Study results of spontaneous and dexamethazone (DEX)-induced or Ca²⁺ ionophor-induced apoptosis of peripheral blood lymphocytes (PBL) in healthy donors and atopic asthma (BA) patients are shown at the pre­sent work. The apoptosis was evaluated by several parameters: change in mitochondrial potential (MP), a ievel of phosphatidylserine (PS) expression on the outer leaflet of the cell membrane, forward (FSC) and side scat­ter (SSC) parameters and DNA fragmentation using flow cytometry. PBL of BA patients incubated in a culture showed later and less intensive DNA fragmentation in comparison with the controls. There were no differences between spontaneous MP and PS dynamics between the study groups. The DEX induced DNA fragmentation significantly earlier and greater after 72, 96 and 120 hrs of the incubation in the BA patients than in the con­trols. PBL incubation with DEX in the BA patients showed a significant decrease in the MP after 48 hrs of the incubation and later compared with the donors. The DEX-induced MP reduction correlated with the increase in the PS expression level. The analogous results were obtained for the Ca²⁺ ionophor-induced apoptosis. They demonstrated the resistance of PBL to spontaneous apoptosis in BA patients. The DEX-induced apoptosis of PBL was mitochondria-dependent. The PBL sensitivity to the DEX-induced apoptosis in the BA patients may be provided by their MP significant shifts compared with the controls.

The lung function, the contractile ability of the diaphragm, spinal and spino-bulbo-spinal reflexes of inter­-costal muscles were investigated in 97 patients with chronic obstructive pulmonary disease (COPD). Disturbances of the reflex activity of spinal and supraspinal structures of the breathing neuromotor system were determined under a high bronchial resistance and the diaphragm weakness.

A comparative assessment of acute bronchodilating tests with ipratropium bromide and salbutamol was performed in 22 chronic obstructrive bronchitis (COB) patients, 23 patients with COB and duodenal or stom­ach ulcers, 23 patients with duodenal or stomach ulcers not having COB and 15 healthy volunteers. The most bronchodilating effects of ipratropium was noted in patients with combination of COB and duodenal or stom­ach ulcers. The drug minimally influenced the expiration parameters in healthy. The conclusion was made regarding the reasonability of its application in patients with COB and duodenal or stomach ulcers.

The functional condition of efferent part of respiratory neuromotor system (RNS) was examined in 67 patients with chronic obstructive pulmonary diseases (COPD) using transcerebral and transspinal magnetic stimulation of diaphragm. The research resultes demonstrated that in spite of the absence of clinical features of respiratory muscles failure (RMF) in 28 COPD patients the maximal transdiaphragmic pressure (P_{di max}) was decreased, cerebral and spinal response amplitudes were reduced (0.74±0.43 mV; p<0.05 and 0.8±0.43 mV; p < 0.05 respectively) under the reliable prolongation of latent time of the spinal motor response (6.4±0.35 ms; p<0.01). Thirty six patients with RMF showed the increased latention of the cerebral and spinal motor responses (17.5±0.9 and 7.9±0.42 ms; p<0.01) against the background of the apparent drop in their amplitudes (0.44±0.039 and 0.51±0.004 mV; p<0.01 in both the cases). Furthermore, the central conduction time was increased by 12.3±1.1% (p<0.05) in 8 (23%) patients with RMF. The study results demonstrated the central and peripheral disturbances of the efferent part of RNS in COPD patients.

1301 medical histories of patients admitted to a specialized allergologic hospital by the reason of acute allergic disorders (AAD) for 8 yrs (1992 to 1999) were analyzed. More than a half of all the hospitalizations (50.1%) were caused by drug-related allergic disorders. Mainly the drug-related AAD were generated by beta-lactams (17.8%), non-steroid anti-inflammatory drugs (16.6%), vaccines and sera (6.4%). There was a great number of recurrent drug-related AAD. The AAD were typically manifested as urticaria and Quincke’s edema (40.8%), dermatitis (35.6%), and anaphylactic shock (13.7%). The Lyell syndrome in 50% of the cases was caused by sulfonamides.

The aim of this study was to search a level of antibodies against Chlamydia pneumoniae (Cp) and Mycoplasma pneumoniae (Mp) in patients with stable bronchial asthma (BA). Sixty five BA patients were examined. Anti-Ср antibodies were found using the indirect immunofluorescent reaction, anti-Mp antibodies were revealed using the indirect immune enzyme assay. The diagnostic titers of anti-Cp antibodies were detected in 23 patients and of anti-Mp antibodies in 25 of 65 patients (38%). It was important that 6 of them (9.2%) had the anti-Cp antibodies as well. Due to this fact all the patients were divided in 2 groups: serologi­cally positive and serologically negative. Differences were displayed in history and laboratory data, comorbidi­ty and treatment. The results provide the necessity of further investigations in this field.

Tuberculosis constitutes an occupational risk for healthcare workers. We studied tuberculosis morbidity in healthcare workers in 1996-2000. For this period tuberculosis was diagnosed in 266 healthcare workers (220 females and 46 males), among them 239 (89.8%) became ill with lung tuberculosis.

We divided all the healthcare workers into 4 groups according to their contacts with tuberculosis patients: 1) medical staff of tuberculosis settings who are in direct touch with tuberculosis patients; 2) workers of tuber­culosis settings who do not render medical services for tuberculosis patients; 3) medical staff of general med­ical settings who diagnose and treat diseases disguising tuberculosis; morbid anatomic and forensic medical staff; 4) the rest healthcare workers not getting a direct contact with tuberculosis patients.

Results of clinical, laboratory and instrumental examinations of 883 patients with bronchial asthma are given. 347 of the patients were elderly or senile; 322 parameters for each patient were taken into account. The material was processed with a mathematical method of COMOD systemic modelling technology. A reliable correlation between the "Peculiarity of bronchial asthma" parameter and 40 parameters of the geriatric patients’ status was revealed. A complex of reliably interrelated parameters providing the particularities of bronchial asthma manifestations in elderly and senile patients was established. Based on these data conclu­sions about arising mechanisms of bronchial asthma peculiarities in elderly patients were made.

Therapy efficacy depends directly on a patient’s keeping of all medical recommendations. The concept of cooperation between a patient and a doctor is quite new in the medicine. The "compliance" term used before can not reproduce relations between a patient and a doctor or between a patient or a healthcare system in detail; it is relevant to a patient's attachment to a treatment mode. This fact made to seek new ways describ­ing the cooperation of a patient and a doctor and resulted in creation of the "cooperation" term and lcBA-50 questionnaire.

The cooperation should obviously change when applying new BA therapeutic or detecting techniques. Taking into account supply of new aerosol drug delivery systems to the home pharmaceutical market it was reasonable to study dynamically the cooperation and the quality of life (QL) under patients' transferring to such the drugs.

The cooperation was evaluated using the lcBA-50 questionnaire which includes 50 points to quantify the cooperation according to 8 principal criteria and a ratings sum method. The QLwas assessed using the SF-36 questionnaire including 36 points and 7 criteria.

The present work shows that the most convenient drug delivery systems and dosing mode can considerably increase a patient's cooperation and QL. But such important points as a patient's keeping of a doctor's recom­mendations and factors influencing cooperation of a patient and a doctor were not involved in the study of the QL. Results allowed to define a doctor’s principal actions to optimize his cooperation with a patient.

We examined 74 bronchial asthma (BA) patients at different stages of the illness and under sympathomymetics therapy to assess changes in their heart haemodynamics. The patients were undergone echocar­diography, doppler echography of intracardiac blood flow, lung function tests. The control group included 36 healthy persons with the appropriate age, weight, height, gender and the arterial blood pressure level. The left ventricle diastolic dysfunction was noted in the BA patients. It was more severe at the BA exacerbation and less in the stable BA and depended on the bronchial obstruction, pulmonary haemodynamics disorders, a structure and a function of the right ventricle and severity of the left ventricle concentric remodelling. Inhalation therapy of bronchial obstruction with 200 mg of Berotec (Boehringer Ingelheim) effected positively on the left ventricle diastolic filing. The changes in the left ventricle diastolic function were not strongly related to the heart beat rate.

In this study we investigated diurnal variability of arterial blood pressure (BP) and peak expiratory flow rate (PEF) in 61 asthmatic patients (the mean age 51.6±1.3 yrs) and 13 healthy controls. Sixteen asthmatics had the essential hypertension (EH), stage I, 15 had the stage II, 20 patients had normal BP. All patients were treated according to recommendations of Global Initiative for Asthma (GINA, 1993). Hypotensive drugs were not used.

We observed-a correlation between BP diurnal values and PEF in some asthmatics, especially in patients with EH, stage I; an improvement in lung function parameters was accompanied by a decrease in BP diurnal values. A relative variability of BP diurnal values was higher in asthma patients with concurrent EH, especially of stage I. The treatment of bronchial asthma exacerbation led to an improvement in lung function parameters and significantly decreased PEF diurnal variability (p<0.05), but did not change the BP diurnal variability.

The pulmonary haemodynamics parameters, the right heart condition and their relationships to the endothelium vessel-regulating function in bronchial asthma (BA) patients were studied in this article. The work proved a high informative value of echocardiography for chronic cor pulmonale detection. Correlations between pulmonary hypertension, the disease severity and the respiratory failure severity were found. The BA patients showed disorders of the functional activity of the brachial artery endothelium which were related to pulmonary haemodynamics changes, the right ventricle wall thickness, and the right atrium end diastolic size. Disorders of the endothelium-dependent dilation demonstrated reduced abilities of the endothelium to synthe­size vasodilating substances in BA patients.

The article analyzes approaches for evaluation of hydrodynamic human airway resistance based on functional testing. Suppositions founding the basis of current methods measuring the airway resistance and physical idea of the measured parameter for healthy and hurt lungs were analyzed. The injured lung loses the homogeneity of the parenchyma and airway physical properties and the measured airway resistance value depends not only on distribution of the airway resistance inside the lungs but also on a character of changes of the parenchyma and airway properties and on a size of the changed area.

A possible way to increase the informative value of functional tests relevant to the detection of the airway resistance and other parameters in the injured lungs is described.

A problem of an assessment of the airway resistance during forced maneuvers is discussed. It is shown that the classic Rorer’s formula calculating the airway resistance fits to a limited range of the expiratory flow rate. Another generalizing formulation for the airway resistance calculation is given. A method measuring the airway resistance during the forced maneuvers based on the maximal flow rate measurement during a cough beat is grounded.

Exhaled hydrogen peroxide is a marker of airway inflammation. However, its utility for monitoring of asth­ma is still uncertain. The aim of this study was to assess the effect of short-acting β₂-agonists and inhaled steroids on the hydrogen peroxide (H₂0₂) concentration in expired breath condensate in asthmatic patients. Fifteen patients with moderate atopic asthma were treated with salbutamol as required for 2 weeks followed 12-week treatment with budesonide (Pulmicort Turbuhaler, 400 meg daily). The exhaled H₂0₂ concentration as measured using a colorimetric assay (Gallati&Pracht, 1985). FEV₁ was assessed using dry spirometer. Airway hyperresponsiveness was considered as a provocative concentration of inhaled histamine causing the 20%-fall in FEV₁ (PD₂₀).

The H₂0₂ baseline level in the asthmatic patients (0.19±0.03 μ‎M) was elevated compared to healthy sub­jects (0.028±0.003, p<0.001). The exhaled H₂0₂ concentration did not change during the treatment with salbutamol but it was diminished by Pulmicort Turbuhaler. This was associated with significant improvement in clinical symptom score, FEV₁ and PD₂₀ in asthma patients.

We conclude that the short-acting β₂-agonists do not influence the H₂0₂ concentration in the exhaled air condensate of the asthma patients but the inhaled steroids decrease it. This may reflect different anti-inflam­matory activities of these medications.

The lipid peroxidation and antioxidant defense in pregnant women with chronic nonspecific lung diseases were studied in various biological objects (blood plasma, erythrocyte membrane, amniotic fluid, exhaled air condensate). The pregnancy course in women with chronic nonspecific lung diseases was characterized by a decrease in the antioxidant enzymes activities (catalase, superoxiddismutase) with an elevation of the lipid per­oxidation products concentrations in all parts of the mother — extraembryonal organs system. The pregnancy in women with chronic nonspecific lung diseases resulted in the activation of lipid peroxidation in the lungs and redistribution of the antioxidant resources with the antiradical factors deficiency in the amniotic fluid.

Epidemiological and pathological peculiarities of lung carcinoma in atomic industry workers and uranium content in persons working at the main manufacture were studied. Exceeding of the morbidity in 2.1-3.7 times in persons exposed to a toxicoradiation factor was found in 1981-2000 compared with control groups. Squamous-cell lung carcinoma (45.28%) and small-cell lung carcinoma (20.75%) prevailed in the workers of the main manufacture. The workers with a lung tumour showed a radionuclide cumulation 25 times more in the liver, 7.7 times more in the kidneys and 1.3 times more in the lungs compared with other patients.

The effectiveness of the main antiresorptive agents was assessed for the treatment of glucocorticoid-induced osteoporosis in patients with severe asthma. Alfacalcidol plus calcium, but not calcium alone, was effective in patients with osteopenia. Combined therapy (calcium, alfacalcidol, calcitonin, anabolic hormone) not only prevented bone loss but had a positive effect on the bone mineral density, relieved the pain, increased the physical activity in patients with severe osteoporosis.

Fifteen patients with endogenous moderate bronchial asthma (BA) were examined. Clinical, esophago-scopic, and radiological features of gastro-esophageal reflux (GER) were evaluated. We applied the modified test of B.Kh.Vasilenko (1971) to reveal esophageal-bronchial reflux. A rubber probe was brought into the medium one third of the esophagus through the nose, then 0.9% saline solution 0.1 N hydrochloric acid solu­ tion were infused drop by drop gradually during 30 min each via the probe. The solution portions were previ­ ously warmed up to 37eC. The infusion rate was 20 to 30 drops for a minute. The forced expiratory volume (FEV₁₎ was measured each 10 min of the infusion procedure. The GER signs were revealed in 40% of all the cases. The GER rate in BA depended on the disease length. The intraesophageal infusion of the hydrochloric acid solution increased the bronchial obstruction in patients with GER signs and the infusion of the saline solu­tion reduced it in all the BA patients.

A course of inhaled therapy with Foradil 12 mcg twice a day for 2 weeks was performed in 12 children with chronic lung diseases manifesting by the bronchoobstructive syndrome. The children's age was 10 to 17 yrs. The clinical and functional efficacy of the drug in children with chronic lung diseases was shown. All the patients demonstrated positive clinical dynamics under the treatment, namely correction of the bronchoob­structive syndrome. The positive effect was noted for the first 2 days of the treatment but the defined solution of the obstructive signs was obtained for 2 to 4 days of the therapy in 9 patients and to 7-9-th day in 3 patients. The positive clinical change was accompanied by improvement in the lung function. Any adverse effects of the drug were not found.

The aim of the study was to Investigate efficacy and tolerability of levofloxacin given consecutively intra­venously and orally in moderate community-acquired pneumonia. The study involved 19 patients (11 females and 8 males), the average age was 43.3 yrs. The efficacy and tolerability were assessed at the 2-4-th day of the therapy and at the 3-5-th and 21-28-th days after finishing the treatment. All the patients firstly received the Intravenous levofloxacin for 3 days, then they took it orally in the dose of 500 mg daily for 6.8 day in average. According to clinical and radiological monitoring results this mode was effective in 18 patients. Adverse digestive effects were noted in 2 patients for short time and abolished after taking eubiotic and antispasmodic drugs.

The negative expiratory pressure (NEP) technique is a simple, rapid, noninvasive method for detecting expiratory flow limitation (FL) during spontaneous breathing.

The purpose of this study was to assess the prevalence of FL during resting breathing in adult cystic fibro­sis (CF) patients in both the seated and supine positions; and whether FL is associated with dyspnea.

We studied 34 CF patients with the NEP technique and conventional method, based on comparison of tidal and maximal expiratory flow-volume curves. Dyspnea was assessed according to the modified Medical Research Council (MRC) scale. The degree of FL was assessed in terms of a 5-point score according to % control tidal volume encompassed by FL and body position.

With NEP, 6 patients were FL in the seated/supine positions and 3 were FL only in the supine position. By contrast, 20 patients were classified as FL with the conventional method. In a multiple regression analysis FL was the best predictor in assessing the severity of dyspnea.

In conclusion, most stable CF patients do not exhibit tidal FL during resting breathing; detection FL may be useful in the evaluation of dyspnea; and the conventional method for assessing FL may lead to erroneous con­clusions.

The study was designed to assess efficacy, tolerability and opportunity to control bronchial asthma (BA) and to improve quality of life (QL) in patients with uncontrolled moderate BA under the treatment with Seretid Multidisk.

Seventy-three moderate BA patients were observed. Before this study 65 (88%) of them received inhaled corticosteroids (ICS) and 8 (12%) of them were treated with cromoglicic acid or sodium nedocromil together with specific immunotherapy. During the present study all the patients were given Seretid Multidisk 50/250 twice a day as the basic therapy for 12 weeks. The prospective monitoring during 1.5 yrs revealed a high effi­ciency of Seretid Multidisk in BA controlling, an opportunity for adjusting the dose to the patients' status and to a trigger influence, and good tolerability. The drug significantly improved the patients' quality of life.

The aim of this study was to assess clinical efficacy of antiinflammatory drug fenspirid in patients with early-stage chronic obstructive pulmonary disease (COPD). We observed 125 patients randomly divided into 2 groups: a study group of 76 patients and a comparative group of 49 patients. Fifty eight patients had the stable COPD and 67 ones had the exacerbation of the disease but did not need antimicrobial therapy.

All 125 COPD patients received bronchodilating therapy according to their bronchial obstruction severity. Besides this, 25 study group patients with stable COPD received fenspirid 80 mg twice a day during 6 months and 10 patients with COPD stage 2 were given inhaled beclomethazone 200 meg twice a day for 6 months. Among 67 patients with exacerbation of COPD 26 were treated with fenspirid for 2 weeks, 26 of them received bronchodilating medication only, 13 received systemic corticosteriods for a week in daily doses equal to 20 mg of prednisolon abolished gradually during the subsequent 7 days. The patients have being observed for 6 months, the principal clinical signs of COPD were assessed, the lung function was tested, bronchodilating tests and the 6-min walking test were performed.

The study led to a conclusion about a significant influence of fenspirid on the main clinical features of COPD stage 1. This was not noted in the comparative group and in COPD treated with inhaled steroids. The 6-month therapy with fenspirid in COPD stage 1 patients resulted in FEV₁ improvement. The greatest effect of fenspirid developed for the first 2 months of the treatment. Under the COPD exacerbation the efficacy of fenspirid and systemic steroids was similar.