The distribution of pro-inflammatory cytokine gene variants (tumour necrosis factor α-TNF, lymphotoxin — LTA, interleukin-1β — IL-1β) was studied in 139 patients with chronic obstructive lung disease (COPD) and in healthy individuals (n = 210). Analysis of -308G/A locus of TNF gene did not reveal significant difference between patients and controls (p > 0.05). It was observed that LTA genotypes were associated with COPD severity. Marked prevalence of AG heterozygous genotype was noted in patients with II and III COPD stages (59.7 % and 55.0 % accordingly), but IV stage COPD patients had increased frequency of GG homozygous mutant genotype up to 11.5 %. The GG genotype of the LTA gene in smokers strongly associated with more severe COPD (OR = 5.21,95%CI: 1.48-18.52). Among patients with -511C/T locus of IL-1β gene, 90.4 % had III and IV COPD stages. Thus, the T/T mutant homozygous patients had a 4.4-fold increased risk for very severe COPD development. TNF/LTA genotype combinations were determined for various COPD stages.

Morphologic examination of respiratory muscles in 71 cases using light and electronic microscopy and morphometry revealed respiratory muscle pathology in COPD patients with different severity of respiratory failure. Mild respiratory failure was characterized by dystrophic and hypertrophic changes prevailed, moderate respiratory failure showed predominant necrotic changes, severe respiratory failure was accompanied by fibrotic tissue spread in necrotic foci and in stroma. The greatest lesions were observed in the inner intercostal muscles, and the slightest ones were in the diaphragm. The morphometric study revealed shifts of the ratio of the parenchyma and stroma due to enlargement of the stromal component. Correlations were found between the latter parameters and FEV₁ (forced expiratory volume at one second).

A simple portable device for vibration drainage of the bronchi was designed. The device combines endobronchial vibration and dosed expiratory resistance. The device generates vibration with a definite speed dynamics improving the wave spreading. A clinical testing of the vibration drainage was performed in 64 patients with chronic obstructive lung disease. A positive dynamics of symptoms was revealed both in single and course application. This fact allows to conclude about the positive effect of vibration drainage on sputum clearance, bronchial obstruction and lung gas exchange.

This study was designed to investigate risk factors for occurrence of chronic obstructive pulmonary disease (COPD) in workers of a large engineering works (as an example, of the Chelyabinsk tractor works). The total number of workers tested was 2 010. A screening programme was created to examine workers. A close negative correlation was found between the smoking history and peak expiratory flow rate (PEFR) (p < 0.05), work length and PEFR (p < 0.05), workers' age and PEFR (p < 0.05). Chronic bronchitis was diagnosed in 22.4 % of the workers, and COPD was found in 7.3 %o. So, our results show that factors contributing COPD occurrence in industry workers are the work length, smoking and time of exposure to industrial pollutants.

Analysis of papers shows that treatment of patients with chronic obstructive lung diseases (COPD) requires a complex approach and a certain type of psychological addition to medication. A programme of medical-and-psychological rehabilitation based on results of investigation of clinical and psychological features of the patients was created to improve the treatment outcome. We performed a complex examination of 182 COPD patients. The results allowed to develop the programme of medical-and-psychological rehabilitation of the COPD patients which included positive information, regulated medication, and correction measures. This programme was tested in 112 patients. A statistically reliable tendency to harmonizing the consideration of the disease was noted. While applying the programme daytime and nighttime COPD symptoms and need in bronchodilators reduced in males and females, number of BALF neutrophils decreased and amount of alveolar macrophages grew. The statistical reliability of the results allows thinking that the treatment efficacy of the COPD patients is higher when using this programme. The programme can be applied by a group of specialists both in inpatient and outpatient facilities. The patients attending the educating course form a united supporting group.

To investigate reproducibility and repeatability of general parameters of impulse oscillometry (IOS) we performed 450 repeated measurements in 10 healthy persons (5 males, 5 females). The oscillation flows with frequencies of 5 to 35 Hz and pressure less than 0.2 kPa were laid on the normal tidal breathing. There were 3 phases of the examination with 60 min intervals for a day. Each phase included 3 to 5 measurements under the condition of normal tidal breathing. The examination repeated 5 times every 7 days. We measured respiratory impedance in the oscillatory frequency of 5 Hz, resonance frequency, resistance in the frequencies of 5, 20, and 35 Hz (R5, R20, R35), frequency dependence of the resistance, reactance in the frequencies of 5 and 35 Hz (X5 and X35) and the X5 deviation from the predictive values. Reference values according to J. Vogel and U. Smidt were used as predictive ones.

The results obtained were comparable with the mean square deviation of the respiratory impedance 0.25 gPa / L / s obtained by F.J. Landser et al. and it was less than the individual bios of components of the respiratory impedance according to A.I. Dyachenko's data. The reproducibility and repeatability of the general parameters of the impulse oscillometry increase the reliability and substantiation of functional diagnosis. They are necessary to determine disorders of the respiratory mechanics and to evaluate their follow-up dynamics.

The data on COPD spread in various regions are extremely inconsistent. One of", the most accessible methods to define the COPD prevalence is screening. Spirometry is a gold standard for COPD detection. The purpose of the present research was to study sensitivity and specificity of spirometry in diagnosing COPD. We examined 3 129 persons aged 17 to 80 yrs. (1 867 males and 1 262 females), pensioners and workers of various enterprises at the Kemerovo city. A great number of persons with reduced respiratory function parameters were found during the screening. After more detailed examination the diagnosis of COPD was verified in 5.4 % of the males and 1.1 % of the females. The disease was detected more often in drivers, railway workers and healthcare workers. According to the screening results the most sensitive diagnostic criterion was FEV₁ < 80 % and the most specific parameter was FEV₁ / FVC < 70 %. Being highly specific PEF < 80 % had low sensitivity. The increase in PEF higher than 90 °%o enhanced its sensitivity up to 88.6 % and its drop less than 70 % augmented its specificity up to 95.5 %o. The results allow to recommend the PEF < 70 % parameter as a diagnostic criterion of COPD in everyday outpatient work and PEF < 90 % as an indication for more detailed examination.

We have analyzed time of diagnosis of pneumonia complicated by exudative pleurisy and of tuberculous pleurisy at general care facilities. Causes of long diagnosis of lung inflammation and pleural effusion were revealed. Most often misdiagnosis was found. We emphasized the epidemiological danger of patients with tuberculous pleurisy pleurisy and МВТ in sputum. Organization of pleural pathology department using modern diagnostic techniques is thought to be reasonable to improve the diagnostic work-up.

Results of examination of 41 patients with pneumonia (23 patients in the study group and 17 ones in the comparative group) showed that fenspiride (Erespal) has a great positive effect in rehabilitation period. It is not a corti-costeriod but it reduced cough and sputum production, improved radiological data and peripheral blood parameters more actively than non-steriod anti-inflammatory drugs. The efficacy of fenspiride was higher in 30-day treatment compared with 15-day course. Fenspiride can be recommended for rehabilitation programmes in pneumonia.

An analysis of medical documents and morphological examination of resected lung samples was done in 25 children had been operated for repeated pneumonias. All the children (100 %) were diagnosed undifferentiated connective tissue dysplasia (CTD) with marked clinical features. Morphological substrate of the repeated pneumonias was various defects of the lung growth. The results showed that the CTD as a genetic systemic pathology provided repeated pneumonias in structural abnormalities of the lungs. This fact should be taken into account in the diagnostic work-up.

Recent guidelines on bronchial asthma treatment in children recommend early administration of anti-inflammatory drugs. But most asthmatic children in spite of following this recommendation do not reach the full asthma control that manifests as daily need in short-acting β₂-agonists. A randomized open trial in parallel groups was performed to investigate efficacy and safety of regular taking of formoterol (Foradyl) in children 5 to 11 yrs with mild to moderate asthma during 12 weeks compared with salbutamol as needed against the background of sodium cromoglycate 20 mg daily. Twenty-one mild to moderate asthma children finished the study. The long-term taking of formoterol (Foradyl) 24 mcg daily was found to improve morning and evening peak expiratory flow rate, to reduce daytime and nighttime asthma symptoms, to improve delayed outcome, to diminish direct expenses for a patient's treatment and was also safe.

The aim was to compare effects of salmeterol/fluticasone propionate 50/100 μg bd (FSL) via Discus™ device with fluticasone propionate (FP) 100 pg bd via Dischaler or beclomethasone dipropionate (BDP 200 pg bid) via Dischaler in 12-week multtcentre randomised controlled trial involved 250 symptomatic children aged 4 to 10 yrs with moderate to severe asthma who had previosly received beclomethasone dipropionate less than 400 pg daily or cromones. The treatment effectiveness was assessed using a dairy card including measurement of asthma symptoms, peak expiratory flow (PEF), need in short-acting β₂-agonists, and a patient's consideration of treatment. The patients receiving FSL had significantly more symptom-free days (64.8 ± 21.8) versus the patients receiving FP (55 ± 23.9, p < 0,05) or BDP (52 ± 24.8, p < 0.05). The FSL patients had fewer days with rescue medication (10.2 ± 12.6) in comparison with the FP (24.9 ± 21.7, p < 0.001) and the BD patients (23.8 ±20.1 p < 0.001). During first 4 weeks of the treatment the morning PEF rates were slightly higher in the FSL patients (114 ±7 % pred.) versus the FP ones (107 ± 8 %) and BDP (106 ± 8 %). Significantly more FSL children and their parents were satisfied with the treatment (97 %) compared with 82 % of the FP and 68 % of the BDP patients (p < 0.001). Children did not have problems using the dry powder inhalers Discus and Dischaler. Adverse events were found in 4 FSL, 7 FP and 12 BDP patients (cold, cough after inhalation, sore throat). These effects were not severe. Thus, the combined treatment with low-dose FP and SL was more effective than two-fold higher dose BDP and the single therapy with low-dose FP in pediatric asthma patients.

We interviewed 312 patients with diabetes mellitus and 545 patients with bronchial asthma to determine association frequency of asthma and diabetes mellitus in probands. The peak flowmetry monitoring was performed in the diabetes patients to assess daily bronchial lability, and the glycosylated protein level and the glucose tolerability test were made in the asthma patients. The results of the investigations did not show negative correlation between these two multifactoral diseases. The genetic predisposition to diabetes or metabolic syndrome in families appears to be a resolving factor for carbohydrate metabolic disorders developing in bronchial asthma patients.

We studied preventive effect of leukotriene receptors' antagonist Accolate on aspirin-induced bronchoconstriction in 18 patients with aspirin-induced asthma (AA) proved by a challenge test. The drug prevented the aspirin-induced bronchospasm in 14 patients and was ineffective in 4 ones having severe course of the disease including 2 of them with combination of AA and atopic asthma. Clinical efficacy of 4-week therapy with Accolate correlated with the test results: 4 patients had not experienced the preventive effect of the drug did not show positive shifts in their asthma course. The asthma attack rate significantly reduced in 14 patients, need in sympathomimetics dropped in 1.5 times. These findings allowed the predictive test to select patients for long-term therapy with Accolate. A significant increase in the supernatant C4, E4, and B4 leukotrienes outbreak was shown in all the AA patients after incubation of the leukocytes with aspizole initially and in 1 hour after taking Accolate.

The aim of the study was to assess abilities for achieving the control of the disease and to improve quality of life in moderate bronchial asthma using the Russian combined drug Biasten (“Pulmomed”) containing budesonid and salbutamol hemisuccinate. A comparative randomized open study involved 43 patients with moderate uncontrolled bronchial asthma (13 men and 30 women), of them 22 patients were treated with Biasten 2 inhaled doses twice a day, and 22 patients received equal doses of Benacort (budesonid) and Salben (salbutamol) during 12 weeks. Dynamics of clinical symptoms, peak flowmetry and flow-volume curve parameters, and daily need in β₂-agonists were evaluated during the treatment. Quality of life was assessed using the AQLQ questionnaire. Results demonstrated high clinical efficacy, safety, possibility of optimal asthma control, and improvement in quality of life in moderate asthmatic patients while taking the combined drug Biasten.