Latex allergy: current state of the problem.

По материалам: Laube B.L., Janssens H.M., de Jongh F.H. et al. What the pulmonary specialist should know about the new inhalation therapies. Eur. Respir. J. 2011; 37 (6): 1308–1331.

Summary. Results of observation of 642 patients with primary spontaneous pheumothorax are given in this article. To determine the etiology of bullous emphysema we performed targeted search of phenotypic criteria of inherited connective tissue disorders. We found that 75 % of patients with primary spontaneous pheumothorax had signs of the connective tissue dysplasia such as the asthenic somatotype, low body mass index, the chest and the spine deformities, joint hypermobility, mitral valve prolapse, myopia, varicose phlebectasia, etc. Results of the study confirm the fact that inherited disorders of the connective tissue could play an important role in the pathogenesis of bullous emphysema.

Summary. The objective of this study was to select the optimal method of alveolar recruitment in patients with refractory hypoxemia. We used the APACHE II scale to assess the severity of the patient's status. We also investigated effects of alveolar recruitment on the blood gas exchange, the central haemodynamics and liquid balance in patients with acute respiratory failure. Patients involved in the study (n = 100) were divided into 3 groups. The control group (n = 45) was treated with conventional mechanical ventilation. A group with moderate hypoxemia (n = 32) was treated using a "sparing" alveolar recruitment technique with noninvasive monitoring of the arterial pressure, the heart beat rate, and SpO2. A group with severe hypoxemia (n = 23) was treated using an "aggressive" alveolar recruitment technique with noninvasive monitoring of the arterial pressure, the heart beat rate and SpO2, blood gases analysis, monitoring of the central haemodynamics, measurements of cardiac output (СО), cardiac index (СI), intrathoracic blood volume index (ITBVI), global end-diastolic volume index (GEDVI), extravascular lung water index (ELWI), and systemic vascular resistance (SVR) by the PICCO monitor. Both methods of alveolar recruitment significantly increased arterial oxygenation but did not worsen the haemodynamics. After the procedure, tidal volume and dynamic lung compliance increased. Alveolar recruitment did not influence on ELWI but decreased peak ITBVI and peak GEDVI. After the procedure of alveolar recruitment, these parameters returned to the baseline. Therefore, alveolar recruitment could improve arterial blood oxygenation and increase number of ventilated alveoli without any negative effects on haemodynamics.

Summary. Patients with ischemic heart disease (IHD) have a high risk of the death during the first year after an episode of pulmonary embolism (PE). This study involved 71 patients with IHD and PE. Data of medical history, clinical manifestations and laboratory findings were analyzed. Factors predictive for poor outcome in patients with IHD and PE were age > 65 yrs, concomitant chronic obstructive pulmonary disease, malignancies, seizures and severe hypertension as clinical manifestations of PE, the left ventricle ejection fraction < 45 %, pulmonary artery systolic pressure > 50 mmHg, diameter of the pulmonary artery > 28 mm.

Summary. A retrospective analysis of clinical, radiological, laboratory and postmortem findings of 74 cases of nosocomial pneumonia (13.8 % of 536 autopsies performed for 5 years) has been carried out. Seriously ill patients died of nosocomial pneumonia alone (28 cases, or 37.8 %) or of another primary disease (13 cases, or 17.6 %), or of their combination (33 cases, or 44.6 %) have been examined. Sixteen significant correlation links between clinical and laboratory parameters were found. This allowed evaluation of those parameters in term of therapeutic strategy and prognosis of nosocomial pneumonia. Bacterial colonization of pleural effusion and/or of pulmonary parenchyma was found in all the cases and was considered as a sign of immune suppression. This could provide rationale for development and implementation of preventive measures of nosocomial pneumonia in certain patients using vaccines or immune modulators.

Summary. Course and complications of community-acquired pneumonia (CAP) during the pandemic influenza A / N1N1 / 2009 were studied based on clinical, laboratory and radiology data. The study involved 250 patients, of them 57 patients with uncomplicated CAP (the 1st group), 124 patients with CAP and the systemic inflammatory response syndrome (SIRS) (the 2nd group), 53 patients with CAP and severe sepsis (the 3rd group), and 16 patients with CAP and septic shock (the 4th group). All patients received antiviral, antibacterial and symptomatic therapy; 193 (77.2 %) patients needed supplemental oxygen, 108 (56 %) were admitted to ICU, 15.6 % of patients needed mechanical ventilation. Bilateral lung injury was diagnosed in 225 patients (90.0 %). Overall mortality was 10.4 %, mortality in obese patients was 30.0 %.

Summary. Algorithms of diagnosis and treatment of chronic obstructive pulmonary disease (COPD) and economic burden of the disease are well established in many countries but there is a lack of such information in Russia. The aim of an epidemiological survey performed in Russia was an assessment of burden of COPD, treatment strategies and patients' quality of life. The survey involved 5,376 patients with COPD. Quality of life was evaluated using the Euro Quality of Life-5Dimension questionnaire (EQ-5D). Results showed the follows: 1) most of COPD patients are able-bodied individuals; 2) COPD impacts significantly on all aspects of the patient's life; 3) treatment of COPD complies with international standards only in rare occasions; 4) patients with early stage COPD are in minority. Therefore, the survey demonstrated the urgent need in improving the knowledge of physicians and patients about COPD. This strategy could help to detect the disease in early stage, to prevent COPD progression and exacerbations.

Summary. The aim of this study was to investigate relationship between arterial stiffness and endothelial dysfunction, on one hand, and clinical ad functional parameters of chronic obstructive pulmonary disease (COPD), on the other hand. This was a prospective cross-sectional comparative study. Arterial stiffness was measured using photoplethysmography (Pulse Trace PCA 2, Micro Medical). We calculated stiffness index (SI) which reflected pulse wave velocity in large arteries, and reflectance index (RI) which is generally related to small vessel tone. Endothelial dysfunction was assessed with RI changes (Δ RISLB) before and after inhalation of salbutamol and also according to serum endothelin-1.

The study involved 41 patients with COPD (mean age, 64.5 ± 7.6 yrs; FEV1, 37.7 ± 14.1 %; РаО2, 63.2 ± 11.2 mm Hg). SI was 11.3 ± 3.3 m / s; RI was 69.1 ± 16.6 % in comparison to 6.9 ± 0.9 m / s and 53.6 ± 14.7 %, respectively, in controls (р < 0.05). In COPD patients, Δ RISLB was significantly lower compared to controls (1.15 [0-10] % vs 11.50 [6–19] %; р < 0.05). As severity of COPD increased, Δ RISLB decreased (р < 0.05). Serum endothelin-1 in COPD patients was higher than normal level (0.47 [0.23–0.71] vs 0.26 fmol / ml; р < 0.05). Serum endothelin-1 was inversely related to RI (R = 0.44; р = 0.02) and Δ RISLB (R = –0.46; р = 0.03). A significant correlation was also found between the indexes and clinical and functional parameters (BMI, RV, DLCO, FEV1, heart beat rate, breathing rate, dyspnea assessment using MRC scale), 6-min walking distance. Therefore, arterial stiffness was significantly higher in COPD patients compared to patients with asthma and healthy volunteers. Increase in arterial stiffness is linearly related to severity of the disease. Endothelial dysfunction in COPD patients was significantly higher compared to that in comparative groups and was related to arterial stiffness.

Summary. Natriuretic peptide is an important marker of the heart failure. NT-proBNP has also been shown to play a role in predicting outcomes in unselected cohort of critically ill patients.

This study was aimed at evaluation the diagnostic and prognostic value of NT-proBNP in patients with acute exacerbation of COPD (AECOPD). This was a prospective observational study enrolled 80 hospitalized patients with AECOPD (age, 65.8 ± 19.9 yrs; FEV1, 38.5 ± 17.3 %pred, PaO2, 53.8 ± 13.0 mmHg, PaCO2, 50.6 ± 15.1 mmHg). The patients underwent a comprehensive diagnostic algorithm including chest radiography, pulmonary function tests, echocardiography and serial measurements of plasma NT-proBNP (Biomedica). Main causes of acute exacerbation of COPD were purulent bronchitis (48.8 %), pneumonia (23.8 %), acute decompensation of chronic heart failure (ADCHF) (17.5 %), and pulmonary embolism (PE) (5 %). Mean plasma concentration of NT-proBNP in COPD patients was 1 057.8 ± 555.3 fmol / ml. NT-proBNP level was elevated in 88.7 % of the cases. Patients with AECOPD and PE had the highest level of NT-proBNP (1 735.9 ± 523.8 fmol / ml). NT-proBNP concentration in COPD patients with ADCHF was 1 405.4 ± 626.8 fmol / ml, in COPD patients with pneumonia – 1 043.5 ± 643.1 fmol / ml, and in COPD patients with purulent bronchitis – 906.6 ± 425.9 fmol / ml. In patients who died during hospital stay (8.4 %), plasma level of NT-proBNP was significantly higher than in survivors (1 484.6 ± 618.7 vs 1 003.7 ± 527.1, respectively, p = 0.013). Conclusions: Plasma level of NT-proBNP may be used as a marker of severity and prognosis in AECOPD.

Summary. Asthma control level was evaluated in 1 000 patients treated in 26 outpatient centers at 12 cities of Russian Federation. Asthma control level was assessed clinically and with special questionnaires ACQ-5 and ACT. Results were referred to GINA criteria. Well-controlled asthma was found in 23 % of patients, partly controlled and poorly controlled asthma was diagnosed in 25 % and 42 % of patients, respectively. Attendant physicians misestimated asthma control level in 49 % of cases. ACQ-5 and ACT questionnaires equally improved estimation of asthma control (64 % and 60 % of adequate estimates, respectively) however, ACT questionnaire demonstrated systematic bias to overestimated asthma control when compared to GINA criteria.

Summary. Morphological characteristics of gastric mucosa in patients with asthma of different severity with regard to corticosteroid therapy were described in this article. The aim of this study was to substantiate optimized standards of asthma treatment. Clinical and morphological investigations were conducted at the city clinical hospital № 31. We investigated all structural components of the gastric mucosa in biopsy specimens with light binocular microscopy and performed morphometric study of inflammatory infiltrates. As a result, several signs of protective effect of inhaled corticosteroids on gastric mucosa were found. We did not obtain any results that could confirm the key role of glucocorticosteroids in occurrence of gastrointestinal erosions in asthma patients. Therefore, prevention of erosive gastritis and other inflammatory gastrointestinal diseases in asthma patients should consider other risk factors besides glucocorticosteroid therapy and cover all stages of asthma.

Summary. The aim of this study was to investigate influence of andriol replacement therapy on clinical course of asthma in patients with acquired androgen deficiency. Thirty six males in age of 53.5 ± 2.4 years with asthma history of 1 to 8 years were examined and treated. Besides of lung function and androgen status, quality of life was assessed before and after andriol replacement therapy. Results of the study showed favorable influence of the andriol replacement therapy on severity and frequency of asthma attacks as well as improvement in several parameters of the patients' quality of life.

Summary. In this cross-sectional study, serum osteocalcin (a biomarker of bone formation), β-CrossLaps (a biomarker of bone resorption), and 25(OH)D were assessed in 64 adults with cystic fibrosis (CF) aged 16 to 35. We evaluated relationships between these biomarkers, bone mineral density (BMD), CF-specific clinical, genetic, anthropometric and functional parameters, serum C-reactive protein (CRP), and rate of low trauma peripheral fractures. β-CrossLaps level was significantly increased while osteocalcin concentration was normal or slightly decreased. A level of 25(OH)D was normal in 9.5 % of the patients and decreased in 90.5 % of the patients. Relationships were found between β-CrossLaps, BMD of the neck and the proximal part of the thigh and gender and between 25(OH)D and CF genotype. Bone biochemical biomarkers and 25(OH)D did not correlate with F508del and CFTRdele2,3(21kb) mutations, CPR level and fracture rate. These results provide rationale for initiating antiresorptive therapy in CF patients with low BMD and fractures and for administration of high-dose vitamin D to prevent bone mass reduction.

Clinical and morphological observation of co-morbid pulmonary tuberculosis and cytomegalovirus lung injury in HIV-infected patients.

Results of XXI Russian Congress on respiratory diseases.

A role of Onbrez Breezhaler (indacaterol) in therapy of chronic obstructive pulmonary disease: conclusion of expert panel.

Georgy V. Trubnikov. To the 80th birthday.