Destruction of the bronchial epithelium in patients with severe asthma according to different patterns of inflammation and cold airway hyperresponsiveness.

AIM: The aim of the research was to study the state of the bronchial mucosa epi-thelium in relation to the severity of clinical manifestations in severe uncon-trolled asthma depending on the pattern of inflammation and the presence of cold airway hyperresponsiveness. MATERIALS AND METHODS: In 48 patients with severe uncontrolled asthma, there were assessed asthma symptoms, clinical signs of cold airway hyperre-sponsiveness, and lung function; the samples of slides were analyzed in the cytological examination of the sputum; the degree of damage to epithelial cells and granulocytes was estimated using the total cell destruction index (CDI). RESULTS: According to the analysis of sputum cytograms, the patients were divided into two groups: group I (22 patients) included persons with eosin-ophilic inflammation pattern (31.0±3.1% of eosinophils and 22.0±2.2% of neutrophils), group II (26 patients) was with mixed inflammation pattern (7.2±1.4 and 71.8±4.2%, respectively). The patients of group II had lower disease control according to Asthma Control Test (ACT; 12.1±0.7 and 17.8±0.2 points, respectively; р<0.05), a greater frequency of exacerbations (4.1±0.3 and 3.2±0.2 per year, respectively; р<0.05), greater incidence of clinical signs of cold airway hyperresponsiveness (79 and 19%, respectively; χ2=14.18; р<0.001); lower lung function (midexpiratory flow rate MEF25-75 was 14.6±1.6 and 20.7±1.9%, respectively; р<0.05); they received a higher dose of the combined medications of inhaled glucocorticosteroid in controller anti-inflammatory therapy (salmeterol/fluticasone at a dose of 705.3±19.7 and 650.7±14.8 µg/day for fluticasone propionate; р<0.05) In patients of group II the correlations of epithelial CDI with neutrophil CDI (r=0.61; p<0.01) and eosinophil CDI (r=0.48; p<0.05), as well as correlation of ACT with neutrophil CDI (r=-0.71; p<0.01) and eosinophil CDI (r=-0.53; p<0.05) were found. CONCLUSION: The degree of destruction of the epithelium and granulocytes in the inflammatory patterns has diagnostic relevance for the assessment of the severity of the disease, clinical manifestations of the airway response to the cold trigger, and the inertia of achieving control in patients with severe un-controlled asthma.

Inflammatory Pattern of the Bronchial Mucosa in Patients with Asthma with Airway Hyperresponsiveness to Hypoosmotic Stimulus.

Positive reaction of the bronchi to distilled water inhalation in asthmatics is associated with significant stimulation of the respiratory epithelium desquamation against the background of increased content of eosinophilic and neutrophilic leukocytes in induced sputum, predomination of eosinophil and neutrophil cytolysis, and lower activity of myeloperoxidase in leukocyte granules (in comparison with the parameter in patients with a negative response to bronchostimulation). Enhanced cytolysis and destruction of leukocytes and high myeloperoxidase concentration in the extracellular space are essential for the development of bronchial hyperresponsiveness to hypoosmotic stimulus in asthma.

[POSSIBILITIES FOR THE USE OF THE ANTI-LEUKOTRIENE DRUG MONTELUKAST IN COMBINED THERAPY OF PATIENTS WITH BRONCHIAL ASTHMA AND COLD-INDUCED BRONCHIAL HYPERACTIVITY].

AIM: To study effectiveness of the use of the anti-leukotriene drug montelukast in combination with inhalation glucocorticoid and long-acting beta-agonist in patients with bronchial asthma (BA) and cold-induced bronchial hyperactivity (CBHA) with a view to optimizing control of the disease. MATERIALS AND METHODS: We carried out an open comparative prospective study of patients with persistent BA in a cold season under conditions of real clinical practice. The patients were divided into 2 groups. Group 1 included patients with CBHA, group 2 consisted of subjects with constant bronchial reactivity in response to cold in the standard provocative test. The patients were followed up for 24 weeks. During the first 12 weeks of the treatment, the patients of group I were given sodium montelukast with budesonide/formoterol. In the next 12 weeks they received only budesonide/formoterol at the same dose. Patients of group 2 were treated with budesonide/formoterol during the entire study period. Efficacy of therapy was assessed by asthma control test (ACT). RESULTS: Control of BA in group 1 (20-25 scores in A CT) was achieved in 83% of the patients within the first 12 week period The result was comparable (87%) with that in group 2. Impairment of control (to 52%) was documented in group I during the last 12 weeks although it was preserved (20-25 scores) in group 2 (81%). CONCLUSION: The use of sodium montelukast in combination with budesonide/formoterol for the treatment of BA with CBHA in winter season ensured control of the disease in most patients during 12 weeks. Withdrawal of montelukast in the subsequent period leads to the loss of control and a rise in the frequency of exacerbation.

[Possibility of achieving and maintaining asthma control in patients with bronchial cold hyperreactivity].

AIM: To evaluate the clinical efficiency of tactics to widen the scope of monotherapy with inhaled glucocorticosteroids (IGCS) in asthmatic patients with bronchial cold hyperreactivity (BCHR) during winter to achieve control of the disease in real clinical practice. SUBJECTS AND METHODS: An open-label longitudinal study was conducted in a cold period in 106 asthmatics divided into 2 groups: 1) those with BCHR and 2) those with unchanged bronchial reactivity to a cold stimulus. The study involved monitoring the symptoms by the asthma control test, peak expiratory flow rate (PEFR), and spirometry results before and after cold bronchoprovocation testing; assessment of the pattern of bronchial inflammation from the ratios of induced sputum (IS) cell populations; and estimation of the number of asthma exacerbations and emergency care recourses. Group 1 used a stepwise increase of the scope of basic therapy with beclomethasone dipropionate 1000 microg/day until asthma control was achieved, which was followed by the therapy with the stable dose. Group 2 received monotherapy with beclomethasone dipropionate as the stable dosage of < or = 500 microg/day. RESULTS: After the first 12 weeks of a follow-up, Group 1 showed the most marked positive changes in the intensity of clinical symptoms, forced expiratory volume in one second, and PEFR that remained within the following 12 weeks during the continued therapy with the stable dose of the drug. A preponderance of the eosinophilic and neutrophilic pattern of inflammation was seen in the patients of this group. By the end of the study, there was a decline in the number of IS inflammatory cells. A discriminant model was developed as a tool to predict asthma control achievement in patients with BCHR. CONCLUSION: A stepwise increase in the scope of IGCS monotherapy in asthmatic patients with BCHR during winter can yield the results of disease control and the incidence of exacerbations, which are similar to those seen in asthmatics with no signs of BCHR (53 and 49%, respectively).

[The neuroendocrine reactions in patients with chronic bronchitis in a region of the northeastern USSR]. / Neiroéndokrinnye reaktsii u bol'nykh khronicheskim bronkhitom v regione Severo-Vostoka SSSR.

The author describes differences in the manifestations of mutually determined reactions of the sympathoadrenal and hypophyseoadrenocortical systems in their interaction with the biologically active substance serotonin in healthy persons (124) and patients suffering from chronic bronchitis at different times of living on the Chukot Peninsula. The most perfect system of the protective effect on the part of the neuroendocrine complex can be seen in chronic bronchitis patients within the first 3-5 years of living in the North as compared with the reaction of the neuroendocrine system in the examined patients with a longer "northern record" (10-15 years and more).

[Several features and mechanisms of lesions of the cardiovascular system in a severe course of hemorrhagic fever with renal syndrome]. / Nekotorye osobennosti i zakonomernosti porazheniia serdechno-sosudistoi sistemy pri tiazhelom techenii gemorragicheskoi likhoradki s pochechnym sindromom.

Peculiarities of lesions of the cardiovascular system were studied in 332 patients with a grave course of hemorrhagic fever with the renal syndrome. Deep cardiovascular disorders manifesting themselves in low or high arterial pressure, ECG changes, hemodynamic disorders in the greater and lesser circulation, disorder of the morphological structure of the myocardium and small vessel walls were revealed.

[Effect of a permanent magnetic field on the thyroid status]. / Vliianie postoiannogo magnitonogo polia na sostoianie shchitovidnoi zhelezy.

Rats were exposed to a constant magnetic field of 26268A/m. Depending on the exposure time, the thyroid gland showed changes in the follicular epithelium height, content of ribonucleoproteins and PAS-positive substance, activity of adenylate cyclase, whereas blood serum exhibited changes in the concentration of thyroid hormones and no changes in the content of thyrotropic hormone.