БЕЗОПАСНОСТЬ ИНГАЛЯЦИОННЫХ ГЛЮКОКОРТИКОСТЕРОИДОВ В ТЕРАПИИ БРОНХИАЛЬНОЙ АСТМЫ
https://doi.org/10.18093/0869-0189-2014-0-3-113-120
Аннотация
Основными препаратами, с помощью которых обеспечивается длительный контроль над бронхиальной астмой (БА), являются ингаляционные глюкокортикостероиды (иГКС), обладающие выраженным противовоспалительным эффектом. При воздействии иГКС снижается уровень смертности при БА, улучшается функция легких, облегчаются симптомы, уменьшается число обострений и повышается качество жизни пациентов. Молекулы иГКС могут различаться по своему терапевтическому индексу, но в эквипотентных дозах они одинаково эффективны. Максимальный эффект иГКС проявляется уже при применении низких / средних доз, предпочтительных для длительного лечения БА. При корректном использовании в диапазоне низких / средних доз иГКС проявляется мало нежелательных эффектов (НЭ), однако риск их возникновения увеличивается с повышением доз.
Данная статья посвящена фармакокинетическим свойствам и механизму действия иГКС, возможным локальным и системным НЭ и мерам их профилактики.
Данная статья посвящена фармакокинетическим свойствам и механизму действия иГКС, возможным локальным и системным НЭ и мерам их профилактики.
Об авторе
Н. М. Ненашева
ГБОУ ДПО "Российская медицинская академия последипломного образования" Минздрава России: 123995, Москва, ул. Баррикадная, 2 / 1
Россия
Россия
д. м. н., профессор кафедры клинической аллергологии ГБОУ ДПО РМАПО; тел.: (499) 196-19-54
Список литературы
1. Controlled trial of effects of cortisone acetate in status asthmaticus; report to the Medical Research Council by the subcommittee on clinical trials in asthma. Lancet. 1956; 271 (6947): 803–806.
2. Clark T.J. Effect of beclomethasone dipropionate delivered by aerosol in patients with asthma. Lancet. 1972; 1 (7765): 1361–1364.
3. Barnes P.J. Glucocorticosteroids: current and future directions. Br. J. Pharmacol. 2011; 163: 29–43.
4. Schacke H., Schottelius A., Docke W.D. et al. Dissociation of transactivation from transrepression by a selective glucocorticoid receptor agonist leads to separation of therapeutic effects from side effects. Proc. Natl. Acad. Sci. USA. 2004; 101: 227–232.
5. Derendorf H., Nave R., Drollman A. et al. Relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma. Eur. Respir. J. 2006; 28: 1042–1050.
6. Stoloff S.W., Kelly H.W. Updates on the use of inhaled corticosteroids in asthma. Curr. Opin. Allergy Clin. Immunol. 2011; 11 (4): 337–344.
7. Чучалин А.Г., Айсанов З.Р., Белевский А.С. и др. Федеральные клинические рекомендации по диагностике и лечению бронхиальной астмы. Пульмонология. 2014; 2: 11–32. / Chuchalin A.G., Aysanov Z.R., Belevskiy A.S. et al. Federal guidelines for the diagnosis and treatment bronchial asthma. Pul'monologiya. 2014; 2: 11–32 (in Russian).
8. Barnes P.J., Pedersen S., Busse W.W. Efficacy and safety of inhaled corticosteroids. New developments. Am. J. Respir. Crit. Care Med. 1998; 157: S1–S53.
9. Buhl R. Local oropharyngeal side effects of inhaled corticosteroids in patients with asthma. Allergy. 2006; 61: 518–526.
10. Roland N.J., Bhalla R.K., Earis J. The local side effects of inhaled corticosteroids: current understanding and review of the literature. Chest. 2004; 126: 213–219.
11. Selroos O., Backman R., Forsen K.O. et al. Local side-effects during 4-year treatment with inhaled corticosteroids – a comparison between pressurized metered-dose inhalers and Turbuhaler. Allergy. 1994; 49: 888–890.
12. Rachelefsky G.S., Liao Y., Faruqi R. Impact of inhaled corticosteroid-induced oropharyngeal adverse events: results from a meta-analysis. Ann. Allergy Asthma Immunol. 2007; 98 (3): 225–238.
13. Leach C.L., Davidson P.J., Hasselquist B.E., Boudreau R.J. Lung deposition of hydrofluoroalkane-134a beclomethasone is greater than that of chlorofluorocarbon fluticasone and chlorofluorocarbon beclomethasone: a cross-over study in healthy volunteers. Chest. 2002; 122: 510–516.
14. Acerbi D., Brambilla G., Kottakis I. Advances in asthma and COPD management: delivering CFC-free inhaled therapy using Modulite technology. Pulm. Pharmacol. Ther. 2007; 20 (3): 290–303.
15. Huchon G., Magnussen H., Chuchalin A. et al. Lung function and asthma control with beclomethasone and formoterol in single inhaler. Respir. Med. 2009; 103: 41–49.
16. Gabrio B.J., Stein S.W., Velasquez D.J. A newmethod to evaluate plume characteristics of hydrofluoroalkane and chlorofluorocarbon metered dose inhalers. Intern. J. Pharm. 1999; 186 (1): 3–12.
17. Lavorini F., Fontana G.A. Targeting drugs to the airways: the role of spaser devices. Exp. Opin. Drug Deliv. 2009; 6 (1): 91–102.
18. Newman S.P., Weisz A.W., Talaee N., Clarke S.W. Improvement of drug delivery with a breath actuated pressurized aerosol for patients with poor inhaler technique. Thorax. 1991; 46: 712–716.
19. Ahmet A., Kim H., Spie S. Adrenal suppression: A practical guide to the screening and management of this under-recognized complication of inhaled corticosteroid therapy. Allergy Asthma Clin. Immunol. 2011, 7: 13. DOI: 10.1186/1710-1492-7-13.
20. Buehring B., Viswanathan R., Binkley N., Busse W. Glucocorticoid-induced osteoporosis: An update on effects and management. J. Allergy Clin. Immunol. 2013; 132: 1019–1030.
21. Ferguson A.C., Van Bever H.P., Teper A.M. et al. A comparison of the relative growth velocities with budesonide and fluticasone propionate in children with asthma. Respir. Med. 2007; 101: 118–129.
22. Pedersen S., Warner J., Wahn U. et al. Growth, systemic safety, and efficacy during 1 year of asthma treatment with different beclomethasone dipropionate formulations: an open-label, randomized comparison of extrafine and conventional aerosols in children. Pediatrics. 2002; 109: e92.
23. Sharek P.J., Bergman D.A. The effect of inhaled steroids on the linear growth of children with asthma: a meta-analysis. Pediatrics. 2000; 106: E8.
24. The Childhood Asthma Management Program Research Group. Long-term effects of budesonide or nedocromil in children with asthma. N. Engl. J. Med. 2000; 343: 1054–1063.
25. Kelly H.W., Nelson H.S. Potential adverse effects of the inhaled corticosteroids. Allergy Clin. Immunol. 2003; 112 (3): 469–478.
26. Lipworth B.J. Systemic adverse effects of inhaled corticosteroid therapy: a systematic review and meta-analysis. Arch. Intern. Med. 1999, 159: 941–955.
27. Bousquet J., Meziane H., Chanez P. et al. The response of two different dosages of beclometasone dipropionate suspension for nebulization versus a standard dose of beclometasone dipropionate via a metered-dose inhaler on bronchoprovocation testing in adults with asthma. Respir. Med. 2003; 97 (Suppl. B): S11–S14.
28. Thompson P.J., Davies R.J., Young W.F. et al. Safety of hydrofluoroalkane-134a beclomethasone dipropionate extrafine aerosol. Respir. Med. 1998; 92 (Suppl. A): 33–39.
29. Bousquet J., Poli G., Acerbi D. et al. Systemic exposure and implications for lung deposition with an extra-fine hydrofluoroalkane beclometasone dipropionate / formoterol fixed combination. Clin. Pharmacokinet. 2009; 48 (6): 347–358.
30. Kelly H.W. Comparison of inhaled corticosteroids: An update. Ann. Pharmacother. 2009; 43 (3): 519–527.
31. Jones A., Fay J.K., Burr M. et al. Inhaled corticosteroid effects on bone metabolism in asthma and mild chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2002; (1): CD003537.
32. Packe G.E., Douglas J.G., McDonald A.F. et al. Bone density in asthmatic patients taking high dose inhaled beclomethasone dipropionate and intermittent systemic corticosteroids. Thorax. 1992; 47: 414–417.
33. Wong C.A., Walsh L.J., Smith C.J. et al. Inhaled corticosteroid use and bone-mineral density in patients with asthma. Lancet. 2000; 355: 1399–1403.
34. Agertoft L., Pedersen S. Effect of long-term treatment with inhaled budesonide on adult height in children with asthma. N. Engl. J. Med. 2000; 343: 1064–1069.
35. Agertoft L., Pedersen S. Short-term lower-leg growth rate and urine cortisol excretion in children treated with ciclesonide. J. Allergy Clin. Immunol. 2005; 115: 940–945.
36. Kelly H.W., Sternberg A.L., Lescher R. et al. Effect of inhaled glucocorticoids in childhood on adult height. N. Engl. J. Med. 2012; 367: 904–912.
37. Chauhan B.F., Chartrand C., Ducharme F.M. Intermittent versus daily inhaled corticosteroids for persistent asthma in children and adults. Cochrane Database Syst. Rev. 2013; (2): CD009611.
38. Cumming R., Mitchell P., Leeder S. Use of inhaled corticosteroids and the risk of cataracts. N. Engl. J. Med. 1997; 337: 8–14.
39. Garbe E., LeLorier J., Boivin J., Suissa S. Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open-angle glaucoma. J.A.M.A. 1997; 277: 722–727.
40. Mak V., Melchor R., Spiro S. Easy bruising as a side-effect of inhaled corticosteroids. Eur. Respir. J. 1992; 5: 1068–1074.
41. Autio P., Karjalainen J., Risteli L. et al. Effects of an inhaled steroid (budesonide) on skin collagen synthesis of asthma patients in vivo. Am. J. Respir. Crit. Care Med. 1996; 153: 1172–1175.
42. Dahl R. Systemic side effects of inhaled corticosteroids in patients with asthma. Respir. Med. 2006; 100 (8): 1307–1317.
Рецензия
Для цитирования:
Ненашева Н.М. БЕЗОПАСНОСТЬ ИНГАЛЯЦИОННЫХ ГЛЮКОКОРТИКОСТЕРОИДОВ В ТЕРАПИИ БРОНХИАЛЬНОЙ АСТМЫ. Пульмонология. 2014;(3):113-120. https://doi.org/10.18093/0869-0189-2014-0-3-113-120
For citation:
Nenasheva N.M. SAFETY OF INHALED CORTICOSTEROIDS IN THE THERAPY OF BRONCHIAL ASTHMA. PULMONOLOGIYA. 2014;(3):113-120. (In Russ.) https://doi.org/10.18093/0869-0189-2014-0-3-113-120
Просмотров:
2573
Послать статью по эл. почте 