Nineteen patients aged 18–65 years with moderate and severe exacerbations of atopic asthma were examined for respiratory viruses, Mycoplasma pneumoniae, and Chlamydophila pneumoniae. Interferon system, IL-4 and γ-IFN serum levels were also investigated. Viral infections (RS-virus, adenovirus, influenza types A (H1N1, H3N2) and B viruses, parainfluenza types 1 and 3 viruses) were diagnosed serologically or using PCR with direct detection of viral nucleic acids in 73.6 % of the patients. Diagnostic level of Mycoplasma pneumoniae antigen was found in 78.9 % of the patients, anti-Chlamydophila pneumoniae antibodies were detected in 31.6 %. Leukocyte interferon-producing function was decreased in all the patients.

One of the most important purposes of treatment of asthma is achievement and maintenance of control of the disease. The present study investigated relationship between a level of asthma control and bronchial hyperreactivity (BHR). This study involved 145 outpatients aged 18 to 34 yrs. The control of asthma was evaluated using the Asthma Control Test (ACT). The ACT score of 25 indicated the full control of asthma, the scores between 20 and 24 indicated the good control and the scores < 20 suggested the poor control. BHR was assessed in the methacholine challenge test; PD20  was the dose of methacholine causing 20 % fall in FEV₁. PD 20 ≤ 0.046 mg suggested high BHR, PD 20 ranged 0.047 mg to 0.228 mg indicated moderate BHR, and PD 20 of 0.229–0.471 mg corresponded to low BHR. Asthma was fully controlled in 17 mild asthma patients (22 %) and was poorly controlled in 13 of them (17 %). No-one of moderate and severe asthma patients had the full control of the disease. Good control of moderate and severe asthma was found in 22 (50 %) and 2 (8 %) respectively, poor control was estimated in 22 (50 %) and 23 (92 %) patients respectively. The mean methacholine concentrations in mild, moderate and severe asthma groups were 0.304 ± 0.011 mg, 0.211 ± 0.019 mg and 0.101 ± 0.015 mg respectively (p = 0.03). BHR was low in all patients with fully controlled asthma with no regards to its severity. The patients with well controlled asthma had predominantly low and moderate BHR, and 9 % of them had high BHR. BHR was also high in 57 % of the patients with poorly controlled asthma. There was a close correlation between the ACT score and PD20 of methacholine (r = 0.78; р < 0.001). In conclusion, the results revealed insufficient quality of outpatient treatment of asthma, particularly of moderate and severe asthma. ACT is reasonable to be used in wide clinical practice, especially in primary care settings.

A cross-sectional analysis of management of asthma patients before and after short-term training of 78 physicians in Bishkek was performed. At baseline, diagnosis of asthma was made in 37 patients (4.1 % of all respiratory diseases). Just after training, in 1 year and in 2 years, asthma was diagnosed in 26, 45 and 26 patients, respectively. At baseline, peak flow measurement and spirometry were not used at all and treatment was mainly symptomatic. The training resulted in improvement of theoretical knowledge score from 84.6 % to 73.3 %; p < 0.001. Use of peak flow measurements increased to 38.5 %, 51.1 % and 38.5 % just after the training, in 1 and 2 years, respectively. Use of spirometry grew to 11.5 %, 17.8 % and 26.9 %, respectively. Inhaled corticosteroids (ICS) were administered to 42.3 %, 53.3 %, and 46.2 %, respectively, vs. 5.4 % at baseline with simultaneous reduction in inadequate administrations of vitamins, antibiotics and expectorants. So, the short-term training was effective. However, application of peak flow measurement in 100 % of the patients should be achieved; the majority of patients need ICS. Ways to increase the training efficiency are necessary.

Investigation of efficacy of various rehabilitation methods in patients with asthma was performed. We observed 165 patients divided into 3 groups. All of them received the basic therapy for asthma. Each group included the study subgroup (40 patients) and the placebo subgroup (15 patients). The 1st study subgroup patients received 250 μg of nebulized ipratropium bromide and 500 μg of phenoterol hydrobromide followed by 22.5 mg of nebulized ambroxol; inhalations of 0.9 % saline solution were as placebo. The 2nd study subgroup patients were treated with acupuncture; and placebo patients received spontaneous pricks of the skin. The 3rd group was treated with willed limitation of deep breathing (WLDB) by K.Buteyko's method and placebo physiotherapy. We noted qualitative changes in clinical course of the disease, significant reduction of drug therapy and improvement in all lung function parameters in the 1st group patients. In the 2nd and the 3rd groups, some patients reported improvement in their health status, reduction in dyspnea and in need in bronchodilators. However, analysis of their peak expiratory flow rate (PEFR) and lung function parameters did not show statistically significant improvement compared to placebo.

Microbial contamination of airways is of great interest due to its influence on bronchial asthma (BA) course. The aim of this study was to investigate sputum and colonic microflora in BA patients, influence of dysbiosis on BA course and to find ways for its correction. The study involved 108 BA patients (84 females, 24 males), 15 to 60 years of age, divided into 2 groups: 69 patients with good clinical effect of standard asthma therapy and 40 patients without clinical improvement after 2-wk standard therapy (torpid BA course). The patients have been observed for a year. We evaluated rate and severity of BA exacerbations, sputum and colonic flora. An original questionnaire has been developed to assess main asthma features and their influence of the patient's status. Pathogenic or conditional-pathogenic flora presented in associations with fungi in 85 % was yielded in all the patients with torpid BA course. Antimicrobial and antifungal medications allowed improved asthma control in 82 % and eradication of airway pathogens in 70 % of the patients. Colonic dysbiosis was found in 94.9 % of BA patients. Its correction resulted in better BA control. This effect have maintained for 3 to 5 months after probiotic therapy was finished. Thereafter these patients required repeated bacteriological monitoring and treatment.

COPD is characterized not only by pulmonary pathology but also by systemic disorders leading to abrupt reduction in physical tolerance causing a significant decrease in the patients' quality of life (QoL). Training of upper and lower limb muscles along with breathing training, training of respiratory muscles using respiratory training devices and adequate drug therapy can improve physical tolerance of COPD patients. The aim of this work was to compare different methods of physical rehabilitation under the therapy with tiotropium bromide (TB). The study involved 45 patients with severe and very severe COPD (the mean age, 64.5 ±11.0 yrs) randomized into 3 groups: the 1st group patients took inhaled corticosteroids (ICS), short-acting b-agonists and TB, the 2nd group patients were treated with the same medications plus respiratory muscle training with Threshold IMT, PEP, and the 3rd group received the same medications plus skeletal muscle training. The study continued for 3 months and included 3 active visits with testing of lung function (LF) and respiratory muscle strength (Pi, Pe), 6-minute walking test (6-MWT), evaluation of QoL using the SF-36 questionnaire and of dyspnea using MRC scale. As a result, all groups have improved QoL, LF, respiratory muscle strength, and 6-minute walk distance after 3-month treatment. The best values of QoL and 6-MWT were seen in the 3rd group. The greatest improvement for the 2nd group patients was noted in LF and respiratory muscle strength. The 1st group also improved all the parameters. Therefore, we can not exclude the effect of TB on physical tolerance in COPD patients. We conclude that combined application of respiratory and skeletal muscle training and drug therapy including TB is the optimal treatment for COPD patients.

Ability of blood sera from 19 asthmatic children and 56 asthmatic adults to modify reactivity of β-adrenoreceptors and M-cholinoreceptors in isolated smooth muscles of the uterus horns from nonpregnant rats (n = 234) and cow trachea (n = 36) have shown that asthma presence did not change serum myocyte-stimulating activity but reduced the sensitizing activity of β-adrenoreceptors and the blocking activity of M-cholinoreceptors and enhanced the blocking activity of β-adrenoreceptors. The similar changes were also seen in child urine and indicated the decreased level of the endogenous sensitizer of β-adrenoreceptors and the growing level of the endogenous blocker of β-adrenoreceptors in asthma patients and the decreased level of endogenous blocker of M-cholinoreceptors in certain asthmatics. These events could provide asthma occurrence.

We studied clinical and immunological relations of respiratory diseases (recurrent maxillar sinusitis, tonsillitis, adenoiditis, laryngotracheobronchitis with obstructive syndrome) in 261 children aged 2 to 14. Relationships between immunological parameters, severity of clinical course and pathogenic activity of the microbial agent were found. A scheme of immunotherapy with leukinterferon and interferon-α was worked out. The therapeutic efficacy of this scheme as a part of the basic therapy of constricting laryngitis and obstructive bronchitis and in children with frequently recurrent respiratory disease was proved. Longer stable period in recurrent respiratory disease, shorter antibacterial courses, less frequent hospitalizations, and possibility of outpatient administration were also seen.

Effective, safe and convenient inhalation therapy of asthma is of particular importance in pediatric practice. We performed open randomized comparative trial to evaluate efficacy of ultra-fine Beclazone ECO Ease Breathe (BEEB) vs fluticasone in equal doses in children with asthma. The study involved 40 children (26 males, 14 females) of 6-17 years of age with moderate asthma. They were treated with fluticasone followed by BEEB 250 μg b.i.d. We analyzed clinical findings, frequency and severity of asthma symptoms, peak expiratory flow rate (PEFR), medications used for asthma, lung function parameters. After 2 months of treatment with BEEB, the full control of asthma has been achieved in 11 patients (27.5 %) vs 9 patients treated with fluticasone (22.5 %). The good control was achieved in 27 (67.5 %) and 28 (70 %) patients, respectively. The asthma control was poor in 2 patients with BEEB (5 %) and 3 patients with fluticasone (7.5 %). Moderate improvement in mean FEV 1 and PEFR and reduction of their postbronchodilator growth were noted. All the children easily acquired the proper inhalation technique for BEEB. After 2 months of treatment, 39 of 40 patients have wished to continue therapy with this inhaler. There were no adverse events of the drug. There were no additional expenses for asthma and need of hospitalization or other medical care during the study. Therefore, BEEB as the basic therapy of childhood moderate asthma improves asthma control and compliance of the patient and the physician, and significantly decreases the cost of treatment.

The aim of this study was to investigate particularities of angiogenesis and stroma formation in various histological types of lung carcinoma in inhabitants from radionuclide-contaminated territories at Semipalatinsk region, Kazakhstan. We used operational and biopsy material from 87 lung carcinoma patients. Of them, 33 patients (the 1st group) lived in the neighbourhood of Semipalatinsk testing area from their childhood to 2002 and were exposed to radiation for a long time (the mean year radiation dose exceeded 0.1 rem). Operational and biopsy material from 54 patients living at Kazakhstan territories with normal radiation level (14 patients) or in Moscow (40 patients) were as controls (the 2nd group). Immunohistochemical methods were used to detect ММР-1, ММР-2, ММР-9, TIMP-1, VEGF, CD34, chromogranin, and CD68. Expression of ММР-1, ММР-2, ММР-9 in tumour cells was enhanced in the 1st group compared to the controls. Angiogenesis in tumour stroma of Semipalatinsk patients was more significant compared to the controls with regard to VEGF expression and density of newly formed vessels. We proposed that the mentioned above factors could provide poor prognosis of lung carcinoma in inhabitants of radionuclide-contaminated territories.

Cell reactions of bronchopulmonary system in COPD exacerbation were investigated in BALF from 182 patients. Patients were divided into 2 groups: with or without pesticide accumulation. Smoking habit was also taken into consideration. We estimated biocide potential of AM using spontaneous and induced NST-test in 4 groups, calculated the stimulation index that revealed several patterns of cell reactions. Chronic excessive activation of AM by smoking, pesticides and/or other risk factors provided hyperresponsiveness of biocide systems of mononuclear monocytes.

Respiratory pathology takes 15 to 35 % of occupational diseases and a half of them falls to chronic obstructive pulmonary disease (COPD) and asthma. The aim of this study was to evaluate clinical efficiency and safety of troventol in workers of rubber industry and other hazardous fields and in agriculture workers suffering from asthma or COPD. The study involved 33 workers of hazardous industries of Moscow and 35 agriculture workers. Methods used included questionnaire, physical examination, spirometry, bronchodilating test, methacholine challenge test, peak flowmetry, measurements of NO in the exhaled air (NOexh) and total IgE level before and after treatment with troventol under the continuing hazardous exposure condition. The daily dose of troventol depended on the severity of the disease and ranged 80 to 240 μg. The therapy with troventol has resulted in improvement of cough from 1.6 to 1.2 score (р ≤ 0.05) and dyspnea from 1.12 to 0.8 (р ≤ 0.04). Asthma attacks ceased in 39.7 % of the workers. Number of the workers having normal Tiffeneau index increased from 36.4 to 48.5 %. Bronchial hyperreactivity reduced. NOexh became normal in 24% of the patients. The drug was generally well tolerated.

This study was designed to investigate parameters of remodeling and diastolic function of right ventricle (RV) in elderly patients with COPD. One hundred patients were observed (of them, 78 had COPD and 22 were controls). The COPD patients had structural disorders and diastolic dysfunction of RV and pulmonary hypertension. A relationship was determined between systolic and diastolic functions of RV.

Chronic obstructive pulmonary disease (COPD) is one of important problems of public healthcare. The aim of the present study was to investigate effect of beclomethazone on endothelial function (endothelin-1 level and results of Celermajer's test) and ultrasound parameters of pulmonary and central circulation in 42 COPD patients. Endothelium dysfunction was found in 66% of patients. It improved after antiinflammatory treatment. The improvement in myocardial diastolic function and decrease in systolic pulmonary artery pressure were revealed after 3-month beclomethazone therapy.