We searched dexamethasone influence on isolates of rat trachea and large bronchi under its short-term application. Dexamethasone 10^-7 —10^{- 5} g/ml did not change the exogenous acetylcholine-induced or histamineinduced smooth muscle basal tonus and contractility, but it decreased muscle responses to electric stimulation of nerve fibers and smooth muscle cells. The most response reduction (up to 76.0±4.7%) was noted under the stimulation of pre-ganglionar nerve fibers. The dexamethasone concentration of 10^-6 g/ml reduced the muscle responses caused by stimulation of the nerve fibers. The greatest changes were observed under the stimulation of the pre-ganglionar nerve fibers: 29.8±4.7% for 10^-5 g/ml of acetylcholine and 64.0±12.1% for 10^-6 g/ml of histamine. A gangliobloker entirely removed the dexamethasone effect under the acetylcholine-induced stimulation of the nerve fibers. It did not influence the dexamethasone effect under the histamine-induced stimulation of the pre-ganglionar nerve fibers and decreased the reactions caused by the stimulation of the post-ganglionar nerve fibers from 75.3±6.9% to 38.8±8.6%. Atropine wholly inhibited the dexamethasone influence on the drug under both types of the stimulation with acethylcholine or histamine application. We concluded that the elimination of bronchospasm resulted from the short-term application of dexamethasone is due not to its direct effect on the smooth muscle cells but to its interaction with the epithelial tracheobronchial receptors. This reaction is realised with different nervous ways under the exogenous acethycholine or histamine.

Treatment of acute asthma is based on rapid reversal of bronchoconstriction and arresting airway inflammation. This study was done to determine effects of intravenous magnesium sulfate for improvement of pulmonary function in patients with acute asthma not responding to routine therapy presenting in a pulmonary department.
This randomized double-blind controlled study was conducted on patients who did not respond to the routine therapy (the magnesium sulphate group, n=48, age 12 to 85 yrs, 26 men. 22 women; and the control (saline) group,n=33, age 15 to 80 yrs, 17 men, 16 women). Peak expiratory flow rate (PEF) was measured before infusion of magnesium sulfate (25 mg/kg) or normal saline solution (100 ml) as a baseline criterion and 30 min and 3 hr after. All the patients were also given bronchodilators. The main outcome parameter was PEF.
Findings were analyzed by χ² and f-test. Differences between the groups were considered significant at p<0.05. The PEF increased in the magnesium sulphate group in comparison with the saline solution group (82.60±5.8 versus 47.8±8.7; p=0.002) 3 hrs after the infusion.
The respiratory rate in the magnesium sulfate group was also increased at 30 min and 3 hr after the infusion. Cyanosis, diaphoresis and respiratory accessory muscles use by patients were decreased in the magnesium sulfate group in comparison with the saline solution group. According to the results, magnesium sulfate was suggested to be an adjunct agent for the treatment of patients with acute non-responding asthma.

ROC-analysis in determination of diagnostic importance of ventilation parameters in bronchial asthma patientsThe aim of this study was the ROC-analysis of diagnostic importance of the lung ventilation parameters: FVC, FEV₁, FEV_i/FVC, flow parameters PEF, FEF_25,50,75, FEF_25-75. The probabilistic approach was considered at this study as an alternative way against a widespread method of comparison of means to evaluate the diagnostic importance of the lung function parameters.
We examined 284 bronchial asthma (BA) patients and 101 persons as a comparative group. The BA patients were divided into 4 groups according to severity of their ventilation disorders (the dividing criterion was FEV₁% .
To assess informative values of the ventilation parameters in the BA patients we plotted ROC-curves, calculated their areas; we also used a "detectability" index. Then a correlative analysis was performed between this index and areas of the ROC-curves. There was a close positive correlation between these values. This fact allowed to recommend this method as an express-method to asses the diagnostic importance of the parameters instead of a more laborious method of the ROC-curves. According to the results of the ROC-analysis and index-based assessment the diagnostic values of the ventilation parameters in the BA patients were decreasingly graded: FEV₁, FEV₁/FVC, FEF₂₅, FEF₅₀, FEF_25-75, PEF, FVC, FEF₇₅.
The our data showed that the ROC-analysis of the diagnostic importance of the ventilation parameters in BA patients gives fuller and more demonstrative conception of diagnostic abilities of the parameters when compared with the method of comparison of means. This fact improves a reliability of diagnosis of the obstructive disorders.

We examined 112 patients with bronchial asthma (BA) of various severity. Twenty of them were diagnosed gastroesophageal reflux by esophagogastroduodenoscopy and esophagotonokymography. The 1^st stage reflux esophagitis was detected in 65%, the 2^nd stage was in 25% and the 3^rd stage was in 10% of the patients. A positive correlation was found between a stage of the reflux esophagitis and severity of lung functional disorders. The conventional treatment of BA resulted in improvement of the patients' status, decreasing in daytime asthma attack rate, but nighttime asthma attacks remained. Differential therapy of reflux esophagitis (diet, change of lifestyle, antacid and prokynetic drugs, high-dosing H₂ -blokers, blokers of the hydrogen pump or their combination with prokynetics) reduced the nighttime asthma attack rate by the 5^th — the 6 ^th day and controlled them in all the patients by the 3^rd week. The clinilcal signs of the reflux esophagitis disappeared and its endoscopic features diminished. Daily doses of BA basic therapy were decreased in some patients.

A new method is proposed to study intrapulmonary gas mixture based on acoustic evaluation of nitrogen washout time while transferring the air breathing to breathing with the gas mixture of 21% O₂  and 79% He. The study involving 12 healthy subjects and 14 chronic obstructive bronchitis patients made possible the quantitative assessment of the intrapulmonary gas distribution in an integral mode or separately for each the lung. The method is absolutely safe and may be used repeatedly to detect early disturbances of the intrapulmonary gas
mixture.

The purpose of this study was to evaluate reversibility of the airway obstruction in asthma patients using a method of spectral tussophonobarography permitting to perform the frequency analysis of cough sounds. As a result the cough sound spectrum was divided into 3 phases: the 1^st phase was due to quick opening of the larynx, the 2^nd, more continuous phase was relevant to the air output out of the lungs, the 3^rd, inconstant phase corresponded to the closure of the larynx at the end of the cough. The method showed significant changes of spectral and temporary parameters of the cough sounds before and after inhalation of a bronchodilator in asthma patients (common duration of cough, duration of each cough phase, frequency of maximal cough sound energy F_max, frequency containing 50% of the cough sound energy F_50%, q coefficient which is the ratio of total energy of low and middle frequencies to the energy of high frequencies). Thus, the spectral tussophonobarography is thought to be an objective method to evaluate the reversibility of the airway obstruction in asthma.

The study was designed to investigate pulmonary haemodynamics and to evaluate its role in dyspnoe occurrence in Chernobyl clean-up workers suffering from chronic bronchitis. The study involved 38 Chernobyl patients with chronic bronchitis observed in 2000-2002. The mean age was 48.1 ±5.1 yrs, their smoking history was 18.0±12.7 pack-yrs. A severity of dyspnoe was evaluated with the MRC questionnaire; body plethysmography, lung diffusing capacity test, 6 -MWT, echocardiography, bronchoscopy with transbronchial lung tissue biopsy were also performed. Results demonstrated that pulmonary hypertension develops in Chernobyl workers even without respiratory functional disorders. This fact is probably due to incorporation of radionuclide dust particles to the lungs and occurrence of radiation-induced pulmonary vasculitis. The elimination of the dust particles out of the respiratory system is thought to delay the pulmonary hypertension development.

Last years impulse oscillometry (IO) has become one of the most important methods to evaluate airway passability based on a measurement of various types of bronchial resistance. The aim of this study was to determine most sensitive IO parameters to diagnose bronchial obstruction in 3 years old children with bronchial asthma (BA). The most informative IO parameters correlating to FEV₁ were found which were resonant frequency (Fr), total respiratory impedance (Zrs) and its components: resistance and reactance at 5 Hz (Rrs5, Zrs5). Xrs5 and Fr were found to be the most sensitive parameters for obstructive syndrome detection. This method is sensitive and informative and can be used to monitor BA in infants when routine methods can not be applied.

The aim of this study was to evaluate nitric oxide (NO) and α₁-acid glycoprotein (AGP) with its glycoforms as biochemical markers of inflammatory activity in the airways of bronchial asthma (BA) patients. We examined expired breath condensate (EBC ) samples of 132 patients with severe (32) and moderate (30) BA and 30 healthy non-smoking volunteers using spectrophotometry to study NO metabolites and immunoassay to study AGP. The EBC NO metabolites levels were found to increase significantly in BA exacerbation depending on its severity. In stable BA patients the NO metabolites levels decreased but they were higher in severe and moderate BA than in healthy volunteers. The highest AGP concentration was measured in BA exacerbation with the maximal values in severe disease. In stable BA the AGP level decreased in all BA groups but it remained higher than in healthy volunteers. The qualitative structure of AGP changed during the BA exacerbation, especially in severe cases. So, according to our results the NO metabolites, AGP and its glycoforms reflect the airway inflammatory activity and can be applied to control the disease.

Six-year dynamics of epidemiology of bronchial asthma was analyzed in Novosibirsk according to a common standardized protocol of the "International Study of Asthma and Allergic Diseases in Children" (ISAAC) programme. The pathology spread was studied using a total surveying among first-form and eight-form pupils (the survey involved 7291 pupils 1996, 6631 ones in 1999 and 6943 children in 2002). The results showed stable spread of bronchial asthma symptoms among the senior and junior pupils and prevalence of mild asthma with rare exacerbations in both the groups. A progredient growth of severe asthma attack rate was noted in eight-form pupils. An increase in frequency of combined upper and lower airway pathologies was registered with reduction in skin atopy rate. A problem of underestimating of the pathology was discussed.

Characteristic features of history and clinical course of the disease, melatonin and nitric oxide production and thrombocyte functional activity were searched in 133 patients with aspirin-induced (Al) asthma. Control groups included 143 patients with non-AI asthma and 54 healthy volunteers. The Al asthma was found to be a specific pathology based on a reduction in the melatonin synthesis by the diffuse neuroendocrine (APUD) system cells. This fact causes simultaneous failure and imbalance of the nervous, endocrine, immune and other systems, functional disorders of the thrombocytes, the vascular system and the homeostasis in general and is accompanied by the asthmatic syndrome development. An increased sensitivity of the thrombocyte receptors and their perverted response on the melatonin and its metabolite having the chemical structure similar to that of the acetylsalicylic acid can be a background of intolerability to aspirin in Al asthma patients and to provide a progress of the disease. Epithalamine and epiphamine were shown to be pathogenic drugs for Al asthma.

Personal features, cerebral bioelectrical activity, vegetative regulation, bronchial hyperreactivity and lung function regulation were analyzed in 219 bronchial asthma patients. The detected disorders allowed to characterize two-staged neuro-respiratory disadaptation syndrome. The mild disorders (the 1^st stage) are described as adjusting overwork of neuro-regulatory systems. More severe disorders (the 2^nd stage) are less adaptive and enhance the disease resulting in ventilation disorders and bronchial hyperreativity.

An analysis of seeking the emergency care by asthma patients during the Asthma Program implementation (1995 to 2002) was performed in Smolensk. A close inverse correlation between number of patients receiving corticosteroids and their seeking the emergency care was found resulted from widespread adoption of inhaled corticosteroid therapy. During the 8-year asthma program implementation period numbers of calls to the emergency care service, emergent hospital admissions and patients seeking the emergency care reduced 3.1, 2.7, 2.2 times respectively.

The goals of the study were to investigate efficacy and safety of nebulized bronchodilators and suspension of Pulmicort (SP) in therapy of severe exacerbation of bronchial asthma (BA). The study involved 75 patients divided into 2 groups: the 1^st group with severe BA exacerbation (45 patients, 15 males, the mean age 56±12 yrs) and the 2^nd group with moderate BA exacerbation (30 patients, 12 males, the mean age 50±14 yrs). The patients received nebulized bronchodilators and SP 2 to 8 mg daily during 8 to 14 days.
The nebulized therapy with SP resulted in improvement of clinical signs to the 5^th-7^th day (p=0.04), reduction in the need of short-acting β₂-agonists 4-5 times (p<0.05), significant improvement of lung functional parameters (FEV₁ increased from 35.6±5.1 to 62.3±2.6% in the 1^st group and from 34.5±2.3 to 75.4±2.4% in the 2^nd group, p<0.05). Sa0₂ grew by 4.66%, p = 0.04. The steroid-dependent BA patients decreased doses of corticosteroids from 15.4 to 6.2 mg daily. The nebulized therapy did not cause considerable adverse events, calcium metabolism was not disturbed. Thus, the nebulized therapy with bronchodilators and S P in severe exacerbation of BA is highly effective and safe and can be considered as an alternative for systemic corticosteroids.

An analysis of influence of functional tests (6 or 12 breathings per minute) and inhaled fenoterol on the heart rate variability (HRV) was performed in 64 moderate bronchial asthma (BA) patients with subsiding exacerbation and in 42 healthy individuals. We evaluated FEV₁, PEF, FEF₅₀, FEF₇₅ and HRV using the frequency analysis. Enhanced sympathetic (in the 6 breathings per minute test) and parasympathetic influences (in the 12 breathings per minute test) on the chronotropic cardiac function were noted.
The sympathetic influence on the heart rate after the inhalation of fenoterol was shown in the BA patients. Combination of both the tests allowed to reveal latent disturbances of the sympathetic and parasympathetic components of the heart rate regulation in the BA patients (relative sympathetic and parasympathetic insufficiency). A reliable correlation was found between the parameters of the bronchial passability and HRV, which permitted to assume a united neuro-vegetative regulation of the cardiac-and-respiratory system.

To evaluate frequency, natural history and peculiarities of cardiac arrhythmia in patients with chronic obstructive pulmonary diseases (COPD) under occurring and progressing of chronic cor pulmonale (CCP) 226 patients were examined using daily ECC Holter monitoring, Doppler echocardiography, lung function tests, the blood gas analysis. The data obtained demonstrate a prevalence of supraventricular arrhythmia in COPD patients and suppose that the right heart hypertrophy and/or dilation and the right ventricular diastolic dysfunction greatly contribute to the natural history of supraventricular arrhythmia when CCP developing. Ventricular extrasystole seems to be caused by the left ventricular myocardial metabolic disorders due to the chronic hypoxia.

We examined 239 patients suffering from various lung diseases with obstructive (84 patients) and restrictive (155 patients) ventilation disorders and 109 healthy persons. Cardiorespiratory interrelation according to echocardiography and spirography in patients with the lung function disorders differed from that in healthy and depended on a type and severity of the ventilation pathology. The relationship between the heart and the lungs became closer in the obstructive type as the ventilation failure progressing and it weakened in the restrictive type. Moreover, there were stable relationships between all the heart parts and ventilation parameters which were more marked for FVC and FEV₁ in obstructive patients. On the contrary, the restrictive patients demonstrated stable interrelation between heart parameters and flow volume parameters of middle and mostly small airways which occurred in moderate stage of the disease.

The aim of this study was to search rate, features of course and diagnostic methods of cardiac-and-vascular pathology in patients with bronchial asthma (BA) and chronic obstructive bronchitis (COB) depending on their severity and also to perform a comparative analysis of clinical and functional disorders.
The study involved 113 BA and COB patients aged 30 to 70 yrs. They were divided into several groups according to the diseases severity based on the GINA criteria (2002) for BA and on the Federal programme (1999) for COB. The examination included cholesterol and р-lipoprotein levels, lung function tests, ECG, Holter ECG, the bicycle exertion test, echocardiography.
The results showed lipid metabolism disorders in any seventy of COB and moderate to severe BA. The myocardial ischaemia was found in 48% of the BA patients and in 58% of the COB patients and painless forms were registered in milder course of the diseases. A positive correlation was revealed between ventricular and supraventricular extrasystole rate and painless myocardial ishcaemia episodes in all BA and COB clinical groups. Echocardiographic parameters tended to worsening of disorders from initial stages of BA and COB to the 2^nd and the 3^rd stages.