[Modern understanding of bronchial asthma with fixed airflow obstruction].

The review provides data on one of the phenotypes of severe bronchial asthma it is asthma with fixed airway obstruction. According to data published today, there is no single pathway for the formation of fixed airway obstruction in patients with severe asthma. Increasing knowledge of the pathophysiology of fixed airway obstruction, as well as identifying the most significant risk factors, is essential for the successful treatment of such patients. In addition, the development of fixed obstruction is associated with a worse and sometimes fatal prognosis. Expanding the existing views is also necessary to overcome the difficulties of differential diagnosis between bronchial asthma with fixed airway obstruction and bronchial asthma in combination with COPD. All this will optimize the approach to the management of patients with bronchial asthma to prevent the formation of fixed airway obstruction.

Features of cellular structure of the induced sputum and profile of cytokines at sintropiya of bronchial asthma and obesity at young patients.

AIM: To estimate changes of cellular structure of the induced sputum at young patients with bronchial asthma at interrelations with BMI and level of cytokines in blood plasma. MATERIALS AND METHODS: 164 patients with bronchial asthma were divided into 2 groups taking into BMI: the 1st group included patients with bronchial asthma and BMI from 18 to 25 kg/m2, patients with bronchial asthma and BMI from 30 to 40 kg/m2 entered into the 2nd group. The group of control was made by 40 almost healthy volunteers. Estimated existence of excess weight and defined obesity degree according to recommendations of World Health Organization. Studied the level of control of bronchial asthma, cellular structure of the induced sputum, the IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-15, IL-17, TNF-α, INF-γ levels in plasma of peripheral blood. RESULTS: There are presented the results of the research of cellular profile of the induced sputum and profile of cytokines at patients with bronchial asthma depending on BMI and severity of the disease. The received results testify to prevalence of eosinophilic type of an inflammation in the group of patients with BMI less than 25 kg/m2 whereas at patients mainly paucigranulation inflammation decided on obesity. The highest content of the Il-17 was registered at patients with bronchial asthma and obesity as in comparison with indicators of patients with normal BMI, and with almost healthy that, perhaps, is the reason of low effect of steroid therapy at these patients. CONCLUSION: Endotype assessment before basic antiinflammatory therapy at patients with the first time diagnosed bronchial asthma, will be able to help with selection of the most optimum treatment to each specific patient.

[ACOS: Clinical and functional features The Russian formulation mesalazine (kansalazine) in the therapy of ulcerative colitis]. / ACOS-sindrom: kliniko-funktsional'nye osobennosti.

AIM: To investigate the clinical and functional parameters in patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) versus those with chronic obstructive pulmonary disease (COPD) and asthma. SUBJECTS AND METHODS: A total of 129 people were examined. 51 patients with ACOS were followed up in Group 1; Group 2 included 38 patients with severe asthma; Group 3 consisted of 40 patients with severe COPD. All the patients underwent clinical examination: history data collection, physical examination, evaluation of disease symptoms, and study of respiratory function (spirometry, body plethysmography). RESULTS: ACOS is clinically characterized by considerable demands for emergency drugs and by more frequent asthmatic fits and exacerbations, which require hospitalization. The parameters of bronchial resistance in ACOS were established to be increased throughout the follow-up period and to be comparable with those in patients with COPD. In the patients with ACOS, the severity of pulmonary hyperinflation was associated with increased demands for emergency drugs (r=0.59; p=0.015). Fixed bronchial obstruction in ACOS can be caused by smoking intensity and duration associated with increased bronchial resistance in expiration (r=0.51; p=0.003) and intrathoracic volume (r=0.71; p=0.0001); as well as increased body mass index (p<0.001) and disease duration, which were interrelated with a reduction in the forced expiratory volume in one second/forced vital capacity ratio (r=-0.63; p=0.001 and r=-0.71; p=0.0034, respectively). CONCLUSION: Patients with ACOS show more severe clinical manifestations and a substantial increase in functional residual capacity and intrathoracic volume throughout the follow-up period, suggesting that the distal bronchi are impaired and pulmonary hyperinflation develops.

[CLINICAL AND PATHOGENETIC PECULIARITIES OF DEVELOPMENT OF ENDOTHELIAL DYSFUNCTION].

The purpose of the study was to examine the relationship between functional parameters, arterial rigidity, lipid profile, markers of systemic inflammation and endothelial dysfunction in patients with COPD and COPD + coronary heart disease. We examined 110 subjects divided into 3 groups. G group 1 included 40 patients with severe and very severe COPD, group 2 consisted of 40 patients with severe and very severe COPD + coronary artery disease, the control group was comprised of 30 healthy volunteers. We studied parameters of respiratory function, the level of blood oxygenation, the main characteristics of arterial rigidity plasma lipid, TNF-α, CRP, fibrinogen, sPECAM-1 levels and the expression of CD38/ADP-ribosylcyclase in peripheral blood lymphocytes. The study revealed increased rigidity of the central arteries in the patients of groups 1and 2 regardless of the duration of observation and the presence of coronary artery disease, as evidenced by the increase of the pulse wave velocity in the aorta. Patients of both groups had elevated levels of TNF-α, CRP and fibrinogen indicating systemic inflammatory response. Taken together, the enhanced expression of CD38 in peripheral blood lymphocytes, elevated concentration of soluble CD31 (sPECAM-1) in both groups related to bronchial obstruction and neutrophil elastase activity as well as increased rigidity of the vascular bed gives evidence that the CD38 and sCD31 relationship plays a role in the formation of endothelial dysfunction, and dysregulation of vascular tone in COPD patients. Disorders of lipid metabolism combined with increased rigidity of the vascular wall, elevated levels of markers of systemic inflammation and endothelia dysfunction, suggest that patients with COPD are at risk of cardiovascular events.

[Functional and laboratory characteristics in the concomitance of asthma and obesity at a young age].

AIM: To study the peripheral blood level of leptin and adiponectin and their possible effect on the functional status of the respiratory system in young asthmatic patients in relation to body mass index (BMI) for the optimization of asthma therapy. MATERIALS AND METHODS: Examinations were made in 133 people, including a study group of 93 patients with asthma who were divided into 2 groups according to BMI: 1) those with a BMI of less 25 kg/m2 and 2) those with a BMI of 30 kg/m2 or more, as well as a control group of 40 apparently healthy patients. The investigators studied external respiratory function (ERF), the peripheral blood levels of leptin and adiponectin, the biochemical composition of plasma, by determining total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. RESULTS: Lipid metabolic disorders as dyslipidemia and hypercholesterolemia, increased severity of disease, and decreased ERF were recorded in the concomitance of obesity and asthma. The peripheral blood level of leptin in young asthmatic patients with obesity was found to be associated with higher BMI. CONCLUSION: A more severe course of disease presenting with decreased ERF, impaired lipid metabolism, and elevated peripheral blood leptin levels were noted in the concomitance of asthma and obesity at a young age.

[Impact of tobacco smoking on the clinical and functional indicators and markers of systemic inflammation in patients with severe asthma].

AIM: To study cytokine status and to reveal a possible relationship of clinical and functional indicators and systemic inflammation in patients with severe asthma to tobacco smoking. Subjects and methods. Examinations were made in 139 patients with severe asthma during its exacerbation and without the latter after 12 months. Groups 1 and 2 included 98 nonsmoking and 41 smoking patients with severe asthma, respectively. A control group consisted of 40 apparently healthy volunteers. External respiratory function, plasma TNF-α, IFN-γ, IL-2, IL-4, IL-6, IL-8, IL-10, C-reactive protein, and neutrophil elastase levels, and integral cytokine index were studied. RESULTS: Systemic inflammation that was more marked on a disease exacerbation and mediated by elevated TNF-α, IL-2, and C-reactive protein levels was detected in severe asthma in both groups. The smoking patient group showed a statistically significant increase in IL-8 and neutrophil elastase levels, which may be indirectly indicative of the active participation of neutrophils in the development of chronic persistent inflammation. CONCLUSION: Tobacco smoking is a clinically significant risk factor that aggravates both the course of asthma and the magnitude of inflammation during a disease exacerbation.

[THE RELATIONSHIP BETWEEN DISORDERS-OF EXTERNAL RESPIRATION AND RIGHT HEART REMODELING IN PATIENTS WITH ATOPIC BRONCHIAL ASTHMA].

This study aimed at the evaluation of the state of the respiratory system and its possible influence on the structural and functional characteristics of the right heart in patients with atopic bronchial asthma (BA) with a view to optimizing diagnostics and prevention of cardiovascular complications. The study included 189 subjects of whom 148 with BA were divided into 3 groups depending on the severity of the disease. Forty practically healthy volunteers comprised the control group. The external respiration function and right ventricle functional parameters were the main variables measured in all the participants of the study. It was shown that disorders of external respiration and pulmonary hyperinflation progressed with severity of BA and thereby promoted right ventricular myocardium remodeling and dysfunction that in turn led to chronic cardiac insufficiency. It is concluded that functional changes in the right heart in of patients with BA of different severity are associated with remodeling of the respiratory tract.

[Relationship between endothelial dysfunction and mechanisms of systemic inflammation in left heart remodeling in patients with bronchial asthma].

The aim of the work was to study clinical and pathophysiological features of endothelial dysfunction, structural and functional state of the left heart in patients with bronchial asthma (BA). The study included 290 patients. 250 of them presented with moderate or severe BA during exacerbation and within 12 months after the onset of observation, 40 healthy volunteers served as controls. The endothelial function was disturbed in 63 and 74% of the patients with moderate and severe BA respectively. They showed reduced endothelium-dependent vasodilation in combination with a significant increase of the plasma sDC31/ sPECAM-1 level. It is concluded that patients with BA develop structural and functional changes in the left ventricular myocardium proportional to the severity of BA which leads to diastolic dysfunction.

[CD38/ADP-ribosyl cyclase, a marker of endothelial dysfunction in bronchial asthma].

The study was aimed at measuring the number of CD38+ lymphocytes in peripheral blood and its relationship with a marker of endothelial dysfunction CD31/PECAM-1 in patients with moderate or severe bronchial asthma (BA) during exacerbation and 12 months after it. The study groups included 153 patients, the control one consisted of 40 subjects. Group 1 comprised 106 patients with moderate BA, group 2 patients with severe steroid-independent BA (n=61), group 3 patients with steroid-dependent BA (n=53). CD38+ lymphocytes were detected by immunocytochemical methods, IL-6, IL-4, IL-2, and TNF-α by solid-phase immunoenzyme assay. BA patients exhibited signs of systemic inflammation reflected in the two-fold and 2.5-fold increase of serum TNF-α and IL-6 levels respectively in the patients of group 1. TNF-α, IL-6 and C-reactive peptide levels increased by 3, 2 and 2.5-4 times in groups 2 and 3. Exacerbation of BA resulted in a 5-fold rise in the number of DC38 lymphocytes that persisted during the next 12 months suggesting a 15% increase in the level of sPECAM-1/sCD31 (a non-substrate ligand of CD38) associated with endothelial dysfunction. The study revealed positive correlation between elevated sPECAM-1/sCD31 levels and the number of CD38+ lymphocytes in all groups (r=0.456; p<0.05).