Аннотация Проблемой современной медицины является оптимизация лечения больных с сочетанной патологией, число которых неуклонно растет в последние годы. Сочетание бронхиальной астмы и ожирения определяет тяжесть течения заболевания, низкий уровень контроля, резистентность к базисной терапии в сочетании с более частым использованием β-агонистов для купирования симптомов, частыми госпитализациями при обострении заболевания. В настоящее время известны только некоторые патогенетические звенья, объясняющие негативное влияния висцерального ожирения на течение астмы.

Clinical presentation of myxomas is diverse, so it is not easy to diagnose this pathology even with available modern instrumental methods. With its “natural” course this pathology is associated with poor outcome, most patients die in several years from the first clinical signs onset.

The purpose of this study was to investigate a role of osteopontin for development of right heart diastolic dysfunction in patients with atopic bronchial asthma (ABA). This is important for early diagnosis of pulmonary hemodynamic disorders. Methods. The study involved 188 subjects: 148 ABA patients who were divided into 3 groups according to asthma severity and 40 healthy volunteers as controls. We measured right ventricle functional parameters and blood osteopontin concentration. Results. While increasing ABA severity blood osteopontin concentration increased and the right ventricle diastolic function decreased in comparison to the healthy controls. Osteopontin concentration was higher in patients with right heart dysfunction. Conclusion: More severe course of ABA was associated with higher blood osteopontin concentration. More significant right heart dysfunction was seen in patients with moderate to severe ABA. Right heart dysfunction in ABA was associated with systemic inflammation, particularly with osteopontin concentration.

The aim of this study was to evaluate cost structure and rationality of pharmacotherapy of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in a pulmonology department of a multiprofile Krasnoyarsk hospital in 2014. Methods. This was a retrospective 1-year study evaluating pharmacotherapy of AECOPD according to electronic medical reports. Medication therapy and frequency of administration of certain drugs were evaluated using frequency analysis. Rationality of medication therapy and treatment expenses were analyzed with ABC/VEN analysis. Results. One hundred and thirty one electronic medical reports were analyzed. Frequency analysis showed that all patients received the combined bronchodilator Berodual and the expectorant bromhexine. Moreover, 81.7% of patients received antibiotics, 75.6% received systemic steroids and 41.2% received inhaled corticosteroids. This is consistent with current scientific trends and recent recommendations. ABC/VEN-analysis showed a rational pharmacotherapy expenditure of funds in patients with AECOPD. The main expenses were associated with vital drugs (58.2%) followed by pharmacotherapy of comorbidity (41.8%) which was administered to 87.8% of the patients. Anticoagulants had the highest cost (22.5% of the total pharmacotherapy of AECOPD). Second-line drugs were not used in the treatment of AECOPD. Conclusion. The main portion of cost of AECOPD pharmacotherapy was related to pathogenic treatment followed by treatment for comorbidity and prevention as the former greatly effects severity and outcomes of COPD.

The aim of the work was to study clinical and pathophysiological features of endothelial dysfunction, structural and functional state of the left heart in patients with bronchial asthma (BA). The study included 290 patients. 250 of them presented with moderate or severe BA during exacerbation and within 12 months after the onset of observation, 40 healthy volunteers served as controls. The endothelial function was disturbed in 63 and 74% of the patients with moderate and severe BA respectively. They showed reduced endothelium-dependent vasodilation in combination with a significant increase of the plasma sDC31/ sPECAM-1 level. It is concluded that patients with BA develop structural and functional changes in the left ventricular myocardium proportional to the severity of BA which leads to diastolic dysfunction.

The study was aimed at measuring the number of CD38+ lymphocytes in peripheral blood and its relationship with a marker of endothelial dysfunction CD31/PECAM-1 in patients with moderate or severe bronchial asthma (BA) during exacerbation and 12 months after it. The study groups included 153 patients, the control one consisted of 40 subjects. Group 1 comprised 106 patients with moderate BA, group 2 patients with severe steroid-independent BA (n=61), group 3 patients with steroid-dependent BA (n=53). CD38+ lymphocytes were detected by immunocytochemical methods, IL-6, IL-4, IL-2, and TNF-α by solid-phase immunoenzyme assay. BA patients exhibited signs of systemic inflammation reflected in the two-fold and 2.5-fold increase of serum TNF-α and IL-6 levels respectively in the patients of group 1. TNF-α, IL-6 and C-reactive peptide levels increased by 3, 2 and 2.5-4 times in groups 2 and 3. Exacerbation of BA resulted in a 5-fold rise in the number of DC38 lymphocytes that persisted during the next 12 months suggesting a 15% increase in the level of sPECAM-1/sCD31 (a non-substrate ligand of CD38) associated with endothelial dysfunction. The study revealed positive correlation between elevated sPECAM-1/sCD31 levels and the number of CD38+ lymphocytes in all groups (r=0.456; p<0.05).

The aim of this study was to analyze drug supplying for outpatients with chronic obstructive pulmonary disease (COPD) at Krasnoyarsk kray. Methods. Federal and regional regulatory documents and databases of Healthcare Ministry of Krasnoyarsk kray and of the Regional Compulsory Health Insurance Fond were analyzed including the period of 2009 – 2014. We assessed number of receipts prescribed for COPD patients. Results. Despite the growing morbidity of COPD in the Krasnoyarsk kray, number of COPD patients received subsidized treatment has reduced annually and decreased by 14.3% during 2009 – 2014. The cost of subsidized treatment of COPD increased twice: from 2.1 thousand rubles in 2009 to 4.2 thousand rubles in 2014 and a recipe cost increased in 1.8 times: from 522.9 rubles in 2009 to 965.2 rubles in 2014. Every COPD patient receives 4 prescriptions per year in average. Conclusion . The results of this study necessitate thorough analysis of concordance with current guidelines for the prescribed drugs.