Russian Journal of AllergyRussian Journal of AllergyРоссийский Аллергологический Журнал1810-88302686-682XPublishing House ABV Press36510.36691/RJA365ArticlesСтатьиResearch ArticleASTHMA PHENOTYPES DIFFICULT TO TREAT: THE POSSIBILITY TO ACHIVE A CONTROLФЕНОТИПЫ ТРУДНОЙ ДЛЯ ТЕРАПИИ БРОНХИАЛЬНОЙ АСТМЫ: ВОЗМОЖНОСТИ ДОСТИЖЕНИЯ КОНТРОЛЯNenashevaN MНенашеваН М

Russian Medical Academy of Postgraduate Education

1444031@gmail.comBelevskiyA SБелевскийА С

Russian National Research Medical University named after N.I. Pirogov

FassahovR SФассаховР С

Institute of fundamental medicine and biology of Kazan Federal University

EmelyanovA VЕмельяновА В

North-Western State Medical University named after I.I. Mechnikov

ФГБОУ ДПО Российская медицинская академия последипломного образованияФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова»Институт фундаментальной медицины и биологии Казанского федерального университетаФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова»15102016134-5NO4-5 (2016)№4-5 (2016)435410032020Copyright ©; 2016, Pharmarus Print MediaCopyright ©; 2016, Фармарус Принт Медиа2016Pharmarus Print MediaФармарус Принт Медиаhttps://rusalljournal.ru/raj/article/view/365

Asthma is a widespread, phenotypically heterogeneous, chronic disease characterized by inflammation and airflow obstruction, bronchial hyperresponsiveness and recurrent symptoms of respiratory discomfort. On the one hand, the treatment of asthma is based on the determination of the severity and on the control of symptoms. On the other hand, it is based on the risk management of exacerbations. The control of asthma in most patients is achieved as a result of conventional treatment with inhaled corticosteroids or a combination of them with long-acting beta-2-agonists. However, a substantial proportion of patients with difficult asthma phenotypes (severe atopic asthma, asthma and obesity, smoker’s asthma, asthma in the elderly, asthma with fixed airflow obstruction) can be refractory to the conventional therapy. Additional therapy with the long-acting anticholinergic drug such as tiotropium can optimize the control in these patients. This article describes the complex phenotypes of asthma and the clinical cases of tiotropium efficacy in therapy of such patients.

Бронхиальная астма - распространенное, фенотипически гетерогенное, хроническое заболевание, характеризующееся воспалением и обструкцией дыхательных путей, бронхиальной гиперреактивностью и рецидивирующими симптомами дыхательного дискомфорта. Терапия астмы основывается на определении тяжести и контроля симптомов, с одной стороны, и учета факторов риска обострений - с другой. Большинство больных астмой достигают контроля в результате традиционной терапии ингаляционными кортикостероидами или их комбинации с длительно действующими агонистами β2-адренорецепторов. Однако многие больные со сложными фенотипами астмы (тяжелая атопическая астма и ожирение, астма курильщика, астма пожилых, астма с фиксированной бронхиальной обструкцией) могут быть рефрактерны к традиционной терапии. Дополнительная терапия длительно действующим антихолинергическим препаратом тиотропием может оптимизировать контроль у таких больных. В настоящей статье обсуждаются сложные фенотипы астмы, приводятся клинические примеры эффективности тиотропия у таких пациентов.

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