??????????? ????????????? ??????? ?????? (????)

1
??????????? ?? ??????????? ?????????? ??? ????
????? ????????????????? ??????? ? ??????? ??????
????????

• II ???????????? ???????? ?????????????? ????????
• 28-30 ?????? 2011, ?.????
• ??????? ?. ?. ??????????????? ???????????
  ???????????

2

• ??????????? ????????????? ??????? ?????? (????)
  ???? ?? ???? ??????? ?????? ?????????? ?? ????
  ????
• ????????? ????????????? ??? ???????????? ???????
  ???? ???????? ?????? ?????? ????????????????? ?
  ??????????? ? ????????? ??? ??????????, ? ?????
  ?????????? ?????, ??????????? ??????? ???????
• ? ???? ????? ????? ???????? ???????
  ????????????????? ? ???? ? ???????? ?? ????????

3
??? ????? ?????
?????????? ?????????? ?? ???????????
????????????? ??????? ?????? (Global Initiative
for Chronic Obstructive Lung Disease - GOLD)
?????????? ???? ???

• ?????????????? ? ????????? ??????????? ?
  ?????????? ????????? ???????????? ?????????,
  ??????? ????? ?????? ?? ??????? ????????? ?
  ?????????. ??? ???????? ?????????
  ??????????????? ???????????? ????????????
  ??????????? ?????, ??????? ????????? ?? ????????.
  ??????????? ???????????? ??????????? ????? ??????
  ????????????? ? ?????????????? ??????????????
  ?????????????? ??????? ?????? ?? ???????????
  ???????????? ?????? ??? ?????
• ???????? ???????
• ???? ?????????????? ? ????????? ???????????
• ??????????? ???????????? ??????????? ?????
  ????????? ?? ???????? ? ?????? ?????????????
• ???????? ???? ?????? ??????????? (?????????)
  ???????
• ???? ??????? ? ??????????? ??????????? ? ????? ??
  ???????? ???????????? ? ????????? ???????

Global Strategy for the Diagnosis, Management,
and Prevention of Chronic Obstructive Pulmonary
Disease, Global Initiative for Chronic
Obstructive Lung Disease (GOLD) 2009. Available
from www.goldcopd.com
4
???? ???????? ???????? ???????? ???
??????????????? ? ?????????

• ???? ??????? ? 210 ???. ??????? ?? ???? ???? ?
  ???????? ? 3 ???. ??????? ???????? (5 ????
  ??????? ? ????)1
• ?? ?????????, ? 2030 ???? ???? ?????? 3-? ?????
  ????? ??????? ?????? ?????? ?? ???? ????2
• ????????????? ????? ?? ???? ????????, ?? ????
  ???????????????? ??????????? ??????? ??????????
• ???????, ????????? ? ???? ??????? ???????, ? 17
  ??? ????, ??? ????????? ? ???? ?????? ???????3
• ??????? ??????? ??????? ????? ? ????????
  ??????????, ? ?????????, ????????????????3
• ???????? ??????? ???????? ??????
  ?????????????????? ????? ? ????? ? ??????????
  ???????????3

1. WHO. COPD Fact Sheet No 315. 2009. Available
from www.who.int/mediacentre/factsheets/fs315/en/i
ndex.html 2. WHO. Chronic respiratory diseases.
Accessed 2010. http//www.who.int/respiratory/copd
/burden/en/index.html 3. Wouters EFM. Respir Med
200397S3-S14.
5
???? ??????????? ? ?????????? ????????
???????????? ? ????????? ???????
???????
???????????? ?????? ? ????? ??????????
???????????? ?????? ??? ?????????
????
???????????????? ???? ? ?????????? ????????
Global Strategy for the Diagnosis, Management,
and Prevention of Chronic Obstructive Pulmonary
Disease, Global Initiative for Chronic
Obstructive Lung Disease (GOLD) 2009. Available
from www.goldcopd.com
6
???? ??????????????? ????????? ? ??????????
????????????
???????? ??????? ????????????
???????????????????
???????????????????
??????????? ??????? (??????) ??????? ??????,
????????? ??????? ???????? ??????????????
??????, ????????? ???????
????????? ????? ?????????????????
???????????(????., ???????? ??????,
????????-?????????? ???????????)
7
??????????? ?????????? ?????? ??????????? ???? ?
?????????? ????
???????? ?????????????? ??????
???
????????????
??????????
??????????
?-????????? CD8
?????????
??????????? ????????????????????? ?????????
????????? ??????????
?????????????????, ????, ?????, ????????
??????????
??????????? ??????????????????????? ?????
Barnes PJ. From Stockley RA, Rennard SI, Rabe K,
et al (Editors). Chronic Obstructive Pulmonary
Disease. Oxford, England Blackwell Publishing
2007860.
8
?????????? ??? ???? ?????????? ?? ?????????? ???
?????
?????
????????
????????????????? ????????
?????????? ?-????????? CD4 ?????? ??????
????????????????????
??????????? ??????????????????????? ?????
?????????
Global Strategy for the Diagnosis, Management,
and Prevention of Chronic Obstructive Pulmonary
Disease, Global Initiative for Chronic
Obstructive Lung Disease (GOLD) 2009. Available
from www.goldcopd.com
9
?????????? ??????????? ????? ????????? ? ?????
?????? ???????? ???? ? ????????????? ?? ????
?????????? ??? ???????
?????? I ?? GOLD
?????? II ? III ?? GOLD
?????? IV ?? GOLD
????? ??????????? ????? ? ?????????????
???????? ()
??????????
?????????
?????? CD8
Adapted from Hogg JC, Chu F, Utokaparch S, et al.
Thorax 20066196-97.
10
??? ????? ???????????
?????????? ?????????? ?? ???????????
????????????? ??????? ?????? (Global Initiative
for Chronic Obstructive Lung Disease - GOLD)
?????????? ?????????? ???

• "??????? ??? ???????????? ??????? ???????????,
  ??????? ??????????????? ?????????? ??????????
  ?????? ??????, ????? ?/??? ????????? ???????,
  ????????? ?? ????? ??????????? ?????????,
  ????????? ????? ? ????? ??????????? ?????????
  ???????? ??????????1
• ????? ???? ??????, ????????? ??? ??????? ??
  ????? ???????. ??????? ?????????? ???????
  ?????????????? ? ?????????????? ????? ??????????
  ???????? ??????????????2
• ?????????? ?????? ????????? ? ??????????
  ?????????????/???????? ???????? ?????? ?
  ??????????? ?????1
• ??? ??????????? ????????????? ?????? ????????
  ??????????3,4
• ????????? ????????? ???????? ? ??????? ??? ?????

1. Global Strategy for the Diagnosis, Management,
and Prevention of Chronic Obstructive Pulmonary
Disease, Global Initiative for Chronic
Obstructive Lung Disease (GOLD) 2009. Available
from www.goldcopd.com. 2. Seemungal TA,
Donaldson GC, Bhowmilk A, et al. Am J Respir Crit
Care Med 20001611608-1613. 3. Perera W, Hurst
JR, Wilkinson TM, et al. Eur Respir J
200729527-534. 4. Papi A, Bellettato CM,
Braccioni F, et al. Am J Respir Crit Care Med
200617311141121.
11
?????????? ????????????? ? ??????????? ?????
?????????????? ??????
This study shows that the numbers of neutrophils
was significantly increased during exacerbations
(Plt0.01).
??? ????????? ?? ?????????? ????
?????????? ? 1 ??2
Acute Exacerbation, Neutrophil
?????????? ???????
??????????
???????????? ?? Saetta M, Di Stefano A,
Maestrelli P, et al. Am J Respir Crit Care Med
19941501646-1652.
12
?????? ?????????? ???????? ?????? ?
???????????????? ???????????
???????????? ?? Wedzicha JA and Seemungal TA.
Lancet 2007370786-796. and Donaldson GC and
Wedzicha JA. Thorax 200661164-168.
13
??????? ???? ? ??????? ??????????
?????? ?? GOLD ??????? ?????????? ?? 1 ??? (????? ?? 1 ????????) ????????? ? ??????? ????????????
II 0,85 22
III 1,34 33
IV 2,00 47

• ???????????? ?? Hurst JR, Vestbo J, Anzueto A
  et al. N Engl J Med 20103631128-1138.

14
???? ????????????? ?? ????????? ?????? ?????????,
???????? ????? ? ?????? ???????????
Global Strategy for the Diagnosis, Management,
and Prevention of Chronic Obstructive Pulmonary
Disease, Global Initiative for Chronic
Obstructive Lung Disease (GOLD) 2009. Available
from www.goldcopd.com
15
???? ??????? ????

• ?????????? ?????????
• ????????? ????????????? ????????
• ????????? ????????? ????????
• ???????????? ? ??????? ??????????
• ?????????????? ???????????????? ???????
• ???????????? ? ??????? ??????????
• ?????????? ??????????

????????? ???????? ???????? ?????????
?????????? ?????? ??????? ???????
???????????? ?? Global Strategy for the
Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease, Global Initiative
for Chronic Obstructive Lung Disease (GOLD) 2009.
Available from www.goldcopd.com
16
?? ???? ???????????????? ??????????? ?????????
??????????? ??????????? ??????????????? ???????
?????? IV?????? ???????
?????? III???????
?????? II?????????
???1/????lt0,70 ???1 lt30?? ??????? ??????1
lt50?? ??????? ??????????? ???????????
???????????????
?????? I??????
???1/????lt0,70 30 ????1lt50?? ???????
???1/????lt0,70 50 ????1lt80?? ???????
???1/????lt0,70 ???1 80?? ???????
???????? ?????????? ???????(-??) ?????
?????????? ?????? ?????? ??????????
???????????????? ????????? ???????? (???
?????????????)
???????? ?????????? ????? ?????? ??? ??????????
????????????????? ??????????? ???????? (???
?????????????) ????????? ????????????
???????? ????????????? ???????????????, ???? ????
????????? ??????????
???????? ?????????? ????????????????, ???? ????
??????????? ?????. ???????????????. ????????
????????????????????????? ???????
Global Strategy for the Diagnosis, Management,
and Prevention of Chronic Obstructive Pulmonary
Disease, Global Initiative for Chronic
Obstructive Lung Disease (GOLD) 2009. Available
from www.goldcopd.com
17
?????????? ???4 ??????????? ? ???????????
??????????
18
???????????????-4 ?????? ?????? ???? ? ??????????
???
35 ????
???
Inflammation
??????????
???????????? ?? Rabe KF. Expert Rev Resp. Med
20104 543555.
19
??????? ???4 ??????????????? ? ????????
?????????????? ???????, ??????????? ? ??????????
????

• ??????????? ?????? ???????? ???

• ???????? ???????? ???

?????? ?????? 4, 7
??????? ????? ???.????? 1, 2, 3, 4, 5, 7
?????????? 4, 7
????????????? ?????? 1, 2, 3, 4, 5, 7, 8
?????????? 4, 7
?????????????? ?????? 2, 3, 4, 5
???????? 1, 3, 4, 7
????????? ????? 1, 3, 4
????????? 1, 3, 4, 5, 7
??????????????? ????? 1, 3, 4
?-?????? (CD4 ? CD8) 3, 4,
7
???????????? ?? Giembycz MA. Monaldi Arch Chest
Dis 20025748-64.
20
??????????? ????????????????? ????????? ???4
??????????
?????????
???????????

• ?????????????, ?????? ????????? ???

• ????????????????? ????????? ???4

• ????????? ?????? ???4D ??????, ??? ??????
  ??????? ???4

21
?????????? ???????? ?????? ?????????????
N-?????? ???????????? ???????????? ???????????
????? ????????? ? ?????
N-????? ????????????
???????????? ? ??????, ?????
???????????
?????, ?
Hatzelmann A, Morcillo EJ, Lungarella G, et al.
Pulmonary Pharm Therapeutics 201023235-256.
22
??????????? ?????? ?????? ???????? ?????????? ?
???????? ???????
????? ????? ??????????
???????? ???????????
IL-8
????????? ????? ??????????
????????? ??????? ???????? ??????????
???????????
???????
Grootendorst DC, Gauw SA, Verhoosel RM, et al.
Thorax 2007621081-1087.
23
??????????? ??????? ?????? ???1 ?? ? ?????
?????????? ????????????????
???1 ?? ?????? ????????????????
???1 ????? ?????? ????????????????
??
??
???????
???????
???????????
???????????
????????? ???1 ?? ????????? ?????? (??)
Grootendorst DC, Gauw SA, Verhoosel RM, et al.
Thorax 2007621081-1087.
24
????????????? ???????????? ? ???????????
?????????????
25
RECORD 6-???????? ???????????? ? ?????????????
???

• - ??????????????, ??????? ??????,
  ?????????????????, ??????? ??????????????
  ???????????? III ????
• - 1 411 ??????? ? ???? ??????? ??????? ? ???????
  24 ??????

24 ??????
?????? ?????????4 ??????
?????? ??????????
??????????? 500 ??? 1 ?/???
??????? 1 ?/???
??????????? 250 ??? 1 ?/???
??????? 1 ?/???
??????????? ??? ????????????? ??????????????????
? ????????? ????????? ???????? ??????????? ?
?????????? ????
Rabe KF, Bateman ED, ODonnell D, et al. Lancet.
2005366563-571.
26
RECORD ??????????? ??????? ??????? ?????? ?
????????? ? ????????? ? ??????? ????
??????????? 500 ???
??????????? 250 ???
??????? ????????? ?? ????????? ?????? ??? ???1
????? ?????? ???????????????? (??)
???????
????? (??????)
plt0,05 ??? ????????? ? ???????? ???????
Rabe KF, Bateman ED, ODonnell D, et al. Lancet
2005366563-571.
27
RECORD ??????????? ???????? ??????? ??????????
? ????????? ? ????????? ? ??????? ????
??????? ????? ?????????? ?? 1 ????????
??????????? 250 ???
??????????? 500 ???
???????
Rabe KF, Bateman ED, ODonnell D, et al. Lancet
2005366563-571.
28
???????? ????????? ????????? ? ?????? ???????????
????????????

• ??????? 40 ???
• ???? ?? ??????????? ATS (M2-111) ??? GOLD
  (M2-112)
• ????????? ???1/???? (????? ??????
  ????????????????) 70
• ???1 (????? ?????? ????????????????) 50 ??
  ???????
• ????????????? ?????????? ??????????? ?????
  (?????? M2-112)
• ??????? ? ??????? ??? ?????????
• ?????????? ?????????? ??????? ????
• ??????? ?????????? ? ???????? ?? ???????????

Calverley PMA, Sanchez-Toril F, McIvor A, et al.
Am J Respir Crit Care Med 2007176154-161. Martin
ez FJ, Calverley PMA, Goehring UM, et al. COPD7
2010 poster 12.
29
?????? ???????????? ?????? ?????? ????? ??????
??????? ?????????? ??? ??????? ?????????????

• ???????????? M2-111

• ???????????? M2-112

• ???????????? ?????? (??????????????)

???????
???????????
????? ?????????? ?? 1 ???????? ? ? ???
Martinez FJ, Calverley PMA, Goehring UM, et al.
COPD7 2010 poster 12.
30
??????????? ?????????? ??????? ??????? ?????? ?
12-???????? ??????????? ?????????????

• ???1 ?? ?????? ????????????????

• ???1 ????? ?????? ????????????????

???????
???????????
??????? ????????? ???1, ??
Calverley PMA, Rabe,KF, Goehring, UM et al.
Lancet 2009374685694.
31
? ?????????, ?????????? ???????????, ???????
?????? ?????????? ??? ????? 4 ?????? ???????

• ???????????? ?2-124

???????
???????????
??????? ????????? ???1 ????? ??????
????????????????, ?
??????????????????
?????, ??????
????????????? ???????? ????????
Adapted from Calverley PMA, Rabe,KF, Goehring,
UM et al. Lancet 2009374685694.
32
??????????? ?????????? ?????? ??????? ????????? ?
??????? ??????????

• ????????? ???????? ????? ??????? ??????????

??????? ??????? ?????????? ?? 1 ???????? ? ???
???????
???????????
Calverley PMA, Rabe,KF, Goehring, UM et al.
Lancet 2009374685694.
33
??????????? ?????????? ??????? ??????? ?????? ???
?????????? ? ?????????

• ???1 ????? ?????? ????????????????

• ???1 ?? ?????? ????????????????

?????????????????? ???????????
??
??
??????? ????????? ???1, ??
Fabbri LM, Calverley PMA, Izquierdo-Alonso JL
,et al. Lancet 2009374695-703.
34
??????????? ?? ???????? ??????? ???????????????
???????, ?????? ????????? ? ??????????? ???

• ??????????????? ???????????? ?????? ????????????
  M2-111 ? M2-112

????????????? ??????? ????????????? ??????? ??? ????????????? ??????? ??? ??? ??????? ??? ??? ??????? ???
????????????? ??????? ???????(n813) ???????????(n809) ???????(n546) ???????????(n518)
???????? ??????? ??????? 11 (1.4) 12 (1.5) 1 (0.2) 2 (0.4)
???????? 5 (0.6) 1 (0.1) 1 (0.2) 0(0.0)
???????? 27 (3.3) 19 (2.3) 3 (0.5) 6 (1.2)
????????? 45 (5.5) 28 (3.5) 9 (1.6) 9 (1.7)
???????????????? ??????
35
?????? ? ??????????? ????????
36
??? ????? ???????

• ?????????? (???????????) ?????? ???????????,
  ?????????? ????????????? ??? ??????? ????
  ????????????????????? ???????? ??? ????????? ?
  ??????? ????, ??????? ???????? ???????????? ?????
  ? ????????, ? ??????? ???????????? ? ????????,
  ?????????? ??????? ?????????????????
• ?????????? ? ??????????? ?????????
  ??????????????? 4 ???? (???4), ?????? ????????
  ????? ? ?????????? ?????????? ????????, ???????
  ??????? ?? ??????????? ??????????, ??????? ?
  ?????? ????

Daxas European SmPC. Available at www.Daxas.com
37
?????? ?????????? ????????????? ? ????????????
????????? ?????????

• ?????? ?????????? ??????? ??????? ?????????? ?
  ???????? ??????? ?????? ??? ?????????? ?
  ?????????????? ??????? ????????????????? ?
  ?????????
• ? ??????? ????
• ? ?????????? ???????????? ????????
• ? ??????? ???????????? ? ????????.

Daxas European SmPC. Available at www.Daxas.com
38
(No Transcript)
39
??????? ?? ????????!