AIM:To evaluate the efficacy of mechanical bacterial lysate on the prevention of infectious exacerbations of chronic obstructive pulmonary disease in patients with frequent exacerbations.MATERIALS AND METHODS:The study included patients (n=60) with frequent exacerbations of COPD (groups C and D according to the GOLD classification). All COPD patients were divided into two groups by blind method. The first group (n=30) received conventional therapy for COPD plus MBL (the course included 3 cycles of 10 days therapy with 20-day intervals between them). The second group of patients (control, n=30) received conventional therapy for COPD without MBL.We evaluated the severity of symptoms, frequency of recurrence of COPD exacerbations, readmissions, need for emergency care and changes in basic therapy of COPD. Evaluations were done on 10 days, 1, 3 and 6 months from the start of the study.RESULTS:Adding of MBL to the therapy list of COPD resulted in a significant decrease of biomarkers of systemic inflammation and sputum purulence during compared to the control group. After 6 months of observation MBL group demonstrated statistically significant improvement of respiratory function, decrease in frequency of COPD exacerbations, needs for emergency medical service, reduced changes in basic therapy and hospitalization for exacerbation of COPD. Therapy with MBL showed a high degree of safety and low incidence of adverse events.CONCLUSION:The results of the study indicate that MBL may be used for the prevention of severe infectious exacerbations of COPD.

In order to optimize the therapy, the functional state of the pancreas (P) and the peculiarities of metabolic activity of intestinal microbiota in adults with cystic fibrosis (CF) were assessed. Materials and methods. 14 CF patients (20-34 years, 7 men, 7 women) were enrolled. In 8 patients, the diagnosis was confirmed in the first year of life on the basis of clinical data, positive sweat test, 5 had genetic confirmation. In 4 patients, the diagnosis was confirmed at the age of 8-13 years and 2 patients aged 18, 27 years. In this group, genetic confirmation was in 4 subjects. In addition to general clinical studies, the level of C-peptide in blood, elastase and the concentration of short chain fatty acids in feces was determined. Results and discussion. Of elastase feces in 9 patients was 5.5±4.7 icg/g, that is revealed severe exocrine insufficiency of the pancreas and in 5 patients the elastase level was normal and amounted to 402±124 icg/g. Deployed the clinical picture of diabetes mellitus was observed in 3 patients. Metabolic activity of the colon microflora as a whole was reduced, the sum of the concentration of short-chain fatty acids (ΣCn) was 6.03±4.11 mg/g at a rate of 10.61±5.11 (p

Summary. The aim of this study was to evaluate diagnostic and prognostic values of heart injury biomarkers heart-type fatty acid binding protein (H-FABP) and troponin I (Tn I) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This was a prospective observational study. We enrolled 80 hospitalized patients with AECOPD (67 males, 13 females; age, 64.2 ± 7.8 years, BMI 25.8 ± 8.8 kg / m2). These patients underwent a complex diagnostic investigation including chest radiography, pulmonary function tests, echocardiography and measurement of serum Tn I (Biomerica), H-FABP (Hycult Biotech) and BNP-fragment (Biomedica). The main causes of AECOPD were purulent bronchitis (43.7 %), pneumonia (32.5 %), acute decompensated chronic heart failure (ADCHF) (12.5 %), and acute myocardial infarction (AMI) (11.3 %). BNP-fragment level was significantly higher in patients with pneumonia (p = 0.007), ADCHF (p = 0.002), AMI (p = 0.012) than in patients with purulent bronchitis. There was no significant difference between patients with pneumonia and ADCHF (p = 0.128), pneumonia and AMI (p = 0.651). Patients with AMI had higher H-FABP level than patients with purulent bronchitis (p = 0.003), but there was no significant difference between other groups of patients. A positive Tn I test was defined as > 0.5 ng / mL and Tn I level was increased in 21.3 % of cases, but there was no significant difference between the patient groups. The area under the ROC curve (AUC) to predict all-cause hospital mortality for BNP-fragment was 0.827 (95%CI: 0.729–0.626, p 0.5 ng / mL compared to survival in patients with Tn I < 0.5 ng / mL (log-rank test, p < 0.0001). In patients with AECOPD, Tn I and H-FABP levels were increased without coronary heart damage; these markers were strong predictors of all-cause hospital mortality in AECOPD.

Summary. This study was designed to evaluate clinical efficacy and safety of carbocysteine lysine salt in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). This was a prospective randomized comparative controlled trial involving 50 hospitalized patients with acute exacerbation of COPD. The patients were divided in 2 groups: the 1st group patients (n = 25) were treated with syrop of carbocysteine lysine salt (Fluifort) 4 050 mg daily during 10 days, the 2nd control group patients (n = 25) did not receive any mucoactive drugs. Clinical and spirometric parameters and C-reactive protein (CRP) level were serially assessed. At the 5th and 10th days of the treatment, clinical symptoms (cough intensity and sputum expectoration) differed significantly between groups in favor of the carbocysteine group (p < 0.05). FEV1 and FVC improved in both the groups at the 10th day of therapy. Other lung function parameters and peripheral blood leukocyte number did not differ significantly between the groups to the 10th day. CRP decreased significantly to the 10th day in the carbocysteine group compared to the controls (6.8 ± 2.3 vs 9.5 ± 1.2 mg × L–1; p < 0.05). Carbocysteine was well-tolerated by all the patients, serious adverse events were not registered. Therefore, addition of carbocysteine lysine salt (Fluifort), a mucoactive drug with antioxidant and anti-inflammatory properties, to a standard therapy of acute exacerbation of COPD has led to improvement of symptoms and systemic inflammatory reaction.

Summary. Natriuretic peptide is an important marker of the heart failure. NT-proBNP has also been shown to play a role in predicting outcomes in unselected cohort of critically ill patients. This study was aimed at evaluation the diagnostic and prognostic value of NT-proBNP in patients with acute exacerbation of COPD (AECOPD). This was a prospective observational study enrolled 80 hospitalized patients with AECOPD (age, 65.8 ± 19.9 yrs; FEV1, 38.5 ± 17.3 %pred, PaO2, 53.8 ± 13.0 mmHg, PaCO2, 50.6 ± 15.1 mmHg). The patients underwent a comprehensive diagnostic algorithm including chest radiography, pulmonary function tests, echocardiography and serial measurements of plasma NT-proBNP (Biomedica). Main causes of acute exacerbation of COPD were purulent bronchitis (48.8 %), pneumonia (23.8 %), acute decompensation of chronic heart failure (ADCHF) (17.5 %), and pulmonary embolism (PE) (5 %). Mean plasma concentration of NT-proBNP in COPD patients was 1 057.8 ± 555.3 fmol / ml. NT-proBNP level was elevated in 88.7 % of the cases. Patients with AECOPD and PE had the highest level of NT-proBNP (1 735.9 ± 523.8 fmol / ml). NT-proBNP concentration in COPD patients with ADCHF was 1 405.4 ± 626.8 fmol / ml, in COPD patients with pneumonia – 1 043.5 ± 643.1 fmol / ml, and in COPD patients with purulent bronchitis – 906.6 ± 425.9 fmol / ml. In patients who died during hospital stay (8.4 %), plasma level of NT-proBNP was significantly higher than in survivors (1 484.6 ± 618.7 vs 1 003.7 ± 527.1, respectively, p = 0.013). Conclusions: Plasma level of NT-proBNP may be used as a marker of severity and prognosis in AECOPD.

Summary. The study analyzed long-term consequences of acute lung injury / acute respiratory distress syndrome (ALI / ARDS) caused by influenza A / H1N1 and effects of long-term treatment with N-acetylcysteine (NAC) on clinical and functional recovery of survived patients. This was an open, prospective, 12-month study involved 22 patients survived from ALI / ARDS caused by influenza A / H1N1. The patients' lung function, arterial blood gases, physical tolerance in 6-min walking test (6MWT) and computed tomography (CT) of the lungs were monitored in 3, 6, and 12 months after discharge. During the follow-up, all lung function parameters improved: FVC, TLC, and DLCO increased by 28.7 %, 17.5 % and 31.4 %, respectively (p < 0.05 for all). In a year after discharge, DLCO < 80 %pred. was found in 23 % of patients. At 12 months, the mean 6MWT distance increased from 454 Ѓ} 37 to 568 Ѓ} 47 m (р = 0.002). Significant improvement was noted in CT findings and 41% of patients had quite normal lung CT at 12 months. Therapy with NAC (n = 11) has led to more rapid improvement in DLCO (76.3 Ѓ} 11.8 %pred. vs 63.0 Ѓ} 10.6 %pred. in controls; р = 0.012) and 6MWT distance (533 Ѓ} 42 m vs 490 Ѓ} 46 m, respectively; р = 0.033) at 3 months. Therefore, patients survived from ALI / ARDS caused by influenza A / H1N1 demonstrated significant recovery of lung function, gas exchange, lung CT picture and physical tolerance but in some of them, persistent disorders of lung function (mainly in DLCO) and lung CT have been still found at 1 year after discharge. Treatment with NAC allowed more rapid improvement in DLCO and exercise tolerance.

Целью исследования было изучение роли С-реактивного белка (СРБ) в диагностике бактериальных инфекций и пневмонии при обострении хронической обструктивной болезни легких (ХОБЛ). Были обследованы 123 пациента (средний возраст - 65,4 ± 48,8 года, индекс курения - 42,8 ± 14,3 пачки / лет), госпитализированных в стационар с обострением ХОБЛ. Уровень СРБ в крови измеряли с помощью системы NycoCard II Test Kit ( AxisShield , Норвегия). У 23 больных с обострением ХОБЛ диагностирована пневмония. Концентрация сывороточного СРБ у больных пневмонией была выше, чем у пациентов без пневмонии (105,8 ± 66,1 мг/л; p n = 26) уровень СРБ был ниже, чем у больных с продукцией гнойной мокроты ( n = 74): 12,1 ± 7,0 мг/л vs 34,5 ± 18,8 мг/л ( p < 0,001). СРБ является ценным маркером бактериальной инфекции и пневмонии у больных с обострением ХОБЛ, что важно для разработки тактики лечения данной категории пациентов.

Нозокомиальная пневмония (НП) - одно из наиболее часто встречающихся в стационаре инфекционных заболеваний. Одним из фак- торов риска развития НП является хроническая обструктивная болезнь легких (ХОБЛ). Целью исследования стало изучение особеннос- тей НП и роли биомаркеров воспаления у больных ХОБЛ. Были обследованы 184 пациента с обострением ХОБЛ. У 22 (11,9 %) больных пневмония развилась в условиях стационара. Среди них - 18 мужчин и 4 женщины; средний возраст составил 66,0 ± 11,02 года. Значе- ние шкалы CPIS для всех больных ХОБЛ с НП составило 9,4 ± 2,1 балла, индекс коморбидности Charlson - 7,9 ± 2,5 балла. У 90,9 % больных НП развилась после 5 дней пребывания в стационаре. У больных были выделены следующие микроорганизмы: Pseudomonas aeruginosa (5), Staphylococcus aureus (4), Streptococcus pneumoniae (4), Acinetobacter spp. (3). Проведение инвазивной вентиляции легких потре- бовалось 13,6 %, неинвазивной вентиляции легких - 36,4 %, оксигенотерапии - 90,9 % больных. Средняя продолжительность госпита- лизации больных ХОБЛ с НП составила 42,6 ± 20,3 дней, умерли 27,3 % пациентов. Концентрации сывороточного С-реактивного бел- ка (СРБ) в день развития НП значительно превышали их исходные значения: 105,5 (83,3-145,8) мг / л vs 14,5 (12,0- 29,3) мг / л ( p p = 0,002). Таким образом, НП у больных ХОБЛ характеризуется тяжелым течением, выраженной системной воспалительной реакцией и острой дыхательной недостаточностью. Наряду со шкалой АРАСНЕ II биомаркеры воспаления позволяют определить прогноз и исходы НП.

Целью исследования явилось изучение распространенности, факторов риска, особенностей течения и прогноза внебольничной пневмонии (ВП) у госпитализированных больных с обострением хронической обструктивной болезни легких (ХОБЛ). Были обследованы 123 больных, госпитализированных в стационар с обострением ХОБЛ. Все больные с обострением ХОБЛ были разделены на 2 группы: обострение ХОБЛ с ВП и обострение ХОБЛ без ВП. У всех больных оценивались демографические показатели, стаж курения, индекс массы тела, симптомы и физикальные признаки, общая тяжесть состояния, рентгенография грудной клетки, общий и биохимический анализ крови, газы артериальной крови, функция внешнего дыхания (кривая поток-объем), сопутствующие заболевания, предшествующая терапия и прогноз. У 23 (18,6 %) больных с обострением ХОБЛ была диагностирована ВП (22 мужчины, средний возраст - 65,9 ± 10,3 года, стаж курения - 38,3 ± 10,3 пачки / лет). Доля пациентов, получавших ингаляционные глюкокортикостероиды (иГКС), была достоверно выше среди больных ХОБЛ с ВП (73,9 % vs 48 %). Тяжесть обострения, по критериям Anthonisen , была больше выражена в группе пациентов с ВП ( p = 0,024). По сравнению с больными ХОБЛ без ВП, у больных с ВП отмечено более значимое повышение температуры тела (38,1 ± 0,7 vs 37,0 ± 0,7 °С), более частые озноб (34,8 % vs 4 %), кровохарканье (21,7 % vs 3,0 %) и боли в грудной клетке (56,5 % vs 15,0 %). Кроме того, у больных ХОБЛ с ВП был отмечен более высокий уровень С-реактивного белка (СРБ) сыворотки (106 ± 66 vs 29 ± 20 мг/л). Длительность госпитализации больных ХОБЛ с ВП была существенно выше, по сравнению с больными ХОБЛ без ВП: 22,9 ± 9,0 vs 16,3 ± 6,9 дня ( р Charlson (ОШ - 1,77; 95%ный ДИ - 1,175-2,667). ВП является относительно частым событием у больных с обострением ХОБЛ. Возможным фактором риска ВП у больных ХОБЛ является прием иГКС. Больные ХОБЛ с ВП имеют определенные клинические (лихорадка, озноб и др.) и лабораторные (высокий уровень СРБ) отличия от больных ХОБЛ без ВП. Наличие ВП ухудшает прогноз больных ХОБЛ.

Objective: to study the clinical and antibacterial efficacy and safety of gemifloxacin in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AE COPD) hospitalized into pulmonology departments. Study design: open non-comparative prospective study. Settings: 25 different pulmonology centres in Russia. A total of 222 patients with AE COPD (156 males and 66 females, mean age 56,4 ± 11,9 years) were included in the study. The majority of patients (70.3 %) were classified as I type Anthonisen of AE COPD. All patients received oral gemifloxacin (Factive ® , Veropharm, Russia) 320 mg once daily for 7 days. Clinical and bacteriological outcomes and treatment safety were assessed at the end of therapy (7–8 days of study) and at follow up (14–16 days of study). At the end of therapy (7–8 days) statistically significant improvements were noted in all symptoms of AE COPD (improvement of cough, dyspnea, sputum volume and purulence). No clinical improvement was seen in 5.6 % of patients, so the clinical success rate of gemifloxacin therapy was 94.4 %. Sputum cultures were performed in 73.0 % of patients and in 60.4 % of them respiratory pathogens were isolated. The leading pathogens were Streptococus pneumoniae (37.7 %) and Haemophilus influenzae (27.8 %). Eradication and presumed eradication of all pathogens were 69.4 % and 26.9 %, respectively. The bacteriological success rate of gemifloxacin therapy was 96.3 %. A total of 15 patients reported adverse events (AEs), most frequent AEs was diarrhea (4.7 %). All AEs were no severe and transitory, and did not require the withdrawal of antibiotic therapy. Oral gemifloxacin had high clinical and bacteriological efficacy in hospitalized patients with AE COPD. The treatment with gemifloxacin was generally well tolerated and was convenient to patients.