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1.
Ter Arkh ; 96(3): 212-217, 2024 Apr 16.
Article in Russian | MEDLINE | ID: mdl-38713034

ABSTRACT

AIM: To assess clinical and demographic characteristics of severe asthma (SA) patients and their management in Russian Federation. MATERIALS AND METHODS: This publication provides data for Russian part of population of the international observational study. In Phase I, retrospective analysis of medical records of patients with SA was performed with assessment of clinical and demographic data, medical history, comorbidities, treatment approaches and healthcare utilization. Phase II was a cross-sectional collection of patient-reported outcomes: level of asthma control assessed by ACT (Asthma Control Test) and health-related quality of life (HRQoL) measured using the EQ-5D-5L questionnaire. Phase I patients were enrolled into Phase II if they signed a written consent form. RESULTS: A total of 315 patients were included in Phase I of the study, 106 (33.6%) of them entered Phase II. Majority of study participants were either obese (n=103; 39.8%) or overweight (n=94; 36.3%). The most common comorbidities were cardiovascular diseases (n=217; 71.4%), followed by chronic respiratory diseases (n=198; 68.8%). There were 268 (85.1%) patients who had at least one exacerbation during last 12 months. Data for blood eosinophil count were available in 176 patients; 81.3% of them (n=143) had only one test in the last 12 months. The mean (SD) last available blood eosinophil count was 161.2 (181.2) cells/mm3. Serum Immunoglobulin E (IgE) value was known for 88 patients, and the mean (SD) last measured IgE value was 254.3 (249.7) ng/mL. Only 4.7% of Phase II participants had ACT scores indicative of controlled asthma (>20). As much as 74.5% had scores ≤15 suggesting uncontrolled disease. Most patients also had impaired HRQoL. CONCLUSION: Most SA patients had poor disease control with frequent exacerbations and high number of comorbidities. Blood eosinophils and IgE level measurements were not evaluated routinely which might be a barrier for appropriate phenotyping and treatment selection.


Subject(s)
Asthma , Quality of Life , Humans , Asthma/epidemiology , Asthma/therapy , Russia/epidemiology , Female , Male , Middle Aged , Adult , Cross-Sectional Studies , Severity of Illness Index , Retrospective Studies , Comorbidity , Cost of Illness , Surveys and Questionnaires
2.
Ter Arkh ; 96(3): 292-297, 2024 Apr 16.
Article in Russian | MEDLINE | ID: mdl-38713046

ABSTRACT

Chronic obstructive pulmonary disease is now one of the most common noncommunicable diseases and the main causes of morbidity, disability and mortality in the world. In recent years, new approaches to epidemiology, diagnosis, classification (categorization), evaluation of phenotypes, as well as characterization and assessment of the severity of сhronic obstructive pulmonary disease exacerbations have emerged. Modern approaches to starting and subsequent drug therapy have changed significantly. This is largely due to the results of recently conducted major clinical trials, demonstrated high efficacy of triple fixed combinations, including inhaled glucocorticosteroids, long-acting beta-agonists and long-acting anticholinergic drugs. The use of non-medication methods (smoking cessation, physical activity and respiratory rehabilitation) and modern approaches to the treatment of respiratory failure and antibiotic therapy remain important. In terms of their significance, all these updates have a significant impact on real clinical practice and can be considered as a novel paradigm of the approaches to the diagnosis and management of this disease.


Subject(s)
Practice Guidelines as Topic , Pulmonary Disease, Chronic Obstructive , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/therapy , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/physiopathology , Humans , Disease Management , Cholinergic Antagonists/therapeutic use , Bronchodilator Agents/therapeutic use
3.
Ter Arkh ; 94(4): 524-529, 2022 May 26.
Article in Russian | MEDLINE | ID: mdl-36286803

ABSTRACT

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.


Subject(s)
Asthma , Pulmonary Disease, Chronic Obstructive , Humans , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy , Asthma/diagnosis , Asthma/epidemiology , Asthma/therapy , Surveys and Questionnaires , Prevalence , Russia/epidemiology
4.
Ter Arkh ; 94(7): 850-858, 2022 Aug 12.
Article in Russian | MEDLINE | ID: mdl-36286942

ABSTRACT

AIM: To evaluate the budgetary impact of using budesonide + formoterol (Symbicort Turbuhaler) as maintenance therapy in real clinical practice compared with standard therapy for asthma of varying severity: for mild asthma with on-demand salbutamol; for moderate and severe asthma with the drug salmeterol + fluticasone and salbutamol on demand. MATERIALS AND METHODS: A static mathematical model was built to assess the impact on the budget when introducing the drug budesonide + formoterol (Symbicort Turbuhaler) in the treatment of asthma into clinical practice from the point of view of the state. Demographic data was taken from the official data of the Federal State Statistics Service. Direct medical costs included the cost of medicines, the cost of hospitalization of patients associated with the development of asthma exacerbations, and the cost of scheduled outpatient visits. Indirect costs considered the loss of GDP due to hospitalization of patients against the background of asthma exacerbations. A one-way sensitivity analysis was performed to confirm the robustness of the study results. RESULTS: Assessment of direct costs in the treatment of mild, moderate and severe asthma showed that a gradual increase in the proportion of patients receiving the drug budesonide + formoterol (Symbicort Turbuhaler) over the years to 5.5, 7.7 and 9.7% accordingly, led to an increase in the cost of pharmacotherapy over 3 years by 1.7 billion rubles, while direct non-drug costs associated with the treatment of complications that developed during the treatment of asthma decreased by 8.3 billion rubles. Thus, the reduction in total direct costs amounted to RUB 6.7 billion. At the same time, indirect costs decreased by 6.0 billion rubles. The total reduction in all costs (direct and indirect) when switching patients to budesonide + formoterol (Symbicort Turbuhaler) amounted to 12.5 billion rubles. In addition, the use of the drug budesonide + formoterol (Symbicort Turbuhaler) resulted in a decrease in the number of exacerbations: in the first year by 3137, in the second by 4393 and in the third by 5534 cases. A total of 13 064 asthma exacerbations were prevented over 3 years. CONCLUSION: Increasing the proportion of patients with asthma of varying severity receiving therapy with budesonide + formoterol (Symbicort Turbuhaler) will reduce the financial burden on both the healthcare system and the budgetary system.


Subject(s)
Asthma , Budesonide, Formoterol Fumarate Drug Combination , Humans , Budesonide, Formoterol Fumarate Drug Combination/therapeutic use , Formoterol Fumarate/therapeutic use , Budesonide/adverse effects , Bronchodilator Agents/therapeutic use , Economics, Pharmaceutical , Ethanolamines/adverse effects , Drug Combinations , Asthma/drug therapy , Albuterol/adverse effects , Fluticasone-Salmeterol Drug Combination/therapeutic use , Delivery of Health Care , Administration, Inhalation
5.
Ter Arkh ; 93(4): 449-455, 2021 Apr 15.
Article in Russian | MEDLINE | ID: mdl-36286780

ABSTRACT

AIM: Patients with mild asthma may experience severe exacerbations. This analysis was conducted to investigate regional peculiarities of mild asthma population in Russia. MATERIALS AND METHODS: The SYGMA2 is a double-blind multinational study involving adult patients with mild asthma (n=4176). We conducted an open-label descriptive analysis of the baseline characteristics of the Russian group (n=579) of SYGMA2 trial comparing to SYGMA2 population from other countries. The subanalysis was descriptive only, and no hypothesis were tested. RESULTS: The Russian population of patients with mild asthma was comparable to the rest of countries in terms of demographic characteristics, smoking status and duration of asthma. The spirometric parameters in the Russian group was slightly worse than in the other population. At the study entry 48% of Russian patients had symptom control on maintenance therapy, but 52% were uncontrolled on short-acting bronchodilators. While in other countries this ratio was inverse (55/45%). More patients with mild asthma in the Russian group had at least one severe exacerbation in the previous year (30.1% vs 20.7% in other countries). CONCLUSION: We revealed a delayed prescription of controller therapy and overuse of short-acting bronchodilators in the Russian group of mild asthma patients, that may increase risk of asthma non-control and severe exacerbation.

6.
Ter Arkh ; 92(1): 89-95, 2020 Jan 15.
Article in Russian | MEDLINE | ID: mdl-32598669

ABSTRACT

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.


Subject(s)
Indans/therapeutic use , Pulmonary Disease, Chronic Obstructive/drug therapy , Quinolones/therapeutic use , Administration, Inhalation , Adrenergic beta-2 Receptor Agonists/therapeutic use , Bronchodilator Agents/therapeutic use , Humans
7.
Kardiologiia ; 59(8S): 24-36, 2019 Sep 16.
Article in Russian | MEDLINE | ID: mdl-31526359

ABSTRACT

In recent years, a greater understanding of the heterogeneity and complexity of chronic obstructive pulmonary disease (COPD) has come from the point of view of an integrated clinical assessment of severity, pathophysiology, and the relationship with other pathologies. A typical COPD patient suffers on average 4 or more concomitant diseases and every day about a third of patients take from 5 to 10 different drugs. The mechanisms of the interaction of COPD and cardiovascular disease (CVD) include the effects of systemic inflammation, hyperinflation (hyperinflation) of the lungs and bronchial obstruction. The risk of developing CVD in patients with COPD is on average 2-3 times higher than in people of a comparable age in the general population, even taking into account the risk of smoking. The prevalence of coronary heart disease, heart failure, and rhythm disturbances among COPD patients is significantly higher than in the general population. The article discusses in detail the safety of prescribing various groups of drugs for the treatment of CVD in patients with COPD. Achieving success in understanding and managing patients with COPD and CVD is possible using an integrated multidisciplinary approach.


Subject(s)
Cardiovascular Diseases , Cardiovascular System , Pulmonary Disease, Chronic Obstructive , Cardiovascular Diseases/complications , Comorbidity , Humans , Prevalence , Pulmonary Disease, Chronic Obstructive/complications , Risk Factors
9.
Ter Arkh ; 77(3): 18-23, 2005.
Article in Russian | MEDLINE | ID: mdl-15881093

ABSTRACT

AIM: To show specific features of respiratory disoders in patients with ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) taking atenolol for a long time. MATERIAL AND METHODS: A long-term study of external respiration function was made in 287 patients with IHD and COPD treated with berodual and atenolol (group 1) vs 74 matched patients taking berodual only. RESULTS: Atenolol treated patients demonstrated more pronounced respiratory disorders. Small respiratory tracts were involved earlier with appearance of expiratory peripheral collapse and early expiratory closure of the respiratory tracts. Diffuse ability of the pulmonary tissue deteriorated. Conclusion. Atenolol has a negative effect on the respiratory system, so it is necessary to control external respiratory function in the course of treatment.


Subject(s)
Adrenergic beta-Antagonists/adverse effects , Atenolol/adverse effects , Myocardial Ischemia/drug therapy , Pulmonary Disease, Chronic Obstructive/drug therapy , Adrenergic beta-Antagonists/therapeutic use , Aged , Atenolol/therapeutic use , Female , Humans , Male , Middle Aged , Myocardial Ischemia/complications , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Ventilation/drug effects , Respiration Disorders/drug therapy
12.
Ter Arkh ; 69(4): 48-51, 1997.
Article in Russian | MEDLINE | ID: mdl-9213960

ABSTRACT

Application of a modern method of introscopy--electroimpedance tomography (EIT) for diagnosis of different types of lung diseases is described. The EIT system including measurement and collecting data devices, 16-electrodes array and IBM PC 486 computer was used. The results of analysis of electrotomograms have demonstrated that the EIT-system can be introduced for detecting abnormal lung fluid levels, pulmonary edema, diagnosis of lung cancer, emphysema, pleuritis, hydrothorax, sarcoidosis. The method provides high sensitivity to the changes in the body physiological state. Other advantages are: safety, fast measurements, ease of equipment transportation and maintenance, low cost.


Subject(s)
Electric Impedance , Pulmonary Medicine/methods , Tomography/methods , Adult , Aged , Electrodes , Female , Humans , Lung Diseases, Obstructive/diagnosis , Lung Neoplasms/diagnosis , Male , Microcomputers , Middle Aged , Pulmonary Medicine/instrumentation , Sarcoidosis, Pulmonary/diagnosis , Tomography/instrumentation
13.
Ter Arkh ; 68(3): 19-23, 1996.
Article in Russian | MEDLINE | ID: mdl-8744096

ABSTRACT

The paper presents morphological, morphometric and densitometric evidence obtained on cytoplasmic inclusions of alveolar macrophages from bronchoalveolar lavage of chronic obstructive bronchitis (COB) sufferers. All of them previously worked in the zone contaminated after the Chernobyl accident. The control consisted of nonexposed to radiation COB patients. In the exposed subjects alveolar macrophages were more active, 20% of cytoplasm was occupied by numerous phagolysosomes varying in form. Their densitometric evaluation has been performed. Further bronchoalveolar lavages will be conducted to follow up the above changes in alveolar macrophages.


Subject(s)
Macrophages, Alveolar/pathology , Occupational Exposure/adverse effects , Power Plants , Radioactive Hazard Release , Adult , Bronchitis/pathology , Bronchoalveolar Lavage Fluid/cytology , Chronic Disease , Densitometry , Humans , Inclusion Bodies/pathology , Inclusion Bodies/radiation effects , Macrophages, Alveolar/radiation effects , Male , Middle Aged , Occupational Exposure/statistics & numerical data , Radioactive Hazard Release/statistics & numerical data , Time Factors , Ukraine
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