Our aim was to investigate an effect of salbutamol on bronchial obstruction, lung hyperinflation and clinical signs in patients with severe chronic obstructive pulmonary disease (COPD). Thirty three COPD patients (the average age was 58±2 yrs, FEV 1 was 27.2±1.9%, FEV 1 /FVC was 33.7±1.6%) were examined using spirometry, body plethysmography; the breathlessness intensity was evaluated with a visual analogue scale (VAS), the exertion tolerance was assessed by 6-min walk test (6MWT) before and 15-20 min after inhalation of salbutamol. There was a significant increase both in FVC and FEV 1 (10±2% and 4±1%, p<0.0001) after 200 meg of salbutamol but FEV 1 /FVC ratio decreased by 0.6%. Salbutamol caused the reliable growth of lung volume values (VC, RV, FRC and IC changed by 9±1%, -18±3%, -9±1% and 9±1%, p<0.0001 for each). TLC did not change significantly (8.45±0.25 and 8.41 ±0.26 L). There was a considerable reduction in the breathlessness severity as measured by the VAS score (4.9±0.4 to 3.9±0.3, p<0.0004) and an increase in the exertion endurance (from 63% pred. to 66% pred., p<0.0065). Correlations were found between the clinical signs severity and the lung hyperinflation. Our data demonstrated that salbutamol caused a significant reduction in FRC and an increase in IC notwithstanding the absence of FEV 1 , dynamics in majority of the COPD patients. The lung hyperinflation dynamics resulted in the breathlessness relief and the improvement of the exertion tolerance.

Persons exposed to inhaled radionuclides are at high risk for lung cancer, primarily, due to lung fibrosis development. This work studied lung fibrotic changes and lung cancer genetic markers in liquidators of the Chernobyl accident consequences. The study involved 33 men worked at the Chernobyl station area in 1986-1987, aged from 37 to 65 years (average 45.45±0.95; M±m ), and 10 control group men comparable on the age, hazards, social and occupational status, lung pathology, but had never exposed to radiation. Lung function tests, fibreoptic bronchoscopy, histological examination of lung and bronchi tissues biopsy specimens, and lung computed tomography were performed. Oncogene c-myc , Ki -67 proliferation marker, and a deletion in the short arm of the chromosome 3 were investigated in the bronchial epithelium. The lung fibrosis was detected in 13 (42.4%) liquidators and in no-one of the control group. The liquidators also had more bronchial epithelium dysregenerative changes with significant prevalence of basement cell hyperplasia (0.58±.09 and 0.2±0.13 cases in the groups accordingly, p <0.05). Meanwhile the control group had no mild dysplasia at all and demonstrated severe dysplasia rather more frequently (0.2±0.13 vs 0.06±0.04 in the liquidators, p <0.05). The liquidators showed the 3p deletion in the bronchial epithelium cells more often (0.21±0.07 and 0.1±0.1 accordingly, p <0.05) and tended to show other genetic lung cancer markers quite more frequent either. The correlation was found between the lung fibrosis and 3p deletion presence ( r =0.45, p <0.05) and also between a pneumonia number anamnestically and Ki -67 expression in the liquidators’ group ( r =0.46, p <0.05). The second patients’ group did not demonstrated such the correlaions. Thus, chronic respiratory pathology liquidators develop lung fibrosis earlier than other patients with the similar lung pathology. Basement cell hyperplasia and some oncogenes ( 3p deletion, c-myc ) encounter considerably more often in liquidators that likely to be poor prognostic signs for lung cancer occurrence. Therefore, the Chernobyl accident liquidators are at higher risk for lung cancer compared to the similar lung pathology patients without radiation exposure

The study was designed to investigate pulmonary haemodynamics and to evaluate its role in dyspnoe occurrence in Chernobyl clean-up workers suffering from chronic bronchitis. The study involved 38 Chernobyl patients with chronic bronchitis observed in 2000-2002. The mean age was 48.1 ±5.1 yrs, their smoking history was 18.0±12.7 pack-yrs. A severity of dyspnoe was evaluated with the MRC questionnaire; body plethysmography, lung diffusing capacity test, 6 -MWT, echocardiography, bronchoscopy with transbronchial lung tissue biopsy were also performed. Results demonstrated that pulmonary hypertension develops in Chernobyl workers even without respiratory functional disorders. This fact is probably due to incorporation of radionuclide dust particles to the lungs and occurrence of radiation-induced pulmonary vasculitis. The elimination of the dust particles out of the respiratory system is thought to delay the pulmonary hypertension development.

Background: Small airway dysfunction (SAD) is a functional hallmark of chronic obstructive pulmonary disease (COPD). However, SAD prevalence and its role in COPD pathophysiology are not yet sufficiently studied.Background: Small airway dysfunction (SAD) is a functional hallmark of chronic obstructive pulmonary disease (COPD). However, SAD prevalence and its role in COPD pathophysiology are not yet sufficiently studied.Aim: To assess the prevalence of SAD in COPD patients by various functional diagnostic methods, such as spirometry, body plethysmography, and impulse oscillometry (IOS).Materials and methods: This was an cross-sectional study. Spirometry, body plethysmography and IOS were used in 132 COPD patients in remission under standard anti-COPD treatments. The presence of SAD was confirmed by at least one of the following criteria or their combination: 1) by spirometry: the difference between vital capacity (VC) and forced vital capacity (FVC) > 10%; 2) the presence of air trapping by body plethysmography; 3) identification of the frequency dependence of the resistive resistance at 5 to 20 Hz (R5 - R20 > 0.07 kPa x s/l), as assessed by IOS.Results: Mean forced expiratory volume in 1 s (FEV1) was 42.9% of predicted. Depending on the severity of the obstruction, the patients were divided into 4 groups: 7 patients (group 1) had the obstruction corresponding to GOLD 1 stage, 37 (group 2) to GOLD 2, 49 (group 3) to GOLD 3, and 39 (group 4) to GOLD 4. SAD was found in 96% of COPD patients, whereas in those with severe obstruction (GOLD 3-4), it was present in 100% of the cases. By spirometry, SAD was identified only in 67% of COPD patients, by body plethysmography in 75% of COPD patients (in those with severe obstruction (GOLD 3 and 4) in 88 and 97%, respectively). With IOS, it was possible to identify SAD in 94% of patients and in 100% of those with severe obstruction (GOLD 3-4).Conclusion: With deterioration of obstructive pulmonary ventilation abnormalities in COPD patients, there is a progressive increase in small airway dysfunction. Impulse oscillometry seems to be the most effective method for diagnosis of small airway dysfunction, as it helped to identify SAD in 94% of COPD patients and in 100% of those with severe and very severe obstruction.

Impulse oscillometry (IO) is an innovative method of diagnosing respiratory mechanics. However, there are many unexplored and contentious issues concerning changes in IO parameters, particularly in chronic obstructive pulmonary disease (COPD). The aim of the study was to compare IO with traditional pulmonary functional methods and to study its possibilities for diagnostics of respiratory mechanics disorders in patients with COPD. Methods. A cross-sectional cohort study was carried out, which included patients with COPD (n = 146: 137 (94%) men, 9 (6%) women; average age – 65 ± 9 years) from 2 medical institutions of Moscow – Acad. N.N.Burdenko The Main Military Clinical Hospital, Ministry of Defense and Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia . Patients were divided into 4 groups depending on the severity of COPD according to the criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD): stage I was diagnosed in 8 patients, stage II – in 43, III – in 54, IV – in 41. The parameters of IO (resistive resistance at an oscillation frequency of 5 Hz ( R rs5 ) and 20 Hz ( R rs20 ), ( R rs5 – R rs20 ), reactive resistance at an oscillation frequency of 5 Hz (Xrs5), area of reaction (A X ), resonance frequency (f res ) are analyzed; spirometry – forced expiratory volume in the 1st second (FEV 1 ), forced vital capacity (FVC) and FEV 1 /FVC; Body plethysmography (total lung capacity, intrathoracic gas volume, residual volume, total respiratory resistance), lung diffusion capacity. Results. The parameters of IO ( R rs5 , R rs5 – R rs20 , A X , ΔXrs5, and f res ) progressively increased from stage I to stage IV (GOLD) of airway obstruction, while statistically significant changes of R rs20 were not detected. The parameters of the traditional methods of investigation of respiratory mechanics and IO were mainly moderately and strongly correlated. Conclusion IO can be used as an alternative method for assessing respiratory mechanics in COPD.

The aim of this study was to analyze lung function in athletes involved in endurance winter sports. Methods. Lung function was measured in 50 athletes including 30 skiers and 20 speed-skaters (24 men and 26 women aged 17 to 33 years; average age, 24.7 ± 3.8 years) using spirometry, body plethysmography and diffusion test. A control ageand sex-matched group consisted of medical students and junior physicians. Results. Lung function in athletes, both skiers and skaters, was significantly higher compared to that of the control group and to reference values (ECSC, 1993). The lung function was not related to the athletes' age. In the total group, the athletes' performance was significantly related to lung volume values (rank correlation). Conclusion. Thus, lung function of the athletes involved in winter sports, such as skiing and speed skating, and focused to building the physical endurance, is higher than in general population. The standard approach to interpretation of pulmonary function test results is based on a comparison of actual and reference values. This can lead to misdiagnosis of lung function impairments.

The aim of this study was to analyze lung function in athletes involved in endurance winter sports. Methods. Lung function was measured in 50 athletes including 30 skiers and 20 speed-skaters (24 men and 26 women aged 17 to 33 years; average age, 24.7 ± 3.8 years) using spirometry, body plethysmography and diffusion test. A control age- and sex-matched group consisted of medical students and junior physicians. Results. Lung function in athletes, both skiers and skaters, was significantly higher compared to that of the control group and to reference values (ECSC, 1993). The lung function was not related to the athletes' age. In the total group, the athletes' performance was significantly related to lung volume values (rank correlation). Conclusion. Thus, lung function of the athletes involved in winter sports, such as skiing and speed skating, and focused to building the physical endurance, is higher than in general population. The standard approach to interpretation of pulmonary function test results is based on a comparison of actual and reference values. This can lead to misdiagnosis of lung function impairments.

The aim of this study was to evaluate changes in lung ventilation and lung diffusing capacity (DLCO) of cystic fibrosis (CF) patients during 1 year after lung transplantation. Methods. Complex lung function was monitored in CF patients underwent bilateral lung transplantation in 2012 – 2016. Results. CF patients (n = 12; mean age, 26.4 ± 4.4 years) were included in the study. Median follow-up after the lung transplantation was 19 (12–57) months. Consistent improvement in lung function parameters and DLCO was observed in 3 months after lung transplantation and maintained during 1 year. The ratio of forced expiratory volume in 1 sec to forced vital capacity was higher the normal level and the bronchial resistance was lower the cut-off values, i.e. the patients did not have bronchial obstruction. The total lung capacity (TLC) decreased to normal according to the anthropometric characteristics of the recipient. Meanwhile, change in the TLC structure, such as non-significant reduction in the vital capacity (VC) together with increase in the functional residual capacity (FRC), residual volume (RV) and RV/TLC ratio, have been developed. Consistent increase in FRC and RV could be explained by changes in the shape and the elasticity of the chest wall after the surgery. DLCO also improved, but was still slightly decreased. Conclusion. The lung function and DLCO improved in a year after bilateral lung transplantation in CF patients. Effects of different factors on postoperative lung function parameters need to be further investigated.

Summary .The study investigated duration of treatment effect of monoclonal anti-IgE-antibodies (omalizumab) after discontinuation of the therapy in asthma patients. The study involved 23 patients treated with monoclonal anti-IgE-antibodies. Daytime and nighttime asthma symptoms, need in rescue medications, daily dose of inhaled steroids (ICS) in beclomethasone equivalents, FEV1, allergy skin tests, quality of life according to AQLQ questionnaire, and asthma control level according to GINA, 2006, were analyzed. Patient-reported control of asthma was evaluated using the Asthma Control test (ACTФ). In 2 months after discontinuation of therapy with monoclonal anti-IgE-antibodies, increase in daytime and nighttime asthma symptoms, need in rescue medications and daily doses of ICS, worsening in asthma control, increase in skin hyperreactivity to domestic and epidermal allergens, and decrease in quality of life were found (all statistically significant). Therefore, the results have shown that monoclonal anti-IgE-antibodies could be administered in discrete regimen; this would allow reduction in frequency of the patient's visits to clinic and in cost of treatment.

Было проведено 12-месячное исследование эффективности и безопасности применения омализумаба (Ксолар) у больных с тяжелой неконтролируемой атопической бронхиальной астмой (БА). В исследовании принимали участие 46 больных. Пациенты были распределены на 2 группы. 1-я группа получала омализумаб в дополнение к базисной терапии, 2-я группа (сравнения) получала только базисную терапию. В ходе исследования анализировались такие показатели, как частота дневных и ночных симптомов, потребность в препаратах неотложной помощи, суточная доза ингаляционных глюкокортикостероидов (иГКС) в пересчете на беклометазона дипропионат, частота обострений и госпитализаций, внеплановых визитов к врачу, качество жизни (по опроснику AQLQ), показатели спирометрии. Уровень контроля БА определялся согласно критериям GINA 2006 г. В ходе исследования в 1-й группе больных наблюдалось статистически значимое, по сравнению с исходными показателями и показателями во 2-й группе, снижение частоты дневных и ночных симптомов БА, потребности в ингаляциях #b2-агонистов короткого действия, суточной дозы иГКС, частоты обострений БА, госпитализаций и числа внеплановых визитов к врачу. Отмечено также статистически значимое улучшение показателей качества жизни, по опроснику AQLQ, и показателей функции внешнего дыхания у больных в 1-й группе. Нежелательные явления, отмеченные в ходе исследования в группе пациентов, получавших лечение омализумабом, были сравнимы с нежелательными явлениями в группе контроля и не потребовали отмены препарата. Таким образом, добавление омализумаба к базисной терапии у больных с тяжелой неконтролируемой атопической БА позволяет эффективно улучшить контроль над заболеванием, снизить суточную дозу иГКС, а также улучшить качество жизни пациентов.

The study was designed to assess clinical efficacy and tolerability of new non-freon aerosol of troventol. The study involved 20 patients (4 males and 16 females) with intermittent or mild persistent stable asthma aged 22 to 67 yrs, the average age, 44.3 ± 11.1 (М ± SD). Anticholinergic effect of troventol was assessed under a single inhalation of the drug (the acute test) which was the 1-st stage of the study, and after long-term (4 wks) treatment which was the 2-nd stage. Clinical efficacy was evaluated by Borg's scoring of cough and dyspnoea, lung and heart auscultation, need in short-acting beta-2-agonists. The acute test included the metacholine challenge test before and 3 hrs after inhalation of 80 mcg of troventol or placebo. The long-term treatment stage included the metacholine challenge test before and in 4 weeks of daily inhalations of 160 mcg of troventol. As a result, the new non-freon aerosol of troventol demonstrated distinct brochodilating and anticholinergic effects which significantly differed from placebo in patients with intermittent or mild persistent stable asthma. Being administered for a long period (4 wks) the drug improved cough and dyspnoea and reduced the need in short-acting beta-agonists while bronchial airflow parameters did not change considerably. There were no adverse events of the therapy during the study.

Severe cough associated with COPD can induce dynamic instability of trachea. It is important to investigate large airways in COPD patients and to create diagnostic program for evaluation of this dynamic changes. Aim: to investigate sensitivity and specificity of different methods for detection of dynamic tracheal instability in COPD patients. Of fifty five patients involved in this study 30 ones were selected according to inclusion criteria. They were divided into 2 groups: 20 COPD stage 2 patients with dynamic tracheal instability detected by fiberoptic bronchoscopy (the 1-st group; 14 females, 6 males; the mean age, 60.9 ± 7.9 yrs; BMI, 28.2 ± 4.3 kg / m2; the smoking history, 35.4 ± 5.2 pack-year) and 10 COPD stage 2 patients without dynamic tracheal instability according to fiberoptic bronchoscopy findings (the 2nd group; 2 females and 8 males; the mean age, 55.2 ± 4.8 yrs; BMI, 26.8 ± 2.6 kg/m2; the smoking history, 28.2 ± 3.4 pack-year). Clinical examination, flow-volume curve, body plethysmography, impulse oscillometry, X-ray examination of trachea, fiberoptic bronchoscopy, and electron-beam tomography were used in our work. As a result, the most sensitive functional method was impulse oscillometry (Se = 85 %). Electron-beam tomography is more sensitive (Se = 90 %) than X-ray examination of trachea (Se = 65 %) while diagnosing dynamic tracheal instability in the COPD patients.

Application of a modern method of introscopy - electroimpedance tomography (EIT) for diagnosis of different types of lung diseases is described. The EIT system including measurement and collecting data devices, 16-electrodes array and IBM PC 486 computer was used. The results of analysis of electrotomograms have demonstrated that the EIT-system can be introduced for detecting abnormal lung fluid levels, pulmonary edema, diagnosis of lung cancer, emphysema, pleuritis, hydrothorax, sarcoidosis. The method provides high sensitivity to the changes in the body physiological state. Other advantages are: safety, fast measurements, ease of equipment transportation and maintenance, low cost.

Application of a modern method of introscopy--electroimpedance tomography (EIT) for diagnosis of different types of lung diseases is described. The EIT system including measurement and collecting data devices, 16-electrodes array and IBM PC 486 computer was used. The results of analysis of electrotomograms have demonstrated that the EIT-system can be introduced for detecting abnormal lung fluid levels, pulmonary edema, diagnosis of lung cancer, emphysema, pleuritis, hydrothorax, sarcoidosis. The method provides high sensitivity to the changes in the body physiological state. Other advantages are: safety, fast measurements, ease of equipment transportation and maintenance, low cost.