Терапия бронхиальной астмы у детей: возрастные аспекты

Геппе Н.А., Кондюрина Е.Г., Ревякина В.А., Малахов А.Б., Колосова Н.Г. Терапия бронхиальной астмы у детей: возрастные аспекты. Педиатрия. Consilium Medicum. 2021; 2: 113–122.
DOI: 10.26442/26586630.2021.2.200928

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Geppe NA, Kondiurina EG, Reviakina VA, Malakhov AB, Kolosova NG. Therapy of bronchial asthma in children: age-related aspects. Pediatrics. Consilium Medicum. 2021; 2: 113–122. DOI: 10.26442/26586630.2021.2.200928

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Аннотация

Бронхиальная астма (БА) – это заболевание, являющееся одним из наиболее частых хронических заболеваний детского возраста. Характерные клинические симптомы БА – свистящие хрипы, кашель, затруднение дыхания, одышка и, конечно, повторные эпизоды бронхиальной обструкции. Они требуют обязательного уточнения семейного и индивидуального аллергоанамнеза, оценки симптомов, дифференциальной диагностики с другими заболеваниями, которые могут протекать с бронхиальной обструкцией. Глобальная инициатива по лечению и профилактике бронхиальной астмы (GINA 2020–2021) сохраняет и развивает возрастной подход к верификации диагноза и выбору терапии, который поддерживается в российской Национальной программе «Бронхиальная астма у детей» и в российских клинических рекомендациях «Бронхиальная астма» 2021 г. При установлении диагноза БА терапия должна начинаться как можно раньше. Назначение низких доз ингаляционных глюкокортикостероидов сразу после постановки диагноза позволяет не только контролировать воспалительный процесс, являющийся основой БА, но и уменьшать выраженность обострений. Ингаляционные глюкокортикостероиды – наиболее эффективные средства для детей в любом возрасте, они обеспечивают контроль над заболеванием и снижают риск обострений БА

Ключевые слова: бронхиальная астма, бронхиальная обструкция, ингаляционная терапия, дети

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Bronchial asthma (BA) is a disease that is one of the most frequent chronic diseases of childhood. Characteristic clinical symptoms of BA are wheezing, cough, difficulty in breathing, shortness of breath and, of course, recurrent episodes of bronchial obstruction. They require mandatory clarification of family and individual allergoanamnesis, assessment of symptoms, differential diagnosis with other diseases that may occur with BA. The Global Initiative for the Treatment and Prevention of Bronchial Asthma (GINA 2020–2021) preserves and develops the ageappropriate approach to verification of diagnosis and therapy selection, which is supported in the Russian National Program "Bronchial Asthma in Children" and in the Russian clinical guidelines "Bronchial Asthma 2021 When the diagnosis of BA is made, therapy should be started as early as possible. Administration of low-dose inhaled glucocorticosteroids (IGCS) immediately after the diagnosis allows not only to control the inflammatory process, which is the basis of BA, but also to reduce the severity of exacerbations. IGCS are the most effective drugs for children of any age, they ensure control of the disease and reduce the risk of AD exacerbations.

Keywords: bronchial asthma, bronchial obstruction, inhalation therapy, children

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Список литературы

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DOI:10.1016/s0022-3999(99)00057-4
24. Beasley R, Holliday M, Reddel HK, et al. Controlled Trial of Budesonide-Formoterol as Needed for Mild Asthma. N Engl J Med. 2019;380(21):2020-30.
DOI:10.1056/NEJMoa1901963
25. Hardy J, Baggott C, Fingleton J, et al. Budesonide-formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild to moderate asthma (PRACTICAL): a 52-week, open-label, multicentre, superiority, randomised controlled trial. Lancet. 2019;394(10202):919-28. DOI:10.1016/S0140-6736(19)31948-8
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1. National program “Bronchial asthma in children. Treatment strategy and prevention”. 5th ed., reprint. and additional. Moscow: Original-maket, 2017 (in Russian)
2. Geppe NA, Kolosova NG, Zaytseva OV, et al. Diagnostic and treatment of bronchial asthma in children of preschool age. Place of nebulized inhaled glucocorticosteroids in treatment of bronchial asthma and croup (Consensus on the results of the council of experts of the pediatric respiratory society). Rossiyskiy vestnik perinatologii i pediatrii. 2018;63(3):124-32 (in Russian) DOI:10.21508/1027-4065-2018-63-3-124-132
3. Bronchial obstruction against the background of acute respiratory infection in preschool children: diagnosis, differential diagnosis, therapy and prevention. Agreed expert recommendations. Moscow: MedKom-Pro, 2019 (in Russian)
4. Carroll WD, Wildhaber J, Brand PLP. Parent misperception of control in childhood/adolescent asthma: the Room to Breathe survey. Eur Respir J. 2012;39:90-6. DOI:10.1183/09031936.00048911
5. Selroos O, Pietinalho A, Löfroos AB, Riska H. Effect of early vs late intervention with inhaled corticosteroid in asthma. Chest. 1995;108(5):1228-34. DOI:10.1378/chest.108.5.1228
6. Selroos O. Effect of disease duration on dose-response of inhaled budesonide in asthma. Respir Med. 2008;102(7):1065-72. DOI:10.1016/j.rmed.2007.12.029
7. Selroos O, Löfroos AB, Pietinalho A, Riska H. Asthma control and steroid doses 5 years after early or delayed introduction of inhaled corticosteroids in asthma: a real-life study. Respir Med. 2004;98(3):254-62. DOI:10.1016/j.rmed.2003.10.007
8. Bronkhial'naia astma. Federal'nye klinicheskie rekomendatsii. Rossiiskoe respiratornoe obshchestvo (RRO). 2019. Available at: http://spulmo.ru/obrazovatelnye-resursy/federalnye-klinicheskie-rekomendatsii/. Accessed 14.09.2020 (in Russian)
9. The Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA). 2020. Available at: http://www.ginasthma.org. Accessed: 02.10.2020.
10. Lavorini F. The challenge of delivering therapeutic aerosols to asthma patients. ISRN Allergy. 2013;2013:102418. DOI:10.1155/2013/102418
11. Laube BL, Janssens HM, de Jongh FHC, et al. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011;37(6):1308-31. DOI:10.1183/09031936.00166410
12. Janson C, Lööf T, Telg G, et al. Difference in resistance to humidity between commonly used dry powder inhalers: an in vitro study. NPJ Prim Care Respir Med. 2016;26:16053.
DOI:10.1038/npjpcrm.2016.53
13. Ramadan WH, Sarkis AT. Patterns of use of dry powder inhalers versus pressurized metered-dose inhalers devices in adult patients with chronic obstructive pulmonary disease or asthma: an observational comparative study. Chron Respir Dis. 2017;14(3):309‑20. DOI:10.1177/1479972316687209
14. Williams RO 3rd, Hu C. Moisture uptake and its influence on pressurized metered-dose inhalers. Pharm Dev Technol. 2000;5(2):153-62. DOI:10.1081/pdt-100100530
15. Wildhaber JH, Dore ND, Wilson JM, et al. Inhalation therapy in asthma: nebulizer or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children. J Pediatr. 1999;135(1):28-33. DOI:10.1016/s0022-3476(99)70323-9
16. Pritchard JN, Hatley RH, Denyer J, Hollen DV. Mesh nebulizers have become the first choice for new nebulized pharmaceutical drug developments. Ther Deliv. 2018;9(2):121-36. DOI:10.4155/tde-2017-0102
17. Borghardt GM, Kloft C, Sharma A. Inhaled Therapy in Respiratory Disease: The Complex Interplay of Pulmonary Kinetic Processes. Can Respir J. 2018;2018:2732017. DOI:10.1155/2018/2732017
18. Castro-Rodriguez JA, Rodriguez-Martinez CE, Ducharme FM. Daily inhaled corticosteroids or montelukast for preschoolers with asthma or recurrent wheezing: A systematic review. Pediatr Pulmonol. 2018;53(12):1670-7. DOI:10.1002/ppul.24176
19. Szefler SJ, Baker JW, Uryniak T, et al. Comparative study of budesonide inhalation suspension and montelukast in young children with mild persistent asthma. J Allergy Clin Immunol. 2007;120(5):1043-50. DOI:10.1016/j.jaci.2007.08.063
20. Chauhan BF, Ducharme FM. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children. Cochrane Database Syst Rev. 2012;2012(5):CD002314. DOI:10.1002/14651858.CD002314.pub3
21. Camargo CA Jr, Ramachandran S, Ryskina KL, et al. Association between common asthma therapies and recurrent asthma exacerbations in children enrolled in a state Medicaid plan. Am J Health Syst Pharm. 2007;64(10):1054-61. DOI:0.2146/ajhp060256
22. Ostrom NK, Decotiis BA, Lincourt WR, et al. Comparative efficacy and safety of low-dose fluticasone propionate and montelukast in children with persistent asthma. J Pediatr. 2005;147(2):213-20. DOI:10.1016/j.jpeds.2005.03.052
23. Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999;47(6):555-67.
DOI:10.1016/s0022-3999(99)00057-4
24. Beasley R, Holliday M, Reddel HK, et al. Controlled Trial of Budesonide-Formoterol as Needed for Mild Asthma. N Engl J Med. 2019;380(21):2020-30.
DOI:10.1056/NEJMoa1901963
25. Hardy J, Baggott C, Fingleton J, et al. Budesonide-formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild to moderate asthma (PRACTICAL): a 52-week, open-label, multicentre, superiority, randomised controlled trial. Lancet. 2019;394(10202):919-28. DOI:10.1016/S0140-6736(19)31948-8
26. O’Byrne PM, FitzGerald JM, Zhong N, et al. The SYGMA programme of phase 3 trials to evaluate the efficacy and safety of budesonide/formoterol given ‘as needed’ in mild asthma: study protocols for two randomised controlled trials. Trials. 2017;18(1):12.
DOI:10.1186/s13063-016-1731-4
27. Rabe KF, Adachi M, Lai CKW, et al. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy Clin Immunol. 2004;114(1):40-7. DOI:10.1016/j.jaci.2004.04.042
28. Ankerst J. Combination inhalers containing inhaled corticosteroids and long-acting beta2-agonists: improved clinical efficacy and dosing options in patients with asthma. J Asthma. 2005;42(9):715-24. DOI:10.1080/02770900500305748
29. Государственный реестр лекарственных средств. Режим доступа: https://grls.rosminzdrav.ru. Ссылка активна на 22.10.2020 [Gosudarstvennyi reestr lekarstvennykh sredstv. Available at: https://grls.rosminzdrav.ru. Accessed 22.10.2020 (in Russian)].
30. Broeders MEAC, Sanchis J, Levy ML, et al. The ADMIT series – issues in inhalation therapy. 2. Improving technique and clinical effectiveness. Prim Care Respir J. 2009;18(2):76-82. DOI:10.4104/pcrj.2009.00025
31. Azouz W, Chrystyn H. Clarifying the dilemmas about inhalation techniques for dry powder inhalers: integrating science with clinical practice. Prim Care Respir J. 2012;21(2):208-13. DOI:10.4104/pcrj.2012.00010

Авторы

Н.А. Геппе*1, Е.Г. Кондюрина2, В.А. Ревякина3, А.Б. Малахов1, Н.Г. Колосова1

1 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
2 ФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава России, Новосибирск, Россия;
3 ФГБУН «Федеральный исследовательский центр питания, биотехнологии и безопасности пищи», Москва, Россия
*geppe@mail.ru

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Natalia A. Geppe*1, Elena G. Kondiurina2, Vera A. Reviakina3, Aleksandr B. Malakhov1, Natalia G. Kolosova1

1 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
2 Novosibirsk State Medical University, Novosibirsk, Russia;
3 Federal Research Centre of Nutrition and Вiotechnology, Moscow, Russia
*geppe@mail.ru

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