В статье приводится обзор 170 источников иностранной литературы, отражающий современные взгляды на общее и различие аллергического ринита и бронхиальной астмы. Рассматривается частота заболеваний в различных странах мира. Анализируются методы лечения и качество жизни.
Ключевые слова: аллергический ринит, бронхиальная астма.
This article gives an overview of the 170 sources of foreign literature, modern perspectives on common and difference of allergic rhinitis and bronchial asthma. Is the frequency of diseases in various countries of the world. Examines the methods of treatment and quality of life.
Key words: allergic rhinitis, bronchial asthma.
В настоящее время аллергическим ринитом (АР) страдает до 40 % населения земного шара [38], причем независимо от региона проживания [2, 5, 7, 8, 13, 15, 27, 28, 29, 30, 34, 41, 46, 53, 54, 55, 61, 70, 74, 75, 82, 84, 87, 91, 92, 96, 100, 122, 130, 131, 135, 136, 137, 141, 146, 150, 158, 168]. Проблема увеличивающегося распространения аллергических заболеваний и АР в частности и бронхиальной астмы (БА) настолько масштабна, что было создано ряд обществ по их изучению: Международное Исследование Астмы и Аллергии у детей (ISAAC), Европейское Сообщество Обследование состояния здоровья (CCASHH), Международное Общество по изучению Зуда (International Forum for the Study of Itch), Всемирная Организация по Аллергии (WAO), Американская Академия Аллергии, Астмы и Иммунологии (AAAAI). Кроме того, была предложена классификации ARIA (аллергический ринит и его влияния на астму — Allergic Rhinitis and its Impact on Asthma).
Наиболее тревожно увеличение заболевания бронхиальной астмой. Бронхиальная астма — хроническое заболевание, в основе которого лежит аллергическое воспаление трахеобронхиального дерева. Так, только в США больше 15 миллионов человек, включая 5 миллионов детей, имеют эту опасную для жизни болезнь. Каждый год на больных астмой приходится почти 2 миллиона чрезвычайных посещений кабинетов врачей, 500 000 госпитализаций и более 5000 смертных случаев. Ежегодно астма обходится американскому обществу примерно в 4,5 миллиарда долларов.
Следует отметить, что, несмотря на огромный прорыв в изучении аллергии, на сегодняшний день нет достоверных сведений о частоте АР у больных БА (табл.).
Таблица
Процентное отношение ринита к бронхиальной астме
|
Авторы |
Страна, континент |
Число наблюдений |
% отношение ринита у астматиков |
|
Terreehorst I. et al. |
Нидерланды |
164 |
92 |
|
Linneberg A. et al. |
Дания |
743 |
100 |
|
Leynert et al. |
Франция |
850 |
78 |
|
Shamssain M. H., Shamsian N. |
Англия |
3000 |
53 у мальчиков 63 у девочек |
|
Celedon J. C. et al. |
Китай |
10009 |
6.2 |
|
Montnemery P. et al. |
Швеция |
12079 |
46 |
|
Leynaert B. et al. |
Европа |
90478 |
74–81 |
В этиологии АР придается большое значение домашней пыли и клещам [20, 132, 143], домашним животным [18, 88, 89, 90, 120, 121, 153, 159, 166], пыльце трав [93], профессиональным вредностям [42, 64, 80, 102, 113, 147, 149, 155, 156, 157], курению [6, 115], продуктам питания [19, 94, 95], бытовому газу [165], керосину как топливу в домашних условиях [151], загрязнениям внутреннего и наружного воздуха окружающей среды [58, 59, 52, 169]. По данным журнала Electromagnetic Biology and Medicine миру грозит эпидемия техногенного недуга — электрогиперчувствительности и к 2017 году ею будет страдать каждый второй человек планеты.
Продолжается накопление и анализ клинической оценки тяжести симптомов аллергического ринита [22, 33, 57, 79, 138, 144] и факторов риска развития БА [26, 73].
Дискуссионным остается вопрос влияния АР на течение БА [23, 67, 68, 101, 116, 117, 145], в том числе на функциональные возможности бронхов и легких [14]. Изучается влияние климатических условий на распространенность симптомов астмы, аллергического ринита и атопической экземы у детей [124, 160].
Систематически осуществляются публикации научных обзоров и клинических рекомендаций по современным вопросам, связанных с изучением и лечением АР и астмы [10, 25, 62, 103, 111, 123, 133, 163].
Предлагаются опросники по изучению АР и БА [12]. Так, в частности, шведскими исследователями [145] разработана и апробирована на большом числе населения карта исследования больных с АР и БА.
Проведено обследование близнецов, братьев и сестер по изучению у них распространенности аллергических заболеваний [97].
В Швеции проведено когортное исследование по изучению индекса массы тела у призывников с аллергическим риноконьюнктивитом и БА [27. 28, 29].
Показано, что клинические проявления АР весьма разнообразны, ибо он может поражать глаза [35, 60, 78, 92, 109, 112].
Изучаются клинические особенности астматических больных и роль хронического гиперпластического риносинусита и полипоза носа [72].
Ведутся исследования о состоянии женщин, больных БА во время беременности [81] и влияние сезонного АР на менструальный цикл [140].
В последние годы разрабатываются научно-методологические подходы к проблемам оценки качества жизни человека в различных разделах сферы деятельности человека, в том числе и медицины. Всё большее внимание обращается на экономическое развитие общества и качество жизни больных АР и БА [3, 27, 28, 29, 43, 77, 83, 88, 89, 90].
Исследования свидетельствуют о том [67, 68], что АР является независимым фактором риска для развития кашля помимо простуды среди взрослых. В этом направлении [134] проведено продольное исследование по изучению АР к появлению у человека рецидивирующего кашля и храпа во время сна.
Накапливаются сведения об изменении состава крови у больных с аллергическими заболеваниями [63, 125, 162], а также роль тучных и стволовых клеток на рецепторный аппарат носа [126].
Для уменьшения выраженности АР во время природного воздействия пыльцы растений и трав предлагается использовать специальные маски — «носовые фильтры» и очки [65, 108]. Даются рекомендации путешественникам по их поведению и методам защиты при природном воздействии аллергенов [4, 56].
Широко обсуждаются вопросы клинического применение и механизма действия различных лекарственных препаратов на больных АР [1, 9, 11, 17, 36, 47, 48, 50, 71, 104, 106, 114, 119, 127, 139, 152, 161], в том числе сублингвально [105, 107, 164] и специфической иммунотерапии АР и БА [37, 40, 66, 99, 154].
Проводятся исследования по изучению сезонной изменчивости бронхиальных клеток, верхних нижних дыхательных путей и мокроты у больных АР и БА [16, 21, 31, 32, 39, 44, 49, 51, 98, 117, 118, 128, 142].
Приводятся сведения о функциональном состоянии легких на фоне АР [45].
Рассматриваются вопросы наследственной расположенности к аллергическим заболеваниям [110].
Изучаются вопросы развития аллергии и астмы у младенцев и маленьких детей до возраста 7 лет с атопическим дерматитом, причем наметились перспективы решений [69].
Особого внимания заслуживают исследования роли уровней IgE человека с аллергическими заболеваниями [24, 76, 167].
Не обойдено вниманием ученых изучение экономических затрат на лечение аллергических заболеваний, в том числе АР и БА [129].
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