Content of the antigenic determinants CD16, CD25, CD95, and HLA-DR in induced sputum of patients with bronchial asthma and chronic obstructive bronchitis

AIM: To examine the content of CD16, CD25, CD95, and HLA-DR antigenic determinants in induced sputum (IS) of patients with bronchial asthma (BA) and chronic obstructive bronchitis (COB). MATERIALS AND METHODS: The study enrolled 36 patients with BA and 15 with COB whose age was 21 to 58 years. The cellular precipitate of IS served as a material for the study. The studied receptors were determined by immunofluorescence using the "Clonospectrum" monoclonal antibodies. RESULTS: There was an increase in the content of CD16, CD25, HLA-DR, CD95 whose expression was decreased when glucocorticosteroids were used. At remission of asthma, the level of these receptors approximated that in the control group. On an exacerbation of COB, the content of these markers was significantly less than that in the controls and the use of antibacterial agents and methylxanthines led to its rise. At remission of COB, CD16 and CD25 cells were not recorded. CONCLUSION: The levels of membrane markers in IM of patients with BA and COB depend on the period of the disease and used therapy.     

Cytological parameters of bronchoalveolar lavage in patients with chronic obstructive bronchitis exposed to laser radiation of blood

AIM: Clinicocytological evaluation of efficacy of combined treatment of chronic obstructive bronchitis (COB) in exacerbation with application of laser radiation of blood. MATERIALS AND METHODS: Combined treatment with the use of He-Ne intravenous and transcutaneous radiation of blood was given to 32 patients with COB. 27 COB patients treated without blood irradiation served control. Mean age of the patients (39 males and 20 females) was 59 +/- 9.5 years. In addition to conventional methods of examination and control of the treatment effect, cytological and bacteriological tests of BAL precipitate smears were made. RESULTS: Combined COB treatment with the use of laser blood radiation has an antiinflammatory action, promotes normalization of mucociliary transport, activation of phagocytosis and immune defense, cleansing of bronchial tree, reduction of obstruction (by FEV per 1 s), effective management of exacerbations. Hospital stay decreased by 3-4 days. Blood irradiation has the advantages as a noninvasive method. CONCLUSION: Clinical, cytological and bacteriological tests, determination of FEV provide a significant assessment of treatment efficacy in dynamics and facilitate the choice of the most effective regimen for management of COB in exacerbation.     

Comparison of acute bronchiolytic effect of inhaling solutions of berodual vs salgim using a nebulizer in patients with chronic obstructive bronchitis and bronchial asthma

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.     

Epidemiology of bronchial asthma in a large industrial region

AIM: To estimate the prevalence of bronchial asthma (BA) basing on the complex of the disease symptoms within the last year associated with bronchial obstruction (BO) and bronchial hyperreactivity (BHR). MATERIALS AND METHODS: A questionnaire survey (IUATLD) has covered 1572 individuals (mean age 40.1 +/- 0.3 years, 837 females). The responders were divided into 3 age groups. BO and BHR were examined, concentration of air pollutants NO2, SO2, CO were measured. RESULTS: The most typical BA symptoms were defined in males and females in different age groups. The relationship between frequency of BA symptoms on concentration of air pollutants was determined. BO and BHR were found in 13.3% of the respondents. CONCLUSION: Prevalence of BA in a large industrial region is 16.4% (17.5% in males and 14.0% in females).     

Clinico-functional effect of a course of interval normobaric hypoxic therapy in patients with chronic obstructive bronchitis and bronchial asthma

AIM: To study short- and long-term clinicofunctional effects of primary and secondary courses of interval normobaric hypoxia (INH) in patients with chronic obstructive bronchitis (COB) and bronchial asthma (BA). MATERIALS AND METHODS: The study group of 45 COB and BA patients were exposed to INH. The control group of 20 COB and BA patients received conventional drugs. The INH patients were examined using the acute hypoxia test, return respiration test, peak-flowmetry, assessment of external respiration function (ERF), immune status, heart rate, blood pressure. Stange test ERF and the disease course within the last 2-3 years were analyzed. RESULTS: INH proved more beneficial for COB and BA patients than the standard drugs. Bronchial obstruction reduced by 10-15%, exercise tolerance, general condition, ventilation, hemodynamic and immunological parameters improved, frequency of bronchopulmonary infection exacerbations dropped 2-fold. CONCLUSION: An INH course is effective in the majority of COB and BA patients. It is recommended for treatment and rehabilitation once or twice a year.     

Analysis of bronchial hypersensitivity in patients with bronchial asthma

AIM: To analyse correlation between bronchial hypersensitivity in bronchial asthma (BA) and environmental factors; to propose methods of relevant correction. MATERIAL AND METHODS: The trial included 97 BA patients (42 males, 55 females) aged 17-79 years. Bronchial sensitivity was studied by means of dose-dependent bronchial resistance curve (Rrs) plotted by the unit Masterlab (Germany) in the course of long-term inhalation of a gradually rising dose of methacholine. A regression analysis was made of the dependence of fluticasone bipropionate effectiveness on clinical symptoms of the disease. RESULTS: Bronchial hypersensitivity depends on initial clinical symptoms of BA, in a less degree on bronchial permeability, severity of inflammation of bronchial mucosa. CONCLUSION: Local corticosteroid fluticasone propionate is a drug of choice in the treatment of mild and moderate BA.     

Hydrogen peroxide--a marker for respiratory tract inflammation in patients with bronchial asthma

AIM: To test H2O2 as a marker of respiratory tract inflammation in patients with bronchial asthma (BA). MATERIAL AND METHODS: The study entered 70 patients (20 males and 50 females) with atopic asthma (AA) aged 18 to 62 years (mean age 32.6 years). H2O2 concentration in the expired air (CEA) was determined spectrophotometrically (Gallati & Pracht, 1985), content of eosinophilic cationic protein (ECP) in blood--with radioimmunoassay kits (Pharmacia & Upjohn, Sweden). Forced expiratory volume per 1 second (FEV1) was used for assessment of severity of bronchial obstruction. Bronchial hyperreactivity was studied by means of the histamine bronchoprovocative test. RESULTS: H2O2 in CEA in BA patients was higher than in healthy subjects (0.127 +/- 0.010 microm/l vs 0.024 +/- 0.004 microm/l). H2O2 concentration significantly correlates with FEV1 (r = -0.449; p < 0.001), bronchial hyperreactivity to histamine (rs = -0.382; p < 0.05) and ECP in blood plasma(r = 0.625; p < 0.01). CONCLUSION: It was proved possible to use H2O2 in CEA for evaluation of respiratory inflammation in BA patients.     

Clinical course, internal picture of the disease and pathogenic reactions in patients with bronchial asthma]

AIM: To study clinical features of bronchial asthma (BA) associated with internal picture and nosogenic reactions. MATERIAL AND METHODS: Clinical features of BA were studied in 108 patients (38 males and 70 females, mean age 44.7 +/- 1.4 years, mean BA duration 6.6 +/- 0.76 years) treated in the clinic of the I. M. Sechenov Moscow Medical Academy in 1995-1998. RESULTS: Clinical and statistical analysis of BA clinical course allowed to single out three leading variants of BA course: persistently obstructive (stable and definite respiratory disturbances with progressive deterioration of bronchial permeability), moist (associated chronic bronchitis, allergic rhinosinusopathy, chronic maxillary sinusitis, intestinal dysbacteriosis, repulsive symptoms, e.g. discharge of much sputum et cet), paroxysmal (short-term episodes of asphyxia arrested by inhalations of beta 2-agonists, absence of stable respiratory disorders). The above variants of BA course significantly correlated with types of the internal picture (IP) and types of nosogenies. Persistently obstructive, moist and paroxysmal BA variants were characterized with vital, defensive and coping IP, respectively, neurotic reactions with hypochondria, hypochondriac depressions; pathocharacterological sensitive reactions; neurotic and affective reactions with "la belle indifference" and "euphoric pseudodementia", respectively. CONCLUSION: The above correlations can be used for planning and conduction of psychocorrective measures aimed at optimisation of patient-doctor compliance.     

Hyperventilation syndrome in bronchial asthma, essential hypertension and organic neurosis. Clinical picture and external respiration function

The external respiration function was studied in 100 patients with hyperventilation syndrome (HVS) divided into 3 groups: 40 patients with HVS and bronchial asthma (group 1) consisting of 15 males and 25 females (age median--45 years, 25 percentile--37 years, 75 percentile--53 years); 39 patients with HVS and essential hypertension (group 2) consisting of 8 males and 31 females (age median 49, 25 percentile--40 years, 75 percentile--57 years); 21 patients with HVS without concurrent somatic diseases of group 3 (7 males, 14 females, age median 45 years, 25 percentile--28 years, 75 percentile--45 years). It is shown that different disorders of pulmonary ventilation correspond to different clinical manifestations of HVS. Thus, in bronchial obstruction (group 1) HVS manifests with "weak respiration", in restrictive pulmonary disorders (group 2) HVS manifests as "heavy respiration", in high parameters of bronchial permeability (group 3)--"shallow respiration".     

Radionuclide diagnosis of functional pulmonary disorders in outpatient setting

AIM: To define informative value of a novel technique in radionuclide examination of microcirculatory and alveolar ventilation disorders in pulmonary diseases and to test its application possibilities in outpatient practice. MATERIAL AND METHODS: Perfusion static scintigraphy of the lungs with 99m-Tc-macrotech and ventilatory aerosol dynamic and static pulmonary scintigraphy after 99m-Tc-pentatech (DTPA analogue) inhalation were performed in 128 patients with bronchial asthma (BA), chronic obstructive bronchitis (COB) and pulmonary abscess. RESULTS: Regional perfusion and ventilation were abnormal in all the examinees with BA and COB including in lower zones of both the lungs characteristic of pulmonary emphysema. In COB ventilation-perfusion correlations were disturbed in both lungs in 87.5%, in one lung in 100% patients. In BA patients after the attack the results of ventilatory pulmonary scintigraphy should be evaluated visually (qualitatively). In pulmonary abscess regional disorders of perfusion and/or ventilation were seen in 94.6%, lack of balance V/Q in the focal zone--in 75%, in the whole affected lung--in 55.4% patients. Compensatory synchrony of ventilation-perfusion relations in impaired regional indices V/Q took place in COB patients in 37.5%, in abscess (in the affected lung)--in 42.9%. Acceleration and delay of alveolar-capillary diffusion were detected in bronchial asthma in 76.5%, COB--in 68.7%, in abscess in the affected lung--in 48.8%, in the contralateral lung--in 56.5%. CONCLUSION: Lung lesion can be assessed with ventilation-perfusion correlations and clearance of 99mTc-pentatech from the right and left lung.     

Spiral computed tomography with functional tests in diagnosis of chronic obstructive diseases of the lungs

The potential of spiral computed tomography (SCT) and high resolution computed tomography (HRST) in diagnosis of chronic obstructive pulmonary diseases (COPD) is described. Semiotic sings of bronchial asthma (BA) and chronic obstructive bronchitis (COB) are specified. Informative value of SCT in differential diagnosis of BA and COB including early stage of the diseases is analysed. An updated technique of SCT and HRCT of the lungs in COPD patients is presented.     

Experience in treating patients with chronic obstructive bronchitis with fenspirid

AIM: To study a clinical effect of fenspirid and its impact on external respiration function in patients with chronic obstructive bronchitis (COB) in the exacerbation phase. MATERIAL AND METHODS: 30 COB patients participated in the trial (20 males, 10 females, age 39-80 years). The severity of clinical symptoms (cough, sputum, dyspnea) was studied using special scales. External respiration function was examined by a spirometric system "Tamrac system spiro sense Y2 14". Fenspirid treatment was conducted in a dose 80 mg twice a day for 3 months. Control examinations were made 2 weeks, 1 and 3 months after the treatment start. RESULTS: A 3-month treatment with fenspirid resulted in regression of COB symptoms: cough and sputum ceased, dyspnea decreased. This led to improvement in external respiration function, especially in patients with mixed ventilatory disorders with prevailing restriction. CONCLUSION: Fenspirid is an effective and well tolerated treatment of chronic obstructive bronchitis.     

Usefulness of induced sputum and fibreoptic bronchoscopy specimens in the diagnosis of pulmonary tuberculosis

We investigated the diagnostic value of induced sputum (IS) and bronchial lavage (BL) specimens in patients with suspected pulmonary tuberculosis who had negative spontaneous sputum specimens or who were unable to produce sputum spontaneously. IS specimens and BL specimens obtained using flexible fibreoptic bronchoscopy from 55 patients were evaluated for the presence of acid-fast bacilli (AFB) and cultured for Mycobacterium tuberculosis. Positive results were found with IS smear in 23 patients, BL smear in 26 patients, and IS or BL culture in 42 patients. Culture of BL specimens had a higher sensitivity than IS or BL smears or culture of IS specimens. The highest sensitivity rate was obtained with a positive BL or IS culture (86%). For early diagnosis (a positive IS or BL smear), the sensitivity was 57%. IS has a higher sensitivity rate than spontaneous sputum for the detection of tuberculosis, and fibreoptic bronchoscopy is useful for the early diagnosis of tuberculosis when AFB are not detected in spontaneous or induced sputum specimens.     

Bone mineral density and risk factors for developing osteoporosis in bronchial asthma patients

AIM: To estimate mineral bone tissue density (MBTD) and risk factors for osteoporosis in patients with bronchial asthma (BA). MATERIAL AND METHODS: A cross-sectional study included 119 patients (48 males and 71 females) aged 18 to 49 years who had no diseases or states that can induce MBTD, except BA. The patients were divided into 3 groups: 1) those untreated with glucocorticoids (GC); 2) those who received inhaled GC; and 3) those who permanently took oral and inhaled GC. The patients underwent questionnaire survey, double-power X-ray absorption of the lumbar vertebral column and proximal femur, and X-ray study; forced expiratory volume per sec and peak expiratory function were measured. RESULTS: In Group 1 patients, there was a high incidence of osteopenia that increased with the severity of BA. About 2.5-year therapy with inhaled GC in large and small doses had no impact on MBTD. The prolonged use of systemic GC caused a marked reduction in MBTD and led to the development of osteoporetic fractures. Changes were detected in both the lumbar spine and proximal femur. In males and females, MBTD decreases were equal. MBTD correlated with the duration of GC therapy and with age at its initiation, but not with the daily dose of GC. In 15.4% of the patients, MBTD remained in the normal range despite the prolonged use of GC in large doses. Osteoporetic fractures were observed at the values of MBTD, which had not reached the stage of osteoporosis according to the WHO criteria, which was indicative of qualitative GC-induced bone tissue changes. CONCLUSION: GC is an important, but not alone, risk factor for osteoporosis in asthmatic patients. The high rate of low MBTD among the patients receiving no GC suggests that it is necessary to make an early diagnosis and to perform rational treatments.     

Intravascular laser irradiation of blood in the treatment of patients with bronchial asthma

AIM: To investigate action of intravascular laser blood irradiation (ILBI) on production of active oxygen forms (AOF) in patients with bronchial asthma (BA). MATERIAL AND METHODS: The trial included 59 BA patients aged 20 to 60 years (mean age 40.2 +/- 3.1 years). AOF generation in whole blood was registered with luminol-dependent chemiluminescence (CL). Basic therapy was given to 42 patients. ILBI was added to basic therapy in 17 patients. RESULT:. CL of whole blood in BA patients depended on severity of inflammation. BA patients with intensive CL exposed to ILBI retained free radical oxidation defects and the disease symptoms. In low intensity of blood CL, ILBI activated A OF generation and raised treatment effectiveness. CONCLUSION: ILBI raises AOF production in the whole blood of BA patients. CL registration can be used for validation of ILBI administration in BA patients and control of effectiveness of laser therapy.     

Quality of life and characteristics of the external respiration function in patients with bronchial asthma

AIM: To investigate correlations between quality of life, bronchial obstruction, nonspecific bronchial hyperreactivity (NSBH) and response of these parameters to treatment with inhalation steroids in patients with bronchial asthma (BA). MATERIAL AND METHODS: The study included 67 BA patients (47 women and 20 men) aged 18 to 62 years (mean age 43 years). 59 of them had the diagnosis of atopic BA, 8 had bacterial BA. Quality of life was assessed with the questionnaire AQLQ, bronchial obstruction was judged by forced expiratory volume per a second (FEV1). Bronchial hyperreactivity was studied with acetylcholine and histamine tests. RESULTS: Quality of life strongly correlated with FEV1 and NSBH. Positive changes in the latter due to treatment with inhalation glucocorticoid budesonide (400 mcg/day) entailed improvement of life quality. CONCLUSION: Bronchial obstruction and NSBH have a significant effect on BA patients' life quality which should be considered in monitoring of BA patients' condition.     

Serum levels of sexual hormones in young and middle-age healthy subjects with risk factors of coronary heart disease and patients with coronary heart disease

AIM: To study sexual hormones levels in risk of beginning and development of coronary heart disease (CHD) in young and middle-aged (up to 50 years) men and women. MATERIAL AND METHODS: Sexual hormones were studied in 105 patients (53 males and 52 females) aged 25-50 years. Of them, 88 suffered from IHD and 17 had CHD risk factors. Twenty healthy controls were matched by age and gender. LH, FSH, estradiol, testosteron were measured in blood serum by enzyme immunoassay (Elecsys kit, Beringer Mannheim). RESULTS: Young and middle-aged (under 50 years of age) males and females with IHD or its risk factors have changed levels of sexual hormones. CONCLUSION: In IHD male hormones levels increase in women but decrease in men while female hormones increase in men and decrease in women.     

The clinicofunctional characterization of the phenotypes of severe uncontrollable bronchial asthma

The aim of the study was to compare the clinical characteristics and the inflammatory process activity in the airway of patients with severe therapy-sensitive and therapy-resistant bronchial asthma (TSBA; TRBA). The subjects were 171 patients with severe bronchial asthma (BA) aged 18 to 60; the diagnosis was established prior to the study according to GINA 2002 criteria. There were 50 TSBA patients, 121 TRBA, and 50 controls. According to a range of criteria, BA in TRBA was more severe than that in TSBA. TRBA patients displayed significantly higher indices of inflammatory process activity, such as absolute and relative number of eosinophiles and neutrophiles in induced sputum (IS), and IS level of IL-5. Evaluation of IS inflammatory markers in patients with severe BA allowed substantiation of the central role of persistent inflammation as a risk factor of TRBA development.     

南京地区支气管哮喘患者合并过敏性鼻炎的现状及其临床表现相关性

背景:过敏性鼻炎和支气管哮喘均为呼吸道炎性疾病,它们常并存于同一患者。目的:了解南京地区支气管哮喘患者中过敏性鼻炎的发生率,并分析过敏性鼻炎与支气管哮喘在临床表现方面的相关性。设计:问卷调查。单位:解放军南京军区南京总医院耳鼻咽喉-头颈外科及呼吸内科。对象:纳入2001-02/2005-04解放军南京军区南京总医院确诊为支气管哮喘的患者134例,男73例,女61例;年龄3～72岁。参照全球哮喘防治创议(Global initiative for asthma,GINA)方案进行哮喘严重程度分级;过敏性鼻炎的诊断标准参照1997-11"海口会议"的修订标准;所有患者均同意参与问卷调查。方法:通过问卷调查,详细了解134例支气管哮喘患者中患支气管哮喘、过敏性鼻炎患者的年龄、症状分型及严重程度、治疗状况、家族史等临床资料。应用统计学描述和两个独立样本的t检验,并计算支气管哮喘合并过敏性鼻炎的发生率,比较支气管哮喘和过敏性鼻炎患者的年龄、发病年龄及病程的差异有无显著性。应用Spearman等级相关分析进行两者严重程度相关性分析。主要观察指标:支气管哮喘患者中过敏性鼻炎的发生率,以及过敏性鼻炎与支气管哮喘在临床表现方面的相关性。结果:支气管哮喘患者134例中82例(61.2%,82/134)并发过敏性鼻炎,其中男45例,女37例。此82例患者中,哮喘严重程度一级(轻度间歇)56例,二级(轻度持续)21例,三级(中度持续)4例,四级(重度持续)1例。其过敏性鼻炎分型,间歇性65例,持续性17例;按严重程度分级,轻度63例,中-重度19例。过敏性鼻炎与支气管哮喘严重程度呈明显正相关(r=0.689,P<0.01)。结论:南京地区支气管哮喘合并过敏性鼻炎的发生率较高;过敏性鼻炎与支气管哮喘严重程度具有高度相关性。     

Pulmonary pathology in patients with systemic lupus erythematosus

AIM: To characterize pulmonary lesion in systemic lupus erythematosus (SLE) on the basis of clinical device and biochemical examination regarding features of the disease onset and development. MATERIAL AND METHODS: The study included 60 SLE patients. Mean age 41.1 +/- 1.32 years. Mean SLE duration 12.42 +/- 1.06 years. Activity according to the SLEDAI and ECLAM indices--16.23 +/- 0.93 and 3.09 +/- 0.18 scores, respectively. The comparison groups: 30 patients with bronchial asthma (BA), 15--with chronic bronchitis (CB), 15--with chronic obstructive bronchitis (COB), 30 healthy donors. The following parameters were studied: spirometric, bodyplethismographic evidence, diffuse ability of the lungs (DAL), plasm concentrations of adrenaline, noradrenaline, dopamine, serotonine, histamine, hemodynamics, anxiety, depression, social adaptation (quality of life) and vegetative dysfunctions. Statistics were obtained with BIOSTATISTIKA program. RESULTS: DAL depends on duration of SLE, severity of lung hypertension (LH), severity of anemia. LH in SLE deteriorated vegetative disorders and social adaptation. Lowering of plasm dopamine concentration was accompanied with LH, formation of vegetative dysfunction and worse social adaptation. CONCLUSION: Affection of the lungs in SLE patients runs without evident clinical symptoms. Initial signs of lung affection manifest with low DAL, LH, moderate restrictive, obstructive and mixed disorders of external respiration function.