The paper contains analysis of morbidity and prevalence of asthma in adult inhabitants of urban and rural regions of Dagestan Republic in 1995 to 2004. The analysis allowed identification of the most ecologically unfavourable regions in term of morbidity and prevalence of asthma. The epidemiologic difference closely depended on a degree of atmospheric pollution. There were important characteristic features of morbidity and prevalence of asthma in rural adult inhabitants at different ecological areas of Dagestan Republic. The population living at southern rural regions had the highest morbidity and prevalence of asthma.

SMART concept implies administration of Symbicort (budesonid/formoterol both as maintenance and reliever therapy of asthma (BA). The present study was designed to evaluate economic efficacy of SMART regimen (Symbicort 320 / 9 or 640 / 18 μg daily plus Symbicort 160 / 4.5 as needed) compared with current practice of asthma therapy in Russia (64 different medications administered in real practice in 34 cities of Russian federation in 2005) and combined therapy with Seretid Multidisk (fluticason / salmeterol 200 / 100 to 1000 / 100 μg daily plus salbutamol as needed). We performed economic analysis of SMART regimen based on the results of international multi center randomized COSMOS trial. We assessed direct medical costs (outpatient pharmacotherapy with the given medications, emergency care for asthma exacerbations, related hospitalisations, scheduled visits to a physician) and non medical expenses and losses (social expenses for temporary disability, loss of income tax for state budget and of non produced gross national product). As a result, cost of SMART regimen was 1.2 fold to 1.4 fold higher than that of the routine therapy but the former has been eventually decreased by 15 % due to reduction in as needed doses. The mean dose of Seretid did not changed in time but the total expenses for the drug therapy became 20 % higher when compared with SMART regimen and 1.5 fold higher when compared with the routine therapy. The BA burden, which is a sum of treatment cost and social expenses related to the disease, in routinely treated patients were 2 fold to 3 fold higher than in SMART patients. Therefore, combined drugs for management of BA (Symbicort SMART and Seretid) have great medical and economical advantaged over the routine therapy.

P-glycoprotein (Pgp) is a membrane transporter of hydrophobic molecules providing efflux of xenobiotics from the cytosole outside the cell. In epithelial cells, Pgp is thought to be responsible for resistance to steroids. Severe bronchial asthma (SBA) is a heterogenous disease characterized by resistance to and dependence on steroids. The goal of this study was to assess expression of Pgp on peripheral blood lymphocytes in severe bronchial asthma and to evaluate the role of Pgp in developing the resistance to glucocorticoid therapy (GC). Assessment of Pgp expression revealed difference in response to GC treatment. All the patients were susceptible to GC, however, the time of therapeutic effect appearance and the number of Pgp-immunopositive cells differed significantly. Thus, more prolonged application of GC for reducing clinical manifestations was required in patients with aspirin induced or fatal bronchial asthma. The number of Pgp-immunopositive lymphocytes per one patients was significantly higher in patients with fatal bronchial asthma and in patients with steroid dependent bronchial asthma (6.8 ± 0.1 and 7.2 ± 0.2, respectively) comparing with patients with non stable bronchial asthma being therapeutically resistant (3.2±0.2 and 3.5±0.1, respectively). Thus, our findings suggest possible pathogenic role of Pgp in development of resistance to GC therapy in patients with bronchial asthma. Detection of Pgp expression on peripheral blood lymphocytes would allow optimizing the volume and duration of intensive anti inflammatory therapy and predicting the doses of basic drugs.

Osteoporosis is one of extrapulmonary features of COPD. This study was aimed to evaluate bone mineral density (BMD) and its correlation to risk factors in patients with COPD. Forty six patients (28 postmenopausal females, 18 males, the average age, 64.3 ± 7.8 yrs) with different COPD stages participated in the study. Fifteen patients have received inhaled corticosteroids (ICS) 500 to 2000 μg of beclomethasone equivalent daily for 5 to 8 yrs. The controls were 38 non COPD patients (35 postmenopausal females, 3 males) comparable to age, smoking history, and co morbidity. BMD was measured in lumbar vertebrae and proximal parts of right and left hips using X ray dual energy absorptiometry. Osteopenia was found in 20 COPD patients (43.48 %) and osteoporosis was in 11 (23.91 %) ones. The mean T criterion in lumbar vertebrae and both femoral necks of COPD patients was significantly lower compared to controls (р = 0.0010–0.0024). BMD in lumbar vertebrae (р = 0.0005–0.006) and femoral necks (р = 0–0,007) was also lower in COPD patients. Lumbar vertebra height did not differ in COPD patients and the controls. We also analyzed sub-groups of severe (FEV₁ < 50 %_pred.) and mild to moderate COPD patients separately. Those with severe COPD had osteopenia and osteoporosis more often (52.6 % vs 37 % and 36.8 % vs 14.8 %, respectively) and T criterion and BMD in both sites reliably lower. These results suppose a role of hypoxia in development of osteoporosis. Both T criterion and BMD in all sites correlated with body mass index (r = 0,453–0,743, p = 0; and r = 0,425–0,663; р = 0, respectively). There was no correlation between cumulative dose of ICS and BMD. No gender differences of BMD in COPD patients indicated that the loss of BMD in COPD could be relevant to chronic pulmonary disease but not to hormonal disorders. We conclude that loss of BMD is one of the systemic effects of COPD.

The aim of the study was to compare the efficacy of nebulized salbutamol and ipratropium with nebulized salbutamol alone in patients with severe exacerbation of COPD. The study was designed as prospective, randomized, single blind. Inclusion criteria were severe exacerbation of COPD (worsening of dyspnea, FEV₁ at admission < 1 L or < 35 %pred. ; SpO₂ < 92 %; respiratory rate > 24 min–1 ); age > 45 yrs; smoking history > 10 packs/yrs; no need for invasive respiratory support. Fifty patients with COPD (M: F = 41: 9; mean age, 68 yrs; mean FEV₁ , 0.72 L, mean PaO₂, 46 mm Hg) were included in the study and randomized to receive either nebilized salbutamol 2.5 mg and ipratropium bromide 500 mg q4h for 7 days (n = 26) or nebilized salbutamol 2.5 mg alone q4h for 7 days (n = 24). All patients also received oral corticosteroids, antibiotics, oxygen and nonin vasive ventilation if necessary. There were no differences between the groups in demographic, functional or gasometric parameters. Both groups showed significant improvements in FEV₁, FVC and IC, but treatment with combined therapy rather than salbutamol alone resulted in more rapid improvement in FVC (in 1 day: 1.90 ± 0.51 L vs 1.61 ± 0.50 L, р = 0.048; in 3 days: 2.00 ± 0.51 L vs 1.67 ± 0.49 L, р = 0.024) and in IC (in 1 day: 1.67 ± 0.39 L vs 1.38 ± 0.37 L, р = 0.010; in 3 days: 21.77 ± 0.51 L vs 1.44 ± 0.40 L, р = 0.015). Dyspnea (Visual Analog Score) also improved more rapidly in patients received salbutamol and ipratropium (in 1 day: 32 ± 13 mm vs 42 ± 15 mm, р = 0.019; in 3 days: 26 ± 11 mm vs 33 ± 13 mm, р = 0.045). The need for additional salbutamol inhalations was significantly higher in patients received salbutamol alone (5.6 ± 3.5 vs 1.3 ± 1.5 inhalations per 1 patient during 7 days, p < 0.01). There was no difference between two groups with regards to other parameters including respiratory rate, pulse, PaCO₂ , pH, and other parameters excepting more marked increase in the PaO₂ in the 1st group after 1 day of the therapy (р = 0.019). The incidence of adverse events was similar in both the groups. Therefore, in severe exacerbations of COPD, the combined therapy with nebulized salbutamol and ipratropium is more effective than nebulized salbutamol alone.

The cell count differential of pleural fluid sample is of great importance for estimation of the nature of pleural effusion. In the present article, we compared the efficiencies of routine cytology method with light microscopy, cytological examination with centrifuge Cytospin-4 and immunocytochemical methods. We have studied cytological samples from 1597 patients, with pleural effusion. Effusions associated with malignancies were reported in 22.7 % of patients including carcinomatosis (74.6 %), primary tumors of pleura (21.5 %), effusions associated with non epithelial malignancies (3.9 %). Benign pleural effusions were reactive (63.6 %), tuberculotic (13.5 %), "cholesterol pleurisy" and chylothorax (0.2 %). Carcinomatous pleuritis was found in patients with lung carcinoma (55.4 %), breast cancer (21.8 %) and ovary cancer (12.2 %). Specific malignant features (direct and indirect) were noted in pleural fluid on breast cancer, carcinomas of ovary, stomach, kidney, small cell lung carcinoma and squamous cell lung carcinoma. These features are hardly detected in patients with malignancies of intestines, prostate and endometria because these types of tumours are rarely metastatic to pleura. We were failed to define particular features of lung adenocarcinoma. The centrifuge Cytospin-4 was used in the most difficult cases (13.5 %) providing minimal number of presumable diagnosis. Primary tumours of pleura are the most difficult for detection. Immunocytochemical analysis found monoclonal mesothelial cell of НВЕМ 1 clone, cytokeratin, vimentin to be positive and carcinoembry onic antigen, Ber-EP4, CD-15 to be negative in the studied tumors.

The reasonability of SMLD in lung carcinoma when compared with resection of enlarged lymph nodes only has been widely discussing in literature. This study was aimed to define the tumour extent and to improve results of surgical treatment of NSSLC applying the "extended" surgical interven tion (with SMLD) as a standard. The study analyzed short term and long term outcomes in 1109 NSSCL patients of 18 to 80 yrs old who were oper ated at the Russian Oncology Scientific Centre in 1980 to 1999. Of the total number of surgical interventions, 417 (37.6 %) were "extended" and 692 (62.4 %) were typical. In the "extended" surgery group, 86 (44.6 %) of the patients had NSSLC stage I, 144 (35.5 %) had the stage II and 87 (20.9 %) had the stage IIIA; in the "typical" group, there were 429 (62 %), 146 (21.1 %) and 117 (16.9 %) patients, respectively. The total survival was significantly higher in the SMLD group (p = 0.03). The 3 year survival and the 5 year survival was 65 % and 55 % after the extended surgery and 54 % and 43 % after the typical surgery, respectively.The tumour relapse in the bronchial stump in 6.2 %, metastases at the mediastinal lymph nodes in 8.7 % and at the supraclavicular lymph nodes in 1.7 % were found in the typical surgery group. These parameters in the extended surgery group were 1.9 %, 3.6 % and 0.9 %, respectively (p < 0.05). Thus, the SMLD technique improves long term results of surgical treatment of NSSLC stages I, II and IIIa. It decreases the rate of local relapses of the tumour and does not increase the rate of post surgery complications and mortality. This type of surgical intervention is thought to be the standard surgical treatment of lung carcinoma and has to be performed in all the patients despite of the tumour size, hystological, clinical and anatomical type and of its location in the lung.

The study was aimed to reveal predictors of death in patients with chronic obstructive pulmonary disease (COPD) and to create an integral prognostic index of fatal outcome. We have observed 86 patients with COPD during 3 to 5 yrs. Of them, 19 patients died including 15 ones died from COPD and its complications. Poor outcomes were not seen in 39 (45,3 %) of the patients. We have concluded that FEV₁ < 40 % of predictive values, SaO₂ < 90 %, distance walked for 6 min < 300 m, systolic pulmonary artery pressure ≥ 40 mm Hg, thickening of the right ventricular wall ≥ 0.7 cm, the right ventriculum size ≥ 3 cm, relative dilation of the right atrium (index ≤ 0.9), right ventricular diastolic dysfunction, clinical signs of heart failure, and hyperkinetic type of circulation predicted risk of death in COPD patients. The risk of death was higher in patients older 60 yrs suffering from dyspnea longer that 10 yrs, with smoking history more than 40 yrs and ≥ 50 pack years. Thus, risk of death in COPD patients can be defined using a simple integrative index HODEH which is associated with poor outcome being > 9.

The efficacy of immunization against various pathogens has been proved in a long term practice worldwide. A delayed effect of vaccination with pneumococcal vaccine Pneumo 23 in 243 workers in a large industrial enterprise in Chelyabinsk has been analyzed in the article. One year after the vaccination a second examination was carried out in 102 persons (38 with chronic simple bronchitis (CSB) and 64 with COPD) and 1.5 years after vaccination it was done in 92 persons (59 persons with CSB and 33 with COPD) The efficacy of the vaccination was assessed by the rate, length and severity of exacerbations of chronic respiratory diseases, as well as by clinical symptoms, results of physical examination, lung function parameters, and quality of life. The 1st control group included 33 patients with COPD, the 2nd control group included 57 patients with chronic bronchitis working in the same enterprise. The groups were compatible for age, length of work, duration of the disease and FEV1 . After immunization the exacer bation rate in the vaccinated patients with CSB decreased by 3.6 and 2.5 times within 1 and 1.5 years correspondingly (р < 0.01). The vaccinated patients with COPD demonstrated a 2.4 fold and a 2.2 fold reduction respectively (р < 0.01). The duration of exacerbations in patients with CSB decreased by 1.6 and 1.1 respectively (р < 0.01) and by 1.78 and 1.2 in patients with COPD respectively (р < 0.01). Of vaccinated patients with COPD 39.4 % did not experience any exacerbations during the follow up period compared to 0 % in the control group. The quality of life of the vaccinated patients improved in terms of physical activity, general and psychological health, vitality, reduction of discomfort. The results allow us to recom mend pneumococcal vaccination for wide implementation in high risk industrial workers.

This work was aimed to study prevalence, morbidity, mortality and morphological features of chronic respiratory pathology (CRP) in population living for a long time at Semipalatinsk region contaminated with radioactive products. We analyzed healthcare reports on prevalence, mortality and morbidity of CRP in population of Semipalatinsk region from 1969 to 2003 and questioned 7 274 residents of Semipalatinsk region using a special ly developed screening questionnaire. The latter considered the radiation related route and clinical status of the person. We have also analysed 631 autopsy reports of died patients with CRP and archive autopsy, biopsy and resected samples from 300 patients with CRP living near the experimental range from their childhood to 2003. The resected and autopsy samples of 22 patients with CRP living at the territories with normal radiation level was the control group. The results showed a tendency to increase in morbidity and mortality of CRP in proportion of the radiation dose and neighbourhood of the living place to the experimental range. The morbidity and mortality of CPR tended to decrease in 1992–2003 when nuclear experiments were stopped. Besides of well known morphological features of CRP we found severe sclerosis of the bronchial walls and interstitial tissue, vascular injuries and haemosiderosis, neuroendocrine cell hyperplasia, dysplasia of bronchial, bronchiolar and alveolar epithelium. These facts suppose the role of radiation as etiological and pathogenic factor of CRP.

The study was aimed to evaluate clinical efficacy, safety, and tolerability of 3 day course of azythromycin (Zitrolid forte) in comparison with a stan dard 7 to 10 day therapy with amoxicillin (Flemoxin solutab) in patients with mild community acquired pneumonia (CAP). Included patients were randomized in 2 groups: 1) 20 patients taking Zitrolid 500 mg daily for 3 days (15 males, 5 females, mean age, 40.7 ± 18.4 yrs); 2) 20 patients taking amoxicillin 500 mg t.i.d. for 7 to 10 days (13 males, 7 females, mean age, 39.8 ± 12.5 yrs). Pneumonia was confirmed by chest X ray in all the patients. Severity of pneumonia was assessed with PSI score. In the 1st group, 12 (60 %) of patients had PSI class I and 8 (40 %) had PSI class II. In the 2nd group, there were 13 (65 %) and 7 (35 %), respectively. In the 1st group patients, improvement in clinical signs and laboratory parame ters was noted at the 3rd day of therapy and complete recovery was detected at the 7th day. The 2nd group patients demonstrated similar dynamics at the 7th and the 14th days, respectively. Microbiological efficacy of the drugs was equal (100 %). The drugs did not differ in rate of adverse events. Therefore, 3 day course of azythromycin in patients with mild CAP were as effective as standard (7 to 10 days) therapy with amoxicillin. Azythromycin (Zitrolid forte) was well tolerated with no serious adverse events requiring interruption the treatment.

We studied effect of α tocopherol on clinical course and production of reactive oxygen species (ROS) in the whole blood in patients with community acquired pneumonia (CAP). The trial involved 70 patients with CAP. Generation of ROS was studied using the luminol dependent chemilumines cence (LDCL) method. Conventional treatment was given to all the patients. Besides this, 35 patients received α tocopherol. LDCL intensity of the blood was enhanced in all the patients. Treatment with α-tocopherol decreased ROS blood concentration and resulted in positive dynamics of clini cal and laboratory parameters. By contrast, patients on the conventional treatment maintained high LDCL intensity and there was slowly resolved course of inflammation in many cases. So, α tocopherol improved redox status in patients with CAP and increased efficiency of the treatment.