The emergence of a new disease COVID-19 (coronavirus disease 2019), caused by the coronavirus named SARS-CoV-2, has significantly changed the usual interaction pattern between a doctor and a patient. Previous large studies have identified risk factors for a severe course of COVID-19, including old age, hypertension, diabetes, cardiovascular diseases, and chronic obstructive pulmonary disease. However, asthma and respiratory allergy have not been identified as risk factors for the severe disease. These factors give clues to the pathogenesis of COVID-19, approaches to the controller medications, target therapy, allergen-specific immunotherapy (ASIT) in patients with various phenotypes and endotypes of asthma during the pandemic.The purpose of this review is to summarize the currently available knowledge about SARS-CoV-2, T2-endotype of asthma, eosinophilic inflammation. The article provides an overview of the data from studies of COVID-19 patients with asthma, the main recommendations of the Global Initiative for Asthma (2021) and the Ministry of Health of the Russian Federation. It shows that targeting the endotypes and phenotypes of asthma can influence the management of COVID-19 patients with asthma. The influence of the imbalance of the immune system, pro-inflammatory cytokines, and effector cells in patients with asthma on the development and progression of COVID-19 is considered. Recommendations are given for the controller medications, targeted therapy, allergen-specific immunotherapy during the pandemic.Conclusion. The current recommendations for asthma treatment, based on the latest research of COVID-19, deepen our understanding of the course of COVID-19 in patients with different phenotypes and endotypes of asthma, approaches to traditional methods of treating asthma according to clinical guidelines during the pandemic.
Бронхиальная астма (БА) -одно из самых распрост-раненных хронических заболеваний -по-прежнему характеризуется низким контролем и высокой час-тотой обострений, связанных с острыми респи-раторными инфекциями (ОРИ). Около 85 % всех обострений БА у детей и у > 50 % взрослых прово-цируются респираторными вирусами, причем иссле-дования свидетельствуют о том, что больные БА тяжелее переносят заболевания респираторными инфекциями по сравнению со здоровыми, что гово-рит о нарушении у них антивирусного иммунного ответа [1][2][3]. Синергичные взаимосвязи могут раз-виваться между аллергеном и вирусом у больных ато-пической БА. В исследованиях с провокацией спе-цифическим аллергеном показано, что респиратор-ные вирусы способны вызывать воспаление в дыха-тельных путях, которое приводит к повышенному иммунному ответу на аллергенный стимул, вызывая таким образом обострение БА [4,5]. Существует определенная связь между аллергическим феноти-пом и снижением антивирусного иммунного ответа, которая была продемонстрирована у больных атопи-ческой БА [4]. Дендритными клетками больных аллергической БА продуцировалось значительно меньше интерферона (IFN)-α в ответ на экспозицию вируса гриппа по сравнению со здоровыми донорами. Efficacy of inhalational immune therapy with Ruzam in patients with atopic bronchial asthma: influence on frequency of respiratory infections and asthma exacerbations SummaryThe aim of this study was to investigate efficacy and safety of inhalational treatment with Ruzam in 63 adult patients with persistent mild to moderate atopic bronchial asthma (BA). In this placebo controlled trial, clinical, functional and laboratory parameters were assessed at the end of 2-week treatment with Ruzam and in 6 months after the treatment. All patients also received inhaled corticosteroids. In patients treated with Ruzam, asthma symptoms, bronchial hyperresponsiveness and nitric oxide in the exhaled air decreased and morning PEF increased when compared to patients treated with inhaled corticosteroids plus placebo. During 6 months after the treatment, there were no asthma exacerbations in the Ruzam group and asthma was well-controlled in these patients. The patients treated with Ruzam significantly decreased a frequency of acute respiratory infections. In the control group (n = 32), exacerbation frequency and asthma control level remained unchanged compared to baseline. Achieving clinical control of asthma in Ruzam group was accompanied by a significant reduction in concentrations of inflammatory markers (IFN-γ, ECP) in serum and in the induced sputum that could be used as a measure of systemic anti-inflammatory effect of Ruzam. Key words: bronchial asthma, Ruzam, asthma control, asthma exacerbation, nitric oxide in the exhaled air, interferon-γ. РезюмеПроведено плацебо-контролируемое исследование по изучению эффективности и безопасности терапии с применением ингаляцион-ной формы препарата Рузам у взрослых больных атопической бронхиальной астмой (БА) персистирующего легкого и среднетяжелого течения. Клинико-функциональные и лабора...
Background. To study the efficacy and safety of inhaled form of ruzam in adult patients with persistent mild and moderate atopic bronchial asthma (ba). Materials and methods. a placebo-controlled prospective, randomized, open label study of an efficacy of ruzam a solution for inhalations (in bottles on 2,5 or 5 ml) on 2,5 ml onсe a day through nebulizer during 2 weeks was conducted in adult asthmatic patients. The efficacy of therapy was evaluated by dynamics of symptoms and requirement in 2-agonists, besides PEfr, spirometry, bronchial hyperresponsiveness (bhr), asthma control test (aCT ), level of the markers of the allergic inflammation were performed. Results. reduction of bа symptoms, increase morning PEfr, decrease of bhr and NОex level in patients who received ruzam compared with control group was observed. achievement of clinical control of bа in patients treated by ruzam was accompanied by statistically significant positive dynamics of markers of inflammation (ifNg, ECP) in blood serum and in supernatant of the induced sputum. it testifies about anti-inflammatory influence of ruzam. Conclusion. inhaled therapy with ruzam in a complex with iNCs basic therapy is an effective and safe method of treatment of persistent atopic bronchial asthma. This combination allows to reach clinical and functional control of ba faster and to reduce inflammation markers in blood serum and induced sputum.
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