Лечение тяжелой бронхиальной астмы: рекомендации Европейского респираторного общества и Американского торакального общества

В документе изложены клинические рекомендации по лечению тяжелой бронхиальной астмы (БА). Проведено подробное обобщение доказательных данных, в т. ч. метаанализов, для анализа всех имеющихся доказательств по вопросам, сформулированным объединенной рабочей группой Европейского респираторного (European Respiratory Society – ERS) и Американского торакального (American Thoracic Society – ATS) обществ. Доказательства оценивались по методике GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Мультидисциплинарной рабочей группой экспертов по БА обсуждались обобщенные доказательные данные и сформулированы рекомендации в форме ответов на 6 конкретных вопросов. После сопоставления желательных и нежелательных последствий, качества доказательных данных, доступности и приемлемости различных вмешательств рабочей группой сформулированы следующие предложения:

• использовать антитела к интерлейкину (IL)-5 и рецептору IL-5 у взрослых больных тяжелой неконтролируемой эозинофильной БА;
• начинать анти-IL-5-терапию у взрослых больных с тяжелой БА при уровне эозинофилов в периферической крови ≥ 150 кл. / мкл;
• использовать пограничные значения для выявления подростков и взрослых с наиболее вероятной эффективностью анти-IgE-терапии при уровне эозинофилов в крови ≥ 260 кл. / мкл и фракции оксида азота в выдыхаемом воздухе ≥ 19,5 ppb;
• использовать ингаляционный тиотропия бромид у подростков и взрослых с тяжелой БА, не контролируемой терапией 4–5-й ступени согласно Глобальной инициативе по БА (Global Initiative for Asthma – GINA), или терапию 5-й ступени согласно Национальной программе по обучению больных и профилактике БА (National Asthma Education and Prevention Program – NAEPP);
• для снижения частоты обострений БА у пациентов с персистирующими симптомами или БА, не контролируемой терапией 5-й ступени по GINA или NAEPP, независимо от фенотипа БА, применять пробную долговременную терапию макролидами;
• использовать антитела к IL-4, -13 у взрослых пациентов с тяжелой эозинофильной или глюкокортикостероид-зависимой БА, независимо от уровня эозинофилов в крови.

При появлении новых доказательств эти рекомендации могут быть пересмотрены.

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