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The review provides current data on new options for the treatment of severe bronchial asthma. The prevalence of severe asthma ranges from 3% to 10%, but it is for the treatment of this group of patients that more than 80% of the funds allocated for the treatment of the disease as a whole are spent. Patients with severe bronchial asthma make up a special category, since traditional therapy, effective in most patients with bronchial asthma, does not allow controlling the disease. Heterogeneity and multivariate disease dictate the need to develop a personalized approach, which is impossible without significant financial and personnel investments. Understanding the pathogenetic pathways underlying the development of inflammation in asthma was the impetus for the development of targeted therapies. Five genetically engineered immunobiological drugs have been developed and approved for patients with severe allergic and/or eosinophilic bronchial asthma. The choice of the right medication should depend on the correct diagnosis of severe asthma, understanding the patient’s endotype, and accounting for patient-specific factors. It is worth noting that all approved biologics and most biologics currently in development focus on T2-immune response. To be sure, there is a huge pool of patients who register a different type of inflammation. And therefore, despite the rapid development of knowledge in the field of targeted therapy of bronchial asthma, further decoding and deepening of knowledge about the pathophysiological mechanisms, in particular non-T2 inflammation, as well as an analysis of the experience of using existing drugs to clearly understand the indications, as well as to assess the effectiveness and safety of existing treatments.

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.

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.

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.

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.

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).

Background. To study the cytokines profile in the peripheral blood of patients with severe asthma and obesity. Methods.139 patients with severe bronchial asthma have been examined, including 66 patients with severe bronchial asthma and body mass index (BMI) 30 (2nd group). The control group was formed from 40 healthy volunteers. The respiratory function, the cytokine integral index and the levels of TNFα, IL4, IL6, IL2, IL10, IFN-γ, IL8, IL17 in the peripheral blood of patients in and out of an exacerbation were studied. Results. More significant systemic inflammation signs expressed in increased levels of TNFα, IL6, IL4, IL2 and IFN-γ were found in exacerbation period of the disease. In obese patients the increased level of proinflammatory cytokine IL17 in exacerbation period was estimated. Conclusion. We have demonstrated the presence of systemic inflammation in patients with severe BA, regardless of the presence of obesity, increased level of proinflammatory cytokine IL17 in patients with severe bronchial asthma and obesity in the period of exacerbation. It can be a reason of the low effect of steroid therapy in patients with BMI >30.

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.