Проблемы ведения пациентов с ХОБЛ в условиях постпандемических волн COVID-19
Пациенты с хронической обструктивной болезнью легких (ХОБЛ) относятся к группе высокого риска в отношении неблагоприятных исходов COVID-19. Для ответа на вопрос, почему пациенты с ХОБЛ подвержены тяжелому течению COVID-19, эксперты предлагают обратиться к изучению различных аспектов, включая экспрессию ангиотензинпревращающего фермента 2-го типа (АПФ2), курение, врожденную иммунную дисрегуляцию, приобретенные нарушения иммунного статуса у пациентов с ХОБЛ. С другой стороны, риски для пациентов с ХОБЛ повышаются за счет характерных особенностей патогенеза COVID-19, таких как гипоксемия на фоне поражения легочной ткани, диффузное повреждение и отек альвеол, тромботические осложнения, нарушение вентиляционно-перфузионных отношений. В условиях пандемии или сохраняющейся значительной постпандемической заболеваемости COVID-19 важно обеспечить полноценное фармакологическое лечение ХОБЛ для предотвращения развития любого обострения заболевания, в т.ч. осложнений, развивающихся на фоне инфицирования вирусом SARS-CoV-2. При развитии обострения ХОБЛ следует соблюдать терапевтические рекомендации, которые не теряют актуальности и во время пандемии COVID-19. Несколько классов препаратов рекомендовано для скорейшего устранения симптомов обострения и снижения риска тяжелого течения и осложнений, к ним относятся в первую очередь бронходилататоры, глюкококортикостероиды, антибиотики, а также мукоактивные препараты. Муколитики применяются для улучшения мукоцилиарного клиренса при ХОБЛ, кроме того, обладают антиоксидантными и противовоспалительными свойствами. Муколитическая терапия не является первостепенной фармакологической опцией при ведении пациента с обострением ХОБЛ, однако добавление эффективного муколитика, такого как N-ацетилцистеин, может приводить не только к снижению вязкости бронхиального секрета и улучшению его экспекторации, но и к уменьшению клинических симптомов, увеличению функциональных показателей. Кроме того, терапия N-ацетилцистеином может снижать риск будущих обострений ХОБЛ.Белоцерковская Ю.Г., Романовских А.Г., Смирнов И.П.
Ключевые слова
хроническая обструктивная болезнь легких
COVID-19
фармакотерапия
муколитическая терапия при ХОБЛ
N-ацетилцистеин
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Об авторах / Для корреспонденции
Автор для связи: Юлия Геннадьевна Белоцерковская, к.м.н., доцент кафедры пульмонологии, Российская медицинская академия непрерывного профессионального образования, Москва, Россия; belo-yuliya@yandex.ru
ORCID:
Ю.Г. Белоцерковская (Yu.G. Belotserkovskaya), https://orcid.org/0000-0003-1224-1904
А.Г. Романовских (A.G. Romanovskikh), https://orcid.org/0000-0001-9675-7451
И.П. Смирнов (I.P. Smirnov), https://orcid.org/0000-0001-8954-5303
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