EDITORIAL
The aim of this study was to analysis the total respiratory impedance and its components and to evaluate the informative value of impulse oscillometry in comparison with conventional methods of lung function testing in patients with pulmonary sarcoidosis.
Methods. The study involved 50 patients (88% of males; mean age, 31 ± 9 years) with newly diagnosed pulmonary sarcoidosis. The diagnosis of sarcoidosis was confirmed by lung biopsy. Spirometry, body plethysmography, and impulse oscillometry were used in all patients; the lung diffusing capacity was measured.
Results. Abnormalities of the respiratory mechanics were found using the conventional diagnostic methods in 34% of the patients, including obstructive disorders in 18% and restrictive disorders in 16%; all were mild to moderate. Parameters of impulse oscillometry were abnormal only in 10% of the patients.
Conclusion. The impulse oscillometry has a low sensitivity to detect mild functional respiratory abnormalities in patients with newly diagnosed pulmonary sarcoidosis.
CLINICAL GUIDELINES
Pulmonary hypertension (PH) is a pathophysiological condition which could develop in many diseases. PH could also complicate majority of cardiovascular and pulmonary diseases. This guideline was developed by European Society of Cardiology (ESC) and European Respiratory Society (ERS). The aim of this guideline was to integrate majority of recent studies and to create educational tools and programmes for implementation of these recommendations into clinical practice. The authors made a systematic review of studies published in Medline database since 2009. An updated common classification for PH in adults and children is included in this guideline. New haemodynamic definition of pulmonary arterial hypertension involves pulmonary vascular resistance. This guideline includes novel findings on pathology, pathobiology, genetics, epidemiology, and risk factors. The authors updated a diagnostic algorithm and screening strategy, and described recent achievements in evaluating severity and therapy of PH including combined treatment. Also, a new short chapter on PH with unclear and/ or multifactorial mechanisms was added.
Continuation. The start of the guidelines is: Pul'monologiya. 2017; 27 (3): 321–345.
ORIGINAL STUDIES
The aim of this study was to investigate ability of multispiral computed tomography (MSCT) post-processing techniques in diagnosis and differentiation of diffuse lung diseases (DLD).
Methods. MSCT data of 261 patients with DLD were analyzed using 16- to 320-slice computer tomographs.
Results. The lung tissue lesions were significantly extended in 151 patients (57.85%). DLD signs and symptoms were newly found in in 8 to 15% of the patients after MSCT post-processing only. MIP and MinIP post-processing algorithms improved the lung macrostructure visualization due to higher spatial resolution, allowed to distinguish vascular and nodular structures and to differentiate ground glass opacity and mosaic perfusion patterns in all the patients.
Conclusion. Native MSCT post-processing is useful for initial diagnosis of DLD in 8 to 15% of patients, for determination the prevalence of pathological changes in 58%, and for better detection of the lesions in 100% of patients.
The purpose of this study was to investigate cytologic and chemiluminescence (ChL) parameters of phagocytes in induced sputum and bronchoalveolar lavage fluid (BALF) of patients with severe acute exacerbation of COPD (AECOPD).
Methods: Eighty-eight patients aged 45 to 75 years (56 males and 32 females) with severe AECOPD were included in the study. The control group included 16 healthy individuals. Cytological examination of induced sputum was done. The luminol-dependent ChL of BALF phagocytes obtained during bronchoscopy was investigated.
Results: Leukocyte cell count and neutrophil/eosinophil ratio were increased and macrophages/lymphocyte ratio was decreased in induced sputum (p < 0.05). Exacerbations of infectious etiology were characterized by higher eosinophil count. Leukocyte cell count has been still significantly increased after resolution of the exacerbation. Eosinophil/macrophage ratio was significantly higher in bronchitis phenotype and neutrophil/lymphocyte ratio was higher in emphysema phenotype (p < 0.05). Phagocyte ChL in patients with AECOPD of infectious etiology was significantly higher compared to that in patients with AECOPD of other etiologies, both in exacerbation (spontaneous ChL, 10,049 ± 1,828 vs 8,886 ± 2,672; induced ChL, 19,912 ± 4,037 vs 10,751 ± 1,354, respectively) and in stable state (spontaneous ChL, 3,878 ± 1,147 vs 2,335 ± 1,277; induced ChL, 4,804 ± 1,284 vs 4,253 ± 1,174, respectively). This could be due to a relatively high eosinophil count in AECOPD of non-infectious etiology and in the bronchitis phenotype of COPD; eosinophils could contribute to phagocytosis and oxidative mechanisms.
Conclusion. Cytological and oxidant characteristics of the airway inflammation and phagocyte-related features of the local immunity are thought to be different in AECOPD of infectious compared to non-infectious etiology and in exacerbation compared to the stable state. The luminol-dependent ChL could reliably assess phagocyte functional activity in the airway material. This method could be proposed to distinguish between infectious vs non-infectious etiologies of AECOPD in patients with bronchitis phenotype or emphysema phenotype and to evaluate the efficacy of anti-inflammatory treatment.
The aim of this study was to develop a method to evaluate risk factors of occupational bronchial asthma (OBA) in nurses.
Methods. A new method to predict occurrence of OBA in nurses has been proposed. This method used the approximation and optimization approach and was based on proceeding medical data using scheduled serial numerical experiments for 287 sanitary and technical characteristics of nurse working conditions.
Results. According to the results, a group of healthcare providers with the highest incidence of occupational allergic diseases was selected. This group included 222 nurses. A number of OBA risk factors were found including antibiotics, drugs, vaccines, detergents, antiseptics (both with and without chlorine), mold, and paper dust.
Conclusion. The approximation and optimization approach for evaluation occupational risk factors in nurses could predict OBA occurrence. This is important for development preventing measures. This study supposed that adherence to occupational safety rules could decrease the risk of OBA.
Recently, growing number of patients with bronchial asthma (BA) and co-morbid cardiovascular diseases has been noted. The purpose of this study was to investigate a relationship between markers of endothelial dysfunction and parameters of arterial stiffness in patients with BA and stable class 1 to 3 angina pectoris. Methods. We examined 32 BA patients 32 patients with co-morbidity of BA and ischemic heart disease (IHD). Results. Arterial stiffness was increased in BA patients. Co-morbidity of BA and IHD resulted in more prominent increase in the arterial stiffness and endothelial dysfunction. Conclusion. Diagnosis IHD in BA patients is quite difficult in clinical practice. Markers of this co-morbidity are needed to improve the diagnostic work-up.
The aim of this study was to analyze clinical efficacy and safety of inhaled thiamphenicol glycinate acetylcisteinate (TGA) compared to conventional systemic antibacterial therapy in children with acute bronchitis.
Methods. This was a randomized open postmarketing parallel-group trial which involved 150 children (71 boys) aged 3 to 17 years with acute bronchitis. Children were included to the trial if they did not improve in 5–6 days of a symptomatic treatment or if they had bacterial respiratory infection. The patients were randomly assigned either to nebulized inhalations of TGA or oral macrolides plus oral N-acetylcysteine for 7 days. Efficacy of therapy was assessed by clinical sign scoring and lung function measured by computed bronchophonography.
Results. In 3 days of the treatment, the body temperature decreased to low-grade fever in both the groups. Clinical signs of acute bronchitis improved significantly in 84% of the TGA group patients with statistically significant difference compared to the controls; cough and sputum production were 1.7 ± 0.06 and 2.1 ± 0.02, respectively (р < 0.05); wheezing reduced in 1.5 times in the TGA group to the 3rd day. To the 7th day of the treatment, improvement was equal in both the group and clinical efficacy (recovering, improvement, or no change) did not differ between the groups. Systemic antibacterial therapy was not required in the TGA group.
Conclusion. The results have shown the high clinical efficacy of inhaled TGA in children with acute bacterial bronchitis. Systemic macrolides did not improve clinical outcomes and did not shortened the length of the disease, but caused more adverse events compared to the inhaled topic antibacterial therapy.
REVIEW
It is known that patients with severe asthma often fail to achieve disease control. Excessive airways eosinophilic inflammation is one of the key causes of severe uncontrolled asthma in this case. The occurrence of eosinophilic phenotype of inflammation is quite high in severe uncontrolled asthma. Thus, about 55% of patients have eosinophil level in induced sputum ≥ 3%. Eosinophilic phenotype of asthma is associated with greater severity of symptoms, presence of atopy, late onset of the disease, and lack of response to inhaled glucocorticosteroids. Numerous studies confirmed the relationship between elevated eosinophils in the airways and more frequent and severe asthma exacerbations, as well as reduced lung function, increased administration of steroids and other medications, and more frequent use of healthcare services. Severe eosinophilic asthma is characterized mainly by late onset of the disease, persistent eosinophilia in the airways and peripheral blood. It is associated with frequent exacerbations, chronic or intermittent need to the use of systemic corticosteroids to achieve better control of the disease, and unfavorable prognosis of the natural course. Predominantly eosinophilic type of airway inflammation is a characteristic manifestation of T2 endotype of asthma, that is implemented due to the domination of Th2-lymphocyte response (allergic asthma) and/or due to high activity of type 2 innate lymphoid cells (ILC2) involved in the development of both non-allergic and allergic asthma. Th2 and ILC2 cells increase IL-5 level, which plays an important role in the formation of uncontrolled eosinophilic inflammation in the airways in patients suffering from T2 endotype of severe asthma, by stimulating eosinophil precursor maturation in the bone marrow, mobilization of eosinophils and precursors from the bone marrow, accumulation of eosinophils in the blood, eosinophilic infiltration of lung tissue, and eosinophil migration in the area of inflammation. The novel medication reslizumab (Cinqair) is the first anti-IL-5 immunological biologic drug registered in Russia for the treatment of severe asthma with eosinophilic airway inflammation. As a humanized monoclonal antibody (IgG4k) with high affinity for IL-5, reslizumab specifically binds to IL-5 and inhibits its interaction with IL-5 receptor on the cell surface, thus disrupting the underlying pathophysiology of bronchial inflammation in asthma, including maturation and survival of eosinophils, inflammation and remodeling of the airways. Clinical effects of reslizumab are manifested as decreased asthma exacerbation rate, improved lung function, and disease control.
Clinical efficacy of an inhalational drugs depends on proper inhalation technique and aerodynamic properties of aerosol including the respirable fraction. Investigations of systemic pharmacokinetics of inhalational drugs could not always estimate their pharmacological equivalence so as relationships between the inhaled dose, the systemic concentration and the topic activity of an inhalational drug are not fully investigated. Therefore, identical formulation and similar route of administration are not sufficient to estimate pharmacological interchangeability. Possibility to interchange inhalational agents has still been controversial. As such, equal efficacy and safety of inhalational drugs with the same active substance could be estimated in real clinical practice according to results of postmarketing trials and pharmacological surveillance. Spontaneous messages are a tool for gathering information about unwanted reactions or drug inefficacy and possible risks of substitution of drugs within the same international nonproprietary name.
In summary, it is necessary to estimate pharmacological equivalence and interchangeability of inhalational drugs carefully. This approach could improve efficacy and safety of treatment of patients with asthma and COPD.
LECTIONS
As the life expectancy of patients with cystic fibrosis (CF) increases, the rate of pulmonary and extrapulmonary complications grows and greater contributes to worsening of general somatic status of the patients. One of such complications is osteoporosis. Osteoporosis is a systemic disease that is characterized by decreased bone density and increased risk of fractures in minimal trauma. The role of osteoporosis in CF patients is defined by consequences of osteoporotic fractures which are immobilization, failure of bronchial tree drainage, exacerbation of respiratory infection, and progress of respiratory failure. Therefore, prevention and treatment of osteoporosis is an important issue of adult CF patients.
ANNIVERSARIES
PRACTICAL NOTES
A case of 59-year old patient has been described in the article. The patients has got multiple home trauma (multiple fragmental fractures of left ribs, left-sided pneumothorax and pneumomediastinum) in January, 2015. At admission, the left pleural cavity was drained and pharmacological treatment was initiated. After the pneumothorax was resolved, the patient refused further treatment and was discharged from the hospital. The further course of the disease was complicated by rib fractures non-union, development of rib valve and diaphragmic hernia. The patient’s condition gradually deteriorated including exacerbations of chronic obstructive pulmonary disease. In May, 2016, he was admitted in a hospital with severe life-threatening acute respiratory failure. Left-sided thoracotomy with reconstruction of a giant defect of the left diaphragmic dome using surgical mesh was performed. To restore the ribcage and to remove the hernia, open surgical reposition and osteosynthesis of the 10#th let rib with its reconstruction were performed. To resolve the spontaneous pneumothorax which had not resolved by the pleural cavity drainage, the bronchus was locked using an endobronchial valve. This technique was developed in this clinic.
A clinical case of community-acquired pneumonia (CAP) caused by Legionellа pneumophila is described in the article. A 37-year-old male, a worker of a nuclear power station, was admitted with dry cough, dyspnea on light exertion, and fever. The disease onset was acute; the patient had been unsuccessfully treated with b-lactam antibiotics for 5 days before the admission. Two weeks before the disease onset, he had been to a neighbor region by business and stayed in a hotel. Non-severe bilateral CAP caused by Legionella was diagnosed using standard methods including Legionella rapid urine antigen test. Pneumonia was complicated by pleural exudate and moderate respiratory failure (class III according to PORT scale). Clinical particularities included diarrhea in the first day of the disease, elevated hepatic enzyme levels in blood, elevated blood urea, and hepatomegaly. Adequate specific therapy with levofloxacin and supplemental oxygen resulted in slow resolving of physical signs of pneumonia and pleuritis during 14 days with complete resolution of clinical symptoms and laboratory abnormalities and long-term maintenance of pulmonary infiltration.
OBITUARY
ISSN 2541-9617 (Online)