Vol 91, No 3 (2019)

Editorial
Arterial hypertension and chronic obstructive pulmonary disease: clinical characteristics and treatment efficasy (according to the national register of arterial hypertension)
Chazova I.E., Lazareva N.V., Oshchepkova E.V.
Abstract
Arterial hypertension (AH) is one of the major factors, causing high level of population mortality in many countries, including Russia. Natural aging of population in the beginning of 20th century leads to medical and social issues; and frequent comorbidity is one of them. The occurrences of chronic obstructive pulmonary disease (COPD) are rather often among the population, especially among city dwellers and males. AH and COPD are frequent comorbid conditions; combination of these diseases contributes to high level of disability and poor prognosis. The objective of the research is studying of demographic and clinical profile as well as treatment effectiveness of patients with AH and COPD based on National Register of Arterial Hypertension. Methods and materials. Among the analyzed selection, consisted of 32 571 patients with AH, who were followed up in the primary medical care, at the average age of 64±7 years old (there were 64% women of them), 5.4% patients with AH had COPD. The analysis of cardiovascular and cerebrovascular diseases frequency as well as treatment effectiveness was made. Results. According to National Register of Arterial Hypertension, cardiovascular [coronary heart disease, Q myocardial infarction, chronic heart failure (CHF), peripheral artery atherosclerosis] and cerebrovascular (stroke/transitory ischemic attack) diseases are accurately more often diagnosed at patients with AH and COPD. Conclusion. Male sex and age are the strongest independent factor, contributing into the risk of development of cardiovascular diseases at these patients. COPD considerably increases the risk of CHF development. The conducted analysis has shown that treatment, prescribed to patients with AH and COPD meets modern recommendations.
Terapevticheskii arkhiv. 2019;91(3):4-10
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Comparison of the integral indices of the vectorcardiogram with the data of echocardiography in patients with idiopathic and chronic thromboembolic pulmonary hypertension
Sakhnova T.A., Blinova E.V., Belevskaya A.A., Saidova M.A., Arkhipova O.A., Yurasova E.S., Alokova F.H., Martynyuk T.V., Chazova I.Y.
Abstract
The aim of the work is to compare vectorcardiographic (VCG) variables - spatial QRS-T angle and electrocardiographic ventricular gradient (VG) with echocardiography (EchoCG) data in patients with idiopathic pulmonary hypertension (IPH) and chronic thromboembolic pulmonary hypertension (CTEPH). Materials and methods. In 40 patients with IPH and 40 patients with CTEPH at the age of 45±12 years, systolic pulmonary artery pressure (SPAP); the sizes of heart chambers, parameters of RV systolic and diastolic function were evaluated with EchoCG. The QRS-T and VG angles were calculated on the VCG, derived from 12-lead digital ECG. Results. In all patients SPAP was greater than 40 mm Hg (mean 83±18 mm Hg), EchoCG data indicated hypertrophy and dilatation of RV, its systolic and diastolic function; dilatation of the right atrium (RA). Prognostically unfavorable changes in EchoCG were observed: the presence of pericardial effusion in 35 (44%) patients, RA area greater than 26 cm2 in 18 (23%) patients; TAPSE less than 1.5 cm in 37 (46%) patients. EchoCG and VCG variables had statistically significant differences in patients with III-IV functional class in comparison with I-II functional class. Statistically significant moderate correlations between VCG and EchoCG variables were revealed. VCG variables allowed to separate patient groups with the presence and absence of prognostically unfavorable changes in EchoCG with sensitivity from 54 to 78% and specificity from 66 to 87%. Conclusion. In patients with IPH and CTEPH, changes of QRS-T angle and VG correlate with SPAP, the size of RV and RA, parameters of RV systolic and diastolic function. The possibility of the use of QRS-T angle and VG for the detection of patients with prognostically unfavorable echocardiographic changes in the general group of patients with IPH and CTEPH has been shown.
Terapevticheskii arkhiv. 2019;91(3):11-16
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Clinical releveance of hemorrhagic component of endobronchial inflammation in severe chronic obstructive pulmonary disease exacerbation
Shteiner M.L., Zhestkov A.V., Babanov S.A., Biktagirov I.I., Protasov A.D., Kulagina V.V., Budash D.S., Zolotov M.O.
Abstract
Aim. The study aimed at investigating the relationship between severe exacerbations of chronic obstructive pulmonary disease and hemorrhagic component of endobronchial inflammation. Materials and methods. Clinico-endoscopic characteristics of 118 patients presenting with severe infectious exacerbation of chronic obstructive pulmonary disease, bloody expectorations and endoscopically confirmed hemorrhagic component of endobronchial inflammation have been analyzed. All patients underwent a series (5-6) of bronchoscopic examinations accompanied by collection of bronchoalveolar lavage specimens to reveal the presence of acid-resistant mycobacteria and to determine the bacterial flora. The exclusion criteria were the concomitant pulmonary or extrapulmonary pathologic conditions which could lead to hemorrhagic endobronchial manifestations. The other direction of the study was to investigate a correlation between jugulation of the exacerbation and dynamics of such endobronchial symptoms as mucosal edema and hyperemia, quality of bronchial secretions and hemorrhagic component of endobronchial inflammation. Results. All patients were found to have diffuse endobronchitis of severity grade II (39.83%) or III (60.17%) by Lemoine. The neoplastic and tuberculosis genesis of the hemorrhagic component of endobronchial inflammation and its clinical equivalent, the bloody expectorations, had been ruled out. In 50.85% of cases the hemorrhagic component of endobronchial inflammation could not be accounted for by hemolytic properties of cultured microorganisms. The mucosal edema and hyperemia remained stable during jugulation of the exacerbation. Unlike the improvement of quality of bronchial secretions, faster reversal of the hemorrhagic component of endobronchial inflammation showed statistical significance. Conclusion. The hemorrhagic component of endobronchial inflammation can represent a non-obligatory manifestation of severe exacerbation of chronic obstructive pulmonary disease, and its relief is the earliest endobronchial sign of incipient remission from severe COPD exacerbation.
Terapevticheskii arkhiv. 2019;91(3):17-21
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Endothelial dysfunction in patients with chronic obstructive pulmonary disease in combination with coronary heart disease
Karoli N.A., Rebrov A.P.
Abstract
Chronic obstructive pulmonary disease is associated with increased cardiovascular mortality. Endothelial dysfunction may underpin this association. Vascular endothelial dysfunction is known to be an important prognostic marker for cardiovascular events. The aim of this study was to evaluate the state of the vascular wall in patients with chronic obstructive pulmonary disease (COPD) combined with chronic coronary artery disease (CAD). Materials and methods. The study included 108 patients: 37 patients with COPD and CAD and 71 patients with COPD without CAD. Endothelial function was studied in tests with reactive hyperemia and nitroglycerin. The number of blood plasma desquamated endotheliocytes were determined by the Hladovec method. In patients with COPD identified are signs of vascular wall remodeling: thickening wall of the brachial artery, reduction of the flow-mediated vasodilation. Patients with COPD in combination with CHD demonstrated higher impairments of the vasoregulatory dysfunction of endothelial of the vascular wall. Conclusion. In patients with COPD combined with chronic coronary heart disease more pronounced endothelial dysfunction with disturbance of endothelium-dependent vasomotor reactions.
Terapevticheskii arkhiv. 2019;91(3):22-26
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Association of SOCS5 gene polymorphism with allergic bronchial asthma
Averyanov A.B., Chercashina I.I., Nikulina S.Y., Maksimov V.N., Shestovitskiy V.A.
Abstract
Aim: to study the association of mononucleotide polymorphism rs6737848 SOCS5 gene with the risk of development of allergic bronchial asthma. Material and methods. Totally 59 patients studied (19 males, 40 females) with allergic bronchial asthma and 50 healthy people (29 males, 21 females) of controls. All patients underwent clinical and instrumental and laboratory investigations in KICH №20 (Krasnoyarsk city) and molecular-genetic investigation of DNA in the Russia-Italian laboratory “MAGI” (Krasnoyarsk city) and Institution of Internal and Preventive Medicine (Novosibirsk city). Statistics included standard programs: Statistica for Windows 7.0. Results. The results of the study showed statistical predominance of prevalent genotype СС of SOCS5 gene in allergic bronchial asthma patients, comparing to control group. Conclusion. Homozygous genotype of СС gene of SOCS5 is a risk factor for allergic bronchial asthma.
Terapevticheskii arkhiv. 2019;91(3):27-30
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Destruction of the bronchial epithelium in patients with severe asthma according to different patterns of inflammation and cold airway hyperresponsiveness
Pirogov A.B., Gassan D.A., Zinov’ev S.S., Prikhodko A.G., Kolosov V.P., Perelman J.M.
Abstract
The aim of the research was to study the state of the bronchial mucosa epi-thelium in relation to the severity of clinical manifestations in severe uncon-trolled asthma depending on the pattern of inflammation and the presence of cold airway hyperresponsiveness. Materials and methods. In 48 patients with severe uncontrolled asthma, there were assessed asthma symptoms, clinical signs of cold airway hyperre-sponsiveness, and lung function; the samples of slides were analyzed in the cytological examination of the sputum; the degree of damage to epithelial cells and granulocytes was estimated using the total cell destruction index (CDI). Results. According to the analysis of sputum cytograms, the patients were divided into two groups: group I (22 patients) included persons with eosin-ophilic inflammation pattern (31.0±3.1% of eosinophils and 22.0±2.2% of neutrophils), group II (26 patients) was with mixed inflammation pattern (7.2±1.4 and 71.8±4.2%, respectively). The patients of group II had lower disease control according to Asthma Control Test (ACT; 12.1±0.7 and 17.8±0.2 points, respectively; р<0.05), a greater frequency of exacerbations (4.1±0.3 and 3.2±0.2 per year, respectively; р<0.05), greater incidence of clinical signs of cold airway hyperresponsiveness (79 and 19%, respectively; χ2=14.18; р<0.001); lower lung function (midexpiratory flow rate MEF25-75 was 14.6±1.6 and 20.7±1.9%, respectively; р<0.05); they received a higher dose of the combined medications of inhaled glucocorticosteroid in controller anti-inflammatory therapy (salmeterol/fluticasone at a dose of 705.3±19.7 and 650.7±14.8 µg/day for fluticasone propionate; р<0.05) In patients of group II the correlations of epithelial CDI with neutrophil CDI (r=0.61; p<0.01) and eosinophil CDI (r=0.48; p<0.05), as well as correlation of ACT with neutrophil CDI (r=-0.71; p<0.01) and eosinophil CDI (r=-0.53; p<0.05) were found. Conclusion. The degree of destruction of the epithelium and granulocytes in the inflammatory patterns has diagnostic relevance for the assessment of the severity of the disease, clinical manifestations of the airway response to the cold trigger, and the inertia of achieving control in patients with severe un-controlled asthma.
Terapevticheskii arkhiv. 2019;91(3):31-35
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Clinical efficacy of acute respiratory viral infections prevention in patients with chronic heart failure
Budnevsky A.V., Shurupova A.D., Kravchenko A.Y., Tokmachev R.E.
Abstract
The aim of the study was to evaluate the ARVI prevention effectiveness in patients with chronic heart failure (CHF) using interferon inducer amixin. Materials and methods. Conducted a comprehensive survey, dynamic monitoring and treatment of 60 patients aged from 49 to 70 years (mean age 60.25±4.57 years, 17 men and 43 women) with CHF with preserved ejection fraction of left ventricle (LVEF) (≥50%), II-III functional class (FC) according to the classification of new York Heart Association (NYHA), which developed as a result of coronary heart disease (CHD), hypertensive disease (HD). Of these, 30 patients (group 1) on the background of standard therapy for CHF received for the prevention of ARVI tiloron (Amixin) at a dose of 125 mg once a week for 6 weeks, two courses for 1 year. Group 2 patients received only standard therapy for CHF. Results. A decrease in the frequency of ARVI in patients with CHF treated with Amixin was found, which was accompanied by a decrease in the severity of subclinical inflammation by reducing the production of proinflammatory (IL-1β) and increasing the production of anti-inflammatory (IL-10) cytokines, reducing neurohumoral activation (reducing levels of aldosterone and Nt-proBNP), increasing the level of α- and γ-interferon. The positive dynamics of biomarkers of systemic inflammation and neurohormonal activation explains the improvement of the clinical course in patients with CHF (increase of tolerance to physical loads, reducing the number of visits to General practitioner and hospital admissions in the hospital during 12 months of observation). Conclusion. A promising approach to the prevention of SARS in patients with CHF is course therapy with Amixin (2 times a year before the seasonal rising in the incidence of respiratory viral infections and influenza), which allows to achieve both decreasing in the frequency of SARS per year, and improvement the clinical course of CHF.
Terapevticheskii arkhiv. 2019;91(3):36-41
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Combination of community acquired pneumonia with chronic obstructive pulmonary disease: clinical peculiarities, production of active oxygen forms, general antioxidant blood status
Farkhutdinov U.R., Amirova E.F., Farkhutdinov R.R.
Abstract
Aim. The objective is to study clinical peculiarities, production of active oxygen forms and general antioxidant blood status in patients with community acquired pneumonia and in its combination with chronic obstructive pulmonary disease. Materials and methods. 59 patients hospitalized in patient department took part in the study. The first group included 32 patients with community acquired pneumonia (CAP).The second group included 27 patients with combination of community acquired pneumonia and chronic obstructive pulmonary disease (CAP+COPD). Symptoms of the disease, clinico-laboratory data and findings of the instrumental investigations were analyzed in the patients. Production of active oxygen forms (AOF) in the whole blood was studied. General antioxidant status (AOS) was analyzed in the blood serum. Results and discussion. The values of prognostic CRB-65 scale and clinical index of the severity of the condition were higher in patients with CAP+COPD compared to the patients with CAP. The reduction of spontaneous and induced by pyrogenal chemiluminescence (ChL) of blood has been found in the patients; this fact indicates decreased production of AOF by the cells. In patients with CAP general AOS of the blood was found to be increased but in patients with CAP+COPD it was decreased. After the course of treatment in patients with CAP+COPD symptoms of the disease remained, the level of C-reactive protein in serum was high and the level of AOS of blood was low, disturbances in the AOF production were observed. Conclusion. In patients with CAP+COPD in comparison with CAP patients the intensity of clinical symptoms was higher, the inflammatory process had a prolonged character, disturbances in the production of AOF and AOS of blood were more marked.
Terapevticheskii arkhiv. 2019;91(3):42-45
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Features of the current of bronchial asthma in the presence of komorbidy allergic rhinitis
Zaripova T.N., Antipova I.I., Reshetova G.G.
Abstract
Aim - study of the influence of komorbidy allergic rhinitis (AR) on the course of bronchial asthma (BA). Materials and methods. Clinical research, single performed by a survey of 96 patients divided into two groups: the main - 73 patients with BA combined with AR and a group of comparison-23 patients who do not have allergic rhinitis. The data of clinic, bronchial passableness, level of control of asthma, severity of inflammation in bronhopulmonary region on content of nitrogen oxide in exhaled air and in nasal flushes of a number of biochemicals were studied in comparative aspect. Indicators, the manifestation of systemic inflammatory response according to biochemical, immunological indicators and calculated lejkocitarnym indices. Results. It is revealed that activity of inflammatory process in patients with BA without AR is higher both in the bronhopulmonary region and at the system level. At the same time in the period of clinical remission, most of them have sufficiently well functioning protective mechanisms on the part of the antioxidant system, humoral immunity, non-specific protection. Conclusion. When combined BA and AR inflammation at both local and system levels is less pronounced, but the activity of protective mechanisms decreases. In parallel to the growth of violations on the part of cell and humoralal links of immunity in the blood increases the content of Circulating immune complexes, which contributes to the torpor current of inflammation, which is the basis of a more significant violation of bronchial permeability and complicates achieve control of asthma. These changes increase as the duration of the disease both BA and AR, as well as frequency exacerbations of the disease.
Terapevticheskii arkhiv. 2019;91(3):46-50
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Indicators of immunological and hormonal research in patients with non-hospital pneumonia-liquidators of the Chernobyl accident after treatment
Selihova L.G., Borzykh O.A., Lavrenko A.V., Digtiar N.I., Gerasymenko N.D.
Abstract
The aim of the study is to study the state of the immunological and hormonal background in patients with non-hospital pneumonia (NP) - liquidators of the accident at the Chernobyl nuclear power plant (ChNPP) after treatment. Materials and methods. Patients with NP were divided into 2 groups of liquidators of the Chernobyl accident (main group), patients with NP who did not participate in liquidation of the Chernobyl accident (control group), which determined immunological parameters [CD3+, CD4+, CD8+, CD16+, CD20+ expressing cells, immunoglobulin concentrations (Ig) A, M, G] and hormonal indicators (antibodies to thyroglobulin, thyroglobulin, triiodothyronine, thyroxin, cortisol, insulin, testosterone, estradiol, estriol). The main group - liquidators of the Chernobyl accident in an immunological study of 32 NP patients, hormonal - 20; control group - respectively 37 and 38. Results. Combined therapy contributed to an increase in T-lymphocytes in the main and control groups, as well as T-suppressors (Tc) and T-helper cells (Tx), respectively (p<0.05). Also increased the content of B-lymphocytes, IgA, IgM, complement and phagocytic activity in the main and control groups. The ratio Tx/Tc decreased, also decreased IgG, load index, zero cells in the main and control groups.The study of hormonal background in patients with NP showed that the content of thyroglobulin after complex therapy in the main group increased, in the control group their content did not change. The content of triiodothyronine and thyroxine increased after treatment in the main group. In patients with NP of the control group, on the contrary, there was a decrease in thyroid function in terms of thyroglobulin. The study of sex hormones showed that the content of testosterone, estradiol, estriol in patients with NP of the main group increased after treatment, whereas in the control group there was a decrease in estradiol confidence, and testosterone level remained unchanged. The content of estriol increased (p<0.001) in the control group. The increased amount of insulin decreased (p<0.01) in the main group, whereas in the control group these indicators almost did not change. Conclusion. After complex therapy, immunological parameters in NP patients in both the main and control groups are normalized, however, recovery in the main group is slower, which requires continued immunological correction in the outpatient setting. Hormonal background approaching the norm more in patients with NP of the control group than the main one.
Terapevticheskii arkhiv. 2019;91(3):51-55
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Clinical efficacy of umifenovir in influenza and ARVI (study ARBITR)
Pshenichnaya N.Y., Bulgakova V.A., Lvov N.I., Poromov A.A., Selkova E.P., Grekova A.I., Shestakova I.V., Maleev V.V., Leneva I.A.
Abstract
In spite of vaccination was recommended by the World Health Organization, the main strategy of influenza is antiviral drugs treatment, one of which is umifenovir. Aim. The aim of the study is to obtain additional data on safety and therapeutic efficacy of the antiviral drug Arbidol (umifenovir) in patients with a diagnosis of influenza and common cold. Materials and methods. Double-blind, randomized, placebo-controlled clinical study investigating efficacy and safety of Arbidol (umifenovir) in Treatment and Prophylaxis of Influenza and Common Cold (ARBITR) IV phase started in November 2011 and completed in April 2016 on the basis of 15 research centers in various regions of the Russian Federation. A total of 359 patients, aged 18 to 65 years with influenza or acute respiratory tract infection, of no more than 36 hours' duration were enrolled in the study. Patients were randomized into two groups: a group of patients (therapy group) treated by Arbidol (umifenovir) at a dosage of 800 mg/day (2 capsules) for 5 days (n=181), and a group of patients receiving placebo 4 times a day for 5 days (n=178). The primary outcome measures of the study were the duration of clinical illness among patients with common cold and influenza/ARVI, the duration and severity of the main symptoms. Number of clinical complications associated with influenza and common cold was assessed as a secondary outcome. Safety was assessed by analyzing number of adverse events that are probably or definitely related to Arbidol, assessing vital signs, examining the physical condition of patients and general clinical laboratory parameters. Results. In the group treated by umifenovir, the number of full recover patients on the 4th day from the disease onset were significantly differed from the number of such cases in the placebo group. The number of cases of complete recovery after 96 hours was 98 patients (54.1%) and 77 (43.3%), p<0.05, and after 108 hours - 117 (64.6%) and 98 (55.1%), p<0.05. Duration of intoxication was reduced with umifenovir compared to placebo, amounted to 77.76 and 88.91 hours, respectively, p=0.013. The duration of all intoxication syndrome symptoms was also lower in the group receiving umifenovir. Thus, in the therapy group and placebo group, these parameters were respectively: fever duration - 67.96 and 75.32 hours (p=0.037), muscle pain - 52.23 and 59.08 hours (p=0.023), headache - 52.78 and 63.28 hours (p=0.013), weakness - 76.90 and 88.89 hours (p=0.008). The incidence of complications in the umifenovir group was 3.8%, in the placebo group 5.62%. Cases of acute tracheobronchitis was an increase in the placebo group (p<0.02). Umifenovir and placebo were well tolerated. A total of 42 cases of adverse events were registered in 11 patients in the treatment group and in 18 patients in the placebo group, which were not associated with umifenovir or placebo. Conclusion. The results of this study indicate umifenovir safety and confirm its effectiveness to the treatment of influenza and other acute respiratory viral infections in adult patients. It was found that effect of umifenovir in the treatment of influenza in adults is most pronounced in the acute stage of the disease and appears in the reduction of time to resolution of all symptoms of the disease, reducing the severity of symptoms of the disease.
Terapevticheskii arkhiv. 2019;91(3):56-63
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Difficulties in Goodpasture's syndrome diagnosing
Podzolkov V.I., Makhnach G.K., Ishina T.I., Ponomarev A.B., Medvedev I.D.
Abstract
The article analyzes the diagnosis and treatment of anti-GBM antibody disease (Goodpasture's syndrome) - a rare, severe progressive disease, associated with anti-glomerular basement membrane antibody-induced pulmonary hemorrhage and glomerulonephritis. The main problem of this pathology is late diagnosis, resulted in ineffective treatment. The article provides current information on the epidemiology, etiology and pathogenesis, diagnosis, and treatment of Goodpasture’s syndrome, as well as clinical case of a patient with this rare disease.
Terapevticheskii arkhiv. 2019;91(3):64-67
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High altitude pulmonary edema misdiagnosed as pneumonia
Sarybaev A.S., Maripov A.M., Muratali-Uulu K., Cholponbaeva M.B., Kushubakova N.A., Sydykov A.S.
Abstract
High altitude pulmonary edema (HAPE) is a relatively rare form of high altitude illness. However, without immediate treatment, HAPE is fatal. Furthermore, HAPE is characterized by non-specific signs and symptoms, and many clinical conditions may mimic it. In the present article, we report a case of HAPE misdiagnosed as pneumonia. We also discuss the issues of prevention and early treatment options in this illness.
Terapevticheskii arkhiv. 2019;91(3):68-70
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Cough: the evolution of views and modern approaches to an objective assessment
Budnevskiy A.V., Ovsyannikov E.S., Shkatova Y.S., Rezova N.V.
Abstract
The article is a review of literature, that provides information on ways to assess cough, how those ways have improved over recent years, the latest data in the field of an objective assessment of cough and the possibility of its use in scientific and clinical practice. Search for articles was carried out in such databases as Pubmed, CyberLeninka, RSCI in English and Russian.
Terapevticheskii arkhiv. 2019;91(3):71-75
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New opportunities of dual bronchodilation therapy for patients with chronic obstructive pulmonary disease
Avdeev S.N., Trushenko N.V.
Abstract
Currently, combinations of long-acting beta2-agonists and long-acting anticholinergics are considered as the basic therapy for majority of patients with chronic obstructive pulmonary disease (COPD). These combinations have different pharmacological characteristics and delivery devices that provides different clinical effects and new opportunities for personalized treatment of COPD. Aclidinium/formoterol fixed combination differs from other dual bronchodilators by twice-daily dosing regimen, good safety profile and a specific delivery system. Recent information on clinical efficacy and safety of aclidinium/formoterol combination in COPD patients is given in this article.
Terapevticheskii arkhiv. 2019;91(3):76-85
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Possibilities of ultrasound research of the diaphragm
Nekludova G.V., Avdeev S.N.
Abstract
The ultrasound method is a non-invasive and safe diagnostic method. Ultrasound examination (ultrasound) of the diaphragm allows you to conduct a direct study of its structure and function. Using stationary and portable ultrasound scanners, the study of the diaphragm can be carried out in specialized laboratories, in outpatient departments, in various departments of the clinic, including in intensive care units, in patients in different clinical conditions. Ultrasound of the diaphragm can be implemented on devices of different technical levels. Despite the fact that at present the diaphragm ultrasound method is not standardized, nevertheless, it provides clinically important information for solving various clinical studies, including when conducting dynamic observation.
Terapevticheskii arkhiv. 2019;91(3):86-92
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Respiratory muscles dysfunction and respiratory diseases
Geltser B.I., Kurpatov I.G., Dej A.A., Kozhanov A.G.
Abstract
This review presents an analysis of the literature on the topic of respiratory muscle (RM) dysfunction in various forms of respiratory pathology: chronic obstructive pulmonary disease (COPD), asthma, community-acquired pneumonia, idiopathic pulmonary fibrosis (IPF), sarcoidosis and interstitial lung diseases (ILD), associated with systemic connective tissue diseases (polymyositis, dermatomyositis and systemic lupus erythematosus - SLE). Various clinical and pathophysiological aspects of RM dysfunction and general patterns of its pathogenesis were examined. It was proved that the role of RM in the development of respiratory failure depends on the form and stage of the pulmonary pathology and the severity of systemic manifestations of these diseases: excessive proteolysis, oxidative stress, hypoxia, chronic systemic inflammation. These factors modify the morphofunctional status of RM, worsens their contractile function, which is contributed to the development of respiratory failure. In some cases, the primary weakness of RM precedes the clinical manifestation of pulmonary pathology, which is distinctive for some variants of myositis-associated ILD and SLE. Endogenous intoxication syndrome plays a significant role in the development of RM dysfunction during community-acquired pneumonia. It is noted that sarcoid pulmonary ventilation disorders associate with the RM weakness, but not with the degree of lung damage. In most cases, secondary RM dysfunction predominates that contributes to respiratory failure progression, which is especially noticeable in case of COPD, asthma and IPF.
Terapevticheskii arkhiv. 2019;91(3):93-100
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Multidisciplinary approach in the diagnosis of idiopathic nonspecific interstitial pneumonia
Ovcharenko S.I., Son E.A., Kapustina V.A.
Abstract
The article provides a modern classification of interstitial lung diseases. The focus is on the poorly studied and difficult to diagnose idiopathic nonspecific interstitial pneumonia, isolated in a separate nosological form and included in the classification only in 2002. The paper presents the features of the clinical, radiological, histological picture of idiopathic nonspecific interstitial pneumonia in comparison with idiopathic pulmonary fibrosis. The presented materials are based on the results of the largest study conducted by the working group of the American Thoracic Society, which shows the importance of the interaction of specialists in the diagnosis of idiopathic nonspecific interstitial pneumonia. A comprehensive assessment of the examination of patients conducted in collaboration with the clinician and radiologist, after their cooperative discussion, in many cases can help to avoid lung biopsy, and the study of morphological material is more often necessary only in difficult diagnostic situations.
Terapevticheskii arkhiv. 2019;91(3):101-106
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Pneumoconiosises: modern view
Babanov S.A., Strizhakov L.A., Lebedeva M.V., Fomin V.V., Budash D.S., Baikova A.G.
Abstract
The article is devoted to the actual problem - dust diseases of the lungs. The peculiarities of occurrence and course of pulmonary lesions that have a significant place in the overall structure of occupational morbidity are considered. Modern approaches to treatment, diagnostics and prevention issues in pneumoconiosis are discussed.
Terapevticheskii arkhiv. 2019;91(3):107-113
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Expert Council resolution on pulmonary arterial hypertension (PAH) "Changing the paradigm of treating patients with pulmonary arterial hypertension"
Chazova I.E., Martynyuk T.V.
Abstract
On behalf of the team of co-authors
Terapevticheskii arkhiv. 2019;91(3):114-116
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