A pulmonologic healthcare system was organized at the Altai region including a regional pulmonology center, pulmonology department of city hospitals, referable pulmonology wards and asthma-schools working as outpatient departments for asthmatic patients. A new structure of a regional pulmonology center was created which involves an intensive care unit for pulmonary pathology and respiratory support and a regional asthmacenter with ambulatory working mode providing oxygen therapy at home.
Due to this, early-stage detection of respiratory pathologies was improved, a number of admissions to hospitals was reduced for certain diseases and a mortality of severe lung pathologies was decreased.

Health losses of respiratory diseases in residents of the Altai region was studied and assessed as a part of social-and-hygienic certificate of the Altai region. They included primary morbidity (incidence) in children, adolescents and adults, and mortality rate. Based on historical analysis a conclusion was made regarding an increase in the environmental (social, natural and consume) influence and a reduction in a human’s biological compensatory abilities. A favorable dynamics of irrevocable losses (mortality) confirms the efficacy of pulmonology service at the region. Monitoring of main parameters characterized the health losses of respiratory pathologies should be included to a healthcare quality control system.

Patients with the lung abscess and gangrene demonstrate quantitative disproportion of the polymorphnonuclear and mononuclear phagocytes and disorders in their oxygen-dependent metabolic, procoagulant and proteolytic activities in BAL fluid from the injured lung. The phagocytes’ reaction to activators and inhibitors can be different depending on the initial status of these cells. The correction of the phagocytes’ function requires a prior assessment of the changes in the leukocytes’ metabolic activity provided by activators and inhibitors. Sometimes the correction could be performed by extracorporal methods only followed by transposition of autologous mononuclear phagocytes into the injured lung.

The problem of treatment of lung abscess has being still actual. A method of intrapulmonary needle-andjet injections was modified and technique of intrapulmonary electrophoresis was developed with regards to characteristics of the blood circulation in the inflammation zone and the necrosis hindering antimicrobial drugs to penetrate out of the vessels. The application of these methods allowed to eliminate the abscess cavities by 23.6% more often using the needle-and-jet injections and by 39.5% more often using the intrapulmonary electrophoresis compared to a combined conservative treatment.

Results of treatment of 548 patients with acute empyema and pyopneumothorax are shown. An application of freshly frozen or cryosupernatant plasma, heparin or proteinase inhibitors provides an improvement in microcirculation at the inflammation area and allows better outcome equally with the adequate drainage of the pleural space.

A complex therapy of acute empyema and pyopneumothorax increases an efficacy of the pathogenic therapy and improves an outcome. It involves cryoplasma and anti-ensyme complex, plasmapheresis, correction of metabolic, coagulant and proteolytic activities of blood and focal (at the inflammation zone) phagocytes, intrapleural application of proteolytic inhibitors and activators depending on the phase of the inflammation.

Destructive lung tuberculosis is a heterogeneous group of various forms of the lung tuberculosis (recent, chronic, advanced) which have common features, such as the presence of cavities, a presence of Mycobacteria tuberculosis and they are hard for treatment. Peculiarities of the microcirculation, the fibrous capsule outside the cavity, the caseous and necrotizing layer inside impede medications to reach the inflammation and destruction zone when applied as intranasal as directly into the cavity. Techniques for drug delivery to the perifocal zone (needle-jet injections, intrapulmonary ionophoresis), dénaturation of the cavity’s pyogeneous layer (hydrodiathermocoagulation) and damming of the draining bronchi (blocking of the cavity) allow to increase a number of the destructive cavities closed 23-43.3% more and to eradicate the Mycobacteria tuberculosis 33-47.5% more copared with a complex conservative treatment.

Results of a combined radiological and morphological examination of 146 patients with the lung cavity syndrome are shown in the article. Three types of the airway structure were revealed using he selective bronchography and simultaneous bronchotomography: short (of the 7-8^th generations), medium (of 9-19^th generations) and long (of 20-24^th generations). In most cases the bullae were situated into the short and medium bronchi. The subsequent computed tomography of 27 patients and pathomorphological examination of the resected samples of the lung in 11 patients demonstrated that the "opened" bullae are located in the proximal and medium parenchima zones and "closed" ones are in the distal zones.

The trials of plasma medications — plasma cryosupernatant (PCS) and freshly frozen plasma (FFP) — performed in patients with acute lung abscess and gangrene (ALAG) demonstrated high therapeutic effect of the PCS and significant regress in clinical signs and radiological findings.
Monitoring of coagulant parameters investigated showed that application of both the medications in patients with ALAG and septic syndrome of disseminated intravascular blood coagulation (DIBC) improved blood haemostasis parameters significantly starting the first doses. There were no reliable difference between the 2 patients' groups regarding most the haemostasis parameters studied. Meanwhile PCS transfusions faster eliminated hyperfibrinogenemia and restored the blood fibrinolytic activity.
The PCS transfusions in patients with ALAG and accompanied septic DIBC syndrome allowed to improve an outcome and to reduce a number of thrombotic complications and mortality.

Two hundred and twelve pneumonia patients aged 16 to 82 years underwent radiological and endoscopic examination. Peculiarities of lobar and segment infiltrates in the chronic obstructive bronchitis patients were volume reduction of the injured lung area and changes in the bronchial-and-vascular architectonics properly due to the bronchi lesion. Bronchoscopy was performed in all the patients to differentiate the pneumonia from carcinoma and lung tuberculosis and to reveal the need in a therapeutic sanitation. The method of intrabronchial lymphotropic therapy of pneumonia in chronic obstructive bronchitis patients was developed. It allowed to reduce the treatment period by 1-1.5 weeks.

An analysis of 154 autopsy protocols of died from community-acquired pneumonia was performed. Males of able-bodied age were found to die from the pneumonia more often. The mortality for first three days of staying at a hospital predominated. There was underdiagnostics (18.8%) as well as overdiagnostics (9.4%). Purulent bilateral subtotal and total pneumonias prevaled. The pathogenic agent in 28.4% of the deaths was pneumocossus. Purulent complications were more often (in 73.3%). Poor social status took place in 57% of the patients.

This trial was aimed to researching an efficacy of the Seretide Multidisk combinated therapy in patients with moderate bronchial asthma.
The "Adult-step" program was designed as a randomized opened comparative multi-center trial. It involved 65 patients with moderate asthma aged 16 to 50 years divided into two groups. The 1^st group patients have received fluticazone propionate 500 meg daily for all the treatment period (5 months) that was the "step up" mode. The 2^nd group patients have received Seretide Multidisk 250/50 meg twice a day for 12 weeks, then they were changed the treatment to the fluticazone propionate 500 meg daily that was the "step down" mode. The control of asthma was assessed in 8 weeks by the E.Bateman's criteria. The 2^nd group patients with unsatisfactory effect were expelled from the study, those of the 1st group were transferred to the "step down" mode. The study protocol included an assessment of the main asthma signs, respiratory function parameters, severity of post-exertion bronchoconstruction.
At the end of the trial 69.7% of patients taking Seretide Multidisk (the 2^nd group) and 28.1% of the patients taking fluticazone propionate (the 1^st group) achieved the asthma symptoms control according to the E.Bateman's criteria. So, the initial therapy with Seretide Multidisk was more effective than the "step up" pharmacological mode in moderate asthma patients.

The open study of efficiency and safety of long-term use of Erespal (fensplride) in patients with chronic obstructive bronchitis (COB) was conducted. The study group included COB patients with stable course of the disease during the previous 2 months; the forced expiratory volume for the 1^st sec (FEV₁) was 50-70% of the predictive values; P_a0₂ was 65 to 80 mm Hg. It corresponded to the moderate COPD (FP). The patients receiving glucocorticosteroids (oral or inhaled) and having severe underlying diseases as well as those with acute or exacerbations of chronic diseases were not included in the investigation. The therapy with Erespal was performed in outpatient conditions for 3 months in the daily dose of 160 mg. The drug was re-administered after three-month interval for another 3 months and longer if the cellular ratio in the bronchial mucosa changed in favour of neutrophiles or clinical and laboratory parameters worsened. A control examination was performed in a hospital at the end of each month for the first 3-month period (M0-M3) and every 3 months subsequently (M6, M9, M12). The drug efficiency was evaluated on the basis of visual analog scales assessing cough, dayspnea, sputum production; the blood gas content, lung function test, endoscopic features of tracheobronchial tree and cellular content of the bronchial mucosa. When finished the study (M12) the significant (p<0.05) improvement in the clinical, laboratory and functional parameters was revealed. The cytogram of tracheobronchial mucosa showed the cell ratio in all the patients tended to the normal values. Nobody of the patients had the disease exacerbation for all the treatment period. FEV₁, and ΔFEV₁ worsening, ECG abnormalities, liver or kidneys, or other organs dysfunction were not also revealed. Side effects of Erespal (epigastric discomfort, nausea, heartburn, xerostomia, sleepiness and hypotension) were observed only in 6 (12.2%) patients and did not require the drug cancellation under medication correction. So, the long-term use of the Erespal both as monotherapy and in combination with broncholytic agents is an effective anti-inflammatory therapeutic method for COPD patients. Long-term use of the drug allows to decrease the disease manifestations, to slow its progression and to improve the quality of life in COPD patients.

The treatment of severe steroid-dependent asthma is a very serious problem. Our aim was to work out a new method of asthma treatment with inhalations of ultra-low (non-cytotoxic) doses of an alkylating drug (Melphalan) and to investigate its efficacy and tolerability.
Forty-two patients with moderate and severe asthma, enrolled into a randomized, double-blind, placebo-controlled trial, were divided into two groups: 21 patients from the Melphalan-treated group (MTG) were treated with the standard therapy plus 5 daily inhalations of 0.1 mg of Melphalan, while the control group (CG) patients (21 persons) were treated with the standard therapy plus placebo inhalations. Spirometric, biochemical, hematological and immunological data were obtained before and 10 days after the treatment. Fiberoptic bronchoscopy with further investigation of bronchial mucosa biopsies was performed in 33 of 42 patients. There were no adverse events during the study. No patient dropped out of this study. An exertion tolerance increased and exacerbation severity and frequency of p2-agonist inhalations markedly reduced in MTG. A positive dynamics of lung ventilation parameters (p<0.05) and of the exertion tolerance was revealed in MTG, while changes in the CG were unreliable. In 60% of MTG patients histo-ultrastructural signs of bronchial epithelium regeneration were revealed.
In conclusion, our data suggest that combined therapy with inhalation of ultra-low doses of Melphalan is a safe and effective method of asthma treatment and needs further investigations.

The aim of the study was to evaluate pharmacodynamics and clinical efficacy of inhaled glucocorticosteriods (IGCS) when used via nebulizer or spacer in patients with bronchial asthma (BA) exacerbation needed to be admitted to a hospital.
The study involved 40 patients with BA exacerbation (the average age was 40.1 ±5 ydars, males/females ratio was 27.5%/72.5%) having the forced expiratory volume for 1 sec (FEV₁) of 30-65% of the predictive values.
The patients were randomly divided to 3 groups: 13 patients received budesonide suspension via nebulizer in the dose of 1000 meg once, 11 patients received flunisolide hemihydrate in a form of an aerosol inhaler with a high volume spacer (1 I) in the dose of 250 meg every 10 min during 2.2 h (the total dose was 3250 meg).
Other 16 patients were given oral prednisolone 40 mg once. The therapy efficacy was assessed with regard to FEV₁ dynamics in 1, 3 and 6 h starting the therapy. The treatment safety was evaluated regarding the patients’ complaints, arterial blood pressure level, heart beat rate and a length of the QT interval.
All the patients demonstrated the FEV₁ growth which was the higher in the patients treated with budesonide.
The maximal FEV₁ rowth level (189.1% of the initial value) in this group was noted in 6 h after beginning the treatment. Flunisolide patients showed the maximal FEV₁ increase (150% of the initial value) in 1 h of the therapy, but there was no the further FEV₁, growth and for the next 5 h there was no any significant changes in the FEV₁, level.
The high doses of IGCS in patients with moderate and severe BA exacerbations who had not received GCS before were more effective and an action came faster compared with those of the oral prednisolone. The less doses of budesonide influenced to bronchial passability parameters more considerable than flunisolide.

An investigation of clinical efficacy, safety and dispensation in airways of 0.1% salbutamol hemisuccinate nebulized solution was performed in moderate to severe bronchial asthma patients under a 10-day inpatient treatment. The analysis showed the Russian β₂-agonist to be an effective medication for bronchial asthma inpatient treatment. It fits to all safety requirements and has the equal efficacy but more beneficial cost-effectiveness compared with the foreign analog Ventolin.

W e performed an opened, uncontrolled study of therapeutic efficacy, safety and tolerability of the psychotropic drug paroxetin (Paxil) in 25 patients with bronchial asthma (BA) and depressive (DD) or anxlity disorders (AD). The patients’ group involved 7 males and 18 females aged 34 to 61 years. All the patients received the antiasthmatic therapy according to the severity of the disease. Paroxetin was taken in the daily dose of 20 mg for 6 weeks. The patients’ status was evaluated with the HADS scale; the reduction of this parameter by 50% and more was considered as an efficacy criterion. The safety and tolerability of the drug were assessed using pneumotachometry and adverse events were evaluated with the UKU scale. The study results showed the paroxetin is well-tolerated (only 3 patients drop out from the study dure to dyspeptic syndrome) and an effective drug for DD and AFD in BA patients. The airway obstruction parameters were significantly increased under the combined treatment with paroxetin and anti-asthmatic medication.

The aim of the study was to evaluate an efficacy and a safety of long-term therapy with Atrovent and Berodual in patients with chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) considering a quality of life and pharmaeconomic aspects. The study is been lasting now, so that this report involves preliminary results.
Forty patients aged 43 to 79 years (in average 60.9±8.7 years) have been examined till now. The I stage of COPD was diagnosed in 11 (28%) of the patients, the IIA stage was in 19 (48%), the IIB stage was in 10 (24%) of the patients. The IHD in the form of angina pectoris the 1st functional class (FC) was found in 9 (28%) of the patients, the 2nd FC was in 20 (63%), the cardiosclerosis was diagnosed in 23 (72%), the heart rhythm disorders were in 4 (13%), the conduction impairment was in 14 (44%) and the heart failure of the 1st FC was in 13 (41%) of the patients. All the patients received bronchodilating therapy with Berodual or Atrovent according to the severity of COPD. The drug was chosen based on the FEN^ growth by 5-12% after the acute inhaled test. The study was performed against the background of the antianginal therapy selected before. W e assessed physical data, lung function parameters, performed the cardiopulmopnary test using bicycle test technique, blood gases analysis, daily electrocardiography, arterial blood pressure and heart beat rate monitoring. The quality of life was evaluated with a Russian version of the SGRQ questionnaire; pharmacoeconomic analysis was performed regarding costs of the full treatment course, the anti-anginal médication, the patients’ status monitoring, the fee of the personnel’s work and the patients’ admission to a hospital.
The preliminary results showed the safety of the long-term application of the bronchodilating drugs in the therapy of patients with combined lung and heart pathology. The analysis demonstrated the necessity and the reasonability of such the treatment programmes. A certain increase in the examination cost is defended by rarer hospitalizations and disabilities.