[Experience of using a triple fixed combination in the treatment of patients with chronic obstructive pulmonary disease].

AIM: To evaluate the effectiveness of a fixed triple combination of vilanterol/umeclidinium bromide/fluticasone furoate in the treatment of chronic obstructive pulmonary disease (COPD) patients with frequent exacerbations. MATERIALS AND METHODS: The study included 46 patients with severe and extremely severe COPD (GOLD 34) with frequent exacerbations. All patients were divided into 2 groups. The 1st group included 22 COPD patients with a content of eosinophils in the peripheral blood of 300 cells/ml, the 2nd group included 24 COPD patients with no signs of eosinophilic inflammation in the peripheral blood. Group 1 patients were recommended therapy with a fixed triple combination of vilanterol/umeclidinium bromide/fluticasone furoate at a dose of 22/55/92 mcg 1 time per day, group 2 patients received vilanterol+umeclidinium bromide at a dose of 22/55 mcg 1 time per day. The duration of follow-up was 12 months. RESULTS: After 12 months of treatment with a fixed triple combination of vilanterol/umeclidinium bromide/fluticasone furoate, a statistically significant decrease in peripheral blood eosinophilia was noted in patients with COPD with frequent exacerbations and peripheral blood eosinophilia (p=0.001), as well as a decrease in shortness of breath on the MMRs scale (p=0.001) and the frequency of exacerbations in patients with COPD with frequent exacerbations and eosinophilia (p=0.001). CONCLUSION: The use of a fixed combination of vilanterol/umeclidinium bromide/fluticasone furoate for 12 months allowed to reduce the impact of the disease, improve respiratory function and quality of life in COPD patients with eosinophilia.

[Analysis of the dynamics of mortality from respiratory diseases in the Russian Federation for 2019-2020].

AIM: To study the dynamics and contribution of mortality from Diseases of the respiratory system (DRS) in 2019 and 2020 to mortality from all causes with and without deaths from COVID-19 in 82 regions of the Russian Federation. MATERIALS AND METHODS: The data provided by Rosstat for 2019 and 2020 on the average annual population and the number of deaths due to causes of DRS (class J00J99) were used the standardised death rate (SDR) were calculated, the regional average value, standard deviation and coefficient of variation. RESULTS: The average increase in the SDR from DRS in 2020 was 22.1913.22 per 100 thousand population (66.4489.6% higher than in 2019). The average regional SDR from DRS + COVID-19 in 2020 was higher than the SDR from DRS in 2019 by 87.6530.1 per 100 thousand population. The average regional share of SDR in the structure of mortality excluding COVID-19 increased from 3.661.44 to 5.062.49%; taking into account COVID-19, it increased to 10.963.13%. In 16 regions, the SDR from DRS + COVID-19 exceeded the increase in mortality from all causes. No correlation was found between SDR (2020) from all causes and SDR from COVID-19 (r=0.09; p=0.39); an inverse correlation was found between SDR from DRS and SDR from COVID-19 in 2020 (r=-0.42; p0.0001). CONCLUSION: Against the background of high interregional variability of SDR from DRS in most regions, an increase in the mortality rate from DRS and the contribution of DRS to total mortality in 2020 was registered.

[Frequency of albuminuria in patients with bronchial obstructive diseases.]

The aim of the study was to study the frequency and features of albuminuria in patients with chronic bronchoobstructive lung diseases. The prospective study involved 219 patients with COPD (GOLD 1-4) and 201 patients with persistent bronchial asthma (BA) of varying severity, who were examined in 2018-2019. The control group consisted of 48 volunteers, comparable in age and gender. In addition to General clinical studies, all patients were calculated BMI and visceral obesity detection based on the waist-hip ratio (WHR), and the Smoking index (HCI) was calculated. Albuminuria was determined based on the calculation of the albumin / creatinine ratio in a single morning portion of urine. The frequency of optimal / slightly elevated AU (A1) was 28,7% (63) among COPD patients and 9% (18) of BA patients. The number of COPD patients with clinically significant AU (A2, A3) was 24,2% (53) of patients, which is statistically significantly higher than among BA patients (5,5% of patients; χ2=22,3, p=0,01). The factors that make a statistically significant contribution to the development of AU in patients with COPD were the frequency of exacerbations over the previous 12 months, ICP, fibrinogen and CRP levels, FEV1; in BA patients - WHR, ICP. Smoking contributes to the development and potentiation of renal dysfunction in patients with bronchial obstructive diseases. The issue of considering BA as a risk factor for renal dysfunction remains controversial, given the diversity of BA both in terms of disease phenotypes, severity, and variety of therapeutic approaches.

[The influence of treatment with inactive vitamin D on intrarenal blood flow in patients with chronic obstructive pulmonary disease.]

The aim of the work was to assess the dynamics of ultrasound parameters of renal blood flow in patients with chronic obstructive pulmonary disease (COPD)and initial stages of chronic kidney disease (CKD) during treatment with inactive vitamin D. The study included 264 patients with COPD of 2-4 degrees of severity in combination with CKD of 1-2 stages: 135 patients of the main group and 129 patients of the control group. Each group was divided into 4 subgroups according to the value of FEV1 and vitamin D level. In the main group, the native vitamin D was prescribed according to the scheme providing maintenance of vitamin D level >34,3 ng/ml during the year, in the control group - according to the recommendations of the Russian Association of Endocrinologists. An ultrasound of the kidneys with the calculation of the resistance index (RI) and albuminuria level were carried out in all patients at inclusion into the study and after its completion. A decrease in the severity of albuminuria from A3 to A2 was revealed in 24,1% (16), and an increase in GFR - in 42,9% (58) patients of all patients in the main group. A statistically significant decrease in the renal artery resistance index was recorded in the group of patients with moderate COPD (GOLD 2) and vitamin D deficiency in the main group (p<0,05). The maintaining of vitamin D levels more than 34,3 ng/ml over 12 months in patients with COPD in combination with CKD stage 1-2 was associated with a decrease in the severity of albuminuria, with an increase in GFR, and statistically significant decrease of resistance index in renal arteries of patients with moderate clinical course of COPD (GOLD 2) and lack of vitamin D.

[The factors associated with vitamin D levels in patients with chronic obstructive pulmonary disease in combination with renal dysfunction.]

The goal of study was to find factors associated with vitamin D levels in patients with chronic obstructive pulmonary disease (COPD) and early stages of kidney dysfunction. The study included 338 patients with 1-2 COPD stages (66,9% of men, mean age was 69,4±6,1 years, mean COPD duration was 18,5±4,1 years); 33,1% of women (mean age 64,8±7,3 years, mean COPD duration was 12,1±5,1 years). All patients were diagnosed with 1-2 stages of chronic kidney disease (CKD). In addition to general clinical examination, potential risk factors for vitamin D deficiency were assessed. During multiple regression with step-by-step inclusion method the following factors showed a significant contribution to the formation of vitamin D levels in patients with COPD and early stages of renal dysfunction: the frequency of exacerbations of COPD in the preceding 12 months (3 (2-4), ß=0,932, p=0,003), SI (44 (15-87), ß=0,038, p=0,006), fibrinogen level (5 (3-7), ß=0,413, p=0,016), GFR (74,9 (68,4-89), ß=0,119, p=0,041), insolation (94,5 (38,5-152), ß=0,026, p=0,0008),the total score on a GDS scale (9 (8-11), ß=0,536, p=0,014). R2 for this model was 0,87. BMI made a significant contribution to the formation of vitamin D level at the step of inclusion to the multivariate analysis, but when included in the analysis of insolation markers, the relationship weakened and completely disappeared when the values of SI were included. FEV1 values do not affect on vitamin D level in COPD patients in combination with early stages of kidney dysfunction.

[Predictors for development of major cardiovascular events in elderly patients with severe and extremely severe chronic obstructive pulmonary disease in combination with early stages of chronic kidney disease].

AIM: To study the structure of major cardiovascular events (MCVE) and to identify their independent predictors in elderly patients with severe and extremely severe chronic obstructive pulmonary disease (COPD) in combination with early stages of chronic kidney disease (CKD). MATERIALS AND METHODS: The study included 172 elderly patients with stage 3-4 COPD associated with stage 1-2 CKD. Initially, risk factors for MCVE were identified and levels of vitamin D (25 (ОН) D) were measured for all patients. In 12 months, MCVE anamnesis was collected, and patients were divided into two groups with and without MCVE during the observation period. The risk factors for MCVE, which were significantly different between the two groups according to results of a one-way analysis, were successively included into a logistic regression for identifying independent predictors of MCVE. A ROC analysis was performed for the identified variables to identify a predictive cut-off point. RESULTS: 21 MCVEs were observed in 8.7% (15) patients. Heart rhythm disorders (HRD) not reversed at the prehospital stage were observed in 38.1% patients; acute cerebrovascular disease and transient ischemic attack - in 23.8%, acute coronary syndrome - in 23.8%, and pulmonary thromboembolism (PTE) - in 14.3%. Two MCVEs, namely, a combination of HRD not reversed at the prehospital stage and PTE, were observed in 3 (20%) patients. The ROC analysis showed that the incidence of COPD exacerbation for the previous 12 months >3 had the highest predictive value for the 12-month risk of MCVE in patients with COPD associated with early CKD (95% CI, 0.823-0.925, р=0.001). A total PROCAM score <50 (95% CI, 0.882-0.964, р=0.001); GFR ≥80 ml/min/1.73 m2 (95% CI, 0.750-0.870, р=0.001); and a level of vitamin D ≥33 ng/ml (95% CI, 0.730-0.855, р=0.001) reduced the risk for MCVE. CONCLUSIONS: In elderly patients with grade 3-4 COPD associated with stage 1-2 CKD, the development of MCVE within 12 months was determined by the incidence of COPD exacerbations for the previous 12 months >3 while a total PROCAM score <50, GFR >80 ml/min/1.73 m3 , and levels of vitamin D >33 ng/ml reduced the risk of MCVE in these patients.

[Factors associated with a reduction in glomerular filtration rate in patients with chronic obstructive pulmonary disease].

AIM: Analysis of factors associated with reduced glomerular filtration rate (GFR) in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: The study included 198 patients with COPD 1-4 degrees of severity (GOLD 2014), who were on examination and treatment in Krasnodar Regional clinical hospital № 2. The control group consisted of 28 healthy volunteers, comparable in age and sex. In addition to clinical research, all patients, we calculated GFR according to the formula CKD-EPI based on cystatin C serum (GFRcys). The contribution of the factors in the risk of developing CKD was determined using multivariate linear regression analysis, as dependent variable used the value of GFRcys. RESULTS AND DISCUSSION: It was found that more than half (51.5%) of patients with COPD have a decrease in GFRcys.

[The relationship of vitamin D level with markers of cardiorenal syndrome in patients with chronic obstructive pulmonary disease.]

The aim of the study was to examine the relationship of vitamin D levels with markers of cardiorenal syndrome in patients with COPD depending on the severity of bronchial obstruction.198 patients with COPD were divided into 2 groups depending on the severity of bronchial obstruction. A deficiency of vitamin D was significantly more prevalent in COPD patients with GFRcys <60 ml/min/1,73 m2 compared to patients with preserved renal function. A medium positive correlation of vitamin D levels with the severity of bronchial obstruction (r=0,419, p=0,001), medium negative correlation of vitamin D levels with exacerbation frequency (r=0,421, p=0,01) and CRP (r=0,301, p=0,02) were observed. Significant negative correlation of vitamin D levels with the magnitude of albuminuria (r=0,345, p=0,02) was also discovered. Significant lower relative frequency of hyperphosphatemia in patients with COPD 3, 4 severity (63,16 vs 78,69%, χ2=6,627, p<0,05), there was a positive correlation between the phosphorus level of the blood serum level of 25(ОН)D (r=+0,475, p=0,025).The level of vitamin D in some clinical situations can be considered as a promising biomarker of current cardiorenal continuum in patients with COPD, and its correction, as a possible way of slowing the progression of cardiovascular complications in such patients.

[Chronic kidney disease: contribution to comorbidity in elderly patients with chronic obstructive pulmonary disease].

The aim was to study the prevalence of risk factors for chronic kidney disease (CKD) and frequency of CKD in patients with chronic obstructive pulmonary disease (COPD). 300 patients with a diagnosis of COPD I-IV were examined. A high prevalence of risk factors CKD was revealed, there are close correlations between the risk factors and the age of patients and severity of obstructive disorders and the spectrum of comorbid pathology. The diagnosis of CKD 1-3B stage is set for 47,6 % of the patients. The obtained data determine the necessity of close attention by clinicians to the study of renal function in elderly patients with COPD.