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Introduction. One of their main aspects in the treatment of patients with bronchial asthma is maintaining adequate control over the course of the disease.The aim: to assess the level of control, the causes of the uncontrolled course of the disease and the quality of life in patients with severe bronchial asthma.Materials and methods. The study involved 160 patients with severe bronchial asthma taking basic anti-inflammatory therapy. The assessment of adherence to baseline therapy was assessed by questionnaires of patients with a modified Morisky-Green questionnaire and a test to assess adherence to inhalers (TAI). A quality of life questionnaire for patients with bronchial asthma (AQLQ) was used to assess quality of life.Results. It was revealed that all patients had reported daily symptoms and a daily need for short acting beta-agonists; 96.6% of the patients enrolled in the study had night awakenings and physical activity restriction. The survey of patients with the help of the Morisky-Green questionnaire showed that deliberate low adherence to therapy was noted in 45.6% of cases, which was formed due to inattention to the hours of medication – 67.1% and missing the drug in good health in 47.9% of patients. Low motivation and low awareness of their disease is recorded in 24.4% of patients.Conclusions. All patients did not achieve control of the disease. In half of patients with severe asthma, there is low deliberate adherence to basic anti-inflammatory therapy, which is formed mainly by missing the drug in good health and inattention to the hours of medication. Asthma symptoms have the greatest impact on the patient’s emotional state, physical activity, and overall quality of life.

This article presents a case of the successful use of dupilumab in a 21-year-old patient with severe atopic dermatitis, concomitant bronchial asthma, and allergic rhinitis. The patient was observed in the allergological department of the Krasnoyarsk Clinical Regional Hospital for 2 years. The disease was characterized by constant skin symptoms, frequent exacerbations, resistance to standard therapy, including systemic glucocorticosteroids and immunosuppressors. Considering the above factors, targeted therapy was started with dupilumab, registered in the Russian Federation for use in atopic dermatitis resistant to standard therapy. Against the background of biological therapy (13 injections were carried out), a stable significant decrease in skin syndrome activity was achieved (SCORAD index decreased from 72 to 9 points), and the patients quality of life significantly improved.

The article presents a case of granulomatosis with polyangiitis, which is difficult for clinical diagnosis. Recently, the incidence of systemic vasculitis has increased, and given the similarity of clinical symptoms with other pathologies, a doctor of any specialty should carry out differential diagnosis. Granulomatosis with polyangiitis is characterized mainly by damage to the upper respiratory tract, lungs, and kidneys. The main method for diagnosing granulomatosis with polyangiitis is biopsy with histological examination, which allows to detect inflammation in the affected tissues. A feature of granulomatosis with polyangiitis is detection of antineutrophil cytoplasmic antibodies in the blood serum. However, these antibodies are recorded only in 80% of patients and are not detected in the remission phase, which makes diagnosis much more difficult.

The review provides data on one of the phenotypes of severe bronchial asthma it is asthma with fixed airway obstruction. According to data published today, there is no single pathway for the formation of fixed airway obstruction in patients with severe asthma. Increasing knowledge of the pathophysiology of fixed airway obstruction, as well as identifying the most significant risk factors, is essential for the successful treatment of such patients. In addition, the development of fixed obstruction is associated with a worse and sometimes fatal prognosis. Expanding the existing views is also necessary to overcome the difficulties of differential diagnosis between bronchial asthma with fixed airway obstruction and bronchial asthma in combination with COPD. All this will optimize the approach to the management of patients with bronchial asthma to prevent the formation of fixed airway obstruction.В обзоре приведены данные по одному из фенотипов тяжелой бронхиальной астмы (БА) астме с фиксированной обструкцией дыхательных путей (ФОДП). По опубликованным сегодня данным, не существует одного пути формирования ФОДП у пациентов с тяжелой БА. Углубление знаний о патофизиологии ФОДП, а также выявление наиболее значимых факторов риска необходимы для успешного лечения таких пациентов. Кроме того, развитие фиксированной обструкции ассоциировано с худшим, а порой и фатальным прогнозом. Расширение имеющихся представлений необходимо также для преодоления трудностей дифференциальной диагностики между БА с ФОДП и БА в сочетании c хронической обструктивной болезнью легких. Все это позволит оптимизировать подход к ведению больных БА для предупреждения формирования ФОДП.

Nowadays, isolated angioedema is one of the most complex and urgent problems of modern allergology and immunology. Hereditary angioedema (HA) refers to orphan and life-threatening diseases associated with a deficiency or decrease in C1-inhibitor function and is characterized by recurrent edema in deep dermis of various localization. A doctor of any specialty can encounter this nosology, which obliges all medical officers to have a general overview concerning HA. Late diagnosis is fraught with unnecessary surgical interventions, psychological symptoms, opiate addiction, or life-threatening laryngeal angioedema. To date, the final diagnosis of HA, and, consequently, adequate drug therapy, is delayed by an average of 8.5 years from disease onset. Sudden edema in the vital organs is a source of constant anxiety, a cause of disability, and sometimes fatal outcomes. The article presents a clinical case and discusses therapy principles, existing possibilities of promising treatment and recommendations for further management. KEYWORDS: hereditary angioedema, recurrent edema, orphan diseases, bradykinin; C1-inhibitor; complement system. FOR CITATION: Sobko E.A., Demko I.V., Solovieva I.A. et al. Complex clinical case: hereditary angioedema. Russian Medical Inquiry. 2021;5(1):50–53. DOI: 10.32364/2587-6821-2021-5-1-50-53.

Chronic obstructive pulmonary disease (COPD) is a global problem in modern medicine. In recent years, the medical community’s understanding of COPD has changed significantly, which is primarily due to the emergence of a new classification and the identification of various phenotypes of the disease. These changes could not affect the tactics of COPD treatment. The article discusses not only the debatable issues of treating COPD; it provides an overview of changes in international (Global Initiative for Chronic Obstructive Lung Disease, 2018) and national (2019) recommendations, but also the significance and benefits of triple therapy in terms of evidence-based medicine as well as the benefits of extra-fine drugs in the treatment of bronchial obstructive syndrome.

Goal: To determine the relationship of cathepsin S level with clinical and functional indicators in patients with severe bronchial asthma. Materials and methods: 109 patients with severe bronchial asthma of women were examined - 84 (77.1%), men - 35 (22.9%), which were divided into 2 groups: 84 people with allergic severe bronchial asthma and 25 with non-allergic severe bronchial asthma. Study of external respiration function was done with whole-body plethysmography ("Erich Eger”, Germany). The concentration of cytokines IL-4, IL-5, IL-13, periostine, cathepsin S, TGF-β in blood plasma was determined with ELISA (eBioscience, USA). Results: Patients with severe bronchial asthma are characterized by an uncontrolled course of the disease. In both allergic and non-allergic severe bronchial asthma, fixed obstruction is recorded in 64% and 68% of cases, respectively. Peripheral blood eosinophilia occurs in 28.5% of cases with allergic and in 16% of cases with non-allergic severe bronchial asthma. In both groups there is an increase in the plasma content of IL-4, IL-13, periostin, TGF-β and cathepsin S. Cathepsin S is in positive correlation with clinical symptoms of the disease and concentration of IL-4, IL-5, IL-13 in allergic severe bronchial asthma. A positive correlation was established between the level of cathepsin S and TGF-β in both groups. Conclusion: The revealed positive correlation between cathepsin S and TGF-β levels may indirectly indicate cathepsin S involvement in airway remodeling processes.

The aim of the research was to study the characteristics of apoptosis, membrane-released microparticles (MRM) formation and cytokines production in case of lymphocyte damage in young patients with bronchial asthma, depending on body mass index. 224 people were examined. In all the patients there was done an assessment of the excessive weight and determination of obesity degree as well as clinical and functional examination; there was performed a determination of cytokines and adipokines; the lymphocytes were separated from the peripheral blood. The number of apoptotic cells was estimated in accordance with the standard protocol; the number of MRM was counted. It was found out that in case of bronchial asthma and obesity syntropy, even at a young age, more often there are patients with moderate and severe clinical course; besides, the severity of bronchial-obstructive syndrome in patients of this group is more significant with the tendency to decrease in FEV1 and FEV1/FVC. In the group of young patients with obesity combined with bronchial asthma in the peripheral blood there was imbalance of both adipokines and cytokines, characterized by evident increase in the levels of pro-inflammatory leptin, IL-4, IL-6, TNF-α, and the decrease in potential body weight regulator IL-15, and at the same time low levels of anti-inflammatory adiponectin. In patients with obesity, the percentage of cells in apoptosis was significantly lower compared to both those in control with obesity and patients with normal body weight. The number of MRM, as cell damage indicator, significantly increased in the group with obesity. It can be assumed that the imbalance of cytokines, adipokines and mechanisms of programmed cell death is a possible pathogenetic factor in asthma and obesity syntropy.

The article deals with changes in arterial rigidity in patients with bronchial asthma, depending on the presence of concomitant hypertension. The aim was to study the arterial rigidity parameters in patients with bronchial asthma depending on the presence of arterial hypertension on the standard antiinflammatory therapy for early diagnosis of complications of the cardiovascular system. A significant increase of arterial rigidity was shown, manifested by an increase in the pulse wave velocity in the aorta (AoPWV) and augmentation index (Alx) in patients with bronchial asthma of moderate and severe course in comparison with the control. In the study of the main indicators of arterial rigidity, depending on the presence or absence of hypertension, it was shown that in the group of patients with hypertension, changes in AoPWV and IA were more significant than in the group of patients with normal blood pressure. Increasing of BMI contributes to the development of arterial rigidity in patients with bronchial asthma. The formation of arterial rigidity is associated with clinical and functional parameters and hypoxemia

Research Objective: Characteristics of apoptosis, MBM formation and cytokines production in case of lymphocyte damage in young patients with bronchial asthma (BA), depending on BMI. Material and Methods: 224 people were examined. 164 patients with asthma were divided into 2 groups: BA+BMI 18-24.9 kg/m2 (1st gr), BA+BMI 30-34.9 kg/m2 (2nd gr). Control: 60 almost healthy volunteers. Studied: degree of obesity, determination of cytokines, adipokines, outflow of lymphocytes in peripheral blood. In addition, the number of apoptotic cells was estimated in accordance with the standard protocol, the number of membrane-released microparticles (MBM) was counted. Results: In the 2nd group, even at a young age, more often there are patients with moderate and severe clinical course, the severity of bronchial-obstructive syndrome is more significant with the tendency to decrease FEV1 and FEV1/FVC. In the 2nd group in the peripheral blood there was debalance of both adipokines and cytokines: increase in the levels of leptin, IL4, IL6, TNFα, and the decrease IL-15, and low levels of adiponectin. In the 2nd group the percentage of cells in apoptosis was significantly lower compared. In 2nd group the number of MBM significantly increased in comparison with the check ones with obesity, whereas in patients with bronchial asthma and normal body weight, this indicator, on the contrary, significantly decreased compared with the check ones without obesity. It can be assumed that the imbalance of cytokines, adipokines and mechanisms of programmed cell death is a possible pathogenetic factor in asthma and in asthma and obesity syntropy.

Aim: to study the effectiveness of specific prevention of pneumococcal infection in patients with chronic heart failure. Materials and Methods: Special questionnaire was developed to assess the clinical effectiveness of vaccination which included an assessment of anamnesis during the year preceding vaccination and anamnesis of the underlying disease during the year after vaccination. 832 patients with chronic heart failure were vaccinated. Patients were divided by age: 50-55, 56-60, 61-65, 66-70, 71-75, 76-80 and over 80 years old. Due to the heterogeneity of the samples, the comparative analysis was carried out by calculating the relative risk and using the student9s t-test. Results: vaccination against pneumococcus in group of patients with chronic heart failure allowed to reduce significantly the number of exacerbations of the basic disease in patients at the age of 56 to 60 years(RR=0.31(95%CI:0.10-0.92)), 66-70 and older than 76 years(p Conclusions: The results indicate a high efficiency of vaccination against pneumococcal infection in patients with chronic heart failure: in all groups a decrease in the incidence of respiratory infections, reduction in the number of exacerbations of the basic disease and hospitalizations for exacerbations was noted.

Research objective: Characteristics of endotypes of inflammation in young patients with bronchial asthma depending on the obesity phenotype. Material and Methods: 164 patients with asthma were divided into 3 groups: BMI 30-34.9 kg/m2 + thickness of epicardial fatty tissue (EFT) ≥7 mm (1st gr), BMI 30-34.9 kg/m2 + EFT Results: The eosinophilic type of inflammation was shown in the 1st and 3rd groups of patients, the paucigranulocytic biotype was more often determined among the patients of the 2nd group. The features of the cytokine status depending on the endotype and phenotype of obesity were revealed: in 1 group, there was a significant increase of the level of IL4, TNFα, IFNγ in eosinophilic inflammation and an increase of TNFα in paucigranulocytic biotype. In 2 gr the paucigranulocytic biotype showed a significant increase of IFNγ, IL17 and a decrease of IL10. Eosinophilic biotype: high of TNFα, IL2, IFNγ, IL4. Mixed-granulocytic biotype: the highest of TNFα, IFNγ, IL10 among all endotypes. Neutrophilic type: the highest of IL2, IL17, IL8. The formation of neutrophilic type of inflammation in the airways is associated with the severity of clinical symptoms of asthma, worsening of bronchial obstruction and increased resistance in the airways. The phenotype of obesity can change the biotype of inflammation in the respiratory tract, the intensity of systemic inflammation.

The aim of this work was to determine the optimal strategy for the treatment of patients with severe exacerbation of bronchial asthma based at a specialized clinic from the perspective of quality management as a basis for a universal therapeutic scheme taking account of the social status of the patient and localization of the medical facility. The study included 100 patients with bronchial asthma (BA) admitted to the Allergic Department of Regional Clinical Hospital. Those of group 1 were given systemic glucocorticosteroids (SGCS) parenterally or inhalation glucocorticosteroids (IGCS) through a metered dose inhaler. Patients of group 2 received SGCS parenterally or IGCS through a nebulizer. Examination included determination of external respiratory function, pulse oximetry, and ECG. Both modalities improved the patients’ clinical conditions within the first 4 hours, with the use of bronchodilators and IGCS through the nebulizer in combination with SGCS producing the most pronounced effect on peak expiratory flow rate. The per patient cost of medication therapy in group 1 was 131.5 rubles/day compared with 199.7 rubles in group 2. The cost of the complete treatment course was 1577.44 and 1797.78 rubles respectively. However, the number of one bed-days spent in the hospital for patients of group 2 was smaller than in group 1 which accounted for the cost of the complete treatment course 27 573.60 and 37 431.64 rubles respectively (р=0,04). It is concluded that the optimal therapeutic modality for the patients with severe exacerbation of bronchial asthma includes the use of bronchodilators and IGCS through a nebulizer in combination with SGCS. It not only improves clinical and functional characteristics of the patients but also reduces their hospital stay and the total cost of the treatment.

The problem of modern medicine is to optimize the treatment of patients with comorbidity, whose number has been growing steadily in recent years. The concurrence of asthma and obesity determines the severity of disease, low-level control, and resistance to basic therapy in conjunction with more frequent use of β-agonists for relief of symptoms, and frequent hospitalizations for a disease exacerbation. Currently, there are only a few known pathogenetic components that are responsible for the negative impact of visceral obesity on the course of asthma.

Research Objective: Assessment of the level of adipokines and their receptors in blood at young patients with bronchial asthma (BA) depending on the obesity phenotype. Material and Methods: 164 patients with BA were divided into 3 groups: BMI 30-34.9 kg/m2 + thickness of epicardial fatty tissue (EFT) ≥7 mm (1st gr.), BMI 30-34.9 kg/m2 + EFT Results: in the 1st group the level of leptin was significantly higher, and the level of adiponectin was significant lower than the 2, 3-groups and control. The adiponectin level is inversely correlated with BMI and positive correlations with the maintenance of lipoproteins of high density. Positive correlations between BMI, waist and leptin that proves primary the predominant influence of adipose tissue on the levels of leptin in plasma. The ObR value was statistically significant lower at patients of the 1st group which emphasizes the presence of receptor pathology in severe conditions with high levels of leptin. However, this group was the highest indications of AdipoR2. Marked negative correlations of AdipoR2 with insulin levels, leptin and TNF-α. In total, obviously dispersing phenotypes of obesity confirmed that AdipoR1 and AdipoR2 are functionally excellent role models of cardiovascular and metabolic diseases. Violation of adipokines receptors of adipokin, thickness of EFT can be used as predictors of prognosis at patients with combined of BA and obesities.

Aim: to study effectiveness of specific prevention of pneumococcal infection in patients with chronic lung diseases. Materials and Methods: to assess the clinical effectiveness of vaccination, special questionnaire was developed, which included an assessment of anamnesis during the year preceding vaccination and anamnesis of the underlying disease during the year after vaccination. 881 patients with chronic lung diseases were vaccinated. Results: vaccination against pneumococcus in patients with chronic lung diseases has significantly reduced the number of exacerbations of the underlying disease in patients aged 56-60years(RR=0.3(95%CI:0.12-0.73),61-65years(RR=0.3(95%CI:0.12-0.73) and 66-70years(RR=0.17(95%CI:0.06-0.49)(p Conclusions: the results indicate a high efficiency of vaccination against pneumococcal infection in patients with chronic lung disease: in all groups a decrease in the incidence of respiratory infections, reduction in the number of exacerbations of the underlying disease and hospitalizations for exacerbations.

Aim. To estimate changes of cellular structure of the induced sputum at young patients with bronchial asthma at interrelations with BMI and level of cytokines in blood plasma. Materials and methods. 164 patients with bronchial asthma were divided into 2 groups taking into BMI: the 1st group included patients with bronchial asthma and BMI from 18 to 25 kg/m2, patients with bronchial asthma and BMI from 30 to 40 kg/m2 entered into the 2nd group. The group of control was made by 40 almost healthy volunteers. Estimated existence of excess weight and defined obesity degree according to recommendations of World Health Organization. Studied the level of control of bronchial asthma, cellular structure of the induced sputum, the IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-15, IL-17, TNF-α, INF-γ levels in plasma of peripheral blood. Results. There are presented the results of the research of cellular profile of the induced sputum and profile of cytokines at patients with bronchial asthma depending on BMI and severity of the disease. The received results testify to prevalence of eosinophilic type of an inflammation in the group of patients with BMI less than 25 kg/m2 whereas at patients mainly paucigranulation inflammation decided on obesity. The highest content of the Il-17 was registered at patients with bronchial asthma and obesity as in comparison with indicators of patients with normal BMI, and with almost healthy that, perhaps, is the reason of low effect of steroid therapy at these patients. Conclusion. Endotype assessment before basic antiinflammatory therapy at patients with the first time diagnosed bronchial asthma, will be able to help with selection of the most optimum treatment to each specific patient.

Background. Urticaria is а common disease characterized by the formation on the skin itchy blisters. It is easy to diagnose an urticaria, but it isn’t always simple to treat because of various severity, frequent resistance to antihistamine drugs, a substantial reduction in quality of life. Objective. The purpose of the study is to carry out the retrospective analysis of medical case history of patients with acute and chronic urticaria for identification of the most significant etiological factors of the disease for the optimization of diagnostics and treatment of such patients. Materials and methods. There were analysed 307 medical cards of the patients with various forms of urticaria who were on treatment in the allergology department from 2008 till 2014. The diagnosis was established on the basis on the results of the clinical methods conforming to the standards of diagnosis of this disease, and also specific allergological research. Results. Though patients with acute and chronic urticaria pass examination and treatment in the hospital according to the one medical economic standard, patients with a chronic urticaria demand wider range of diagnostic actions. Respectively, their medical examination is more expensive. Conclusion. Despite on a wide range of the possible reasons of an urticaria, there are patients at whom the provocative factor isn»t taped. Thus, the urticaria is a multicausal disease at which complex examination of the patient is required.

The purpose of the study was to examine the relationship between functional parameters, arterial rigidity, lipid profile, markers of systemic inflammation and endothelial dysfunction in patients with COPD and COPD + coronary heart disease. We examined 110 subjects divided into 3 groups. Ggroup 1 included 40 patients with severe and very severe COPD, group 2 consisted of 40 patients with severe and very severe COPD + coronary artery disease, the control group was comprised of 30 healthy volunteers. We studied parameters of respiratory function, the level of blood oxygenation, the main characteristics of arterial rigidity, plasma lipid, TNF-a, CRP, fibrinogen, sPECAM-1 levels and the expression of CD38/ADP-ribosylcyclase in peripheral blood lymphocytes. The study revealed increased rigidity of the central arteries in the patients of groups 1 and 2 regardless of the duration of observation and the presence of coronary artery disease, as evidenced by the increase of the pulse wave velocity in the aorta. Patients of both groups had elevated levels of TNF-a, CRP and fibrinogen indicating systemic inflammatory response. Taken together, the enhanced expression of CD38 in peripheral blood lymphocytes, elevated concentration of soluble CD31 (sPECAM-1) in both groups related to bronchial obstruction and neutrophil elastase activity as well as increased rigidity of the vascular bed gives evidence that the CD38 and sCD31 relationship plays a role in the formation of endothelial dysfunction, and dysregulation of vascular tone in COPD patients. Disorders of lipid metabolism combined with increased rigidity of the vascular wall, elevated levels of markers of systemic inflammation and endothelial dysfunction, suggest that patients with COPD are at risk of cardiovascular events.

Purpose — to study rationality of financial expenses on the treatment of patients with the severe pneumonia. Materials and methods. It was selected 30 medical histories of patients with severe community-acquires pneumonia passing hospitalization in pulmonology department and department of intensive care in 2004, 2011 and 2014. The frequency analysis was applied to studying the structure of the carried-out drug treatment and identification of frequency of the separate medicinal preparations. We have data about the cost of drug which were received from the database of «1C: Drugstore» of regional clinical hospital. Results. Expenses on the treatment of severe community-acquires pneumonia according to 2014 year are rational, 92.23% of expenses are vitally necessary drug entering into modern clinical references. According to the ABC/VEN analysis during the period from 2004 till 2014 we found positive dynamics of increase of expenditure of money at category V. The appreciable attention should be paid to the treatment of accompanying pathology in the therapy of severe communityacquires pneumonia which can make heavier a current of basic disease and become the reason of complications, often fatal. Costs of the medicinal preparations for treatment of the accompanying pathology in 2014 year was made 6.27% that it is necessary to consider at advance planning of provision of medicines in pulmonology department. Conclusion. The results received by us testify about rational use of financial costs on treatment of patients with severe community-acquires pneumonia.

To investigate the clinical and functional parameters in patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) versus those with chronic obstructive pulmonary disease (COPD) and asthma.A total of 129 people were examined. 51 patients with ACOS were followed up in Group 1; Group 2 included 38 patients with severe asthma; Group 3 consisted of 40 patients with severe COPD. All the patients underwent clinical examination: history data collection, physical examination, evaluation of disease symptoms, and study of respiratory function (spirometry, body plethysmography).ACOS is clinically characterized by considerable demands for emergency drugs and by more frequent asthmatic fits and exacerbations, which require hospitalization. The parameters of bronchial resistance in ACOS were established to be increased throughout the follow-up period and to be comparable with those in patients with COPD. In the patients with ACOS, the severity of pulmonary hyperinflation was associated with increased demands for emergency drugs (r=0.59; p=0.015). Fixed bronchial obstruction in ACOS can be caused by smoking intensity and duration associated with increased bronchial resistance in expiration (r=0.51; p=0.003) and intrathoracic volume (r=0.71; p=0.0001); as well as increased body mass index (p0.001) and disease duration, which were interrelated with a reduction in the forced expiratory volume in one second/forced vital capacity ratio (r=-0.63; p=0.001 and r=-0.71; p=0.0034, respectively).Patients with ACOS show more severe clinical manifestations and a substantial increase in functional residual capacity and intrathoracic volume throughout the follow-up period, suggesting that the distal bronchi are impaired and pulmonary hyperinflation develops.Цель исследования. Изучить клинико-функциональные параметры у больных ACOS-синдромом по сравнению с пациентами, страдающими хронической обструктивной болезнью легких (ХОБЛ) и бронхиальной астмой (БА). Материалы и методы. Обследовали 129 человек. В 1-й группе наблюдался 51 пациент с ACOS-синдромом, во 2-ю группу вошли 38 больных БА тяжелого течения, в 3-ю - 40 пациентов с ХОБЛ тяжелого течения. Всем больным проводили клиническое обследование: сбор анамнеза, осмотр, оценка симптомов заболевания и исследование функции внешнего дыхания (спирометрия, бодиплетизмография). Результаты. ACOS-синдром клинически характеризуется значительной потребностью в препаратах неотложной помощи, более частыми приступами удушья и обострениями, при которых требуется госпитализация. Установлено, что параметры сопротивления бронхов при ACOS-синдроме повышены на протяжении всего периода наблюдения и сопоставимы с показателями при ХОБЛ. У больных с ACOS-синдромом выраженность избыточной воздушности легочной ткани ассоциирована с более частой потребностью в препаратах для неотложной помощи (r=0,59; p=0,015). Фиксированная обструкция бронхов при ACOS-синдроме может быть обусловлена интенсивностью и длительностью курения, ассоциированной с повышением бронхиального сопротивления выдоха (r=0,51; p=0,003) и внутригрудного объема (r=0,71; p=0,0001), а также повышенным индексом массы тела (р0,001) и продолжительностью заболевания, взаимосвязанными со снижением отношения объем форсированного выдоха за 1-ю секунду/форсированная жизненная емкость легких (r=–0,63; p=0,001 и r=–0,71; p=0,0034 соответственно). Заключение. Для больных с ACOS-синдромом характерны более выраженные клинические проявления и существенное повышение функциональной остаточной емкости легких и внутригрудного объема на протяжении всего периода обследования, что свидетельствует о поражении дистальных бронхов и развитии избыточной воздушности легочной ткани.

Background. To study the clinical and functional features in interrelationship between the level of proinflammatory and antiinflammatory cytokines in young patients with bronchial asthma and alimentary obesity for optimization of therapy. Methods. 133 persons were examined: 93 patients with bronchial asthma were divided into 2 groups depending on body weight index (BWI): the 1st group included patients with bronchial asthma with BWI less than 25 kg/m2, the 2nd group included patients with bronchial asthma with BWI 30 kg/m2 and more. The group of control included 40 almost healthy persons. We studied external respiration function, cellular structure of the induced sputum, the level of TNFα, IL-2, IL-4, IL-6, IL-15, Creactive protein in blood. Results. The results of cytokines at patients with bronchial asthma depending on BWI out of an exacerbation of the disease within the last 2 months. We found the signs of more significant systemic inflammation in the group with obesity the increasing of the level of IL2, IL6, TNFa and Creactive protein in plasma was found. Conclusion. We found that there was more sever course of bronchial asthma in young patients with obesity, decreased external respiration functions, increased level of proinflammatory cytokines and proteins of acute phase in peripheral blood.

Purpose: an assessment of clinical efficiency and carrying out the pharmacoeconomic analysis of allergen immunotherapy at patients with mild and moderate allergic bronchial asthma. Materials and methods. 108 patients were examined with mild and moderate allergic bronchial asthma, of both sexes who were divided into 4 groups depending on their therapy. The period of observation was 12 months. The 1st group were included 35 patients of mild allergic bronchial asthma receiving allergen immunotherapy in combination with antiinflammatory therapy; the 2nd group were consisted of 22 patients of mild allergic bronchial asthma using only basic therapy; in the 3rd group 17 patients of moderate allergic bronchial asthma receiving allergen immunotherapy in combination with antiinflammatory medicine were observed; the 4th group was made by 34 patients of moderate allergic bronchial asthma receiving only basic therapy. At all patient were investigated the function of external respiration, scarification tests, test АСТтм. For the pharmacoeconomic analysis we used the cost-effectiveness ratio. Results. Our analysis showed that the scheme of treatment at patients of the 3rd group was economically more profitable in comparison with the scheme of treatment at patients of the 4th group. So at the 3rd group in the end of the period of observation was noted significant improvement of the following indicators: FEV1, decrease of day and night dyspnea attacks, quantity of exacerbations, increase of total point of АСТтм test. Despite the larger value of coefficient of expensive efficiency at patients of the 1st group in comparison with the 2nd group, it is necessary to consider that the allergen immunotherapy interferes the progressing of the disease that will compensate the cost of this method of treatment in the future. Conclusion. We received the results that showed the efficiency of the timely done allergen immunotherapy at patients with the mild and moderate allergic bronchial asthma, and is able tto reduce financial expenses considerably.

Обследовано 174 больных АБА, обоего пола, получающих АСИТ. Всем больным проводилось иссле-дование функции внешнего дыхания, скарификационные пробы, аллергенспецифицеская иммунотерапия, статистическая обработка результатов исследования осуществлена с помощью пакета прикладных программ Statistica-6.0 for Windows.

The article presents a case of hypersensitive pneumonitis in young 21-year-old patient. Currently there are no accurate data on the prevalence of this pathology. The complexity of the diagnosis of hypersensitive pneumonitis is explained by the low awareness of the doctors about this disease and the need for special high-tech methods of examination.

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Purpose: To study features of parameters of function of external respiration, X-ray pattern and level of neutrophylic elastase at ACOS. Materials and Methods: 129 people were examined in total. The 1st group included 51 patients with asthma-COPD overlap syndrome (ACOS), into 2nd group - 38 patients with severe asthma, in the 3rd - 40 patients with severe COPD. The control group was made by 40 volunteers. Assessment of function of external respiration, results of a computer tomography of high resolution, quantity of neutrophils was carried out. In the blood plasma determined the content of the neutrophylic elastase. Results: Rising of the level of neutrophylic elastase was interconnected with the maintenance of neutrophils of the peripheral blood at patients with ACOS (r=0.56, p=0.035) and severe COPD (r=0.51, p=0.04) that can demonstrate formation of mainly neutrophylic type of an inflammation in these groups. At patients with severe COPD and patients with ACOS rising the volume of pulmonary tissue with formation of emphysema according to computer tomography of high resolution was observed. At patients with severe bronchial asthma emphysematous changes were expressed least. Formation of emphysema at patients with severe bronchial asthma and severe COPD was interconnected with rising of an indicator of the relation of bronchial resistance of exhalation to the bronchial resistance of inspiration (r=0.79; r=0.81 respectively, р˂0,001). At patients with ACOS the level of neutrophylic elastase in blood plasma was interconnected with rising of volume of a pulmonary tissue according to computer tomography of high resolution (r=0.90, р =0.03) and requirement in short-range s-agonists (r=0.76, р =0.02).

Aim was to study efficiency of specific prevention of pneumococcal infection at patients from the risk groups in Krasnoyarsk region. 12 080 patients with chronic lung diseases, chronic heart failure and diabetes mellitus were examined. The special questionnaire which included anamnesis assessment within the year previous bacterinations and anamnesis of basic disease within a year after bacterination was developed for assessment of clinical performance of bacterination. Immunization against pneumococcal infection was carried out to the following categories of patients: 41.08% with chronic heart failure, 28.44% suffering from diabetes mellitus, 30.07% with chronic lung diseases, 2.4% had pneumonia. 9986 (82.67%) were vaccinated with 13th inoculated by the valent pneumococcal conjugated vaccine, among them the combined bacterination with flu – 5070 (41.97%). By a pneumococcal polysaccharide vaccine were vaccinated – 1967(16.28%), from them it was single-step with flu – 1181(9.83%). Thanks to carrying out in the region of large-scale campaign for prevention of pneumococcal infection positive takes were received: the number of exacerbations or decompensations of basic diseases was reduced by 3 times, the number of hospitalization decreased by 11.5, the case rate pneumonia decreased by 4.8, and a acute respiratory virus infection or flu by 6.6. The received results testify to high efficiency of bacterination against a pneumococcal infection according to the prevention of development of pneumonia, depression of the case rate respiratory infections, reduction the number of hospitalization concerning exacerbations or decompensations as a result of stabilization of current disease.

Бронхиальная астма (БА) является глобальной про-блемой здравоохранения, что связано с устойчивой тенденцией к росту заболеваемости и социальными по-терями при данной патологии [5,7,8]. В настоящее время проблема БА из пульмонологической переходит в кардио-пульмонологическую, так как гемодинамические нару-шения малого круга кровообращения часто определяют прогноз жизни больных при этой патологии. Одной из главных причин инвалидизации и смертности при БА является вовлечение в процесс сердца и сосудов [1]. Из-менения в структуре и функции правого желудочка (ПЖ) чаще вызваны первичным расстройством респираторной системы [11]. Известно, что легочная гипертензия, изменения в ле-гочных сосудах и правом желудочке сердца развиваются раньше, чем определяются клинические, рентгенологиче-ские, электрокардиографические признаки гипертрофии правых отделов сердца. Гипертрофию правого желудочка рассматривают как поздний и необязательный признак БА, а проблема дисфункции правого желудочка не рассматри-вается как ведущая до этапа его декомпенсации. Взаимное отягощение и прогрессирование при сочета-нии бронхолегочных и сердечно-сосудистых заболеваний основано на общности некоторых звеньев патогенеза, что может приводить к ускоренному прогрессированию коро-нарной и сердечной недостаточности, раннему развитию жизнеугрожающих кардиореспираторных осложнений [6].

Research objective: To study the level of markers of systemic inflammation and features of formation of endothelial dysfunction of ACOS-syndrome. Materials and methods: 108 persons have been examined. The 1st group included 54 patients with ACOS-syndrome, the 2nd group-54 persons with severe asthma. Level of TNF-α,Il-6,sCD31, neutrophil elastase,CRP were performed with ELISA. Detection of CD38+ lymphocytes in peripheral blood was done with immunofluorescence. Results: High levels of markers of systemic inflammation(IL-6,TNF-α,CRP) are registered in both groups in comparison with control. At ACOS-syndrome we found the increased level of neutrophil elastase(p Conclusion: ACOS-syndrome is characterized by more significant level of systemic inflammation and formation of endothelial dysfunction. The received results can have prognostic value and influence therapeutic and preventive approaches to disease.

Research objective: To study clinical and functional features of parameters of ACOS-syndrome. Materials and methods: 148 persons have been examined. The 1st group included 54 patients with ACOS-syndrome, the 2nd group - 54 patients with severe asthma. The control group was made by 40 healthy volunteers. There were assessment of clinical symptoms, number of exacerbations and hospitalizations, the study of respiratory function. Results: For patients with ACOS-syndrome characterized by more severe course of the disease that is confirmed by a large number of day symptoms and requirements in short-range beta-2 agonists as at the time of including in research (r=0.016,p According to the results of bodyplethismography was installed in 1st group was significantly increased indicators of bronchial resistance as inhalation and exhalation, and also TLC, mainly due to the increase of RV, RV/TLC, FRC as at the time of including in the study and after 12 months of observation in comparison with the parameters of patients from the 2nd group and control(p Development of a hyperinflation at ACOS-syndrome is associated with expression of clinical implications that the established correlation connection between the bronchial resistance of an exhalation, residual volume and number of day attacks of a dyspnea confirms(r=0.54,r=0.49 respectively). Thus, ACOS-syndrome is characterized by a more severe course of the disease manifested by persistent decrease in respiratory function, increased of lung volumes compared with the patients suffering from asthma.

Research: to study interrelation of clinical and functional parametres, level of markers of system inflammation, arterial rigidity at patient with COPD and at a combination COPD and coronary heart disease. Study of external respiration function was done with whole-body plethysmography, functional parameters of the right departments of the heart was done with echocardiography. We estimated parametres of rigidity of an aorta by means of an indirect arteriography. Measurements of TNF-α, Il-6, Il-8, sCD31 levels in the peripheral blood were performed with ELISA. Detection of CD38+ lymphocytes in the peripheral blood was done with immunofluorescence. 50 patients were examed in the period of exacerbation and after 12 month of observation. The 1st group included 30 patients with severe and very severe COPD, the 2nd group - 20 patients with severe and very severe COPD in combination with coronary heart disease. The control group was made by 20 non-smoking healthy persons. In both groups independently of the period of observation we found violation mechanical properties of aorta that manifested as the increase of pulse wave velocity in aorta (PWVao). But Aix brachial changed at patients of the 1st group more significantly. Both groups in the period of exacerbation and after 12 months marked the increase of expression of CD38 on peripheral blood lymphocytes and sCD31 – marker of endothelial dysfunction. In the groups we found the increase of the level of Il-8 independently of the period of observation that shows persisting systemic inflammation. The informative marker reflexing the phase of disease is TNF-α. Results confirm the presence of endothelial dysfunction and remodeling of vessels at patients with COPD.

Small aquatic ecosystems of the boreal zone are known to be most sensitive indicators of on-going environmental change as well as local anthropogenic pressure, while being highly vulnerable to external impacts. Compared to rather detailed knowledge of the evolution of large and small lakes in Scandinavia and Canada, and large lakes in Eurasia, highly abundant small boreal lakes of northwest Russia have received very little attention, although they may become important centers of attraction of growing rural population in the near future. Here we present the results of a multidisciplinary, multi-annual study of a small boreal humic lake of NW Russia. A shallow (3 m) and a deep (16 m) site of this lake were regularly sampled for a range of chemical and biological parameters. Average multi-daily, summer-time values of the epilimnion (upper oxygenated) layer of the lake provided indications of possible trends in temperature, nutrients, and bacterio-plankton concentration that revealed the local pollution impact in the shallow zone and overall environmental trend in the deep sampling point of the lake. Organic phosphorus, nitrate, and lead were found to be most efficient tracers of local anthropogenic pollution, especially visible in the surface layer of the shallow site of the lake. Cycling of trace elements between the epilimnion and hypolimnion is tightly linked to dissolved organic matter speciation and size fractionation due to the dominance of organic and organo-ferric colloids. The capacity of lake self-purification depends on the ratio of primary productivity to mineralization of organic matter. This ratio remained >1 both during winter and summer periods, which suggests a high potential of lake recovery from the input of allochthonous dissolved organic matter and local anthropogenic pollution.

To study the peripheral blood level of leptin and adiponectin and their possible effect on the functional status of the respiratory system in young asthmatic patients in relation to body mass index (BMI) for the optimization of asthma therapy.Examinations were made in 133 people, including a study group of 93 patients with asthma who were divided into 2 groups according to BMI: 1) those with a BMI of less 25 kg/m2 and 2) those with a BMI of 30 kg/m2 or more, as well as a control group of 40 apparently healthy patients. The investigators studied external respiratory function (ERF), the peripheral blood levels of leptin and adiponectin, the biochemical composition of plasma, by determining total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides.Lipid metabolic disorders as dyslipidemia and hypercholesterolemia, increased severity of disease, and decreased ERF were recorded in the concomitance of obesity and asthma. The peripheral blood level of leptin in young asthmatic patients with obesity was found to be associated with higher BMI.A more severe course of disease presenting with decreased ERF, impaired lipid metabolism, and elevated peripheral blood leptin levels were noted in the concomitance of asthma and obesity at a young age.Цель исследования. Изучить уровень лептина и адипонектина в периферической крови и их возможное влияние на функциональное состояние респираторной системы у больных бронхиальной астмой (БА) молодого возраста в зависимости от индекса массы тела (ИМТ) для оптимизации противоастматической терапии. Материалы и методы. Обследованы 133 человека: 93 больных БА, которых разделили на 2 группы с учетом ИМТ, и 40 практически здоровых добровольцев, составивших группу контроля. В 1-ю группу включили больных БА с ИМТ менее 25 кг/м2, во 2-ю группу - больные БА с ИМТ 30 кг/м2 и более. Изучали функцию внешнего дыхания (ФВД), уровни лептина и адипонектина в периферической крови, биохимический состав плазмы крови с определением общего холестерина (ХС), ХС липопротеидов высокой плотности, ХС липопротеидов низкой плотности, триглицеридов. Результаты. При сочетании ожирения и БА зарегистрированы нарушение липидного обмена по типу дислипидемии и гиперхолестеринемии, увеличение тяжести заболевания, снижения показателей ФВД. Установлено, что уровень лептина в периферической крови у больных БА молодого возраста с ожирением ассоциирован с повышением ИМТ. Заключение. При сочетании БА и ожирения в молодом возрасте отмечается более тяжелое течение заболевания, проявляющееся снижением показателей ФВД, нарушением липидного обмена и повышением уровня лептина в периферической крови.

To study cytokine status and to reveal a possible relationship of clinical and functional indicators and systemic inflammation in patients with severe asthma to tobacco smoking. Subjects and methods. Examinations were made in 139 patients with severe asthma during its exacerbation and without the latter after 12 months. Groups 1 and 2 included 98 nonsmoking and 41 smoking patients with severe asthma, respectively. A control group consisted of 40 apparently healthy volunteers. External respiratory function, plasma TNF-α, IFN-γ, IL-2, IL-4, IL-6, IL-8, IL-10, C-reactive protein, and neutrophil elastase levels, and integral cytokine index were studied.Systemic inflammation that was more marked on a disease exacerbation and mediated by elevated TNF-α, IL-2, and C-reactive protein levels was detected in severe asthma in both groups. The smoking patient group showed a statistically significant increase in IL-8 and neutrophil elastase levels, which may be indirectly indicative of the active participation of neutrophils in the development of chronic persistent inflammation.Tobacco smoking is a clinically significant risk factor that aggravates both the course of asthma and the magnitude of inflammation during a disease exacerbation.Цель исследования. Изучить цитокиновый статус и выявить возможную взаимосвязь клинико-функциональных показателей и системного воспаления у больных бронхиальной астмой (БА) тяжелого течения в зависимости от курения. Материалы и методы. Обследовали 139 больных БА тяжелого течения в период обострения и вне его через 12 мес. В 1-ю группу вошли 98 некурящих больных с БА тяжелого течения, во 2-й группе наблюдался 41 курящий больной БА тяжелого течения. Группу контроля составили 40 относительно здоровых добровольцев. Изучали функцию внешнего дыхания, уровни α-ФНО, ИФН-γ, ИЛ-2, ИЛ-4, ИЛ-6, ИЛ-8, ИЛ-10, С-реактивного белка, нейтрофильной эластазы в плазме крови и интегральный цитокиновый индекс. Результаты. При БА тяжелого течения выявлено системное воспаление, более выраженное в период обострения заболевания и опосредованное повышенным уровнем ФНО-α, ИЛ-2, С-реактивного белка в обеих группах. В группе курящих пациентов отмечено статистически значимое повышение уровня ИЛ-8 и нейтрофильной эластазы, что может косвенно свидетельствовать об активном участии нейтрофилов в формировании хронического персистирующего воспаления. Заключение. Курение является клинически значимым фактором риска, отягощающим как течение БА, так выраженность воспаления в период обострения заболевания.