Modern data about structure and functions of lung surfactant system (LSS) are discussed in this review. The main chemical components of LSS are phospholipids and surfactant proteins which are specific for lungs; they significantly contribute LSS functioning. Causes and nature of LSS alteration in some acute and chronic diseases are considered. Diffuse acute injuries of LSS are leading mechanism in acute respiratoryfailure pathogenesis including respiratory distress-syndrome of adults. The most perspective method for correction of surfactant deficient is replasing surfactant therapy with either natural or synthetic surfactant. In some cases it is possible to apply certain non-specific methods and techniques which im-prove LSS condition.

In 1998 wood fire'in the Far East lasted from July to November and seized the territory of 2.1 rAillion of hectares. More than 1 million of residents have undergone td an influence of smoke from burning wood for long time. Though the mortality and morbidity from respiratory diseases did not increase in 1998, the authors revealed a number of quantitative changes in the course of principal respiratory diseases in the period of the smoke influence.
Hospitalization of patients with pneumonia in Khabarovsk and Komsomolsk hospitals increased by 20-30%. This disease run more severe compared with the same period of 1997. Bilateral lung injury and dry cough were observed more often. A peculiar bronchopneumopathy with breathlessness, dry cough, crackles and wheezing on auscultation, bilateral bronchial wall thickening on chest radiography, absence of fever and intoxication, high efficacy of glucocorticosteroids and bronchodilators was noted in children aged 5-13 years.
In 191 adult patients with lung obstructive disease the effect of traditional complex therapy was reliably worse assessed by the FEV₁ dynamics. The increase of atmospheric CO concentration more than 3 mg/m3 was accompanied by an improvement of bronchial passability in asthmatic patients and its worsening in chronic obstructive bronchitis patients (p<0.05). This is thought to involve different obstruction mechanisms in these diseases.

One hundred and eighteen bronchial asthma (BA) patients were examined by means of the Toronto alexithymie scale (TAS), and a brief version of the personality multilateral investigation method (PMIM), and the Spilberg-Khanin’s anxiety scale. Among them 55.1% of the patients were recognized as alexithymie persons. Asthmatic patients with alexithymia were reliably more neurotized compared with non-alexithymic ones. The revealed peculiarities of an actual personal condition of the alexithymie bronchial asthma patients cause a necessity of including methods of psychotherapeutic correction of alexithymia to a prevention measures system.

This article displays results of clinical and morphological comparison of acute pneumonia (AP) in 32 infants with signs of primary immune deficiency (PID). Etiology AP and a form of PID were recognized by means of a complex of immunological testing during the patients’ lifetime and post-mortem immunohistochemical, histobacterioscopic, and bacteriological examinations. Principal distinguishing features of AC under PID background were: 1) mixed etiology of the disease, in which viral-and-bacterial-and-mycotic associations acquire the great importance; 2) a significant extension of lung tissue injury with predominance of an alternative component of inflammation; 3) a tendency of infectious and inflammatory lung processes to generalization.

Cell volume characteristics of peripheral blood populations of neutrophyls, lymphocytes and monocytes were compared in healthy persons and in patients with bronchial asthma, chronic bronchitis and pneumonia. The parameters of volume distribution such as an average value, SD, As, Ex were calculated for every of those leukocytes types. A significant increase in lymphocytes average corpuscular volume was found under all the diseases. It was ascertained that blood leukocytic link also responds to bronchopulmonary pathological disorders by changing different cell volumes ratio, arising the population heterogeneity and narrowing a range of volume values variation within the pool. The greatest disorders of this kind were noted for lymphocytes and neutrophyls in bronchial asthma and pneumonia. The conclusion was made about an opportunity to apply the accounting parameters of different leukocytes volume distribution for diagnostic purpose.

This study demonstrates the treatment results of 96 abscess-forming pneumonic patients treated with a method developed by the authors. It involves sanitating fibreoptic bronchoscopy and intrabronchial lymphotropic infusion of 1 g of Claforan combined either with 100 meg of T-activin or 100 mg of lysozyme. According to the results obtained this method is thought not only to cure all the patients but also to facilitate a partial restoration of structure and function of both ciliary epithelium and mucociliary transport.

The results of 58 COPD patients’ dynamic observation (56 males and 2 females) were analysed. The patients had been treated in the State Scientific Pulmonology Centre of Health Ministry of Russian Federation and the municipal pulmonology hospital N 2 of Sankt-Peterburg city in the years 1996-1998. The patients were examined using standard clinical techniques, lung function and diffusing capacity tests, blood gas analysis, echography of pulmonary circulation. Prognostic criteria were evaluated which enable to determine the optimal date for lung grafting.
Initially all the patients were divided into two groups: 9 patients whose lifetime had not exceeded 18 months after their first examination and 49 patients who had lived more than 18 months after their first examination. The first group patients demonstrated the signs of right heart hypertrophy and overload significantly more often.
Their pulmonary artery blood pressure was increased to 38 mm Hg and the capillary blood oxygen contents was greatly diminished. Lung function and diffusing capacity parameters, pCO₂ did not differ in the groups.
Next, the certain indices’ influence on the life-expectancy as well as the prognostic value of chronic cor pulmonale existence and severity were assessed.
The correlation analysis displayed a strong tie between the COPD patients’ life-expectancy and the pulmonary artery blood pressure level, dyspnoe, heart beat rate, hypoxaemia level and also between the pulmonary artery blood pressure level and the capillary blood oxygen contents. The correlation between the severity of corpulmonale failure and the patients’ life-expectancy was faint.
The pulmonary artery blood pressure proved to be the most important parameter for the patients’ prognosis: ones having it normal lived more than 2 years meanwhile the patients with the pulmonary artery blood pressure higher 50 mm Hg lived not more 18 months. The lung functional parametbrs were not found to be the independent prognostic factors.
So, based on the result obtained the indications for lung grafting in COPD patients are thought to be the pulmonary artery blood pressure higher than 50 mm Hg, the pO₂ level less than 60 mm Hg and the conservative therapy failure.

Clinical and pathomorphological study of visceral organs’ condition including gastrointestinal canal, hepatobiliary system, heart and kidneys was undertaken at 432 patients and 33 persons died from bronchial asthma. A wide spectrum of internal organs’ visceral iesions which were morphologically significant was marked. In a number of cases they led to underlying pathology with clinical manifestations required therapeutic correction. The sectional material generally displayed more frequent pathological changes.

One of the most important tasks of the up-to-date medicine is to achieve a high level of cooperation (compliance) between, a patient and healthcare initiatives. Majority of compliance evaluation methods are medical regimen oriented. Meanwhile a treatment progress is a complex of healthcare initiatives. Besides that at present time compliance evaluation does not consider availability of healthcare initiatives.
The target of this article is to analyze medical and social factors influencing the index of cooperation (IC) for asthma patients. IC is wider (than compliance) concept featuring level of a patient's desire and possibility to follow all doctor’s recommendations.
For IC evaluation ICBA-50 questionnaire was used. It contains 50 questions assessing IC in accordance with 8 main criteria. Seventy three asthmatic out-patients were involved in this study.
It was established that a total IC (TIC) for the asthmatic patients was 65.66±1.60%. The most strong TIC correlation (p<0.001) was revealed for the patients’ initial cooperation level (InC), comprehension of a danger (CD), a level of knowledge (KN) and a level of the patients’ satisfaction with the cooperation (S).
A positive correlation was determined between TIC and objective spirometry data: % FEV₁ and % PEF (p<0.05), and subjective asthma controllability level (p<0.01). A positive correlation was also defined between TIC and the patients’ age (pcO.001), gender (p<0.01), educational level (p<0.05), occupation (p<0.05), marital status (p<0.01), number of family members (p<0.01), family income (p<0.05), and number of family members suffering from asthma (p<0.05). A negative correlation between TIC and smoking index (p<0.0l), asthma duration (p<0.001), and asthma treatment expenditures (p<0.01) was established.
The current results allow to determine necessary doctor’s actions directed to the optimization of the cooperation with patients according to his medical and social status.

Our purpose was to evaluate mortality rates at two years on the basis of lung function in adult cystic fibrosis (CF) patients during 1993-2000.
Forty five adults CF patients were included in our study. The diagnosis was confirmed by the typical clinical findings together with an abnormal sweat test results.
Twelve patients (27%) of all the CF patients died during the study period. Mortality was significant higher (p=0.002) in patients with severe lung disease. Regression analysis confirmed that all the covariants (FEV₁, FVC, BMI, sex and age) were reliable predictors of death. Among all the variables, FEV₁ was the most significant predictor of mortality.
Standard lung function tests make it possible to assess the survival of adult CF patients.

Authors studied the prolonged catamnesis of 165 children with recurrent croup and found out the high frequency of allergy in patients and their relatives and its transformation to bronchial asthma in 27.8% of children. Forty patients were treated for the relapse prophylaxis with “Tilade Mint” which was done for the first time. The high efficiency of this medicine was established.

An analysis of a quality of specialized aid for COPD patients showed a necessity of its modernization according to current tendencies and of arrangement of pulmonological schools under certain local conditions. In this case it is a question of residents of Gyandji town (Azerbaïdjan republic).
The whole educational course in a school for COPD patients consisted of 6 daily lessons lasted for 60 minutes. The individual work was conducted with 253 COPD patients; as a result, 168 ones wished studying in a pulmonological school; 85 patients did not attend the school due to various reasons but still were observed by general practitioners. Most patients were voluntarily examined with additional clinical and functional tests. Thirty nine patients gave their consent for bronchological examination.
The educational programme was of great importance in a treatment of COPD patients. The majority of them agreed to modify their bronchodilating therapy according to modern standards. The main principles of the bronchodilating therapy became the primary application of aerosol cholinolytic agents, beta-2-agonists and a systemic check of their efficacy. The COPD patients’ education was a significant part of smoking cessation programme: 20% of the patients stopped smoking on psychotherapy and 35.7% of them quitted tobacco use on the combination of psychotherapeutic intervention and nicotine replacement therapy.

Bronchial washouts (BW) were studied in patients with atopic bronchial asthma (BA) exacerbation. Flixotid’s efficacy was assessed based on dynamics of clinical signs and BW parameters after 3-month application of the drug. In bronchial asthma exacerbation BW showed the high cytosis (2.31 ±0.05 • 10⁶/l); cell contents displayed the increased eosinophyls (5.06±0.62%), lymphocytes (14.73±0.41%), neutrophyls (5.49±0.55%) number and lowering in macrophages amount (38.89±2.01%). Secretory lysozyme activity (35.24±2.16%) and SlgA level (0.22±0.01g/l) were reduced, IgG concentration was increased.
After the therapy with Flixotid distinct positive changes in clinical signs and peak flow rate were noted. It was observed a significant cytosis reduction, a diminishing in the inflammatory cells amount, and an increase in macrophages number in BW. Comparative analysis of BW humoral indices found a reliable increase in lysozyme activity and SlgA level and also a lowering in IgG concentration.
The data obtained give the evidence concerning Flixotid’s anti-inflammatory efficiency.

Ampicillin, cotrimoxazole (Biseptol) and azithromycin (Sumamed) were applied for outpatient treatment of 90 patients with lower airways infection. The study consisted of comparison of clinical efficacy and pharmacoeconomic analysis by the "cost-effectiveness" method. The clinical efficacy was 80, 67 and 97% for ampicillin, Biseptol and Sumamed correspondingly. The best tolerability was noted for Sumamed. The pharmacoeconomic effectiveness of the therapy was evaluated as the ratio of the cost and the number of both recovering and improved patients and it was 372, 656 and 366 rubles per a convalescent for ampicillin, Biseptol and Sumamed accordingly.