Eighty patients with exogenous allergic alveolitis (EAA) were examined. EAA was diagnosed using liquid (BALF) and histological (transbronchial) biopsies performed during bronchological examination. Acute phase of alveolitis is accompanied by a high total cytosis (900 000-1 500 000 per 1 ml), lymphocytosis (up to 79%, in average 41.8%), eosinophylia up to 3.7% and morphological surprises, such as lung stroma edema, lymphoid and macrophageal infiltration, fibrin penetration in alveoli. Chronic course of exogenous alveolitis characterized by normal cytosis value, moderate BALF lymphocytosis (up to 22%) and morphological signs, such as interstitial fibrosis, vasculitis, fibroatelectases and patchy emphysema.

A comparative study of Mycoplasma infection (Ml) course in 109 patients with bronchial asthma (BA) and 156 patients with not asthmatic bronchial injury was performed. More unfavourable course was found in BA children. A burdened effect of adenoviral infection on the clinical course was noted. A correction was found between a severity of Ml clinical features and SlgA and specific serum and secretory antibodies' levels.

The experience of the Sankt-Petersburg scientific and clinical Center of intensive pulmonology and thoracic surgery in 1995-1998 is presented in the article. The Center’s structure merges the outpatient department, the pulmonology department, the thoracic surgery department and the cardiorespiratory intensive care unit in a single technological chain. Results of examination and treatment of 17 845 patients demonstrate advantages of such a form of specialized medical care.
The interaction between the outpatient and inpatient departments contributed to a reduction in the mean bed-day for therapeutic patients and a preoperative bed-day for thoracic surgery patients. The outpatient department allowed solving diagnostic and therapeutic problems in 92% of the patients without their hospitaization. While using this technique we managed to reduce a preoperative bed-day in the thoracic surgery department up to 2.3 days and to increase the operative activity up to 89%. The method offered is based on the idea of a closed cycle of the diagnostics and treatment starting from the primary consultation via the inpatient stage, if necessary, up to the outpatient rehabilitation period. The advantages and reserve of this method are discussed in the article.

The aim of the work was to study a dynamics of quality of life (QoL) in chronic bronchitis (CB) patients under the treatment. The study involved 69 chronic bronchitis patients admitted to a therapeutic hospital of the I.P.Pavlov medical university in Sankt-Petersburg. The QoL was assessed using a Russian version of the questionnaire MOS SF-36. The patients filled in the questionnaire independently at the cut points according to a stage of the disease and a phase of the treatment: before the treatment when admitted to the hospital at the exacerbation stage (the 1^st cut-point); in 21 day starting the therapy at the reducing exacerbation stage (the 2^nd cut-point); in 2 months starting the therapy at the stable condition (the 3rd cut-point).
The study showed that the QoL parameters, mostly role functioning parameters (as physical as emotional fields) decreased at the exacerbation stage. At whole the physical health parameters were lower than psychological ones. The disease deteriorated all the vital activities: physical, emotional, role, psychological and social fields compared with a control group. The 2-month standard therapy of CB significantly improved some QoL parameters excluding those of physical functioning and pain which were still lower after 2 months of the treatment compared with the controls. So, the CB exacerbation considerably deteriorated the QoL. All the parameters of the SF-36 questionnaire had statistically lower values compares with the controls. The physical functioning of the patients with the CB exacerbation was disordered more than psychological one. The 1-month standard therapy improved the total QoL and this tendency have been maintaining after 2 months of the treatment. The QoL parameters of the CB patients in 2 months starting the therapy became equal with those of healthy persons excluding the parameters of physical functioning and pain.

The method of combined bronchophonography (BPG), which provides sound selection of air and structural voice conduction to a chest wall, was applied in 74 patients with bacterial pneumonia. A control group involved 55 healthy subjects. All the persons underwent the BPG 2 to 3 times at intervals. The results were compared with clinical and radiological findings. A pneumonic focus situated corresponding to radiological and physical data was detected in 69 pneumonia patients (the sensitivity was 0.93). The acoustic focus revealed had a reinforced structural sound conduction and a weaken air sound conduction, was placed asymmetrically and disappeared over time according to the patient’s recovering. False positive results were obtained in 3 controls (the specificity was 0.94). Therefore, the BPG can be used as an additional objective method for the diagnostics of pneumonia and monitoring the dynamics of a pneumonic focus.

Bronchophonography (BPG) is a functional diagnostic method for the breathing pattern assessment. It is based on an analysis of frequency-peak parameters of the breathing sound spectrum. The method allows to fix a temporary acoustic curve arising during the respiration with the subsequent mathematical processing of the data. The breathing sound fluctuation amplitude ranges within 0-12.4 kHz that permits to calculate an acoustic breathing work equivalent the lung work aimed to the breathing. Hardware-software complex displays the fixed breathing sounds and evaluates their parameters not revealed during the physical examination. The highfrequency range (5.0-12.4 kHz) corresponds to wheezing.
We examined 76 bronchial asthmatic children aged from 1 to 14 years. The control group involved 48 children with no lung pathology. The examination included clinical, spirography and BPG testing.
The BPG method contributes to the routine lung functional testing and allows evaluating the bronchial asthma severity in children.

Inflammatory markers dynamics in 75 cystic fibrosis (CF) patients during a treatment of lung disease exacerbation has been investigated. As a rule, a clinical improvement is associated with decrease in the tumor necrosis factor-alpha and interleukin-8 levels in the sputum specimens. The neutrophil elastase (NE) activity assay is of special interest. It is the single inflammatory marker, which reflects the disease severity. Thus, CF patients with relatively good lung function (FVC and FEV₁>70%) demonstrated lower NE activity. In contrast, the subjects with poor lung function (FVC and FEV₁<70%) show the higher NE activity in the sputa. Though successful antibacterial therapy usually resulted in a decrease in the sputum elastase activity some severe CF patients demonstrate its elevation. This paradoxical result may be associated with neutrophil death and NE deliberation in the CF lung. It is very difficult to find the signs of systemic inflammation in peripheral blood of CF patients. However, our experience shows that the change of the peripheral blood lymphocytes sensitivity to the corticosteroid (dexamethasone) antiproliferative effect can inform a physician about the inflammatory process activation and an antibacterial treatment efficacy. Malon dialdehyde (MDA) plasma concentration is another parameter, which can show paradoxical results in CF subjects. During acute lung exacerbation some patients who were treated with enzymes during hospitalization period only in spite of the pancreatic insufficiency demonstrated marked increase in plasma MDA level. Authors postulate that such the increase does not reflect the activation of the infection but resuits from the systemic oxidative stress. The latter is a consequence of the improvement in fat absorption and of increase in the number of free radical targets.

The article demonstrates results of study of alveolomucin 3EG5, oncomarkers CA-125 and CA-15.3 in the blood and cell compound of bronchoalveolar washes in 40 welders. Among fhem 18 patients were diagnosed pneumoconiosis, 6 patients suffered from chronic bronchitis, 2 patients had vibration disease and the others exposed to the welding aerosol have not got any occupational diseases. An increased level of alveolomucin was found in 23% of the patients with various diseases including those without pulmonary clinical signs. This fact evidences the hyperplasia of alveolocytes type 2 and moderate interstitial pulmonary fibrosis, sometimes of latent course, in workers exposed to the welding aerosol. The cell compound of the bronchoalveolar washes suspected neutrophil alveolitis in the welders.

Ninety-five bronchial asthmatic children (64 boys and 31 girls aged 6-15 years) and 97 healthy children (56 boys and 41 girls aged 5-14 years) were examined. A frequencies of alleles NAT2*5, NAT2*6 of arylamine N-acetyltransferase gene (NAT2) and homozygous deletions in glutethione S-transferase p (GSTM1"-") and 0 (GSTT1"-") genes were estimated. Age and gender were shown to influence on risk of bronchial asthma occurrence associated with these genotypes. NAT2*5 allele was associated with resistance to bronchial asthma. This interrelationship was stronger in girls and weakened with maturation. NAT2*6 allele was associated with susceptibility to asthma. The value of this interrelationship was also stronger in girls and dropped with maturation. The risk significance of GSTM1"-" genotype increased with maturation and was greater in girls. The risk significance of GSTT1"-" decreased in girls and rose in boys with maturation. Interaction of these features and an impact of smoking were analysed.

Age peculiarities of symptoms, airway morphological and functional status, respiratory APUD cell activity and biogenic monoamines (BMA) (serotonin, epinephrine and norepinephrine) concentration in bronchial mucous membrane (BM) were studied in 205 bronchial asthma patients 15 to 83 years old. The controls were 75 healthy persons of different age. Morphological and functional disorders were detected using radiological methods (chest X-ray examination, CT scan, scintigraphy), fiberoptic bronchoscopy, Doppler-echocardiography and spirometry. Respiratory APUD cell activity was assessed evaluating neuron-specific enolasa (NCE) concentration, which is a marker of APUD cells, in bronchial lavage fluid using immune enzyme assay. An amount of BMA in BM biopsy specimens was determined with the Falk—Hillarp histochemical procedure. Correlation analysis allowed to discover an interrelationship between age BM injury, pulmonary microcirculation impairment, bronchial passability disorders, occurrence of pulmonary emphysema and, on the other hand, the APUD cell activity and certain BMA concentration in BM.

A comparative analysis of uric acid level in children with acute bronchopulmonary diseases (80 pneumonic and 65 bronchitis patients) revealed a clear correlation between its concentration and a respiratory failure severity, and a hypoxaemia level as well. This fact confirms a role of hypoxia in purine nucleotides catabolism, resulting in uric acid production. The relation established between a uric acid concentration and lipid peroxidation products content proved the role of purine metabolism acute disorders in a lipid peroxidation enhancement caused by a xanthinoxidase activation that had been shown experimentally. An application of metronidazole as a xanthinoxidase inhibitor in severe pneumonia and Riboxine as a source of inosine in obstructive bronchitis with severe respiratory disorders led to shortening of a dyspnoe period and of length of stay in an intensive care unit and also facilitated an inhibition of excessive lipid peroxidation of cell membranes.

A frequency of C.pneumoniae and C.trachomatis infection was studied in 44 aspirin-induced asthma (AsBA) patients and 65 asthma patients with no aspirin intolerance (NBA) compared with certain immune system parameters and clinical course of the disease. The controls were 21 healthy persons. Each second bronchial asthma patient was found to have chronic Chlamydia infection that was confirmed by secretory IgA level >1:8. AsBA patients prevalently have IgA titre >1:32, an increased sera immune complexes level and a decreased monocyte migration inhibition index. A reduction in melatonin synthesis and associated immune disorders in AsBA patients probably facilitate the infection to transform to chronic state as soon as 91.7% of the patients younger 50 years show a high IgA-antibodies level associated with early occurrence of bronchial asthma. These data display a necessity of timely detection of Chlamydia infection and differentiated approach to antibiotics administration for asthma exacerbations in such the patients.

The aim of the study was morphological evaluation of bronchial mucosa in exacerbation of various bronchial asthma forms. Seventy seven bronchial asthma patients aged 15 to 68 years underwent bronchoscopy with endobronchial biopsy, and quantitative analysis of cell compound of the obtained material was performed. There were no a significant difference in the basal membrane thickness, number of histiocytes, macrophages and plasmocytes in the stroma cell infiltrate between various forms, of bronchial asthma. Interepithelial lymphocyte and eosinophil number was considerably more in atopic asthma as well as high cell density of the infiltrate and more eosinophils, lymphocytes and fibroblasts and less neutrophils in it. The combined form of bronchial asthma differed from the atopic one by less eosinophil and more neutrophil amount in the stroma. The only difference between the infectious asthma and the combined asthma was the eosinophil number in the stroma that was significantly higher in the combined asthma. So, the eosinophil account in 1 mm² of the stroma became the only parameter which differed reliably between all the forms of bronchial asthma.

Outpatient care for bronchial asthma patients, is one of the primary problems of the Russian healthcare.
The article shows an analysis of 4-year work for outpatient management of asthma patients based on a pharmacoeconomic modelling method. A gradual implication of GINA principles allowed to improve the asthma detection in 4 times, to reduce a number of admitting to a hospital and of emergency care calls in 5.8 and 4.8 times accordingly. Treatment expenses for one asthma patient in the polyclinic №15 considering hospitalizations and privilege medication cost was 43% less than totally at Samara city.
An analysis of quality of life using the SF-36 questionnaire demonstrated the asthma patients observed in the polyclinic №15 to have a higher quality of life compared with other asthma patients at Samara especially on the criteria of their social activity and mental status.

The aim of this study was to evaluate influence of combined therapy with Seretid-Multidisk on quality of life (QoL) in patients with brittle and moderate asthma (BA). The study involved 33 patients: 21 patients had moderate BA (the 1^st group) and 12 ones had brittle BA (the 2^nd group) who received 1500 meg of beclomethazone dipropionate daily or another inhaled steriod in the equal dose 2.5 months at least and kept the daily bronchial lability more than 40% for at least 50% of the latter 75-day period. The basic therapy included Seretid-Multidisk 50/250: 1 inhaled dose twice a day in the 1^st group and 2 inhaled doses twice a day in the 2^nd group.
The combined therapy with Seretid-Multidisk abolished a difference between QoL in moderate and brittle asthmatic patients. Seretid-Multidisk effected to the psycho-emotional and social fields in the brittle BA patients more than to those in the moderate BA patients. The combined therapy improved the QoL in BA patients in 3 days on the treatment keeping the effect up to 3 months.

Melphalan (Alkeran) is an alkylating drug belonging to the nitrogen mustard family. It is known as cytostatic and immunosuppressive agent. Cytostatic effect of melphalan can be realized in the dose range of 0.6 to 1.4 mg/kg bodyweight or in the concentration of 0.1 mg/ml in vitro. At the same time the 100-fold lower concentrations of the alkylating agents still demonstrate their properties resulted from a selective block of cytokine receptors. Forty two patients with exacerbation of steroid-resistant asthma were enrolled into the trial. Twenty one subjects were treated with basic therapy only (the control group) and 21 others received the basic therapy and melphalan inhalations (0.1 mg daily). Inflammatory markers of the bronchoalveolar lavage fluid and blood were investigated. The combined therapy with melphalan provided a significant benefit compared with the basic therapy alone. Marked elevation in the bronchoalveolar lavage fluid cytokine level was observed in the patients treated with melphalan. This could be associated with the airway epithelium regeneration. A significant decrease in CD95 expression by the blood lymphocytes as well as a diminution of the lymphocyte resistance to glucocorticoids was also demonstrated.