Vol 84, No 3 (2012)

Articles
Bronchial asthma: new prospects in therapy
Chuchalin A.G.
Abstract
The article reviews original and literature data on the use of monoclonal antibodies (MAB) for treatment of patients with severe bronchial asthma (BA), methods of MAB obtaining. Biomolecule targets in BA are some immunoglobulins, CD4 lymphosytes and TNFalpha. Successful use of monoclonal anti-IgE antibodies in BA by Russian clinicians in 1980s and current experience with administration of foreign MAB drugs (omalizumab, mepolizumab, infliximab, etc.) are considered.
Terapevticheskii arkhiv. 2012;84(3):5-11
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Arterial stiffness in patients with chronic obstructive pulmonary disease
Karoli N.A., Rebrov A.P.
Abstract
Aim. To estimate arterial stiffness (AS) in patients with chronic obstructive pulmonary disease (COPD). Material and methods. A total of 112 COPD patients over 40 years of age entered a population-based trial. The patients with coronary heart diseases, peripheral vascular atherosclerosis, other severe chronic diseases in exacerbation were withdrawn. The control group consisted of 26 healthy volunteers matched by gender and age. AS was measured at arteriograph "Tensioclinic" ("Tensiomed", Hungary). Results. COPD patients, first of all elderly ones, had abnormal properties of arterial wall. Increased arterial rigidity and pulse wave reflection (accelerated pulse wave velocity and high index of augmentation) are strongly associated with elevation of central arterial pressure. Conclusion. High arterial wall stiffness in COPD patients suggests an increased risk of cardiovascular diseases that necessitates examination in prospective studies.
Terapevticheskii arkhiv. 2012;84(3):12-16
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PHYSICAL TRAINING IS A UNIVERSAL METHOD OF PULMONARY REHABILITATION OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Mescheryakova N.N., Belevsky A.S., Chernyak A.V., Neklyudova G.V., Lebedin Y.S.
Abstract
Aim. To study systemic effects of chronic obstructive pulmonary disease (COPD) of stage III—IV and to assess their response to pulmonary rehabilitation method physical training (PT). Material and methods. The study enrolled 112 patients aged 46-72 years (mean age 64.3 years) with severe and extremely severe COPD. Of them, 57 patients received standard pharmacotherapy, exercise training and training with respiratory trainers. The control group of 55 patients received only pharmacotherapy. At the start and in the end of the study the following parameters were examined: 6-min walk, inspiratory and expiratory muscles performance (Pi, Pe), functional changes in the lungs, quality of life by MOS SF-36 questionnaire, depressive alterations by CES-D questionnaire, markers of systemic inflammation (TNF-alpha, IL-6, IL-1beta, C-reactive protein, testosterone). Results. At the start of the study all the examinees had low exercise tolerance according to 6-min walk test (266,7 м), inspiratory and expiratory muscles performance (Pi 54,8 cm of water, Pe 75,3 cm of water). Patients from the PT group improved the above parameters: pulmonary function, 6-min walk by 80 m, Pi — to 77.2 cm, Pe — to 89.8 cm, functional residual capacity reduced by 14%, residual pulmonary volume by 30%, CRP by 8.1 mg/l, IL-6 by 8.3 pkg/ml, depression regressed, testosterone rose. Patients from the control group improved the above parameters insignificantly. Conclusion. PT is a universal method of pulmonary rehabilitation having a positive action on various COPD systemic effects.
Terapevticheskii arkhiv. 2012;84(3):17-21
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SECONDARY PULMONARY HYPERTENSION: SOME ASPECTS OF PATHOGENESIS
Neklyudova G.V., Avdeev S.N., Tsareva N.A., Chernyaev A.L., Samsonova M.V., Naumenko Z.K., Mikhale L.M.
Abstract
Aim. To study morphofunctional condition of pulmonary vessels in chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF), to specify the role of endothelial dysfunction in pathogenesis of secondary pulmonary hypertension (SPH). Material and methods. Functional examination of cardiovascular and respiratory systems, measurement of systolic pressure (SP) in the pulmonary artery were made in 178 patients: 99 with COPD (8 females and 91 males, mean age 57.2 ± 9.8 years), 79 with IPF (58 females and 21 males, mean age 54.1 ± 12.7 years). The examination has detected echocardiographic signs of pulmonary hypertension (PH). Then 45 PH patients (22 with COPD and 23 with IPF) were tested for vasoreactivity in response to inhalation of O 2, NO in combination with O 2 and iloprost (prostacycline i 2) with О 2. Next stage of the study was morphometric and immunohistochemical examinations of small branches of the pulmonary artery (PA). Results. PA SP in COPD patients was 42.8 ± 11.1 mmHg, in IPF patients — 41.8 ± 12.6 mmHg. Elevation of PA SP above 35 mmHg was registered in 48.5% patients with COPD and in 43.0% with IPF. Patients of both groups responded to a vasodilating impact of inhalatory NO and iloprost while reaction to O 2 inhalation was absent. Morphological study of PA small branches revealed marked changes in the structure of vascular wall which were most manifest in the intima. Conclusion. The findings evidence for an essential role of endothelial dysfunction in formation and progression of PH in pulmonary pathology.
Terapevticheskii arkhiv. 2012;84(3):22-28
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DEVICE DIAGNOSIS AND COMBINED TREATMENT OF HYPERVENTILATION SYNDROME
Koryakov V.V.
Abstract
Hyperventilation syndrome is a separate disease and a symptom of other psychosomatic diseases. A variant of device diagnosis of the disease is proposed — integral rheoplethysmography by M.I. Tischenko and cardiointervalography by R.M. Baevsky. Hyperand asthenic courses of the disease are described, the pathological psychoemotional pattern is recognized. The proposed treatment combines physiohemotherapy (laser treatment) and pharmacotherapy.
Terapevticheskii arkhiv. 2012;84(3):28-31
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HYPERVENTILATION SYNDROME AND BRONCHIAL ASTHMA: ROLE OF VERBAL DYSPNEA CHARACTERISTICS IN DIFFERENTIAL DIAGNOSIS
Trushenko N.V., Chikina S.Y., Lukashenko E.P., Makhnach G.K., Chuchalin A.G.
Abstract
Aim. To investigate verbal dyspnea characteristics in patients with bronchial asthma (BA) and hyperventilation syndrome (HVS). Material and methods. The trial covered 52 patients with BA, 10 patients with BA combination with HVS and 18 patients with HVS. Verbal dyspnea characteristics were studied with P.M. Simon questionnaire. The examination of the patients was made using scale HADS, Naimigen questionnaire, bodyplethysmography, bronchodilation test, capnography with spontaneous hyperventilation test, analysis of arterial blood gas composition. Results. Most commonly BA patients characterized dyspnea with such words as " I am breathless" (n=8, 33.3%), "I breathe with effort" (n=6, 25%) and "I feel suffocation" (n = 6, 25%). HVS patients characterized their dyspnea most often as "air shortage" (n = 14, 77.8%), "I can’t take a deep breath" (n = 10, 55.6%), "breathing needs concentration" (n = 6, 33.3%) and "I have to grasp air with mouth" (n = 5, 17.9%). The latter description correlated with capnometric markers of HVS and responses to Naimigen questionnaire. The description "I feel suffocation" directly correlated with BA stage by GINA and bronchial obstruction severity. Conclusion. Verbal dyspnea characteristics differ in BA and HVS patients and this can be used in differential diagnosis of these conditions.
Terapevticheskii arkhiv. 2012;84(3):31-37
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ORGANIZING PNEUMONIA: DIAGNOSIS AND TREATMENT
Avdeev S.N., Chernyaev A.L., Chuchalin A.G.
Abstract
According to current classifications, organizing pneumonia (OP) belongs to the group of diffuse parenchymatous diseases of the lungs. Morphological picture of OP is characterized by the presence of polypoid granulation tissue consisting of proliferating fibroblasts and myofibroblasts in the gap of respiratory bronchioles. In most cases OP is idiopathic. Among the causes, most significant are diffuse diseases of the connective tissue and complications of pharmacotherapy. OP develops more frequently in 50-60-year old males and females. Typical for OP is an acute/subacute course with a clinical picture of bacterial pneumonia. Mean duration of the symptoms to diagnosis is 2-6 months. Roentgenologically, OP often presents with spotted bilateral (less often unilateral) dense consolidation foci of subpleural location; pulmonary volumes are, as a rule, unaffected. OP treatment of choice is administration of glucocorticosteroid drugs. The prognosis of OP is favourable, most of the patients are completely cured by glucocorticosteroids.
Terapevticheskii arkhiv. 2012;84(3):38-44
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FIVE-YEAR MONITORING OF ANNUAL PULMONARY FUNCTION DECLINE IN INDIVIDUALS EXPOSED TO CHRONIC INTERMITTENT HYPOXIA
Vinnikov D.V.
Abstract
Aim. To study annual decline of pulmonary function in individuals exposed to chronic intermittent hypoxia (CIH) working in conditions of high altitude for 5 years. Material and methods. A total of 9553 spirograms were obtained during 5 annual examinations of 795 open-cast miners (age 38.6 ± 8.5 years, 6.4 ± 5.0 years of service) working at the altitude of 3800-4500 m above the sea level. The miners were examined using spirometry with bronchodilation test. Results. An annual decline of vital lung capacity (VC) was 33.5 ml/year, of forced VC 33.8 ml/year, forced expiratory volume (FEV) 64.4 ml/year. In the group of non-smokers the decline was less than in smokers FEV. 59.5 ml/year vs 72.0 ml/year. No-smoking rules in the open-cast mine inhibited a respiratory function decline. Conclusion. Individuals exposed to CIH show an accelerated decline of spirometric indices. No-smoking rules at open-cast high altitude mines result in inhibition of annual decline of respiratory function in CIH-exposed individuals including non-smokers. Smoking ban in such conditions not only inhibits decline of the respiratory function but improves this function.
Terapevticheskii arkhiv. 2012;84(3):45-48
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A GENETIC ANALYSIS OF A H1N1 PANDEMIC INFLUENZA VIRUS IN THE COURSE OF THE EPIDEMIC
Kostryukova E.S., Zakharzhevskaya N.B., Kostin P.A., Ilyina E.N., Larin A.K., Gribanov O.G., Selezneva O.V., Prikhodko E.A., Akopian T.A., Generozov E.V., Lazarev V.N., Levitsky S.A., Kondratov I.G., Alekseev D.G., Bazaleev N.A., Klimova E.A., Esaulova M.R., Yuschuk N.D., Govorun V.M., Sergienko V.I.
Abstract
Aim. To assess genetic variability of A H1N1 pan influenza virus (IV) in the course of the epidemic and to detect a set of human nucleotide polymorphisms responsible for a severe course of the disease. Material and methods. Extraction and purification ofviral genomic RNA from the nasopharyngeal smears and genomic human DNA from the leukocytic fraction of venous blood was made in 230 patients from Moscow, Moscow and Sverdlovsk Regions with severe acute respiratory virus infection (ARVI). A flu virus type was established in amplification reaction with on-line detection of the products with application of primers recommended by WHO. Genetic polymorphisms of A H1N1 pan IV and human genes were determined with minisequencing reaction followed by detection of the products of MALDI-time-of-flight mass-spectrometry. Nucleotide sequences of the complete genome were revealed for 15 isolates of A H1N1 pan IV. Results. A H1N1 IV was identified in 77 cases (46 were pandemic, 31 seasonal). Mutations causing genetically determined resistance to adamants (amantadin, rimantadin) were detected in all 46 samples of genomic RNA of A H1N1 pan IV. Mutation leading to oseltamivir (tamiflu) resistance was found in one sample. It is shown that a severe course of A H1N1 pan IV infection is associated with genotypes predisposing to development of thromboses, bronchopulmonary diseases and hypertention. Genetic tests for prognosis of a complicated course of the flu are proposed. The revealed full-genome sequences of the segments of genomic RNA of 15 A H1N1 pan influenza viruses are deposited in GenBank. Conclusion. We are the first in Russia to detect a mutant variant of A H1N1 pan IV resistant to oseltamivir. We describe a set of nucleotide polymorphisms which determine a complicated course of the flu in patients with identified A H1N1 pan IV.
Terapevticheskii arkhiv. 2012;84(3):48-54
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ADULT-ONSET MUCOVISCIDOSIS: LONGER SURVIVAL OF PATIENTS IN MOSCOW AND MOSCOW REGION
Krasovsky S.A., Amelina E.L., Chernyak A.V., Nikonova V.S., Voronkova A.Y., Kashirskaya N.Y., Kapranov N.I., Chistyakova V.P., Samoilenko V.A., Semykin S.Y., Simonova O.I., Petrova N.V., Gorinova Y.V., Chuchalin A.G.
Abstract
Aim. To estimate survival median and its changes, number of patients over 18 years of age for 1991—2000 and 2001-2010 for 20-year period (1991-2010), to elucidate factors affecting survival for 2001—2010 in mucoviscidosis children living in Moscow and Moscow Region and treated outpatiently in specialized medical centers. Material and methods. Case records were analysed for mucoviscidosis patients registered in specialized clinics of Moscow on 01.01.01 and 01.01.11. Survival was assessed with Kaplan-Mеier curve. Results. Survival medians for 1991 — 2000 and 2001 — 2010 was 25.7 and 35.1 years, respectively. In the group of mucoviscidosis patients with Staphylococcus aureus infection survival was significantly higher than in those infected with gram-negative microflora. Longer survival was reported in patients with "soft" mutation (p = 0.06927). Conclusion. The survival median for mucoviscidosis patients for 2001-2010 was 35.1 years. The percentage of adult patients in the last decade significantly rose from 19.5 to 32%. Gram-negative microflora significantly reduces survival, while "soft" mutation prolongs survival. Creation of National Register will specify survival of mucoviscidosis patients in all regions of the Russian Federation.
Terapevticheskii arkhiv. 2012;84(3):54-58
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PATHOLOGICAL ANATOMY OF SOME RARE DISEASES OF THE LUNGS
Chernyaev A.L., Samsonova M.V.
Abstract
The article gives a brief review of some rare diseases of the lungs. According to international registers, rare diseases are those which occur in one individual per 2000 population. Brief characteristics, description of pathological anatomy of tumor and other lesions of the lungs are outlined.
Terapevticheskii arkhiv. 2012;84(3):59-62
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USE OF WALK TESTS IN PULMONOLOGY
Ots O.N., Maliev B.M., Chushkin M.I., Mandrykin Y.V., Yartsev S.S.
Abstract
Functional assessment is an obligatory part of examination of patients with chronic respiratory diseases. Ergospirometry is a "gold standard" of functional examination of the cardiorespiratory system. Walk tests are alternative to ergospirometry and can be performed outside laboratories of functional diagnosis. A 6-min walk test provides information on functional condition, treatment efficacy and prognosis in many diseases of the heart and lungs. The result of this test under 350 m suggests a high risk of death. However, this test has a serious defect an insignificant result in weak motivation of the patient. The defects of a 6-min walk test can be corrected by the shuttle-test with growing or permanent load. The test with growing load measures physical performance, while that with permanent load estimates the ability to endure long-term loading.
Terapevticheskii arkhiv. 2012;84(3):62-67
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EOSINOPHILIC DISEASES OF THE LUNGS
Anaev E.K.
Abstract
Pulmonary eosinophilias belong to a heterogenous group of the diseases characterized by pulmonary shadows related to pulmonary tissue and/or peripheral blood eosinophilia. Although the inflammatory infiltrate consists of macrophages, lymphocytes, neutrophils and eosinophils, a significant marker for the diagnosis and treatment is eosinophilia. By etiology, eosinophilic diseases of the lungs fall into primary or idiopathic (common pulmonary eosinophilia, chronic eosinophilic pneumonia, hypereosinophilic syndrome), secondary or of known origin (allergic bronchopulmonary aspergillesis, bronchocentric granulematosis, parasitic invasions, drug-induced reactions, fungal and mycobacterial infection, pulmonary diseases caused by radiation or toxins). Pulmonary eosinophilia can be also associated with systemic diseases (Churg-Strauss syndrome) and tumors. Clinicoroentgenological picture of different eosinophilic diseases of the lungs is almost the same. Verification of the diagnosis is based on the presence of bronchial asthma and extrapulmonary manifestations, the level of eosinophilia in the blood, bronchoalveolar lavage and total IgE, histological and chest CT findings. This article presents modern classification, clinicoroentgenological and histological characteristics of different, primarily idiopathic, eosinophilic diseases of the lungs.
Terapevticheskii arkhiv. 2012;84(3):67-73
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THE ROLE OF ENDOTHELIAL DYSFUNCTION AND ARTERIAL RIGIDITY IN PATHOGENESIS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Makarova M.A., Avdeev S.N., Chuchalin A.G.
Abstract
Chronic obstructive pulmonary disease (COPD) is a disease with progressive dysfunction of external respiration due to inflammatory reaction of pulmonary tissue to irritation by different pathogenic agents and gases. According to population-based studies, COPD patients have a 2-3-fold higher risk of cardiovascular death, while the number of lethal outcomes comprise about 50% of total number of deaths. As shown by the evidence from studies, COPD patients demonstrate high arterial rigidity and endothelial dysfunction. It is important that these changes can be corrected with pharmacological and non-pharmacological impacts. Examination of structural-functional vascular changes in COPD patients is of great clinicoprognostic importance and can modify therapeutic and prophylactic approaches to COPD.
Terapevticheskii arkhiv. 2012;84(3):74-80
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