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Хроническая обструктивная болезнь легких: проблемные вопросы клинической эпидемиологии, факторов риска и базисной терапии (обзор литературы)
Хроническая обструктивная болезнь легких: проблемные вопросы клинической эпидемиологии, факторов риска и базисной терапии (обзор литературы)
Лещенко И.В., Баранова И.И. Хроническая обструктивная болезнь легких: проблемные вопросы клинической эпидемиологии, факторов риска и базисной терапии (обзор литературы). Consilium Medicum. 2016; 18 (11): 8–18. DOI: 10.26442/2075-1753_2016.11.8-18
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Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Хроническая обструктивная болезнь легких (ХОБЛ) – серьезная медицинская проблема. По данным исследования Global Alliance Against Chronic Respiratory Diseases (GARD), распространенность ХОБЛ в популяции 15,3%. Установлены внешние и внутренние факторы риска ХОБЛ. Для пациентов с ХОБЛ существенным является влияние болезни на их повседневную деятельность, так как болезнь часто сопровождается одним или более сопутствующими заболеваниями и/или системными эффектами. Повышенные маркеры воспаления значимо ассоциируются с повышением смертности от любых причин среди больных ХОБЛ, а увеличение физической активности снижает уровень системного воспаления. Отмечается, что значение пищевых волокон также может быть связано с их противовоспалительным и антиоксидантным действием. В статье подчеркивается, что клинические фенотипы ХОБЛ могут быть сложносоставными, поскольку могут меняться под влиянием терапии и/или вследствие обычного течения заболевания. При выраженных симптомах ХОБЛ стартовая терапия должна состоять из длительно действующих b2-агонистов и М-холинилитиков. Вопрос о дополнительном назначении ингаляционных глюкокортикостероидов и ингибиторов фосфодиэстеразы-4 решается в зависимости от особенностей дальнейшего течения ХОБЛ.
Ключевые слова: хроническая обструктивная болезнь легких, эпидемиология, факторы риска, базисная терапия.
Ключевые слова: хроническая обструктивная болезнь легких, эпидемиология, факторы риска, базисная терапия.
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Key words: chronic obstructive pulmonary disease, epidemiology, risk factors, basic therapy.
Полный текст
Список литературы
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3. Anto JM, Vermeire P, Vestbo J, Sunyer J. Epidemiology of chronic obstructive pulmonary disease. ERS J Ltd 2001.
4. Thun MJ, Carter BD, Feskanich D et al. 50-year trends in smoking-related mortality in the United States. N Engl J Med 2013; 368: 351–64.
5. Guarascio AJ, Ray SM, Finch CK et al. The clinical and economic burden of chronic obstructive pulmonary disease in the USA. Clinicoecon Outcomes Res 2013; 5: 235–45.
6. Chuchalin AG, Khaltaev N, Antonov NS et al. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. Int J COPD 2014; 12: 963–74.
7. Aisanov Z, Bai C, Bauerle O et al. Primary care physician perceptions on the diagnosis and management of chronic obstructive pulmonary disease in diverse regions of the world. Int J COPD 2012; 7: 1–12.
8. Lamprecht B, Soriano JB, Studnicka M et al. BOLD Collaborative Research Group, the EPI-SCAN Team, the PLATINO Team, and the PREPOCOL Study Group. Determinants of underdiagnosis of COPD in national and international surveys. Chest 2015; 148 (4): 971–85.
9. Menezes AM, Perez-Padilla R, Hallal PC et al. Worldwide burden of COPD in high- and low-income countries. Part II. Burden of chronic obstructive lung disease in Latin America: the PLATINO study Int J Tuberc Lung Dis 2008; 12: 709–12.
10. Global Strategy for the Diagnosis, Management, and Prevention of COPD. Updated 2016. www.goldcopd.com
11. Vermeire P, Vestbo J, Viegi G et al. Recommendations for epidemiological studies on COPD. Eur Respir J 2011; 38: 1261–77.
12. Federal'nye klinicheskie rekomendatsii po diagnostike i lecheniiu khronicheskoi obstruktivnoi bolezni legkikh. Pul'monologiia. 2014; 3: 15–61. [in Russian]
13. Vestbo J, Hurd SS, Agusti AG et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.
Am J Respir Crit Care Med 2013; 187: 347–65.
14. Hardie JA, Buist AS, Vollmer WM et al. Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers. Eur Respir J 2002; 20: 1117–22.
15. Cerveri I, Corsico AG, Accordini S et al. Underestimation of airflow obstruction among young adults using FEV1/FVC<70% as a fixed cut-off: a longitudinal evaluation of clinical and functional outcomes. Thorax 2008; 63: 1040–5.
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19. Ware JE Jr, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQoLA) project. J Clin Epidemiol 1998; 51: 903–12.
20. Schunemann HJ, Goldstein R, Mador MJ et al. A randomised trial to evaluate the self-administered standardized chronic respiratory questionnaire. Eur Respir J 2005; 25: 31–40.
21. Maille AR, Koning CJ, Zwinderman AH et al. The development of the "Quality-of-life for Respiratory Illness Questionnaire (QoL-RIQ)'': a disease-specific quality-of-life questionnaire for patients with mild to moderate chronic nonspecific lung disease. Respir Med 1997; 91: 297–309.
22. Hajiro T, Nishimura K, Tsukino M et al. Analysis of clinical methods used to evaluate dyspnea in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 158: 1185–9.
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24. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377–81.
25. Rostron BL, Chang CM, Pechacek TF. Estimation of cigarette smoking-attributable morbidity in the United States. JAMA Intern Med 2014; 174: 1922–8.
26. Salvi SS, Barnes PJ. Chronic obstructive pulmonary disease in non-smokers. Lancet 2009; 374: 733–43.
27. Anto JM, Vermeire P, Vestbo J, Sunyer J. Epidemiology of chronic obstructive pulmonary disease. Eur Respir J 2001; 17: 982–94.
28. Lokke A, Lange P, Scharling H et al. Developing COPD: a 25 year follow up study of the general population. Thorax 2006; 61: 935–9.
29. Pillai SG, Ge D, Zhu G et al. A genome-wide association study in chronic obstructive pulmonary disease (COPD): identification of two major susceptibility loci. PLoS Genet 2009; 5: e1000421.
30. Kim WJ, Lee SD. Candidate genes for COPD: current evidence and research. Int J COPD 2015; 10: 2249–55.
31. Zhao Z, Peng F, Zhou Y et al. Exon sequencing identifies a novel CHRNA3-CHRNA5CHRNB4 variant that increases the risk for chronic obstructive pulmonary disease. Respirology 2015; 20: 790–8.
32. Horita N, Miyazawa N, Tomaru K et al. Vitamin D binding protein genotype variants and risk of chronic obstructive pulmonary disease: a meta-analysis. Respirology 2015; 20: 219–25.
33. Ou C-Y, Chen C-Z, Hsiue T-R et al. Genetic variants of pulmonary SP-D predict disease outcome of COPD in a Chinese population. Respirology 2015; 20: 296–303.
34. Chubachi S, Nakamura H, Sasaki M et al. Polymorphism of LRP5 gene and emphysema severity are associated with osteoporosis in Japanese patients with or at risk for COPD. Respirology 2015; 20: 286–95.
35. Negewo NA, Gibson PG, McDonald VM. COPD and its comorbidities: impact, measurement and mechanisms. Respirology 2015; 20: 1160–71.
36. Drazen JM, Fabbri LM. Ageing and multimorbidity. Eur Respir J 2014; 44: 557.
37. Faner R, Cruz T, Lopez-Giraldo A et al. Network medicine, multimorbidity and the lung in the elderly. Eur Respir J 2014; 44: 775–88.
38. Divo MJ, Martinez CH, Mannino DM. Ageing and the epidemiology of multimorbidity. EurRespir J 2014; 44: 1055–68.
39. Patel AR, Donaldson GC, Mackay AJ et al. The impact of ischemic heart disease on symptoms, health status, and exacerbations in patients with COPD. Chest 2012; 141: 851–7.
40. Mannino DM, Thorn D, Swensen A et al. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008; 32: 962–9.
41. Wilson DO, Leader JK, Fuhrman CR et al. Quantitative computed tomography analysis, airflow obstruction, and lung cancer in the Pittsburgh lung screening study. J Thorac Oncol 2011; 6: 1200–5.
42. Calverley PM, Anderson JA, Celli B et al. TORCH investigators. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007; 356: 775–89.
43. Vanfleteren LE, Spruit MA, Groenen M et al. Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013; 187: 728–35.
44. Roca M, Verduri A, Corbetta L et al. Mechanisms of acute exacerbation of respiratory symptoms in chronic obstructive pulmonary disease. Eur J Clin Invest 2013; 43: 510–21.
45. Donaldson GC, Hurst JR, Smith CJ et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest 2010; 137: 1091–7.
46. Bowler RP, Kim V, Regan E et al. COPD Gene Investigators. Prediction of acute respiratory disease in current and former smokers with and without COPD. Chest 2014; 146: 941–50.
47. Tan WC, Bourbeau J, Hernandez P et al. Can COLD Collaborative Research Group. Exacerbation-like respiratory symptoms in individuals without chronic obstructive pulmonary disease: results from a population-based study. Thorax 2014; 69: 709–17.
48. Marin JM, Soriano JB, Carrizo SJ et al. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. Am J Respir Crit Care Med 2010; 182: 325–31.
49. Ingebrigtsen TS, Marott JL, Vestbo J et al. Gastro-esophageal reflux disease and exacerbations in chronic obstructive pulmonary disease. Respirology 2015; 20: 101–7.
50. Jung JY, Kim YS, Kim SK et al. KOLD Study. Relationship of vitamin D status with lung function and exercise capacity in COPD. Respirology 2015; 20: 782–9.
51. Lange NE, Sparrow D, Vokonas P, Litonjua AA. Vitamin D deficiency, smoking, and lung function in the Normative Aging Study. Am J Respir Crit Care Med 2012; 186 (7): 616–21.
52. Kunisaki KM, Niewoehner DE, Singh RJ, Connett JE. Vitamin D status and longitudinal lung function decline in the Lung Health Study. Eur Respir J 2011; 37 (2): 238–43.
53. Britton JR, Pavord ID, Richards KA et al. Dietary antioxidant vitamin intake and lung function in the general population. Am J Respir Crit Care Med 1995; 151: 1383–7.
54. Ford ES, Cunningham TJ, Mannino DM. Inflammatory markers and mortality among US adults with obstructive lung function. Respirology 2015; 20: 587–93.
55. Eltboli O, Mistry V, Barker B. Relationship between blood and bronchial submucosal eosinophilia and reticular basement membrane thickening in chronic obstructive pulmonary disease. Respirology 2015; 20: 667–70.
56. Ijiri N, Kanazawa H, Asai K et al. Irisin, a newly discovered myokine, is a novel biomarker associate with physical activity in patients with chronic obstructive pulmonary disease. Respirology 2015; 20: 612–7.
57. Ferrer M, Alonso J, Morera J et al. Chronic obstructive pulmonary disease stage and health-related quality of life. The Quality of Life of Chronic Obstructive Pulmonary Disease Study Group. Ann Intern Med 1997; 127: 1072–9.
58. Ofir D, Laveneziana P, Webb KA et al. Mechanisms of dyspnea during cycle exercise in symptomatic patients with GOLD stage I chronic obstructive pulmonary disease. Am J RespirCrit Care Med 2008; 177: 622–9.
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60. MacNee W. Oxidants/antioxidants and COPD. Chest 2000; 117: 303–17S.
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Авторы
И.В.Лещенко*, И.И.Баранова
ФГБОУ ВО Уральский государственный медицинский университет Минздрава России. 620028, Россия, Екатеринбург, ул. Репина, д. 3;
ООО Медицинское объединение «Новая больница». 620109, Россия, Екатеринбург, ул. Заводская, д. 29
*leshhcenkoiv@mail.ru
ФГБОУ ВО Уральский государственный медицинский университет Минздрава России. 620028, Россия, Екатеринбург, ул. Репина, д. 3;
ООО Медицинское объединение «Новая больница». 620109, Россия, Екатеринбург, ул. Заводская, д. 29
*leshhcenkoiv@mail.ru
________________________________________________
I.V. Leshchenko*, I.I.Baranova
Ural State Medical University of the Ministry of Health of the Russian Federation. 620028, Russian Federation, Yekaterinburg, ul. Repina, d. 3;
Medical Association «Novaya Bolnitza». 620109, Russian Federation, Yekaterinburg, ul. Zavodskaia, d. 29
*leshhcenkoiv@mail.ru
Ural State Medical University of the Ministry of Health of the Russian Federation. 620028, Russian Federation, Yekaterinburg, ul. Repina, d. 3;
Medical Association «Novaya Bolnitza». 620109, Russian Federation, Yekaterinburg, ul. Zavodskaia, d. 29
*leshhcenkoiv@mail.ru
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