?????????? ?????????? ??? ???????? ??????? ? ?? ??????????? :?????????? ?????????? ??? ???????? ??????? ? ?? ??????????? 15 ???? 2009 ?. ? ??????? ???????? ??????????? ???????????? ??????????????? ??? ??. ?.?. ????????


???????? ??? ???????????? ?????? :???????? ??? ???????????? ?????? ???????? ??? ?????? ???????????? ?????????? GINA ???????? «??????» ?? ??????????? ???????? ?????? ???????????? ? ???????????: ? ???????????? GOAL ?????? ???????? ??? ???????????? ?????????? ? ??????? 13-14 ?????? ? ???????? ? ?????? ????????? «??????» ???? ???????? ?????????? ????? ? ??????? ?????????? ???? ?????????? 27% Bateman ED et al. Allergy 2008: 63: 932–938


??? ???????? ???????? ??? ??????????? :??? ???????? ???????? ??? ??????????? ????????????? ??? ????? ??????????? ???????: ?????????? ???????? ??? ?????????? ? 5 ??????????? ?????????????, ????? ??????? ? ????????? ???????????? ???? ? ?????? ??????????????? ??? ????????? ???????????? ?????????? ??????? ???????? ??? ??????


????????? ? ??????? ???????????? ?????????? ??????? ???????? ??? ?????? «??????» :????????? ? ??????? ???????????? ?????????? ??????? ???????? ??? ?????? «??????» Dahl R. et al. Respir Med, 2006; Vol. 100: 152–1162. Aalbers R at al. Current Med Res and Opinion VOL. 20, NO. 2, 2004, 225–240 Kuna P et al. Abstract presented at the ERS Congress 2006 Bousquet J. et al. Abstract presented at the ERS Congress 2008 Vogelmeier C. et al. Eur Respir J 2005; 26: 819–828


???????? ????? ? ???????????: :???????? ????? ? ???????????: ???????? ????? ?????????? ???????????? ????????????? ???????? ??????? ???????????? ??????????????? ???????


???????????? ?????????? ??(?????? 6-?? ???) :???????????? ?????????? ??(?????? 6-?? ???) ?? ????????? ? ???????? ?????? ???. ??? (n=3765) ????????????? SMART ??????? ???? ?????????? ?? 43%* ?? ????????? ? ???????? ?????? ???????? ? ?????????? (n=4680) ?????????? SMART ??????? ???? ?????????? ?? 29%* ??????? SMART – ???????? ??????????? ?????? ???????????? ?????????? * - P<0,001 O’Byrne PM, Bateman ED. Poster ERS 2008


Slide 7:O’Byrne PM, Bateman ED. Poster ERS 2008 ??????? ???????????? ????? ???????? «??????» ???????? ????? ? ??????? ??????? = ????????? ? ????????????? ???? ??????? = ????????? ? ????????????? ????, ?? ????????? ? ?????? SMART ?? 29% ????? ??????????.


???????????? ????????, ??? SMART ????? ???????????? ??? ??????????? ???????? :???????????? ????????, ??? SMART ????? ???????????? ??? ??????????? ???????? SMART ??????? ?? ?????????? ??. ????? ????????? SABA ?? ??????????? ? ????? ?? ?????? ????????????


???????????? ????????, ??? SMART ????? ???????????? ??? ??????????? ???????? :???????????? ????????, ??? SMART ????? ???????????? ??? ??????????? ???????? Sears et al., Eur Respir J 2008 - 14% p=0.0036 SMART ??????? ?? ?????????? ??. ????? ????????? ??? ??????????? ????????? ? ?????? SMART ?? 14% ????, ??? ? ?????? ??????? ?????????? ??????? ???????? ??????????? ??????????


????? ??????? ????????????? SMART ?????????? ?? ???? ?????????? ????? ?????? ??? ??? :????? ??????? ????????????? SMART ?????????? ?? ???? ?????????? ????? ?????? ??? ??? Sears et al., Eur Respir J 2008 - 26% p=0.0001 SMART ??????? ?? ?????????? ??. ???? ???? (? ????????? ?? ???) ? ?????? SMART ????????? ?? 14% ????, ??? ? ?????? ???????, ?????????? ??????? ???????? ??????????? ??????????


???????????? COMPASS :???????????? COMPASS 2143 ??????? ? ??????? ???????????? ?????? ????????? SMART vs ??????? ? ????????????? ???? ? ?????? SMART ?? ????????? ? ?????????: ???? ?????????? ?? ?? 33% ???? ???? ?????????????? ?? 31% ???? ??. ???? ??? ?? 32% ???? Kuna P et al. Int J Clin Practice, 2007


???? ???? ??? – ???? ??????? ?? ???????: :???? ???? ??? – ???? ??????? ?? ???????: ?? 1 ???. ?????? ????? ?????????? ? ???: ??????? ?????????? – 119 ??????? ??????? ??? – 152 ??????? ????????? SMART – 192 ??????? ????????????? ?????? ?????????? 160/4,5 – 120 ??? ????????? ??????? ??????? ??? ?? 7-14%.


???????? ????? ?????????????? ????????? ??????????? ????????? ????? ????? ???????????? ????? :???????? ????? ?????????????? ????????? ??????????? ????????? ????? ????? ???????????? ????? 19 929 ???. 118 134 ???. 24 039 ???. 3 840


59% ???? ???????, ??????? ???????? SMART ?? ?????????? ?????????????? ????????? :59% ???? ???????, ??????? ???????? SMART ?? ?????????? ?????????????? ????????? % ???? ? ??????????? ????????? ?? ??????????? 0 20 40 60 80 0 1 - 2 >2 >4 ????? ????????? ?? ??????????? ? ???? >6 0.8 SMART-??????? ??????????? 2197 ??????? (???????????? STEY, STEAM ? STEP) 3 13 28 59


???????, ??????? ???????? SMART, ?????????? ?? ??????? ?? ????????? ? ??????? ?? ????? 1-? ?????????????? ????????? ?????????? ? ???? :???????, ??????? ???????? SMART, ?????????? ?? ??????? ?? ????????? ? ??????? ?? ????? 1-? ?????????????? ????????? ?????????? ? ????


????? ????????? ??????? ?????: :????? ????????? ??????? ?????: ??????? ???? ???????? ???????? ??????? ??????? ???????????? ??? ?????? ????? ?????????? ??????? ??????? ? ???????????????? ????????????? ????? ??????? ? ??????? ???????? ?? ????????? ?? ???????? ????? ?????????? SMART


????? ?? ???? ? LABA ? ?????? ??????????? ???? ????????????? SMART? :????? ?? ???? ? LABA ? ?????? ??????????? ???? ????????????? SMART? ????? ???????, ??????? ???? ? LABA ????????? ? ???? ????????? ???????????, ??????? ?? ????????? ??? (???-?????, ?????????? ?????????? ??????? ? ?????? ??? ???????). ?????????? LABA ??? ???? ????? ???? ??????? ??? ???????? ? ?????? ??????? ???????????????


??? ????? ???????????? ????????? ??? ???????? ??????? ? ?? ???????????? :??? ????? ???????????? ????????? ??? ???????? ??????? ? ?? ???????????? ??????? ? ?????? ?????????????? ????????? ?? ?????????? ????????? ?? ?????? ?????? ???????, ?? ???????? ??? ?? – ??????????? ?????????? ???? ? ?? ?????????? ??????? ?? ???????? ??? SMART: ??????? ?????????? ??? ?????? ? ???? ??????? ?????? ????????? ??????????? ???? ????????? ? ??????????? ? ?????? ????????????


???? :???? ?? 1 (2 ? ??????? ? ??????? ?? - ?) ????????? ?????????? 160/4,5 ??? ????? ? ??????? + ????????? 160/4,5 ?? ?? ??????????? (? ????? ??? ???????????? ??????????? ??????? ?????????? ?? ????? 30 ?????????????? ??? ?????????? – ½ ????????) ????? ???? ?? ????? 12 ????????? ? ???? ?????????? ??, ????????? ?? ???? ????????????? SMART, ???????? ?? ????? ????????.