spbmedicalrecordsНовые Санкт-Петербургские врачебные ведомостиNew St. Petersburg Medical Records1609-2201Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова10.24884/1609-2201-2025-104-4-19-30spbmedicalrecords-112Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSДиагностика и лечение обострений бронхиальной астмыDiagnosis and treatment of bronchial asthma exacerbationshttps://orcid.org/0000-0003-1544-4336СергееваГ. Р.SergeevaG. R.

Сергеева Галина Раисовна, доктор медицинских наук, доцент кафедры пульмонологии

Санкт-Петербург

Galina R. Sergeeva, Dr. of Sci. (Med.), Associate Professor of Pulmonology

Saint Petersburg

Galina.Sergeeva@szgmu.ruСеверо-Западный государственный медицинский университет им. И. И. МечниковаРоссияNorth-Western Medical University named after I. MechnikovRussian Federation202521042026041930Copyright © Сергеева Г.Р., 20262026Сергеева Г.Р.Sergeeva G.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.docved.ru/jour/article/view/112

В статье обсуждаются современные представления о диагностике и лечении обострений бронхиальной астмы, имеющих высокое социально-экономическое значение. Рассматриваются принципы и подходы к терапии обострений астмы в зависимости от степени их тяжести в соответствии с актуальными национальными и международными рекомендациями.

Review is focused on modern approaches to diagnosis and treatment of asthma exacerbations as events of high socio-economic importance. Principles of management of patients with asthma exacerbations of different severity based on actual international and national recommendations are discussed.

бронхиальная астмаобострениядиагностикалечениеasthmaexacerbationsdiagnosticstreatmentReferencesМинистерство здравоохранения Российской Федерации. Клинические рекомендации: Бронхиальная астма. 2024. URL: https://cr.minzdrav.gov.ru/preview-cr/359_3?ysclid=m-fv64zharq871520387 (дата обращения: 14.10.25).Ministry of Health of the Russian Federation. Clinical guidelines: Bronchial asthma. 2024. Available at: https://cr.minzdrav.gov.ru/preview-cr/359_3?ysclid=mfv64zharq871520387 (accessed: 14.10.25). (In Russ.).Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma. Updated 2025. URL: www.ginasthma.org (accessed: 10.01.26).Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma. Updated 2025. URL: www.ginasthma.org (accessed: 10.01.26).Rodrigo G. J., Rodrigo C., Hall J. B. Acute asthma in adults: a review // Chest. 2004. Vol. 125, № 3. P. 1081–1102. https://doi.org/10.1378/chest.125.3.1081.Rodrigo G. J., Rodrigo C., Hall J. B. Acute asthma in adults: a review. Chest. 2004;125(3):1081–1102. https://doi.org/10.1378/chest.125.3.1081.Alvarez G. G., Schulzer M., Jung D., Fitzgerald J. M. A systematic review of risk factors associated with near-fatal and fatal asthma // Can Respir J. 2005. Vol. 12, № 5. P. 265–70. https://doi.org/10.1155/2005/837645.Alvarez G. G., Schulzer M., Jung D., Fitzgerald J. M. A systematic review of risk factors associated with near-fatal and fatal asthma. Can Respir J. 2005;12(5):265–70. https://doi.org/10.1155/2005/837645.Silver J. D., Sutherland M. F., Johnston F. H. et al. Seasonal asthma in Melbourne, Australia, and some observations on the occurrence of thunderstorm asthma and its predictability // PLoS One. 2018. Vol. 13, № 4. P. e0194929. https://doi.org/10.1371/journal.pone.0194929.Silver J. D., Sutherland M. F., Johnston F. H. et al. Seasonal asthma in Melbourne, Australia, and some observations on the occurrence of thunderstorm asthma and its predictability. PLoS One. 2018;13(4):e0194929. https://doi.org/10.1371/journal.pone.0194929.Kinoshita H., Kubota A., Kasuda S. et al. An autopsy case of asthmatic death--usefulness of biochemical examination // Vojnosanit Pregl. 2008. Vol. 65, № 5. P. 404–6. https://doi.org/10.2298/vsp0805404k.Kinoshita H., Kubota A., Kasuda S. et al. An autopsy case of asthmatic death--usefulness of biochemical examination. Vojnosanit Pregl. 2008;65(5):404–6. https://doi.org/10.2298/vsp0805404k.Romagnoli M., Caramori G., Braccioni F. et al. Near-fatal asthma phenotype in the ENFUMOSA Cohort // Clin Exp Allergy. 2007. Vol. 37, № 4. P. 552–7. https://doi.org/10.1111/j.1365-2222.2007.02683.x.Romagnoli M., Caramori G., Braccioni F. et al. Near-fatal asthma phenotype in the ENFUMOSA Cohort. Clin Exp Allergy. 2007;37(4):552–7. https://doi.org/10.1111/j.1365-2222.2007.02683.x.O’Byrne P. M., FitzGerald J. M., Bateman E. D. et al. Inhaled Combined Budesonide-Formoterol as Needed in Mild Asthma // N Engl J Med. 2018. Vol. 378, № 20. P. 1865–1876. https://doi.org/10.1056/NEJMoa1715274.O’Byrne P. M., FitzGerald J. M., Bateman E. D. et al. Inhaled Combined Budesonide-Formoterol as Needed in Mild Asthma. N Engl J Med. 2018;378(20):1865–1876. https://doi.org/10.1056/NEJMoa1715274.Papi A., Chipps B. E., Beasley R. et al. Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma // N Engl J Med. 2022. Vol. 386, № 22. P. 2071–2083. https://doi.org/10.1056/NEJMoa2203163.Papi A., Chipps B. E., Beasley R. et al. Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma. N Engl J Med. 2022;386(22):2071–2083. https://doi.org/10.1056/NEJMoa2203163.Bateman E. D., Reddel H. K., O’Byrne P. M. et al. As-Needed Budesonide-Formoterol versus Maintenance Budesonide in Mild Asthma // N Engl J Med. 2018. Vol. 378, № 20. P. 1877–1887. https://doi.org/10.1056/NEJMoa1715275.Bateman E. D., Reddel H. K., O’Byrne P. M. et al. As-Needed Budesonide-Formoterol versus Maintenance Budesonide in Mild Asthma. N Engl J Med. 2018;378(20):1877–1887. https://doi.org/10.1056/NEJMoa1715275.Reddel H. K., Barnes D. J., Exacerbation Advisory Panel. Pharmacological strategies for self-management of asthma exacerbations // Eur Respir J. 2006. Vol. 28, № 1. P. 182–99. https://doi.org/10.1183/09031936.06.00105305.Reddel H. K., Barnes D. J., Exacerbation Advisory Panel. Pharmacological strategies for self-management of asthma exacerbations. Eur Respir J. 2006;28(1):182–99. https://doi.org/10.1183/09031936.06.00105305.McKeever T., Mortimer K., Wilson A. et al. Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations // N Engl J Med. 2018. Vol. 378, № 10. P. 902–910. https://doi.org/10.1056/NEJMoa1714257.McKeever T., Mortimer K., Wilson A. et al. Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations. N Engl J Med. 2018;378(10):902–910. https://doi.org/10.1056/NEJMoa1714257.Richards R. N. Side effects of short-term oral corticosteroids // J Cutan Med Surg. 2008. Vol. 12, № 2. P. 77–81. https://doi.org/10.2310/7750.2008.07029.Richards R. N. Side effects of short-term oral corticosteroids. J Cutan Med Surg. 2008;12(2):77–81. https://doi.org/10.2310/7750.2008.07029.Cates C. J., Welsh E. J., Rowe B. H. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma // Cochrane Database Syst Rev. 2013. Vol. 2013, № 9. P. CD000052. https://doi.org/10.1002/14651858.CD000052.pub3.Cates C. J., Welsh E. J., Rowe B. H. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2013;2013(9):CD000052. https://doi.org/10.1002/14651858.CD000052.pub3.Siemieniuk R. A. C., Chu D. K., Kim L. H. et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline // BMJ. 2018. Vol. 363. P. k4169. https://doi.org/10.1136/bmj.k4169.Siemieniuk R. A. C., Chu D. K., Kim L. H. et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ. 2018;363:k4169. https://doi.org/10.1136/bmj.k4169.Perrin K., Wijesinghe M., Healy B. et al. Randomised controlled trial of high concentration versus titrated oxygen therapy in severe exacerbations of asthma // Thorax. 2011. Vol. 66, № 11. P. 937–41. https://doi.org/10.1136/thx.2010.155259.Perrin K., Wijesinghe M., Healy B. et al. Randomised controlled trial of high concentration versus titrated oxygen therapy in severe exacerbations of asthma. Thorax. 2011;66(11):937–41. https://doi.org/10.1136/thx.2010.155259.Patel B., Khine H., Shah A. et al. Randomized clinical trial of high concentration versus titrated oxygen use in pediatric asthma // Pediatr Pulmonol. 2019. Vol. 54, № 7. P. 970–976. https://doi.org/10.1002/ppul.24329.Patel B., Khine H., Shah A. et al. Randomized clinical trial of high concentration versus titrated oxygen use in pediatric asthma. Pediatr Pulmonol. 2019;54(7):970–976. https://doi.org/10.1002/ppul.24329.Hui D. S., Chow B. K., Chu L. C. Y. et al. Exhaled air and aerosolized droplet dispersion during application of a jet nebulizer // Chest. 2009. Vol. 135, № 3. P. 648–654. https://doi.org/10.1378/chest.08-1998.Hui D. S., Chow B. K., Chu L. C. Y. et al. Exhaled air and aerosolized droplet dispersion during application of a jet nebulizer. Chest. 2009;135(3):648–654. https://doi.org/10.1378/chest.08-1998.Travers A. H., Milan S. J., Jones A. P. et al. Addition of intravenous beta(2)-agonists to inhaled beta(2)-agonists for acute asthma // Cochrane Database Syst Rev. 2012. Vol. 12, № 12. P. CD010179. https://doi.org/10.1002/14651858.CD010179.Travers A. H., Milan S. J., Jones A. P. et al. Addition of intravenous beta(2)-agonists to inhaled beta(2)-agonists for acute asthma. Cochrane Database Syst Rev. 2012;12(12):CD010179. https://doi.org/10.1002/14651858.CD010179.Kirkland S. W., Cross E., Campbell S. et al. Intramuscular versus oral corticosteroids to reduce relapses following discharge from the emergency department for acute asthma // Cochrane Database Syst Rev. 2018. Vol. 6, № 6. P. CD012629. https://doi.org/10.1002/14651858.CD012629.pub2.Kirkland S. W., Cross E., Campbell S. et al. Intramuscular versus oral corticosteroids to reduce relapses following discharge from the emergency department for acute asthma. Cochrane Database Syst Rev. 2018;6(6):CD012629. https://doi.org/10.1002/14651858.CD012629.pub2.Kearns N., Maijers I., Harper J. et al. Inhaled Corticosteroids in Acute Asthma: A Systemic Review and Meta-Analysis // J Allergy Clin Immunol Pract. 2020. Vol. 8, 2. P. 605–617.e6. https://doi.org/10.1016/j.jaip.2019.08.051.Kearns N., Maijers I., Harper J. et al. Inhaled Corticosteroids in Acute Asthma: A Systemic Review and Meta-Analysis. J Allergy Clin Immunol Pract. 2020;8(2):605–617.e6. https://doi.org/10.1016/j.jaip.2019.08.051.Авдеев С. Н. Небулайзерная терапия суспензией Пульмикорта: место в лечении заболеваний дыхательных путей: метод. рекомендации для врачей. 2008. 2-е изд., перераб. и доп. 43 с.Avdeev S. N. Nebulajzernaja terapija suspenziej Pul’mikorta: mesto v lechenii zabolevanij dyhatel’nyh putej: metod. rekomendacii dlja vrachej. 2008. 2-e izd., pererab. i dop. 43 s. (In Russ.).Kornthatchapong K., Chatchairatanavej N., Chormai N. et al. Nebulised high-dose corticosteroids as add-on therapy for adults with asthma exacerbation: a randomised controlled trial // Emerg Med J. 2025. Vol. 42, № 2. P. 91–97. https://doi.org/10.1136/emermed-2024-213893.Kornthatchapong K., Chatchairatanavej N., Chormai N. et al. Nebulised high-dose corticosteroids as add-on therapy for adults with asthma exacerbation: a randomised controlled trial. Emerg Med J. 2025;42(2):91–97. https://doi.org/10.1136/emermed-2024-213893.Kelly A. M., Kerr D., Powell C. Is severity assessment after one hour of treatment better for predicting the need for admission in acute asthma? // Respir Med. 2004. Vol. 98, № 8. P. 777–81. https://doi.org/10.1016/j.rmed.2004.01.008.Kelly A. M., Kerr D., Powell C. Is severity assessment after one hour of treatment better for predicting the need for admission in acute asthma? Respir Med. 2004;98(8):777–81. https://doi.org/10.1016/j. rmed.2004.01.008.Kirkland S. W., Vandenberghe C., Voaklander B. et al. Combined inhaled beta-agonist and anticholinergic agents for emergency management in adults with asthma // Cochrane Database Syst Rev. 2017. Vol. 1, № 1. P. CD001284. https://doi.org/10.1002/14651858.CD001284.pub2.Kirkland S. W., Vandenberghe C., Voaklander B. et al. Combined inhaled beta-agonist and anticholinergic agents for emergency management in adults with asthma. Cochrane Database Syst Rev. 2017;1(1):CD001284. https://doi.org/10.1002/14651858.CD001284. pub2.Craig S. S., Dalziel S. R., Powell C. V. et al. Interventions for escalation of therapy for acute exacerbations of asthma in children: an overview of Cochrane Reviews // Cochrane Database Syst Rev. 2020. Vol. 8, № 8. P. CD012977. https://doi.org/10.1002/14651858.CD012977.pub2.Craig S. S., Dalziel S. R., Powell C. V. et al. Interventions for escalation of therapy for acute exacerbations of asthma in children: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2020;8(8):CD012977. https://doi.org/10.1002/14651858.CD012977.pub2.Ind P. W., Dixon C. M., Fuller R. W., Barnes P. J. Anticholinergic blockade of beta-blocker-induced bronchoconstriction // Am Rev Respir Dis. 1989. Vol. 139, № 6. P. 1390–4. https://doi.org/10.1164/ajrccm/139.6.1390.Ind P. W., Dixon C. M., Fuller R. W., Barnes P. J. Anticholinergic blockade of beta-blocker-induced bronchoconstriction. Am Rev Respir Dis. 1989;139(6):1390–4. https://doi.org/10.1164/ajrccm/139.6.1390.Alter H. J., Koepsell T. D., Hilty W. M. Intravenous magnesium as an adjuvant in acute bronchospasm: a meta-analysis // Ann Emerg Med. 2000. Vol. 36, № 3. P. 191–7. https://doi.org/10.1067/mem.2000.109170.Alter H. J., Koepsell T. D., Hilty W. M. Intravenous magnesium as an adjuvant in acute bronchospasm: a meta-analysis. Ann Emerg Med. 2000;36(3):191–7. https://doi.org/10.1067/mem.2000.109170.Reuben A. D., Harris A. R. Heliox for asthma in the emergency department: a review of the literature // Emerg Med J. 2004. Vol. 21, № 2. P. 131–5. https://doi.org/10.1136/emj.2002.003483.Reuben A. D., Harris A. R. Heliox for asthma in the emergency department: a review of the literature. Emerg Med J. 2004;21(2):131–5. https://doi.org/10.1136/emj.2002.003483.Ramakrishnan S., Russell R. E. K., Mahmood H. R. et al. Treating eosinophilic exacerbations of asthma and COPD with benralizumab (ABRA): a double-blind, double-dummy, active placebo-controlled randomised trial // Lancet Respir Med. 2025. Vol. 13, № 1. P. 59–68. https://doi.org/10.1016/S2213-2600(24)00299-6.Ramakrishnan S., Russell R. E. K., Mahmood H. R. et al. Treating eosinophilic exacerbations of asthma and COPD with benralizumab (ABRA): a double-blind, double-dummy, active placebo-controlled randomised trial. Lancet Respir Med. 2025;13(1):59–68. https://doi.org/10.1016/S2213-2600(24)00299-6.Homer-Bouthiette C., Wilson K. C. Noninvasive Ventilation in Acute Asthma Exacerbations: A Systematic Review // Ann Am Thorac Soc. 2025. Vol. 22, № 5. P. 776–784. https://doi.org/10.1513/AnnalsATS.202407-799OC.Homer-Bouthiette C., Wilson K. C. Noninvasive Ventilation in Acute Asthma Exacerbations: A Systematic Review. Ann Am Thorac Soc. 2025;22(5):776–784. https://doi.org/10.1513/AnnalsATS.202407-799OC.Авдеев С. Н. Респираторная поддержка при астматическом статусе. В книге: Клинические рекомендации. Бронхиальная астма у взрослых / под ред. А. Г. Чучалина. М. : Атмосфера, 2002. С. 130–155.Avdeev S. N. Respiratornaja podderzhka pri astmaticheskom statuse. V knige: Klinicheskie rekomendacii. Bronhial’naja astma u vzroslyh. Pod red. A.G. Chuchalina. Moscow, Atmosfera, 2002. S. 130–155. (In Russ.).Oddo M., Feihl F., Schaller M. D., Perret C. Management of mechanical ventilation in acute severe asthma: practical aspects // Intensive Care Med. 2006. Vol. 32, № 4. P. 501–10. https://doi.org/10.1007/s00134-005-0045-x.Oddo M., Feihl F., Schaller M. D., Perret C. Management of mechanical ventilation in acute severe asthma: practical aspects. Intensive Care Med. 2006;32(4):501–10. https://doi.org/10.1007/s00134-005-0045-x.Garner O., Ramey J. S., Hanania N. A. Management of Life-Threatening Asthma: Severe Asthma Series // Chest. 2022. Vol. 162, № 4. P. 747– 756. https://doi.org/10.1016/j.chest.2022.02.029.Garner O., Ramey J. S., Hanania N. A. Management of Life-Threatening Asthma: Severe Asthma Series. Chest. 2022;162(4):747–756. https:// doi.org/10.1016/j.chest.2022.02.029.Zakrajsek J. K., Min S. J., Ho P. M. et al. Extracorporeal Membrane Oxygenation for Refractory Asthma Exacerbations With Respiratory Failure // Chest. 2023. Vol. 163, № 1. P. 38–51. https://doi.org/10.1016/j.chest.2022.09.029.Zakrajsek J. K., Min S. J., Ho P. M. et al. Extracorporeal Membrane Oxygenation for Refractory Asthma Exacerbations With Respiratory Failure. Chest. 2023;163(1):38–51. https://doi.org/10.1016/j.chest.2022.09.029.

The authors declare that there are no conflicts of interest present.