Цель. Оценить функциональное состояние респираторной системы и эффективность терапевтической тактики бронхообструктивного синдрома (БОС) у пациентов в постковидном периоде. Материалы и методы. Двухцентровое когортное проспективное исследование включало 10 456 и 89 больных. В комплексную оценку респираторной системы входили клинико-лабораторные и функциональные данные, включающие спирометрию, бодиплетизмографию и исследование диффузионной способности легких по монооксиду углерода (DLCO). Терапия БОС состояла из назначения суспензии будесонида или экстрамелкодисперсного беклометазона дипропионата/формотерола. Результаты. Частота БОС в когорте составила 72% (7497 больных). В 13% (n=974) случаев впервые диагностирована бронхиальная астма, в 4,4% (n=328) – хроническая обструктивная болезнь легких. Определены факторы риска развития БОС и снижения DLCO в постковидном периоде. В группе комплексного инструментального обследования функции легких определено отсутствие нарушений спирометрических данных и показателей, определяемых при бодиплетизмографии. Заключение. Факторами риска БОС в постковидном периоде являются атопия, частые острые респираторные инфекции в анамнезе, курение, эозинофилия крови, среднетяжелая и тяжелая формы COVID-19. Показано преимущество фиксированной комбинации – экстрамелкодисперсного дозированного аэрозольного ингалятора беклометазона дипропионата/формотерола в режиме MART по сравнению с небулизированными супензией будесонида + раствор сальбутамола при лечении БОС. Установлены факторы риска нарушения DLCO: перенесенный тяжелый COVID-19, госпитализация в отделение интенсивной терапии, потребность в дополнительной кислородной поддержке.
Aim. Assess the functional state of trespiratory system and effectiveness of therapeutic tactics for broncho-obstructive syndrome (BOS) in patients in the post-COVID period. Materials and methods. A two-center cohort prospective study included 10 456 and 89 patients, respectively. A comprehensive assessment of the respiratory system included clinical, laboratory and functional data, spirometry, body plethysmography, and a study of diffusive capacity of the lungs (DLCO). Therapy consisted of budesonide suspension or fixed combination beclomethasone dipropionate/formoterol (EMD BDP/FORM). Results. The frequency of BOS in the cohort was 72% (7497 patients). In 13% (n=974) of cases, bronchial asthma was diagnosed for the first time, in 4.4% (n=328) – chronic obstructive pulmonary disease. Risk factors for the development and decrease in DLCO in the post-COVID period were identified. In the group of complex instrumental examination of lung function, the absence of violations of spirometric data and indicators determined by body plethysmography was determined. Conclusion. Risk factors for BOS in post-COVID period are atopy, a history of frequent acute respiratory infections, smoking, blood eosinophilia, moderate and severe forms of COVID-19. The advantage of a fixed combination of EMD BDP/FORM in MART mode compared with nebulized suspension budesonide + solution of salbutamol in treatment of BOS was shown. Risk factors for DLCO disorders were established: severe COVID-19, hospitalization in the intensive care unit, the need for additional oxygen therapy.
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5. Venkatesan P. NICE guideline on long COVID. Lancet Respir Med. 2021;9(2):129. DOI:10.1016/S2213-2600(21)00031-X
6. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9. DOI:10.1001/jama.2020.6775
7. Lee JH, Yim JJ, Park J. Pulmonary function and chest computed tomography abnormalities 6–12 months after recovery from COVID-19: a systematic review and meta-analysis. Respir Res. 2022;23(1):233. DOI:10.1186/s12931-022-02163-x
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11. Рекомендации Российского респираторного общества по проведению функциональных исследований системы дыхания в период пандемии COVID-19 Версия 1.1. от 19.05.2020. Режим доступа: https://cr.minzdrav.gov.ru/ Ссылка активна на 05.01.2023 [Recommendations of the Russian Respiratory Society for conducting functional studies of the respiratory system during the COVID-19 pandemic Version 1.1. from 19.05.2020. Available at: https://cr.minzdrav.gov.ru/ Accessed: 05.01.2023 (in Russian)].
12. Архипов В.В., Айсанов З.P., Авдеев C.Н. Эффективность комбинаций ингаляционных глюкокортикостероидов и длительно действующих β-агонистов в условиях реальной медицинской практики: результаты многоцентрового кросс-секционного исследования у российских пациентов с бронхиальной астмой. Пульмонология. 2021;31(5):613-26 [Arkhipov VV, Aisanov ZR, Avdeev SN. Effectiveness of inhaled corticosteroids and long-acting β-agonists combinations in real clinical practice: results of a multicenter cross-sectional study in Russian patients with asthma. Pulmonologiya. 2021;31(5):613-26 (in Russian)]. DOI:10.18093/0869-0189-2021-31-5-613-626
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14. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9. DOI:10.1001/jama.2020.6775
15. Bellan M, Baricich A, Patrucco F, et al. Long-term sequelae are highly prevalent one year after hospitalization for severe COVID-19. Sci Rep. 2021;11(1):22666.
DOI:10.1038/s41598-021-01215-4
16. Stewart I, Jacob J, George PM, et al. Residual Lung Abnormalities Following COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID Study. Am J Respir Crit Care Med. 2022. DOI:10.1164/rccm.202203-0564OC
17. Wu X, Liu X, Zhou Y, et al. 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. Lancet Respir Med. 2021;9:747754. DOI:10.1016/S2213-2600(21)00174-0
18. Steinbeis F, Thibeault C, Doellinger F, et al. Severity of respiratory failure and computed chest tomography in acute COVID-19 correlates with pulmonary function and respiratory symptoms after infection with SARS-CoV-2: An observational longitudinal study over 12 months. Respir Med. 191:106709. DOI:10.1016/j.rmed.2021.106709
19. Castanares-Zapatero D, Chalon P, Kohn L, et al. Pathophysiology and mechanism of long COVID: a comprehensive review. Ann Med. 2022;54(1):1473-87. DOI:10.1080/07853890.2022.2076901
20. Dhawan RT, Gopalan D, Howard L, et al. Beyond the clot: perfusion imaging of the pulmonary vasculature after COVID-19. Lancet Respir Med. 2021;9(1):107-16.
DOI:10.1016/S2213-2600(20)30407-0
21. Nazerian Y, Ghasemi M, Yassaghi Y, et al. Role of SARS-CoV-2-induced cytokine storm in multi-organ failure: Molecular pathways and potential therapeutic options. Int Immunopharmacol. 2022;113(Pt B):109428. DOI:10.1016/j.intimp.2022.109428
22. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. 2019 Report. Available at: https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf. Accessed: 15.01.2023.
________________________________________________
1. Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-15. DOI:10.1038/s41591-021-01283-z
2. Canas LS, Molteni E, Deng J, et al. Profiling post-COVID syndrome across different variants of SARS-CoV-2. medRxiv. 2022. DOI:10.1101/2022.07.28.22278159
3. Woodruff P, Bhakta N, Fahy J. Asthma: Pathogenesis and Phentoypes. In: Murray and Nadel's textbook of respiratory medicine. 6-th ed. 2016; p. 713-30.
4. Song WJ, Hui CKM, Hull JH, et al. Confronting COVID-19-associated cough and the post-COVID syndrome: Role of viral neurotropism, neuroinflammation, and neuroimmune responses. Lancet Respir Med. 2021;9(5):533-44. DOI:10.1016/S2213-2600(21)00125-9
5. Venkatesan P. NICE guideline on long COVID. Lancet Respir Med. 2021;9(2):129. DOI:10.1016/S2213-2600(21)00031-X
6. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9. DOI:10.1001/jama.2020.6775
7. Lee JH, Yim JJ, Park J. Pulmonary function and chest computed tomography abnormalities 6–12 months after recovery from COVID-19: a systematic review and meta-analysis. Respir Res. 2022;23(1):233. DOI:10.1186/s12931-022-02163-x
8. Antoniou KM, Vasarmidi E, Russell AM, et al. European Respiratory Society statement on long COVID follow-up. Eur Respir J. 2022;60(2):2102174. DOI:10.1183/13993003.02174-2021
9. Clinical recommendations “Bronchial asthma” 2021. Russian Respiratory Society (RRS). Available at: https://cr.minzdrav.gov.ru/ Accessed: 05.01.2023 (in Russian).
10. From the Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2021. Available at: http://www.ginasthma.org. Accessed: 04.01.2023.
11. Recommendations of the Russian Respiratory Society for conducting functional studies of the respiratory system during the COVID-19 pandemic Version 1.1. from 19.05.2020. Available at: https://cr.minzdrav.gov.ru/ Accessed: 05.01.2023 (in Russian).
12. Arkhipov VV, Aisanov ZR, Avdeev SN. Effectiveness of inhaled corticosteroids and long-acting β-agonists combinations in real clinical practice: results of a multicenter cross-sectional study in Russian patients with asthma. Pulmonologiya. 2021;31(5):613-26 (in Russian). DOI:10.18093/0869-0189-2021-31-5-613-626
13. Avdeev SA, Aisanov ZR, Arkhipov VV, et al. A role of inhaled corticosteroids in management of patients with chronic obstructive pulmonary disease: current recommendations. Expert panel conclusion. Pulmonologiya. 2019;29(5):632-6 (in Russian). DOI:10.18093/0869-0189-2019-29-5-632-636
14. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9. DOI:10.1001/jama.2020.6775
15. Bellan M, Baricich A, Patrucco F, et al. Long-term sequelae are highly prevalent one year after hospitalization for severe COVID-19. Sci Rep. 2021;11(1):22666.
DOI:10.1038/s41598-021-01215-4
16. Stewart I, Jacob J, George PM, et al. Residual Lung Abnormalities Following COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID Study. Am J Respir Crit Care Med. 2022. DOI:10.1164/rccm.202203-0564OC
17. Wu X, Liu X, Zhou Y, et al. 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. Lancet Respir Med. 2021;9:747754. DOI:10.1016/S2213-2600(21)00174-0
18. Steinbeis F, Thibeault C, Doellinger F, et al. Severity of respiratory failure and computed chest tomography in acute COVID-19 correlates with pulmonary function and respiratory symptoms after infection with SARS-CoV-2: An observational longitudinal study over 12 months. Respir Med. 191:106709. DOI:10.1016/j.rmed.2021.106709
19. Castanares-Zapatero D, Chalon P, Kohn L, et al. Pathophysiology and mechanism of long COVID: a comprehensive review. Ann Med. 2022;54(1):1473-87. DOI:10.1080/07853890.2022.2076901
20. Dhawan RT, Gopalan D, Howard L, et al. Beyond the clot: perfusion imaging of the pulmonary vasculature after COVID-19. Lancet Respir Med. 2021;9(1):107-16.
DOI:10.1016/S2213-2600(20)30407-0
21. Nazerian Y, Ghasemi M, Yassaghi Y, et al. Role of SARS-CoV-2-induced cytokine storm in multi-organ failure: Molecular pathways and potential therapeutic options. Int Immunopharmacol. 2022;113(Pt B):109428. DOI:10.1016/j.intimp.2022.109428
22. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. 2019 Report. Available at: https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf. Accessed: 15.01.2023.
1 ФГБОУ ВО «Уральский государственный медицинский университет» Минздрава России, Екатеринбург, Россия;
2 Уральский научно-исследовательский институт фтизиопульмонологии – филиал ФГБУ «Национальный медицинский исследовательский центр фтизиопульмонологии и инфекционных заболеваний» Минздрава России, Екатеринбург, Россия;
3 ООО «Медицинское объединение “Новая больница”», Екатеринбург, Россия
*leshchenkoiv@yandex.ru
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Igor V. Leshchenko*1–3, Natalia A. Esaulova1,3, Tatyana V. Glushkova2, Sergey N. Skornyakov1,2
1 Ural State Medical University, Yekaterinburg, Russia;
2 Ural Research Institute of Phthisiopulmonology – branch of the National Medical Research Center for Phthisiopulmonology and Infectious Diseases, Yekaterinburg, Russia;
3 LLC “Medical Association “New Hospital”, Yekaterinburg, Russia
*leshchenkoiv@yandex.ru