Bronchial asthma: novel therapeutic approaches.

По материалам Lloberes P., Dura’n-Cantolla J., MartI’nez-GarcI’a M.A’. et al. Diagnosis and treatment of sleep apnea-hypopnea syndrome. Spanish Society of Pulmonology and Thoracic Surgery. Arch. Bronconeumol. 2011; 47 (3): 143–156.

Summary. Mortality rate in July – August, 2010, according to findings of the pathomorphological department of Clinical hospital N57 in Moscow has been analyzed and compared with the appropriate period of 2009. During abnormally hot weather and air pollution (smog), mortality from cardiovascular and respiratory diseases has significantly increased in Moscow. The most prominent growth in mortality rate was seen among patients with ischaemic heart disease and congestive heart failure and among patients with bronchial asthma complicated with status asthmaticus.

Summary. In summer 2010, European Russia experienced extremely hot weather with air temperature exceeding the average norm by more than 5 °C for over 1.5 months in several regions with population of more than 101 million people. Subsequent analysis showed that cumulative excess mortality in July and August, 2010, was 54,000 including 34,500 deaths from cardiovascular diseases and 1,300 deaths from respiratory diseases when compared to the same period of 2009. In some regions, relative increase in monthly total mortality rates was 50–60 %. In Moscow, the first half of 2010 was characterized by lowering mortality in comparison with the same period of 2009 but in July and August, 2010, mortality increased by 11,000 deaths (60 % in relation to that of 2009) including 5,951 deaths from cardiovascular diseases and 339 deaths from respiratory diseases.

Summary. To compare tobacco smoking habits and unfavorable environmental exposure as risk factors of respiratory disorders in adolescents, we questioned pupils in schools and colleges of Samara region. In total, 314 adolescents participated in the study underwent screening questioning, anthropometry, and spirometry; exhaled carbon monooxide was also measured. Results showed that tobacco smoking is stronger risk factor of respiratory disorders that unfavorable environmental exposure; while acting together these factors could potentiate each other.

Summary. Clinical and functional status including quality of life, CAT test and BODE index in relation to level of hypoxemia was assessed in 44 patients with COPD only and in 35 patients with COPD and cardiovascular co-morbidity (ischemic disease heart and systemic hypertension). CAT score, BODE index and MRS score were higher and 6-min walking distance was shorter in hypoxemic COPD patients n comparison to COPD patients without hypoxemia. The most significant disorders were seen in COPD patients with cardiovascular co-morbidity. CAT is a simple and effective test to assess the impact of disease on health status in COPD patients with cardiovascular co-morbidity and hypoxemia.

Summary. The study analyzed long-term consequences of acute lung injury / acute respiratory distress syndrome (ALI / ARDS) caused by influenza A / H1N1 and effects of long-term treatment with N-acetylcysteine (NAC) on clinical and functional recovery of survived patients. This was an open, prospective, 12-month study involved 22 patients survived from ALI / ARDS caused by influenza A / H1N1. The patients' lung function, arterial blood gases, physical tolerance in 6-min walking test (6MWT) and computed tomography (CT) of the lungs were monitored in 3, 6, and 12 months after discharge.

During the follow-up, all lung function parameters improved: FVC, TLC, and DLCO increased by 28.7 %, 17.5 % and 31.4 %, respectively (p < 0.05 for all). In a year after discharge, DLCO < 80 %pred. was found in 23 % of patients. At 12 months, the mean 6MWT distance increased from 454 Ѓ} 37 to 568 Ѓ} 47 m (р = 0.002). Significant improvement was noted in CT findings and 41% of patients had quite normal lung CT at 12 months. Therapy with NAC (n = 11) has led to more rapid improvement in DLCO (76.3 Ѓ} 11.8 %pred. vs 63.0 Ѓ} 10.6 %pred. in controls; р = 0.012) and 6MWT distance (533 Ѓ} 42 m vs 490 Ѓ} 46 m, respectively; р = 0.033) at 3 months.

Therefore, patients survived from ALI / ARDS caused by influenza A / H1N1 demonstrated significant recovery of lung function, gas exchange, lung CT picture and physical tolerance but in some of them, persistent disorders of lung function (mainly in DLCO) and lung CT have been still found at 1 year after discharge. Treatment with NAC allowed more rapid improvement in DLCO and exercise tolerance.

Summary. To diagnose community-acquired pneumonia, we used high-resolution computed tomography (HRCT) of the lung together with routine diagnostic criteria, which gives an opportunity to analyze fine structures of the lung closely to pathomorphologic findings. HRCT could detect more extensive and persisting changes in the lung tissue compared to the standard chest X-ray examination.

Summary. Asthma and chronic obstructive pulmonary disease (COPD) can exhibit overlapping clinical features; therefore, diagnosis of these diseases can be difficult. Search of new biomarkers represents an active research field in modern respiratory medicine. The objective of this study was to investigate spectrum of semi-volatile organic compounds (SvOCs) in exhaled breath condensate (EBC) of healthy volunteers and patients with asthma and COPD and to assess the possibility for using these biomarkers in differential diagnosis of obstructive lung diseases. Seventy subjects participated in this cross-sectional study: 20 patients with exacerbation of COPD (age, 66.5 Ѓ} 8.5 years; FEV1, 57.3 Ѓ} 22.9 %pred), 20 patients with exacerbation of asthma (age, 50.2 Ѓ} 13.2 years; FEV1, 71.4 Ѓ} 20.7 %pred) and 30 healthy nonsmoking volunteers (age, 25.4 Ѓ} 9.6 years, FEV1, 98.4 Ѓ} 6.8 %pred). EBC was collected using ECoScreen equipment. Testing for SvOC of different polarity was conducted by gas chromatography/mass-spectrometry (GC / MS) method in EBC. The data collected were analyzed using an algorithm based on linear methods of pattern recognition theory. More than a hundred of SvOC in ultra-low concentrations were detected in EBC of the participants; 33 of SvOC were identified; 9 compounds (2.3-dihydro-1-H- inden-1-on, ethyl citrate, decanol-1.2-phenoxyethanol, etc.) had the highest informative value to differentiate the conditions. Mathematical analysis allowed distinguishing healthy volunteers from patients with asthma with reliability of 75 %, healthy subjects from COPD patients with reliability of 85 % and asthma patients from COPD patients with reliability of 83 %. In conclusion, we have developed a highly accurate GC-MS method to measure ultra-low concentrations of SvOC in EBC. This method can be used for diagnosis and differentiation of COPD and asthma.

Summary. The purpose of this prospective study was to evaluate asthma control in patients of Krasnoyarsk pulmonary and allergological center. Treatment efficacy was evaluated in 48-wk follow-up using the validated Russian version of the ACT questionnaire. In 48 weeks, improvement in asthma control was achieved in patients with moderate asthma: to the end of the follow-up, 68.3 % of the patients achieved adequate and good control. In majority of patients with severe asthma (90.3 %), the level of control remained poor. Thus, there is a reserve to improve asthma control with adequate pharmaceutical support, regular follow-up and timely correction of the basic therapy.

Summary. Results of efficacy and safety trial of Russian inhaled beclomethasone dipropionate BeclospirR in mild to moderate asthma have been shown in the article. The study involved 60 patients with asthma. During 3 months, clinical efficacy of BeclospirR was compared to that of another preparation of beclomethasone Beclasone Eco using the following common criteria:

• clinical symptoms of asthma (patients' dairies);

• daily need in short-acting bronchodilators;

• peak flow rate;

• level of asthma control;

• spirometric parameters (FEV1 before and after inhalation of salbutamol);

• safety of treatment with BeclospirR.

The results demonstrated that BeclospirR was not inferior to Beclasone Eco. Moreover, BeclospirR in the daily dose of 1 000 μg had certain advantages against Beclasone Eco.

Key points of antibacterial therapy of acute exacerbation of chronic obstructive pulmonary disease.

About the genetics of pulmonary emphysema.

Arterial wall stiffness and endothelial dysfunction in patients with chronic obstructive pulmonary disease.

Role of mucoactive drugs in treatment of chronic obstructive pulmonary disease.

Osteoporosis in cystic fibrosis patients: a new problem and unresolved issues.

First experience of using nebulized tobramycin in patients with acute exacerbation of bronchiectasis.

Vladimir G. Alexeev. To the 60th birthday.

Vladimir N. Saperov. To the 80th birthday.