[Assessment of the respiratory muscles strength at patients with chronic obstructive pulmonary disease with various forms of comorbidity].

The respiratory muscles (RM) strength is the main indicator of their functional state. However, RM strength is not used as criteria for chronic obstructive pulmonary disease (COPD) stratification. AIM: To evaluate the RM power of COPD patients with various variants of comorbidity and to determine the role of comorbidity in the development of respiratory muscle dysfunction. MATERIALS AND METHODS: RM strength of 64 men with exacerbation of COPD was studied. The severity of comorbidity was assessed by the Charlson index. Depending on the prevalence of comorbidity, patients were divided into 3 groups: cardiovascular, cerebrovascular and metabolic. Maximum inspiratory (MIP) and expiratory (MEP) pressures in the oral cavity, maximum rate of pressure development (MRPD), sniff nasal inspiratory pressure (SNIP), MEP/MIP and SNIP/MIP indexes were determined with MicroRPM device (UK). Measured values of MIP, MEP and SNIP were compared with the proper ones. The most noticeable decrease of RM strength was defined in the group of patients with severe comorbidity. RESULTS: In case of a mild comorbidity MEP and SNIP values were 68 and 78% of the predicted values and MIP value corresponded to the personified standard. RM strength of patients with COPD depended on the clinical variant of comorbidity. Thus, in the group of patients with cardiovascular variant of comorbidity auxiliary inspiratory muscles strength decreased. In the group of patients with cerebrovascular variant of comorbidity the expiratory muscles dysfunction predominated. In the group of patients with metabolic variant of comorbidity diaphragm dysfunction predominated. CONCLUSION: The pathogenetic significance of various factors of COPD comorbidity in the development of RM dysfunction was confirmed by the results of the correlation analysis.

[Assessment of the respiratory muscles strength at various stages of ischemic stroke]. / Otsenka sily dykhatel'nykh myshts na razlichnykh stadiiakh ishemicheskogo insul'ta.

Power characteristics of the respiratory muscles (RM) in the dynamics of ischemic stroke (IS) is an important tool for the early diagnosis of RM dysfunction and development of individual programs for treatment at different stages of rehabilitation. AIM: To assess the power of RM in patients with IS at different stages of the disease. MATERIAL AND METHODS: Power characteristics of RM of 56 patients with IS with different severity of the disease were examined after 2-4, 5-6 and 13-14 months of IS onset. Maximum inspiratory (MIP) and expiratory (MEP) pressures in the oral cavity, maximum rate of pressure development (MRPD) and sniff nasal inspiratory pressure (SNIP) were determined. RESULTS AND CONCLUSION: A decrease in expiratory and inspiratory RM strength was shown in the early and late periods of IS, severity of which was depended on the severity of neurologic disorders. The bronchial obstruction resulted in RM dysfunction. Expiratory muscles weakness only was observed in the remote period while one third of patients had obstructive disorders of breathing. The functional activity of different RM at different IS stages was correlated with the smoking index, forced expiratory volume in the first second, forced vital capacity, skeletal muscles mass and severity of dyspnea, asthenia and disturbances of vital functions. These differences were the most obvious in elderly group of people. RM power examination of IS patients is an important mechanism of early diagnosis and rehabilitation.

Respiratory muscles dysfunction and respiratory diseases.

This review presents an analysis of the literature on the topic of respiratory muscle (RM) dysfunction in various forms of respiratory pathology: chronic obstructive pulmonary disease (COPD), asthma, community-acquired pneumonia, idiopathic pulmonary fibrosis (IPF), sarcoidosis and interstitial lung diseases (ILD), associated with systemic connective tissue diseases (polymyositis, dermatomyositis and systemic lupus erythematosus - SLE). Various clinical and pathophysiological aspects of RM dysfunction and general patterns of its pathogenesis were examined. It was proved that the role of RM in the development of respiratory failure depends on the form and stage of the pulmonary pathology and the severity of systemic manifestations of these diseases: excessive proteolysis, oxidative stress, hypoxia, chronic systemic inflammation. These factors modify the morphofunctional status of RM, worsens their contractile function, which is contributed to the development of respiratory failure. In some cases, the primary weakness of RM precedes the clinical manifestation of pulmonary pathology, which is distinctive for some variants of myositis-associated ILD and SLE. Endogenous intoxication syndrome plays a significant role in the development of RM dysfunction during community-acquired pneumonia. It is noted that sarcoid pulmonary ventilation disorders associate with the RM weakness, but not with the degree of lung damage. In most cases, secondary RM dysfunction predominates that contributes to respiratory failure progression, which is especially noticeable in case of COPD, asthma and IPF.

Chronic obstructive pulmonary disease and cerebrovascular diseases: functional and clinical aspect of comorbidity.

Literature data of chronic obstructive pulmonary disease (COPD) and cerebrovascular diseases (CVD) comorbidity are represented in this review. Key aspects of this interaction and its importance for clinical medicine have been considered. CVD and COPD are the main mortality factors in adults, which contribute to great economic wastes. The incidence of chronic cerebral ischemia for COPD patients is almost three times as high as for general population. The incidence of ischemic stroke for COPD patients is 1,2 times higher than in general population. For hemorrhagic stroke and subarachnoid haemorrhages, this figures are 1,3 and 1,46 respectively. Chronic systemic inflammation, tissue hypoxia and oxidative stress play the crucial role in respiratory and cerebrovascular comorbidity. Metabolites of these processes (especially proinflammatory cytokines, reactive oxygen species, C-reactive protein and some neurotrophins) increase the permeability of blood-brain barrier, destroy brain cells and activate atherogenesis in pre- and intracerebral arteries. Endothelial dysfunction affects autoregulation of cerebral circulation. Systemic symptoms of COPD are closely associated with different structural-functional disorders of the brain such as reduction in white matter integrity, grey matter volume reduction and cerebral microbleeds. Also, venous encephalopathy is developed as a result of intrathoracic pressure elevation and stasis in superior vena cava system. These processes result in neurological symptomatology. The intensity of symptoms depends on COPD severity. The occurrence of cognitive impairment, psychic tension, depression, panic disorders also increases. However COPD and CVD comorbidity is an important problem of modern medicine, pathophysiologic mechanisms and clinic aspects of this problem remain unresolved. Understanding of their role opens perspectives for rational pharmacotherapy.