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PULMONOLOGIYA

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No 6 (2007)
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https://doi.org/10.18093/0869-0189-2007-0-6

EDITORIAL

CLINICAL GUIDELINES

ORIGINAL STUDIES

23-28 339
Abstract
The aim of the study was to investigate functional status of cardiorespiratory system and post-mortem morphometric characteristics of the heart and the lung arteries in secondary pulmonary hypertension (PH) associated with idiopathic pulmonary fibrosis (IPF). A retrospective analysis of functional status of cardiorespiratory system in 10 died patients with IPF (5 males and 5 females, the average age, 63.1 ± 9.2 yrs) was performed. During the last 6 months of their life, all the patients were investigated using body plethysmography, lung diffusing capacity test, arterial blood gas analysis and Doppler echocardiography measuring maximal systolic pulmonary artery (PA) pressure (sysPAP). We also performed histological examination of autopsy samples and morphometric examination of the PA and the heart. Severe restrictive disorders, significant decrease in the lung diffusing capacity with alveolo-capillary block and arterial hypoxemia have been found. The sysPAP was 44.9 ± 17.4 mm Hg in average. Microscopic lung tissue disorders were characteristic for usual interstitial pneumonia. Diameter of the pulmonary vessel lumen in IPF patients was 1.5-fold less and the vessel area was 1.7-fold less than those in controls. In IPF patients, the PA branch wall was 2.9-fold thicker, the proportion of the muscle area was 2.2-fold more and that of the intima area was 4.1-fold more than those in controls. Correlations were found between sysPAP and the cross-sectional area f the PA small branches (r = 0.71; p < 0.05), sysPAP and the proportion of intima area (r = 0.68, p < 0.05). Lumen diameter of the PA small branches correlated with the right atrium length (r = –0.81; p < 0.05) and the right ventricle mass correlated with diameter (r = –0.71; p < 0.05) and the cross-sectional area of the PA small branches (r = –0.75; p < 0.05). Significant correlations were also found between lung function, lung diffusing capacity and function signs of PH. Therefore, secondary PH in IPF is characterized by wall remodeling in the PA branches, mainly due to changes of intima. The 1.5-fold reduction of the vessel lumen is thought to be a cause of moderate growth of sysPAP followed by occurrence of cor pulmonale.
29-33 349
Abstract
The aim of the study was to evaluate efficacy of surfactant treatment in patients with a slowly resolving pneumonia. Fifty patients with slowly resolving pneumonia were randomized into 2 groups. The studyt group patients (n = 10) received nebulised natural surfactant. The control group patients (n = 40) were treated without surfactant. Clinical and immunological methods were used in all patients at admission and in 2 weeks. There were no adverse effects of surfactant in our trial. In 14 days, lung function parameters improved significantly in the study group compared to the baseline and to the controls. The 6-min walk distance also increased greater in the study group. Significant increase in T-lymphocytes number, phagocyte number and phagocytic index was seen in the study group patients compared to the controls. Therefore, efficacy of this complex therapy of slowly resolving pneumonia was higher than in patients not receiving surfactant.
34-38 469
Abstract
We studied psychovegetative status and efficacy of Afobazol for correction of psychovegetative disorders and prevention of adverse effects of antituberculosis drugs in patients with newly diagnosed tuberculosis. The study involved 98 patients: 49 patients received antituberculosis therapy and Afobazol (the 1st group) and 49 patients were treated with antituberculosis medications only (the 2nd group). We found that 100 % of newly diagnosed tuberculosis patients had psychovegetative disorders with imbalance in all components of the vegetative nervous system, hyperactivity of the sympathetic component and high levels of somatic and psychic anxiety. Antituberculosis chemotherapy enhances psychovegetative disorders. Addition of anxiolytic drug Afobazol to the antituberculosis therapy improved results of the treatment probably due to improvement in the vegetative nervous function, alleviation of psychic disorders and increase tolerability of antituberculosis therapy.
39-42 472
Abstract
The purpose of the study was to investigate airway reactivity in patients with diabetes mellitus. We examined 68 patients with diabetes mellitus of 16 to 66 years of age. Of them, 29 patients (20 with diabetes mellitus type 1 and 9 with diabetes mellitus type 2) were tested with phenoterol (the 1st group). The 2nd group patients (12 with diabetes mellitus type 1 and 27 with diabetes mellitus type 2) were examined with histamine challenge test. Bronchodilator test (ΔFEV1 > 200 ml or > 12 % of the baseline value) was positive in 6 (20.7 %) patients, five of them had diabetes type 1. The histamine challenge test was positive in 9 patients with diabetes type 2 (23.1 %). This was an evidence of significant bronchial hyperreactivity. A qualitative analysis using Fisher's discriminant criterion revealed the following correlations: 1) between bronchial hyperreactivity and a type of diabetes mellitus; 2) between bronchial hyperreactivity and administration of oral antidiabetic drugs. Correlations between bronchial hyperreactivity, body mass index, duration of the disease and late complications of diabetes mellitus were not revealed. In conclusion, the positive bronchodilator test predominated in patients with diabetes mellitus type 1 and bronchial hyperreactivity for histamine was mainly detected in patients with diabetes mellitus type 2. This could be considered as an evidence of different mechanisms of bronchoconstriction in patients with diabetes mellitus types 1 and 2. Generally, susceptibility to bronchoconstriction may be an unfavorable factor for occurrence of nonspecific lung disease in patients with diabetes mellitus.
43-48 323
Abstract
This randomized controlled trial was designed to evaluate the efficacy of education of patients with COPD. The principal inclusive criterion was the confirmed stable COPD (GOLD, 2003). We had created an original program of self-efficacy and self-management of COPD patients, which was used in this trial. The education was performed individually or at small groups (3-4 persons) with or without pulmonary rehabilitation. Eighty nine patients were involved in the trial, of them 75 patients were divided into 4 groups according to educating methods and 14 patients not drawn in the educational or rehabilitation programs were included in the control group. The efficacy of this educational program was investigated with a control test of the patients' basic information about the disease. Other parameters evaluated were hospital admission rate, exacerbation rate, need for the emergency care, pulmonary function, 6-min walking distance, dyspnea severity. A health-related quality of life was measured by the SF-36 questionnaire and the St. George's hospital Respiratory Questionnaire (SGRQ). The education of COPD patients reduced the need for the emergency care during the consequent year. It did not change number of hospital admissions and the total number of exacerbations, but increased the rate of mild exacerbations. The educational program alone did not affect pulmonary function (FVC, FEV1), physical tolerability and dyspnoe but improved the health-related quality of life mainly due to the emotional part. Combination of educational and rehabilitation programs improved physical performance and shortness of breath. We concluded that education should be the essential part of management of patients with COPD. The most effective mode was individual education along with pulmonary rehabilitation but its positive effects were kept up for short time.
49-55 1083
Abstract
Acute bronchitis is a wide-spread disease. Although it is generally caused by viruses, antibiotics are used for its treatment too much often. So it is very important to evaluate alternative therapy of acute bronchitis. The aim of the trial was to assess efficacy and safety of Pelargonium Sidoides (EPs 7630 is a registered trademark of Dr. Willmar Schwabe GmbH & Co, Karlsruhe, Germany) compared to placebo in patients with acute bronchitis. Study design: randomised, double-blind, placebo controlled trial with planned interim analysis. The trial centres: 6 outpatient medical centres. Patients: 124 adult patients with acute bronchitis, onset of the disease ≤ 48 h, and severity of symptoms ≥ 5 according to BSS scale gave written informed concert. EPs 7630 or placebo were administered in the dose of 30 drops t.i.d. during 7 days. The primary outcome measure was BSS scoring at the 7th day of the treatment. BSS scoring decreased by 7.2 ± 3.1 in the EPs 7630 group (n = 64) vs 4.9 ± 2.7 in the placebo group (n = 60). 95 % confidence interval (CI, 1.21, 3.56) for difference of the effects between two groups demonstrated significant improvement in the EPs 7630 in 7 days of the treatment compared to the placebo group (p < 0.0001). The EPs 7630 patients had parameters of complete recovery for every of 5 individual symptoms reliably higher compared to placebo patients. During the first 4 days of the treatment therapeutic effect was noted in 68.8 % of the EPs 7630 group vs 33.3 % of the placebo group (p < 0.0001). Health-related quality of life improved better in the EPs 7630 patients compared to the placebo group. Adverse events were found in 25 of 124 patients: 15 / 64 in the EPs 7630 group and 10 / 60 in the placebo group. All the adverse events were considered as non-serious. The efficacy of EPs 7630 in treatment of adults with acute bronchitis was higher compared to placebo. It could be an efficient alternative drug in therapy of acute bronchitis at the absence of indications for antibiotics administration.
58-62 322
Abstract
Under the epidemic rising of tobacco consumption among working-aged people worldwide, there is little Russian detailed data on prevalence and particularities of active and passive tobacco smoking among adolescents. The present 4-stage study involved schoolchildren and students of trade schools (13 to 18 years of age) at Chapaevsk, which is a large industry center of Samara region. The prevalence of tobacco smoking among these adolescents was as high as 28 %. The average age of starting smoking was 14.7 ± 0.4 yrs. A significant effect of tobacco smoking on airway aerodynamics and low motivation for quitting the smoking were found. The most of adolescents had low nicotine dependence but were poorly motivated for smoking cessation and highly influenced by the social surroundings to re-start smoking. The majority of adolescents renewed smoking after return to habitual social conditions.
63-66 421
Abstract
Exhaled air gases were investigated in experimental animals using intraresonator laser acousto-optic sensor ILPA-1 and methane detector before and after sensitization with ovalbumin. Absorption lines typical for CO2 and NH3 were found in exhaled air of intact guinea pigs. After the challenge inhalation, absorption coefficients for СО2 and NH3 decreased and absorption lines for N2O and NO2 occurred. Methane flow decreased after sensitization. Reduction in CO2 concentration could be due to lowering gas exchange between the alveolar air and the blood because of breathing disorders. Ammonium having alkaline properties can bind and precipitate bronchial secret due to pH shift to acidic media. N2O и NO2 are products of NO metabolism and could occur because of enhanced nitric oxide production by inducible NO-synthase. Methane flow reduction is thought to be due to inhibition of airway microflora.
67-72 537
Abstract
The trial was aimed to evaluation of clinical and microbiological efficacy, safety and tolerability of levofloxacin in patients with moderate to severe acute exacerbation of COPD. There was an open, non-randomised prospective study involving 20 patients with acute exacerbation of COPD (16 males, 4 females, the average age, 63.1 ± 8.6 yrs; smoking history, 36.2 ± 14.3 pack/yrs). The drug was administered in the daily dose of 500 mg during 7 days (in 18 patients) or 1 000 mg during 14 days (in 2 patients with P.aeruginosa isolated from sputum). Clinical and microbiological efficacy and tolerability were evaluated in 3, 7 and 14 days of the antimicrobial therapy. Clinical improvement in 3 days of the therapy was noted in 15 patients (75 %) and in 7 days in 19 patients (95 %). Significant improvement was found in lung function parameters (FEV1 , from 40.5 ± 14.7 % pred. to 52.0 ± 18.6 %pred.; р = 0.0001; FVC, from 68.3 ± 21.3 %pred. to 77.6 ± 15.0%pred .; р = 0.005). During the therapy, blood hemoglobin level (р = 0.013) and leukocytes count (р = 0.001) have decreased. Eradication and supposed eradication of pathogens were obtained in 81.8 % of the cases. The drug tolerability was considered as excellent in 85 % of the patients and good in 15 % of the patients. Adverse events were rare, mold and transitional and did not require withdrawal of the drug. Therefore, levofloxacin is an effective antimicrobial drug for treatment of moderate to severe acute exacerbation of COPD; clinical efficacy was 95 % and microbiological efficacy was 82 %.The drug is well tolerated and has a convenient dosing regimen.
74-76 305
Abstract
The aim of this study was to analyze preferential drug provision (PDP) of asthma patients in Dagestan Republic in 2006. This analysis was performed using a personified database of the preferential drug provision. We studied spectrum of administered antiasthmatic therapy. Results revealed that salmeterol / fluticasone propionate and budesonide / formoterol take the most portion of the PDP cost.

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ISSN 0869-0189 (Print)
ISSN 2541-9617 (Online)