An influence of long-term atmospheric air pollution on health status in population of the Moscow Central district (CD) was studied in 1992-1999. A retrospective analysis of air condition monitoring data, respiratory diseases spread and mortality of them was performed. The leading air pollutants at the district during that period were nitric oxide, nitric dioxide, phenol and suspended particles.
An increase in the average annual concentration (AAC) of nitric oxide promoted a spread extension of chronic tonsil diseases in adults, chronic pharyngitis in adolescents and adults, allergic rhinitis and bronchial asthma in children and adults, and women's mortality of chronic bronchitis as well.
The AAC of nitric dioxide correlated directly with a growth of number of children with chronic pharyngitis and men's mortality of chronic bronchitis.
The AAC of phenol correlated directly with the spread of allergic rhinitis in adolescents and correlated inversely with morbidity of pneumonia in all age groups.
An increase in the AAC of suspended particles at the atmospheric air was directly associated with the growing number of children suffering from the chronic pharyngitis.
The study performed permits to conclude that the evaluation of the atmospheric air pollution should take into account a sensitivity of adults and children. The analysis of curve of exponential growth showed that the growth of respiratory diseases spread takes place if the AACs of the air pollutants exceeded certain levels. The further data accumulation will allow to define these threshold values to following detection the permissible AACs of atmospheric air pollutants.

The issues of early detection of occupational lung diseases and their prognosis are covered in this article based on modern methods for the assessment of cellular and serum-transferable immunity.
Clinical and immunological examination of 120 patients with industrial dust-related lung diseases and 72 healthy persons exposed to high concentrated industrial dust was performed the recent 3 years. Immune disorders were developing during the exposure period. The severity and specific features of these changes depended on fibrogenic activity of the dust particles. The cellular and serum-transferable immunity disorders were shown to be observed in patients exposed to industrial dust before radiological signs of pulmonary fibrosis and lung function disturbances appeared. After the cessation of the exposure the cellular and serum-transferable immunity parameters did not return to the normal level typical for healthy people.
Methods of clinical immunology make possible early detection and prediction of outcome of lung diseases caused by industrial dust exposure.

In order to improve the diagnosis of bronchoobstructive syndrome (BOS) an analysis of data of X-ray and computed tomography examinations and the complete respiratory function testing of 30 pneumoconiosis (PC) patients and 27 occupational chronic obstructive pulmonary disease (COPD) patients was performed depending on the dust type. The comparison of X-ray and computed tomography examination results was carried out to diagnose the pulmonary emphysema. Differences in the BOS manifestation in dependence on the dust type were revealed. Obstructive disorders were noted more often in welders’ PC than in silicosis patients. The functional disorders in silicosis depended on the irregular emphysema appearance. The BOS in COPD patients exposed to highly fibrogenic dust and in welders was characterized by general obstructive disorders, while in COPD caused by polimetallic dust the obstructive disorders were noted in the peripheral airways and were accompanied by the marked functional signs of the pulmonary emphysema.

The purpose of this research was to assess a significance of a computed dermography (CD) method to detect bronchoobstructive syndrome (BOS), to evaluate bronchial reversibility during a bronchodilating test in chronic obstructive bronchitis (COB) patients and to reveal bronchoconstruction in healthy smokers. Eighty four persons were observed: 30 healthy non-smokers (the control group), 24 smokers not having clinical manifestations of pulmonary diseases (the risk group), and 30 patients with COB of different seventy at the exacerbation stage. The bronchial reversibility was diagnosed using instrumental methods: CD, spirography, peakflowmetry. The CD method rejects the theory organ-point and investigates more complex relationships in contradistinction to other well-known reflex-diagnostic methods. The CD is easy, non-invasive and informative.
The control group was examined by the CD, spirography, peakflowmetry. Normal CD-criteria were found. The risk group was examined by the same methods before and in 5-10, 30-40, and 60-90 minutes after smoking. The CD method was found out to be an objective and more sensitive method which allowed to detect bronchoconstriction in smokers after smoking, while the results of the spirography and peakflowmetry were negative. The COB patients were examined before and in 30 minutes after the test with Berodual. As a result, the CD-criteria of the BOS were revealed. It was shown that the CD as more sensitive and objective method could be used equally to spirography and peakflowmetry to assess the bronchial reversibility in the COB patients and to choose bronchodilating therapy.

A radiological-and-bronchological room at the Republican clinical hospital was opened 18 years ago. The last 10 years when fibrobronchoscopy has become available we performed bronchological examination for 14,646 patients: 1003 of them received therapeutic peripheral bronchial catheterization, bronchographic procedure under a local anesthesia was made in 6819 patients and that under narcosis was done in 372 patients. Based on this experience we concluded that morphological validation of pulmonary diagnosis should become an inalienable part of the diagnostic work-up. The bronchoscopy should be available and be included into a necessary clinical examination of a pulmonary patient. This allows not only detection of malignant lesions but also revelation of respiratory tuberculosis more often than in a specialized institution. Besides the bronchoscopic rooms, organization of régional radiological-and-bronchological centres or rooms based on several régional hospitals is reasonable. If a doctor is informed of médical facilities' equipment and indications for an invasive diagnostic method and is aware of a danger of long-term observation of patients with uncertain diagnosis and test therapy he can create the optimal and economically bénéficiai diagnostic algorithm for any patient.

Lung defects are detected according to various authors' data in 0.15-50% of all lung pathologies. As a rule the defected lungs are subjected to viral and bacterial infections resulted in pneumonia at the defected field. There are a great problem to distinguish the lung defects and tissue deformations at productive inflammation areas. Our study examined 22 recruits aged 19.4±0.2 yrs at the initial 6 to 8 months of their military service. All the patients have had lower-lobe pneumonia 1 to 3 yrs before their call-up. When clinically recovering after repeated pneumonia during the active service, the patients underwent bronchography revealed bronchiectasis and the lung hypoplasia. Thirteen patients were made lobectomy. The macroscopic examination of the resected lobes confirmed the lower lobe hypoplasia in all the surgically treated patients. The histological examination revealed multiple signs of the bronchi and respiratory tissue growth defects with intralobar séquestration. Simultaneously exudative and productive inflammation features associated with the growth defects were found.

Sixty four bronchial asthma patients with clinical symptoms of gastroesophageal reflux (GER) were observed. Together with the general clinical examination the patients underwent acidogastrometric pH daily monitoring at the distal part of the esophagus and the measurement of main GER parameters. A treatment programme for GER correction according to its severity was created. It was found that the drug correction of GER not only reduced dyspeptic and respiratory signs but contributed to relieve the bronchial asthma course, to achieve the stable condition, to decrease the need in antiasthmatic medication.

Our aim was to investigate an effect of salbutamol on bronchial obstruction, lung hyperinflation and clinical signs in patients with severe chronic obstructive pulmonary disease (COPD).
Thirty three COPD patients (the average age was 58±2 yrs, FEV₁ was 27.2±1.9%, FEV₁/FVC was 33.7±1.6%) were examined using spirometry, body plethysmography; the breathlessness intensity was evaluated with a visual analogue scale (VAS), the exertion tolerance was assessed by 6-min walk test (6MWT) before and 15-20 min after inhalation of salbutamol.
There was a significant increase both in FVC and FEV₁ (10±2% and 4±1%, p<0.0001) after 200 meg of salbutamol but FEV₁/FVC ratio decreased by 0.6%. Salbutamol caused the reliable growth of lung volume values (VC, RV, FRC and IC changed by 9±1%, -18±3%, -9±1% and 9±1%, p<0.0001 for each). TLC did not change significantly (8.45±0.25 and 8.41 ±0.26 L). There was a considerable reduction in the breathlessness severity as measured by the VAS score (4.9±0.4 to 3.9±0.3, p<0.0004) and an increase in the exertion endurance (from 63% pred. to 66% pred., p<0.0065). Correlations were found between the clinical signs severity and the lung hyperinflation. Our data demonstrated that salbutamol caused a significant reduction in FRC and an increase in IC notwithstanding the absence of FEV₁, dynamics in majority of the COPD patients. The lung hyperinflation dynamics resulted in the breathlessness relief and the improvement of the exertion tolerance.

The present review discusses data on cellular mechanisms of interaction of beta-adrenergic agonists and glucocorticoids which are a basis of beneficial asthma therapy being inhaled in common. We show that besides inhibition of myosin light chains beta-agonists can influence the smooth muscle cells modulating the Ca²⁺-channels’ activity due to cytoskeleton's proteins, and regulate the smooth muscle cell contraction independently on proteinkinase A. Moreover, the beta-agonists are able to stimulate gene expression and to control the initiation of programme cell death (apoptosis) like steroid hormones do. In turn the steroids can beinvolved to the pathogenesis of bronchial asthma without the expression of genes controlling inflammatory reactions, while the beta-agonists effect the inflammation via production of extracellular cyclic AMP and adenosine.

The aim was to study efficacy and safety of combined drug fomroterol/budesonide (Simbicort Turbuhaler) in various doses in bronchial asthma patients.
Fifteen patients (7 females and 8 males) with controlled exacerbation of moderate atopic asthma aged 43 to 66 (51.1 in average) were observed. The first 2 weeks the patients used short-acting β₂-agonists if needed. Then they received Simbicort Turbuhaler 2 inhaled doses twice a day for 4 weeks and 1 inhaled dose twice a day for the following 8 weeks. Clinical sighs, quality of life (the AQLAQ questionnaire), lung function parameters (peakflowmetry, FEV₁) were assessed during the treatment period. Hydrogen peroxide (H₂0₂) concentration at the exhaled breath condensate was measured spectrophotometrically to evaluate the airway inflammation activity. The plasma cortizol concentration was determined with an immunoenzyme assay.
A reliable growth of the peak expiratory flow volume was noted at the 1st day of the treatment in 3 min after the inhalation of 2 doses of Simbicort Turbuhaler and kept for 12 h. During the further treatment with various doses of this drug a positive dynamics in the clinical sighs and the quality of life was noted. A significant increase in the lung function values was observed at the 14^th day of the treatment. A considerable reduction in the H₂0₂ concentration at the exhaled breath condensate was found at the end of the 3^rd month of the treatment which is probably due to the anti-inflammatory activity of the drug. The plasma cortizol level did not change.
The data obtained show the combination formoterol/budesonide (Simbicort Turbuhaler) to demonstrate a rapid action. It can be used to achieve and maintain an individual control for moderate asthma. The positive effect was distinctly reached to the end of the 3^rd month of the treatment that confirms the need of long-term application of the combined drugs. Therapeutic doses of Simbicort Turbuhaler were well-tolerated and did not give adverse effects.

This study was devoted to comparative clinical-and-economical analysis of levofloxacin and ceftriaxone/cefuroxime axetyl for treatment of community-acquired pneumonia. The study was based on results of the opened multi-center comparative randomized clinical trial of T.M.File, J.Sergeti, R. Player et al. (1997) which had demonstrated a statistically significant difference in the antibiotic effectiveness at the 5^th to 7^th days of the therapy. A sensitivity of the model to the cost range and to a potential rate variability of different administering of the drugs was also investigated.
The final analysis of the antibiotics efficacy involved 226 patients treated with levofloxacin and 230 ones received ceftriaxone/cefuroxime axetyl. The therapy was clinically sufficient to the 5^th-7^th day in 96% of the patients treated with levofloxacin and 90% patients received ceftriaxone/cefuroxime axetyl (the 95% confidence interval was 10.7 to 1.3%). According to our results Tavanic was more benefit compared with the Rocephin/Zinnat mode as it was more effective and less expensive.
The conclusive results regarding the economic benefit of levofloxacin requires further clinical and economical trials to compare levofloxacin with other domestic modes for the therapy of the community-acquired pneumonia.

Screening COPD at Kuban was performed twice in 15 yrs at the same area of active husbandry — UstLabinsk agriculture complex. The number of the persons examined was 1727 in 1986 and 1442 in 2002. A standard design of a screening search was used including a questionnaire, therapeutist’s examination, a large picture frame photoroentgenography, lung function test. A differentiated diagnosis was made in bronchial obstruction cases.
The screening showed that the CORD rate at Kuban increased by 4.2% in 15 yrs. The mortality structure in COPD patients demonstrated a death prevalence of chronic respiratory failure and acute impairment of cerebral circulation compared with the equal population parameters.

Comparative randomized opened study involved 50 patients with brittle phenotype of severe asthma. The purpose of study was to compare efficacy and safety of different combined therapeutic modes in patients with severe uncontrollable asthma. The research consisted of 2 stages: initial 10-week treatment (beclomethasone 1500 meg daily) and actually investigation of different modes of combined 20-week therapy (Seretid Multidisk 250/50 2 inhaled doses daily; Flixotide 2000 meg daily; Flixotide 1000 meg daily + long-acting theophylline; Flixotide 1000 meg daily + leucotrien antagonists; Seretide Multidisk 250/50 2 inhaled doses daily and minimal effective doses of prednisolone). The evaluation of the asthma control level was assessed with E.Bateman's criteria. The safety of the drugs was estimated by questions, electrocardiogram data, serum potassium and cortisol levels.
The combined therapy with Seretid Multidisk demonstrated the high efficacy and safety when compared with other investigated therapeutic modes.

This article demonstrates high clinical efficacy of long-term treatment of bronchial obstructive syndrome in cystic fibrosis (CF) patients with N-acetylcysteine (Fluimucil, Zambon Group). Lung function parameters, oxygen saturation, sputum viscosity, biochemical parameters of inflammation activity in sputum (elastase, sialic acid and α₁-antitripsin concentrations) were evaluated. Oral Fliumucil was combined with inhaled N-acetyl-Lcysteine. The therapy resulted in reduction of the sputum viscosity, recovering of the mucociliary clearance, improvement in the lung function, antiinflammatory and antioxidative effects of Fliumucil. This allows to recommend the drug for the long-term basic therapy of bronchoobstructive syndrome in CF patients.

The aim of this study was to define full cost of therapy of adult bronchial asthma (BA) taking into account BA spread in Lesnoy and to evaluate economical benefit of modern BA management using the cost-benefit and cost-effectiveness analyses.
The investigation was performed in Lesnoy town of Sverdlovsk region having 46,500 adult residents and BA spread 5.7% (the patients' age was 18 to 74 yrs). Three hundred and fifty three BA patients were registered in 1999 and 636 were in 2002 when seeking the aid. A list of antiasthmatic medications was determined including domestic drugs: Benacort, Salben, Saltos, Salgim. Sixty four per cent of the BA patients registered received the basic therapy with the domestic medications. The clinical-and-economical investigation used methods detecting full cost of the disease and cost-benefit and cost-effectiveness analysis.
The results allowed to define the full cost of BA in Lesnoy which was 625,672 USD, or 13 USD for every resident of the town and 237 USD for every BA patient annually. The structural analysis of the BA cost showed a prevalence of direct (59%) expenses compared with the indirect ones (41%). Among the direct expenses the inpatient treatment (63%) and medication (27%) costs predominated. Manufacture waste (45%) prevailed in the indirect expenses. This analysis demonstrated a significant decrease (in near 2 times) in the direct and indirect expenses resulted from application of the modern methods of the BA management with the domestic medications. An economic efficiency of the domestic drug Benacort was showed which decreased the cost-benefit ratio in 6 times.
The application of the modern management of the registered BA patients diminished the cost-effectiveness ratio in more than 2 times.
So, the clinical-and-economical study of the modern BA management efficiency under the local antiasthmatic programme analyzed the full cost of the disease, the cost-benefit and the cost-effectiveness ratio and allowed to determine the BA expenditure in Lesnoy; it showed the economical effect of the domestic antiasthmatic medications and of the new approach to the cost-effectiveness of the modern BA management.

Results of radiography and computed tomography (KT) of 38 patients with various morphological types of idiopathic interstitial pneumonia were analyzed. Differentiated diagnosis of various types of the idiopathic interstitial pneumonia at the initial stage of the disease was found to be difficult but test therapy and CT monitoring make possible to reject or confirm the idiopathic interstitial fibrosis which is one of the most frequent and hardly treated types of the pneumonia. At the advanced stage, when significant destructive lesions of the lung parenchyma take place, the CT was quite specific and sensitive to specify the disease's nature that allowed to avoid the lung tissue biopsy.