Бронхиальная астма и COVID-19: обзор рекомендаций по ведению пациентов с бронхиальной астмой во время пандемии COVID-19

При появлении нового заболевания COVID-19 (COronaVIrus Disease–2019), вызванного коронавирусом SARS-CoV-2, значительно изменилась привычная схема взаимодействия врача и пациента. По данным крупных исследований выявлен ряд факторов риска развития тяжелого течения заболевания COVID-19 – пожилой возраст, гипертония, сахарный диабет, сердечно-сосудистые заболевания, хроническая обструктивня болезнь легких. Однако бронхиальная астма (БА) и респираторная аллергия не идентифицированы как существенные факторы риска тяжелого течения заболевания, а выявление этих факторов дает важную информацию о патогенезе COVID-19, подходах к базисной, таргетной и аллерген-специфической терапии (АСИТ) в условиях пандемии при различных фенотипах и эндотипах БА.

Целью обзора явилось обобщение имеющихся в настоящее время знаний о SARS‐CoV‐2, Т2-эндотипе БА, эозинофильном воспалении. Представлены данные исследований по изучению особенностей течения COVID-19 у пациентов с БА, основные рекомендации Глобальной инициативы по БА (Global Initiative for Asthma – GINA, 2021) и Министерства здравоохранения Российской Федерации. Показано, что ориентирование на эндотипы и фенотипы БА способствует выбору оптимальной тактики ведения пациентов с COVID-19 и БА. Рассмотрено влияние дисбаланса иммунной системы, провоспалительных цитокинов, эффекторных клеток у больных БА на развитие и прогрессирование COVID-19. Приведены рекомендации по ведению пациентов препаратами базисной, таргетной терапии, АСИТ в условиях пандемии.

Заключение. Текущие рекомендации по лечению БА, основанные на результатах последних исследований, в контексте c COVID-19 углубляют понимание особенностей течения коорновирусной болезни у пациентов с различными фенотипами и эндотипами БА и подходов к традиционным методам ее лечения согласно клиническим рекомендациям в условиях пандемии.

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