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Relevance. Polypharmacy in taking medicines as one of the main consequences of comorbid pathology is a well-known risk factor for adverse drug reactions (ADRs). ADRs are often the cause of worsening disease course, disability, and mortality, especially in the elderly. This trend necessitates optimization of pharmacotherapy used in elderly patients using analytical algorithms for safety assessment. Objective. To analyze the safety of antibacterial and bronchodilator pharmacotherapy in COPD patients over 65 years old by means of comparative analysis of the data obtained according to EURO FORTA system methods and STOPP/START criteria. Methods. To conduct the study, a patient portrait was made on the basis of inpatient records data with the determination of Charlson and ADO indices. The influence of the severity of COPD course and comorbid pathology on polypharmacy was determined using the Spearman correlation coefficient (r). Evaluation of efficiency in the application of EURO FORTA and STOPP/START analytical criteria was carried out using a comparative analysis method. Statistical processing of the obtained data was performed using the StatPlus 7.0 program. Results. 113 inpatient records of elderly patients with moderately severe and severe COPD were studied. On the background of high severity of comorbid pathology, polypharmacy was observed in 102 patients (90.2%). The application of EURO FORTA and STOPP/START analytical tools in the analysis of bronchodilator and antibacterial therapy revealed 71 prescriptions of potentially unrecommended drugs in 61 (53,9%) patients. Conclusion. The analysis showed a high rate of prescribing drugs with significant risk in elderly patients. The conducted comparative analysis of two analytical tools for evaluation of the used pharmacotherapy EURO FORTA and STOPP/START demonstrated the necessity of their joint use to achieve the best results in ensuring safety of treatment of elderly patients, as they successfully complement each other.

Chronic obstructive pulmonary disease (COPD) is often associated with atherosclerotic cardiovascular disease (ASCVD), of which obliterating atherosclerosis of lower limb arteries or peripheral arterial disease (PAD) is an important component. The aim of the study was to evaluate the clinical, functional and immunological characteristics of COPD with the phenotype of frequent exacerbations in combination with PAD. Materials and methods. Four groups of COPD patients were included: 20 COPD patients with infrequent exacerbations without ASCVD, 20 COPD patients with frequent exacerbations without ASCVD, 20 patients with frequent exacerbations and PAD, and 20 COPD patients with a phenotype of frequent exacerbations and PAD. Data from 20 healthy controls were analysed for comparison. Clinical and spirometric data were evaluated. General clinical laboratory data and immunological markers (interleukin 1 beta (IL1b) and tumor necrosis factor (TNF) in exhaled breath condensate (EBC) and serum were analysed. Results. Higher levels of IL1b and TNF in EBC and serum were found in patients with COPD and PAD compared to COPD patients without ASCVD (p

Цель. Определить способность нортриптилина самостоятельно и в сочетании с будесонидом ингибировать продукцию провоспалительных цитокинов в естественных киллерах (ЕК-клетках) крови пациентов с хронической обструктивной болезнью легких (ХОБЛ) и установить молекулярные механизмы, лежащие в основе комбинированного действия данных препаратов. Материал и методы. Клетки крови пациентов с ХОБЛ (n=21) инкубировали с будесонидом, нортриптилином или их сочетанием. Продукцию цитокинов, экспрессию глюкокортикоидного рецептора β (ГРβ), гистон деацетилазы 2 (ГДА2) и фосфорилированной p38 митоген-активируемой протеинкиназы (ф-p38 МАПК) в ЕК-клетках анализировали методом проточной цитометрии. Результаты. Комбинация нортриптилина (10 мкМ) и будесонида (10 нМ) снижала в ЕK-клетках синтез интерлейкина 4 (ИЛ-4), ИЛ-8, интерферона γ, фактора некроза опухоли α и экспрессию ГРβ, ф-p38-МАПК, а также повышала экспрессию ГДА2 более значительно, чем один будесонид. Выводы. Нортриптилин усиливает противовоспалительное действие будесонида путем изменения экспрессии ГДА2, ГРβ, ф-p38 МАПК в ЕК-клетках крови пациентов с ХОБЛ. Полученные данные свидетельствуют о целесообразности комбинации нортриптилина с будесонидом для лечения ХОБЛ.

Background. A combination of different types of lung cancer and chronic obstructive pulmonary disease (COPD) is very common. COPD, accompanied by ventilation disorders and, often, respiratory failure, is a significant additional risk factor for mortality in these patients. Identification of risk factors for mortality in patients with lung cancer and COPD can potentially be associated with better long-term outcomes.Materials and methods. Using a Cox regression model based on information about the outcome of the disease and life expectancy after treatment initiation, a survival analysis was performed with an assessment of the contribution of various clinical and anamnestic factors for a group of 118 COPD patients with primary diagnosed lung cancer. These patients received treatment at the Cancer Research Institute in Tomsk in 2013–2019.Results. The study included 118 patients (87.3% men and 12.7% women). Among them, 77.97% of patients were active or former smokers with smoking index (SI) ≥ 10 pack-years, and 22% of patients had never smoked or had SI < 10 pack-years but had other risk factors for COPD. Peripheral lung cancer was detected in 45.8% of cases. Squamous cell carcinoma was noted in 54.2% of cases, adenocarcinoma – in 34.7%, large cell carcinoma – in 1.7%, small cell carcinoma – in 5.9%, and carcinoid tumors – in 2.5% of cases. Patients were characterized by varying degrees of severity of ventilation disorders in accordance with the GOLD classification: stage 1 was observed in 44% of patients, stage 2 – in 38.1 % of patients, stage 3 – in 16.9 % of patients, and stage 4 – in one patient. Threeyear mortality was 28.12%.Conclusion. According to the results of the Cox regression analysis, factors that significantly reduced the survival rate of patients with lung cancer in combination with COPD were more severe stages in terms of the size of the primary tumor and its localization, the prevalence of metastasis (according to TNM classification), more severe dyspnea (mMRC scale), lower oxygen saturation values, atelectasis, and episodes of pneumonia, including paracancrotic pneumonia, over the previous 12 months. The presence of certain types of metastases, such as metastatic lesions of the pleura, adrenal glands, distant non-regional lymph nodes, and bones should also be noted as negative factors for survival. It is worth noting that surgical treatment of the primary tumor was associated with an increase in the survival rate in patients with lung cancer in combination with COPD.

Aim. To review the current progress in the use of remote health monitoring (RHM) technologies for chronic noncommunicable diseases (CNCD).To search for data, we used Web of Science, Scopus, Russian Science Citation Index, Academic Search Complete (EBSCO), Cochrain, and PubMed databases. The date range was 5–10 years. The importance of development of RHM technologies and their further study was shown to confirm the evidence of effect of certain RHM systems.New approaches to the integration of the medical community into the international telemedicine strategy are considered. It was established that RHM can potentially decrease treatment costs and reduce the burden on medical organizations. The review analyzes the experience in using RHM in patients with cardiovascular diseases, as well as respiratory and endocrine disorders. The review also summarizes and systematizes the findings of studies on assessing the effectiveness of RHM technologies in clinical practice, including their use in the COVID-19 pandemic.It is noted that despite high interest of the scientific community in the study of RHM technologies, unambiguous results demonstrating the effectiveness of such developments in clinical practice have not been presented.

The aim of the study consisted in assessing the long-term effectiveness of the drug in the treatment of chronic disease based on Markov modeling (on the example of the use of roflumilast in the treatment of chronic obstructive pulmonary disease).Materials and methods. The data on the dependence of exacerbations on the stage of COPD from the ECLIPSE study (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) were used as materials for the study. The simulation was carried out using MO Excel software based on the Markov model. The input data were 1 000 patients with COPD II stage. The time horizon was 10 years. The Markov cycle was 1 year. Additional patients were not included in the model and did not drop out during the simulation.Results. The number of patients with stage IV for the last modeling cycle (10 years) will be 265 patients with the addition of roflumilast to COPD, then without roflumilast, this figure will be 296 patients. The addition of roflumilast to COPD therapy slows the transition to stage IV COPD by 10.5 % for 10 years.The conclusion. The Markov model of the transition of patients suffering from COPD through stages of the disease characterizes the course of the disease on the time horizon at 10 years. Of the model group of 1000 patients (suffering from stage II COPD), only 48.4 % of patients remain in this stage at the end of the simulation. On the last cycle of the modeling time horizon, in stage III there are 22.1% of the initial cohort of patients, in stage IV — 29.6 %. ttese data reflect actual clinical practice. When modeling using the frequencies of transitions between states obtained during studies in which the efficacy of adding roflumilast, inhibitor of PDE-4 to treatment regimens was studied, modeling slowed down the progression of the disease.

Objective. To estimate the value of measuring plasma eosinophilic cationic protein (ECP) levels in patients with chronic obstructive pulmonary disease (COPD) as a potential biomarker for determining the activity of eosinophilic inflammation. To compare it to determining the number of blood eosinophils and predicting the severity of COPD by determining such clinical characteristics as respiratory function, exacerbation frequency and the BODE index.Materials and methods. Based on the protocol, 161 patients with COPD participated in the study. They made 2 visits for the collection of anamnestic data and the performance of the main study procedures: respiratory function test, 6-minute step test, dyspnea assessment according to the Medical Research Council Scale questionnaire and sputum and blood analysis in order to determine the level of eosinophils and ECP. The second visit was conducted 12 months after the first to assess the dynamics of the disease. We paid particular attention to the presence of allergies in the case history, the frequency of exacerbations, the number of courses of treatment with antibacterial drugs and inhalants, and systemic glucocorticoids.Results. The study has demonstrated that high plasma levels of ECP in patients with COPD are associated with a more severe course of disease and the development of more frequent infection-related exacerbations of the disease, which require the administration of inhaled glucocorticoids and antibiotics. We have demonstrated an inverse relationship between the ECP level and forced expiratory volume in 1 second (FEV1). This allows the use of this indicator as a predictor of the severity of COPD in patients.Conclusion. According to the obtained data, measuring the ECP level of blood plasma can be recommended for use as a clinical marker in the prognosis of COPD and selection of personalized therapy. It is a noninvasive and a relatively easily accomplished research method.

Цель: Проанализировать состав микробиома мокроты и тяжесть нарушения бронхиальной проходимости в период обострения у возрастных пациентов с различными клиническими фенотипами хронической обструктивной болезни легких (ХОБЛ). Методы: Ретроспективный анализ 86 историй болезни пациентов старше 60 лет, каждый из которых имел в анамнезе ХОБЛ не менее 5 лет и был госпитализирован по поводу очередного обострения ХОБЛ. В зависимости от клинического фенотипа пациенты разделены на 2 группы: с редкими (n = 56) и частыми (n = 30) обострениями. Каждому пациенту проводились спирометрия и бактериологическое исследование мокроты. Использовался точный метод Фишера и другие методы статистики. Результаты: В группе с редкими обострениями показатель ОФВ1 > 60 % выявлен у 18 больных из 56, что значимо больше (p < 0,05), чем в группе с частыми обострениями - 3 человека из 30. В группе с частыми обострениями чаще (15 из 30) выявлялось одновременное снижение ОФВ1 ниже 50 % и ФЖЕЛ ниже 50 %, чем в группе с редкими обострениями (13 из 56, p < 0,05). Разнообразные представители фирмикутов (44,3 % [95 % ДИ 37,1-51,5 %]), протеобактерий (25,9 % [95 % ДИ 19,6-32,2 %]), актинобактерий (2,7 % [95 % ДИ 0,9-5,5 %]), а также грибы рода кандида (27 % [95 % ДИ 20,6-33.4 %]) были обнаружены в мокроте в обеих группах. Потенциально опасные микроорганизмы преобладали в 26 случаях. Высевались клебсиелла пневмонии, синегнойная палочка, золотистый стафилококк, моракселлы, ацинето и энтеробактеры. Случаев выявления пневмококка и гемофильной палочки не зарегистрировано. Представители родов Ацинетобактеров и Моракселл, принадлежащие к одному семейству моракселловых, встречались в группе пациентов с частыми обострениями 6 раз из 64 (9,4 % [95 % ДИ 5,6-21,7 %]) против 2 раз из 121 в группе пациентов с редкими обострениями (1,7 % [95 % ДИ 0,2-4,8 %] p < 0,05). Выводы: 1) Фенотип ХОБЛ с частыми обострениями у пожилых пациентов отличается большей тяжестью нарушений бронхиальной проходимости; 2) в микробиоме мокроты пожилых пациентов с различными фенотипами ХОБЛ представлены три типа бактерий: фирмикуты, протеобактерии и актинобактерии, а также грибы рода кандида; 3) у пожилых пациентов с частыми обострениями ХОБЛ наблюдается смещение соотношений типов микроорганизмов в микробиоме мокроты в сторону протеобактерий в основном за счет увеличения представителей семейства моракселловых.

The Moscow Lung Cancer Screening Project was launched inMoscowin 2017 aimed at selective screening for lung malignant neoplasms using low-dose computed tomography (LDCT) in outpatient settings.The objective of the study: to assess the prevalence of lung cancer predictors, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), detected by selective screening for lung cancer by LDCT inMoscow.Subjects and methods. A retrospective study included randomly selected LDCT examinations performed as a part of the Moscow Lung Cancer Screening Program. When re-viewing images and protocols, abnormalities such as foci in the lungs, emphysema, coronary calcium were taken into account.Results. When assessing the prevalence and nature of random findings revealed by screening with LDCT, the following pathologies were found to be the most frequently detected (% of the number of individuals with random findings): coronary artery calcification - 49.3%, thickening of the walls of the bronchi - 34.9%, bronchiectasis - 34.9%, and pulmonary emphysema - 21.6%. In most cases, these findings may have high clinical and/or prognostic significance.Screening for COPD and coronary heart disease will significantly improve the cost-effectiveness and diagnostic value of ongoing ultra-low-dose lung cancer screening.

The purpose of the study. The aim of this work is to assess the socio – economic and general humanitarian significance of chronic obstructive pulmonary disease (COPD). Results. The study covered the socio-economic assessment of the global burden of COPD. This article shows that the degree of differences in the prevalence, morbidity and mortality due to COPD varies significantly depending on the geographical location, and a number of other factors, including socio-economic. The correct formulation of the concept of COPD, the use of common diagnostic criteria, a standardized approach to research are important conditions in assessing the level of socio-economic burden on society, patients and their families caused by this disease. Conclusion. The results of the study allow the conclusion that COPD is not only a medical but also socio-economic and humanitarian problem of modern society.

Actuality. Modern medicine shows a sharp growth of patients with comorbid and concurrent chronic diseases, involving not only the mature and older persons but also the young people. Combined diseases of the circulatory and respiratory systems are the main cause of death, disability of the population and major labor losses. The aim of this work was to study the vaccine prophylaxis effectiveness for chronic obstructive pulmonary disease (COPD) patients having the different Charlson comorbidity index. Material and methods: This study covered 174 patients with COPD and IHD. All patients were subject to the complex clinical research, including the medical assessment, patient complaints, medical history, physical and instrumental examinations and pathology tests Assessment of respiratory function and general Body plethysmography were performed Degree of dyspnea was assessed using a scale provided by Medical Research Center. Number of COPD exacerbations, hospitalizations and pneumonia development cases were analyzed. Modified Charlson comorbidity index was calculated for all patients Results and conclusions: Among the patients with comorbidity the severe manifestations of chronic obstructive pulmonary disease correspond to the more pronounced functional classes of angina pectoris. With the comorbidity index growth the number of exacerbations, hospitalizations and pneumonia cases were increasing. Vaccine prophylaxis is the most effective for the patients having the lower comorbidity indices and shows a tendency to stabilize these indicators for the patients having the moderate & high levels of comorbidity, and therefore, are to be recommended for all COPD and CVD patients. Changes in clinical and functional parameters of respiratory function for COPD patients are statistical-significantly different for the patients having the low and high levels of comorbidity.

The article presents the results of vaccination against diphtheria, tetanus and hepatitis B virus with the use of combined vaccine Bubo-M or a monovalent vaccine Hepatitis B in 120 patients with severe and medium chronic obstructive pulmonary disease (COPD) and 77 healthy people at the age 35 - 60 years. The lack of protective antibodies to diphtheria in patients with COPD was noted. The safety of immunization and the delayed production of post-vaccination antibodies to these infections were shown. The level of post-vaccination antibodies was the same as in healthy group after the administration of 3-rd dose both of the monovaccine and the combined one. During the year a clinical effect in reducing the number of exacerbations of the disease after a triple injection of the combined Bubo-M vaccine in patients with COPD was observed, comparable to that in patients with the combined use of the immunomodulator and hepatitis B vaccine. Moreover combined vaccination with immunomodulator led to normalization of level of the inflammatory mediators. Conclusion: Vaccination of patients with COPD with the use of the combined vaccine Bubo-M has both an advantages in clinical effect and the spectrum of anti-infection protection in comparison with the monovaccine against hepatitis

Background. Nowadays little data related to the hemostatic system and fibrinolysis in patients with chronic obstructive pulmonary disease (COPD) are available. This is due to the lack of standardized methods for studying the hemostasis system, as well as to the lack of a single functional test that allows the evaluation of the complete fibrinogenesis cycle in whole blood.Aim. The aim of our study was to develop a functional test capable of analyzing the blood gas composition in the “point-of-care test” method for the evaluation of the hemostatic potential in patients with COPD, based on a standardized test stimulus, which is tissue hypoxia. The current level of clinical and laboratory diagnostics requires personification and research of the hemo-coagulation system in real time (point-of-care test), which allows low-frequency piezotromboelastography(NVTEG) to be performed.Materials and methods. NVTEG was chosen to estimate the state of the hemocoagulation system. Ten patients with COPD and 10 healthy volunteers were examined. Hypoxia was selected as a standardized test stimulus. Hypoxia conditions were caused by smoking one standard cigarette (composition: resin 10 mg/cig., nicotine 0,7 mg/cig., CO 10 mg/cig.). The degree of tissue hypoxia was assessed with the GASTAT-navi blood gas analyzer.Results. The study has shown that in response to the standard test stimulus, which is the tissue hypoxia caused by smoking of a standardized cigarette, two types of haemostatic potential reaction were detected both in patients with COPD and healthy volunteers. The first type of reaction – “hypercoagulation” – is characterized by the formation of chronometric and structural hypercoagulation at all stages of fibrinogenesis and increased coagulation activity by 25–30% compared with the response in healthy individuals. The second type of reaction – “hypocoagulation” – is characterized by the formation of chronometric and structural hypocoagulation, a decrease in coagulation activity by 25–30% compared with the response in healthy individuals.Conclusion. Test stimulus, which acts as tissue hypoxia, causes a uniform spectrum of changes in the blood gas composition and hemocoagulation system in both healthy volunteers and patients with COPD. The possibility of online assessment of all stages of fibrinogenesis makes it possible to stratify patients with COPD by type of reaction, which is certain to have an important diagnostic and prognostic value and in the future will allow a more personified approach for choosing the treatment tactics.

The use of noninvasive ventilation (NIV) of lungs during the last two decades significantly improved the results of management of severe COPD patients with acute or chronic respiratory failure during both periods of exacerbation and stability. At present, NIV is considered to be the first-line therapy for acute exacerbation of COPD with hypercapnia and respiratory acidosis. This method of airway support turned out to be effective in patients after extubation both for the relief of excommunication from a respirator and for prophylaxis and treatment of postextubation respiratory failure. NIV was proven to be successful in patients with a combination of COPD and obstructive sleep apnea (overlap syndrome), in COPD with pneumonia and in postoperative COPD patients who have undergone lung resectional surgery. The efficacy of NIV under intensive care and intensive therapy unit conditions has stimulated the interest to the use of mask ventilation in hospitals and out-patient departments (for a prolonged domestic therapy). This article presents a review of NIV use in patients with COPD during both periods of exacerbation and stability.

Background. According to the World Health Organization, chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in the world. COPD with frequent exacerbations is a most challenging variant of the disease. Currently it is not clear how respiratory microbiota can modify the immune response in this disease.Aim. To establish the role of bacterial oligonucleotides in modification of the immune response in patients with COPD.Materials and мethods. In accordance with the protocol of the study, 10 patients with stable COPD with frequent exacerbations and 10 patients without frequent exacerbations were included. Immature dendritic cells were obtained by culturing the monocyte fraction of the peripheral blood of patients with COPD. The cells were stimulated by addition of bacterial lipopolysaccharide and small oligodeoxynucleotides (CpG-ODN) of A or B classes. Then the immunophenotypical profile of the obtained cells was determined by flow-cytometry with the use of monoclonal antibodies to antigens CD40, CD83, CD86. To determine the antigen-presenting properties, these dendritic cells were cultivated with CD4+, and then the phenotypic profile of the obtained T-lymphocytes was evaluated by using antibodies to CD4, CD25, CD127, and CD45RO.Results. Cultivation of stimulated dendritic cells by СpG-ODN of A class with T-cells in COPD patients without exacerbations leads to an increase of the amount of lymphocytes of CD25+CD45RO phenotype (15% increase after stimulation), in contrast to the group of patients with frequent exacerbations of COPD (p = 0,018). It may indicate inadequate control of persistent inflammation, mediated by CD25+CD45RO pool of cells in the group of COPD patients with frequent exacerbations.Conclusion. This study demonstrated the presence of discoordination of the immune response of a bidirectional nature in patients with COPD with frequent and infrequent exacerbations.

Goal of study: to assess the Charlson comorbidity index in those suffering from chronic obstructive pulmonary disease (COPD).Materials and methods. 207 patients suffering from COPD smoking for a long period of time (the smoker index of 240 and time of smoking of 40 packs/years were enrolled into the study. SCORE risk charts were used for evaluation of cardiovascular risk. The respiratory function was evaluated by the multi-module unit of MasterLab/Jaeger type. Charlson comorbidity index was used to assess comorbidity.Results. Charlson comorbidity index made 4.49 ± 1.50 scores in the studied group, those with very high cardiovascular risk made 68.9%. The confident correlation has been found out between total cardiovascular risk and Charlson comorbidity index. Direct moderate correlation has been found out between comorbidity index and rates of packs/years. Confident correlations have been found between comorbidity index and VC (r = -0.39, p

The goal of study: to investigate CAT-test in those suffering from chronic obstructive pulmonary disease (COPD).Subjects and Methods. 53 COPD patients were examined. The studied group included COPD patients with the long history of smoking. The respiratory function was evaluated by the multi-module unit of MasterLab/Jaeger type. The patients were requested to fill in the Beck Depression Inventory. CAT test was used to evaluate the general condition.Results. As the stages of COPD progressed, the number of CAT scores increased: in the patients with stage 2 of COPD it made 21.30 ± 7.34 and with stage 4 CAT scores made 26.7 ± 10.2. The level of depression was increasing with higher severity of COPD: the maximum number of scores of the Beck Depression Inventory was observed in COPD patients with stage 4 and it made 19.62 ± 11.2, and it was the lowest in COPD patients, stage 2 - 10.68 ± 8.41 The direct moderate association was observed between CAT and the level of depression (r = 0.53, p < 0.05). No true correlation was found between CAT and FEV1 (p > 0.05).

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The goal of the study: to define theoretic correlation between BODE index in men with chronic obstructive pulmonary disease (COPD) and risk of osteoporotic fractures assessed as per bone mineral density and FRAX integral rate.Materials and methods. 125 men suffering from COPD smoking for a long period of time (the smoker index of 240 and time of smoking (packs/years) of 40) were included into the study. 10 year risk of osteoporotic fractures was assessed by FRAX software. The respiratory function was evaluated by the multi-module unit of MasterLab/Jaeger type. BODE index was defined in the patients.Results. The minimum level of BODE was observed in those suffering from COPD of the 2nd stage – 2.23 ± 0.88. In case of the 3rd stage of COPD BODE made 5.05 ± 1.19, in the 4th stage of COPD it made 7.0 ± 1.0. The maximum risk of fractures was detected in the patients of the 4th stage of COPD. The minimum risk of fractures was diagnosed in the patients of the 2nd stage of COPD. The confident correlations were found between BODE and bone mineral density (r = -0.71, p

Aim. To evaluate effects of broncholytic therapy on ventricular rhythm disorders and high resolution electrocardiogram indices in patients with chronic obstructive pulmonary disease (COPD).Material and methods. 144 patients (54 women and 90 men; aged 47,1±1,5 y.o.) with COPD and 35 patients of control group without respiratory and cardiovascular diseases (23 men and 12 women; aged 42,4±2,8 y.o.) were examined. 24-hour ECG monitoring and high resolution ECG with time and spectral-time mapping of ventricular ECG complex were performed in patients additionally to routine examination.Results. Reduction of ventricular rhythm disorders rate was detected during therapy with extended-release theophylline or salmeterol/fluticasone in patients with moderate and severe COPD. This effect was more significant for salmeterol/fluticasone treatment. Treatment with extended-release theophylline led to increase of a number of ventricular extra systoles in patients with severe COPD. Salmeterol/fluticasone treatment did not influence number of ventricular extrasystoles. Broncholytic therapy had positive influence on processes of ventricular depolarization. It was shown by high resolution ECG indicators improvement and by late ventricular potential rate reduction.Conclusion. Salmeterol/fluticasone combination is more reasonable than extended-release theophylline for broncholytic therapy in patients with severe COPD and ventricular rhythm disorders.

Ответ иммунной системы на вакцину против гриппа зависит от многих факторов. Среди них: возраст человека, наличие сопутствующих заболеваний, состояние коллективного иммунитета и история предшествующих заражений вирусом. Оценка эффективности и продолжительности действия вакцины важна для разработки программ профилактических мероприятий в начале сезона обострений респираторных заболеваний. Исследователи из Научно-исследовательского центра ВМС США в Сан-Диего (Naval Health Research Center in San Diego, CA) провели изучение эффективности вакцины в течение полугода после вакцинации. О результатах работы они сделали доклад на международной конференции по новым и инфекционным заболеваниям в Атланте (Джорджия).

По оценкам ВОЗ, хроническими обструктивными болезнями легких в умеренной и тяжелой форме страдают 65 млн человек, на их долю приходится 5% от всех смертей в мире. Согласно прогнозам, в следующие 10 лет ситуация будет стремительно ухудшаться, если не будут предприняты срочные шаги для ослабления действия факторов риска и обеспечения пациентов адекватной терапией. О состоянии с респираторной заболеваемостью в РФ, перспективах и успехах терапии рассказывает д.м.н., профессор кафедры пульмонологии РНИМУ им. Н.И. Пирогова, главный пульмонолог Департамента здравоохранения г. Москвы Андрей Станиславович Белевский.

The purpose is to identify the leptin and adiponectin content in blood regarding their receptor expression in the soft tissue of the hip in case of chronic obstructive pulmonary disease with the signs of osteporosis.80 COPD patients and 76 healthy persons were examined. Receptor expression to leptin and adiponectin in the vessels was tested by immune-fluorescent technique in 30 patients.Control leptin and adiponectin expression was presented in skin, subcutaneous fat and cross-striped muscles. In case of COPD leptin and adiponectin expression was identified in skin and subcutaneous fat. In control cases and COPD leptin expression was identified in endothelium and myocytes achieving confident reduction at stages II and III. Adiponectin expression in control cases and in stage I was detection only in adventitia. In stages II and III stages adiponectin is expressed in myocytes and endothelium. Receptor expression to leptin and adiponectin repeats their content in blood. The correlations between leptin and adiponectin and their expression with body mass index and mineral bone density have been found out.The detected changes confirm the contribution of adiponectin to re-modeling of muscle and bone tissue in case of COPD.

The purpose of the study – to examine the capabilities of the method of digital chest fluorography in diagnosis of chronic obstructive pulmonary disease (COPD) of different stages. By chest digital fluorography 247 patients with clinically diagnosed COPD stage I–III were examined. The average age of the patients was (55.3  1.7) years (16 to 88 years), forced expiration volume for the first second (FEV1) was (59.17  16.28) %. It was shown that for patients with COPD stage I most characteristic radiographic symptom was emphysema of the lung in the upper regions (26 (48%) of 54 patients); the mean values of the inspiratory lung optical density (ILOD) ranged from (703.48  2.15) to (807.47  5.61) optical density units (ODU), the expiratory lung optical density (ELOD) – from (786.05  6.15) to (830.23  4.71) ODU. For patients with COPD stage II the most common radiographic sign was the presence of amplification and deformation pulmonary pattern (95 (89%) of 107 patients); the mean values of ILOD ranged from (646.20  4.94) to (791.38  2.81) ODU, ELOD – from (677.34  9.91) to (813.91  3.29) ODU. Patients with COPD stage III were characterized by a combination of amplification and deformation pulmonary pattern (77 (90%) of 86 patients) with lung emphysema (51 (59%) of 86 patients); the mean values of the inspiratory lung optical density ranged from (765.93  16.4) to (863.37  15.83) ODU, expiratory lung optical density – from (826.80  11.64) to (881.37  4.29) ODU. Thus, we concluded that the method of digital chest fluorography, possessing low dose burden to the patient, can detect the characteristic radiological symptoms and determine the stage of the disease up to the values of the lung optical density in patients with COPD.

12-13 марта 2014 г. под патронатом Правительства и Департамента здравоохранения г. Москвы в рамках направления «Внедрение новых медицинских технологий, методик лечения и профилактики заболеваний в практическое здравоохранение г. Москвы и Московского региона» состоялась VI научно-практическая конференция «Актуальные вопросы респираторной медицины». Целью мероприятия явилось информирование врачей о новых эффективных методах профилактики, диагностики и лечения заболеваний дыхательной системы, современных медицинских технологиях. Также в ходе работы конференции обсуждались вопросы внедрения в повседневную клиническую и амбулаторно-поликлиническую практику новых федеральных клинических рекомендаций по лечению хронических респираторных заболеваний. По итогам конференции на вопросы редакции журнала «Медицинский совет» ответил председатель симпозиумов конференции, главный внештатный специалист-пульмонолог Департамента здравоохранения г. Москвы, д.м.н., профессор кафедры пульмонологии ФУВ «РНИМУ им. Н.И. Пирогова» Андрей Станиславович БЕЛЕВСКИЙ.

Хроническая обструктивная болезнь легких (ХОБЛ) по-прежнему остается серьезной проблемой для отечественного и мирового здравоохранения из-за широкой распространенности, сокращения продолжительности и качества жизни, значительного экономического ущерба, который возникает из-за временной и постоянной утраты трудоспособности самой активной части населения. По прогнозам Всемирной организации здравоохранения, к 2030 г. ХОБЛ может стать третьей по значимости во всем мире причиной смерти. На вопросы о современном состоянии проблемы, портрете сегодняшнего пациента с ХОБЛ и о нюансах терапии отвечает заслуженный деятель науки РФ, заведующий отделом дифференциальной диагностики Центрального НИИ туберкулеза РАМН г. Москвы, д.м.н., профессор Евгений Иванович Шмелев.

One of the most common systemic defects in patients with chronic obstructive pulmonary disease is skeletal and respiratory muscle dysfunction. Physical exercise in the therapy of such patients therefore plays an important role. The Institute of Pulmonology of the Russian FMBA has developed a system of special physical exercises to decrease dysfunction of respiratory and skeletal muscles and affect the hyperinflation of the lungs. The physical program includes strength exercises for upper and lower skeletal muscles, breathing exercises, training of the respiratory muscles using simulators and high-frequency chest wall oscillation.

It often happens in clinical practice that patient with chronic obstructive pulmonary disease (COPD) is diagnosed both with arterial hypertension (AH) and chronic heart failure (CHF). The effect of antioxidant drug Mexidol on the quality of life and the degree of bronchial obstruction syndrome (BOS) in these patients was evaluated.

Aim of the study – to enhance the diagnostic and treatment tactics of stable COPD patients management at outpatient stage by studying the serum AAT. Data of 45 outpatients with COPD (GOLD I-IV) and 20 healthy persons were included into analysis. Sex, age, height, weight, body mass index (BMI), smoking status were assessed. Lung function and serum AAT were measured. These results suggest that sex, age, height, weight, BMI do not influence on serum AAT both in stable COPD patients and healthy persons. Serum AAT statistically significant negatively correlate with airways obstruction degree in stable COPD patients. Significant moderate negative correlation between serum AAT and number of exacerbation during last year was found in stable COPD patients. This finding allows to suggest that serum AAT could be used as an indicator for COPD prognosis. [ABSTRACT FROM AUTHOR]

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The article summarizes the results of studies on the composition of microbial communities in stool samples of patients with chronic obstructive pulmonary disease (COPD) compared with healthy volunteers using genome-metagenomic sequencing. It is shown that the microbial community of the intestine in COPD patients is characterized as diverse taxonomic composition of metagenomes that the healthy volunteers microbiota. In this case, the normal composition of intestinal microbiota in patients with COPD is exposed to the qualitative and quantitative modifications. In contrast to healthy volunteers, the intestinal microbiota in patients with COPD is characterized by the presence of representatives of the Proteobacteria, as Citrobacter, Enterobacter, Eggerthella,Proteus, Salmonella, Anaerococcus, Clostridium difficile, Pseudomonas, as well as higher insemination fungus genusCandida (Candida dubliniensis and Candida albicans).

The article presents the study of early sings of dysfunction of right and left chambers of heart in patients with COPD 2 - 3 severity, correlation between structural and electrical remodeling of heart according to the stages of pulmonary hypertension. Standard tissue Doppler echocardiographic parameters and modes were used for the diagnosing. We examined 35 patients with COPD 2 - 3 severity; the control group consisted of 15 patients. The ECG Holter monitoring was made for all patients to identify cardiac rhythm disturbance and correlation with the COPD severity. Standard method of the ECG with modes of tissue Doppler (pulsed wave Tissue Doppler Imaging - PW TDI, color tissue Doppler imaging -TDI, tissue myocardial Doppler - TMD, tissue Tracking - TT, Doppler for evaluation of myocardial strain and myocardial strain rate) were made to identify the stage of dysfunction. The results of the study concluded that according to the TDI the dysfunction of right ventricle was more apparent in patients with COPD 3 severity. Pathological arrhythmias were significantly detected in group of patients with COPD 3 severity. In compliance with our observations, the reduce of rapid myocardial strain rates and its inverse proportion with the severity in accordance to the evaluation of longitudinal strain and rate of movement of fibrous ring in tricuspid valve were observed in patients with COPD. Thus the application of the TDI modes for evaluating of early signs of cardiac remodeling in patients with COPD and potential adequate jugulation for preventing chronic cor pulmonale is expedient.

Spontaneous pneumothorax was treated by placing two endobronchial valves during rigid bronchoscopy under anesthesia in a patient with severe end-stage chronic obstructive pulmonary disease (an emphysematous phenotype) and overall paraseptal emphysema in the presence of grade III respiratory failure, with complicated spontaneous pneumothorax recurring manifold even after surgical treatment for spontaneous pneumothorax. This gave rise to the expansion of the lung that had collapsed within 18 months, to healing of bronchopleural fistula, and to return to normal life.The duration of a follow-up was 1 year with the valves being present in the bronchi and another year after their removal; there was no recurrence of spontaneous pneumothorax. Examination of respiratory function established significant positive changes (forced expiratory volume, vital capacity, and forced vital capacity after one year, then after removal of endobronchial valves). There were more significant positive changes in blood gas composition: normalization of blood oxygen saturation was achieved.

The prevalence of respiratory diseases was analyzed in the Republic of Sakha (Yakutia). A cross-sectional clinical and instrumental study of 2856 dwellers from the town of Yakutsk and the village of Churapcha showed that the proportion of chronic obstructive pulmonary diseases (COPD) was 14.1 and 20.5% in the town and in the village, respectively. One of its chief causes is a considerable spread of tobacco smoking among the urban and rural dwellers of Yakutia. The incidence of COPD among the males aged over 60 years was higher than that in the women; that was almost 2-fold in the rural area; and the male-to-female ratio was nearly equal in the urban area. According to our data, the urban and rural rates of catarrhal diseases were 54.5 and 43.9%, respectively; which was also due to severe climatic conditions and one of the risk factors for COPD.

Актуальность. В основе патологического процесса в бронхолегочной системе лежит дисбаланс в системе цитокинового профиля. Показано, что у пациентов с ХОБЛ провоспалительные цитокины усиливают воспалительный процесс. Развитие хронического воспалительного процесса в легочной паренхиме приводит к нарушениям баланса цитокинов не только в зоне повреждения, но и в общем кровотоке, приводя к развитию системных эффектов.

The aim of comparative research was the estimation of alarm and depression dynamics at patients with stable chronic obstructive pulmonary disease under influence of tiotropium treatment on HADS questionnaire. Are surveyed 30 patients who were not receiving supporting therapy and 27 patients, using a fluticasone/salmeterol combination. After 3 months of tiotropium treatment the level of alarm and depression decreased in both groups.

Health subjects (n = 15), patients with bronchial asthma (n = 30), COPD (n = 16), and community-acquired pneumonia (n = 17) have been inspected in the mixed group (40 men, 38 women, 15-64 years old). The results of research of breathing patterns with interruption of air stream have been used to construct Raw, FEV1, FEV1% and FEV1/FVC% mathematical models. High diagnostic importance of FEV1% and FEV1/FVC% models in prediction of bronchial permeability disturbance has been shown.

The article is devoted to the peculiarities of cytokines (IL) affects on the kinetics of rosella formed lymphocytes (RFL) in 38 patients with chronic obstructive pulmonary disease (COPD). It is established that proinflammatory IL has depressiveу affect on rosella formed capacity of lymphocytes and promotes the development of immunodeficient condition.

In 70 patients with COPD studied mechanisms of oxidative stress on the changes in oxidant-antioxidant status of erythrocytes. Found that the intensity of oxidative stress in red blood cells is directly dependent on the severity of the disease. Maximum activity of antioxidant enzymes found in patients with secondary erythrocytosis with stage II disease. In patients with stage III COPD, oxidative stress was significantly expressed and is associated with a sharp fall in activity of antioxidant systems.

Метод, разработанный Швейцарским институтом тропиков и общественного здоровья в Базеле, называется TAM-ТБ и является анализом крови, не требующим сбора мокроты. Диагноз основан на иммунологическом феномене, наблюдаемом при туберкулезе, когда во время активной формы инфекции специфичные к микобактериям CD4 Т-лимфоциты утрачивают специфичный поверхностный маркер (CD27). Результат анализа готов в течение 24 ч.