[Combination of thiotropium bromide with almitrine and pulmonary rehabilitation in the treatment of patients with chronic obstructive pulmonary disease].

AIM: To elucidate efficacy of a combination almitrine+thiotropium bromide (TB)+pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) of stage II-III complicated with chronic respiratory failure (CRF). MATERIAL AND METHODS: Efficacy of therapy was compared in two groups of patients: group 1 (n = 22) received TB in a dose 18 mcg/day for one year, almitrine in a dose 10 mg/kg/day for 3 months, an 8 week course of PR, group 2 (n = 17) received TB and PR. The treatment efficacy was determined by spirometric parameters of external respiration function, blood gases, dyspnea indices, exercise tolerance assessed by 6-min walk test, quality of life (St. George Hospital Respiratory Questionnaire). RESULTS: Group 1 patients walked longer distance after a course of PR and 1 year later (by 90.5 +/- 25.4 and 44.5 +/- 10.2 m, respectively, p < 0.05), had reduced desaturation measured by pulsoxym-etry at the end of 6-min walk test, increased PaO2 in baseline under 70 mmHg (by 5.8 +/- 1.2 mmHg, p > 0.05), decreased exacerbation rate per 1 patient a year (by 25%). CONCLUSION: Combination treatment with TB, almitrine and PR is indicated for COPD patients with moderate hypoxemia.

[Effect of tiotropium bromide on exercise tolerance in patients with chronic obstructive pulmonary disease].

This open prospective randomized parallel-group comparative study included 43 patients with moderate or severe chronic obstructive pulmonary disease (COPD). The patients of active working age were referred to the disability groups II-III based on the average forced expiratory volume in 1 second (1.70+/0.43 1 or 49.1+/-10.7% the normal value) and received an eight-week course of pulmonary rehabilitation. During the study, the patients were given tiotropium bromide (TB) for 14 weeks to assess its effect on the tolerance of physical activity. A combination of TB with pulmonary rehabilitation was shown to improve tolerance evaluated by whole-body rheography (WBR) in a 6 minute step-test and the standard functional test. Also, this treatment resulted in the clinically significant alleviation of dyspnea and permitted to decrease the intake of salbutamol (used "as required") compared with pulmonary rehabilitation alone. It is concluded that combination of TB and pulmonary rehabilitation provides an effective tool for the treatment of patients with COPD. The whole-body rheographic technique can be used to evaluate the functional state of the patients and the efficiency of their rehabilitation.

[Sensitization of lymphocytes to insulin as one of risk factors of ischemic heart disease].

Prevalence and character of sensitization of lymphocytes to insulin and its prognostic significance were studied in 71 patients with ischemic heart disease and 55 healthy people. Direct overt sensitization of lymphocytes to insulin was found in 14 of 71 patients (p<0.01 compared with control group). This type of reaction was associated with myocardial infarction. Concealed indirect reaction of lymphocytes to insulin was revealed at inhibition of cells with receptors to histamine or prostaglandin synthesizing cells in 13 and 19 of 71 patients, respectively (p<0.01 and p<0.05 compared with control group). Direct overt sensitization of lymphocytes to insulin and concealed indirect sensitization revealed at inhibition of functional activity of cells with receptors to histamine serve as prognostically unfavorable factors because they are associated with development of heart failure and higher rate of lethal outcome.

[Effects of positive oscillatory expiratory pressure on functional condition of patients with chronic diseases of the lungs].

Clinical and cardiorespiratory findings in patients with chronic obstructive pulmonary disease (COPD) stage I and IIA and the results of exercise tolerance tests in patients with mild and moderate bronchial asthma (BA) at a remission stage were studied for effects of positive oscillatory expiratory pressure created in respiration through flatter on exercise adaptation. It was proved that breathing through flatter before exercise tolerance test raises tolerance to exercise in COPD patients, modifies a cardiorespiratory response in direction of its optimization and lowers nonspecific bronchial hyperreactivity in BA patients.

[Etiologic significance of hereditary deficiency of proteinase alpha1-inhibitor in the formation of respiratory diseases]. / Etiologicheskoe znachenie nasledstvennogo defitsita alpha1-ingibitora proteaz v formirovanii zabolevanii organov dykhaniia.

A study was made of the content of protease alpha 1-inhibitor and of the phenotyping of protease alpha 1-inhibitor subtypes in 666 patients with different chronic non-specific pulmonary diseases. It is concluded that pronounced deficiency of protease alpha 1-inhibitor is of importance in the formation of primary emphysema, chronic obstructive bronchitis and bronchial asthma. The clinical characteristics of obstructive pulmonary diseases marked by protease alpha 1-inhibitor deficiency have been investigated.