Timely diagnosis of bronchial asthma (BA) in adolescence and adequate therapy controlling the disease provide not only a good prognosis but also are of social importance. Moreover, BA in male adolescents is relevant to their fitness for military service. The purpose of our work was to study clin# ical and functional features of BA in 603 adolescent males aged 16 to 19 years treated in allergology department of City Clinical Hospital No.52 in 2006 to 2007. The results demonstrated that atopic BA phenotype prevailed among adolescent males with BA (99 % of the teenagers). Those patients had mild BA (89.6 %) with physiological stabilization. Lung function of patients with mild (especially intermittent) BA in stable condition did not differ from that of healthy individuals. Disorders could be seen only in worsening of the disease. Challenge test is helpful for detection of mild BA in adolescents with normal pulmonary function test and no response to β_2-agonists. Most adolescent males (77 %) with BA had specific or nonspecif# ic bronchial hyperreactivity even while having intermittent asthma with no symptoms. Most adolescents with BA received inadequate therapy and poor awareness of asthma treatment and prevention.

Diastolic dysfunction of both right and left heart could not be diagnosed using usual Doppler echocardiography in early#stage bronchial asthma. Recently a new more sensitive method of tissue Doppler echocardiography is available which allows detection of right and left heart diastolic dysfunction in mild asthma patients whereas spectral Doppler echocardiography reveals these disorders in moderate and severe asthma.

The aim of this trial was to evaluate efficacy of budesonide suspension for treatment of asthma exacerbations in comparison with systemic corticosteroids (SCS) with regards to clinical and functional changes and also to inflammatory activity in induced sputum (IS) and exhaled breath condensate (EBC). The trial involved 56 inpatients, mean age, 49.1 ± 14.3 years, with moderate and severe asthma exacerbation. The patients were divided into 2 groups: the 1st group (26 patients) received nebulized budesonide suspension (Pulmicort Respules, AstraZeneca) 2.0 mg b.i.d., the 2nd group (30 patients) were treated with oral prednisolone 30 mg daily with gradual reduction of the dose followed by withdrawal the drug. Moreover, all the patients received nebulized bronchodilators, oxygen supplementation if needed, expectorants, antibiotics, and medications for co-morbidities. Effectiveness of therapy for asthma exacerbation was evaluated with reduction in asthma attacks and additional use of short-acting β₂ -agonists, improvement in daily physical activity and peak expiratory flow rate (PEFR). Spirometry with assessment of bronchodilator response, IS cell count, and measurement of NO metabolites in EBC were performed before and after treatment. In all patients, the treatment resulted in significant improvement in clinical and functional parameters with no difference between the groups. Dyspnea and wheezing improved more in budesonide group than were in prednisolone group. Good asthma control was achieved in 18 patients of the budesonide group (75 %) and in 21 patients of the prednisolone group (70 %). Partial control of asthma was achieved in 6 (25 %) and 9 (30 %) patients, respectively. The mean duration of treatment was longer in prednisolone group (9.3 ± 1.1 vs. 6.1 ± 1.0 days respectively, р < 0.001). Cytosis, eosinophil and neutrohil counts reliably decreased and macrophages number increased, EBC NO metabolite levels significantly reduced in both the groups with no difference between the groups. IS cell counts and EBC NO metabolite levels correlated to the degree of asthma control. Generally, the therapy with nebulized buidesonide was welltolerated, adverse events were more frequent in prednisolone group. Therefore, nebulized budesonide suspension was as highly clinically effective in asthma exacerbation as SCS; it could be used as the alternative drug with better safety profile.

The aim of this study was to estimate prevalence of asthma in adults at industrial city Tomsk. A total of 2000 responders aged 18 to 75 yrs participated in the study. Prevalence of asthma-like symptoms was estimated using the standardized questionnaire ECRHS. Two hundred patients with asthma-like symptoms underwent clinical, functional, and allergological examination. Asthma-like symptoms were revealed in 37.8 % of the studied population. Prevalence of asthma was 9.8 %. These findings significantly exceed official data. Asthma was newly diagnosed in 60 % of symptomatic adults that is evidence of late detection of the disease.

The aim of this work was to investigate a role of endothelial dysfunction for development of pulmonary hypertension in young and middle-aged bronchial asthma (BA) patients. In total, 56 patients with mild and moderate persisting BA were examined. The endothelial function was assessed using nitrate levels in erythrocytes and plasma and L-arginin concentration in plasma. Endothelial dysfunction was more prominent in patients with moderate BA. Severity of endothelial dysfunction correlated to obstructive disorders. Plasma and erythrocytes nitrates and plasma L-arginin concentrations were lower in females than were in males and were lower in middle-aged patients compared to youngs. Endothelial dysfunction was more severe in patients with pulmonary hypertension than were patients with normal pulmonary artery pressure. Correlations were revealed between plasma level of nitrates and pulmonary artery pressure, plasma level of nitrates and the right ventricle size. Therefore, endothelial dysfunction could result in cardiovascular pathology in asthmatic patients.

The purpose of the research was to study mechanical properties of the aorta using functional tests in patients with asthma. We examined 54 asthmatic patients and 25 healthy volunteers using noninvasive arteriography (arteriograph TensioClinic TL1, TensioMed, Hungary), exercise (PE) and nitroglycerine (NG) tests. Transitory increase in aortal stiffness was observed in patients with exacerbation of severe and moderate asthma. The degree of this increase closely correlated to severity of the disease, ventilation disorders, and hypoxemia. These results suggest higher cardiovascular risk in such patients. Patients with asthma demonstrated amplified or weakened reaction of aortic pulse wave velocity (aPWV) to the PE depending on baseline values of these parameters: higher aPWV corresponded to weaker reaction to PE, and vise versa. As a whole, reduction in arterial stiffness during the NG test in asthma patients was significantly less than in healthy persons. The aPWV reaction to NG was more prominent during exacerbations of severe asthma. Therefore, functional tests investigating mechanical properties of aorta substantially supplemented traditional arteriography. Pathological reaction to PE was seen in some patients with stable asthma and normal aPWV values.

Eighty-seven patients with occupational bronchial asthma in the post-exposure period (8.5 years in average) and 105 patients with non-occupational asthma were studied. In 64 % of cases, asthma was induced by high-molecular weight antigens of organic dust of various types. Severe course of the disease and steroid dependence were noted somewhat more often in patients with occupational professional asthma compared to non-occupational one (23 % among men and 30 % among women vs. 21 % and 20 %, respectively). Well-controlled occupational asthma was more often (9.60 % and 4.76 %, respectively) which could be explained by elimination of causative agent, annual examination and treatment in clinics of occupational pathology with further correction of the therapy in outpatient primary care facilities. The authors recommend applying criteria of asthma control to estimate the degree of the patient's disability.

The aim of this study was to investigate NO- and lipid peroxidation (LPO)-related airway reactivity and its correlation to ventilation disorders in different clinical variants of asthma. NO, malone dialdehyde, IL-4, TNF-α, and IgE were measured in BAL fluid and blood serum of 39 asthma patients and 15 healthy volunteers matched for age and gender.

In patients with stable asthma, airflow parameters in small and medium airways were significantly decreased compared to those of healthy persons. Concentrations of key cytokines of atopic inflammation in BAL fluid and serum were increased in asthma patients. Serum IgE tended to decrease and IL-4 and TNF-α in BAL fluid increased in asthma patients while the disease worsened. Inverse correlations were found between NO and TNF-α, malone dialdehyde concentration and parameters of bronchial obstruction.

In conclusion, NO production in airways is caused by strong accumulation of inflammatory cells with high metabolic activity resulting in release of inflammatory and pro-inflammatory cytokines which regulate immunopathological reagine-induced inflammation.

The main problem in preventing exacerbations of chronic obstructive pulmonary disease (COPD) is high cost of medication for regular use and low income of the most patients. Frequent need in antibiotic therapy in COPD patients with concomitant polyvalent allergy, virus infections, antibiotic resistance of pathogens arises some problems in prevention and treatment of COPD. Today there is a great need not only in potent antibiotics but also in additional cheap treatment methods for use in regular basis. These methods should be applicable to other treatments and be active against not only bacterial flora but also other microorganisms. One of such methods meeting these requirements is nebulization of ionized silver solution. Aim of this study was clinical investigation of a new method for prevention of COPD exacerbations using nebulization of ionized silver solution. This double-blind, randomized, placebo-controlled study of long-term therapy with nebulization of ionized silver solution was carried out in 160 patients with mild to moderate COPD. The treatment duration varied from 30 to 180 days. Results showed positive changes in lung function and clinical symptoms. Number and duration of COPD exacerbations associated with acute respiratory virus infections decreased. The optimal daily dose of ionized silver via inhalations was 2 mg.

The study was aimed to investigate clinical and functional particularities of cardiovascular system in patients with COPD and chronic heart failure (CHF). We examined 1737 patients, of them, 498 with COPD (the 1st group), 721 with COPD and concomitant class I to III stable angina (the 2nd group), and 519 with class I to III stable angina (the 3rd group). All the patients also had CHF. The study included clinical assessment using modified R. Cody's scale, ECG, Holter monitoring, lung function testing, Doppler echocardiography, 6-minute walk test (6MWT). Obstructive disorders were found in 424 of the 2nd group patients (58.8 %) and 268 of the 3rd group patients (51.7 %). Number of patients with class II to IV chronic cor pulmonale was similar in all groups. The class III was determined more often in the 2nd group (36.5 %; р < 0.05), the class I prevailed in the 1st group (17.8 %; р < 0.05). The stage I CHF predominated in the 1st group (31.9 %; р < 0.05), the stages IIА and IIБ were seen mainly in the 2nd group (51.6 % and 26.4 % respectively; р < 0.05). The majority of the 3rd group patients (57.3 %) had the stage IIA CHF. According to most clinical signs, CHF was more severe in the 2nd group. 6MWT was 308.08 ± 6.03 m in the 1st group, 156.4 ± 4.38 m in the 2nd group, and 212.8 ± 5.65 m in the 3rd group (р < 0.05). Low left ventricular (LV) ejection fraction was seen significantly more often in COPD patients with concomitant angina. This group as well as COPD patients had significantly higher mean pulmonary artery pressure (mPAP) (24.7 ± 0.41 mm Hg and 29.9 ± 0.27 mm Hg respectively) compared to 21.7 ± 0.07 mm Hg in the 3rd group patients. Right ventricular (RV) diastolic dysfunction was revealed in 154 patients of the 1st group (83.7 %), 194 patients of the 2nd group (91.9 %) and 72 patients of the 3rd group (43.1 %). In conclusion, all the patients had RV and LV remodeling signs. COPD patients had more prominent RV hypertrophy and dilation, angina patients had enlargement of left heart and moderate decrease in LV contractility. The patients with COPD and angina had the greatest increase in size and wall thickness of both LV and RV and low pump function of LV.

Distributions of alleles and genotypes of GSTP1Ile105Val and Ala114Val, CAT С(-262)T and C1167T, NQO1 C609T and C465T, GPX1Pro197Leu, GSTM1, GSTT1 polymorphic loci have been studied in patients with occupational chronic bronchitis and in healthy workers. No statistically significant difference was determined in distribution of alleles and genotypes of GSTP1 Ala114Val, CAT С(-262)T and C1167T, NQO1 C609T, GPX1Pro197Leu, GSTM1, GSTT1 polymorphisms between these groups. Polymorphic marker NQO1 C465T was associated with higher risk of occupational chronic bronchitis (OR = 3.68; CI 95 %: 1.68-8.31) suggesting involvement of this gene in development of this pathology.

Amoxicillin/clavulanic acid (ACA) is one of the drugs of choice for treatment of lower respiratory tract infections (LRTI) in adults. One of the serious disadvantages of ACA is relatively high rate of gastrointestinal adverse events (AE). A new form of ACA, which is dispersable tablets Solutab, could potentially reduce the rate of AE because of more rapid and predictable absorption of clavulanic acid from intestine and improve clinical outcomes due to higher adherence to treatment. This trial was aimed to compare AE rate and clinical efficacy of the new dispersable ACA form Solutab with those of traditional ACA tabs in adult patients with non-severe LRTI. The treatment regimen comprised 500/125 mg t.i.d. during 5 to12 days. This was an open, prospective randomized trial performed at 4 clinical centres. Adults with clinically and radiologically detected non-severe community-acquired pneumonia or I or II types COPD exacerbations with purulent sputum received dispersable ACA tablets (the 1st group) or traditional coated tabs of ACA (the 2nd group) in a random proportion of 1 : 1. Clinical efficacy was evaluated with clinical signs, physical symptoms, additional laboratory and instrumental testing. The safety was assessed based on the patient's complaints and results of physical and laboratory examination in visits 2 (Day 3 or 4), 3 (Day 5 to 12), and 4 (Day 30 to 40 after taking the first dose of the drug). The trial involved 200 patients, the mean age, 32.7 ± 18.7 and 33.3 ± 18.6 yrs in the 1st and the 2nd groups, respectively. The groups were similar for history, severity, and clinical course of the disease. Clinical efficacy was 96.9 % in both groups in visit 3, 95.9 % and 96.9 % in the 1st and the 2nd group, respectively, in visit 4. The mean duration of antibacterial therapy was 7.1 ± 1.5 days in the 1st group and 7.2 ± 1.4 days in the 2nd group. AE were reported in 15 % and 31 % of the patients, respectively (p = 0.01). Gastrointestinal AE predominated in both the groups but the rate of diarrhea was lower in patients receiving dispersable ACA: 6 % vs. 17 % in the 2nd group (p = 0.027). Therefore, the new dispersable drug form of ACA has better safety profile in adult patients with non-severe LRTI compared to traditional ACA that was demonstrated by reduction in the AE, mainly diarrhea, rate. Both drug forms showed equally high clinical efficacy.

Several reports have shown results of antifibrotic action of antibiotics in experimental models of idiopathic pulmonary fibrosis (IPF). Effects of antibiotics on course of IPF has been also investigated in the present work. IPF model was created in male rats Vistar (n = 41) using intratracheal instillations of bleomycin 10 mg/kg followed by intramuscular injections of cefotaxime (n = 10) or erythromycin (n = 10) after the 5th day during 8 days. We evaluated bronchoalveolar lavage fluid (BALF) cell count and differentiation, oxidative activity of alveolar macrophages (AM) using luminol-dependent chemiluminescence, and histological changes in the lung tissue. Both the antimicrobials decreased total cell count in BALF, increased AM and lymphocyte numbers and decreased neutrophil number. Erythromycin increased oxidative activity of AM and cefotaxime reduced it in some degree. Structure of the lung tissue after 14 days of administration of antibiotics did not differ from that seen in rats received bleomycin alone but the formers had more severe vascular lesions such as vasculitis, perivascular fibrosis, full-blooded capillaries. Therefore, antibiotics inhibited neutrophil-related inflammation, heterogeneously affected oxidative activity of AM, caused vascular lesions and did not influence fibrosis. These results do not suggest antibiotics to be used as therapeutic drugs in IPF.

The total amount of nonvolatile substances in exhaled breath condensate (EBC) is a biomarker of formation of dispersed aerosol in airways. Exhaled endogenous nonvolatile substances have been studied in 358 healthy persons and patients with respiratory, heart, and renal diseases. The exhalation of endogenous nonvolatile substances was not associated with gender but enhanced with aging. Smoking, acute period of pneumonia, and chronic renal insufficiency increased nonvolatile substances volume in EBC. Chronic heart failure and COPD reduced this parameter. Concentration of nonvolatile substances in EBC increased in all these diseases. Proposed diagnostic test could be useful for investigation of EBC.

This report introduces a mathematical model of forced expiration to analyze pulmonary function. Results of 3-year lung function monitoring of an ex-smoker have been shown in the paper. Actual values of lung volumes and airway resistance were used for modeling. The computerized data were compared to the flow-volume curve parameters and lung volumes measured during the forced expiration. Weak correlation between the "flow-volume" curve parameters and the time after quitting smoking together with significant change in the lung volumes and the airway resistance seen in the study could be due to some processes which have not been followed in this study (lung compliance, airway resistance at forced expiration, and elastic properties of airway walls).The results demonstrated that mathematical models could increase informative value of pulmonary functional tests. In addition, the model could emphasize additional functional tests for better diagnostic usefulness of functional investigations.