ПЕРСПЕКТИВЫ ПРИМЕНЕНИЯ СОВРЕМЕННЫХ МУКОАКТИВНЫХ ПРЕПАРАТОВ В ТЕРАПИИ ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ


https://doi.org/10.18093/0869-0189-2014-0-2-100-108

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Аннотация

При повышении количества (гиперсекреция) и вязкости секрета (дискриния) развивается интралюминальная окклюзия дыхательных путей (ДП) у пациентов с хронической обструктивной болезнью легких (ХОБЛ), кроме того, гиперпродукция бронхиального секрета способствует ухудшению течения заболевания и делает пациента более склонным к инфекциям ДП. Эрдостеин (производное тиола) – новый мукоактивный препарат для терапии больных ХОБЛ, с помощью которого модулируется продукция и состав бронхиального секрета, уменьшается его вязкость и улучшается мукоцилиарный транспорт. Кроме того, эрдостеин обладает антиадгезивной, антиоксидантной и противовоспалительной активностью. По данным проведенных исследований, при длительной поддерживающей терапии эрдостеином (рекомендуемая доза – 600 мг в сутки) при ХОБЛ улучшается клиническая картина, качество жизни больных, уменьшается число обострений ХОБЛ. При обострении ХОБЛ в результате терапии эрдостеином (рекомендуемые дозы 600–900 мг в сутки) уменьшаются симптомы обострения, выраженность местной и системной воспалительной реакции и ускоряется разрешение обострения.

Об авторе

С. Н. Авдеев
ФГБУ "НИИ пульмонологии" ФМБА России: 105077, Россия, Москва, ул. 11-я Парковая, 32, корп. 4
Россия

д. м. н., профессор, руководитель клинического отдела ФГБУ "НИИ пульмонологии" ФМБА России; тел. / факс: (495) 465-52-64



Список литературы

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI / WHO workshop report. Last updated 2014. www.goldcopd.org

2. Celli B.R., MacNee W.; ATS / ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS / ERS position paper. Eur. Respir. J. 2004; 23: 932–946.

3. Barnes P.J., Shapiro S.D., Pauwels R.A. Chronic obstructive pulmonary disease: molecular and cellular mechanisms. Eur. Respir. J. 2003; 22: 672–688.

4. Hogg J.C. Pathophysiology of airflow limitation in chronic obstructive pulmonary disease. Lancet 2004; 364: 709–721.

5. Barnes P.J. Chronic obstructive pulmonary disease. N. Engl. J. Med. 2000; 343: 269–280.

6. Barnes P.J. Molecular genetics of chronic obstructive pulmonary disease. Thorax. 1999; 54: 245–252.

7. Meshi B., Vitalis T.Z., Ionescu D. et al. Emphysematous lung destruction by cigarette smoke. The effects of latent adenoviral infection on the lung inflammatory response. Am. J. Respir. Cell. Mol. Biol. 2002; 26: 52–57.

8. Ito K., Barnes P.J., Adcock I.M. Glucocorticoid receptor recruitment of histone deacetylase 2 inhibits interleukin-1binduced histone H4 acetylation on lysines 8 and 12. Mol. Cell. Biol. 2000; 20: 6891–6903.

9. Rutgers S.R., Postma D.S., ten Hacken N.H. et al. Ongoing airway inflammation in patients with COPD who do not currently smoke. Thorax 2000; 55: 12–18.

10. Burgel P.R., Nadel J.A. Epidermal growth factor receptormediated innate immune responses and their roles in airway diseases. Eur. Respir. J. 2008; 32: 1068–1081.

11. Randell S.H., Boucher R.C. Effective mucus clearance is essential for respiratory health. Am. J. Respir. Cell. Mol. Biol. 2006; 35: 20–28.

12. Innes A.L., Carrington S.D., Thornton D.J. et al. Ex vivo sputum analysis reveals impairment of protease-dependent mucus degradation by plasma proteins in acute asthma. Am. J. Respir. Crit. Care Med. 2009; 180: 203–210.

13. Rogers D.F., Barnes P.J. Treatment of airway mucus hypersecretion. Ann. Med. 2006; 38: 116–125.

14. Lethem M.I., James S.L., Marriott C., Burke J.F. The origin of DNA associated with mucus glycoproteins in cystic fibrosis sputum. Eur. Respir. J. 1990; 3: 19–23.

15. Tomkiewicz R.P., Kishioka C., Freeman J., Rubin B.K. DNA and actin filament ultrastructure in cystic fibrosis sputum. In: Baum G.L., Priel Z., Roth Y., Liron N., Ostfeld E.J., eds. Cilia, Mucus, and Mucociliary Interactions. New York: Dekker; 1998: 333–341.

16. Shah S.A., Santago P., Rubin B.K. Quantification of biopolymer filament structure. Ultramicroscopy. 2005; 104: 244–254.

17. Hogg J.C., Chu F., Utokaparch S. et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N. Engl. J. Med. 2004; 350: 2645–2653.

18. James A.L., Wenzel S. Clinical relevance of airway remodeling in airway diseases. Eur. Respir. J. 2007; 30: 134–155.

19. Macklem P.T., Proctor D.F., Hogg J.C. The stability of peripheral airways. Respir. Physiol. 1970; 8: 191–203.

20. Hogg J.C., Chu F.S., Tan W.C. et al. Survival after lung volume reduction in chronic obstructive pulmonary disease: insights from small airway pathology. Am. J. Respir. Crit. Care Med. 2007; 176: 454–459.

21. Openshaw P.J., Turner-Warwick M. Observations on sputum production in patients with variable airflow obstruction; implications for the diagnosis of asthma and chronic bronchitis. Respir. Med. 1989; 83: 25–31.

22. Turner-Warwick M., Openshaw P. Sputum in asthma. Postgrad. Med. J. 1987; 63 (Suppl. 1): 79–82.

23. Rogers D.F. Mucoactive agents for airway mucus hypersecretory diseases. Respir. Care. 2007; 52: 1176–1193.

24. Burgel P.-R., Nesme-Meyer P., Chanez P. et al. Cough and sputum production are associated with frequent exacerbations and hospitalizations in COPD subjects. Chest. 2009; 135: 975–982.

25. Speizer F.E., Fay M.E., Dockery D.W. et al. Chronic obstructive pulmonary disease mortality in six U.S. cities. Am. Rev. Respir. Dis. 1989; 140 (Suppl. 3): S49–S55.

26. Prescott E., Lange P., Vestbo J. Chronic mucus hypersecretion in COPD and death from pulmonary infection. Eur. Respir. J. 1995; 8: 1333–1338.

27. Vestbo J., Prescott E., Lange P. Association of chronic mucus hypersecretion with FEV1 decline and chronic obstructive pulmonary disease morbidity. Copenhagen City Heart Study Group. Am. J. Respir. Crit. Care Med. 1996; 153: 1530–1535.

28. De Marco R., Accordini S., Cerveri I. et al. Incidence of chronic obstructive pulmonary disease in a cohort of young adults according to the presence of chronic cough and phlegm. Am. J. Respir. Crit. Care Med. 2007; 175: 32–39.

29. Kohansal R., Martinez-Camblor P., Agusti A. et al. The natural history of chronic air flow obstruction revisited: an analysis of the Framingham offspring cohort. Am. J. Respir. Crit. Care Med. 2009; 180: 3–10.

30. Авдеев С.Н. Значение мукоактивных препаратов в терапии хронической обструктивной болезни легких. Пульмонология. 2011; 4: 118–124. / Avdeev S.N. A role of mucoactive drugs in therapy of chronic obstructive pulmonary disease. Pul'monologiya. 2011; 4: 118–124 (in Russian).

31. van der Vliet A., O'Neill C.A., Cross C.E. et al. Determination of low-molecular-mass antioxidant concentrations in human respiratory tract lining fluids. Am. J. Physiol. 1999; 276: L289–296.

32. Rahman I., Adcock I.M. Oxidative stress and redox regulation of lung inflammation in COPD. Eur. Respir. J. 2006; 28: 219–242.

33. Ricevuti G., Mazzone A., Uccelli E. et al. Influence of erdosteine, a mucolytic agent, on amoxycillin penetration into sputum in patients with an infective exacerbation of chronic bronchitis. Thorax. 1988; 43: 585–590.

34. Moldeus P., Cotgreave I.A., Berggren M. Lung protection by a thiol-containing antioxidant: N-acetylcysteine. Respiration. 1986; 50: 31–42. 35. Tashkin D.P., Celli B., Senn S. et al. for the UPLIFT Study Investigators. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N. Engl. J. Med. 2008; 359: 1543–1554.

35. Moretti M. Pharmacology and clinical efficacy of erdosteine in chronic obstructive pulmonary disease. Expert Rev. Respir. Med. 2007; 1 (3): 307–316.

36. Moretti M. Erdosteine: its relevance in COPD treatment. Expert Opin. Drug Metab. Toxicol. 2009; 5: 333–343. 38. Savu S., Mitrea M., Silvestro L., Mancini C. HPLC with on-line mass spectrometry detection applicable to elucidate erdosteine metabolism. Int. J. Clin. Pharmacol. Ther. 2000; 38: 415–417.

37. Marchioni C.F., Moretti M., Muratori M. et al. Effects of erdosteine on sputum biochemical and rheologic properties: pharmacokinetics in chronic obstructive lung disease. Lung 1990; 168: 285–293.

38. Olivieri D., Del Donno M., Casalini A. et al. Activity of erdosteine on mucociliary transport in patients affected by chronic bronchitis. Respiration 1991; 58: 91–94.

39. Hotzinger H. Erdosteine or placebo combined with co-trimoxazole in the treatment of hypersecretive infectious bronchitis. Med. Praxis 1991; 12: 171–181.

40. Zanasi A., Menarini A. Erdosteine versus N-acetylcysteine in the treatment of exacerbation of chronic bronchopneumopathies. Med. Praxis 1991; 12: 207–217.

41. Ghiringhelli G. Cross-over study of efficacy and tolerability of erdosteine in the treatment of chronic obstructive bronchial disease in stable hypersecretive phase: Controlled double-blind study vs placebo. Arch. Med. Inter. 1995; 47: 113–120.

42. Braga P.C., Dal Sasso M., Sala M.T., Gianelle V. Effects of erdosteine and its metabolites on bacterial adhesiveness. Arzneimittel-Forsch. 1999; 49: 344–350.

43. Braga P.C. Bacterial adhesion to human cells. In: Edi-Aipo Scientifica 2000: 1–63.

44. Dal Negro R.W., Visconti M., Micheletto C., Tognella S. Changes in blood ROS, e-NO, and some pro-inflammatory mediators in bronchial secretions following erdosteine or placebo: a controlled study in current smokers with mild COPD. Pulm. Pharmacol. Ther. 2008; 21: 304–308.

45. Braga P.C. Oxidative stress: respiratory diseases and thiol compounds. Edi-Aipo Scientifica 2006: 1–104.

46. Miyake K., Kaise T., Hosoe H. et al. The effect of Erdosteine and its active metabolite on reactive oxygen species production by inflammatory cells. Inflam. Res. 1999; 48: 205–209.

47. Manchini C., Nicola M., Lumachi B. Erdosteine effects on serum malondialdehyde of healthy smokers and non-smokers. A pilot study. Eur. Respir. J. 1997; 10 (Suppl. 25): 95s.

48. Mitrea M. Reduced (GSH) and oxidized (GSSG) levels in plasma and BAL of chronic bronchitis patients treated with erdosteine or N-acetylcysteine (NAC). In: 6th International Conference on Bronchoalveolar Lavage: Abstracts. Corfu (Greece), June 24–27 1998.

49. Dal Negro R.W., Visconti M., Tognella S., Micheletto C. Erdosteine affects eicosanoid production in COPD. Int. J. Clin. Pharmacol. Ther. 2011; 49: 41–45.

50. Malerba M., Ponticiello A., Radaeli A. et al. Effect of twelvemonths therapy with oral ambroxol in preventing exacerbations in patients with COPD. Double-blind, randomized, multicenter, placebo-controlled study (the AMETHIST Trial). Pulm. Pharmacol. Ther. 2004; 17: 27–34.

51. Poole P., Black P.N. Mucolytic agents for chronic bronchitis and chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2006; 19 (3): JulCD001287.

52. Zheng J.P., Kang J., Huang S.G. et al. Effect of carbocisteine on acute exacerbation of chronic obstructive pulmonary disease (PEACE study): a randomised placebo-controlled study. Lancet. 2008; 371: 2013–2018.

53. Tse H.N., Raiteri L., Wong K.Y. et al. High-dose N-acetylcysteine in stable COPD: the 1-year, double-blind, randomized, placebo-controlled HIACE study. Chest. 2013; 144: 106–118.

54. Zheng J.-P., Wen F.-Q., Bai C.-X. et al., on behalf of the PANTHEON study group. Twice daily N-acetylcysteine 600 mg for exacerbations of chronic obstructive pulmonary disease (PANTHEON): a randomised, double-blind placebo-controlled trial. Lancet Respir. Med. 2014; 2: 187–194.

55. Aubier M., Berdah L. Étude multicentrique, contrôlée, en double aveugle, de l'efficacité et de la tolérance de Vectrine (erdosteine) versus placebo dans le traitement de la bronchite chronique hypersecretante stabilisee. Rev. Mal. Respir. 1999; 16: 521–528.

56. Fioretti M., Bandera M. Prevention of exacerbations in chronic bronchitic patients with erdosteine. Med. Praxis. 1991; 12: 219–227.

57. Moretti M., Bottrighi P., Dallari R. et al. The effect of long-term treatment with erdosteine on chronic obstructive pulmonary disease: The equalife study. Drugs Exp. Clin. Res. 2004, 30: 143–152.

58. Stanford R.H., Shen Y., McLaughlin T. Cost of chronic obstructive pulmonary disease in the emergency department and hospital: an analysis of administrative data from 218 US hospitals. Treat. Respir. Med. 2006; 5: 343–349.

59. O'Donnell D.E., Parker C.M. COPD exacerbations: Pathophysiology. Thorax. 2006; 61: 354–361.

60. Donaldson G.C., Seemungal T.A.R., Bhowmik A., Wedzicha J.A. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002; 57: 847–852.

61. Seemungal T.A.R., Donaldson G.C., Paul E.A. et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1998; 151: 1418–1422.

62. Miravitlles M., Murio C., Guerrero T. et al. Pharmacoeconomic evaluation of acute exacerbations of chronic bronchitis and COPD. Chest 2002; 121: 1449–1455.

63. Zuin R., Palamidese A., Negrin R. et al. High dose N-acetylcysteine in patients with exacerbations of chronic obstructive pulmonary disease. Clin. Drug Invest. 2005; 25: 401–408.

64. Marchioni C.F., Polu J.M., Taytard A. et al. Evaluation of efficacy and safety of erdosteine in patients affected by chronic bronchitis during an infective exacerbation phase and receiving amoxycillin as basic treatment (ECOBES, European Chronic Obstructive Bronchitis Erdosteine Study). Int. J. Clin. Pharmacol. Ther. 1995; 33: 612–618.

65. Mohanty K.C., Thiappanna G., Singh V., Mancini C. Evaluation of efficacy and safety of erdosteine in patients affected by exacerbation of chronic bronchitis and receiving ciprofloxacin as basic treatment. J. Clin. Res. 2001; 4: 35–39.

66. Bisetti A., Mancini C. Mucolytic activity of erdosteine double blind clinical trial vs placebo. Arch. Med. Inter. 1995; 47: 89–97.

67. Bianchi B., Ballabio M., Moretti M. Effects of erdosteine on serum biomarker concentrations at COPD exacerbation. Eur. Respir. J. 2010; 36 (Suppl.): 378.


Дополнительные файлы

Для цитирования: Авдеев С.Н. ПЕРСПЕКТИВЫ ПРИМЕНЕНИЯ СОВРЕМЕННЫХ МУКОАКТИВНЫХ ПРЕПАРАТОВ В ТЕРАПИИ ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ.  Пульмонология. 2014;(2):100-108. https://doi.org/10.18093/0869-0189-2014-0-2-100-108

For citation: Avdeev S.N. PERSPECTIVES OF NOVEL MUCOACTIVE DRUGS IN THERAPY OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE. Russian Pulmonology. 2014;(2):100-108. (In Russ.) https://doi.org/10.18093/0869-0189-2014-0-2-100-108

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