The prevalence of bronchial asthma (BA) in the world ranges from 4 to 10%, this rate among the adult ranges from 2.2 to 5-7%, and among children reaches 10%. Despite the prevalence and medical and social significancy the BA therapy is not optimal yet. The application of inhaled corticosteroids does not solve all the problems. The new class of drugs became the so called "antileukotriene substations". This article provides the information on montelukast sodium (Singlon®) – the representative from this group of drugs. Materials and methods . Literature review. Results. The application of montelukast sodium (Singlon®) 1 time each day is safe and effective and helps to improve general condition of the patients, to reduce of broncho-obstructive syndrome, to stop physical changes, to 'normalize' all laboratory values.

В настоящее время значение нейтрофильного воспаления при бронхиальной астме (БА) является предметом тщательного изучения. Именно нейтрофильнная эластаза (НЭ) наиболее активно участвует в остром и хроническом воспалении, поскольку она способна деградировать эластин, коллаген, другие матричные белки и гликопротеиды, обеспечивающие процессы защиты и адаптации. Исследования активности НЭ и ƒ1-антитрипсина у пациентов с БА немногочисленны. Целью настоящей работы явилась оценка диагностической и прогностической значимости определения НЭ у пациентов с атопической БА среднетяжелого и тяжелого течения. Активность эластазы сыворотки крови определялась спектрофотометрическим методом у 34 таких больных. Был выявлен повышенный уровень активности НЭ у пациентов с неконтролируемым течением БА, вне зависимости от тяжести патологии. Коррекция терапии привела к значимому снижению активности НЭ только у пациентов, которым была назначена терапия фиксированными комбинациями ингаляционных глюкокортикостероидов и длительнодействующих ƒ2-агонистов (иГКС / ДДБА) в режиме стабильного дозирования. У курящих пациентов с БА адекватное лечение с применением иГКС / ДДБА привело к значимому улучшению клинических и функциональных показателей, но не повлияло на активность НЭ.

Background: In Russia, current therapy for the long-term management of asthma is mainly nonsteroidal. This situation provides the opportunity to evaluate new asthma treatments in a patient cohort with little previous exposure to inhaled corticosteroids. Objectives: To compare the effect of formoterol (Oxis®) Turbuhaler® plus budesonide (Pulmicort®) Turbuhaler with budesonide Turbuhaler alone, on the health-related quality of life (HRQL) of patients with mild to moderate asthma. Methods: A double-blind, parallel-group, randomized, 12-week study compared formoterol Turbuhaler plus budesonide Turbuhaler and budesonide Turbuhaler alone with an open control group of the investigator’s choice of noncorticosteroid therapy. Patients completed the Short Form 36 (SF-36) and the Asthma Quality of Life Questionnaire (AQLQ). Results: The improvement in HRQL scores for patients treated with noncorticosteroids was significantly less (p < 0.05) than those treated with formoterol plus budesonide and budesonide alone in all domains of the SF-36 and AQLQ with one marginal exception (budesonide versus investigator’s choice, SF-36, Mental Component Scale, p = 0.053). Improvements in HRQL scores of formoterol plus budesonide, compared with budesonide alone, although generally higher, were not significantly different. Formoterol plus budesonide was more effective in improving lung function and reducing both symptoms and the need for relief terbutaline inhalation. Conclusion: Formoterol Turbuhaler plus budesonide Turbuhaler and budesonide Turbuhaler alone significantly improved the HRQL of patients with mild to moderate asthma compared with noncorticosteroid treatment.

Current therapy in Russia for long-term management of asthma is mainly non-steroidal. This provided the opportunity to compare the efficacy and safety of formoterol (Oxis) Turbuhaler plus budesonide (Pulmicort) Turbuhaler with budesonide Turbuhaler alone in adults (n=338) with mild to moderate asthma who had little previous exposure to inhaled corticosteroids. The 12-week study followed a randomised, double-blind, parallel group design and included an open control group of patients who were treated with conventional non-corticosteroid therapy. Patients treated with formoterol plus budesonide benefited from a significantly greater improvement in their pulmonary function and asthma symptoms compared with budesonide alone (95% Cl of difference in mean morning peak expiratory flow [PEF] 8.7-36.3 l/min, p=0.0015). Non-corticosteroid treatment was significantly less effective than formoterol plus budesonide and budesonide alone (95% CIs of differences in mean morning PEF were 36.4-63.6 l/min and 14.1-41.1 l/min, respectively, both p=0.0001). Although the incidence and frequency of adverse events was not significantly different between the groups, formoterol plus budesonide and budesonide alone were better tolerated than non-corticosteroid treatment, and there were fewer incidences of asthma deterioration. Overall, formoterol Turbuhaler plus budesonide Turbuhaler was the safest and most effective treatment.

Total trypsin-like (BAEE esterase), elastase-like (BOC esterase) and antitryptic activities were studied in blood serum of patients with atopic diseases. The elastase-like activity was increased in blood serum of all the patients examined during the acute period of the disease; the enzyme activation depended on the pathology severity and clinical picture manifestations. The increase in blood plasma total proteolytic activity correlated with reverse alteration in blood antitryptic potential. The data obtained suggest that activation of neutrophils occurred in atopic diseases, thus the rate of elastase-like activity in blood might be used as an objective pattern in examination of patients and in checking of treatment course. The developed inhibitory-protease index may serve also as a criterion in evaluation of the pathological state severity.

IgE- and IgG-reagins were investigated in the sera of 120 patients with atopic bronchial asthma. Two clinicopathogenetic variants of disease were defined with relation to the genetic variants of disease were defined with relation to the main immunological mechanism: IgE-dependent (in 78 patients) and IgE-IgG-dependent (in 42 patients). Variations in a clinical picture, the results of specific allergological examination, the level of total serum IgE in different variants of the atopic form of bronchial asthma were established. Specific immunotherapy produced a good effect in the IgE-dependent variant. In the patients with the IgE-IgG-dependent variant specific immunotherapy with a house dust allergen proved to be ineffective in most cases.

Activity of kallikrein and content of prekallikrein were estimated in blood serum of 34 patients with atopy and of 17 patients with urticaria by means of the chromatographic procedure. In these patients activity of alpha 1-proteolytic inhibitor (alpha 1-PI) and alpha 2-macroglobulin (alpha 2-MG) was studied. At the acute period of pollinosis activation of the kallikrein-kinin system was found, which correlated with the disease aggravation. During specific immunotherapy of the patients with atopy activation of the kallikrein-kinin system occurred, which depended on the total concentration of allergen administered. At the same time, activation of the kallikrein-kinin system, observed under conditions of urticaria, was most distinct in the patients with chronic relapsing urticaria and was related to the degree of the disease aggravation. Preparations of proteinase inhibitors analogous to contrical were only short-term effective in chronic relapsing urticaria. In the patients with distinct aggravation of pollinosis inhibitory activity of alpha 2-MG was markedly increased which occurred apparently as a result of blood pachyemia simultaneously with activation of the kallikrein-kinin system. Distinct increase in the alpha 1-PI activity was not found in the patients with pollinosis and urticaria even at the step of pronounced aggravation. Phenotyping of the inhibitor in 10 patients with a marked decrease in its activity enabled to find 6 persons exhibiting the heterozygous genotype with a defect allele.