Рекомендации Европейского респираторного общества по диагностике и лечению хронического кашля у взрослых и детей

В рекомендации включены последние достижения в понимании патофизиологии хронического кашля (ХК), его диагностики и лечения. Кашлевая гиперчувствительность явилась объединяющим термином, с помощью которого описывается исключительная чувствительность пациентов к внешним раздражителям, таким как холодный воздух, запахи, дым и отбеливатели. Таким образом, симптомы у взрослых с ХК получили ясное физиологическое объяснение, основанное на афферентной гиперчувствительности блуждающего нерва. Существуют различные излечимые черты этой патологии – кашлевой вариант бронхиальной астмы / эозинофильный бронхит, которые отвечают на терапию противовоспалительными препаратами; некислотный рефлюкс, поддающийся терапии прокинетическими препаратами, а не препаратами для уменьшения желудочной кислотности. Альтернативной стратегией борьбы с кашлем становится снижение гиперчувствительности за счет нейромодуляции. У пациентов с кашлем, устойчивым к другим методам лечения, очень эффективен морфин в низких дозах. Также рекомендуются габапентин и прегабалин, но их применение ограничивается нежелательными явлениями. Возможно, наиболее многообещающими фармакологическими разработками являются препараты, при воздействии которых снижается нейрональная гиперчувствительность, блокирующая возбудимость афферентных нервов, например, за счет ингибирования рецепторов аденозинтрифосфорной кислоты (P2X3). Наконец, очень эффективной может быть кашель-контролирующая терапия при условии проведения ее опытным врачом. Дети – это не маленькие взрослые, у них следует стремиться выявить первопричину кашля. Например, среди детей раннего возраста распространена аспирация инородных тел. Частой причиной влажного кашля у детей является затяжной бактериальный бронхит, что ранее было малоизвестно. Излечения в этих случаях можно добиться с помощью терапии антибактериальными препаратами (АБП) (выбор АБП, доз и продолжительности применения еще предстоит определить). У детей следует использовать специальный педиатрический алгоритм.

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