[On the assessment of medical rehabilitation effectiveness in patients with chronic obstructive pulmonary disease in the resort setting]. / K voprosu ob otsenke effektivnosti reabilitatsii bol'nykh khronicheskoi obstruktivnoi bolezn'yu legkikh na kurorte.

Despite significant successes of health resort rehabilitation in patients with chronic obstructive pulmonary disease (COPD), the assessment of rehabilitation effectiveness remains challenging for resort physicians in Russia. OBJECTIVE: To perform a comparative analysis of methods for assessing the medical rehabilitation outcomes in COPD patients in the resort setting. MATERIAL AND METHODS: The study involved 71 patients with stage I-II COPD, with bronchitis (66.2%) and mixed (COPD + asthma, 33.8%) phenotypes in the clinical remission phase. The mean age of the patients was 57.0±9.8 years, and the mean duration of disease was 7.8±5.1 years. Within 14 days, all patients received an identical set of rehabilitation measures with natural and preformed physical therapeutic resort factors. Before and after the medical rehabilitation course, clinical, laboratory, functional tests and questionnaires were performed on each patient. The effectiveness of course-based complex rehabilitation was assessed using one of three methods: CAT (COPD [chronic obstructive pulmonary disease] Assessment Test), the International Classification of Functioning, Disability and Health (ICF), the COPD control and control stability criteria system. RESULTS: Comparison of the three methods of assessment of COPD patients' rehabilitation outcomes in resort settings showed that the CAT score is the easiest to use, the least time-consuming, highly valid, and informative. According to the CAT score, the resort medical rehabilitation effectiveness was 96.4%, with «improvement¼ and «significant improvement¼ recorded in 82.1% of cases. The use of ICF provides reliable information about the rehabilitation complex effect on the main pathogenetic links of the disease, which allows proper adjusting of rehabilitation procedures to improve effectiveness in the resort setting. Specified grades of ICF domains make it possible to translate qualitative and quantitative attributes inherent to a particular subject into points. The points trend during the medical rehabilitation indicates its effectiveness in terms of recovery of specific functions impaired by the disease. At the same time, the ICF does not allow to rank the medical rehabilitation outcomes in the resort setting in terms of the currently accepted concepts of «significant improvement,¼ «improvement,¼ «slight improvement,¼ «no change,¼ «deterioration,¼ which limits its application in resorts. We believe that assessment of rehabilitation outcomes based on COPD control and control stability is not applicable to resort setting due to possible discrepancy between the impression formed in a short time (14 days) about these characteristics of the pathological process and the actual status, as well as due to lack of knowledge about the effect of achieved/not achieved disease control on the choice of rehabilitation technology. CONCLUSION: A simple and highly informative CAT score can be recommended to assess the effectiveness of resort medical rehabilitation in patients with chronic obstructive pulmonary disease.

[Leukocyte indices of patients with bronchial asthma: informative significance of use].

AIM: Determination of informativeness of leukocyte indices in patients with bronchial asthma, who have comorbid diseases in clinical remission of asthma. MATERIALS AND METHODS: The work based on a single examination of 225 patients with bronchial asthma. Criteria for inclusion in the study are following: the presence of a verified diagnosis of bronchial asthma, the phase of clinical remission. The patients have been divided into 4 groups, taking into account the type of comorbid diseases: the 1 group (53 patients) bronchial asthma was combined with lesions of the upper gastrointestinal tract; the 2 group (73 patients) with allergic rhinitis; the 3 group (76 patients) with hypertension; the 4 group (23 patients) comparison group: the patients without comorbid pathology. According to the clinical blood analysis, 10 leukocyte indices were calculated for each group of patients and their values were analyzed taking into account the frequency and severity of deviations from the reference values. Mathematical processing of the material was carried out using the statistical software package SPSS13.0 for Windows. RESULTS: Using leukocyte indices, it has been revealed that even during the period of clinical remission, almost all examined patients with BA have endogenous intoxication, the severity of which increases in comorbid diseases. Intoxication was inflammatory in nature and, according to the data of leukocyte indices, was due to the presence of persistent inflammation (local and systemic) and during clinical remission. Violation of immunological reactivity has been revealed in most of the examined patients. The presence of correlation relationships of leukocyte indices with a number of biochemical and immunological indicators allows one to exclude the latter from the plan of examination of patients without reducing the quality of their examination: for example, in the conditions of polyclinics, small hospitals, and resorts. Eight leukocyte indices that are the most informative at BA have been selected. CONCLUSION: Additional information about the condition of BA patients who have comorbid diseases during clinical remission can be used to develop programs for their comprehensive treatment and rehabilitation.

[Continuous-cycle technology of rehabilitation of patients with chronic obstructive pulmonary disease on an outpatient basis]. / Nepreryvno-tsiklovaya tekhnologiya reabilitatsii bol'nykh khronicheskoi obstruktivnoi bolezn'yu legkikh na ambulatornom etape.

AIM: Of this study is to substantiate the effectiveness of continuous-cycle technology of rehabilitation of patients with chronic obstructive pulmonary disease (COPD) on an outpatient basis. MATERIAL AND METHODS: 140 patients with moderate to severe (stage II-III) COPD were examined: 82% with chronic bronchitis phenotype and 18% - with emphysema phenotype. 44% of patients had frequent exacerbations. Patients were admitted to outpatient rehabilitation after stages I and II because of the exacerbation of the disease. 2 comparable groups were formed: the primary group included 68 patients who were engaged in active physical rehabilitation according to a continuous-cycle technique for 10-12 months; the comparison group consisted of 72 patients receiving only basic drug therapy. Continuous-cycle technique included: regular exercise therapy, cycling and procedures that improve tolerance to them (hardware chest vibration, chlorpromazine electrophoresis), oxygen cocktail, general ultraviolet radiation in the unfavorable period of the year. Diagnostics of early signs of an exacerbation of the disease and prophylactic prescription of physiotherapeutic procedures were carried out. RESULTS AND DISCUSSION: During the year of observation during treatment, only 4 cases failed to prevent full exacerbation of the disease. During the year, in the patients of the primary group, in contrast to the comparison group, there was a significant improvement in the clinical signs of the disease, an increase in VC, an improvement in bronchial patency, an increase in physical performance and exercise tolerance, and a decrease in the activity of systemic inflammation. A year later, we registered an improvement in the course of the disease n 70% of patients of the primary group, and only stabilization of the process - in 82% of the comparison group. Frequency of exacerbations in the primary group decreased 5.1 times, which was 3.9 times more significant than in the comparison group.

Features of the current of bronchial asthma in the presence of komorbidy allergic rhinitis.

AIM: Aim - study of the influence of komorbidy allergic rhinitis (AR) on the course of bronchial asthma (BA). MATERIALS AND METHODS: Clinical research, single performed by a survey of 96 patients divided into two groups: the main - 73 patients with BA combined with AR and a group of comparison-23 patients who do not have allergic rhinitis. The data of clinic, bronchial passableness, level of control of asthma, severity of inflammation in bronhopulmonary region on content of nitrogen oxide in exhaled air and in nasal flushes of a number of biochemicals were studied in comparative aspect. Indicators, the manifestation of systemic inflammatory response according to biochemical, immunological indicators and calculated lejkocitarnym indices. RESULTS: It is revealed that activity of inflammatory process in patients with BA without AR is higher both in the bronhopulmonary region and at the system level. At the same time in the period of clinical remission, most of them have sufficiently well functioning protective mechanisms on the part of the antioxidant system, humoral immunity, non-specific protection. CONCLUSION: When combined BA and AR inflammation at both local and system levels is less pronounced, but the activity of protective mechanisms decreases. In parallel to the growth of violations on the part of cell and humoralal links of immunity in the blood increases the content of Circulating immune complexes, which contributes to the torpor current of inflammation, which is the basis of a more significant violation of bronchial permeability and complicates achieve control of asthma. These changes increase as the duration of the disease both BA and AR, as well as frequency exacerbations of the disease.

[The substantiation of the use of high-frequency intrapulmonary ventilation in the patients presenting with chronic obstructive pulmonary disease at the spa and health resort stage of rehabilitation]. / Obosnovanie ispol'zovaniya vysokochastotnoi intrapul'monal'noi ventilyatsii u bol'nykh khronicheskoi obstruktivnoi bolezn'yu legkikh na sanatorno-kurortnom etape reabilitatsii.

UNLABELLED: The importance of the development of the new methods for the rehabilitation of the patients presenting with chronic obstructive pulmonary disease under conditions of the spa and health resort-based treatment arises from the high prevalence and the progressive character of this disease, poor quality of the patients' life, great economic losses due to the reduction of the working capacity of the patients, and the high cost of COPD treatment. AIM: The objective of the present study was to substantiate the advisability of inclusion of high-frequency intrapulmonary ventilation in the program of the therapeutic and rehabilitative treatment of the patients with COPD based at a spa and health resort facility. PATIENTS AND METHODS: The analysis of the results of examination and rehabilitative treatment included 49 patients treated at the «Belokurikha¼ health resort (14 women and 35 men presenting with stage 1 and 2 COPD). The patients were divided into two groups. The main one included 23 patients while the group of comparison consisted of 26 patients. Those of the main group were given the treatment that included the mineral water baths, inhalations, exercise therapy for the training of skeletal muscles, manual massage, high-frequency intrapulmonary ventilation, intake of extract maral root (Rhaponticum carthamoides) and the «Yantar antiox¼ (amber antiox) preparation. The patients of the comparison group received the same rehabilitative treatment but without high-frequency intrapulmonary ventilation. The effectiveness of the rehabilitative measures was comprehensively estimated from the dynamics of the clinical data, indices of the inflammatory activity, the results of spirography and 6 minute walking test. RESULTS: It has been shown that the introduction of high-frequency intrapulmonary ventilation into the spa and health resort-based rehabilitative program facilitates the elimination of clinical manifestation of the disease, promotes recovery of the external respiration function due to sputum recruiting and stimulation of mucociliary clearance that in turn decreases the activity of the inflammatory processes. Simultaneously, the thoracic mobility and physical efficiency of the patients increased. The overall result of the treatment was the enhanced quality of rehabilitation of the patients suffering COPD within 14-16 days of their stay at the health resort with excellent tolerability of the proposed therapeutic modality.

[The treatment of exacerbations of chronic laryngitis in the vocal professionals].

UNLABELLED: The objective of the present study was to develop a method for the AIM: comprehensive and uniform evaluation of the results of the treatment of vocal professionals experiencing exacerbations of chronic laryngitis under effect of physical factors. We propose the system of quantitative gradation of the main clinical and functional characteristics that should be taken into consideration for the assessment of the health status of the patients presenting with exacerbations of chronic laryngitis. In addition, the aggregate health index was calculated the dynamics of which can be used to estimate the results of the treatment. The quantitative criteria were developed for the expert evaluation of the temporary incapacity for work in the vocal professionals experiencing exacerbations of chronic laryngitis. It is concluded that the proposed approach can be employed by otorhinolaryngologists, phoniatrists, physiatrists, and developers of new technologies for the treatment of exacerbations of chronic laryngitis. Moreover, it is recommended for the application in out-patient and in-patient healthcare facilities, centresof restorative and rehabilitative medicine, medical research and development institutions.

[A new approach to the treatment of patients presenting with bronchial asthma and concomitant allergic rhinitis].

The present study included 73 patients presenting with bronchial asthma (BA) and concomitant allergic rhinitis (AR). Based on the results of their examination, a program of their two-step treatment was proposed including elimination therapy during 5-7 days followed by the combined treatment with the use of physical factors, such as peloid therapy, supratonal frequency currents, inhalations, massage, and remedial gymnastics. This approach allows to significantly reduce the frequency of clinical manifestations of the primary and concomitant diseases. Specifically, the incidence of daytime choking fits decreased by 66.7%, coughing by 76.7%, nasal stiffness by 60%, and rhinorrhea by 62,6 with the simultaneous acceleration of the overall clinical effect by 3-4 days. The requirement for short-acting broncholytic agents decreased after the treatment by 56.7%. Its anti-inflammatory effect in the upper and lower respiratory tract was confirmed by the results of endoscopic examination of the nasal cavity (the occurrence of mucosal hyperemia and mucosal oedema decreased by 70% and 60% respectively whereas the presence of secretion in the nasal passages was recorded 76.7% less frequently than prior to the treatment). Cytological studies of surface epithelium revealed reduced neutrophilia and eosinophilia, decreased number of goblet cells in nasal mucosa, and lowered content of sialic acids, IL-1, and IL-6 in nasal lavage. Combined therapy improved the patency of both upper and lower respiratory tract. Moreover, the number of patients with the totally controlled clinical course of BA increased by 66.6%. It was shown that remission of BA and AR persisted within 10 and 8.2 months after the treatment respectively.

[Mathematical prognostication of the efficacy of peloidotherapy in the patients with chronic bronchitis and obstructive pulmonary disease].

This study included prognostication of the results of daily application of peloids for the treatment of the patients presenting with chronic bronchitis and obstructive pulmonary disease using a mathematical model. It was shown that the individualized selection of the patients for the daily application of peloid preparations taking into consideration the results of mathematical prognostication makes it possible to significantly improve the total efficacy of the treatment (up to 97.7%), accelerate the achievement of positive outcome of peloidotherapy, reduce by a factor of 4 the frequency of moderately severe balneoreactions, and increase the duration of the remission period by 3.5-4 months.

[Vibrophoresis of mud lipid extract in the rehabilitation of patients with osteoarthrosis]. / Vibroforez ékstrakta lipidov griazi v vosstanovitel'nom lechenii bol'nykh osteoartrozom.

Experimental and clinical evidence (76 patients with osteoarthrosis) justifies combined use of thermovibration massage and lipid extract from therapeutic mud eplir. This combination produces analgetic, antiedematic, antiinflammatory actions and promotes normalization of systemic immunity and peripheral hemodynamics.

[Physical factors in rehabilitation treatment of patients with Ixodes tick-borne borreliosis with primary lesions of the joints]. / Fizicheskie faktory v vosstanovitel'nom lechenii bol'nykh iksodovym kleshchevym borreliozom s preimushchestvennym porazheniem sustavov.

The studies made in 96 patients suffering from chronic ixode tick borreliosis with a prevalent joint lesion justified two-stage treatment with physiotherapy at the second stage. The proposed therapy is well tolerated, produced a good improvement in 82.4% patients, the response persisting for 8.8 +/- 0.2 months vs 5.6 +/- 1.0 months in the control group on pharmacotherapy alone.

[Anti-inflammatory effect of mineral water inhalation: validity of identification of biochemical markers in nasal secretion]. / Protivovospalitel'noe deistvie ingaliatsii mineral'nykh vod: tselesoobraznost' opredelenia biokhimicheskikh markerov vospaleniia v nazal'nom sekrete.

The study was made of therapeutic activity of silicon mineral water Tersinka inhalations on clinical symptoms, external respiration function and activity of inflammation in patients with chronic bronchitis and bronchial asthma as shown by biochemical markers of inflammation in the blood serum and nasal secretion. A correlation was found between treatment efficacy and concentration of sialic acids in the nasal secretion in pulmonological patients.

[Determination of sialic acids in the nasal mucosa lavage]. / Opredelenie sialovykh kislot v smyvakh so slizistoi obolochki polosti nosa.

A modified method of determining the sialic acids by using Ehrlich's reagent and according to G. Sydow (1985) was worked out; the method is characterized by a higher sensitivity as compared to the unified methods of Hess and Svennerholm, which enables to process the nasal mucous lavage that has an essentially lower concentration of sialic acids than the blood serum. A clinical approbation of the modified method (in patients with bronchial asthma, and with obstructive and non-obstructive bronchitis) showed that it preserved the specificity typical of the original method and is sufficiently sensitive. Examinations of 12 healthy volunteers showed that the concentration of sialic acids in their lavage amounted to 0.110 +/- 0.012 mumol/L.

[An intensive regimen of pelotherapy in pulmonology]. / Intensivnyi rezhim peloidoterapii v pul'monologii.

The authors show that intensification of peloid therapy, i.e. more frequent procedures, in patients with pulmonary diseases imposes additional load on the regulatory systems: vegetative, cardiovascular, immune. Moderate balneological reactions become more frequent, therapeutic results worsen. How to correct the above negative effects is proposed.

[The possibility of using the inhalations of some types of Kamchatka mineral waters in bronchopulmonary pathology]. / Vozmozhnost' ispol'zovaniia ingaliatsii nekotorykh tipov mineral'nykh vod Kamchatki pri bronkholegochnoi patologii.

Kamchatka spring mineral water (wells 6.9 and 32 of Ketkinskoye, Malkinskoye and Verkhne-Paratunskoye deposits, respectively) was used in inhalations in 54 patients with chronic bronchitis. Clinical and experimental findings evidenced irritating effect of the water from well 9 which activated inflammation and reduced bronchial patency. Water from well 6 can be used in nonobstructive processes, whereas that from well 32 is effective in inflammation-induced bronchial obstructions and is fit to stimulate respiratory reserves.

[The use of thermal vibromassage of the chest cavity in patients with chronic obstructive bronchitis for improving their tolerance for physical loads]. / Ispol'zovanie termovibromassazha grudnoi kletki u bol'nykh khronicheskim obstruktivnym bronkhitom dlia uluchsheniia perenosimosti fizicheskikh nagruzok.

According to the bicycle ergometry data the greater part of patients with chronic obstructive bronchitis are characterized by reduced physical work fitness. The latter one was found to rise under the effect of thermal vibromassage of the chest at a frequency of 30 Hz. The method has been elaborated and the advisability of its use has been theoretically based. The given method can be applied to the rehabilitation treatment of patients, particularly before exercise therapy.

[2-stage treatment of acute pneumonia patients with rehabilitation at the sanatorial stage]. / Dvukhétapnoe lechenie bol'nykh ostroi pnevmoniei s reabilitatsiei na sanatornom étape.

A total of 73 patients with acute pneumonia received two-stage treatment: etiotropic treatment based on early etiological diagnosis (at hospital) and subsequent early rehabilitation at sanatorium with the use of peloid therapy. It made it possible to attain the best short-term results in the treatment of pneumonias (as compared with control group patients), to shorten 2-4-fold the times of the patients' stay at hospital and to raise bed capacity, to reduce the total doses and duration of antibacterial therapy, to decrease the possibility of the allergic reactions and side effects, and to reduce 2-fold the cost of antibacterial therapy.