В последнее время все чаще изучается влияние неправильного питания на возникновение и прогрессирование бронхиальной астмы (БА) и ожирения. Ожирение представляет собой пандемию XXI века. В настоящий момент имеются данные о влиянии ожирения на риск развития БА. Повышенное потребление насыщенных жиров приводит к увеличению содержания циркулирующих свободных жирных кислот в организме. Это индуцирует провоспалительные процессы в том числе в дыхательных путях, что приводит к ухудшению функционирования легких, утяжелению протекания БА, учащению обострений данного заболевания, увеличению числа госпитализаций по поводу тяжести течения астмы. Кроме того, учеными выявлено, что диета с низким содержанием пищевых волокон также способствует развитию системного воспаления, тем самым ухудшая течение БА. Имеются данные о влиянии дефицита витамина D на развитие, прогрессирование и ухудшение контроля хронических и аутоиммунных заболеваний, к которым также относится БА, на ухудшение состояния липидного обмена исследуемых. Повышение уровня витамина D в организме пациентов приводит к улучшению отдельных характеристик течения и проявления данных заболеваний. Использование средиземноморской диеты уменьшает вероятность возникновения и прогрессирования БА, бронхиальной обструкции, аллергических реакций. Достаточное употребление витаминов А, С, Е приводит к снижению воспалительных реакций в бронхиальном дереве, улучшению показателей функции легких, уменьшению обострений БА и частоты госпитализаций, связанных с ухудшением контроля заболевания. Таким образом, актуально и целесообразно проводить научную и клиническую работу по определению и более глубокому изучению влияния питания на развитие и течение БА и ожирения, выявлению взаимосвязи между данными заболеваниями. Recently, the influence of malnutrition on the occurrence and progression of bronchial asthma and obesityhas been increasingly studied. Obesity is a 21st century pandemic. Now, there is evidence of the effect of obesity on the risk of developing bronchial asthma. An increased intake of saturated fat leads to an increase in circulating free fatty acids in the body. This induces pro-inflammatory processes, including in the respiratory tract, which leads to a deterioration in the functioning of the lungs, an aggravation of the course of bronchial asthma, an increase in exacerbations of this disease, an increase in the number of hospitalizations due to the severity of the course of asthma. In addition, scientists have found that a diet low in dietary fiber also contributes to the development of systemic inflammation, thereby worsening the course of bronchial asthma. There is evidence of the effect of vitamin D deficiency on the development, progression and deterioration of control of chronic and autoimmune diseases, which also include bronchial asthma, on the deterioration of the state of lipid metabolism in the subjects. An increase in the level of vitamin D in the body of patients leads to an improvement in certain characteristics of the course and manifestation of these diseases. The use of a Mediterranean diet reduces the likelihood and progression of bronchial asthma, bronchial obstruction, and allergic reactions. Adequate intake of vitamins A, C, E leads to a decrease in inflammatory reactions in the bronchial tree, an improvement in lung function indicators, a decrease in exacerbations of bronchial asthma and the frequency of hospitalizations associated with a deterioration in the control of this pathology. Thus, it is relevant and expedient to carry out scientific and clinical work to determine and in-depth study of the influence of nutrition on the development and course of obesity and bronchial asthma, and to identify the relationship between these diseases.

The materials of statistical reports on morbidity and mortality due to chronic obstructive pulmonary disease (COPD), primary detection of patients both in the framework of clinical examinations, and in the daily work of a primary care doctor-a General practitioner and a therapist were studied. It is shown that screening spirometric examination during medical examination can serve as an effective tool for early diagnosis of COPD, and the use of new organizational forms of work of the region brings pulmonological care to the population of the districts of the Voronezh region (VO), where there is no pulmonologist. An important role in the management of COPD patients is played by educational pro-grams for primary care physicians, which are a mandatory element of pulmonary health Days.

An anonymous survey of physicians in the Tambov region was conducted using a questionnaire based on guidelines, which evaluated knowledge of managing patients with pneumonia as part of the multicenter study “KNOCAP” (“The assessment of physicians' knowledge of community- acquired pneumonia basics”) . To study the issues of prevention, diagnosis and treatment of pneumonia, the distance course “Review of guidelines “Pneumonia” was developed and posted on the Moodle. The results of the survey were analyzed before and after distance training.

Проанализирована клиническая эффективность стационарного этапа реабилитации у пациентов с ОИМ. Продемонстрировано, что мультидисциплинарный подход и разработанные индивидуальные программы реабилитации на стационарном этапе у больных, перенесших ОИИМ, способствуют повышению толерантности к физическим нагрузкам и улучшению психо-эмоционального состояния у большинства пациентов. Оценку динамики физического состояния пациентов целесообразно проводить с помощью теста 6-минутной ходьбы (Т6Х), а психического состояния с помощью анкеты Госпитальной шкалы тревоги и депрессии (HADS).

Изучены вопросы актуальности включения вопросов экспертизы временной нетрудоспособности при проведении обучения лечащих врачей, как непосредственных исполнителей этой функции на сертификационных и аккредитационных циклах. Выводы основаны на результатах анкетирования врачей, проходящих переподготовку на кафедре терапевтических дисциплин.

The aim of this study was to improve efficacy of treatment and preventive measures in outpatients with COPD using computed monitoring system. Methods. Clinical course of the disease and outpatient treatment effectiveness in 59 patients with COPD II–III stage (of them, 46 were males) have been analyzed using computed pulmonology register. The age of patients was 59.66 ± 0.74 years. Thirty eight patients were vaccinated against influenza infection and 21 patients were not vaccinated. Results. The computed programme "Monitoring system for patients with chronic obstructive pulmonary disease" demonstrated that vaccination of COPD II to III stage patients reduced rate of acute respiratory infection episodes, hospitalisations, visits to a physician and emergency calls. Conclusion. The computed programme allowed to improve treatment and to analyze efficacy of preventive measures in COPD patients. Vaccination against influenza in COPD patients was highly effective and safe.

The aim of this study was to assess effects of non-thermal microwave electromagnetic radiation (NMER) on asthma control and quality of life of patients with bronchial asthma (BA). Methods. Sixty outpatients with moderate BA aged 18 to 60 years were treated with NMER using the "Aster" device, 4 courses for 10 days of each Results. Clinical and spirometry parameters, asthma control and quality of life were significantly improved in comparison with BA patients receiving the standard therapy only. Conclusion. Thus, NMER in BA outpatients allowed increasing efficacy of therapy and prevention.

Summary. Sixty patients aged 18 to 60 years with bronchial asthma (BA) were examined. Clinical and psychological state was evaluated before and 1 month after an educational course. Implementation of individual education programs has led to a reliable increase in compliance and asthma control and in clinical and psychological improvement in comparison with BA patients involved in group education programs. Thus, the individual education programs allow increasing the efficiency of therapeutic and preventive measures in BA patients.

The aim of the study which included 2311 patients (aged 18—80 yrs), examined by 100 physicians (57% allergists, 37% pulmonologists and 7% general practitioner) in 18 Russian cities, was to assess the prevalence of allergic rhinitis in patients with asthma, as well as to evaluate the specifics of the course of these diseases, when concomitant or not. The study design included one outpatient visit, followed by the completion of studyspecific case report forms and Asthma Control Questionnaire (ACQ) validated for use in Russia. The vast majority (88%)of asthma patients had concomitant allergic rhinitis (Group 1). Patients with asthma only (Group 2) were older (50,6±0,78 vs 41,9±0,35 yr, p

The article presents the results of the study the clinical course of coronary heart disease patients with subclinical hypothyroidism. Dependence of the clinical course of coronary artery disease from the level of thyroid hormones. The main relationship of clinical, instrumental, psychological, and laboratory parameters, allowed to build a predictive model of the clinical course of coronary artery disease.

This article reviews the significance of distal airways inflammation in asthma, current methods of investigations and therapeutic approaches to control inflammation at the level of small bronchi. It is demonstrated that inflammation in most asthma patients involves all airways including the small bronchi. The new drugs targeting distal airways, including extrafine formulations of inhaled steroids and P2-agonists (beclomethazone/formoterol (Fostair), can successfully treat pathologic process in small bronchi of asthma patients.