This paper shows results of comparative study of DNA reparation system and gene polymorphism of biotransformation enzymes of xenobiotics in patients with lung cancer (LC), chronic obstructive pulmonary disease (COPD) and healthy adults.
We examined 50 patients with central LC: 41 males, 9 females with the average age of 56.57 ± 7.96 yrs treated in Oncology Research Institute in Tomsk. Comparative groups involved 46 chronic bronchitis patients with preneoplastic lesions of bronchial epithelium proved by morphologic and endoscopic examinations and 50 healthy men of the same age without respiratory pathology.
Cell reparative activity was studied in blood lymphocytes. DNA samples of the LC and COPD patients were typed for polymorphism of GSTT1, GSTM1 and CYP2C19 biotransformation genes.
The results showed reduced functional activity of DNA reparation systems as well as in chronic bronchitis patients and LC patients. Investigation of DNA reparative synthesis intensity revealed significant inhibition of this process in most of the LC patients. This intensity was related to a histological type of the tumour and its stage. The LC patients had decreased rate of the GSTM1 null genotype that could be specific for this pathology. The genotype spread in the LC patients greatly differed from that in healthy (p = 0.047) but the spread in the COPD patients was close to that in healthy. A difference between the LC patients and COPD patients was not found because of a small size of the groups. Thus, studies with larger sizes are required. Practical importance of such studies could be development of genotyping test sets to predict an increased risk for neoplasm occurrence.

We summarized 20-year (1981 to 2001) experience of scheduled surgical treatment of 1,307 lung carcinoma patients. Postoperative mortality was 1.7 %, of them 2.4 % in 635 pulmonectomy cases, 1.2 % in 672 lobectomy and bilobectomy cases. A complex math analysis was performed based on operation outcomes in 650 patients at the N.N.Burdenko surgical clinic from 1972 to 2002. This allowed to detail 16 significant criteria of operative risk which are given according to their importance: 1) malignancy as the main pathology; 2) chronic lung diseases with severe respiratory failure; 3) traumatic volume of the intervention; 4) severe obesity; 5) drug allergic reactions; 6) blood group A, Rh-positive; 7) males; 8) left ventricle ejection fraction < 49 %; 9) severe stable angina; 10) chronic hepatic failure; 11) 2 previous abdominal surgical interventions; 12) length of a malignant disease precedes 1 year; 13) smoking; 14) moderate arterial hypertension; 15) previous thoracotomy; 16) chronic renal failure as a competitive pathology. This classification can be applied to predict an outcome of a scheduled surgical intervention. Preliminary assessed significance of this classification precedes those of wide-spread Northern American prognostic systems (APACHE — Acute Physiology Assessment and Chronic Health Evaluation — I—III; SAPS — Simplified Acute Physiology Score; SOFA — Sepsis-Related Organ Failure Assessment; MPM — Mortality Prediction Model).

We conducted a simple prospective trial studied influence of pentoxifylline on the course of active pulmonary sarcoidosis in 70 patients. This drug decreasing TNF-α (tissue necrosis factor-α) level was given orally in the dose of 600 mg 3 times a day in combination with α-to copherol in the dose of 400 IU twice a day. Fourteen patients stopped treatment because of side effects (nausea, dizziness). Fifty-six patients had clinical improvement in 71.4 % of cases, reduction of intrathoracic lymphadenopathy in 71.8 %, reliable improvement in DLCO (lung diffusing capacity for carbon monoxide) and increase in the blood lymphocyte count. The clinical effectiveness of this drug combination was less in chronic sarcoidosis and in patients who had taken systemic glucocorticosteroids or antituberculotics before. A multicentral comparative trial is required to include pentoxifylline to guidelines on management sarcoidosis patients.

The authors’ treatment experience of 292 patients with spontaneous pneumothorax is presented. Results of the pleural drainage (188 patients), thoracoscopy and talc pleurodesis (43 patients), videothoracoscopic surgical treatment (61 patients) are discussed. Recurrent pneumothorax after videothoracoscopic treatment was in 1 case only and only 1 patient needed in open thoracotomy (p < 0.05). Videothoracoscopy is an accurate, safe, and reliable alternative for open thoracotomy and conservative treatment in the management of patients with spontaneous pneumothorax.

The aim of this study was to investigate free radical and lipid disorders in idiopathic pulmonary fibrosis (IPF), to assess clinical efficacy of Fluimucil and to substantiate its administration in different stages of the disease.
We observed 127 IPF patients, of them 59 were treated typically with prednisolone, colchicines, or azathioprin, 68 ones received immunosuppressors and Fluimucil. The diagnosis of IPF was verified morphologically in open lung biopsy samples. The patients’ age was 25 to 74 yrs, the mean age, 46.7 ± 9.8 yrs. A control group included 20 healthy donors, the mean age, 41.2 ± 1.2 yrs.
N-acetylcysteine (Fluimucil, Zambon group) was administered initially IV 1800 mg a day for 14 days, then orally 1 800 mg a day for a month, then 600 mg a day for 3 months. Clinical and free radical conditions were monitored before the treatment and 3, 6 and 12 months starting the therapy.
Fluimucil improved thrombocyte antioxidant activity and plasma antioxidant activity, reduced CT signs of IPF, provided a stable growth in FEV1 and FVC (by 10 % and 12 % respectively) and DLco. Fluimucil was well-tolerated, adverse effects (nausea, stomach ache) were noted in 7 patients (10.2 %). Thus, the results confirmed antioxidant efficacy of Fluimucil in IPF. The long-term administration of Fluimucil combined with the immunosuppressive drugs in IPF patients was safe and reasonable as this inhibited progression of the disease.

This work was aimed to graphic analysis of informative reliability of FEV₁ in the bronchodilation test assessed as the ratio to baseline or predictive values and to determine the optimal FEV₁ cut-off in bronchial asthma (BA) patients.
The study analyzed 529 bronchodilation test results in 365 BA patients. A control group included 48 persons. The FEV₁ changes were calculated twice in each test: as ratios to the baseline and predictive values.
A high diagnostic reliability of FEV₁ in the bronchodilation test as a percentage of baseline and predictive values was found in BA patients with baseline ventilation disorders using the ROC method. The informative reliability of the FEV_1%pred. was worse.
Graphic analysis of cut-off for FEV₁ improvement made to distinguish positive or negative bronchodilation test results showed 10 % increase independently on the method.
We propose the differentiated assessment of the bronchodilation test results using 10 % to 12 % cut-off depending on severity of ventilation disorders.

Regarding poor detection of bronchial asthma (BA) in outpatient facilities diagnostic values of main clinical and phenotypical BA signs were investigated to improve early diagnosis of the disease. To verify the diagnosis we elaborated a clinic variant of BA, assessed medical documents and questioned 96 patients. The correct diagnosis was found to be reached usually in some years after the appearance of the first BA symptoms (in average 12.49 ± 7.32 yrs) in spite of typical onset of the disease in all the cases: dry cough attacks in 82.2 %, asthma attacks in 6.3 %, dyspnoea in 46.9 %, and chest tightness while contacting with an allergen or an unspecific irritant (dynamic physical exercise, stress, cold air) in 7.3 % of the patients. Detailing of symptoms was performed and diagnostic value of every sign was determined. Discriminative coefficients were calculated for reliably high influencing signs; their informative values and probability of BA detection were defined. Subjective and objective causes of late BA diagnosis were retrospectively analyzed based on medical documentation and questioning 92 doctors of outpatient facilities.

The aim of the study was to investigate features of respiratory infection inducing acute non-atopic late-onset asthma (NLA). Virologic and microbiologic examinations of brash biopsy samples of rhinopharyngeal and bronchial mucosa and bronchial lavage fluid were performed in 116 NLA patients admitted to a hospital in autumn and winter.
The leading cause of acute NLA was found to be respiratory viral infections. We noted that different clinical NLA types had different sensibility to various viruses: adenoviruses mainly caused exacerbations of aspirin-induced asthma, respiratory syncytial and influenza A viruses were prevalently determined in non-atopic asthma. Patients with posttuberculotic lesions of the lungs mostly had viral and bacterial associations. Such mixed infection resulted in more severe and prolonged exacerbations of NLA.

Endocrine system of the gastrointestinal mucus membrane was studied in atopic bronchial asthma (BA) patients. Chronic IgE-determined immune inflammation under imbalance of the local endocrine mechanisms was revealed in the gastrointestinal mucus membrane of these patients. This fact proposes immunoendocrine causes of gastrointestinal injury in BA.

We investigated 75 bronchial asthma (BA) patients to determine the incidence and causes of insulin resistance occurrence. We performed a subcutaneous insulin test, assessed tissue hypoxia and studied the oxygen transferring blood system. The impairment of insulin binding with the receptors was found in the BA patients due to both decreasing in the receptors affinity to insulin and reduction in their number under the tissue hypoxia, pH shift and the acid-base imbalance provided by the therapy with steroids and adrenoceptor agonists. This results in insulin resistance. The insulin resistance was detected in 58.7 % of the BA patients in our study.

An open comparative trial was designed to compare clinical efficacy of beclomethasone dipropionate (BDP) via non-freon metered dose inhaler (MDI) Easy Breathe or freon-containing MDI.
The trial involved 30 patients not younger than 18 yrs with stable moderate to severe bronchial asthma (BA). The length of the disease exceeded 12 months and duration of previous therapy with inhaled steroids (freon-containing BDP) 1 000 to 1 500 mcg daily was at least 4 months. The trial duration was 6 months. The patients were randomised into 2 groups, 15 patients in each. Clinical signs, peak expiratory flow rate, need in short-acting β₂-agonists were monitored. The study group patients were given non-freon BDP (Easy Breathe) instead of freon-containing BDP in the ratio 1 : 1. The control group patients continued treatment with freon-containing BDP. Then BDP daily doses were gradually reduced in both the groups while BA was controlled adequately. The daily dose was reduced by 500 mcg in average in 11 of 15 (73.3 %) non-freon BDP patients and in 6 (40 %) freon-containing BPD patients.
So, BDP via MDI ECO Easy Breathe allows moderate to severe BA to be controlled with lower doses of the drug. This reduces a cost of the therapy, rate of potential adverse effects and results in improvement of quality of life of the patients.

Clinical course of bronchial asthma (BA) was followed-up during pregnancy (in I, II, and III trimesters). We observed 62.3 % of patients with mild BA, 29.8 % with moderate and 7.9 % with severe BA. Acute bronchial asthma was diagnosed in 68.4 % of the patients, of them 40.5 % were in the I trimester, 55.7 % were in the II trimester and 54.4 % were in the III trimester. During the follow-up period BA was stable in 43 % of the cases, improved in 14 % and worsened in 43 %. Complicated pregnancy course was diagnosed in 94.7 % of the patients. High frequency of perinatal complications was found. A complex assessment of lung function using spirography and zonal reography of the lungs allows early detection of the respiratory failure and timely diagnosis of BA impairment.

A screening search of 495 adolescents found bronchial asthma in 7.45 % and allergic diseases (AD) in general in 44.8 %. Most frequent AD were allergic rhinitis (16.6 %) and skin lesions (15.1 %). AD patients considerably more often nave respiratory signs (cough, breathlessness, sputum, wheezing), bronchial obstruction (22.7 % vs. 6.6 %, P < 0.05) and bronchial hyperresponsiveness (34.3 % vs. 5.7 %, P < 0.05) as compared to controls.

Long-term oxygen therapy (LTOT) improves survival of patients with chronic obstructive pulmonary disease (COPD) having severe respiratory failure and chronic hypoxemia. In our study 51 patients received LTOT at home via concentrators (34 males, the mean age, 65.5 ± 7.8 yrs; 17 females, the mean age, 62.8 ± 4.1 yrs). Of them, 37 (72.5 %) survived 6-year period and 14 died (13 males and 1 female).
Causes of death were acute respiratory viral infection (in 1 patient), insult (in 1 patient), chronic heart and lung failure (in 12 patients). Survival of patients with chronic restrictive pulmonary diseases was not longer than 3 years.
A control group included 45 COPD patients with severe respiratory failure not receiving LTOT (30 males, the mean age, 66.3 ± 8.5 yrs; 15 females, the mean age, 69.1 ± 4.6 yrs). Of them, 16 survived 6 years and 29 died (5 females, the mean age, 72.6 ± 3.6 yrs, 24 males, the mean age, 67.8 ± 5.2 yrs).
So, LTOT at home improves survival of COPD patients with severe respiratory failure.

The aim of the study was to search delayed results and to characterize patients with heterogeneous emphysema which do not improve their quality of life after lung volume reduction surgery.
Retrospective analysis was done based on medical history reports from July, 1994, to January, 1998.
The surgical lung volume reduction was performed in 81 patients (45 males and 13 females, the average age was 61.9 yrs).
Postoperative mortality was 6.9 % (4 patients).
Twenty-three patients died within 5 yrs after the intervention; their mean follow-up period was 33.3 months.
The average follow-up period was 54.3 months. Functional parameters for patients survived 3 to 5 yrs were: FEV₁ 50 ± 23.8 %, RV 35.6 ± 29.1 %, RV / TLC 12.3 ± 12 %, the 6-min walk distance was 96.7 ± 62 m.
The total 5-year survival was 63.8 %, the survival for the patients having FEV₁> 30 % was 83.8 % and that for the patients with FEV₁ < 30 % was 50 %.
Age and lung function parameters did not differ in survivors and died patients. On the contrary, differences in the blood gas parameters, oxygen therapy time and 6-min walk distance were significant between these groups.
Some negative factors were revealed: predominant injury of the lower lung fields, FEV₁ < 30 % pred., respiratory failure (PaCO₂ ≥ 48 mm Hg), oxygen therapy longer than 6 months, the 6-min walk distance shorter than 80 m.

Irrational administration of antimicrobials, incorrect regimens and dosing provide occurrence of adverse effects with minimal therapeutic results and development of drug resistance including anti-tuberculosis drugs.
The study was designed to detect information sources on drug therapy used by general practitioners and TB specialists, to establish stereotypical models of antibacterial drug administration in prevalent upper and lower airway diseases at the Samara region and to substantiate the supposition about unreasonable empiric administration of anti-tuberculosis drugs in a respiratory patient without microbiological confirmation as a probable cause of drug resistant tuberculosis. A cross-sectional study based on a special questionnaire was performed in 425 general practitioners in primary care facilities, hospitals and in TB specialists at the Samara region. The questionnaire contained several clinical situations and their solving and the respondents should choose the most suitable ones.
Results demonstrated that majority of the practitioners (80 %, or 340 / 425 cases) widely use advertising information regarding antimicrobials. Several doctors (1.7 %) chose antibacterial drugs to treat acute respiratory viral infection, 0.8 to 1.6 % of doctors certainly decided to administer anti-tuberculotics in non-TB respiratory diseases such as acute bronchitis, chronic obstructive pulmonary disease, communityacquired pneumonia and acute tonsillitis, and approximately one fifth of the practitioners thought to administer antituberculotics in these diseases (18.4 % (78 / 425) – rifampicin, 21.2 % (90 / 425) – isoniasid).

The objective of the “IKAR-COPD” study was to evaluate quality of life in COPD patients with different treatment regimens.
This multi-center population-based study was performed in 10 regions of Russia, 702 COPD patients aged 40 to 85 yrs were included in this study: 18.5 % with COPD stage I, 20.7 % with COPD stage II, 40.9 % with COPD stage III and 19.9 % with COPD stage IV (according to the GOLD 2003 criteria).
The official Russian versions of the MOS SF-36 questionnaire and the St. George’s Respiratory Questionnaire (SGRQ) were used as generic and disease-specific health-related measures of quality of life.
COPD significantly impaired the patients’ quality of life, mostly their physical activity. The quality of life depended on severity of COPD, a patient’s age, duration of the disease and smoking history.

Chronic obstructive pulmonary disease (COPD) is an actual healthcare problem due to its widespread, progressive course and mortality. A great deal of the patients’ treatment takes a symptomatic therapy. Results of outpatient treatment with Berodual-N of patients with COPD stage 1 to 2 in stable condition are shown in the article. A significant improvement in clinical signs, lung function parameters (FEV₁) and physical tolerance were noted.