Хронический бронхит: федеральные клинические рекомендации по диагностике и лечению

Представлены современные сведения об этиологии и патогенезе, клинических проявлениях, диагностике и лечении хронического бронхита.

Методология. Целевой аудиторией данных клинических рекомендаций являются врачи общей практики, врачи-терапевты и врачи-пульмонологи. Каждый тезис-рекомендация по проведению диагностических и лечебных мероприятий оценивается по шкалам уровней достоверности доказательств от 1 до 5 и шкале оценки уровней убедительности рекомендаций по категориям А, В, С. Клинические рекомендации содержат также комментарии и разъяснения к указанным тезисам-рекомендациям, алгоритм ведения пациентов с установленным диагнозом хронический бронхит.

Заключение. Представленные клинические рекомендации по диагностике и лечению хронического бронхита одобрены Научно-практическим советом Министерства здравоохранения Российской Федерации (2021). 

1. Definition and classification of chronic bronchitis for clinical and epidemiological purposes: A report to the Medical Research Council by their Committee on the Aetiology of Chronic Bronchitis. Lancet. 1965; 1 (7389): 775-779. https://doi.org/10.1016/S0140-6736(65)92953-3.

2. Brаman S.S. Chronic cough due to chronic bronchitis: ACCP Evidence-Based clinical practice guidelines. Chest. 2006; 129 (1, Suppl.): 104S-115S. https://doi.org/10.1378/chest.129.1_suppl.104S.

3. Черняев А.Л. Патоморфология хронического обструктивного бронхита. Русский медицинский журнал. 1997; (17): 3-10. Доступно на: https://www.rmj.ru/articles/obshchie-stati/PATOMORFOLOGIYa_HRONIChESKOGO_OBSTRUKTIVNOGO_BRONHITA

4. Pallasaho P., Lundback B., Laspa S.L. et al. Increasing prevalence of asthma but not of chronic bronchitis in Finland? Report from the FinEsS-Helsinki Study. Respir. Med. 1999; 93 (11): 798-809. https://doi.org/10.1016/s0954-6111(99)90265-2.

5. Sobradillo V., Miravitlles M., Jimenez C.A. et al. Epidemiological study of chronic obstructive pulmonary disease in Spain (IBERPOC): prevalence of chronic respiratory symptoms and airflow limitation. Arch. Bronconeumol. 1999; 35 (4): 159-166. https://doi.org/10.1016/s0300-2896(15)30272-6.

6. Cerveri I., Accordini S., Verlato G. et al. European community respiratory health survey (ECRHS) study group. Variations in the prevalence across countries of chronic bronchitis and smoking habits in young adults. Eur. Respir. J. 2001; 18 (1): 85-92. https://doi.org/10.1183/09031936.01.00087101.

7. Janson C., Chinn S., Jarvis D., Burney P. Determinants of cough in young adults participating in the European Community Respiratory Health Survey. Eur. Respir. J. 2001; 18 (4): 647-654. https://doi.org/10.1183/09031936.01.00098701.

8. Huchon G.J., Vergnenegre A., Neukirch F. et al. Chronic bronchitis among French adults: high prevalence and underdiagnosis. Eur. Respir. J. 2002; 20 (4): 806-812. https://doi.org/10.1183/09031936.02.00042002.

9. Miravitlles M., de la Roza C., Morera J. et al. Chronic respiratory symptoms, spirometry and knowledge of COPD among general population. Respir. Med. 2006; 100 (11): 1973-1980. https://doi.org/10.1016/j.rmed.2006.02.024.

10. Pelkonen M., Notkola I.L., Nissinen A. et al. Thirty-year cumulative incidence of chronic bronchitis and COPD in relation to 30-year pulmonary function and 40-year mortality: a follow-up in middle-aged rural men. Chest. 2006; 130 (4): 1129-1137. https://doi.org/10.1378/chest.130.4.1129.

11. 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 (1): 32-39. https://doi.org/10.1164/rccm.200603-381OC.

12. Miravitlles M., Soriano J.B., Garcia-Rio F. et al. Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities. Thorax. 2009; 64 (10): 863-868. https://doi.org/10.1136/thx.2009.115725.

13. Martinez C., Chen Y., Kazerooni E. et al. Non-obstructive chronic bronchitis in the COPDGene cohort. Am. J. Respir. Crit. Care Med. 2012; 185: 6622. https://doi.org/10.1164/ajrccm-conference.2012.185.1_MeetingAbstracts.A6622.

14. Косарев В.В., Бабанов С.А. Социальные аспекты хронического бронхита по данным эпидемиологического исследования. Экология человека. 2005; (12): 46-49. Доступно на: https://cyberleninka.ru/article/n/sotsialnye-aspekty-hronicheskogo-bronhita-po-dannym-epidemiologicheskogo-issledovaniya/viewer.

15. Международная классификация болезней 10-го пересмотра. Доступно на: https://mkb-10.com

16. Smith J.A., Woodcock A. Chronic cough. N. Engl. J. Med. 2016; 375 (16): 1544-1551. https://doi.org/10.1056/NEJMcp1414215.

17. Terasaki G., Paauw D.S. Evaluation and treatment of chronic cough. Med. Clin. N. Am. 2014; 98 (3): 391-403. https://doi.org/10.1016/j.mcna.2014.01.002.

18. Achilleos A. Evidence-based evaluation and management of chronic cough. Med. Clin. North Am. 2016; 100 (5): 1033-1045. https://doi.org/10.1016/j.mcna.2016.04.008

19. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2020 Report. Available at: https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINALver1.2-03Dec19_WMV.pdf

20. Dicpinigaitis P.V. Angiotensin-converting enzyme inhibitor-induced cough:ACCP evidence-based clinical practice guidelines. Chest. 2006; 129 (1, Suppl.): 169S-173S. https://doi.org/10.1378/chest.129.1_suppl.169S.

21. Pratter M.R. Overview of common causes of chronic cough. ACCP evidence-based clinical practice guidelines. Chest. 2006; 129 (1, Suppl.): 59S-62S. https://doi.org/10.1378/chest.129.1_suppl.59S.

22. Braman S.S. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. 2006; 129 (1, Suppl.): 104S-115S. https://doi.org/10.1378/chest.129.1_suppl.104S.

23. Celli B., 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 (6): 932-946. https://doi.org/10.1183/09031936.04.00014304.

24. Синопальников А.И., Клячкина И.Л. Кашель: Карманные рекомендации. М.: Ремедиум; 2013.

25. Anthonisen N.R., Manfreda J., Warren C.P. et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann. Intern. Med. 1987; 106 (2): 196-204. https://doi.org/10.7326/0003-4819-106-2-196.

26. Feeney A. S., Fendrick A. M., Quintiliani R. Acute exacerbation of chronic bronchitis: a primary care consensus guideline. Am. J. Manag. Care. 2004; 10 (10): 689-696. Available at: https://www.ajmc.com/view/oct04-1903p689-696

27. Irwin R.S., French C.I., Chang A.B.et. al. Classification of cough as a symptom in adults and management algorithms. CHEST Guideline and Expert Panel Report. Chest. 2018; 153 (1): 196-209. https://doi.org/10.1016/j.chest.2017.10.016.

28. Шепеленко А.Ф. Хронический бронхит. Трудный пациент. 2009; 7 (3): 33-38. Доступно на: https://cyberleninka.ru/article/n/hronicheskiy-bronhit/viewer.

29. Woodhead M., Blasi F., Ewig S. et al. Guidelines for the management of adult lover respiratory tract infections. Clin. Microbiol. Infect. 2011; 17 (Suppl. 6): 1-24. https://doi.org/10.1111/j.1469-0691.2011.03602.x.

30. Weis N., Almdal T. C-reactive protein - can it be used as a marker of infection in patients with exacerbation of chronic obstructive pulmonary disease. Eur. J. Intern. Med. 2006; 17 (2): 88-91. https://doi.org/10.1016/j.ejim.2005.09.020.

31. Amalakanti S., Pentakota M. R. Pulse oximetry overestimates oxygen saturation in COPD. Respir. Care. 2016; 61 (4): 423-427. https://doi.org/10.4187/respcare.04435.

32. Dev D., Sankaran E.W.R., Cunnife J. et al. Value of C-reactive protein in exacerbation of chronic obstructive pulmonary disease. Respir. Med. 1998; 92 (4): 664-667. https://doi.org/10.1016/s0954-6111(98)90515-7.

33. Wielpütz M.O., Heußel C.P., Herth F.J., Kauczor H.U. Radiological diagnosis in lung disease: factoring treatment options into the choice of diagnostic modality. Dtsch. Arztebl. Int. 2014; 111 (11): 181. https://doi.org/10.3238/arztebl.2014.0181.

34. Agarwal R. L., Kumar D., Agarwal D.K.; Chabra G.S. Diagnostic values of electrocardiogram in chronic obstructive pulmonary disease (COPD). Lung India. 2008; 25 (2): 78. https://doi.org/10.4103/0970-2113.44125.

35. Chen M., Chen P., Zhong N. et al. The Chinese national guidelines on diagnosis and management of cough (December 2010). Chinese Med. J. 2011; 124 (20): 3207-3219. https://doi.org/10.3760/cma.j.issn.0366-6999.2011.20.002.

36. Lai K., Shen H., Zhou X. et al. Clinical practice guidelines for diagnosis and management of cough: Chinese Thoracic Society (CTS) asthma consortium. J. Thorac. Dis. 2018; 10 (11): 6314-6351. https://doi.org/10.21037/jtd.2018.09.153.

37. Irwin R.S. Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines. Chest. 2006; 129 (1, Suppl.): 80S-94S. https://doi.org/10.1378/chest.129.1_suppl.80S.

38. Hukkinen M., Korhonen T., Broms U. et al. Long-Term smoking behavior patterns predicting self-reported chronic bronchitis. J. COPD. 2009; 6 (4): 242-249. https://doi.org/10.1080/15412550903051781.

39. Pelkonen M. Smoking: relationship to chronic bronchitis, chronic obstructive pulmonary disease and mortality. Cur. Opin. Pulm. Med. 2008; 14 (2): 105-109. https://doi.org/10.1097/MCP.0b013e3282f379e9.

40. Wynder E., Kaufman P., Lerrer R. et al. A short term follow up study on ex-cigarette smokers: with special emphasis on persistent cough and weight gain. Am. Rev. Respir. Dis. 1967; 96 (4): 645-655. https://doi.org/10.1164/arrd.1967.96.4.645.

41. Chandler M.A., Rennard S.I. Smoking cessation. Chest. 2010; 137 (2): 428-435. https://doi.org/10.1378/chest.09-0124.

42. Jorenby D.E., Leischow S.J., Nides M.A. et al. A controlled trial of sustained- release bupropion, a nicotine patch, or both for smoking cessation. N. Engl. J. Med. 1999; 340 (9): 685-691. https://doi.org/10.1056/NEJM199903043400903.

43. Faessel H., Ravva P., Williams K. Pharmacokinetics, safety, and tolerability of varenicline in healthy adolescent smokers: a multicenter, randomized, double-blind, placebocontrolled, parallel-group study. Clin. Ther. 2009; 31 (1): 177-189. https://doi.org/10.1016/j.clinthera.2009.01.003.

44. Willemse B.W.M., Postma D.S., Timens W., ten Hacken N.H.T. The impact of smoking cessation on respiratory symptoms, lung function, airway hyperresponsiveness and inflammation. Eur. Respir. J. 2004; 23 (3): 464-476. https://doi.org/10.1183/09031936.04.00012704.

45. Anthonisen N.R., Connett J.E., Kiley J.P. et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV 1: The Lung Health Study. JAMA. 1994; 272 (19): 1497-1505. https://doi.org/10.1001/jama.1994.03520190043033.

46. Kardos P., Berck H., Fuchs K.H. et al. Guidelines of the German respiratory society for diagnosis and treatment of adults suffering from acute or chronic cough. Pneumologie. 2010; 64 (11): 701-711. https://doi.org/10.1055/s-0030-1255526.

47. Kardos P., Dinh Q.T., Fuchs K.H. et al. [Guidelines of the German Respiratory Society for diagnosis and treatment of adults suffering from acute, subacute and chronic cough]. Pneumologie. 2019; 73 (3): 143-180. https://doi.org/10.1055/a-0808-7409 (in German).

48. Poole P., Black P.N. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2010; (2): CD001287. https://doi.org/10.1002/14651858.CD001287.pub3.

49. Sevelius H., McCoy J.F., Colmore J.P. Dose response to codeine in patients with chronic cough. Clin. Pharmacol. Ther. 1971; 12 (3): 449-455. https://doi.org/10.1002/cpt1971123449.

50. Poole P., Sathananthan K., Fortescue R. Mucolytic agents versus placebo for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2019; (5): CD001287. https://doi.org/10.1002/14651858.CD001287.pub6.

51. Melloni B., Germouty J. [The influence of a new beta agonist: formoterol on mucociliary function]. Rev. Mal. Respir. 1992; 9 (5): 503-507 (in French).

52. Casaburi R., Mahler D., Jones P. et al. A long-term evaluation of once-daily inhaled tiotropium in chronic obstructive pulmonary disease. Eur. Respir. J. 2002; 19 (2): 217-224. https://doi.org/10.1183/09031936.02.00269802.

53. Cazzola M., Page C. Long-acting bronchodilators in COPD: where are we now and where are we going? Breathe. 2014; 10 (2): 110-120. https://doi.org/10.1183/20734735.014813.

54. Ghafouri R., Patil K., Kass I. Sputum changes associated with the use of ipratropium bromide. Chest. 1984; 86 (3): 387-393. https://doi.org/10.1378/chest.86.3.387.

55. Ram F., Jones P., Castro A. et al. Oral theophylline for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2002: 2002 (2): CD003902. https://doi.org/10.1002/14651858.CD003902.

56. Lai K., Shen H., Zhou X. et al. Clinical Practice Guidelines for Diagnosis and Management of Cough-Chinese Thoracic Society (CTS) Asthma Consortium. J. Thorac. Dis. 2018; 10 (11): 6314-6351. https://doi.org/10.21037/jtd.2018.09.153.

57. Staykova T., Black P., Chacko E., Poole P. Prophylactic antibiotic therapy for chronic bronchitis. Cochrane Database Syst. Rev. 2003; (1): CD004105. https://doi.org/10.1002/14651858.CD004105.

58. El Moussaoui R., Roede B.M., Speelman P. et al. Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax. 2008; 63 (5): 415-422. https://doi.org/10.1136/thx.2007.090613.

59. Adams S., Luther M. Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of chronic obstructive pulmonary disease. Chest. 2000; 117 (5): 1345-1352. https://doi.org/10.1378/chest.117.5.1345.

60. Dimopoulos G., Siempos I.I., Korbila I.P. et al. Comparison of first line with secondline antibiotics for acute exacerba tions of chronic bronchitis: a meta-analysis of randomized controlled trials. Chest. 2007; 132 (2): 447-455. https://doi.org/10.1378/chest.07-0149.

61. Giménez M., Aguilar L., Granizo J.J. Revisiting cefditoren for the treatment of community-acquired infections caused by human-adapted respiratory pathogens in adults. Multidiscip. Respir. Med. 2018; 13: 40. https://doi.org/10.1186/s40248-018-0152-5.

62. Miravitlles M., Espinosa C., Fernandez-Laso E. et al. Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Study Group of Bacterial Infection in COPD. Chest. 1999; 116 (1): 40-46. https://doi.org/10.1378/chest.116.1.40.

63. Синопальников А.И., Зайцев А.А. Антибактериальная терапия при обострении хронической обструктивной болезни легких: фокус на длительность «безынфекционного» периода. Consilium Medicum. 2012; 14 (3): 74-78. Доступно на: https://consilium.orscience.ru/2075-1753/article/view/93587

64. Siempos I.I., Dimopoulos G., Korbila I.P. et al. Macrolides, quinolones and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis. Eur. Respir. J. 2007; 29 (6): 1127-1137. https://doi.org/10.1183/09031936.00147806.

65. Falagas M., Avgeri S., Matthaiou D., Dimopoulos G. Short-versus long-duration antimicrobial treatment for exacerbations of chronic bronchitis: a meta-analysis. J. Antimicrob. Chemother. 2008; 62 (3): 442-450. https://doi.org/10.1093/jac/dkn201.

66. Lorenz J., Steinfeld P., Drath L. et al. Efficacy and tolerability of 5- vs 10-day cefixime therapy in acute exacerbations of chronic bronchitis. Clin. Drug Investig. 1998; 15 (1): 13-20. https://doi.org/10.2165/00044011-199815010-00002.

67. Синопальников А.И., Зайцев А.А. Комплаентность пациентов с инфекциями дыхательных путей. Клиническая микробиология и антимикробная химиотерапия. 2008; 10 (1): 15-23. Доступно на: https://cmac-journal.ru/publication/2008/1/cmac-2008-t10-n1-p015

68. Chodosh S., DeAbate C., Haverstock D. et al. Short-course moxifloxacin therapy for treatment of acute bacterial exacerbations of chronic bronchitis. The Bronchitis Study Group. Respir. Med. 2000; 94 (1): 18-27. https://doi.org/10.1053/rmed.1999.0708.

69. Masterton R., Burley C. Randomized, double-blind study comparing 5- and 7-day regimens of oral levofloxacin in patients with acute exacerbation of chronic bronchitis. Int. J. Antimicrob. Agents. 2001; 18 (6): 503-512. https://doi.org/10.1016/s0924-8579(01)00435-6.

70. Higgings B.G., Powell R.M., Cooper S., Tattersfield A.E. Effect of salbutamol and ipratropium bromide on airway calibre and bronchial reactivity in asthma and chronic bronchitis. Eur. Respir. J. 1991; 4 (4): 415-420. Available at: https://erj.ersjournals.com/content/erj/4/4/415.full.pdf

71. Berton D.C., Reis M., Siqueira A.C. et al. Effects of tiotropium and formoterol on dynamic hyperinflation and exercise endurance in COPD. Respir. Med. 2010; 104 (9): 1288-1296. https://doi.org/10.1016/j.rmed.2010.05.017.

72. Tashkin D.P., Donohue J.F., Mahler D.A. et al. Effects of arformoterol twice daily, tiotropium once daily, and their combination in patients with COPD. Respir. Med. 2009; 103 (4): 516-524. https://doi.org/10.1016/j.rmed.2008.12.014.

73. D’Urzo A., Rennard S., Kerwin E. et al. A randomised double-blind, placebo-controlled, long-term extension study of the efficacy, safety and tolerability of fixed-dose combinations of aclidinium/formoterol or monotherapy in the treatment of chronic obstructive pulmonary disease. Respir. Med. 2017; 125: 39-48. https://doi.org/10.1016/j.rmed.2017.02.008.

74. Pauwels R.A., Buist A.S., Calverley P.M. et al. GOLD scientific committee. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) workshop summary. Am. J. Respir. Crit. Care Med. 2001; 163 (5): 1256-1276. https://doi.org/10.1164/ajrccm.163.5.2101039.

75. Walters J. A. E. et al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2014; (9): CD001288. https://doi.org/10.1002/14651858.CD001288.pub4.

76. Leuppi J.D., Schuetz P., Bingisser R. et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA. 2013; 309 (21): 2223-2231. https://doi.org/10.1001/jama.2013.5023

77. Niewoehner D.E., Erbland M.L., Deupree R.H. et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of veterans affairs cooperative study group. N. Engl. J. Med. 1999; 340 (25): 1941-1947. https://doi.org/10.1056/NEJM199906243402502.

78. Rubin B.K. Mucolytics, expectorants, and mucokinetic medications. Respir. Care. 2007; 52 (7): 859-865. Available at: https://rc.rcjournal.com/content/52/7/859

79. Avdeev S.N., Vizel A. A., Abrosimo V.N. et al. Management of cough in patients with chronic obstructive pulmonary disease: results of the multicenter randomized placebo-controlled clinical trial. Int. J. Chron. Obstruct. Pulmon. Dis. 2021; 16: 1243-1253. https://doi.org/10.2147/COPD.S292109.

80. Зайцев А.А., Оковитый С.В. Кашель: дифференциальный диагноз и рациональная фармакотерапия. Терапевтический архив. 2014; 86 (12): 85-91. Доступно на: https://ter-arkhiv.ru/0040-3660/article/view/31635.

81. Nici L., Donner C., Wouters E. et al. American Thoracic Society/ European Respiratory Society statement on pulmonary rehabilitation. Am. J. Respir. Crit. Care Med. 2006; 173 (12): 1390-1413. https://doi.org/10.1164/rccm.200508-1211ST.

82. Ries A.L., Bauldoff G.S., Carlin B.W. et al. Pulmonary rehabilitation: joint ACCP/AACVPR Evidence-Based clinical practice guidelines. Chest. 2007; 131 (5, Suppl.): 4S-42S. https://doi.org/10.1378/chest.06-2418.

83. Mahler D.A. Pulmonary rehabilitation. Chest. 1998; 113 (4, Suppl.): 263S-268S. https://doi.org/10.1378/chest.113.4_supplement.263s.

84. Heffner J.E., Fahy B., Hilling L., Barbieri C. Outcomes of advance directive education of pulmonary rehabilitation patients. Am. J. Respir. Crit. Care Med. 1997; 155 (3): 1055-1059. https://doi.org/10.1164/ajrccm.155.3.9116986.

85. Heffner J.E., Fahy B., Hilling L., Barbieri C. Outcomes of advance directive education of pulmonary rehabilitation patients. Am. J. Respir. Crit. Care Med. 1997; 155 (3): 1055-1059. https://doi.org/10.1164/ajrccm.155.3.9116986.

86. Гриппозные вакцины: документ по позиции ВОЗ. Еженедельный эпидемиологический бюллетень. 2012, 87 (47): 461- 476.

87. Grohskopf L.A., Olsen S.J., Sokolow L.Z. et al. Prevention and control of seasonal Influenza with vaccines: recommendations of the advisory committee on immunization practices - United States, 2014-2015. MMWR Morb. Mortal. Wkly Rep. 2014; 63 (32): 691-697. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4584910

88. Moberley S., Holden J., Tatham D.P., Andrews R.M. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst. Rev. 2013; (1): CD000422. https://doi.org/10.1002/14651858.CD000422.pub3.

89. Приказ Министерства здравоохранения Российской Федерации от 15.11.12 № 916н «Об утверждении Порядка оказания медицинской помощи населению по профилю “пульмонология”». Доступно на: https://rg.ru/2013/04/11/legkie-dok.html.