ПАТОГЕНЕТИЧЕСКИЕ ОСНОВЫ ХОЛИНОЛИТИЧЕСКОЙ ТЕРАПИИ И ВОЗМОЖНЫЕ МЕХАНИЗМЫ ЕЕ ПОТЕНЦИРОВАНИЯ ПОД ВЛИЯНИЕМ β2-АДРЕНОМИМЕТИКОВ
Аннотация
В настоящее время терапия ингаляционными бронхолитическими препаратами длительного и ультрадлительного действия является основой поддерживающей терапии хронической обструктивной болезни легких. В статье описаны патогенетические основы холинолитической терапии и возможные механизмы ее потенцирования под влиянием β2-адреномиметиков. Разрабатываются несколько фиксированных комбинаций холинолитиков и β2-адреномиметиков ультрадлительного действия. В 2013 г. в Европе зарегистрирована 1-я фиксированная комбинация, содержащая гликопирроний и индакатерол. Имеются все основания предполагать, что комбинация 2 типов бронхолитиков является фармакологически успешной: во-первых, добавление β2-адреноагонистов снижает высвобождение ацетилхолина (ACh) за счет изменения холинергической нейрональной передачи пресинаптическими β2-адренорецепторами, приводя к усилению релаксации гладких мышц бронхов, вызванной холинолитиками; во-вторых, добавление холинолитика может редуцировать констрикторный эффект ACh, чье высвобождение модулируется β2-адреноагонистами, и амплифицировать бронходилатацию, вызванную β2-адреноагонистами посредством прямой стимуляции β2-адренорецепторов.
Об авторах
В. И. Трофимов
ГБОУ ВПО "Первый Санкт-Петербургский государственный медицинский университет имени академика И.П.Павлова" Минздрава России: 197022, Санкт-Петербург, ул. Льва Толстого, 6–8
Россия
д. м. н., зав. кафедрой госпитальной терапии ГБОУ ВПО "ПСПГМУ им. акад. И.П.Павлова" Минздрава Рос-
сии, главный внештатный пульмонолог Северо-Западного региона; тел.: (921) 913-13-28
Россия
д. м. н., зав. кафедрой госпитальной терапии ГБОУ ВПО "ПСПГМУ им. акад. И.П.Павлова" Минздрава Рос-
сии, главный внештатный пульмонолог Северо-Западного региона; тел.: (921) 913-13-28
Л. Н. Сорокина
ГБОУ ВПО "Первый Санкт-Петербургский государственный медицинский университет имени академика И.П.Павлова" Минздрава России: 197022, Санкт-Петербург, ул. Льва Толстого, 6–8
Россия
д. м. н., доцент кафедры госпитальной терапии ГБОУ ВПО "ПСПГМУ им. акад. И.П.Павлова" Минздрава России; тел.: (921) 403-90-35
Россия
д. м. н., доцент кафедры госпитальной терапии ГБОУ ВПО "ПСПГМУ им. акад. И.П.Павлова" Минздрава России; тел.: (921) 403-90-35
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Для цитирования:
Трофимов В.И., Сорокина Л.Н. ПАТОГЕНЕТИЧЕСКИЕ ОСНОВЫ ХОЛИНОЛИТИЧЕСКОЙ ТЕРАПИИ И ВОЗМОЖНЫЕ МЕХАНИЗМЫ ЕЕ ПОТЕНЦИРОВАНИЯ ПОД ВЛИЯНИЕМ β2-АДРЕНОМИМЕТИКОВ. Пульмонология. 2014;(2):91-99. https://doi.org/10.18093/0869-0189-2014-0-2-91-99
For citation:
Trofimov V.I., Sorokina L.N. MECHANISMS OF ANTICHOLINERGIC EFFECTS AND PROBABLE MECHANISMS OF THEIR POTENTIATION USING BETA-2-AGONISTS. PULMONOLOGIYA. 2014;(2):91-99. (In Russ.) https://doi.org/10.18093/0869-0189-2014-0-2-91-99
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