Ринит является одним из самых распространенных заболеваний и как зонтичный диагноз используется для пациентов с разными клиническими фенотипами заболевания (аллергический, неаллергический, инфекционный и др.). Признавая высокое социально-экономическое бремя болезни и сложности выбора оптимальной терапии, важно акцентировать внимание на междисциплинарных взаимодействиях, что нашло отражение в современных клинических рекомендациях, созданных экспертами ARIA, EAACI, EPOS и национальными профессиональными обществами. Пациенты с симптомами ринита нередко занимаются самолечением, пользуются советами работников аптек, получают рекомендации врачей первичного звена в амбулаторной практике; лишь часть больных попадают к специалистам (ЛОР или аллерголог-иммунолог), поэтому при многих клинических ситуациях критерии контроля болезни (симптомы, качество жизни, объективные измерения) не достигаются. В настоящее время международными сообществами разработаны инновационные терапевтические подходы, основанные на знании фенотипов/эндотипов ринита для достижения контроля. Врачам как первичной, так и специализированной помощи предлагается использовать ступенчатую терапию. В современном подходе к лечению на основании контроля симптомов заболевания самыми эффективными противовоспалительными препаратами для длительного контроля ринита, особенно среднетяжелого/тяжелого течения, считаются интраназальные глюкокортикостероиды (ИнГКС). Хорошо доказанная эффективность ИнГКС и их преимущества перед другими классами препаратов делают их терапией 1-й линии в лечении аллергического ринита (уровень доказательности А), а также препаратами выбора для неаллергического ринита, риносинуситов. В представленном обзоре обсуждается один из востребованных ИнГКС – флутиказона пропионат, который в течение многих лет является основой лечения аллергического ринита.
Rhinitis is one of the most common diseases and this term is used as an umbrella diagnosis for patients with different clinical phenotypes of the disease (allergic, non-allergic, infectious, etc.). Recognizing the high socio-economic burden of the disease and complexities of choosing an optimal therapy, it is important to focus on interdisciplinary interactions, which are reflected in modern clinical guidelines created by experts from ARIA, EAACI, EPOS, as well as national and professional societies. Patients with rhinitis symptoms often self-medicate, use the advice of pharmacist, receive recommendations from general practitioners in outpatient practice, and very few patients get specialists (ENT or allergist-immunologist) advice; herefore, in many cases, optimal criteria for disease control (symptoms, quality of life, objective measurements) cannot be achieved. Currently international professional communities have developed innovative therapeutic approaches based on knowledge of the phenotypes/endotypes of rhinitis to achieve such a control. Physicians in both primary and specialized care are encouraged to use step therapy. This approach to treatment is based on the control of disease symptoms, and intranasal corticosteroids (InGCS) are considered to be the most effective anti-inflammatory drugs for long-term control of rhinitis, especially in moderate-severe/severe cases. This well-proven efficacy of InGCS and their advantages over other classes of drugs make them the first-line therapy in the treatment of allergic rhinitis (evidence level A), as well as the drugs of choice for non-allergic rhinitis and rhinosinusitis. This review discusses fluticasone propionate, one of the in-demand InGCS, which has been the cornerstone of the treatment of allergic rhinitis for many years.
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DOI:10.1002/alr.22741
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1. Wise SK, Lin SY, Toskala E, et al. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol. 2018;8(2):108-352. DOI:10.1002/alr.22073
2. Bousquet J, Schünemann HJ, Togias A, et al; Allergic Rhinitis and Its Impact on Asthma Working Group. Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol. 2020;145(1):70-80.e3. DOI:10.1016/j.jaci.2019.06.049
3. Bousquet J, Schunemann HJ, Hellings PW, et al. MACVIA clinical decision algorithm in adolescents and adults with allergic rhinitis. J Allergy Clin Immunol. 2016;138(2):367-74. DOI:10.1016/j.jaci.2016.03.025
4. Bousquet J, Schünemann HJ, Hellings PW, et al; MASK study group. MACVIA clinical decision algorithm in adolescents and adults with allergic rhinitis. J Allergy Clin Immunol. 2016;138(2):367-74.e2. DOI:10.1016/j.jaci.2016.03.025
5. Fokkens W, Lund V, Hopkins HP, et al. EPOS2020: European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl. S29):1-464.
6. Global atlas of allergic rhinitis and chronic rhinosinusitis. Ed. CA Akdis, PW Hellings, I Agache, et al. Zurich, Switzerland: European Academy of Allergy and Clinical Immunology, 2015.
7. Papadopoulos NG, Bernstein JA, Demoly P, et al. Phenotypes and endotypes of rhinitis and their impact on management: a PRACTALL report. Allergy. 2015;70(5):474-94. DOI:10.1111/all.12573
8. Brożek JL, Bousquet J, Agache I, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) Guidelines – 2016 Revision. J Allergy Clin Immunol. 2017;140(4):950-8. DOI:10.1016/j.jaci.2017.03.050
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DOI:10.1002/alr.22741
1 ФГБОУ ВО «Саратовский государственный медицинский университет им. В.И. Разумовского» Минздрава России, Саратов, Россия;
2 Лидс Тринити университет, Школа здравоохранения и социальных наук, Великобритания
*astang@mail.ru
________________________________________________
Natalia G. Astafieva*1, Inna V. Gamova1, Denis Yu. Kobzev2, Irina A. Perfilova1, Ekaterina N. Udovichenko1, Lybov V. Aleschina1
1 Razumovsky Saratov State Medical University, Saratov, Russia;
2 Leeds Trinity University, School of Health and Social Sciences, UK
*astang@mail.ru