[Hyperammonaemia in patients with chronic obstructive pulmonary disease and obesity: association mechanisms, detection rate and correction].

Chronic obstructive pulmonary disease (COPD) is a world-wide problem. It is characterized by comorbidity. Among the numerous comorbidity obesity is considered. The common pathogenetic factors cause the more severe course of COPD. Obesity is a complex metabolic condition affecting many physiological systems, in particular, the metabolic liver affection is developing in the type of non-alcoholic liver disease. In patients with different stages of non-alcoholic liver disease detoxification function is reduced. Toxic ammonia does not convert in urea. Ammonia begins to affect the whole organism. AIM: To identify the frequency of hyperammonemia in patients with COPD and obesity, to analyze the degree of its influence on the COPD course and the quality of patients life, to assess the possibility of hyperammonemia correction with L-ornithine L-aspartate (LOLA). MATERIALS AND METHODS: The study included 50 patients with non-acute COPD (GOLD 2), Group D, phenotype with frequent exacerbations, central-type obesity. At the 1st stage of the investigation, COPD course was evaluated, specific evaluation tests (mMRC, CCQ, CAT, SGRQ, SF-36) were used, the biochemical blood test was performed, hyperammoniemia was detected on a Pocket Chem BA PA-4140, and Number Connecting Test was performed. In the 2ndstage of the investigation, all patients were prescribed a course of treatment with LOLA and after 4 weeks the estimated parameters were compared in dynamics. RESULTS: After 4 weeks, comparative analysis showed reliable positive dynamics of subjective assessment of weakness, 2 scales of SGRQ questionnaire, all scales of SF-36 questionnaire, as well as reliable reduction of ammonia level by 18.26 mol/l, normal value of Number Connecting Test. CONCLUSION: Detection of hyperammoniemia in patients with COPD and obesity and its correction with LOLA seems rational in order to reduce toxic effects of ammonia on organs and systems in this category of patients.

[Pulmonary rehabilitation as an effective method for optimizing therapeutic and preventive measures in patients with chronic obstructive pulmonary disease concurrent with metabolic syndrome]. / Legochnaya reabilitatsiya kak effektivnyi metod optimizatsii lechebno-profilakticheskikh meropriyatii u bol'nykh khronicheskoi obstruktivnoi bolezn'yu legkikh s metabolicheskim sindromom.

AIM: to evaluate the impact of a pulmonary rehabilitation (PR) cycle based on patient education, smoking cessation, physical exercises, and balanced nutrition in addition to standard therapy for chronic obstructive pulmonary disease COPD in patients with this condition. SUBJECTS AND METHODS: 70 patients (27 (38.6%) women and 43 (61.4%) men) aged 18 to 60 years (mean age, 48.31±0.64 years) with moderate COPD in remission concurrent with MS were examined. The comprehensive examination of the patients encompassed assessment of clinical, instrumental, and laboratory findings at baseline and 12 months. The patients were randomized into two groups: 1) 35 patients who underwent a RH cycle in addition to standard therapy for COPD; 2) 35 patients who received standard COPD treatment only. RESULTS: Group 1 was found to have significant differences in reducing the number of patients with COPD exacerbations, emergency calls, hospitalizations, severity of clinical symptoms of COPD and their impact on the physical activity and health of the patients, as well as better quality of life and exercise tolerance. CONCLUSION: The therapeutic and preventive measures for patients with COPD and MS should involve educational programs and physical trainings, which are developed, by taking into account of a comorbidity in order to optimize therapeutic and preventive measures and to improve quality of life in this category of patients.

Chronic obstructive pulmonary disease and diabetes: a look at the epidemiology, pathogenetic mechanisms, treatment.

Lately, increasingly studied the negative impact of diabetes type 2 on chronic obstructive pulmonary disease (COPD). According to literary data diabetes type 2 is more often diagnosed in patients with COPD in comparison with the general population: diabetes type 2 occur among patients with COPD in 18.7%, in comparison with patients without COPD - in 10,5%. The complexity of this association is primarily that chronic obstructive lung disease is regarded as a risk factor for diabetes type 2. The results of some researches show existence of close connection between the glycemic status and spirometric indicators - forced expiratory volume 1-second, forced vital capacity. Obstructive, restrictive, mixed ventilatory lung dysfunction observed in the states prior to the beginning of diabetes, such as impaired glucose tolerance and / or in patients with metabolic syndrome. The associations between lungs function and diabetes type 2 is explained by biochemical changes in airways, in lungs tissue. In patients with diabetes type 2 the decrease of lungs function is considered as a result of diabetes type 2 and as risk of development and progressing of COPD. Communication between the two complex nosologies - COPD and diabetes type 2 is confirmed by epidemiological data, common pathogenetic mechanisms - chronic systemic inflammation, oxidative stress, hypoxia, chronic hyperglycemia, side effects of drugs used in the treatment of two diseases - inhaled and / or systemic corticosteroids, inhaled bronchodilators, oral hypoglycemic agents. However, the pathogenetic mechanisms underlying the high prevalence of diabetes type 2 in patients with COPD is still unclear and requires a detailed study. Thus, it is actually and reasonable to conduct scientific and clinical work on identifying and better understanding of the exact mechanisms of the association between COPD and diabetes type 2 to develop methods for their correction, prevention and selection of adequate combination regimens in patients with these comorbid pathologies.