous rate of exacerbations, the study length, etc. Currently, no one therapeutic approach can completely eliminate the risk of exacerbations. The efficacy of different therapeutic methods in preventing AECOPD is 15% to 50%. Methods for preventing AECOPD can be divided to pharmacological and non-pharmacological ones. There is a need to search for target pharmacological approaches for preventing AECOPD including currently available drugs.

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