[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.

[The concept of chronic obstructive pulmonary disease clinical control as a decision - making tool in real clinical practice for optimizing of basic pharmacotherapy].

The main goals of COPD therapy are to achieve clinical stability with minimal clinical manifestations and low risk of relapse. The proposed COPD control concept by analogy with asthma has not been quite well characterized yet. COPD control is defined as "the long - term maintenance of a clinical situation with a low impact of symptoms on the patient's life and absence of exacerbations." The situation of clinical control in COPD is considered desirable and potentially achievable for most patients with COPD. Pharmacotherapeutic options for COPD are constantly expanding. The control concept may be useful when the decision on treatment of COPD is made for dynamic adjustment of the therapy volume.

[Dynamics of clinical, X-ray and functional data during treatment of patients with sarcoidosis].

Aim: To analyze the literature data and the results of original studies on the respiratory function in patients with sarcoidosis. Material and methods: The study included 1199 patients with sarcoidosis (67.8% women and 32.2% of males, median age 43 years). The first X-ray stage was documented in 34.8% of patients , stage II in 57.0%, stage III in 6.1%, stage IV in 1.3%, stage 0 in 0.7%. One patient (0.1%) had pleural sarcoidosis. Loefgren syndrome was diagnosed in 20% of the patients. In 658 patients (54.9%) the diagnosis was confirmed by biopsy studies. Results: The patients with sarcoidosis exhibited significant correlation between radiographic and spirometric characteristics. In those with Loefgren syndrome, all breathing parameters were much better than in the remaining ones. Changes of spirometry parameters were more pronounced in smokers and in patients with concomitant lung diseases. However, the lung function remained impaired after adjustment for these factors, and 9,7% of the cases positively responded to the administration of a short-acting bronchodilator. Х-ray examination and spirometry are independent methods for the evaluation of the health status of patients with sarcoidosis and their results do not always correlate with each other after different treatment regimens. Changes in Х-ray image and lung vital capacity were consistent in patients treated with prednisone, methotrexate and pentoxifylline, but not in the cases treated with vitamin E and in the absence of treatment. Spirometry with simultaneous X-ray examination is recommended for all patients with intrathoracic sarcoidosis. Conclusion: Forced vital capacity of lungs (FVC) is an independent criterion for evaluating the condition of patients with sarcoidosis and the effectiveness of the treatment.

[The use of methotrexate for the treatment of sarcoidosis (data from a controlled prospective study)].

We estimated the effectiveness and safety of methotrexate monotherapy of sarcoidosis in 63 patients refractory to the previous treatment. Methotrexate was given weekly at a dose of 5-20 mg. 54% of the patients reported improvement of their condition. Parameters of spirogram and the ray picture improved in 63.2 and 54% of the cases respectively. Methotrexate proved safe and had to be discontinued only in 12.6% of the patients. It is concluded that methotrexate can be used at least in half of the cases as a safe alternative to systemic steroid therapy.

[X-ray, laboratory, and functional parallels in intrathoracic sarcoidosis].

AIM: to compare respiratory function and laboratory data with the radiographic stages of intrathoracic sarcoidosis. SUBJECTS AND METHODS: Three hundred and eleven patients (70.4% for women and 29.6% for men; mean age, 44.7±0.6 years) with histologically verified sarcoidosis underwent X-ray computed tomography, spirography, estimation of carbon monoxide diffusing capacity (DLCO), oxygen saturation, blood count and serum total calcium blood test. The patients were assigned according to sarcoidosis stages as follows: 3.9% with stage 0; 16.4% with stage I; 65.3% with stage II; 13.2% with stage III; 1.3% with stage IV, and 12.9% with Löfgren's syndrome. Results. DLCo decreased together with an increasing sarcoidosis stage (<80% of the due X2=8.69 for DLCO; p=0.057); the difference was significant between stages I (84.2±2.8%) and III (76.1±2.9%, p=0.05). According to the radiographic changes, there were decreases in forced vital capacity (FVC) from 99.0±2.5% in stage I to 76.1±3.5% in Stage IV and in forced instantaneous expiratory flow rate at 75% of lung volume (FEF75) from 64.4±3.1 to 44.0±5.9%, respectively. DLCO correlated with FVC, peak expiratory flow, and FEF, (p<0.01) and arterial oxygen saturation (SaO2) did only with FVC. There was a strong association between the decrease in DLCO and FVC below 80% of the due values (X2=28.23; d.f.=1; p<0.001). L6fgren's syndrome failed to affect functional data. In the patients with Löfgren's syndrome, the serum level of calcium was significantly lower (2.09±0.10 versus 2.35±0.02 mmol/l(p=0.023); however, this indicator did not significantly differ between the radiological stages of intrathoracic sarcoidosis. CONCLUSION: In sarcoidosis, the changes in DLCO and FVC vary with radiological stages. Decreased SaG2 was observed in Stage IV. The total level of total blood calcium is an indicator independent of the radiological stages of sarcoidosis.

[Multicenter retrospective analysis of the patients with sarcoidosis with a 10 year interval in observations].

Comparison of the state of 83 patients with histologically confirmed sarcoidosis observed with a 10 year interval revealed remission in 47% of the cases. The main factors having negative effect on prognosis of the disease included extrapulmonary symptoms, the use ofcorticosteroids (at all stages, especially at stage I and in Lofgren syndrome) and antituberculosis drugs, positive TB test. Risk factors of relapses were stage II sarcoidosis, the use of systemic corticosteroids in patients with Lofgren syndrome and antituberculosis drugs, initially low FEV1/FVLC ratio and the number of lymphocytes in peripheral blood.

[Comparative analysis of the treatment of inpatients with community-acquired pneumonia and its different outcomes].

The aim of the work was to compare the quality of medical care provided to patients with severe community-acquired pneumonia (CAP) and its different outcomes. (complete recovery, or death--25 patients in either group). In the latter group, the patients did not undergo adequate clinical and instrumental examination at the pre-hospital stage). Most recovered patients were given high doses of ceftriaxone, clarithromycin and ambroxol or low doses of systemic glucocorticoids. A pulmonologist participated in the treatment of these patients twice as frequently as in the treatment of the patients of the latter group. Effects of high doses of systemic glucocorticoids remains debatable.

[Evaluation of the efficiency of various treatment regimens for patients with newly-detected sarcoidosis in the Republic of Tatarstan].

The natural history of sarcoidosis was analyzed in 279 patients with its history of as long as 2 years among the 832 with this disease registered in the Republic of Tatarstan in 1999 to 2002. The patients were divided into 3 groups: (1) 79 (28.3%) receiving systemic glucocorticosteroids (SGS); (2) 146 (52.3%) patients having therapy without SGS; (3) 54 (19.3%) patients receiving no drug therapy, but they were followed up by a physician. There was no strong evidence for that it was expedient to use prednisolone in most of patients. Prednisolone exerted a significant effect on clinical manifestations, laboratory values, and radiation pattern in patients with sarcoidosis, but more commonly (28.9%) led to its relapses than alternative treatment and active follow-up. Patients treated with prednisolone and other drugs and those untreated showed no significant differences in the frequency of cases of a worse X-ray pattern during 28 years. It is advisable to follow an active observation policy in patients having a stable course of sarcoidosis, by restricting indications for the use of prednisolone in those who have apparently progressive or threatening extrapulmonary manifestations of the disease (heart, nervous system, eyes).

[Comparison of acute bronchodilator tests in patients with chronic obstructive lung disease and bronchial asthma].

Three hundred and thirty-five patients with bronchial asthma (BA) and 534 patients with chronic obstructive lung disease (COLD) were examined. Before and after tests using salbutamol, phenoterol, ipratropium bromide and a fixed combination of phenoterol and ipratropium bromide, the forced expiratory flow-volume curve was recorded in the patients on each visit (1008 and 1398 visits of patients with BA and COLD, respectively). The study was controlled open-labeled, and prospective. All the bronchodilators were found to be effective in both BA and COLD. However, in asthmatic patients without (less than 4%) and with (more than 5%) eosinophilia, the increase in forced expiratory volume per second (FEV1) was 23.7+/-22.1% and 16.0+/-14.6% of the baseline values, respectively (p < 0.05). Among these patients with ESR of less than 100 mm/hour, the increase in FEV1 was significantly higher--21.7+/-19.7% than in those who had ERS more than 15 mm/hour and this was 13.8+/-17.9% of the baseline values (p < 0.05). Among asthmatic patients, more than 15% increases in FEV1 after administration of bronchodilators were noted in 48% of the patients untreated with inhaled corticosteroids (ICS) and in 61% of the ICS-treated patients (chi2 = 6.55; d.f. = 1; p = 0.01). Among ICS-treated and untreated patients with BA, the mean increase in FEV1 was 24.4+/-22.5% and 19.6+/-22.0% of the baseline values, respectively (p < 0.05). In COLD patients, these differences were absent. It has been concluded that eosinophilic inflammation typical of BA decreases the effect of bronchodilators in BA and that inhaled steroids improve it.

Fluoroquinolones for treating tuberculosis.

BACKGROUND: Fluoroquinolones are sometimes used to treat multiple-drug-resistant and drug-sensitive tuberculosis. The effects of fluoroquinolones in tuberculosis regimens need to be assessed. OBJECTIVES: To assess fluoroquinolones as additional or substitute components to antituberculous drug regimens for drug-sensitive and drug-resistant tuberculosis. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (April 2005), CENTRAL (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to April 2005), EMBASE (1974 to April 2005), LILACS (1982 to April 2005), Science Citation Index (1940 to April 2005), and Russian database (1988 to April 2005). We also scanned reference lists of all identified studies and contacted researchers. SELECTION CRITERIA: Randomized controlled trials of antituberculous regimens containing fluoroquinolones in people diagnosed with bacteriologically positive (sputum smear or culture) pulmonary tuberculosis. DATA COLLECTION AND ANALYSIS: Two authors independently applied inclusion criteria, assessed methodological quality, and extracted data. We used relative risk (RR) for dichotomous data, weighted mean difference (WMD) for continuous data (both with 95% confidence intervals (CI)), and the random-effects model if we detected heterogeneity and appropriate to combine data. MAIN RESULTS: Ten trials (1178 participants) met the inclusion criteria. No statistically significant difference was found in trials substituting ciprofloxacin or ofloxacin for first-line drugs in relation to cure (89 participants, 2 trials), treatment failure (388 participants, 3 trials), or clinical or radiological improvement (216 participants, 2 trials). Substituting ciprofloxacin into first-line regimens in drug-sensitive tuberculosis led to a higher incidence of relapse (RR 7.17, 95% CI 1.33 to 38.58; 384 participants, 3 trials) and longer time to sputum culture conversion (WMD 0.50 months, 95% CI 0.18 to 0.82; 168 participants, 1 trial), although this was confined to HIV-positive participants. Adding or substituting levofloxacin to basic regimens in drug-resistant areas had no effect. A comparison of sparfloxacin versus ofloxacin added to regimens showed no statistically significant difference in cure (184 participants, 2 trials), treatment failure (149 participants, 2 trials), or total number of adverse events (253 participants, 3 trials). AUTHORS' CONCLUSIONS: Only ciprofloxacin, ofloxacin, levofloxacin, and sparfloxacin have been tested in randomized controlled trials for treating tuberculosis. We cannot recommend ciprofloxacin in treating tuberculosis. Trials of newer fluoroquinolones for treating tuberculosis are needed. No difference has been demonstrated between sparfloxacin and ofloxacin in drug-resistant tuberculosis.

[Sarcoidosis and pregnancy: data from scientific publications and a clinical case]. / Sarkoidoz i beremennost': dannye nauchnykh publikatsii i klinicheskii primer.

The paper analyzes the literature on sarcoidosis and pregnancy, available from the MedLine bases and Russian journals. It also presents a clinical case of sarcoidosis developed and recurred in a female after the first and repeated pregnancy. It is concluded that pregnancy in sarcoidosis may be preserved in most cases. Life-threatening rhythm and conduction disturbances, significant failure of the organs and systems afflicted by sarcoidosis, as well as female genital sarcoidosis may be a reason for deciding whether pregnancy should be preserved.

[A comparative study of lymphocytic apoptosis and ventilation disorders in patients with pulmonary tuberculosis]. / Sravnitel'noe issledovanie apoptoza limfotsitov i ventiliatsionnykh narushenii u bol'nykh tuberkulezom legkikh.

Due to the increasing interest in studies of apoptosis (programmed cell death) in the pathogenesis of many diseases and to the emergence of data on the direct impact of apoptotic disorders on the course of bronchial asthma and the magnitude of the obstructive syndrome, this study was undertaken to investigate apoptosis in patients with new-onset pulmonary tuberculosis who had varying bronchial obstructive syndrome. Twenty-eight patients with new-onset tuberculosis, including 25 (89.3%), 2(7.1%), 1(3.6%) patients with infiltrative, disseminated, and fibrocavernous pulmonary tuberculosis, respectively, were examined. The study of external respiratory function included spirometry, determination of the flow-volume of forced expiration, body plethysmography, examination of lung elasticity by esophageal probing. The mechanisms of spontaneous apoptosis of peripheral lymphocytes from donors and patients with pulmonary tuberculosis were studied. The apoptosis was evaluated in dynamics by some parameters: the change of the mitochondrial potential (MP), the level of phosphatidyl serine, as well as DNA fragmentation by flow cytofluorometry. The results have indicated that there are significant signs of impaired peripheral lymphocytic apoptosis. Examining external respiratory function indicated that the bronchial obstruction syndrome was mild in 7 (25%) patients, moderate in 11 (39.3%), and severe in 5 (17.9%), absent in 5 (17.9%). Mild restrictive disorders were detected in 11 (39.3%) patients. The factor associating the degree of obstruction, with the count of MC540(+)- and MC540-DiOC6(+)-lymphocytes, i.e., with the count of lymphocytes with cellular membranous changes and with the decreased MP, which are one of the most significant signs of apoptosis. Thus, there is a negative correlation of the parameters of apoptosis of peripheral lymphocytes from patients with tuberculosis with those of ventilation obstruction disorders, which suggests that impaired apoptosis might be involved in the development of bronchial obstruction.

[Specific features of cardiorespiratory system in patients with intrathoracic sarcoidosis]. / Osobennosti sostoianiia kardiorespiratornoi sistemy u bol'nykh vnutrigrudnym sarkoidozom.

A hundred thirty eight patients with pulmonary sarcoidosis were examined for the status of the respiratory and cardiovascular systems. There is a trend for external respiratory parameters to decrease as the X-ray stage increases (by 30-50% in Stage IV). The revealed cardiovascular changes in patients with different X-ray stages did not differ significantly and there was no clear correlation with the activity of a process and external respiratory parameters. The only hemodynamic indicator clearly associated with the status of the lung was pulmonary hypertension. The involvement of the heart was ascertained not to depend on the stage and activity of sarcoidosis and on the degree of respiratory disorders clearly, which requires cardiovascular monitoring in all patients with sarcoidosis.

[Sarcoidosis as seen by a patient: results of questionnaire survey]. / Sarkoidoz glazami patsienta: resul'taty oprosov bol'nykh.

Two hundred patients with sarcoidosis were interviewed by a questionnaire in the global Internet. For comparison, the same questionnaire was used in the interviews of 60 patients in Kazan. Among international responders, patients from the USA were prevalent. The age of 30-39 years was predominant in both groups, females were three fourths. Predominance of these or those social groups was not established. At the same time, analysis of professions revealed a large number of medical workers in both Kazan (11.7%) and abroad (17%). In global practice the diagnosis of sarcoidosis is much more frequently histologically verified though in Russia the likely diagnosis of sarcoidosis is much earlier established during the patient's visit to a doctor. The basic drugs for its therapy are glucocorticoids. Inhaled steroids are used relatively rarely. Only Russia is marked by the use of antituberculous agents. The authors note that the Internet may be a field for research activities in medical science.

[Comparative evaluation of effects of various bronchodilators in sarcoidosis]. / Sravnitel'naia otsenka deistviia razlichnykh bronkholitikov pri sarkoidoze.

The investigation was undertaken to compare three bronchodilators on patients with respiratory sarcoidosis. Ninety patients (66 females and 24 males) with intrathoracic sarcoidosis were examined. X-ray stages I, II, III, and IV were seen in 48.9, 46.7, 3.3, and 1.1%, respectively. A flow-volume curve was recorded on a Masterscreen Pnevmo apparatus (Erich Jaeger) before and after inhalations of salbutamol (200 micrograms, a flask), ipratropium bromide (40 micrograms, a flask), and 1 ml of berodual solution through a Boreal nebulizer. The mean baseline values of forced expiration were normal, except for MOS75 (51.0 +/- 1.3% of the normal values). After salbutamol, the increment of MOS75 was higher than that after ipratropium (20.7 +/- 3.1% and 12.3 +/- 2.3%, respectively, p < 0.05); however, after berodual nebulization, the increase in MOS50 was greater than that after inhalation of ipratropium (17.2 +/- 1.9% versus 10.7 +/- 1.6%, p < 0.05) or salbutamol (10.1 +/- 6%, p < 0.01). The changes in these parameters in smokers and nonsmokers were similar. The one-month or more inhalation of budesonide (benacort) potentiated the bronchodilating action of salbutamol on all the parameters of forced expiration, but failed to affect the effect of ipratropium and berodual. Prednisolone did not affect the effects of bronchodilators. A combination of beta 2 agonist and inhaled steroid may be effective in intrathoracic sarcoidosis with the bronchial obstruction syndrome. The mechanism of varying action of the drugs having different mechanisms of action requires further investigations.

[Comparison of acute bronchiolytic effect of inhaling solutions of berodual vs salgim using a nebulizer in patients with chronic obstructive bronchitis and bronchial asthma]. / Sopostavlenie ostrogo bronkholiticheskogo éffekta ingaliatsii rastvorov veroduala i sal'gima s pomoshch'iu nebulai u bol'nykh khronicheskim obstruktivnym bronkhitom i bronkhial'noi astmoi.

AIM: Comparison of acute response to nebulizer inhalation of therapeutic doses of combined broncholitic berodual and domestic bronchoselective adrenomimetic salgim in patients with bronchial asthma (BA) and chronic obstructive bronchitis (COB). MATERIAL AND METHODS: The trial included 17 COB and 15 BA patients who for two consecutive days inhaled berodual and salgim solutions. Before and after the inhalations, subjective condition of the patients and parameters of the forced expiration were recorded. The sequence of the solutions use was determined randomly. RESULTS: Nebulizer inhalations of berodual and salgim relieved respiration subjectively in 83.9 and 93.5% patients, respectively. Significant bronchodilation was registered 30 min after inhalation of each of the solutions both in BA and COB. Berodual caused no side effects, salgim provoked short-term cough in 6(19.4%) patients. CONCLUSION: Nebulizer therapy of berodual or salgim is clinically and cost effective in moderate and severe obstruction in BA and COB patients.