The aim of the study was an analyze of literal and some own data on a diagnostic problem of COPD in ischaemic heart disease (IHD) patients.

An assessment of diagnostic value of respiratory function examination, bicycle test, electrocardiography Holter's daily monitoring, electrocardiogram telemetry, and echocardiography was performed in 1554 patients with COPD accompanied by IHD. It was revealed that the most informative diagnostic method for ischaemic disorders in such patients is the dynamic electrocardiogram daily monitoring, especially in patients with severe ventilation disorders. A prevalence of combined arrhythmias and aberrations of ventricular complex on superventricular arrythymias was recorded and thought to follow atrial-and-ventricular dyssynergy or ventricular asynergy. It was found that the earliest phenomena of intracardiac haemodynamic disorders in combined COPD and IHD patients were left atrium dysfunction and dilatation.

We suppose that a prognosis of the combined pathology generally depends on the left heart contractility. Beta-blokers caused a significant loss in the respiratory function and a formation of the pathologic syndrome of airways early expiratory closure. A correction of management of both the diseases consists of the early COPD and IHD diagnostics taking into account the interrelated features of cardiorespiratory functional status.

The aim of this work was to assess an effect of angiotensin-converting factor (ACF) inhibitors on the antithrombogenic and vasoregulating activity of vascular wall in bronchial asthma (BA) patients. This opened, controlled and randomized study involved severe steroid-dependent bronchial asthma patients. Two patients' groups were separated using the randomization method. Captopril, which is an angiotensin-converting factor inhibitor, was applied in a complex therapy of 25 steroid-dependent bronchial asthma patients (the 1st group). The 2nd group patients (25 persons) did not receive angiotensin-converting factor inhibitors. Antithrombogenic (anti-aggregating, anti-coagulating, fibrinolytic) and vasoregulating activities of vascular walls were investigated. It was found that the treatment with captopril improved antithrombogenic, mainly anti-aggregating, endothelium activity, increased the blood anti-thrombin reserve and reduced a severity of a skin hemorrhagic syndrome. After 2-week therapy with Capoten the vasoregulating activity of the vascular wall did not improve significantly. The difference in a rate of solving the antithrombogenic and vasoregulating endothelium functions disorders in bronchial asthma patients received and did not receive Capoten proves the administration of ACF inhibitors to be reasonable in a complex therapy of severe bronchial asthma patients under long-term use of systemic corticosteroids, especially when steroid vasculitis develops.

We investigated airway obstruction and daily changes of blood pressure (BP) and heart rate using 24h BP monitoring in 50 chronic bronchitis and asthma patients. In patients with normal average daily BP we detected BP elevations, partly coinciding with troubled breath episodes. Forty three per cent of the patients showed no adequate nocturnal BP decreasing. Besides of these facts, patients with bronchial obstruction and coexisting mild or moderate arterial hypertension had a higher heart rate and morning BP increase rate, especially in bronchial asthma; greater BP variability as well as greater prevalence of non-dippers. A correlation was found between the circadian BP dynamics and changes in FES/^ and airway resistance in bronchodilator test.

The aim of this work was to determine the optimal period for lung transplantation in idiopathic fibrosing alveolitis (IFA) patients.

Retrospective analyze of 134 patients’ medical cards was performed. The patients (29 males and 105 females) met principal requirements for lung transplant recipients. The average age of the patients was 43 years, the mean life expectancy of 55 died was 30.26±4.3 months. The patients underwent chest X-ray examination, electrocardiography, echocardiograhy, angiopulmonography, lung function testing, and blood gas analyze.

The mean life expectancy in nonspecific interstitial pneumonia patients was noted to be reliably shorter, than in those with usual interstitial pneumonia (16.6±5.3 vs 30.9±9.2 months, p<0.01). The life expectancy did not depend on the patients’ age, the lung diffusing capacity parameters, breathlessness, pulmonary artery pressure, arterial blood carbon dioxide tension, gender, and length of the disease. A reverse linear relation was shown between the life expectancy and a functional degree of chronic cor pulmonale. A probability of lethal outcome during 1.5 years abruptly increased if p02 level reduced less than 60 mmHg. Thus, a complex dynamic evaluation of right heart parameters can be a criterion for identification of the optimal period for lung transplantation in such the patients.

We examined 21093 patients with different bronchopulmonary pathologies to verify the diagnosis and perform treatment and rehabilitation in a specialized pulmonologic diagnostic and rehabilitation center. 17167 radiological and computed tomographic investigations, 5047 sputum examinations and 5597 lung function tests were performed. Ventilation disorders were revealed in 79.6% of the patients, they were severe in 33.2%. Results of the treatment and rehabilitation settings were analyzed in 2416 patients. Dyspnoe disappeared in 71.5%, cough stopped in 80.6%, sputum expectoration stopped in 78.2% of the patients. Lung function became normal in 64% and its disorders reduced to moderate in 30.2%. Among the patients who had received bronchodilators constantly before the rehabilitation 68.3% abolished them and 31.7% reduced the doses. A stable period lengthened up to 6-8 months in chronic bronchitis patients and to 3-4 months in bronchial asthma patients.

So, outpatient rehabilitation of ventilation disorders in a stable period facilitates respiratory function to become normal, reduces drug consumption and cost of the treatment, improves the quality of life.

Colour identification of normal black-and-white chest radiograms using the UAR-2 imaging device has provided additional abilities to study all the parts of pleura, lung tissue, stroma and lung vessels as well as to get the information on density, width and area of different mediastinal parts. A correlation between coloured imaging data and constitution, gender and age has been established.

Nighttime cardiorespiratory monitoring was performed in 30 congestive heart failure (CHF) patients resulting from ischaemic heart disease, systemic arterial hypertension and dilating cardiomiopathy. The results were compared with those of obstructive sleep apnoea and hypopnoea syndrome (OSAHS) patients with no CHF signs.

Sleep disorders were found in all the patients tested. Mild to moderate OSAHS prevailed. It was determined that inspiratory and expiratory time and total tidal time were significantly reduced (p<0.05) and breathing frequency increased in the CHF patients compared to a control group. The CHF patients demonstrated an increase of a minute ventilation, a tidal volume and the mean inspiratory flow while sleep disorders became more severe. These resulted from hypoxic stimulation of the encephalic breathing center. Moreover, changes of a functional residual capacity and intraalveolar volume were found at a positive pressure end-expiration. The changes revealed can cause fatigue and weakness of respiratory muscles and disturb an intracardiac haemodynamics. So, we propose that CFH patients need CPAP-therapy during sleep.

The study performed allowed to reproduce experimentally the dust bronchitis and to show a dynamic development of the pathological process in the lungs. After intratracheal insufflation of fine-dispersed inorganic dust there was a certain morphological dynamics in the lungs. Destructive changes of bronchi, bronchiole and bronchopheumonia were observed at an early stage. A productive macrophage reaction developed at the 7th day with the granuloma formation linked topographically with the dust deposition. When the experience period lengthened up to 14 days, granulomatous process grew, exudative and destructive processes calmed down; a tendency to peribronchial and perivascular sclerosis appeared. At a later stage (12 months) the lungs eliminated the dust, the granulomas amount diminished, the peribronchial and perivascular sclerosis spreaded, and centriacinar emphysema developed.

The aim: to reveal bronchial asthma (BA) spread on the basis of different risk factors for the disease and of regional features, to develop an algorithm for determination of BA prevalence at a large industrial region. We asked 2045 citizens using the random method and the verifying questionnaire ECRHS. Answers were given by 1572 (76.9%) respondents, their mean age was 40.1±0.3 years, 837 females were among them. Air pollutants (N0₂, S0₂, CO) concentrations were detected. Bronchial hyperreactivity (BHR) and bronchial obstruction (BO) were estimated in 288 subjects. The most typical asthma-like symptom was "loaded or sibilant breathing during the last year" (31.3% of the positive answers). A dependence of asthma-like symptoms frequency on the air pollutants concentration and nose allergic diseases was determined. BO and BHR were revealed in 14.3% of the cases. The BA spread at the large industrial region was 6.2% in total (6.9% for males and 5.5% for females). An optimized method for BA prevalence detection at a large industrial region was developed.

A prevalence of bronchial asthma in Uzbekistan tends to increase. It is highest in the Republic of Karakalpakstan and the lowest in the Samarkand area. The bronchial asthma prevalence differs in some areas of Uzbekistan: it is the highest in children of Karakalpakstan and elderly of Tashkent city. The bronchial asthma prevalence depends on smoking.

During an examination and management of 431 lung abscess patients a preoperative programme was elaborated taking into account the stage of the process (the 1^st group – an exacerbation, the 2^nd group – the process stabilization, the 3^rd group – a stable condition) and an endotoxicosis degree, immune and hormonal status as well. The 1^st group patients were differentially administered immune correctors (parenteral, endobronchial, or topic), Dalargin, arachidonic acid metabolites inhibitors; the abscesses were treated with sorbents. Such management was effective and allowed to avoid the operation in 181 (63.07%) of 287 the 1^st group patients, while only 14 (11.48%) of the 2^nd group patients and 8 (36.36%) of the 3^rd group patients were treated without the operation. A significant standardizing effect on the immune system was achieved against the background of the process localization and stabilization. This fact permitted diminishing the surgical intervention in 218 (95.61%) patients of 228 operated. We observed postoperative complications in 16.04% of the 1^st group cases against 22.22% in the 2^nd group and 28.57% in the 3^rd group. This also confirms the effectiveness of the developed preoperative programme.

A comparative cytological examination of bronchoalveolar lavage fluid (BALF) has been performed in 93 patients with exacerbations of chronic specific and nonspecific lung diseases. We evaluated BALF cell contents, spontaneous and prodigiozan-stimulated NBT reduction due to the alveolar macrophages activity. We also analyzed a correlation between NBT-test results and neutrophil, lymphocyte and eosinophil amounts. It was found that there were twice less cells in BALF from tuberculosis patients compared with those of chronic nonspecific lung diseases patients. In patients with nonspecific lung parenchyma lesion one third of alveolar macrophage population reduced NBT, but additional stimulation with prodigiozan activated almost all the cells. In infiltrative tuberculosis patients the alveolar macrophages were not sensitive to an additional stimulus. A positive correlation was found between the functional activity of the alveolar macrophages and the amount of different types of BALF leucocytes. The alveolar macrophages’ ability to produce oxygen reactive metabolites caused the neutrophiles accumulation in airways of chronic bronchitis and fibrocavernous tuberculosis patients. A positive correlation between NBT-test results and lymphocytes amount was found in nonspecific chronic lung diseases patients but not in tuberculosis ones.

The aim was to study some reasons of therapy-resistance in patients with moderate-to-severe atopic bronchial asthma. Thirty-five moderate-to-severe atopic bronchial asthma patients were treated with inhaled "Flixotide" (GlaxoWellcome) 1000 meg daily and "Serevent" (GlaxoWellcome) 100 meg daily for three months. Changes in clinical and functional features and IL-4, IL-5, TNFα levels in serum were studied. Most of patients (80%) have achieved goals of asthma therapy (E.Bateman's criteria, 1999) after 12 weeks of the therapy. Seven patients demonstrated a therapy-resistance in our study. They have not got positive changes in clinical and functional features and IL-4, IL-5, TNFα sera levels. So, one of the reasons of the therapy-resistance in the patients tested is thought to be the cytokines imbalance.

This work assessed possibilities of using the inhaled nebulized corticosteroid budesonide (Pulmicort) in bronchial asthma exacerbation children. The study involved 92 children with moderate to severe bronchial asthma aged 1.5 to 14 years and one child with stenosing laryngotracheitis. Clinical data, spirography and bronchophonography results were analyzed.

Seventy eight (84.8%) children improved their condition in 1 or 2 days after inhalations of bronchodilator (berodual in doses according to the patients’ age). Insufficient bronchodilating effect was in 14 (15.2%) children. The children were divided into 2 groups: 8 of them were treated with systemic corticosteroids 2 mg/kg and 6 ones were given Pulmicort suspension via nebulizer 0.5-1 mg twice a day during 2-5 days. The children's condition became stable in both of the groups in 2 days. The children received systemic steroids improved more slowly than those given Pulmicort.

So, nebulized Pulmicort suspension demonstrates its high efficiency especially in infants and pre-school children. The nebulized therapy allows achieving the result faster than systemic steroids do. Any adverse effects of Pulmicort were noted.

An opened study of efficiency and safety of Erespal (fenspiride) long-term use in management of stable chronic obstructive bronchitis (COB) patients was conducted. The study group included COB patients without exacerbations of the disease during the previous 2 months; the forced expiratory volume for the 1st second (FEV₁ constituted 35-70% of predictive values; the total lung capacity (TLC) was more than 80% of predictive values; pa0₂ was from 65 to 80 mm Hg. It corresponded to moderate COB according to GOLD. The patients receiving any glucocorticosteroid therapy and having severe coexisting diseases as well as acute diseases or exacerbations of chronic diseases were not included in the investigation. Ambulatory Erespal therapy was conducted during 3 months in daily dose of 160 mg. Control examination was conducted in a hospital at the end of each month (M0-M3). The drug efficiency was evaluated using visual analog scales reflecting a seventy of cougji, dyspnea, sputum expectoration, blood gas content and lung function parameters, bronchoscopic features and cellular content of bronchial mucosa specimens. While finished the therapy (М3) the significant (p<0,05) improvement in clinical, laboratory and functional indices was revealed. The average increase in FEV₁ constituted 18,7%. Macrophages number in tracheobronchial mucosa cytogram significantly (p<0,05) increased. Cell ratio approached to the normal values in all the patients. Side effects (epigastric discomfort, nausea, and heartburn) were observed only in 2 patients with the history of duodenal ulcer; after drug correction the Erespal abolition wasn’t required. So, the Erespal long-term use both as monotherapy and in combination with broncholdilating agents is an effective method for anti-inflammatory therapy of COB patients.

Clinical and immunological efficiency of immunotherapy with thymus and bone marrow peptides, Ribomunyl, IRS 19 and their combination was assessed in 370 children being frequently ill in the near (12 months) and remote periods. In contradistinction to the thymus and bone marrow peptides a long-term positive influence of Ribomunyl alone and in combination with IRS 19 on the synthesis of lgA, SlgA and saliva lyzosime was shown, especially in the children with recurrent respiratory infections. A necessity of the immunologic monitoring in children frequently being ill was marked not only for systemic immunity but also for local (mucous) one.