The object of the research was to study peculiarities of BA course with regard to a phenomenon of overcoming the disease.
Moderate asthma patients were recruited to the trial using a questionnaire of overcoming a disease (QOD); they were divided in 2 groups: with a high (the 1 st group) and a low (the 2 nd group) QOD index. Sputum eosinophil number, airway flow rate and pulmonary hemodynamics were investigated twice simultaneously in both the groups (in 6 and 10 or 12 months).
Patients with the high QOD index amounted 7.2 % of the patients examined. The 1 st group patients were characterized by stable treatment results, more stable condition under lower doses of inhaled steroids during the 6 month follow up and a reliable reduction in the pulmonary hypertension to the end of the follow up.
Thus, being included to the diagnostic algorithm the QOD index could allow distinguishing BA patients with favorable and unfavorable courses of the disease, improving the treatment strategy and reducing a probability of the pulmonary hypertension worsening.

We examined 364 asthma patients while treated in the Saratov pulmonary centre from 1989 to 2002. The aim of the work was to improve medication course programs including Russian oral bronchodilating drugs. The coefficient of harmony of changes which indicates a rate and synchrony of dynamics of clinical and laboratory parameters under a therapy was calculated using the method of regressive and graphic ratio. Severity of acute asthma exacerbation and, at less extent, severity of asthma course were proven to exert decisive influence upon results of the therapy

Effect of different physiotherapeutic methods (transcranial electromagnetic stimulation combined with other positions of electrodes (adrenal glands, spleen, thymus or thyroid gland); transcranial electric impulse therapy; cryomassage of the chest; interval normobaric hypoxic training and silvinite speleotherapy) on clinical signs, blood and sputum laboratory parameters, immune and endocrine systems, spirographic, echocardiographic and cardiointervalographic parameters were investigated in 308 patients with moderate asthma.
As a result efficacy of the methods was evaluated and differentiated indications for their administration were developed with regards to characteristic features of the disease and co morbid status.

A problem of lung pathology in called up aged men notwithstanding its great significance has not been studied completely. Four hundred outpatients of the Saratov Pulmonary Center were recruited to this investigation. Of them, 243, or 60.7 %, patients of called up age and younger were admitted by military registration offices. Sixty patients (15 %) more of the same age were admitted to the clinic by city outpatient departments for treatment. Asthma prevailed at the nosology structure of lung diseases in the called up aged patients (90.1 %); chronic obstructive bronchitis (COB) (4.5 %) and chronic non obstructive bronchitis (CNOB) (2.9 %) were rarer. Most of the patients (91.4 %) were in stable condition. Of the patients admitted by the outpatient departments, asthma and COB also predominated but 63.4 % of them had acute exacerbations. Such situation apparently reflects different motivations of admission to a hospital in these patient groups (expert evaluation or conventional diagnosis and treatment). Preliminary diagnosis of the military registration offices was mostly confirmed. The diagnosis was changed in 10 % of the cases demonstrating under estimation or overestimation of asthma and COB, 30 % of the patients needed the diagnosis to be verified. The collective "portrait" of a called up aged man is the following: a student of 17 years old with stable intermittent or mild persistent asthma, rarer mild COB, with no lung function disorders, low blood eosinophil number, regular pollinosis, not requiring therapy.

Management of asthma patients is little known in departmental, partly in military medicine. This study was designed to evaluate the efficacy of a management programme for asthmatic militaries. We assessed asthma attack rate (day and nighttime), need in bronchodilators, peak expiratory flow rate and forced expiratory volume for 1 s as per cent of predictive values, number of acute exacerbations and admissions to a hospital per a year and their length, days lost from work, calls for emergency aid before and 1 year after implementation of the programme. We found significant reductions in frequency of nighttime asthma attacks, need in bronchodilators, number of calls for emergency aid, rates of acute exacerbations and hospitalizations, their length, improvement in lung function. Therefore, we concluded that the management programme for asthmatic militaries is effective.

A goal of the study was to evaluate efficacy of inhaled budesonide suspension via nebulizer compared with systemic steroids in acute severe bronchial asthma. We examined 68 patients admitted for acute severe asthma (FEV₁ < 40 %_pred., PEF < 150 L / min). A first step therapy included inhaled salbutamol 5 to10 mg, oxygen, prednisolone IV for 1.5 to 2 h. Then the patients were divided into 2 groups: good respondents (n = 32) with increase in FEV 1 up to 50 %_pred. at least and patients with insufficient response (n = 36) and co existing COPD which still had FEV₁ < 40 %_pred. The group 1 patients were randomized in 2 subgroups: experimental (budesonide 4 mg / day) and control (prednisolone 120 mg / day IV). All of the group 2 patients received oral prednisolone 30 mg / day and were also randomized in experimental (prednisolone + budesonide 4 mg / day) and control (prednisolone + placebo) subgroups. The clinical course and pulmonary function were assessed after 5 days of the treatment.
As a result, the efficacy of budesonide in the group 1 was similar to that of IV steroids. The group 2 patients receiving budesonide demonstrated faster clinical improvement and better FEV₁ and PEF dynamics as compared to the controls (p < 0.05). Administration of budesonide allowed reducing the duration of the steroid therapy.
So, inhaled budesonide can replace systemic steroids in patients with acute severe asthma and good response to the first step therapy. Early addition of budesonide to prednisolone in patients with more severe asthma and COPD allows to reach the asthma control faster and to reduce doses of steroids.

The aim of this study was to analyze the rationality of antibiotics administration and choice in patients with different respiratory diseases referred from outpatient departments to the city diagnostic center № 1 at Saint Petersburg. Two hundred and thirty five outpatient medical histories were analyzed. We revealed cases of unreasonable (in patients with bronchial asthma and exogenous allergic alveolitis) and irrational antibiotic administration (rare administration of inhibitor protected aminopenicillins, cefuroxime axetil, respiratory quinolones; use of aminoglycozides, co trimoxazolе and tetracyclines in therapeutic patients). Elderly and senile age, smoking and post tuberculotic lung pathology provided lingering pneumonia course. Eighteen patients with uncomplicated pneumonia (including lingering variants), exacerbation of chronic bronchitis and bronchiectasis were successfully treated by sparfloxacin.

Last decades chronic obstructive pulmonary disease (COPD) has got particular medical and social importance by virtue of its growing spread and essential contribution to morbidity, disability and the death rate. The purpose of this work was to study the prevalence of tobacco smoking as the most aggressive COPD risk factor in various population groups at a large industrial centre. 2,304 industrial workers (males and females) of Kemerovo city were examined. The prevalence and intensity of tobacco smoking and relationship between basic smoking indexes and occupational factors, age, education, smoking of parents, living conditions, or blood group were evaluated in this research. The prevalence of the tobacco smoking among the workers questioned was 70.1 % of males and 25.7 % of females. Of the men, the absolute leaders of the tobacco smoking considering all the parameters were drivers; differences between other groups were insignificant. The greatest value of the smoking index in males was found in those of 40 to 49 and 50 to 59 years old out of proportion to their occupation, the smoking intensity in older men decreased. Attitude to smoking was provided by setting of the environmental and intrinsic factors: high educated men smoked less; probability of the smoking raised in children whose parents were smokers or ex smokers. The blood group III is thought to contribute to the smoking predisposition.

Impulse oscillometry (IOS) measures the total respiratory system impedance (Z) at incremental frequencies during normal tidal breathing.
Our aim was to establish the total respiratory impedance and how IOS measurements relate to conventional lung function indices in patients with cystic fibrosis (CF). Results from spirometry, static lung volumes and IOS (R, X, Z, resonant frequency (FR) and reactance area 5Hz — FR (AX)) were compared in 66 adult CF patients recruited from CF Care Centre of Moscow. Patients had airway obstruction (FEV₁ = 57 % _pred.), hyperinflation (RV = 253 % pred., FRC = 158 % _pred., RV / TLC = 52 %). IOS demonstrated a frequency dependent increase in R (R5 = 173 % _pred., R20 = 140 % _pred.) and a decrease in X (X5 = –0,23 kPa/L / s) with a shift in FR to higher frequencies (FR = 18 Hz, AX = 1,4 kPa / L). There were significant correlations between FR, X20, R5, R20, AX and conventional lung function indices (FEV₁ = – 0,74; 0,78; –0,42; –0,31 and –0,76 respectively). The data indicate that measurement of reactance and FR may reflect the degree of airway obstruction. IOS is an effort independent measurement that could be used in clinical routine especially in patients with severe lung diseases.

A pilot study was designed to analyze causes of late diagnosis of lung tuberculosis and late start of the specific therapy. Thirty-eight inpatients with proven infiltrative lung tuberculosis were randomly involved in the study; they were city and rural dwellers of different age. A special questionnaire was developed to determine reasons of late diagnosis. An analysis of results obtained has shown that 8 patients, or 21 % were diagnosed at a scheduled large frame photofluorography, 30 % of the late diagnosed patients were not aware of their disease, 25 % of the females and 64 % of the maleswere self-treated. Primary care therapeutists were blamed for the late diagnosis in 33 % of the patients while failed to perform necessary investigations; the delay was 2 to 11 months.

The efficacy and safety of almitrine bismesylate treatment was assessed in COPD patients in 6 month open prospective multicentre trial. 77 COPD patients with moderate hypoxemia were included (males / females — 57 / 20, mean age 63.2 ± 9.7 years; mean FEV1 0.95 ± 0.38 L, mean PaO₂ 63.3 ± 5.4 mmHg, mean PaСO₂ 44.1 ± 7.3 mmHg). We used an intermittent regime of almitrine administration: 1 mg / kg / day, for 3 months, then a "window" of 1 month, and again active therapy for 2 months. Almitrine therapy resulted in improvement of РаО2: rise after 1 month to 71.5 ± 10.6 mmHg, after 3 month — to 70.3 ± 8.3 mmHg, and after 6 month — to 72.5 ± 14.2 mmHg (р < 0.001). There was a significant fall in dyspnea during daily life activities (MRC score): from 3.5 ± 0.9 to 3.0 ± 0.9 (1 month), 2.8 ± 0.9 (3 month), 2.6 ± 0.7 (6 month) (р < 0.001). The distance during 6 minute walk test (6 MWT) increased from 334 ± 108 m to 371 ± 101 m (1 month), 377 ± 88 m (3 month), 398 ± 104 m (6 month) (р < 0.001). The levels of desaturation and Borg dyspnea score during 6 MWT significantly decreased (both р < 0.001). During almitrine treatment an improvement in almost all domains of SF 36 quality of life questionnaire was noted. 58 COPD patients completed the study. The most common adverse effects were parasthesia (6.4 %) and worsening of dyspnea (5 %), pulmonary artery pressure did not change during study.
Conclusions: almitrine treatment in COPD patients with moderate hypoxemia resulted in improvement of arterial oxygenation, reduction of dyspnea during daily life activities and exercise, increase of physical capacity and improvement of health related quality of life.

This study was designed to investigate long term treatment effects of short acting bronchodilators on respiratory symptoms, lung function, and the mean pulmonary artery pressure (mPAP) in patients with chronic obstructive pulmonary disease (COPD) and COPD combined with asthma (COPD + BA).
The study involved 14 COPD patients and 16 COPD+BA patients, males and females (the average age, 60 yrs) with moderate to severe disease and the mPAP higher than 20 mm Hg. Clinical examination with scoring of cough, sputum, dyspnea, and lung auscultation signs; spirometry, ECG, echocardiography, chest X ray, and blood analysis were used. Clinical status and lung function were evaluated primarily and in 4, 12, and 24 wks; the mPAP was measured initially and in 12 and 24 wks. Before the study no one patient received persistent supporting therapy with bronchodilators, 15 COPD + BA patients and 7 COPD patients were given inhaled steroids. Persistent therapy of all the patients with Berodual 2 doses 4 times daily for 24 wks resulted in improvement in the clinical symptoms and lung function parameters, reduction in mPAP in both the groups but the results were better and they were reached faster in the patients with combined pathology. Thus, the regularly combined therapy with short acting β₂ agonists and anticholinergics (Berodual) can be included in the algorithm of therapy of pulmonary hypertension in patients with COPD and COPD + BA.

Efficacy of fluticasone propionate (FP) – Flixonase, GSK, in 76 patients with nasal polyposis (NP) was studied. After the first 3-month trial phase (FP 400 mcg / day), 46 patients (the 1 st group) have continued the 12-month treatment with FP 200 mcg / day, and 23 patients (the 2-nd group) have stopped the therapy with nasal steroids. Intensity of nasal symptoms using a 4-point scale, need for topical vasoconstrictors, rhinometric ventilation parameters (nasal inspiratory flow, NIF, nasal resistance, NR) and endoscopic symptoms were evaluated every 3 months. Trial results showed various shifts in clinical and functional parameters in the compared groups. The intensity of NP symptoms in the 1-st group decreased and reached the minimal level in 6 to 12 months, NIF rate reduced and NR decreased while reaching the normal values after 12 months of the FP therapy. The 2-nd patient group had a considerable worsening of the NP symptoms and in the functional parameters of the nasal breath within 3 months after FP cancellation. After 6 month follow up these indices did not differ essentially from those at the baseline condition. Thus, the early FP cancellation can cause instability of clinical effect and fast recurrence to the initial status. Long-term (for several months) therapy of NP with decrease in the FP dose in 3 months not only can keep the achieved results, but also allows to improve them considerably.

The study was designed to investigate efficacy, safety and tolerability of Benacort in patients with moderate to severe acute asthma. The study involved 30 patients (19 females and 11 males, the mean ages, 46.2 ± 18.6 yrs and 54.3 ± 13.6 yrs respectively) with mild, moderate to severe asthma. They were divided into 2 groups: 20 patients with moderate acute asthma who received budesonide 1 000 to 2 000 mcg daily, and 10 patients with severe acute asthma, receiving the drug 2 000 to 4 000 mcg daily. Benacort was given via nebulizer 15 to 20 minutes after an inhaled bronchodilator. We monitores lung function parameters (LFP's), cardiovascular function, glucose and cortisol blood levels.
The study resulted in a stable positive improvement in LFP's. The therapy allowed reducing systemic steroid doses in steroid dependent asthma. The treatment failed in severe resistant asthma requiring systemic steroids to be administered. The therapy with Benacort did not impact cardiovascular function, glucose level and baseline cortisol level. Eighty three per cent of the patients reported good and excellent tolerability of the drug, 5 patients (17 %) complained of the mouth dryness which did not require to cancel the treatment. The cost of the course treatment with Benacort was 3 times cheaper compared with the foreign analogue Pulmicort suspension (AstraZeneca).