pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2017-27-1-114-121pulmo-827Research ArticleКЛИНИЧЕСКАЯ ФАРМАКОЛОГИЯCLINICAL PHARMACOLOGYМесто фиксированной комбинации будесонид / формотерол в лечении хронической обструктивной болезни легких стабильного течения. Заключение совета экспертов Приволжского федерального округа Российской ФедерацииA role of budesonide/formoterol fixed combination in the treatment of stable chronic obstructive pulmonary disease. A conclusion of the Expert Council of the Volga Federal district of RussiaОвчаренкоС. И.OvcharenkoS. I.

д. м. н., профессор кафедры факультетской терапии № 1 лечебного факультета 

Doctor of Medicine, Professor at Department of General Internal Medicine No.1, Medical Faculty

svetftk@mail.ruВизельА. А.Vizel'A. A.

д. м. н., профессор, заведующий кафедрой фтизиопульмонологии

Doctor of Medicine, Professor, Head of Department of Phthisiology and Pulmonology

lordara@inbox.ruГамоваИ. В.GamovaI. V.

к. м. н., доцент кафедры клинической иммунологии и аллергологии

Candidate of Medicine, Associate Professor at Department of Allergology and Immunology

innapris@yandex.ruДобротинаИ. С.DobrotinaI. S.

к. м. н., доцент кафедры госпитальной терапии

Candidate of Medicine, Associate Professor at Department of Hospital Internal Medicine

dobrotina@mail.ruЗагидуллинШ. З.ZagidullinSh. Z.

д. м. н., профессор, заведующий кафедрой пропедевтики внутренних болезней

Doctor of Medicine, Professor, Head of Department of Propaedeutics of Internal Diseases

zshamil@inbox.ruКупаевВ. И.KupaevV. I.

д. м. н., профессор, заведующий кафедрой семейной медицины

Doctor of Medicine, Professor, Head of Department of Family Medicine

vk1964sam@rambler.ruНедашковскаяН. Г.NedashkovskayaN. G.

заведующая пульмонологическим отделением

Head of Department of Pulmonology

nenagen@mail.ruПостниковаЛ. Б.PostnikovaL. B.

д. м. н., профессор кафедры внутренних болезней

Doctor of Medicine, Professor at Department of Internal Medicine

plbreath@mail.ruУхановаО. П.UkhanovaO. P.

д. м. н., профессор кафедры иммунологии 

Doctor of Medicine, Professor at Department of Immunology

uhanova_1976@mail.ruФассаховР. С.FassakhovR. S.

д. м. н., профессор 

Doctor of Medicine, Professor

farrus@mail.ruХамитовР. Ф.KhamitovR. F.

д. м. н., профессор, заведующий кафедрой внутренних болезней № 2

Doctor of Medicine, Professor, Head of Department of Internal Medicine No.2

rhamitov@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М.Сеченова» Министерства здравоохранения Российской ФедерацииРоссияI.M.Sechenov First Moscow State Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Казанский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияKazan' State Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Саратовский государственный медицинский университет имени В.И.Разумовского» Министерства здравоохранения Российской ФедерацииРоссияV.I.Razumovskiy Saratov State Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Нижегородская государственная медицинская академия им. В.Г.Вогралика» Минздрава РоссииРоссияV.G.Vogralik Nizhniy Novgorod State Medical Academy, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Башкирский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияBashkir State Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Самарский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияSamara State Medical University, Healthcare Ministry of RussiaRussian FederationГосударственное бюджетное учреждение Ростовской области «Областная клиническая больница № 2»РоссияRostov Regional Clinical Hospital No.2Russian FederationГосударственное бюджетное учреждение здравоохранения Нижегородской области «Городская клиническая больница № 38 Нижегородского района г. Нижнего Новгорода»РоссияNizhniy Novgorod City Clinical Hospital No.38Russian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Ставропольский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияStavropol' State Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Казанский (Приволжский) федеральный университет»РоссияKazan' (Privolzhskiy) Federal UniversityRussian Federation201702052017271114121Copyright © Овчаренко С.И., Визель А.А., Гамова И.В., Добротина И.С., Загидуллин Ш.З., Купаев В.И., Недашковская Н.Г., Постникова Л.Б., Уханова О.П., Фассахов Р.С., Хамитов Р.Ф., 20172017Овчаренко С.И., Визель А.А., Гамова И.В., Добротина И.С., Загидуллин Ш.З., Купаев В.И., Недашковская Н.Г., Постникова Л.Б., Уханова О.П., Фассахов Р.С., Хамитов Р.Ф.Ovcharenko S.I., Vizel' A.A., Gamova I.V., Dobrotina I.S., Zagidullin S.Z., Kupaev V.I., Nedashkovskaya N.G., Postnikova L.B., Ukhanova O.P., Fassakhov R.S., Khamitov R.F.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/827

Несмотря на появление новых препаратов для лечения пациентов с хронической обструктивной болезнью легких (ХОБЛ), в настоящее время нерешенными проблемами в терапии этого заболевания остаются поздняя диагностика и выявление ХОБЛ уже на стадии тяжело протекающего заболевания, высокий риск обострений, низкая комплаентность пациентов, побочное действие лекарственных средств. Персонализированная медицина требует четких показаний, предикторов эффективности и безопасности лечения. Терапия фиксированной комбинацией будесонид / формотерол рекомендована пациентам с сочетанием бронхиальной астмы (БА) и ХОБЛ; высоким уровнем эозинофилов в периферической крови (> 300 клеток в 1 мкл крови) при исключении других причин (гельминты, лямблии и т. п.) и с постбронходилатационным объемом форсированного выдоха за 1-ю секунду (ОФВ1) < 50 %долж.; бронхитическим фенотипом; ≥ 2 обострениями в предшествующий год; ≥ 1 госпитализацией по поводу обострения в течение 1 года при наличии постбронходилатационного ОФВ1 < 50 %долж. Фиксированная комбинация будесонид / формотерол не рекомендуется к регулярному назначению при эмфизематозном фенотипе ХОБЛ у больных с редкими обострениями (< 2 / без госпитализаций за предшествующий год).

Late diagnosis of chronic obstructive pulmonary disease (COPD) at advanced stage, high risk of exacerbations, low compliance of patients, and adverse effects of treatment have been still unresolved problems in the treatment of COPD despite the development of new drugs. The personalized medicine rneeds distinct indications and predictors of efficacy and safety of treatment. Budesonide/formoterol fixed combination is recommended for patients with asthma – COPD overlap syndrome and bronchitis phenotype, blood eosinophilia > 300 cells/mm3, if other causes were excluded, post-bronchodilator forced expiratory volume in 1 second (FEV1) < 50% pred.; and ≥ 2 exacerbations or ≥ 1 hospitalization related to exacerbation during the previous year. Budesonide/formoterol fixed combination is not recommended for regular use in patients with emphysema phenotype of COPD and rare exacerbations (< 2 exacerbations and without hospitalizations in the previous year).

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