Новые клинические рекомендации по ХОБЛ – смена парадигмы

Авдеев С.Н., Лещенко И.В., Айсанов З.Р., Архипов В.В., Белевский А.С., Овчаренко С.И., Емельянов А.В., Синопальников А.И., Шмелев Е.И., Чучалин А.Г., от имени рабочей группы по разработке и пересмотру Федеральных клинических рекомендаций по ХОБЛ. Новые клинические рекомендации по ХОБЛ – смена парадигмы. Терапевтический архив. 2024;96(3):292–297. DOI: 10.26442/00403660.2024.03.202646

© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.

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Avdeev SN, Leshchenko IV, Aisanov ZR, Arkhipov VV, Belevskiy AS, Ovcharenko SI, Emelyanov AV, Sinopalnikov AI, Shmelev EI, Chuchalin AG, on behalf of the working group for the development and revision of Federal clinical guidelines for COPD. New clinical guidelines for COPD – a paradigm shift: A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(3):292–297. DOI: 10.26442/00403660.2024.03.202646

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Аннотация

Хроническая обструктивная болезнь легких сегодня является одной из наиболее распространенных неинфекционных заболеваний и основных причин заболеваемости, инвалидности и смертности в мире. В последние годы появились новые подходы к эпидемиологии, диагностике, классификации (категоризации), оценке фенотипов, а также характеристике и оценке тяжести обострений хронической обструктивной болезни легких. Существенно изменились современные подходы к стартовой и последующей медикаментозной терапии. Это во многом связано с результатами проведенных в последние годы крупных исследований, продемонстрировавших высокую эффективность тройных фиксированных комбинаций, включающих ингаляционные глюкокортикостероиды, длительно действующие β-агонисты и антихолинергические препараты. Важными остаются вопросы использования немедикаментозных методов терапии (отказ от курения, физическая активность и дыхательная реабилитация), современные подходы к лечению дыхательной недостаточности и антибактериальная терапия. По своей значимости все эти обновления оказывают существенное влияние на реальную клиническую практику и могут рассматриваться как новая парадигма наших подходов к диагностике и ведению этого заболевания.

Ключевые слова: хроническая обструктивная болезнь легких, клинические рекомендации, руководство, алгоритм

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Chronic obstructive pulmonary disease is now one of the most common noncommunicable diseases and the main causes of morbidity, disability and mortality in the world. In recent years, new approaches to epidemiology, diagnosis, classification (categorization), evaluation of phenotypes, as well as characterization and assessment of the severity of сhronic obstructive pulmonary disease exacerbations have emerged. Modern approaches to starting and subsequent drug therapy have changed significantly. This is largely due to the results of recently conducted major clinical trials, demonstrated high efficacy of triple fixed combinations, including inhaled glucocorticosteroids, long-acting beta-agonists and long-acting anticholinergic drugs. The use of non-medication methods (smoking cessation, physical activity and respiratory rehabilitation) and modern approaches to the treatment of respiratory failure and antibiotic therapy remain important. In terms of their significance, all these updates have a significant impact on real clinical practice and can be considered as a novel paradigm of the approaches to the diagnosis and management of this disease.

Keywords: сhronic obstructive pulmonary disease, clinical recommendations, guidelines, algorithm

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Список литературы

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17. Yu AP, Guérin A, Ponce de Leon D, et al. Therapy persistence and adherence in patients with chronic obstructive pulmonary disease: multiple versus single long-acting maintenance inhalers. J Med Econ. 2011;14(4):486-96. DOI:10.3111/13696998.2011.594123
18. Chong J, Poole P, Leung B, Black PN. Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011;(5):CD002309. DOI:10.1002/14651858.CD002309.pub3
19. Albert RK, Connett J, Bailey WC, et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011;365(8):689-98. DOI:10.1056/NEJMoa1104623
20. Cazzola M, Calzetta L, Page C, J et al. Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis. Eur Respir Rev. 2015;24(137):451-61. DOI:10.1183/16000617.00002215
21. White P, Thornton H, Pinnock H, et al. Overtreatment of COPD with inhaled corticosteroids – implications for safety and costs: cross-sectional observational study. PLoS One. 2013;8(10):e75221. DOI:10.1371/journal.pone.0075221
22. Rossi A, Guerriero M, Corrado A; OPTIMO/AIPO Study Group. Withdrawal of inhaled corticosteroids can be safe in COPD patients at low risk of exacerbation: a real-life study on the appropriateness of treatment in moderate COPD patients (OPTIMO). Respir Res. 2014;15(1):77. DOI:10.1186/1465-9921-15-77
23. Magnussen H, Disse B, Rodriguez-Roisin R, et al. Withdrawal of inhaled glucocorticoids and exacerbations of COPD. N Engl J Med. 2014;371(14):1285-94. DOI:10.1056/NEJMoa1407154
24. Stoller JK, Panos RJ, Krachman S, et al. Long-term Oxygen Treatment Trial Research Group. Oxygen therapy for patients with COPD: current evidence and the long-term oxygen treatment trial. Chest. 2010;138(1):179-87. DOI:10.1378/chest.09-2555
25. Sculley JA, Corbridge SJ, Prieto-Centurion V, et al. Home Oxygen Therapy for Patients With COPD: Time for a Reboot. Respir Care. 2019;64(12):1574-85. DOI:10.4187/respcare.07135
26. Ergan B, Nava S. Long-Term Oxygen Therapy in COPD Patients Who Do Not Meet the Actual Recommendations. COPD. 2017;14(3):351-66. DOI:10.1080/15412555.2017.1319918
27. Jacobs SS, Krishnan JA, Lederer DJ, et al. Home Oxygen Therapy for Adults with Chronic Lung Disease. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020;202(10):e121-41. DOI:10.1164/rccm.202009-3608ST
28. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. Am J Respir Crit Care Med. 1995;152(5 Pt. 2): S77-121.
29. Авдеев С.Н. Неинвазивная вентиляция легких у пациентов с хронической обструктивной болезнью легких в стационаре и домашних условиях. Пульмонология. 2017;27(2):232-49 [Avdeev SN. Non-invasive ventilation in patients with chronic obstructive pulmonary disease in a hospital and at home. Pulmonologiya. 2017;27(2):232-49 (in Russian)]. DOI:10.18093/0869-0189-2017-27-2-232-249
30. Nagata K, Horie T, Chohnabayashi N, et al. Home High-Flow Nasal Cannula Oxygen Therapy for Stable Hypercapnic COPD: A Randomized Clinical Trial. Am J Respir Crit Care Med. 2022;206(11):1326-35. DOI:10.1164/rccm.202201-0199OC
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________________________________________________

1. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024. Available at: http://www.goldcopd.org/ Accessed: 29.12.2023.
2. Halpin DMG, Celli BR, Criner GJ, et al. The GOLD Summit on chronic obstructive pulmonary disease in low- and middle-income countries. Int J Tuberc Lung Dis. 2019;23(11):1131-41. DOI:10.5588/ijtld.19.0397
3. Diab N, Gershon AS, Sin DD, et al. Underdiagnosis and Overdiagnosis of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2018;198(9):1130-9. DOI:10.1164/rccm.201804-0621CI
4. World Health Organization. The top 10 causes of death. Available at: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Accessed: 12.12.2023.
5. Kontsevaya AV, Mukaneyeva DK, Balanova YA, et al. Economic burden of respiratory diseases and chronic obstructive pulmonary disease in Russian Federation, 2016. Pulmonologiya. 2019;29(2):159-66 (in Russian). DOI:10.18093/0869-0189-2019-29-2-159-166
6. Skajaa N, Laugesen K, Horváth-Puhó E, Sørensen HT. Comorbidities and mortality among patients with chronic obstructive pulmonary disease. BMJ Open Respir Res. 2023;10(1):e001798. DOI:10.1136/bmjresp-2023-001798.
7. Aisanov ZR, Chuchalin AG, Kalmanova EN. Chronic obstructive pulmonary disease and cardiovascular comorbidity. Kardiologiia. 2019;59(8S):24-36 (in Russian). DOI:10.18087/cardio.2572
8. Giezeman M, Sundh J, Athlin Å, et al. Comorbid Heart Disease in Patients with COPD is Associated with Increased Hospitalization and Mortality – A 15-Year Follow-Up. Int J Chron Obstruct Pulmon Dis. 2023;18:11-21. DOI:10.2147/COPD.S378979
9. Celli BR, Fabbri LM, Aaron SD, et al. An Updated Definition and Severity Classification of Chronic Obstructive Pulmonary Disease Exacerbations: The Rome Proposal. Am J Respir Crit Care Med. 2021;204(11):1251-8. DOI:10.1164/rccm.202108-1819PP
10. Rothnie KJ, Müllerová H, Smeeth L, Quint JK. Natural History of Chronic Obstructive Pulmonary Disease Exacerbations in a General Practice-based Population with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2018;198(4):464-71. DOI:10.1164/rccm.201710-2029OC
11. Farne HA, Cates CJ. Long-acting beta2-agonist in addition to tiotropium versus either tiotropium or long-acting beta2-agonist alone for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015;(10):CD008989. DOI:10.1002/14651858.CD008989.pub3
12. van der Molen T, Cazzola M. Beyond lung function in COPD management: effectiveness of LABA/LAMA combination therapy on patient-centred outcomes. Prim Care Respir J. 2012;21(1):101-8. DOI:10.4104/pcrj.2011.00102
13. Mahler DA, Decramer M, D'Urzo A, et al. Dual bronchodilation with QVA149 reduces patient-reported dyspnoea in COPD: the BLAZE study. Eur Respir J. 2014;43(6):1599-609. DOI:10.1183/09031936.00124013
14. Singh D, Agusti A, Martinez FJ, et al. Blood Eosinophils and Chronic Obstructive Pulmonary Disease: A Global Initiative for Chronic Obstructive Lung Disease Science Committee 2022 Review. Am J Respir Crit Care Med. 2022;206(1):17-24. DOI:10.1164/rccm.202201-0209PP
15. Calzetta L, Ritondo BL, de Marco P, et al. Evaluating triple ICS/LABA/LAMA therapies for COPD patients: a network meta-analysis of ETHOS, KRONOS, IMPACT, and TRILOGY studies. Expert Rev Respir Med. 2021;15(1):143-52. DOI:10.1080/17476348.2020.1816830
16. Cazzola M, Rogliani P, Laitano R, et al. Beyond Dual Bronchodilation – Triple Therapy, When and Why. Int J Chron Obstruct Pulmon Dis. 2022;17:165-80. DOI:10.2147/COPD.S345263
17. Yu AP, Guérin A, Ponce de Leon D, et al. Therapy persistence and adherence in patients with chronic obstructive pulmonary disease: multiple versus single long-acting maintenance inhalers. J Med Econ. 2011;14(4):486-96. DOI:10.3111/13696998.2011.594123
18. Chong J, Poole P, Leung B, Black PN. Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011;(5):CD002309. DOI:10.1002/14651858.CD002309.pub3
19. Albert RK, Connett J, Bailey WC, et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011;365(8):689-98. DOI:10.1056/NEJMoa1104623
20. Cazzola M, Calzetta L, Page C, J et al. Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis. Eur Respir Rev. 2015;24(137):451-61. DOI:10.1183/16000617.00002215
21. White P, Thornton H, Pinnock H, et al. Overtreatment of COPD with inhaled corticosteroids – implications for safety and costs: cross-sectional observational study. PLoS One. 2013;8(10):e75221. DOI:10.1371/journal.pone.0075221
22. Rossi A, Guerriero M, Corrado A; OPTIMO/AIPO Study Group. Withdrawal of inhaled corticosteroids can be safe in COPD patients at low risk of exacerbation: a real-life study on the appropriateness of treatment in moderate COPD patients (OPTIMO). Respir Res. 2014;15(1):77. DOI:10.1186/1465-9921-15-77
23. Magnussen H, Disse B, Rodriguez-Roisin R, et al. Withdrawal of inhaled glucocorticoids and exacerbations of COPD. N Engl J Med. 2014;371(14):1285-94. DOI:10.1056/NEJMoa1407154
24. Stoller JK, Panos RJ, Krachman S, et al. Long-term Oxygen Treatment Trial Research Group. Oxygen therapy for patients with COPD: current evidence and the long-term oxygen treatment trial. Chest. 2010;138(1):179-87. DOI:10.1378/chest.09-2555
25. Sculley JA, Corbridge SJ, Prieto-Centurion V, et al. Home Oxygen Therapy for Patients With COPD: Time for a Reboot. Respir Care. 2019;64(12):1574-85. DOI:10.4187/respcare.07135
26. Ergan B, Nava S. Long-Term Oxygen Therapy in COPD Patients Who Do Not Meet the Actual Recommendations. COPD. 2017;14(3):351-66. DOI:10.1080/15412555.2017.1319918
27. Jacobs SS, Krishnan JA, Lederer DJ, et al. Home Oxygen Therapy for Adults with Chronic Lung Disease. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020;202(10):e121-41. DOI:10.1164/rccm.202009-3608ST
28. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. Am J Respir Crit Care Med. 1995;152(5 Pt. 2): S77-121.
29. Avdeev SN. Non-invasive ventilation in patients with chronic obstructive pulmonary disease in a hospital and at home. Pulmonologiya. 2017;27(2):232-49 (in Russian). DOI:10.18093/0869-0189-2017-27-2-232-249
30. Nagata K, Horie T, Chohnabayashi N, et al. Home High-Flow Nasal Cannula Oxygen Therapy for Stable Hypercapnic COPD: A Randomized Clinical Trial. Am J Respir Crit Care Med. 2022;206(11):1326-35. DOI:10.1164/rccm.202201-0199OC
31. Avdeev SN, Leshchenko IV, Aisanov ZR. A new concept and algorithm for the management of patients with chronic obstructive pulmonary disease. Pulmonologiya. 2023;5:587-94 (in Russian). DOI:10.18093/0869-0189-2023-33-5-587-594

Авторы

С.Н. Авдеев*^1,2, И.В. Лещенко^3,4, З.Р. Айсанов⁵, В.В. Архипов⁶, А.С. Белевский⁵, С.И. Овчаренко¹, А.В. Емельянов⁷, А.И. Синопальников⁶, Е.И. Шмелев⁸, А.Г. Чучалин⁵, от имени рабочей группы по разработке и пересмотру Федеральных клинических рекомендаций по ХОБЛ

¹ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
²ФГБУ «Научно-исследовательский институт пульмонологии» ФМБА России, Москва, Россия;
³ФГБОУ ВО «Уральский государственный медицинский университет» Минздрава России, Екатеринбург, Россия;
⁴Уральский научно-исследовательский институт фтизиопульмонологии – филиал ФГБУ «Национальный медицинский исследовательский центр фтизиопульмонологии и инфекционных заболеваний», Екатеринбург, Россия;
⁵ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
⁶ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
⁷ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия;
⁸ФГБНУ «Центральный научно-исследовательский институт туберкулеза», Москва, Россия
*serg_avdeev@list.ru

________________________________________________

Sergey N. Avdeev*^1,2, Igor V. Leshchenko^3,4, Zaurbek R. Aisanov⁵, Vladimir V. Arkhipov⁶, Andrey S. Belevskiy⁵, Svetlana I. Ovcharenko¹, Alexander V. Emelyanov⁷, Alexander I. Sinopalnikov⁶, Evgene I. Shmelev⁸, Alexander G. Chuchalin⁵, on behalf of the working group for the development and revision of Federal clinical guidelines for COPD

¹Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
²Research Institute of Pulmonology, Moscow, Russia;
³Ural State Medical University, Yekaterinburg, Russia;
⁴Ural Research Institute of Phthisiopulmonology – branch of the National Medical Research Center for Phthisiopulmonology and Infectious Diseases, Yekaterinburg, Russia;
⁵Pirogov Russian National Research Medical University, Moscow, Russia;
⁶Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
⁷Mechnikov North-Western State Medical University, Saint Petersburg, Russia;
⁸Central Research Institute of Tuberculosis, Moscow, Russia
*serg_avdeev@list.ru

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