The aim of our study was to assess the efficacy of high resolution computed tomography (HRCT) in detection of pulmonary signs of cystic fibrosis. We examined 55 CF children using CT.

The most frequent pulmonary findings were bronchiectasis — in 47patients (85 % ), bronchial wall thickening in 42 patients (76 % ), mosaic perfusion in 39 patients (71 % ), centrilobular nodules in 24 patients (38 % ), mucous plugging in 23 patients (42 % ). Less frequent findings were atelectasis in 15 (27 % ), lymphatic nodules enlargement in 12 (22 % ), bullae in 4 (7 % ), pneumothorax in 2 (3.6 % ) patients.

To evaluate reversibility of these disorders 9 patients were reassessed after the treatment, 13 patients were investigated repeatedly in 2 years. Serial CT scans allowed assessment of the evolution of pulmonary abnormalities.

The CT was found to be more accurate method than the routine chest X-ray examination when assessing spread, severity and dynamics of pulmonary lesions in cystic fibrosis patients.

Fifty-two children with cystic fibrosis (CF) were examined. An association between risk factors for mycosis and mycoallergosis occurrence in CF children was found. Clinical features of this patology were reviewed. A relation between systemic mycosis prevalence and CF severity was shown. Diagnosis criteria and management of mycotic infections and allergic complications in CF were developed.

Based on the long-term surveillance of 127 patients older than 15 yrs and 173 children aged 3 months to 15 yrs we concluded of the survival age of cystic fibrosis patients in Russia (16.9 ±1.1 yrs). Patients older than 15 yrs take 30.1 % of all the investigated patients. Under the adequate surveillance and treatment conditions 82.4 % of adult patients keep their social activity and only 17.6 % of the patients do not work and do not study.

We studied 21 children with cystic fibrosis (CF). W e carried out bronchial challenge tests with methacholine and histamine and revealed hyperreactivity in 18 patients. A comparative study was performed of the bronchial reactivity depending on the CF severity, the patients' phenotype, course of inflammatory respiratory process and co-existing allergic pathology, nose and digestive diseases.

In this study the morning (9 a.m.) and evening (6 p.m.) levels of noradrenaline (NA) and dopamine (D) were investigated by spectrofluorometry in breathing condensate (B P ) from 51 asthmatic patients (mean age 51.4  ± 1.5 yrs) and 13 healthy controls. 16 asthmatics had stage I of essential hypertension (EH), 15 — stage II, 20 patients had normal blood pressure. All patients were treated according to recommendations of Global initiative for asthma (GINA), 1993. Hypotensive drugs were not used. The evening level of NA excretion after exercebation of bronchial asthma (BA) was significantly higher in astmatics with stage I of EH (10.27 ± 4.50 mkg/l), than in astmatics with stage II of EH (1.42 ± 0.58 mkg/l) and control group (0.57 ± 0.42 mkg/l), p < 0.05. Morning level of D excretion before asthma treatment in all asthmatics was significantly higher, than in control group, and after treatment — in asthmatics with stage I of EH only (0.307 ± 0.119 mkg/ml), p < 0.05.

The data obtained suggested higher catecholamine excretion in asthmatics with stage I of EH. B P investigation could give valuable information about changes in catechoamine metabolism in patients with BA and EH.

The method of intermittent normobaric hypoxic therapy (INHT) was applied in 82 asthmatic patients to investigate the response of respiratory circadian rhythms to hypoxic stimulation. Results of the study showed that the INHT effect was appeared as a growth of average daily values of the lung vital capacity and forced expiration volume provided mainly by unidirectional changes in medium and small bronchi resistance. The achrophase synchronisation of the intrasystemic parameters and vanishing of the daily and the 12-h rhythms took place along with restoration of the blood oxygenation rhythm.

The lung volume and flow rate parameters of the morning chronotype responded to the hypoxic training by considerable changes in the phase values under insignificant dynamics of the quantitative rhythm parameters, such as amplitude and measure. On the contrary, the rhythm variations of the evening chronotype were characterised by great changes in the amplitude and the measure while the achrophase shift was unreliable.

The paper is concerned with bronchial asthma clinical features. Complications, co-existing diseases, clinical and pathogenic types of asthma are considered. Three hundred patients were examined. Treatment results were analyzed and commented. An improvement in the treatment of asthma patients using neural networks is offered.

The spectral analysis of the heart rate variability was performed to assess the autonomic nervous system activity associated with 49 asthma attacks in 19 asthma patients. The 24-h Holter ECG recordings during 5-min intervals for 2 hours before to 1 hour after each asthma attack were analyzed using the fast Fourier analysis. There were no changes in low and high frequency bands in 73 % of the cases. The high frequency band (0.15-0.40 Hz) reflecting the parasympathetic activity increased 10 to 40 min before the asthma attacks in 27 % of the cases. The low frequency band (0.05-0.15 Hz) reflecting sympathetic activity increased before the asthma attacks finishing in 37 % of the cases that was typically for the nighttime symptoms and the attacks with the previous increase of the parasympathetic activity.

The aim of this study was to assess an impact of different anti-inflammatory therapy modes on the quality of life in moderate to severe patients asthma and to choose the most optimal mode of the therapy.

A multi-center prospective comparative study of the therapy with fluticasone+salmeterol (Seretide Multidisk) and beclomethasone was conducted in patients with uncontrolled moderate to severe asthma. The study enrolled 130 patients with severe asthma and 241 patients with moderate persistent asthma. Seretide Multidisk was given to 82 severe asthma patients and 184 moderate asthma patients; beclomethasone was administered to 28 severe asthma patients and 57 those with moderate asthma.

Health-related quality of life was evaluated using the Russian versions of MOS Shot-form 36 -Item (MOS SF-36 ) "Shot-form questionnaire of health status assessment" and the specific Asthma Quality of Life Questionnaire (AQLQ) "Health-related quality of life questionnaire in asthmatic children".

The adequate anti-inflammatory therapy in moderate to severe asthma patients provides decreasing in frequency and severity of asthma symptoms and improves patient’s quality of life. The combined therapy (inhaled corticosteroids and long-acting p2“a 9 ° n'sts) resulted in the most significant improvement in clinical symptoms and general and specific life quality.

The long-term therapy of the asthma (during 12 weeks) makes the patients’ quality of life close to the population norms. The degree of improvement correlates with asthma control level. The most significant approximation of the quality of life to the population norms was achieved using the combined therapy with the inhaled corticosteroid and the long acting p2-agonist (Seretide Multidisk).

The study involved 287 BA patients (66 adolescents and 221 adults) aged 10 to 70 yrs, having BA symptoms not less once a week and peak expiratory flow rate less than 50 % of predicted values just before the study. The researchers questioned the patients and registered their drug consumption for the previous month effecting the airways. Then the patients were given Symbicort Turbuhaler 320/9 meg daily in mild BA and 640/18 meg daily in moderate to severe BA. Salbutamol was also used to solve the BA symptoms. The patients kept taking other basic antiasthmatic drugs if needed (cromones, antileukotrienes, long-acting theophyllines). To assess the treat­ ment efficacy we chose BA control degree scored according to ACQ questionnaire as the main parameter. To assess the economic efficiency we calculated the cost-effectiveness for the drug consumption before and after the study. The administration of Symbicort Turbuhaler was clinically and economically approved in patients need­ ed high doses of fluticazone (more than 500 meg daily) and economically justified in children and adolescents provided with its additional advantages (better complains, simple inhalation maneuver, adaptable dosing, etc.).

The study was designed to search efficiency and safety of the 3-rd generation glucocorticosteroid (GCS) budesonide (Benacort) as 0.05 % nebulized solution in patients with exacerbation of moderate bronchial asthma (BA). The study involved 18 males and 12 females aged 42 to 65 yrs suffering from BA for 3 months to 30 yrs, 27 of them completed the investigation. Three patients broke off the study because of unpleasant taste, sour throat, cough attacks during the inhalations. Before the study 22 patients had not received any basic therapy, 8 ones had been treated with inhaled GSC 600 to 1 200 meg daily or cromones. Starting the study all the patients had moderate exacerbations of BA.

The budesonide solution was inhaled via a nebulizer 1 000 to 2 000 meg daily. All the patients also received inhaled β₂-agonists. The efficacy of budesonide was evaluated with clinical picture, lung function parameters, need in β₂-agonists. The therapy with nebulized budesonide lasted 7 to 10 days. The full control of BA was reached in 5 (18 % ) of the patients, sufficient control was in 10 (37 % ) and partial control was obtained in 13 (48 % ) of them. There were not significant shifts in endogenous cortisol and glucose levels, arterial blood pres­ sure and heart beat rate parameters for the treatment period. So, this study demonstrated that the nebulized Benacort is highly effective and safe when used in patients with BA exacerbations. Combined administration of nebulized β₂-agonists and GCS is thought to be the alternative for systemic GCS and xanthines.

Sixty males with COPD were examined, their average age was 47.6 ± 1.13 yrs. The mild to moderate COPD patients were included into the 1-st group and the severe COPD patients were involved in the 2-nd group. Fifty one healthy volunteers were the control group, they were divided into the 1-st control group (35 nonsmokers) and the 2-nd control group (16 active smokers without bronchial obstruction). The endothelial function was searched using the reactive hyperemia test and the nitroglycerin test. An amount of desquamated blood endotheliocytes was detected with J.HIadovec's method (1978).

The COPD patients and the active smokers of the control group had the number of circulating endothelial cells significantly more than in healthy. The COPD patients and the 2-nd control group smokers also had reliably wider brachial artery diameter and lower level of flow-dependent dilation when compared with the healthy nonsmokers. So, the COPD patients demonstrated features of endothelium lesion and disorders of vasoregulating activity of the vascular wall requiring further investugation.

The aim of this study was to search cell structure of induced sputum (IS), activity of tripsin-like proteinase, elastase and their inhibitors: α₁-proteinase inhibitor, α₂-macroglobulin and acid-stable inhibitors in the IS and blood serum and of blood neutrophil activity in smokers and healthy nonsmokers.

We examined 67 healthy volunteers aged 19 to 42 yrs. The IS cytograms showed that the absolute amount of neutrophils and the percentage of lym phocytes were significantly higher and the percentage of macrophages was lower in smokers. They also had greater tripsin-like proteinase activity in serum and IS. The average cytochemical coefficient and the percentage of neutrophils with myeloperoxidase granules did not differ reliably in smokers and nonsmokers. There were quite strong positive correlations between smoking, neutrophils, lymphocytes, macrophages in IS and the tripsin-like activity in sputum and serum.

Tobacco smoking is known to play a major role in the pathogenesis of chronic bronchitis (CB). The aim of this investigation was to determine an influence of long-term tobacco smoking on lipid peroxidation (LP) processes, antioxidant activity, and immune status in 122 stable CB patients. The study group Included 60 "unconditional" smokers (the smoking history was 19.0 ± 0.7 pack-years). The control group consisted of 62 nonsmokers.

It was found that tobacco smoking resulted in activation of LP processes (an Increase in malonyldlaldehyde serum level) and to formation of a new oxidant-antioxidant balance at higher level of free radical oxidation. Smoking also had an immunosuppressive effect on local immunity (decrease In secretory IgA and lysozyme levels). Thus, the data obtained confirmed the Importance of smoking cessation in the management of CB patients.

Dynamics of parameters lung mechanics and gas exchange at the 123 patients with chronic obstructive bronchitis (C O B) on a background of treatment of an exacerbation of disease were investigated. W ere revealed significant positive (though also small on size) change of the majority of functional parameters. The variants of dependence of dynamics of parameters of the mechanics of breath and gas exchange from changes VC and FEV₁ are revealed, that enables to use these two parameters (most accessible in clinical practice) as criteria describing change obstructive syndromes and gas exchange at treatment of an exacerbation at the COB patients.

The study objective was to assess effects of inhaled nitric oxide (iNO) on pulmonary hemodynamics and gas exchange in patients with acute cor pulmonale due to acute exacerbation of COPD and to evaluate an optimal dose and factors predicting the response to iNO in these patients.

Fifteen patients (3 females, 12 males; mean age of 58.0 ± 6.4 yrs; FEV₁ 0.88 ± 0.24 L; PaO₂ 52.6 ± 3.5 mm Hg; PaCO₂ 49.4 ± 8.2 mm Hg) with acute exacerbation of COPD, not requiring respiratory support were involved to the study.

Oxygenation and haemodynamic variables were measured initially against the supplemental oxygen back­ ground and then 15 min after each sequential addition of 10, 20, and 30 ppm iNO to the gas mixture. The patients were considered as responders if the mean pulmonary artery pressure (Ppa) or the pulmonary vascular resistance (PVR) decreased by 20 % . An electrochemical gas sensor device PrinterNOx provided continuous analysis of nitric oxide and oxidative nitric oxide products.

There was an improvement in haemodynamic variables during the iNO inhalations: Poa decreased from 36 ± 6 to 28 ± 3 mm Hg, PVR decreased from 371 ± 83 to 249 ± 49 dyne sec/cm^-5 (all p < 0.01), the cardiac index did not change. There was a mild but significant improvement in oxygenation at 10 ppm iNO ( P a 0 2 increased from 64 ± 6 to 6 8 ± 9 mm Hg, p < 0.01, and Qs/Qt reduced from 23 ± 5 to 20 ± 4 % , p < 0.05), Pa C 0 2 remained unchanged. Twelve patients (80 % ) responded to iNO. The ¡NO-induced decrease in Ppa and PVR correlated positively with the basal Ppa and PVR (all p< 0 .01 ) and negatively with the basal pH (all p < 0.05).

Conclusion. Our data show that iNO improves the pulmonary hemodynamics and oxygenation in patients with acute exacerbation of COPD and that the optimal iNO dose for the treatment of both pulmonary hyper tension and hypoxemia was 10 ppm. The response to iNO was greater in patients with more severe pulmonary hypertension and respiratory acidosis.

Pulmonary hypertension and chronic cor pulmonale are the most important consequences of bronchial obstruction in COPD. Effects of typical bronchodilating therapy on the pulmonary artery haemodynamics are quite uncertain.

The aim of this study was to search effects of long-term inhaled bronchodilating therapy on the pulmonary artery hypertension (PAH) in patient with COPD. The study involved 60 patients with 2 to 3 stage COPD and pulmonary artery pressure (PA P) higher than 20 mm Hg treated with Berodual 2 doses 4 times daily for 24 weeks. When having FEV₁ less that 50 % of predicted values, patients received the drug via a nebulizer. The main COPD symptoms (cough, sputum, dyspnoea, wheesing) were scored. We also used spirometry, chest X- ray, ECG and Doppler echocardiography.

On the 24-week therapy the main symptoms reduced from 7.6 ± 0.4 до 1.6 ± 0.2 numbers (p < 0.05), the PAH dropped from 32.3 ± 0.8 до 23.2 ± 1.2 mm Hg (p < 0.05). The ECG and the chest X-ray examination appeared to be not quite valuable to detect PAH. Therefore, the Doppler echocardiography is thought to be used to diagnose PAH in COPD. As far as the long-term bronchodilating therapy resulted in the PAP decrease, it should be included to an algorithm of managing COPD patients with PAH.

Comparative efficacy of long-tem treatment with Erespal (fenspirid, Servier) and Atrovent as the basic therapy of patients with COPD exacerbation was studied. The patients with clinical and laboratory signs of COPD exacerbation were involved in the study. Patients treated by oral or inhaled glucocorticosteroids, with severe concomitant diseases and with acute exacerbations of chronic co-existing diseases were excluded. The patients were randomized into 2 groups: the 1-st group patients (n = 35) were treated with Erespal 160 mg daily during 3 months, the 2-nd group patients (n = 32) were treated with Atrovent 40 meg 3 to 4 times daily. The efficacy was evaluated by visual scoring of cough and dyspnoea severity, sputum volume, elastase-like and tripsin-like serum and sputum activities, TNF-a serum and sputum levels, lung function parameters, cell number in induced sputum and bronchial mucus brushing. A reliable improvement (p < 0.05) in clinical symptoms was observed in both the groups at the end of the treatment, but the dyspnoea decreased reliably (p < 0.05) only in the patients treated with Erespal. The lung function parameters were considerably improved (p < 0.05) in both the groups. The elastase-like and tripsin-like serum and sputum activities and the TNF-a serum and sputum levels were significantly decreased (p < 0.05) only in the patients treated with Erespal. The neutrophil number was reliably decreased (p < 0 .0001 ) and macrophages number was reliably increased (p<0 .0 0 0 1 ) in the induced sputum, atrophic and proliferating bronchial epithelial cell counts were reliably decreased (p < 0.05) in the 1-st group patients compared with the 2-nd group. Thus, Erespal is effective antiinflammatory drug for treatment of COPD patients. Persisting bronchial inflammation at clinically stable period (after 3-month therapy) is a reason to include Erespal in the basic therapy of COPD.

The article presents results of gas exchange study at rest and under exertion and echocardiography data of 32 patients with chronic obstructive bronchitis (COB).

Reduction in gas exchange parameters under the exertion and limitation of functional and adapting capacity of the respiratory system in all the COB patients were found to precede ventricular diastolic dysfunction that allows predicting this complication. An increase of diffusion disorders severity is regularly accompanied by worsening of the left and right ventricles dysfunctions as well as by growing of pulmonary arterial pressure and the myocardial weight.