[Problems and opportunities to improve diagnosis of asthma and chronic obstructive pulmonary disease in Russia: resolution of advisory board].

Asthma and chronic obstructive pulmonary disease remain major problems of medicine, and still there is need to improve the level and quality of diagnosis of these diseases. Primary care physicians (general practitioners, therapists) should be involved widely and actively in this process. To simplify the diagnosis, special questionnaires have been developed, they can be used in a real clinical practice. Only this approach will bring statistical data closer to the true prevalence of these diseases and improve quality of their treatment.

[Data from the Russian Severe Asthma Registry (RSAR)].

AIM: Creation of the "Russian register of patients with severe asthma" and obtaining data on the population characteristics of patients with severe asthma (SA), the prevalence of SA phenotypes, treatment outcomes and the degree of disease control. MATERIALS AND METHODS: Observational non-interventional study, which consists in the data analysis obtained on the basis of registration cards of the Russian Register of Patients with Severe Bronchial Asthma, data collection in which was carried out on the Oracle XE platform. Statistical data processing was carried out using Power BI, PSPP and Microsoft Excel spreadsheets. RESULTS: The study included 4376 adult patients (mean age 60.613.5 years, 65% women) diagnosed with SA from 57 regions of Russia for the period from June 2018 to December 2021. T2 inflammation was detected in 94.8% of patients when determining blood eosinophils and IgE of blood serum; 69% of patients with SA corresponded to the allergic phenotype. 83.3% of patients had no control of BA and 53% had 1 or more exacerbations of BA per year. 8% of patients received systemic corticosteroids as a permanent therapy, while biologics 10.6%. CONCLUSION: The vast majority of adult patients with SA correspond to the T2 phenotype, have uncontrolled asthma with a high frequency of exacerbations and reduced lung function. A more favorable course of the disease was noted in patients receiving biological therapy, which requires appropriate measures to increase the possibility of access to this type of therapy.

[Allergic rhinitis: what is the patient's choice of drug based on? Russian study's results]. / Allergicheskii rinit: na chem osnovan vybor lekarstvennogo preparata patsientom? Rezul'taty rossiiskogo issledovaniya.

BACKGROUND: Allergic rhinitis (AR) is a disease that significantly affects the quality of life (QOL) of the patients. Scientific researches that reveal the reasons for the uncontrolled course of AR and the low level of QoL in patients are rare. OBJECTIVE: Of this study was to establish how often patients with moderate AR seek medical care or prefer to choose a drug on their own in a pharmacy. MATERIAL AND METHODS: The study consisted of an online survey of 328 adults over the age of 18 who bought drugs in a pharmacy for treatment of AR. The respondents were divided into two groups: 1) those who bought the drug according to the recommendation of a doctor (164), 2) those who chose the drug on their own (164). RESULTS: The study revealed a dissonance between the severity of clinical symptoms of AR and how patients assess their QoL. The majority of patients estimated the symptoms of AR as moderate, but the disease itself was characterized as mild, not interfering with daily activity and sleep. The more severe the manifestations of AR were, the more often patients did not seek medical care from a doctor, preferring an independent choice of drugs, the help of a pharmacist, or focusing on long-standing doctor's recommendations. 48% of patients have never visited a doctor for AR. We have found a discrepancy between the optimal choice of drugs for the treatment of AR and the patient's attitude to this choice. 95% of patients purchased oral antihistamines from the pharmacy, 71% - decongestants, 26% - vitamins and food supplements. Although topical steroids were recommended by a doctor in 57% of cases, only 37% of patients bought intranasal corticosteroids in a pharmacy. When choosing a drug, 36% of patients preferred the advice of pharmacists; almost 50% followed advice from relatives and friends, 23% of patients used information from the Internet. CONCLUSION: This study confirmed a tendency towards a decrease in patient adherence to modern AR therapy algorithms. Patient seeking medical care for AR is extremely low. It is required to optimize the education of primary care physicians and pharmacists, develop educational programs for patients.

[Participation of neutrophils in the pathogenesis of allergic inflammation: inhibitory-protease index in assessing and predicting atopic illnesses]. / Uchastie neitrofilov v patogeneze allergicheskogo vospaleniia: ingibitorno-proteaznyi indeks v otsenke i prognozirovanii atopicheskikh zabolevanii.

Total trypsin-like (BAEE esterase), elastase-like (BOC esterase) and antitryptic activities were studied in blood serum of patients with atopic diseases. The elastase-like activity was increased in blood serum of all the patients examined during the acute period of the disease; the enzyme activation depended on the pathology severity and clinical picture manifestations. The increase in blood plasma total proteolytic activity correlated with reverse alteration in blood antitryptic potential. The data obtained suggest that activation of neutrophils occurred in atopic diseases, thus the rate of elastase-like activity in blood might be used as an objective pattern in examination of patients and in checking of treatment course. The developed inhibitory-protease index may serve also as a criterion in evaluation of the pathological state severity.

[The mechanism of activation of kallikrein-kinin system in the plasma of patients with atopic allergic diseases]. / Mekhanizm aktivirovaniia kallikrein-kininovoi sistemy plazmy krovi u bol'nykh atopicheskimi allergicheskimi zabolevaniiami.

Data early obtained on activation of the kallikrein-kinin system in acute forms of pollinosis and urticaria were corroborated in vitro. These experiments exhibited enzymatic activation of Hageman factor and prekallikrein using "liberator", obtained after incubation of the leukocyte fraction enriched with basophils and specific allergen. I ml of the "liberator" containing 10(7) cells activated Hageman factor up to 12-20 mU per min (evaluated by BAEE-esterase activity of the kallikrein developed) as well as kallikrein activity was increased up to 80-130 mU within 1.5-2 hrs of incubation. The Hageman factor was distinctly inactivated after long-term incubation with the "liberator".

[Activity of the prekallikrein-kallikrein system and characteristics of its regulation in various allergies]. / Aktivnost' sistemy prekallikrein-kallikrein i osobennosti ee regulatsii pri nekotorykh allergicheskikh zabolevaniiakh.

Activity of kallikrein and content of prekallikrein were estimated in blood serum of 34 patients with atopy and of 17 patients with urticaria by means of the chromatographic procedure. In these patients activity of alpha 1-proteolytic inhibitor (alpha 1-PI) and alpha 2-macroglobulin (alpha 2-MG) was studied. At the acute period of pollinosis activation of the kallikrein-kinin system was found, which correlated with the disease aggravation. During specific immunotherapy of the patients with atopy activation of the kallikrein-kinin system occurred, which depended on the total concentration of allergen administered. At the same time, activation of the kallikrein-kinin system, observed under conditions of urticaria, was most distinct in the patients with chronic relapsing urticaria and was related to the degree of the disease aggravation. Preparations of proteinase inhibitors analogous to contrical were only short-term effective in chronic relapsing urticaria. In the patients with distinct aggravation of pollinosis inhibitory activity of alpha 2-MG was markedly increased which occurred apparently as a result of blood pachyemia simultaneously with activation of the kallikrein-kinin system. Distinct increase in the alpha 1-PI activity was not found in the patients with pollinosis and urticaria even at the step of pronounced aggravation. Phenotyping of the inhibitor in 10 patients with a marked decrease in its activity enabled to find 6 persons exhibiting the heterozygous genotype with a defect allele.