Резюме
Победьонна Г.П., Федотова О.Я., Кострюкова Л.М.,Афанас’євська М.С. ХОЗЛ і коморбідність – значення та напрями лікування.
В статті розглядаються патогенетичні аспекти і сучасні засоби лікування ХОЗЛ, які розроблені на патогенетичних засадах.
Ключові слова: ХОЗЛ, коморбідність, лікування.

Резюме
Победенная Г.П.¹, Федотова Е.Я.², Кострюкова Л.Н.², Афанасьевская М.С.¹ ХОЗЛ и коморбидность: значение и направления терапии.
В статье рассматриваются патогенетические аспекты и современные средства лечения ХОЗЛ, которые разработаны на патогенетических началах.
Ключевые слова: ХОЗЛ, коморбидность, лечение.

Summary
Pobedyonnaja G.P.,Fedotova E.Ja., Kostrukova L.N., Afanas’evska M.S. СOPD and comorbidity role and admitions of the treatment.
The pathogenetic basis and modern drugs, which were performed on their basis for COPD, are considered in the article.
Key words: COPD, сomorbidity, treatment.

Рецензент: д.мед.н., проф. Л.М. Іванова

УДК 616.233-002-085+615.23

¹ГЗ «Луганский государственный медицинский университет»

State Establishment "Lugansk State Medical University"

²Управление здравоохранения г. Луганска

Department of Health of Lugansk

g-pobeda@ukr.net

Chronic obstructive pulmonary disease (COPD) is one of major problems of modern medicine. Considerable prevalence, duration of treatment, such serious social consequences as expenses of patient and states for treatment of COPD determine attention of specialists to the disease.

COPD develops under the influence of risk factors among that the most meaningful are smoking and its experience, state of environment, working conditions and also some genetic features of a patient. Being in the most cases the disease of the second half of life, COPD quite often combines with other medical diseases for one patient that has an effect on the clinical manifestations, its severity, volume of treatment and prognosis for a patient.

Today COPD is considered as local inflammation in a respiratory tract with systemic symptoms.

Among the comorbide states for the patients with COPD  the most often ones became cardiovascular - ischemic heart disease (IHD)  with development of myocardial infarction (MI) that were diagnosed for 11,2% of  patients. The peculiarity of IHD clinical progression was a frequent presence of arrhythmias, episodes of painless ischemia that resulted in late diagnostics of MI [9]. Approximately with the same frequency is marked combination of COPD and stenocardias, arterial hypertension has been diagnosed for more than half of patients.

Among other often met types of comorbidity is marked adipositas (for the fifth part of patients), gastrointestinal diseases are marked for the fourth part of patients (among them are gastroduodenal ulcer, gastritises, chronic pancreatitis). Such diseases of hepatobiliary system as nonalcoholic steatohepatitis, chronic cholecystitis, cholelithiasis, hepatocirrhosis were marked for the sixth part of patients with COPD.  6% of patients had diabetes mellitus.

Quite often other malconditions arise on the background of carrying base therapy of COPD or it is discussed the role of preparations  for base treatment in the origin of these states.

At presence of comorbidity treatment of COPD turns into enough difficult clinical task. A primary goal of COPD treatment is slowing of disease progress and falling of respiratory volumes for a patient, improvement of quality of his life. Treatment of patients with COPD in a stable period and period of recrudescence requires individual approach. Thus amount of recrudescences and state of respiratory function of a patient according to recommendations of GOLD - 2011 will determine the volume of base therapy.

Basis of symptomatic treatment of COPD are broncholytic preparations. New preparation for base broncholytic therapy is β2-agonist of ultra-long action indacaterol has good prospects in treatment of COPD. Among bronchial spasmolytics of long-lasting action application of prolonged М-cholinolytic tiotropium for patients with COPD is related to more considerable improvement of indexes of lungs function   and quality of life. Inhaled corticosteroids are used in base treatment of COPD at presence of frequent recrudescences. The well-proven antiinflammatory efficiency was shown by the representative of new class of preparations decreasing inflammation by means of blockade of enzyme of phosphodiesterase4 type (PDE- 4) roflumilast (Daxas).

Pleiotropic effects of statins may be useful in treatment of COPD for patients with arterial hypertension, diabetes mellitus, metabolic syndrome and cardiac decompensation.

Considerable threat for progress of disease and increase of death risk of patients with COPD cause recrudescences. Early diagnostics and balanced case management in the period of recrudescence, correctly determined strategy of treatment including physical rehabilitation will assist not only the improvement of course of disease and increase of  patient's quality of life but also will slow its progress. Rehabilitation actions with the use of respiratory exercises, adequate nutrition, rational motor conditions, oxygen-therapy will allow to improve pulmonary mechanics, provide the increase of expiratory time that will result in the symptomatic relief of disease for patients.

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