Determine the effectiveness of lipid-lowering therapy in patients with chronic obstructive pulmonary disease combined with coronary heart disease.

INTRODUCTION: In complex treatment of chronic obstructive pulmonary disease (COPD) combined with ischemic heart disease (IHD) more and more attention is drawn to pleiotropic effect of statins. The aim of our researches became determining the effectivity of utilization of rosuvastatin (CRESTOR®, IPR PHARMACEUTICALS, Inc.) in complex treatment of COPD combined with IHD. MATERIALS AND METHODS: Basing on pulmonology department of Poltava regional clinical hospital, 30 patients with COPD combined with IHD have been examined (stable effort angina FC II) aged from 51 to 67 y.o. (average age was 57,03 ± 3,51). The patients were divided into two age compatible groups. Patients of the main group (n = 15) underwent regular COPD and IHD treatment, addind 20 mg of rosuvastatin per night. The observed group (n = 15) didn't receive rosuvastatin. The examination of patients was held before and half year of treatment, included the estimation of respiratory symptoms of the disease, the degree of intensity of dyspnea (Medical Research Council Dyspnea Scale). The tolerance to physical exercise was studied with 6 minute walking test. The cholesterine level, HDL, LDL, function of ventilation have been tested as well. The average frequency of aggravations during the year was estimated through retrospective examination of anamnesis. RESULTS: After the treatment the improvement of clinical state has been noticed at both groups due to decrease of intensity of respiratory symptoms of the disease, such as cough, amount of expectoration, dyspnea and also increase of tolerance to physical exercise and improvement of laboratory-instrumental indexes. Though the patients of the main group were noticed to have significantly less amount of expectoration and cough. The distance covered in 6 minutes was positively longer (р < 0,05). It has to be noted that the patients of the main group had positive decrease of wheezing after treatment, due to increase of FEV1, GI (р < 0,01). The retrospective studying of the anamnesis revealed that the frequency of arrogations during the year was 1-2 times a year (1,6 ± 0,48). CONCLUSIONS: Including rosuvastatin into the treatment scheme allows to decrease and stabilize the main clinical symptoms of this constellation of diseases, improving the quality of life, reduce the frequency of exacerbations.

Intensifying approach to the therapy of patients with constellation of the diseases: chronic obstructive pulmonary disease and osteoarthritis.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is one of 21st century. About 210 million people all over the world are suffering with COPD, and annually 3 million people die of it. Under the influence of different factors, such as smoking, air prolusion, evaporation of chemicals, poisoning effect of chemical firings, inflammation processes take place in lungs, and if it is prolonged and take place simultaneously with morphological changes in the lungs, it it provide the de4velopment of the systemic inflammation process. At present systemic inflammation is regarded to be an essential component of COPD pathogeneses capable to become risk factor in developing and progressing multiple complications of the disease. The development of osteoporoses as the basis for the development of osteoarthritis (OA) is often considered one of a great amount of COPD complications and systemic effects. In the course of complex approach to treating patients for COPD, especially in the case when it is accompanied with OA, resolving therapy is more and more often referred to nowadays, namely, to the use of fenspirid hydrochloride. The aim of the article is to depict the results of the study of the effectiveness of fenspirid hydrochloride (EurespalR, ≪Servier≫ France) included in complex therapy in treating patients for COPD accompanied with OA. MATERIALS AND METHODS: Hospitalized in the Pulmonology Department of Poltava regional clinical hospital named after N.V. Sklifosovsky served as the bases for the research, the investigation being carried out in the Institute of genetic and immune studies of development of pathology and pharmocogenetics of Ukrainian Higher State Educational Establishment "Ukrainian Medical Stomatological Academy of Poltava". Under investigation there were 33 patients (the average age of them was 54.4±3.1) suffering from exacerbation of COPD (clinic group B-GOPDII), accompanied with OA - basic group. Patients of the basic group were divided into two representative subgroups - A and B. The patients of A subgroup were restricted to basic therapy COPD according to the running protocol, while in B subgroup the basic therapy was accompanied with fenspirid hydrochloride hydrochloride per 80 mg twice a day 12 days running. Check group included 25 practically healthy people of the identical age. Results obtained showed that regress of the illness (cough decreasing) among the patients of the subgroup with COPD accompanied with OA, who were given fenspirid hydrochloride together with the basic therapy, 2.9±0.4 days earlier, dyspnoea 2.3±0.33 comparing to another subgroup ( p<0.05), the quality of the patients' life was getting better, the ability to endue more physical assignment increased. By the end of the treatment the sharpened forced exhalation FEV1level within the A subgroup patients equaled 57.1 ±4.2% (before the treatment it was 53.4±3.9 %), while within the B subgroup patients it became 59.9 ±3.9 (before the treatment it was 53.9±4.0 %). Repayments of bronchial obstruction in both groups became a bit higher- in A subgroup by 3.2±0.7%, and in B subgroup - by 3.6±0.5%. Concentration of IL-1ß in blood serum of basic group patients was 14.6 times higher than that of practically healthy people. After the therapy the level of IL-1ß within the A subgroup patients became 1.7 times lower (p < 0.01). After the basic therapy being accompanied with fenspirid hydrochloride to B subgroup patients the level of lowering was more vivid, and equelled 2.8 times ( p < 0.001). Decrease of the concentration of other mediators of inflammatory process under the influence of fenspirid hydrochloride was evident in other researches as well. Strong negative correlation ( r = -0.812; p < 0.05) between the level of IL-1ß in blood serum of basic group patients and their sharpened forced inhalation/exhalation. Forced expiratory volume (FEV)1 level before the treatment became moderately negative within the patients of A subgroup ( r= - 0.681; p < 0.05) and week within the patients of B subgroup ( r= -0.475; p <0.05). The term of treatment of A subgroup patients was 14.3 ± 0.4 days, and that of B subgroup patients it was a bit less, namely, 12.9 ± 0.5 days. An important result of the therapy with additional use of fenspirid hydrochloride was determining the periods between the case when next COPD exacerbation occurs because it is the frequency of the disease exacerbation that predicts the disease. Within A subgroup this time was 10.3±0.9 months, and within B subgroup it was 15.7±1.1 months. CONCLUSION: All this made it possible to draw the conclusion that usage of fenspirid hydrochloride hydrochloride in addition to complex therapy essentially reduces the level of IL-1ß in blood serum in compereson to the cases when only basic remedy was used, favours reduction of cases and intensity of systemic inflammations associated with increasing the duration of remission within this type/constellation of patients.