The use of exogenous surfactant in pulmonological practice

Abstract

A lung surfactant is a complex mixture of lipids and proteins necessary to maintain proper lung function. Drug changes play an important role in chronic lung diseases such as chronic obstructive pulmonary disease, bronchial asthma and idiopathic pulmonary fibrosis. The purpose of this article is to substantiate the use of exogenous surfactant in various respiratory diseases, based on the analysis of publications in domestic and international medical journals, as well as their own experience of application in real clinical practice. This review primarily discusses the contribution of pulmonary surfactants to maintaining homeostasis of the respiratory system; optimal delivery routes; differences between natural and synthetic surfactant; diseases associated with impaired surfactant production, such as idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, acute respiratory distress syndrome, pulmonary alveolar proteinosis, cystic fibrosis. Special attention is paid to the immunological properties of specific proteins of surfactants A and D, their effect on protection against respiratory viral infection. Data on the direct effect of exogenous surfactant on pulmonary function, an increase in post-bronchodilation FEV1 and FVC are presented. Special attention is paid to the use of surfactant in the new coronavirus infection COVID-19. Pharmacological and therapeutic strategies to improve pulmonary surfactant dysfunction can prevent alveolar collapse, reduce the proinflammatory response, and limit viral infection. Currently, the use of surfactant preparations for the treatment of various respiratory diseases is being studied in several clinical trials, which will significantly revise the understanding of the therapeutic possibilities of an exogenous surfactant and expand its application areas.