A complex intensive therapy of the acute respiratory failure in newborns with the BL home surfactant and Exosurf enables to reduce the mortality in intensive care units. Any differences were not found in the actions of the surfactants. The inhaled and microjet home surfactant can be used successfully to treat the respiratory distress-syndrome in newborns.

The most frequent causes of perinatal morbidity and mortality due to respiratory disorders are asphyxia, respiratory distress-syndrome, aspiration of amniotic fluid, and neonatal pneumonia. The article is based on an analysis of domestic and foreign experience of different medical facilities and discusses the main principles of organization of urgent care of newborns with respiratory failure who represent a great deal of newborn patients at intensive care units. About 90% of the newborns have a good prognosis under the adequate and timely medical care.

The results of an impact of infusing therapy on haemostasis and complement system parameters in 35 children 1 month to 3 years old admitted to intensive care units with pneumonia complicated by the respiratory distress-syndrome of the adult type have been reported. The comparative analysis of two infusing therapy programmes was performed in the patients with hypocoagulation and active fibrinolysis or low anticoagulant activity. We applied two therapeutic complexes:
1. Glucose-containing mixture with fresh-frozen plasma;
2. Glucose-containing mixture with fresh-frozen plasma and Rheopolyglucin.
The results obtained showed that the infusing therapy normalizes significantly the parameters investigated. The glucose-containing mixture combined with fresh-frozen plasma and Rheopolyglucin is more effective.

Study results of pharmacokinetics of Sizomycine and Amikacin aminoglycozyde antibiotics in infants with severe pneumonia have been shown. It was revealed that the pharmacokinetics of these drugs depends on the patients’ condition severity. A significant individual variability of the antibiotics’ pharmacokinetics was found that requires their individual dosage. The pharmacokinetic variability is due to "patient’s factors". A multiple correlation analysis demonstrated quantitative relationships between pharmacokinetic parameters and such the "patient’s factors" as body weight, leukocytes amount, red blood cells sedimentation rate, hematocrit, creatinine and urea serum concentrations, oxygen and carbon dioxide blood partial pressures. An individual prediction of pharmacokinetic parameters, e.g. a total clearance of creatinine according to the "patient’s factors" is the basis for the initial calculation of the antibiotic individual dose when it is important to determine the optimal dose quickly.

Clinical and radiological features, bronchial inflammation, the immunological status, and prognosis were studied in 96 children with bronchopulmonary dysplasia aged from 1 month to 7 years. These characteristics were found to be relevant to the disease severity. The severe form of the pathology can-transform to the chronic bronchiolitis. An analysis of the autopsy results of 9 children died from the bronchopulmonary dysplasia at the age of 6 -2 3 days demonstrated the disease sings at the 6^th day of the life.

A number of children with chronic non-specific lung diseases requiring surgical treatment has reduced last decades due to improved therapy of pneumonia in children and to diminution in number of congenital lung defects. A discussion of surgical treatment for chronic non-specific lung diseases in children generally considers particular problems; principal points in this field are thought to be solved. The main point is an early revelation of children with pathology suspicious for chronic non-specific lung diseases and timely qualified X-ray and bronchological examination.

The article sums up a multi-profile epidemiological and clinical study performed for the last decade in the Russian Federation. Clinical peculiarities of child’s intrathoracic tuberculosis, reasons of complicated forms occurrence and an influence of various factors on their frequency were viewed. An importance of the differentiated approach to intrathoracic tuberculosis detection in phthysiopaediatric and general therapeutic facilities was shown.
A comparison of clinical signs of extended complicated and uncomplicated tuberculosis has determined that the mild forms have several characteristic features. The disease onset is typically gradual. Sensitivity to tuberculin is quite low in most patients. Intoxication could be mild or manifested by single symptom s, hyporexia or mild fever, etc. X-ray examination detects localized lesions of intrathoracic lymph nodes or single small foci in the lung tissue. The complicated forms are prevalently characterized by com plications in the lung tissue, such as the lung tissue decay, seeding, pleural effusion or lung atelectasis.

An analysis of implementation of the national programme "Bronchial asthma in children. Strategy of treatment and prevention" starting 1997 was performed. The application of modern preventing anti-asthmaticdrugs in children according to a bronchial asthma severity became an important achievement. The attention was paid to a significant increase in scientific trials’ number devoted to bronchial asthma in various aged children.

An investigation of bronchial asthma spread according to the ISAAC programme was performed. Under the data obtained the spread of bronchial asthma symptoms was 20.52% among the 1st class pupils and 22.17% among the 8th class pupils. As an examination result bronchial asthma was detected in 7.8% of the 1st class pupils and 8.3% of the 8th class pupils. These values exceed significantly official data of childhood bronchial asthma spread. Bronchial asthma was diagnosed considerably more frequent in children living in wet and mouldy buildings. Elderly children were noted to have a correlation between bronchial asthma and passive smoking. A reliable relation was shown between bronchial asthma in younger children and a presence of home dust collectors, such as carpets, at a child’s bedroom.

We assessed a contribution of genetic factors to the bronchial asthma development in children basing on the genealogy analysis of 302 asthmatic children. It was dem onstrated that the inherited factors play the principal role in the disease occurrence providing by the additive action of polygens.
The genetic predisposing markers of bronchial asthma were revealed in Russian children (alleles HLA DRB1 ) and their distribution was investigated in the families burdened by the disease. This information could be used to form the high-risk groups for the bronchial asthma development and to predict its occurrence in the families.

A role of ecology factors in childhood bronchial asthma development is discussed considering data of epidemiology and immnology studies. This disease is a sensitive biological marker of ecological troubles. Its wide spread is closely related to a total air pollution level. The immunological studies performed proved the chemical industry allergens (nickel, chrome, form aldehyde) sensitizing an organism to contribute the childhood bronchial asthma occurrence. Such immune techniques as a specific mode of com plement-binding reaction (CBR) or a specific IgE-binding reaction with a chemical allergen in vitro allow detection of chemical industry allergens sensitizing in children. Pathogenic significant immune criteria of sensitizing to industry pollutants are anti-hapten antibodies high titre (CBR, 1:160 and more) combined with an increased concentration of serum total IgE level and the effect of specific IgE binding with the corresponding chemical allergen in vitro. Such high anti-hapten antibody levels (1:160 and more) were revealed in 15% and the specific IgE binding with various haptens in vitro took place in 18-24% of bronchial asthmatic children. Equally with atmospheric air pollution an important role of air quality inside buildings was shown.

The article discusses principles of detection bronchial asthma seventy in childhood. Now a set of clinical and functional criteria presented at the "Bronchial asthma in children. A strategy of treatment and prevention" National program me is being implicated for its assessment. The analysis performed shows a quite frequent disparity in clinical findings and lung function disorders, first of all, FEV1 parameter in childhood asthma exacerbation. Results of peak expiratory flow rate monitoring less differ from clinical criteria of bronchial asthma seventy and correspond at whole to the range recommended. Problem s of improvement the assessment of childhood asthma severity and a competence of use the "intermitting asthma" term , a diagnostic algorithm and its conformity to international standards are considered.

We examined 60 patients to investigate clinical features of severe bronchial asthma in various aged children.
The typical diagnostic com plexincluding the disease history, clinical and allergy testing, functional and laboratory techniques was used in this work.
The work has demonstrated that a course of the severe bronchial asthma has some peculiarities in different ages. The infants experience the disease exacerbations against an acute respiratory infection background, previous or simultaneous atopic dermatitis, quite often food sensibilization or low effect of p2-agonists. A significance of triggers, psychological pathology, the disease impact on the quality of life, a risk for development of steroid resistance and asthma com plications are enhanced at elder ages.
So, the data obtained allow concluding that the main predictor of the severe bronchial asthma in children is a high atopy index.

When diagnosing childhood bronchial asthma misdiagnosis is quite often. According to data o f a consultative department mistakes in bronchial asthma detection are encountered in 62% of patients. Seven to eight hundred bronchial asthmatic children from various regions have been annually treated at the pulmonology clinic of our institute. All the patients had been observed at their residences before they were admitted to the clinic, but diagnostic mistakes were revealed in 5 to 7% of them after the examinationin the clinic.
Two hundred and eight children’s case reports were analyzed which had the diagnosis changed in the clinic. Underestimation of bronchial asthma was in 173 patients and overestimation was in 35 ones. Only 15.9% of the children had bronchial asthma diagnosed within the initial 6 months of the disease, 18.8% of cases were diagnosed after 2 years and the others were done over 5 or 10 years or later. The children were admitted to the clinic with misdiagnoses of asthmatic or chronic bronchitis, or various chronic non-specific lung diseases (or chronic pneumonia), or such quite rare diseases as cystic fibrosis, William s-Campbell syndrome, m icrolytiasis.
Overestimation of bronchial asthma was also encountered in paediatric practice., Different diseases characterized by bronchial obstruction were taken for bronchial asthma. These were larynx, trachea and bronchi disorders, partly bronchial papilloma, tum ours (carcinoid), neurogenous or psychogenous dyspnoe including schizophrenia.
To improve bronchial asthma detection in children a computed expert system was created which was shown to be effective in more than 87% of the cases according to the studies perform ed.

The aim of this work was to analyze a dynamic of a ) a severity of children’s acute asthma at the Sankt-Petersburg in 1999-2000: mortality of asthma and a frequency of severe asthma tic attacks, severity of asthma attacks according to data provided by the emergency care facilities; b) basic therapy of asthma at the same period. We used city statistic information, archive materials of city hospitals and 2 medical emergency care stations, medical documentation of pediatric allergy and pulmonology facilities.
For the last decade a number of emergency care calls by the reason of bronchial asthma attack o r severe asthmatic attack has reduced in 1.95 and 2.6 times correspondingly, there were not acute severe asthma cases and mortality of asthma at the Sankt-Petersburg the last 3 years notwithstanding the growth of the total number of asthmatic children m ore than 2 times and an increase in severe asthma children number as well. The amount of patients receiving inhaled steroids was 1 5 -20 children in 1990, 11 0-1 15 children in 1995 and 1050-1100 ones in 2000. The number of patients given cromones has increased more than 10 times for these years.
An economic efficiency of short-term admission wards and nebulized therapy was demonstrated on the pattern of one of the medical emergency service stations.
The acute asthma dymanics found was obviously related to the general change of the approaches to the basic therapy of the disease and the patients’ management in acute asthma.

The object of the investigation was to define a dynamics of quality of life and to evaluate an influence of different pharm acotherapeutic methods on bronchial asthma child's w ell-being. The analysis of quality of life was carried out in 264 bronchial asthma (BA) children of 4 -1 6 years old and 55 healthy children of the same age in Vladivostok Childhood Asthma Centre in 19 98 -199 9 using the Russian version of A. West's and D .French's "Childhood asthma questionnaire" adopted by V.I.Petrov and I.V.Smolenov. The BA patients were determined to have life activity reduced in combination with deep distress that led to child's misadaptation among the same aged children. The dynamics of quality of life in moderate bronchial asthma patients showed the positive influence of the basic therapy on their well-being. It was m ore distinct when using sodium nedocromil (Tilade) and fluticazone propionate (Flixotide). The analysis contributed to the clinical assessment of the therapy efficacy and proved that capacity of correction of the BA child’s life activity and its period are mostly determined by a medication choice.

The article demonstrates results of paediatricians’ and the rapeutists’ joint work assessing peculiarities of course and outcome of chronic lung diseases in different ages (a child — an adolescent — an adult). It was revealed that various form s of chronic lung pathology (chronic bronchitis, bronchiectasia, primary ciliary dyskinesia, bronchial asthma) start in childhood and, as a rule, go on in maturity. Factors effecting the disease outcome are analyzed.

A cost-effectiveness analysis of supporting therapy was carried out in 30 various severity asthmatic patients against the background of use foreign anti-asthmatic drugs in 1997-1998 and the home inhaled glucocorticosteroid Benacort in 1999-2000. The patients at the exacerbation applied Benacort 800 meg daily and then the dose was reduced up to 4 0 0 -6 0 0 meg daily in mild and moderate asthmatic patients if the stable state was achieved, but not less than in 3 months.
The therapy efficiency was estimated by clinical symptoms dynamics, the daily need in β₂-agonists, a lung function dynamics before and in 1, 3 and 5 months of the treatment. The night asthmatic attacks disappeared in all the patients within 2 -3 weeks, the need in inhaled bronchodilators decreased sharply over a month, and a frequency of daytime asthma and cough attacks also decreased. Lung function parameters became normal in the mild asthma patients in 3 months and improved significantly in the moderate and severe asthma patients over 3 and 5 months accordingly, though the severe asthma patients did not reach the norm al lung function values. We did not reveal undesirable local effects of Benacort but we had to abolish the drug in one patient after 4 days o f the treatment because of severe cough. Generally, the out-patient application of Benacort as the basic therapy in various severity asthmatic patients was shown to control the disease course, to improve the quality of life and to reduce the yearly cost of supporting therapy for mild, moderate and severe bronchial asthma in 2.2, 1.48 and 1.71 times accordingly.

Forty two children aged from 6 to 15 years (15 children with bronchial asthma and 27 ones with chronic pneumonia) were examined. All the children underwent a clinical inspection, lung function testing and a pharmacological test with ipratropium bromide. The IC50 for M acetylcholine receptors of peripheral blood polymorphnonuclear leucocytes and a simultaneous effect of ipratropium bromide on a stimulated Ca⁺² ion level in bronchoalveolar lavage fluid cells were studied in 14 children with bronchial asthma and 25 ones with chronic pneumonia.
M-cholinolytic effect of ipratropium bromide on the blood cells was found to appear in bronchial asthma children in less concentration compared with the chronic pneumonia ones. Ipratropium bromide reduced the stimulated calcium ion response of bronchoalveolar lavage fluid cells and improved the lung function parameters in both the groups. The increase in the lung function values was more in the bronchial asthma children than in chronic pneumonia ones and under the norm al lung maturity than in chronic inflammation under a lung maturity defect. A correlation was noted between the increase in the lung function parameters and the decline of the Ca⁺² ion level in bronchoalveolar lavage fluid cells stimulated by ipratropium bromide.