Ингаляционные глюкокортикостероиды в лечении хронической обструктивной болезни легких

Основными задачами терапии хронической обструктивной болезни легких (ХОБЛ) являются уменьшение выраженности симптомов заболевания и снижение риска обострений. В статье обсуждается роль локального и системного воспаления в патогенезе ХОБЛ, а также различные механизмы фармакологического влияния на него. Рассмотрены подходы к назначению базисной терапии пациентам с ХОБЛ, рекомендуемые различными национальными и глобальными руководствами (клинические рекомендации Российского респираторного общества, критерии Глобальной стратегии по лечению хронической обструктивной болезни легких (Global Initiative for Chronic Obstructive Lung Disease – GOLD), руководство Национального института совершенствования здравоохранения Великобритании (National Institute for Health and Clinical Excellence – NICE)), а также рекомендации по периодичности пересмотра терапии. В настоящее время в мире разрабатываются и регистрируются т. н. тройные комбинации – фиксированные комбинации двойных бронхолитических препаратов с ингаляционными глюкокортикостероидами, при этом их место и значение в лечении ХОБЛ вызывает многочисленные дискуссии. В работе обсуждается роль фиксированных тройных комбинаций при снижении частоты обострений ХОБЛ, воздействии на функциональные и пациент-репортированные исходы, приведены рекомендации по применению тройных комбинаций у пациентов с ХОБЛ с учетом соотношения польза / риск.

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