Current study present results of comnblned treatment with fluticasone propionate and salmeterol in 52 patients with moderate persistent asthma (11 male, 41 female), who received inhaled steroids for more than 3 month before study and/or in combination with different brochodilators.
Efficacy of the treatment (fluticasone — 250 meg, salmeterol — 50 meg) during 9 weeks was evaluated by clinical observation, peak flow and flow-volume measurement with reversibility response to pronchodilators and daily needs to short acting β₂-agonists.
Obtained results demonstrated that administration of ccombined therapy with fluticasone and salmeterol the optimal way of treatment of patients according to efficacy and security. This treatment provide stabile and long-term effect on bronchial contuctance and daily variability and support its efficacy during whole treatment period. Combined administration of fluticasone and salmeterol doesn’t have serious systemic and cardiotoxic side effects.

As a serious chronic illness, asthma imposes a significant burden on society in terms of cost to patients, their families and the healthcare and social security system. More specifically, the burden on patients is characterised by impact on lifestyle and well-being, as well as on livelihood. Instruments are available that describe and measure the impact of asthma and its treatment on patients’ health-related quality of life, and a number of these have translated and adapted for use in Russia. Use of these will contribute to improvement in care of asthma patients in Russia in the future.

The open investigation of 60 mild to moderate bronchial asthma patients was caried out to test the efficacy and safety of "Akolat". Non-smoking adult males and females who received short-acting inhaled beta-agonists as monotherapy or combinated with inhaled corticosteroids in dose up to 1000 meg daily were involved in this investigation. The efficacy was evaluated according to the asthmatic symptoms score, dynamics of pulmonary function parameters and to changes in frequency of taking beta-agonists.
The significant improvement in daytime asthma symptoms evaluation (score number decreased by 56%), reduction of freqiency of nighttime awakenings because of asthma (by 53%) and reduction of mean number of mornings with asthma in a week (from 4.5 to 2.5) were registered after 6-week treatment with “Akolat” in 20 mg 2 times daily. Also the improvement of lung function (FEV₁ and REF values increased accordingly by 16.8% and 22.6%) and reduction of beta-agonists necessity were noted. All the changes were statistically reliable. Side effects were basically mild to moderate and as a rule they did not require to abolish the drug. Two patients only had given up taking the drug because of unfavourable phenomens which were solved for two days.
Conclusion: “Akolat" is effective and well-tolerable drug for basic therapy of mild to moderate asthma.

Theraputic efficacy of Akolat was studied in 41 atopic asthma children. Treir age was from 9 to 14 years. Mild to moderate asthma course was in 34 patients, severe asthma course — in 7 children.Duration of Akolat treatment varied from 2 weeks to 6 months. Inhaled beta-agonists were used for resolution of asthmatic symptoms, if it was necessary. Akolat therapy was effective in 38 asthmatic patients (99.8%). The reduction of bronchial attacks frequency, relief of their course and nighttime cough stopping were recorded during the Akolat treatment. Akolat treatment assisted either standardization of lung ventilatory function or reduction of its disorders in 45.5% of patients. This medicine was more useful for children with mild to moderate bronchial asthma.

Cardiovascular consequences of obstructive sleep apnea-hypopnea syndrome are known to be one of the main causes of increased morbidity and mortality associated with this disease. Pathophysiological mechanisms underlying hemodynamic abnormalities in OSAS, the role of increased sympathetic tonus are being discussed. The CPAP efficiency for correction of OSAS hemodynamic consequences has not been established yet. The aim of the current study was to assess cardiovascular response to physical load and the short-term effects of CPAP-therapy on hemodynamics in OSAS patients. Ten severe OSAS patients were examined. A bicycle exercise test dynamic stress-echocardiography was performed to study cardiovascular response to physical load. Tests were performed before and 5 days after the starting of CPAP therapy. The results of study showed that hyperdynamic B P response to physical load was common for severe OSAS patients and associated with the initial decrease of left ventricular stroke volume. Short-term CPAP course improved the central hemodynamic pattern and the blood pressure response. One of the possible involved mechanisms could be the reduction of sympathetic nervous activity due to the CPAP effects on nocturnal hypoxemia and sleep fragmentation. Conclusion: short-term CPAP-therapy produces positive changes in hemodynamic response to physical load in OSAS patients.

Main metabolite of melatonin (MT) — 6-sulfatoxymelatonin (6-SOMT) urine contence and the influence of different melatonin doses in vitro on ADF-induced thrombocytes (T) aggregation were studied in 17 aspirin-induced asthmatic patients (AIA), 17 non-aspirin-induced asthmatic patients (NAA) and 16 healthy subjects. It was found that daytime urine 6-SOMT excretion in aspirin-induced asthmatics was lower that evidances reduced melatonin synthesis. Melatonin level in human organism effects on ADF-induced thrombocytes aggregation and on change of its parameters in consequent addition of melatonin in vitro. Aspirin-induced asthmatics have increased intensity and rate of the first aggregation phaze during incubation of enriched by T blood plasma with MT in dose 0.01 pg/ml of plasma in difference from non-asthmatics and healthy subjects that is connected with openning of receptor-operated calcium canals and/or calcium’s comming out of intracellular depot. The obtained results evidance the reception’s disorder of melatonin and its metabolite — N-acetyl-5-metoxykinurenamine, which chemically is like acetylsalicylic acid — in aspirin-induced asthma.lt possibly defines aspirin intolerance in aspirin-induced asthma patients.

21 patients with chronic obstructive bronchitis (COB) and 4 patients with chronic non-obstructive bronchitis (C N B) were studied by bodyplethysmography. It was demonstrated that lung hyperinflation decreased in the most of patients after breathing with P EE P 5 or 7 sm H₂O for 20 minutes. Different bronchial reactions to PEEP were revealed. The improvement of bronchial passability was obtained in 9 patients, neutral reaction (no changes) — in 18 and changes for the worse — in 4 COB patients. Pulmonary function did not change in CN B patients. Thus, the breathing with PEEP could be used in treatment of patients with COB exacerbation.

The new universal diagnostic test for cancer grow (TURTEST) have been investigated in modified test hemagglutination of erythrocytes (immunomodification of ESR). The test was made in 368 patients with different lung diseases. The sensitiveness of this method in patients with lung cancer was 84%. The TURTEST’s data was not differ in patients with benign tumours and nontumoural pulmonary diseases from control droup. This method is technically simple and can be used in outpatient conditions. It has been shown that oncotest is reasonable to be used for screening, diagnostics and monitoring in patients with lung cancer.

Dynamic histological and electron microscopic rat lung investigation using morphometria was carried out after intratracheal bleomycin administration and consequent three-time lung surfactant inhalation.There were found out the significant decrease of both intensity and extension of intracellular oedema, alveolitis and focal bronchopneumonia.One of the possible mechanisms of revealed effect could be the recorded decrease of alveolocyte-ll alteration

The study of functional respiratory disorders in patients with neurocirculatory dystonia has been conducted. Various respiratory disorders combined to hypocapnia, hypercapnia, normocapnia and changers of respiratory patterns are revealed. The features of acute hyperventilatory syndrome course are presented. It is signed that the capnographic investigation is important for clinical interpretation of functional respiratory disorders.

Results of 41 270 autopsy protocols in N.V.Sklifosovsky Emergency Care Research Institute’ United Pathology Department have been analyzed. In 9073 cases (22%) all types of pneumonias have been found.
Pathological, bacterioscopic, bacteriological and histobacterioscopic data are presented. 378 cases (42%) of lobular pneumonias, 231 cases (27.9%) of postoperative pneumonias and 3729 cases (41.1%) of pneumonias in cerebral supply disorders are especially selected.
The clinical diagnosis is shown to be on quite low level. Twenty five percent of pneumonias had not been diagnosed in clinical period.
Speaking about pneumonia etiology Pneumococcus (45.7%) and Clebsiella (31.5%) are more often found in lobular pneumonia, Staphylococcus (47.5%) and Clebsiellapneumoniae (22%) predominate in postoperative pneumonia. Etiology of pneumonias in cerebral supply disorders is variuos, there are primarily different dramnegative bacterial associations.

The efficacy of 18-month usage of Fluticasone propionate (FP, 1000 meg daily) combined with Salmeterol (100 meg daily) was studied in 37 steroid-dependent asthma patients aged from 15 to 66 years, who had received systemic steroids (SS) for the period from 2 to 20 years.Thirteen patients (1 group) had taken. SS intermittently, with interruptions not longer than 1 month. Twenty four patients (2 group) had taken SS constantly. Treatment appreciation was performed taking into account dynamics of daytime and nighttime asthma symptoms, short-acting beta-agonists need, lung function parameters, tolerance to physical load (by bicycle execise) and blood plasma cortisol level.
The carried out investigation showed that long-time treatment by FP and Salmeterol ensured steady clinical and functional improvement in patients’ condition: it decreased frequency and intensity of asthma symptoms, reduced the need of short-acting beta-agonists, eliminated variable bronchial obstruction and enhanced the tolerance to physical load. SS were replaced by FP in all the patients from the first group and in 18 patients from the second group. Six patients with partly abolished SS reduced their doses in 2—5 times. Factors limited the opportunity of complete SS abolition were the duration of SS constant treatment (more than 5 years) and hign supporting doses (more than15 mg).
Increase of basal cortisol level on the FP and Salmeterol treatment background, absence of arrythmiac effects, low degree of local complications (signs of moderate oral candidiasis were in 2 persons and transient dysphonia was in 4 persons) evidence concerning safety of long-time FP and Salmeterol treatment of steroiddependent asthma patients.

This multi-centre, randomised, double-blind, parallel group 12-week ‘switch’ study have compared the tolerability and efficacy of 200 meg salbutamol/propellants 11/12 qds and 200 meg salbutamol/GR106642X qds in adult patients with reversible airway obstruction. A total of 547 patients were randomised to treatment; 277 patients received salbutamol/GR106642X and 270 patients — salbutamol/propellants 11/12. Nineteen patients were withdrawn from the 12-week treatment period. There were no changes in heart rate over the treatment period (mean change from the baseline was 0 beats per minute). Statistical analysis showed that there was no difference between the two formulations. The findings of this primary tolerability variable were supported by the analysis of the secondary efficacy variables. The frequency and variants of adverse events was similar in patients received salbutamol/GR106642X (32% ) and patients received salbutamol/propellants 11/12 (36% ) and in control group and there was a small difference in the frequency of individual adverse events. There was a low frequency of the pharmacologically predictable events such as headache, tremors, palpitations and tachycardia in both groups. There were no reports of paradoxical bronchospasm, muscle cramps or hypokaliemia. Eight patients experienced serious adverse events during the treatment period including six persons from the salbutamol/GR106642X group. Two patients received salbutamol/GR106642X and 3 patients received salbutamol/propellants 11/12 were withdrawn because of adverse events. This study have demonstrated clinical equivalence in tolerability and efficacy of 200 meg salbutamol/propellants 11/12 qds and 200 meg salbutamol/GR106642X qds.

The efficiency of chronic treatment with beclometasone dipropionate was assessed in 10 asthmatic subjects aged 20—45 years in stable condition. Beclometasone dipropionate — Becotide (GlaxoWellcome, England) was inhaled in a dose of 400 meg daily during 11 weeks.
Regular treatment with beclometasone dipropionate in asthmatic patients showed the significant benefit of lung function parameters and reduced airway responsiveness (log PC20 to histamine increased by 1.96 mgxm^-1, beclometasone dipropionate caused a mean 49-fold increase in PC20 to histamine).
Chronic treatment with beclometasone dipropionate in asthmatic patients is highly effective in clinical practice.

At present asthma-rooms system is developed in regional polyclinics mainly and it is intended for patients’ education in remission. However, such approach excludes patients living in provinces and patients in exacerbation from modern programmes of treatment and education of bronchial asthma patients.This situation is due to remote places of patients’ residence, insufficient doctors' training in provinces, inadequate asthma treatment that lead to severe course and frequent exacerbations. According to that, education of patients living in provinces becomes crucial. This article showes the experience of organization and work of asthma-room in regional in-patient department; the study methods, the particularities of education of patients living in provinces. Nowadays such form of patients’ education allows to realize modern programmes of asthma treatment. Simultaneously asthma-room of regional in-patient department becomes the methodic centre for doctors’ education and for the control of quality of asthmatic patients’ treatment, for adoption of new diagnostic and treatment technologies.