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Лекарственная терапия сухого/влажного кашля: современная клиническая парадигма
Лекарственная терапия сухого/влажного кашля: современная клиническая парадигма
Бабак С.Л., Горбунова М.В., Малявин А.Г. Лекарственная терапия сухого/влажного кашля: современная клиническая парадигма. Consilium Medicum. Болезни органов дыхания (Прил.). 2015; с. 14–20.
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Аннотация
Цель работы: обзор-анализ физиологических и патологических механизмов развития сухого/влажного кашля и представление современной лечебной парадигмы при нарушениях трахеобронхиального клиренса.
Основные положения. Продукция мокроты вместе с нарушениями трахеобронхиального клиренса являются значимыми в патофизиологии многих тяжелых легочных состояний. Данные симптомы являются показанием к назначению веществ, воздействующих на слизь, – мукоактивных препаратов. Данный обзор выполнен для обновления знаний врачей о механизмах болезни и современной концепции лекарственной терапии.
Ключевые слова: продуктивный кашель, непродуктивный кашель, бронхиальный клиренс, мукоактивные препараты, лечебная парадигма.
The main provisions. Sputum production, together with violations of the tracheobronchial clearance are important in the pathophysiology of many severe lung conditions. These symptoms are indication for substances affecting the mucus – mucoactive drugs. This review is to update the knowledge of doctors about the mechanisms of the disease and the modern concept of drug therapy.
Key words: productive cough, nonproductive cough, bronchial clearance, mucoactive drugs, medical paradigm.
Основные положения. Продукция мокроты вместе с нарушениями трахеобронхиального клиренса являются значимыми в патофизиологии многих тяжелых легочных состояний. Данные симптомы являются показанием к назначению веществ, воздействующих на слизь, – мукоактивных препаратов. Данный обзор выполнен для обновления знаний врачей о механизмах болезни и современной концепции лекарственной терапии.
Ключевые слова: продуктивный кашель, непродуктивный кашель, бронхиальный клиренс, мукоактивные препараты, лечебная парадигма.
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The main provisions. Sputum production, together with violations of the tracheobronchial clearance are important in the pathophysiology of many severe lung conditions. These symptoms are indication for substances affecting the mucus – mucoactive drugs. This review is to update the knowledge of doctors about the mechanisms of the disease and the modern concept of drug therapy.
Key words: productive cough, nonproductive cough, bronchial clearance, mucoactive drugs, medical paradigm.
Полный текст
Список литературы
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15. Ratjen F et al. A double-blind placebo controlled trial with oral ambroxol and N-acetylcysteine for mucolytic treatment in cystic fibrosis. Eur J Pediatr 1985; 144: 374–7.
16. Caramina G et al. The management of cystic fibrosis with carbocysteine lysine salt: single blind comparative study with ambroxol hydrochloride. J Int Med Res 1995; 23: 284–93.
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18. Wauer RR et al. Randomized double blind trial of ambroxol for the treatment of respiratory distress syndrome. Eur J Pediatr 1992; 151: 357–63.
19. Siergiejko Z, Obrzut D, Rogalewska A. Value of ambroxol in treatment of bronchial asthma and spastic bronchitis. Pol Tyg Lek 1991; 46: 424–7.
20. Fegiz G et al. Prevention by ambroxol of broncho-pulmonary complications after upper abdominal surgery: double blind Italian multicenter clinical study versus placebo. Lung 1991; 169: 69–76.
21. Hashizume T et al. Pulmonary alveolar proteinosis successfully treated with ambroxol. Intern Med 2002; 41: 1175–8.
22. Szmeja Z et al. Use of mucolytic preparations (Mucosolvan) in selected diseases of the upper respiratory tract. Part II. Otolaryngol Pol 1997; 5: 480–6.
23. Perez-Neria J et al. Ambroxol-amoxiciline fixed combination vs. amoxiciline in acute infectious respiratory conditions – comparative study of antibiotic levels in bronchial mucus and blood. Compend Invest Clin Lat Arn 1992; 12: 5–10.
24. Beeh KM et al. Antiinflammatory properties of ambroxol. Eur J Med Res 2008; 13: 557–62.
25. Malerba M et al. Effect of twelve-months 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.
26. Wunderer H et al. The cleaning system of the airways. Sonderdruckaus Med Monatsschr Pharm 2009; 32: 42–7.
27. Murray JF. The Normal Lung: The Basis for Diagnosis and Treatment of Pulmonary Disease. Philadelphia: W.B.Saunders, 1986; p. 23–82.
28. Davies JR et al. Respiratory tract mucins: structure and expression patterns. Novartis Found Symp 2002; 248: 76–88.
2. The writings of Benjamin Franklin. Collected and edited with a life and introduction by Albert Henry. London: Macmillan & Co., LTD., 1906. Vol. VI: 1773–1776; p. 676.
3. Davidson T, Odle TG. Common Cold. The Gale Encyclopaedia of Medicine. Vol. 2. Detroit: Gale, 2006; p. 955–9.
4. Revision of the International Classification of Diseases (ICD). World Health Organization. Retrieved 29 October 2010.
5. Rogers DF. Mucoactive agents for airway mucus hypersecretory diseases. Respir Care 2007; 52 (9): 1176–97.
6. Wirtz HR. Effekt von Ambroxol auf die Surfactantsekretion und synthese von isolierten, alveolaren Typ II-Zellen. Pneumologie 2000; 54: 278–83.
7. Oliveri D et al. Ambroxol for the prevention of chronic bronchitis exacerbations: Long-term multicentre trial. Respiration 1987; 51 (Suppl.): 42–51.
8. Gillissen A, Nowak D Characterization of N-acetylcysteine and ambroxol in anti-oxidant therapy. Respir Med 1998; 92: 609–23.
9. Nowak D et al. Antioxidant properties of ambroxol. Free Rad Biol Med 1994; 16: 517–22.
10. Weiser T, Wilson N. Inhibition of tetrodotoxin (TTX)-resistant and TTX-sensitive neuronal Na+ channels by the secretolytic ambroxol. Mol Pharmacol 2002; 62 (3): 433–8.
11. Pauwels RA et al. GOLD scientific committee. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: updated. 2009; p. 1–55.
12. Alcozer G et al. An open, long-term, multicenter study in 5635 patients. Prevention of chronic bronchitis exacerbations with ambroxol (mucosolvan retard). Respiration 1989; 55 (Suppl.): 84–96.
13. Poole PJ, Black PN. Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary diseases: systematic review. BMJ 2001; 322: 1271–3.
14. Ekberg-Jansson A et al. Preventing exacerbations of chronic bronchitis and COPD. BMJ 2001; 322: 1259–61.
15. Ratjen F et al. A double-blind placebo controlled trial with oral ambroxol and N-acetylcysteine for mucolytic treatment in cystic fibrosis. Eur J Pediatr 1985; 144: 374–7.
16. Caramina G et al. The management of cystic fibrosis with carbocysteine lysine salt: single blind comparative study with ambroxol hydrochloride. J Int Med Res 1995; 23: 284–93.
17. Luerti M et al. An alternative to steroids for prevention of respiratory distress syndrome (RDS): Multicenter controlled study to compare ambroxol and betamethasone. J Perinat Med 1987; 15: 227–38.
18. Wauer RR et al. Randomized double blind trial of ambroxol for the treatment of respiratory distress syndrome. Eur J Pediatr 1992; 151: 357–63.
19. Siergiejko Z, Obrzut D, Rogalewska A. Value of ambroxol in treatment of bronchial asthma and spastic bronchitis. Pol Tyg Lek 1991; 46: 424–7.
20. Fegiz G et al. Prevention by ambroxol of broncho-pulmonary complications after upper abdominal surgery: double blind Italian multicenter clinical study versus placebo. Lung 1991; 169: 69–76.
21. Hashizume T et al. Pulmonary alveolar proteinosis successfully treated with ambroxol. Intern Med 2002; 41: 1175–8.
22. Szmeja Z et al. Use of mucolytic preparations (Mucosolvan) in selected diseases of the upper respiratory tract. Part II. Otolaryngol Pol 1997; 5: 480–6.
23. Perez-Neria J et al. Ambroxol-amoxiciline fixed combination vs. amoxiciline in acute infectious respiratory conditions – comparative study of antibiotic levels in bronchial mucus and blood. Compend Invest Clin Lat Arn 1992; 12: 5–10.
24. Beeh KM et al. Antiinflammatory properties of ambroxol. Eur J Med Res 2008; 13: 557–62.
25. Malerba M et al. Effect of twelve-months 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.
26. Wunderer H et al. The cleaning system of the airways. Sonderdruckaus Med Monatsschr Pharm 2009; 32: 42–7.
27. Murray JF. The Normal Lung: The Basis for Diagnosis and Treatment of Pulmonary Disease. Philadelphia: W.B.Saunders, 1986; p. 23–82.
28. Davies JR et al. Respiratory tract mucins: structure and expression patterns. Novartis Found Symp 2002; 248: 76–88.
2. The writings of Benjamin Franklin. Collected and edited with a life and introduction by Albert Henry. London: Macmillan & Co., LTD., 1906. Vol. VI: 1773–1776; p. 676.
3. Davidson T, Odle TG. Common Cold. The Gale Encyclopaedia of Medicine. Vol. 2. Detroit: Gale, 2006; p. 955–9.
4. Revision of the International Classification of Diseases (ICD). World Health Organization. Retrieved 29 October 2010.
5. Rogers DF. Mucoactive agents for airway mucus hypersecretory diseases. Respir Care 2007; 52 (9): 1176–97.
6. Wirtz HR. Effekt von Ambroxol auf die Surfactantsekretion und synthese von isolierten, alveolaren Typ II-Zellen. Pneumologie 2000; 54: 278–83.
7. Oliveri D et al. Ambroxol for the prevention of chronic bronchitis exacerbations: Long-term multicentre trial. Respiration 1987; 51 (Suppl.): 42–51.
8. Gillissen A, Nowak D Characterization of N-acetylcysteine and ambroxol in anti-oxidant therapy. Respir Med 1998; 92: 609–23.
9. Nowak D et al. Antioxidant properties of ambroxol. Free Rad Biol Med 1994; 16: 517–22.
10. Weiser T, Wilson N. Inhibition of tetrodotoxin (TTX)-resistant and TTX-sensitive neuronal Na+ channels by the secretolytic ambroxol. Mol Pharmacol 2002; 62 (3): 433–8.
11. Pauwels RA et al. GOLD scientific committee. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: updated. 2009; p. 1–55.
12. Alcozer G et al. An open, long-term, multicenter study in 5635 patients. Prevention of chronic bronchitis exacerbations with ambroxol (mucosolvan retard). Respiration 1989; 55 (Suppl.): 84–96.
13. Poole PJ, Black PN. Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary diseases: systematic review. BMJ 2001; 322: 1271–3.
14. Ekberg-Jansson A et al. Preventing exacerbations of chronic bronchitis and COPD. BMJ 2001; 322: 1259–61.
15. Ratjen F et al. A double-blind placebo controlled trial with oral ambroxol and N-acetylcysteine for mucolytic treatment in cystic fibrosis. Eur J Pediatr 1985; 144: 374–7.
16. Caramina G et al. The management of cystic fibrosis with carbocysteine lysine salt: single blind comparative study with ambroxol hydrochloride. J Int Med Res 1995; 23: 284–93.
17. Luerti M et al. An alternative to steroids for prevention of respiratory distress syndrome (RDS): Multicenter controlled study to compare ambroxol and betamethasone. J Perinat Med 1987; 15: 227–38.
18. Wauer RR et al. Randomized double blind trial of ambroxol for the treatment of respiratory distress syndrome. Eur J Pediatr 1992; 151: 357–63.
19. Siergiejko Z, Obrzut D, Rogalewska A. Value of ambroxol in treatment of bronchial asthma and spastic bronchitis. Pol Tyg Lek 1991; 46: 424–7.
20. Fegiz G et al. Prevention by ambroxol of broncho-pulmonary complications after upper abdominal surgery: double blind Italian multicenter clinical study versus placebo. Lung 1991; 169: 69–76.
21. Hashizume T et al. Pulmonary alveolar proteinosis successfully treated with ambroxol. Intern Med 2002; 41: 1175–8.
22. Szmeja Z et al. Use of mucolytic preparations (Mucosolvan) in selected diseases of the upper respiratory tract. Part II. Otolaryngol Pol 1997; 5: 480–6.
23. Perez-Neria J et al. Ambroxol-amoxiciline fixed combination vs. amoxiciline in acute infectious respiratory conditions – comparative study of antibiotic levels in bronchial mucus and blood. Compend Invest Clin Lat Arn 1992; 12: 5–10.
24. Beeh KM et al. Antiinflammatory properties of ambroxol. Eur J Med Res 2008; 13: 557–62.
25. Malerba M et al. Effect of twelve-months 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.
26. Wunderer H et al. The cleaning system of the airways. Sonderdruckaus Med Monatsschr Pharm 2009; 32: 42–7.
27. Murray JF. The Normal Lung: The Basis for Diagnosis and Treatment of Pulmonary Disease. Philadelphia: W.B.Saunders, 1986; p. 23–82.
28. Davies JR et al. Respiratory tract mucins: structure and expression patterns. Novartis Found Symp 2002; 248: 76–88.
________________________________________________
2. The writings of Benjamin Franklin. Collected and edited with a life and introduction by Albert Henry. London: Macmillan & Co., LTD., 1906. Vol. VI: 1773–1776; p. 676.
3. Davidson T, Odle TG. Common Cold. The Gale Encyclopaedia of Medicine. Vol. 2. Detroit: Gale, 2006; p. 955–9.
4. Revision of the International Classification of Diseases (ICD). World Health Organization. Retrieved 29 October 2010.
5. Rogers DF. Mucoactive agents for airway mucus hypersecretory diseases. Respir Care 2007; 52 (9): 1176–97.
6. Wirtz HR. Effekt von Ambroxol auf die Surfactantsekretion und synthese von isolierten, alveolaren Typ II-Zellen. Pneumologie 2000; 54: 278–83.
7. Oliveri D et al. Ambroxol for the prevention of chronic bronchitis exacerbations: Long-term multicentre trial. Respiration 1987; 51 (Suppl.): 42–51.
8. Gillissen A, Nowak D Characterization of N-acetylcysteine and ambroxol in anti-oxidant therapy. Respir Med 1998; 92: 609–23.
9. Nowak D et al. Antioxidant properties of ambroxol. Free Rad Biol Med 1994; 16: 517–22.
10. Weiser T, Wilson N. Inhibition of tetrodotoxin (TTX)-resistant and TTX-sensitive neuronal Na+ channels by the secretolytic ambroxol. Mol Pharmacol 2002; 62 (3): 433–8.
11. Pauwels RA et al. GOLD scientific committee. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: updated. 2009; p. 1–55.
12. Alcozer G et al. An open, long-term, multicenter study in 5635 patients. Prevention of chronic bronchitis exacerbations with ambroxol (mucosolvan retard). Respiration 1989; 55 (Suppl.): 84–96.
13. Poole PJ, Black PN. Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary diseases: systematic review. BMJ 2001; 322: 1271–3.
14. Ekberg-Jansson A et al. Preventing exacerbations of chronic bronchitis and COPD. BMJ 2001; 322: 1259–61.
15. Ratjen F et al. A double-blind placebo controlled trial with oral ambroxol and N-acetylcysteine for mucolytic treatment in cystic fibrosis. Eur J Pediatr 1985; 144: 374–7.
16. Caramina G et al. The management of cystic fibrosis with carbocysteine lysine salt: single blind comparative study with ambroxol hydrochloride. J Int Med Res 1995; 23: 284–93.
17. Luerti M et al. An alternative to steroids for prevention of respiratory distress syndrome (RDS): Multicenter controlled study to compare ambroxol and betamethasone. J Perinat Med 1987; 15: 227–38.
18. Wauer RR et al. Randomized double blind trial of ambroxol for the treatment of respiratory distress syndrome. Eur J Pediatr 1992; 151: 357–63.
19. Siergiejko Z, Obrzut D, Rogalewska A. Value of ambroxol in treatment of bronchial asthma and spastic bronchitis. Pol Tyg Lek 1991; 46: 424–7.
20. Fegiz G et al. Prevention by ambroxol of broncho-pulmonary complications after upper abdominal surgery: double blind Italian multicenter clinical study versus placebo. Lung 1991; 169: 69–76.
21. Hashizume T et al. Pulmonary alveolar proteinosis successfully treated with ambroxol. Intern Med 2002; 41: 1175–8.
22. Szmeja Z et al. Use of mucolytic preparations (Mucosolvan) in selected diseases of the upper respiratory tract. Part II. Otolaryngol Pol 1997; 5: 480–6.
23. Perez-Neria J et al. Ambroxol-amoxiciline fixed combination vs. amoxiciline in acute infectious respiratory conditions – comparative study of antibiotic levels in bronchial mucus and blood. Compend Invest Clin Lat Arn 1992; 12: 5–10.
24. Beeh KM et al. Antiinflammatory properties of ambroxol. Eur J Med Res 2008; 13: 557–62.
25. Malerba M et al. Effect of twelve-months 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.
26. Wunderer H et al. The cleaning system of the airways. Sonderdruckaus Med Monatsschr Pharm 2009; 32: 42–7.
27. Murray JF. The Normal Lung: The Basis for Diagnosis and Treatment of Pulmonary Disease. Philadelphia: W.B.Saunders, 1986; p. 23–82.
28. Davies JR et al. Respiratory tract mucins: structure and expression patterns. Novartis Found Symp 2002; 248: 76–88.
Авторы
С.Л.Бабак*, М.В.Горбунова, А.Г.Малявин
ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1
*sergbabak@mail.ru
A.I.Evdokimov Moscow State Medical and Dental University of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1
*sergbabak@mail.ru
ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1
*sergbabak@mail.ru
________________________________________________
A.I.Evdokimov Moscow State Medical and Dental University of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1
*sergbabak@mail.ru
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