[Choice of basic therapy for asthma in real clinical practice].

According to the Global Initiative for Asthma, the treatment of asthma should be mainly based on its control that encompasses symptom control and exacerbation risk reduction. Control-based treatment contributes to decreases in the frequency of exacerbations, the incidence of drug side effects, the needs of asthmatic patients for emergency care, and the number of their visits to a doctor and hospitalizations, resulting in a reduction of direct health care costs of asthma. Drugs for the basic therapy of asthma are chosen on the basis of evidence for their efficacy and safety and the view of availability and cost of treatment. In case of poor asthma control it is important to reveal its causes and to change basic therapy according to the individual needs of the patient. A major role in the achievement of asthma control is assigned to a combination of inhaled glucocorticosteroids (ICS) and long-acting ß2-agonists. Combined medications are prescribed to asthma patients in accordance with the daily ICS dose required to achieve asthma control.

[Effect of basic therapy on clinical symptoms, quality of life and systemic inflammation in patients with chronic obstructive pulmonary disease].

The study included 38 men with moderately severe chronic obstructive pulmonary disease (COPD) (mean age 60.6 ± 10.2 yr) and 42 ones with severe COPD (mean age 61.2 ± 7.2 yr). They were treated with tiotropium bromide, formoterol and beclomethasone dipropionate for 24 weeks (stage 1), TB alone for 12 weeks (stage 2) and TB+formoterol (long-acting bronchodilators, LABD) for another 12 weeks. Each stage was followed by evaluation of COPD symptoms using the St-George's Hospital questionnaire, daily requirements for short-acting beta-2 agonists (SABA), heart rate (HR), forced expiratory volume in the 1st second (FEV-1) before and after SABA test, hemoglobin saturation with oxygen in arterial blood during pulse oxymetry before and after 6 min walking test, blood surfactant protein D level (SP-D). The control group was comprised of 34 healthy men (mean age 62.3 ± 5.8 yr). Patients with moderately severe COPD experienced worsening of clinical symptoms (p < 0.001), required more SABA (p < 0.001), had increased HR (p = 0.01) and SP-D levels (p = 0.01) whereas FEV-1 (p = 0.05) decreased during stage 2 as compared with stage 1. Positive dynamics of all these variables except COPD symptoms and HR was observed at stage 3. Alteration in the extent of basal therapy in patients with stage III COPD did not result in dynamics of clinical and laboratory characteristics. The data obtained suggest the necessity of combined therapy with LABD or triple basal therapy of moderately severe COPD and the possibility of therapy with one or two LABD having different sites of action in the patients with clinically stable stage II COPD.