Хроническая обструктивная болезнь легких: профилактика обострений. Клинические рекомендации Американской коллегии торакальных врачей и Канадского торакального общества (часть 2-я)

Хроническая обструктивная болезнь легких (ХОБЛ) является одной из основных причин заболеваемости и летальности в США и в мире. Обострения ХОБЛ (периодическое усиление кашля, одышки и продукции мокроты) вносят серьезный вклад в снижение легочной функции, качества жизни, повышение потребности в неотложной помощи и госпитализациях, а также в стоимость лечения больных. В последние десятилетия выполнены исследования, по результатам которых существенно углубилось понимание патогенеза ХОБЛ и расширились терапевтические возможности. Накоплен также большой объем публикаций по предотвращению обострений ХОБЛ.

Материалы и методы. Для разъяснения важности предотвращения обострений ХОБЛ Американской коллегией торакальных врачей (American College of Chest Physicians – CHEST) и Канадским торакальным обществом (Canadian Thoracic Society Guideline – CTS) разработаны совместные Клинические рекомендации, в которых описан существующий сегодня подход к профилактике обострений ХОБЛ. Выделены 3 основных клинических проблемы профилактики обострений ХОБЛ на основе принципов PICO (Population, Intervention, Comparator, Outcome – Популяция, Вмешательства, Сравнение, Исходы) – немедикаментозное лечение, ингаляционная и пероральная терапия. Использована общепринятая система отбора соответствующих клинических исследований и оценки класса рекомендаций.

Результаты. Особенность Клинических рекомендаций по профилактике обострений ХОБЛ заключается не только в их тематике, но также в том, что они стали первым результатом сотрудничества 2 крупных торакальных обществ Северной Америки. Намерение Надзорного комитета по созданию клинических рекомендаций CHEST в сотрудничестве с Клинической ассамблеей по ХОБЛ CTS заключается в том, чтобы на основе систематического обзора и критической оценки опубликованной литературы, сделанных клиническими экспертами и исследователями в области ХОБЛ, разработать клинические рекомендации с целью помочь клиницистам в ведении пациентов с этим заболеванием.

Заключение. В данных Рекомендациях содержится современный доказательный анализ опубликованных результатов рандомизированных контролируемых исследований по профилактике обострений ХОБЛ.

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