Background.Granulocyte myeloperoxidase (MPO) play an important role in the link between the oxidative stress and inflammation that maintain airway hyperresponsiveness.We aimed to assess the relationship between the level of myeloperoxidase activity of granulocytes, the accumulation of oxidatively modified lipids in the bronchi, and cold airway hyperresponsiveness in patients with different inflammation phenotypes of asthma.Methods.116 patients with asthma (mean age 43.2±0.8years; ACT 13.2±0.27points; FEV 1 86.6±1.0%)underwent testing of lung function (FEV 1 ,%), airway response (ΔFEV 1 ) to 3-minute isocapnic hyperventilation with cold (-20°C) air (IHCA).The cellular composition (%) of induced sputum (IS) and myeloperoxidase (MPO) activity were studied.The concentration of the products of lipid peroxidation in the expired breath condensate was studied using the ultraviolet absorption spectra of lipid extracts using Unico 2804 spectrophotometer.The concentration of diene conjugates was estimated in units of optical density at 233 nm (E233), conjugated trienes (ketodienes) at 278 nm (E278), and the absorption of unoxidized lipids at 206 nm (E206).The lipid oxidation indexes was calculated as the ratio of absorption E233/206 and E278/206.Results.The patients were divided into two groups depending on the number of neutrophils in the IS (less or over 40%): group 1 included 52 people (neutrophils 23.2±0.84%,eosinophils 21.2±1.4%), group 2 -64 people (neutrophils 54.1±1.4%,eosinophils 14.3±1.4%).Patients had no differences in FEV 1 and the frequency of cold airway hyperresponsiveness.In patients of group 2, the increase in the number of neutrophils correlated with a more pronounced airway reaction (ΔFEV 1 ) to the IHCA (r=-0.18,p=0.047), and with an increase in the MPO in IS (r=0.47;p=0.0001).A higher concentration of MPO in group 2 (135.9±12.1 vs. 81.7±3.6,p=0.00001) showed an intensification of the synthesis and activation of the enzyme excretion into the extracellular space.The level of diene conjugates E233 in group 2 compared with group 1 was significantly higher (0.10±0.03 vs. 0.04±0.006,p=0.013), as was E233/206 (0.37±0.06 vs 0.19±0.03,p=0.028).A close relationship was found between E278/206 and airway response (ΔMEF 25-75 ) to the IHCA (r=0.39;p=0.017).Conclusion.In patients with uncontrolled asthma, an increase in the number of neutrophils in sputum leads to an increase in the peroxidase activity of granulocytes, associated with the activation of lipid peroxidation and an increase in the response of the respiratory passages to exposure to cold.

Introduction. Hypoalimentation with the formation of protein-energy malnutrition can reduce the body’s resistance to acute respiratory infections (ARI). Soy and pumpkin can be a promising source of normalization of the diet.Aim. To study the effectiveness of the use of soybean-pumpkin products in the diet of healthy people to increase the resistance of the human body to ARI.Materials and methods. An open, randomized, parallel group study was conducted. Group 1 included 18 people who took a soy-pumpkin drink and dessert for 10 weeks in addition to their usual diet. Group 2 included 17 people on a regular diet. The concentration of vitamin E, cholesterol, α- and β-lipoproteins was determined in blood serum. Diene conjugates and unoxidized lipids were determined in the expired air condensate (EAC) by means of spectrophotometry. Lung function was assessed using spirometry.Results. According to the questionnaire survey, 50% of the participants in group 1 registered a positive dynamics from the regular use of soybean-pumpkin products. Only one participant underwent ARI. In the 2nd group, 7 people (41%) applied for medical help (χ2=4.43; p˂0.05), of which 6 (35%) had ARIs. At the end of the observation, an increase in vitamin E (from 34.1±0.68 to 36.4±0.55 μg/mL, p=0.0036), a decrease in total cholesterol (from 4.85±0.23 to 4.32±0.14 mmol/L, p=0.0013) and β-lipoproteins (from 2.92±0.24 to 2.31±0.18 mmol/L, p=0.0003). At the beginning of the study, in individuals of group 1, there was a relationship between age and the concentration of total cholesterol (r=0.50; p=0.036) and β-lipoproteins (r=0.47; p=0.048), as well as the weight and level of α-lipoproteins (r=-0.49; p=0.041), the concentration of unoxidized lipids (r=0.55; p=0.02), diene conjugates (r=0.48; p=0.043) in EAC. After regular use of soybean-pumpkin products, this correlation dependence was lost.Conclusion. Regular use of soy-pumpkin products for 10 weeks has a beneficial effect on the lipid profile of the blood, increases antioxidant defence, and reduces the susceptibility of a healthy person to ARI.

AIM:To study effectiveness of the use of the anti-leukotriene drug montelukast in combination with inhalation glucocorticoid and long-acting beta-agonist in patients with bronchial asthma (BA) and cold-induced bronchial hyperactivity (CBHA) with a view to optimizing control of the disease.MATERIALS AND METHODS:We carried out an open comparative prospective study of patients with persistent BA in a cold season under conditions of real clinical practice. The patients were divided into 2 groups. Group 1 included patients with CBHA, group 2 consisted of subjects with constant bronchial reactivity in response to cold in the standard provocative test. The patients were followed up for 24 weeks. During the first 12 weeks of the treatment, the patients of group I were given sodium montelukast with budesonide/formoterol. In the next 12 weeks they received only budesonide/formoterol at the same dose. Patients of group 2 were treated with budesonide/formoterol during the entire study period. Efficacy of therapy was assessed by asthma control test (ACT).RESULTS:Control of BA in group 1 (20-25 scores in A CT) was achieved in 83% of the patients within the first 12 week period The result was comparable (87%) with that in group 2. Impairment of control (to 52%) was documented in group I during the last 12 weeks although it was preserved (20-25 scores) in group 2 (81%).CONCLUSION:The use of sodium montelukast in combination with budesonide/formoterol for the treatment of BA with CBHA in winter season ensured control of the disease in most patients during 12 weeks. Withdrawal of montelukast in the subsequent period leads to the loss of control and a rise in the frequency of exacerbation.

Цель работы состояла в определении прогностического значения мукоцилиарной недостаточности (МЦН) в контроле течения бронхиальной астмы (БА), разработке модели прогнозирования уровня фармакотерапевтического контроля астмы. В течение 48 нед. 92 больных БА получали базисную терапию в соответствии с GINA. У всех пациентов исходно и по окончании наблюдения определялись параметры интегрального показателя мукоцилиарного клиренса методом динамической ингаляционной пульмоносцинтиграфии, проводилась бронхоскопия, комплексное морфофункциональное исследование бронхобиоптатов слизистой оболочки бронхов, изуче ние вязкоэластических свойств трахеобронхиального секрета. Установлено, что деятельность мукоцилиарной системы может являться одним из факторов, определяющих достижение контроля БА. Вероятность развития неконтролируемой астмы у больных с МЦН в 3 раза выше, чем у пациентов с отсутствием МЦН. У 60 % больных с неконтролируемой астмой определяется МЦН и II-III степени, которая является существенным прогностическим фактором развития резистентности к стандартной базисной терапии. Предполагаемый уровень фармакотерапевтического контроля астмы можно прогнозировать по исходным значениям интегрального показателя муко цилиарного клиренса или тесно связанным с ним параметрам активности эндобронхита, частоты биения ресничек мерцательного эпителия бронхов, вязкоэластических свойств трахеобронхиального секрета. К использованию в клинической практике предлагаются вероятностные прогнозные модели, основанные на решении дискриминантных уравнений.

Functioning of mucociliary system (MCS) including integral rate of tracheobronchial mucociliary clearance (MCC) using dynamic perfusion-lung scanning, ciliary activity in bronchial biopsy specimens and viscous and elastic properties of bronchial mucus was studied in 128 patients with chronic obstructive pulmonary disease (COPD). Of them, 90 % had mucociliary insufficiency (MCI), the intensity of which was in direct proportion to the disease severity. Development of MCI was caused by decrease in ciliary beat frequency, increased viscosity of bronchial mucus and active inflammation identified during bronchoscopy. While considered correlations between these parameters and integral rate of MCC, a method for detection of MCI has been proposed based on the solution of a discriminant equation; this method allows diagnosing MCI with 81 % of probability. Changes of MCC rate were investigated in a 6-wk prospective comparative randomized controlled trial in 69 patients with stage II COPD under different therapies according to GOLD recommendations. As a result, functional MCI was improved in 14 of 29 patients (48 %) receiving standard therapy during exacerbation and in stable condition, whereas similar improvement was reached in 28 of 40 patients (70 %) who additionally took long-acting anticholinergic drug tiotropium bromide 18 μg daily. Other 12 patients (30 %) had a weak response of MCC to tiotropium bromide due to low baseline MCC rate. A method predicting effect of tiotropium bromide on MCI in patients with stage II COPD using baseline MCC rate and a discriminant equation has been proposed.