pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2018-28-1-84-95pulmo-965Research ArticleОБЗОРЫREVIEWЛегкая бронхиальная астма: настоящее и будущееMild bronchial asthma: the present and the futureАвдеевС. Н.AvdeevS. N.

Авдеев Сергей Николаевич – доктор медицинских наук, член-корр. Российской академии наук, профессор, заведующий кафедрой пульмонологии; заместитель директора. 

 

Sergey N. Avdeev, Doctor of Medicine, Professor, Corresponding Member of Russian Academy of Sciences, Head of Department of Pulmonology; Deputy Director for Science.

ul. Trubetskaya 8, build. 2, Moscow, 119991.

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

Айсанов Заурбек Рамазанович – доктор медицинских наук, профессор кафедры пульмонологии.

 

Zaurbek R. Aisanov, Doctor of Medicine, Professor, Department of Pulmonology.

ul. Ostrovityanova 1, Moscow, 117997.

aisanov@mail.ruБелевскийА. С.BelevskiyA. S.

Белевский Андрей Станиславович – доктор медицинских наук, профессор, заведующий кафедрой пульмонологии.

 

Andrey S. Belevskiy, Doctor of Medicine, Professor, Head of Department of Pulmonology.

ul. Ostrovityanova 1, Moscow, 117997.

pulmobas@yandex.ruКулбаисовА. М.KulbaisovA. M.

Кулбаисов Амиржан Магажанович – кандидат медицинских наук, заведующий пульмонологическим отделением. 

460000, Оренбург, ул. Невельская, 24.

Amirzhan M. Kulbaisov, Candidate of Medicine, Head of Pulmonology Department.

ul. Nevel'skaya 24, Orenburg, 460000.

kul60@yandex.ruКурбачеваО. М.KurbachevaO. M.

Курбачева Оксана Михайловна – доктор медицинских наук, профессор, заведующий отделением бронхиальной астмы. 

 

Oksana M. Kurbacheva, Doctor of Medicine, Professor.

Kashirskoe shosse 24, build. 2, Moscow, 115478.

kurbacheva@gmail.comЛещенкоИ. В.LeshchenkoI. V.

Лещенко Игорь Викторович – доктор медицинских наук, профессор кафедры фтизиатрии, пульмонологии и торакальной хирургии.

 

Igor' V. Leshchenko, Doctor of Medicine, Professor, Department of Phthisiology, Pulmonology and Thoracic Surgery; Chief Pulmonologist of Sverdlovsk region and Ekaterinburg, Academic Advisor of “Novaya bol'nitsa” clinical association.

ul. Repina 3, Ekaterinburg, 620028.

leshchenkoiv@mail.ruНенашеваН. М.NenashevaN. M.

Ненашева Наталья Михайловна – доктор медицинских наук, профессор кафедры клинической аллергологии. 

125993, Москва, ул. Баррикадная, 2 / 1, стр. 1.

Natal'ya M. Nenasheva, Doctor of Medicine, Professor.

ul. Barrikadnaya 2/1, Moscow, 123995.

1444031@gmail.comФассаховР. С.FassakhovR. S.

Фассахов Рустем Салахович –  доктор медицинских наук, профессор кафедры фундаментальных основ клинической медицины. 

420008, Казань, ул. Кремлевская, 18.

Rustem S. Fassakhov, Doctor of Medicine, Professor, Department of Basic Clinical Medicine.

ul. Kremlevskaya18, Kazan', 420008.

farrus@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М.Сеченова» Министерства здравоохранения Российской Федерации; Федеральное государственное бюджетное учреждение «Научно-исследовательский институт пульмонологии» Федерального медико-биологического агентства.РоссияM.Sechenov First Moscow State Medical University, Healthcare Ministry of Russia; Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia.Russian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И.Пирогова» Министерства здравоохранения Российской Федерации.РоссияN.I.Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia.Russian FederationГосударственное автономное учреждение здравоохранения «Оренбургская областная клиническая больница № 2».РоссияOrenburg State Regional Teaching Hospital No.2.Russian FederationФедеральное государственное бюджетное учреждение «Государственный научный центр "Институт иммунологии"» Федерального медико-биологического агентства.РоссияFederal Research Center "Institute of Immunology", Federal Medical and Biological Agency of Russia.Russian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Уральский государственный медицинский университет» Министерства здравоохранения Российской Федерации.РоссияUral State Medical University, Healthcare Ministry of Russia.Russian FederationФедеральное государственное бюджетное образовательное учреждение дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской Федерации.РоссияRussian State Academy of Continued Medical Education, Healthcare Ministry of Russia.Russian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Казанский (Приволжский) федеральный университет».РоссияKazan (Privolzhskiy) Federal University.Russian Federation2018270420182818495Copyright © Авдеев С.Н., Айсанов З.Р., Белевский А.С., Кулбаисов А.М., Курбачева О.М., Лещенко И.В., Ненашева Н.М., Фассахов Р.С., 20182018Авдеев С.Н., Айсанов З.Р., Белевский А.С., Кулбаисов А.М., Курбачева О.М., Лещенко И.В., Ненашева Н.М., Фассахов Р.С.Avdeev S.N., Aisanov Z.R., Belevskiy A.S., Kulbaisov A.M., Kurbacheva O.M., Leshchenko I.V., Nenasheva N.M., Fassakhov R.S.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/965

При легком течении бронхиальной астмы (БА) часто отмечается недостаточно серьезное отношение врачей и больных к указанному заболеванию по причине редких и не причиняющих особых неудобств клинических проявлений. При БА легкой степени вероятность тяжелых обострений вплоть до астматического статуса врачами недооценивается, а у пациентов часто отмечается очень низкая приверженность назначенному лечению. Также существуют проблемы своевременного выявления, правильной диагностики и подбора адекватной терапии БА врачами первичного звена, к которым в первую очередь обращаются такие больные. Парадокс БА, лечение хронического воспалительного заболевания короткодействующими β2-агонистами (КДБА) приводит к чрезмерной зависимости от скоропомощных препаратов и недостаточной приверженности поддерживающей противовоспалительной терапии, что может явиться причиной обострений и летального исхода у пациентов с БА легкой степени. При этом лечение КДБА в виде монотерапии следует ограничить. Для улучшения диагностики и лечения БА необходимо создание доступных и удобных в реальной практике вопросников, алгоритмов и схем терапии, прежде всего для врачей первичного звена. Изменению парадигмы в лечении больных легкой БА по влиянию на риск обострения, контроль над симптомами БА, степень воспаления дыхательных путей и экономическую эффективность будут способствовать положительные результаты исследований применения Будесонид / Формотерол Турбухалер® в новом режиме по требованию.

Mild asthma is characterized by infrequent and slight clinical manifestations and, therefore, is paid lack of attention both from patients and physicians. Physicians tend to underestimate risk of severe exacerbations including asthmatic status in patients with mild asthma. Patients with mild asthma are often poorly adherent to treatment. Also, certain difficulties are related to timely and correct diagnosis and the choice of the optimal treatment by primary care physicians who are first physicians encountering such patients. The paradoxus of asthma and use of short-acting β2-agonists (SABA) to treat chronic airway inflammation lead to excessive dependence on rescue inhalers and insufficient adherence to maintenance anti-inflammatory therapy. This could trigger acute exacerbations and even fatal outcomes in patients with mild asthma. Therefore, SABA monotherapy has to be limited. Easy-to-use questionnaires, algorithms and treatment protocols accessible for primary care physicians could improve detection of mild asthma. Favorable results of clinical trials on as-needed use of budesonide/formoterol Turbuhaler® could change the management paradigm for mild asthma regarding risk of exacerbations, control of asthma symptoms, airway inflammation, and cost-efficacy.

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