[The risk of bronchial asthma exacerbations among smokers with asthma-chronic obstructive pulmonary disease overlap after inpatient treatment].

AIM: To assess the risk of exacerbations of bronchial asthma (BA) in smoking patients with the asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) after inpatient treatment. MATERIALS AND METHODS: 36 smokers with ACO (main group) and 36 non-smoking patients (control group) with severe or moderate exacerbation of bronchial asthma were examined. Assessment of the severity of exacerbation of BA before treatment, levels of control and risk of exacerbations of BA after treatment was determined according to the Federal clinical guidelines for the diagnosis and treatment of BA (2016). Spirometry, monitoring of blood oxygenation using transcutaneous spectral pulse oximetry and enzyme immunoassay for determination of matrix metalloproteinases 9 were performed. Smoking experience, smoking index and pack/years index were taken into account in patients with ACO. The carboxyhaemoglobin level was analyzed by the carbon monoxide fraction in the exhaled air. RESULTS: For the first time in patients with the ACO, the ability of heavy tobacco smoking and associated decrease in blood oxygenation to potentiate the negative impact of other predictors on the risk of exacerbations of the underlying disease was revealed. In smoking patients with the ACO, for the first time, a direct association of higher levels of matrix metalloproteinases 9 (measured before inpatient treatment) with such a predictor of the risk of further exacerbations of the disease as more frequent detection of symptoms of uncontrolled BA was revealed. In non-smoking patients with BA, a direct relationship between increased sputum secretion and eosinophilia of blood and/or sputum (a predictor of exacerbation of BA) and the relative duration of episodes of decreased blood oxygenation was established. CONCLUSION: It was found that intensive and prolonged smoking increases the duration and reduces the effectiveness of inpatient treatment of patients with ACO, contributing to the preservation of air traps and low (forced expiratory volume in 1 second 60%) ventilation capacity of the lungs with the persistence of moderately reduced blood oxygenation; the risk of further exacerbations of BA in this phenotype of patients is significantly higher than in non-smoking patients with BA without combination with COPD.

[Matrix metalloproteinases and clinical and functional status in smokers with persistent asthma].

AIM: To assess the role of matrix metalloproteinases (MMP) in the clinical and functional status of smoking patients with persistent asthma. SUBJECTS AND METHODS: Examinations were made in 16 healthy smokers (a control group), 22 healthy nonsmoking volunteers (a volunteer group), and 16 patients with endogenous (n = 6) and mixed (n = 10) persistent asthma (a study group) with varying disease control. The investigators used the following techniques: spirometry; determination of airway resistance and FeCO in the expired air; 30-minute percutaneous monitoring of blood oxygenation and 6-minute walk test; enzyme immunoassay for matrix metalloproteinase levels. RESULTS: The longer duration and higher intensity of smoking increase airway inflammation in the asthmatic patients and the length of blood oxygenation within the very low range. The combined negative influence of tobacco smoking and the underlying disease leads to a clinically significant decrease in pulmonary ventilation ability and basic levels of blood oxygenation, the occurring asthma control reduction being correlating with the longer duration of treatment. The investigators revealed the predictors of lowering the mean level of blood oxygenation (MMP-9, FeCO, and airway resistance), as well as the factors that negatively influence the level of dyspnea and fatigue in asthmatic smokers. CONCLUSION: The serum levels of FeCO and MMP-9 may serve as markers reflecting the intensity of airway inflammation in smokers with persistent asthma.

[Evaluation of the degree of respiratory failure in patients with chronic obstructive pulmonary disease].

Thirty practically healthy individuals and 111 patients suffering from chronic obstructive pulmonary disease (COPD) with I to III degree chronic respiratory failure (CRF) were examined. The study established a negative correlation between partial oxygen pressure in arterial blood (AB), the degree of bronchial obstruction, hemoglobin saturation, and the degree of CRF. It was found that the degree of CRF was in a significant correlation with the degree of pulmonary physiological (alveolar) shunt and the degree of hypercapnia. The author proposes an algorithm for precise determination of the degree of CRF that includes calculation of alveolar shunt as an integral parameter reflecting the degree of AB gas changes.

[Functional state of the diaphragm during several non-drug methods of the treatment of chronic pulmonary insufficiency]. / Funktsional'noe sostoianie diafragmal'noi myshtsy pri nekotorykh nemedikamentoznykh metodakh lecheniia khronicheskoi legochnoi nedostatochnosti.

The study compared the effect of conventional therapy of aggravated chronic obstructive bronchitis (COB), inpatient oxygen treatment of large duration (OT), normobaric hypoxic stimulation (NBHS), inspiratory resistance on the diaphragmatic muscle function in COB patients with chronic pulmonary insufficiency. The function was assessed at stimulation electromyography of the diaphragm. The latter reflected enhanced bioelectric activity of the diaphragm in response to OT and inspiratory resistive training as shown by increased time parameters. Conventional COB treatment induced no changes in the myographic picture. Long-term response to NBHS needs further investigations.

[The hospital stage of the long-term oxygen therapy of chronic lung failure in patients with chronic obstructive bronchitis]. / Statsionarnyi étap dlitel'noi kislorodoterapii khronicheskoi legochnoi nedostatochnosti u bol'nykh s khronicheskim obstruktivnym bronkhitom.

The authors analyze the role of the initial inpatient stage of long-term oxygen therapy (LOT) in combined treatment of chronic pulmonary failure in patients with chronic obstructive bronchitis, lung emphysema, and pneumosclerosis. The treatment lasted 30 days both in the main and in the control groups. In addition to basic therapy, the main group patients received 38% O2 for 15 h a day. To decrease the risk of PaCO2 elevation with a possible respiratory disorder, particularly in patients with initial hypercapnia, it is suggested that a special oxygen test with simultaneous control of acid-base balance and gas composition of the arterial blood may be carried out. In contrast to the control group, the main group patients demonstrated an improvement of gas composition of the arterial blood and of the parameters such as the alveolar-arterial gradient according to O2, the physiological pulmonary shunt. The combined use of oxygen therapy and resistance at expiration made it possible to ameliorate a number of external respiration function parameters, diffusion lung capacity, and enhanced the effect of oxygen therapy. It is shown that patients with PaO2 may be given LOT within the range of 60-69 mm Hg, provided the pulmonary physiological shunt exceeds 20%.