The results of the experimental study of blood cells (BC) lipid composition in bronchial asthma patients and possible correction of lipid changes by the unloading-dietary therapy (UDT) and glucocorticoid therapy (GCT) are given in this article. It has been shown that content of blood cells’ phospholipids, especially of phosphatydilcholine (PTC) which is the main component of cell membranes, is reliably reduced in patients with bronchial asthma. UDT and GCT only partly enable to correct membrane structure by reducing the content of non-specific for cell membrane lipids (triacylglycerides and cholesterol esters). The control of erythrocytes membrane condition and its correction are suggested in certain cases of bronchial asthma therapy.

The aim of this study was to reveal the peculiarities of erythrocytes skeleton content in bronchial asthma (BA) patients under the modulation of adrenergic agents. The cytoskeleton was studied in 5 healthy men and 13 patients with BA by modified Chentsov’se ta l. method (1982). The integral optic density was evaluated by imagining analyser of “Ista-Videotesf firm (Saint-Petersburg city). It was found that cytoskeleton proteins were decreased (in BA especially in endogenous BA (enBA). The cytoskeleton proteins were decreased under the adrenalin influence in healthy men, in exogenous BA (exBA) and in enBA but they were increased under the β-adernoblokers influence (Obsidan) in the same group except exBA which was characterized by the decreased cytoskeleton content. The data obtained indicates cytoskeleton’s peculiarities depending on BA variants and on a close relation between the erythrocytes adernoreactive system and the cytoskeleton as well.

Multiplanned clinical and laboratory study of patients who had taken part in the liquidation of the Cnernobyl accident consequences before development the disease and had received the mean irradiation dose 25 R was carried out. Those patients suffered from main broncho-pulmonary pathology forms: 33 persons — from pneumonia, 44 persons — from chronic bronchitis, 34 persons — from bronchial asthma. The results of this study were compared with the similar parameters of the control patients’ group corresponding to the basic one at the nosology, gender and age. It was revealed that the pathology in the ex-liquidators was characterized by disorders of the main homeostasis systems such as immunological, hormonal, antioxidative and coagulative systems accompanied the basic disease. This fact apparently determines the torpid course of the diseases independently on the nosology character.

The respiratory diseases are characterized by mass spreading and great loss of ability to work. The permanent tendency to increase of morbidity and number of disabled people is noted in Saratov region. Thus, the main problem for health care agencies becomes the improving of quality of management for patients with respiratory diseases and the most attention should be paid to health centers and outpatients departments. We observed 360 patients with respiratory diseases during their preventing examination. Screening of these patients in outpatients department permitted to form three streams of patients: 1) having a high risk for the disease; 2) for whom the pathology was first detected; 3) for whom the diagnose was reached before. Differentiated and extremely individualized rehabilitation programmes allow to organize an effective medical and rehabilitative process in outpatients departments which has on the foreground non-medicinal physiotherapeutic methods, physical training and climatic methods combined with medicinal oligotherapy. The treatment should be based on the continual dynamic and objective evaluation of the gained results.

The aim of this study was to investigate efficacy and safety of inhaled glucocorticoids (budesonide and beclometazone dipropionate) in bronchial asthma (BA) patients. Nineteen patients (8 males and 11 females) with moderate BA were observed. They have received these drugs for 9 months. The patients demonstrated significantreduction in asthmatic attacks frequency and in need for short-acting β₂-agonists inhalations during the treatment. The reliable increase of bronchial passability parameters was registered only over 3 months after the starting of the therapy and was maintained up to the end of the observation period. Cortizol blood level, magnesium, calcium and potassium concentrations in serum, erythrocytes and in daily urine, serum osteocalcine content, lumbar vertebra density (L₂-L₄) did not differ significantly after 3, 6 and 9 months of treatment compared with the initial parameters.
Thus, the inhaled glucocorticoids possess high clinical activity in asthmatic patients’ treatment. These drugs should be prescribed for at least 3 months. The inhaled glucocorticoids used in average therapeutic doses do not effect negatively on cortizol blood level, mineral metabolism and osseous tissue.

The paper reports the data of a two-stage research conducted in random groups of schoolchildren (n=8247) aged 7—8 and 13—14 years and adults (n=5395) aged 20—59 years living at an industrial city (Irkutsk) and in a rural area. The first stage included a questionnaire screening (using the ISAAC and ECRHS questionnaires). During the second stage clinical and allergological as well as functional examinations were carried out in the subjects who reported asthma-like symptoms. The BA prevalence was 4.6—8.3% for children and teenagers and 3.1—5.6% for adults according to the investigation results. These results are considerably higher than statistical data given by medical institutions. The highest prevalence index was registered among the population of the industrial city, that is likely to be connected with a high level of industrial air pollution. An atopic type of the disease predominates in the etiological structure of BA and constitutes 68—73% and 89—92% among adults and children respectively. The analysis of the obtained results evidences that late diagnostics of BA takes place at the region, that is the reason of high proportion of patients with severe and complicated course of the disease.

We determined whether inhaled budesonide (600mcg) had given by Cyclohaler (Pulmomed) before allergen inhalation challenge (AC) inhibited the late asthmatic responce (LAR) and subsequent bronchial hyperpesponsiveness to histamine (BR). Five asthmatics sensitized to Dermatophagoides pteronyssinus (Prick-test), who had previously shown the development of early and late asthmatic responce to AC with Dermatophagoides pteronyssinus, were studied in a double-blind placebo-controlled randomised protocol.
Budesonide significantly reduced the LAR induced by Dermatophagoides pteronyssinus (maximum % fall of FEV₁: -16.0±6.1% with budesonide versus -26.2±5.5% with placebo; p<0.01) and inhibited the increase of BR (decrease of logPC₂₀ by 1.43±0.69 mg/ml with budesonide versus 4.11±0.83 mg/ml with placebo, p<0.05).
Our data suggest that budesonide reduces the LAR and protects airways against increased BR after AC.

The peculiarities of nutritious status, respiratory tract physiology and the prevalence of genetics sighs of connective tissue systemic dysplasia have been studied in emphysema patients. It was shown that significant disorders of patients’ nutritious status and subsequent development of complex anatomical and functional changes which characterize systemic sighs of connective tissue dysplasia in the respiratory tract and in the whole organism take place in emphisema patients under prolonged exposure of risk factors particularly of tobacco use. It was supposed that emphysema is an independent disease with certain stages of course and with clinical sings appropriate to a systemic process.

The microbioilogical and immunological examination of 173 children with cystic fibrosis was carried out in 1986— 1997 in dynamics. The polyetiology of lungs infectious inflammatory process with the prevalence of S.aureus and Ps.aeruginosa which course the colonisation and acute and chronic infections was revealed. Criteria for diagnostics of th ese infectious forms were produced. The intensive purposeful antibiotics therapy allowed to remove the acute process and to prevent its conversion to chronical form. The severity of course was due to chronic Ps.aeruginosa infection which appeared with the frequency depending on the genotype.

Bronchological study was performed in 123 children with severe and moderate bronchial asthma at their remission stages. Severe asthma course was in 83 children. The patients’ age was 4 —14 years. Broncho-alveolar lavage fluid and bronchial biopsies were investigated (84 and 37 samples correspondingly). The complex examination carried out has shown that severe inflammation signs remain in bronchial mucousmem brane in severe asthma remissions due to IgE-depended and immunocomplex mechanisms, reduction of antibody-producing cells number, hyperplasia and degranulation of APUD-cells and imbalance of cyclic nucleotides.

The efficacy of the programme implemented in 1995 in Smolensk for preventing bronchial asthma, patients’ rehabilitation and provision with drugs was estimated. This programme was based on the number of patients admitted to the city hospitals with asthma exacerbation, on the quantity of asthmatic states and on the direct expense of city budget for asthmatic patients’ treatment in the city hospitals and polyclinics. The structure of anti-asthmatic therapy in 1992—1997 was also analyzed.
The implementation of the anti-asthmatic programme based on the modern treatment tactics has led to the diffusion of anti-inflammatory therapy due to the prevalent use of inhaled glucocorticoids and selective β₂-agonists. This process was accompanied to reduction of asthmatic exacerbation number and to conversion of the disease to milder forms with long remission periods. At the same time the number of hospitalizations has diminished in 2 times and the number of patients admitted to the hospitals with asthmatic state — in 6 times. The cost-effectiveness of the reduction of hospitalization number by 485 cases per year was more than 103000 USD.

Eighteen non-smoking patients (13 females and 5 males) with severe non-atopic bronchial asthma exacerbation, who had not been treated with any glucocorticosteroids before now, received Pulmicort-turbuhaler during 4 weeks in the dose 1000 meg daily. Besides of a dynamic evaluation of the clinical signs score and daily need for β₂-agonists, a bronchial response to p2-agonists in lung functional test was also checked before the treatment and after the 1-st, the 2-nd, the 4-th week of the treatment. Local and systemic adverse events were controlled by an inspection of an oral cavity, a dynamic investigation of 11 -oxycorticosteroids, insulin, glucose and electrolytes levels and blood biochemical parameters.
Four-week treatment course was effective in 89% of patients that was demonstrated by the clinical signs regression and improvement in lung function parameters up to the level appropriate to a mild bronchial obstruction.
The FEV₁ increase by more than 25% at the salbutamol test after the 1 -st, the 2-nd, the 4-th week of the treatment appears to be the evidence of a bronchial hyperreactivity. A local irritation of mucous membrane was found in 2 patients from 18. Any systemic effects were not revealed.
Thus, the obtained data confirm the fact of a high anti-inflammatory activity of Pulmicort-turbuhaler. The examination of its safety has not found any systemic adverse events. These results according to the high clinical efficiency and the comfortable application allow to recommend this drug as a drug of choice for patients with severe bronchial asthma exacerbations who did not use to be treated with any glucocorticosteroids. Эффективность и безопасность применения пульмикорта-турбухалера 1000 мкг/сутки у больных с обострением бронхиальной астмы, ранее не получавших ингаляционные глю ко кортикостероиды.