Possibilities of non-invasive diagnosis of fibrotic phenotype of interstitial lung diseases.

Progressive pulmonary fibrosis is a major problem in respiratory medicine. Currently, there are no reliable biomarkers for early diagnosis of progressive pulmonary fibrosis, which leads to delayed diagnosis. AIM: To determine the role of serum biomarkers CA-19-9 and CA-125 and the possibilities of capillaroscopy of the nail fold in the diagnosis of progressive pulmonary fibrosis. MATERIALS AND METHODS: The study included 43 patients with interstitial changes in the lungs. Based on the presence/absence of signs of progression over the previous 12 months, patients were divided into 2 groups. All patients underwent forced spirometry, body plethysmography, diffusion test, CT, lung ultrasound, capillaroscopy of the nail fold, study of serum concentrations of CA-19-9 and CA-125. RESULTS: In the group of patients with a progressive fibrotic phenotype of Interstitial lung diseases, a greater severity of capillaroscopic changes and a higher level of CA-19-9 were revealed. Correlation of these parameters with changes according to CT scan data (Warrick test) and lung ultrasound was shown. CONCLUSION: The data obtained demonstrate the possibilities of non-invasive diagnosis of progressive fibrosing interstitial lung diseases and require further research and prospective follow-up to assess the diagnostic and prognostic role of the studied biomarkers, as well as to determine their place in clinical practice.

[Inducibility of arterialized capillary blood gases and acid-base balance determination ].

The reproducibility of determining gases and acid-base balance (ABB) in the arterialized capillary blood taken by 1 and 2 earlap punctures at an 3-15-min interval for up to 7-28 days was studied in 171 subjects (16 healthy individuals and 155 patients with tuberculosis and other diseases of the lung. No relationship was found between the reproducibility of paO2, PaCO2, and SO2, the duration test intervals and that for BE, SB, and pH. The opinion as to the time course of changes in arterialized capillary blood gases and ABB may be regarded as justified only with the changes in paO2 > 4 mm Hg, paCO2 > 2 mm Hg, SO2 > 1%, BE > 0.5 mmol x l(-1), SB > 0.6 mmol x l(-1), and pH > 0.01 at shorter test intervals, BE > 1.1 mmol x l(-1), SB > 0.8 mmoll x l(-1), and pH > 0.02 at longer test intervals.

[Impaired bronchial patency in patients with idiopathic interstitial pneumonias].

Idiopathic interstitial pneumonias are well-known to be mainly characterized by restrictive ventilation dysfunctions and a diminished lung diffuse capacity. No separate significance is generally attached to bronchial obstructive disorders that may be detected along with restrictive ones in some patients. The made analysis of the ventilation capacity of the lung in 53 patients with idiopathic interstitial pneumonias has revealed impaired bronchial patency in 47.2% of the cases, which gives grounds to study this problem in future.

[Function in patients with chronic fibrocavernous tuberculosis].

Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/VC%, PEF, MEF25, MEF50, MEF75, TLC, TGV, residual volume (RV), R(aw), R(in), R(ex), DLCO-SB, DLCO-SS, PaO2, and PaCO2 were determined in 62 patients with chronic fibrocavernous tuberculosis. Lung dysfunctions were detected in 96.8% of the patients. Changes in lung volumes and capacities were found in 90.3%, impaired bronchial patency was in 90.3%, and pulmonary gas exchange dysfunction was in 79.0%. The lung volume and capacity changes appeared as decreased VC and FVC, decreased and increased TLC, TGV, RV; impaired bronchial patency presented as decreased PEF, MEF25, MEF50, MEF75, and FEV1/VC%; and increased R(aw), R(in), R(ex); pulmonary gas exchange dysfunction manifested itself as reduced DLCO-SB, DLCO-SS, PaO2, and decreased and increased PaCO2. The magnitude of the observed functional changes ranges from slight to significant and drastic with a predominance of considerable and drastic changes in lung volumes and capacities and mild impairments of bronchial patency and pulmonary gas exchange function.

[Pulmonary function in patients with focal pulmonary tuberculosis].

Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/VC%, PEF, MEF25, MEF50, MEF75, TLC, TGV, pulmonary residual volume (PRV), Raw, Rin, Rcx, DLCO-SB, DLCO-SS/VA, PaO2, and PaCO2 were determined in 40 patients with focal pulmonary tuberculosis. Changes were found in lung volumes and capacities in 75%, impaired bronchial patency and pulmonary gas exchange dysfunction were in 57.5 and 25%, respectively. The lung volume and capacity changes appeared mainly as increased TGV and PRV; impaired bronchial patency presented as decreased MEF50, MEF75, and FEV1/VC%; pulmonary gas exchange dysfunction manifested itself as reduced DLCO-SB, PaO2, and PaCO2. The magnitude of the observed functional changes was generally slight. TGV and PRL increased up to 148-187 and 142-223% of the normal values, respectively; MEF50, MEF75, FEV1/VC%, and DLCO decreased to 59-24, 58-26, 78-57, and 78-67% of the normal values and PaO2 and PaCO2 did to 79-69 and 34-30 cm Hg.

[Pulmonary function in patients with disseminated pulmonary tuberculosis].

Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/VC%, PEF, MEF25%, MEF50%, MEF75%, TLS, TGV, pulmonary residual volume (PRV), Raw, Rin, Rex, DLCO-SB, DLCO-SS, PaO2, and PaCO2 were determined in 29 patients with disseminated pulmonary tuberculosis. Pulmonary dysfunction was detected in 93.1% of the patients. Changes were found in lung volumes and capacities in 65.5%, impaired bronchial patency and pulmonary gas exchange dysfunction were in 79.3 and 37.9%, respectively. The changes in pulmonary volumes and capacities appeared as increased PRV, decreased VC, FVC, and TLS, decreased and increased TGV; impaired bronchial patency presented as decreased PEF, MEF25%, MEF50%, MEF75%, and FEV1/VC% and increased Raw, Rin, and Rex; pulmonary gas exchange dysfunction manifested itself as reduced DLCO-SS and PaO2 and decreased and increased PaCO2. The observed functional changes varied from slight to significant and pronounced with a preponderance of small disorders, a lower detection rate of significant disorders, and rare detection of very pronounced ones.

[Pulmonary function in patients with infiltrative pulmonary tuberculosis].

Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/VC%, PEF, MEF25, MEF50, MEF75, TLC, TGV, pulmonary residual volume (PRV), R(aw), R(in),, R(ex), DLCO-SB, DLCO-SS, PaO2, and PaCO2 were determined in 103 patients with infiltrative pulmonary tuberculosis. Pulmonary dysfunction was detected in 83.5% of the patients. Changes were found in lung volumes and capacities in 63.1%, impaired bronchial patency and pulmonary gas exchange dysfunction were in 60.2 and 41.7%, respectively. The changes in pulmonary volumes and capacities appeared as increased PRV, decreased VC and FVC, and decreased and increased TGV and TLC; impaired bronchial patency presented as decreased PEF, MEF25, MEF50, MEF75, FEV1/VC% and increased R(aw) R(in), and R(ex); pulmonary gas exchange dysfunction manifested itself as reduced DLCO-SB, DLCO-SS, and PaO2 and decreased and increased PaCO2. The magnitude of the observed functional changes was generally slight. Significant disorders were observed rarely and very pronounced ones were exceptional.

[Effect of surfactant-BL on ventilation and gas exchange function in patients with destructive pulmonary tuberculosis].

The fact that the treatment of pulmonary tuberculosis is a topical problem is beyond question. At present, it is well known that there is dissociation between the time of a negative sputum reaction and later cavernous healing, resolution of inflammatory changes. Therefore, search for new possibilities of pathogenetic action on the course of a tuberculous process, healing of destructive changes, and the maximum recovery of functional disorders are one of the ways of enhancing the efficiency of treatment in patients with destructive pulmonary tuberculosis. Over 70 years' history of the discovery and studies of the pulmonary surfactant system has made it possible to formulate a current concept of surfactant as a multicomponent system of cellular and non-cellular elements that ensure the antiatelectatic, antiedematous, protective, and other functions of the lung. The effects of surfactant preparations as an agent of pathogenetic therapy are being investigated at the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences. The present paper presents the results of changes in external respiratory function and gas exchange before and after surfactant therapy in 64 patients with established drug-resistant infiltrative pulmonary tuberculosis. Along with the performed antituberculous therapy, the natural agent Surfactant-BL made in Russia was used by taking into account individual sensitivity. The agent was inhalationally administered in a daily dose of 25 mg by the schedule for 8 weeks.

[Evaluation of the course of chronic obstructive lung diseases according to the classifications of the European Respiratory Society and the Global Initiative on Chronic Obstructive Lung Disease].

In 91 patients with chronic obstructive lung disease (COLD), the severity of this disease according to the Classifications of the European Respiratory Society (ERS) and the Global Initiative on Chronic Obstructive Lung Disease (GOLD) was compared with that of pulmonary dysfunction according to the data of a comprehensive study, involving the determination of bronchial patency, lung volumes, capacities, and gas-exchange function. This follows that the ERS and GOLD classifications are to be positively appraised as they provide an eligible group of patients for clinical practice in terms of the severity of pulmonary dysfunction and that of COLD. However, the concomitant clinical use of both classifications cannot be regarded as justifiable due to that there are differences in the number of detectable grades (stages) of COLD and borderline (COLD differentiating grades (stages) values of EFV1). In this connection, both classifications have approximately equally significant merits and shortcomings and it is practically impossible to give preference to one of them as the best one. The optimal way out of the established situation is to develop a new (improved) classification of the severity of COLD on the bases of these two existing classifications.

[Lung dysfunction in patients with severe chronic obstructive bronchitis].

VC, FVC, FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, TCL, TGV, RV, Raw, Rin, Rex, DLCO-SS, PaO2, and PaCO2 were determined in 36 patients with severe chronic obstructive lung disease (FEV1 < 50% of the normal value). All the patients were found to have impaired bronchial patency and changes in lung volumes and capacities; 83.3% of the patients had pulmonary gas exchange dysfunction. Impaired bronchial patency mainly appeared as decreased FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, Raw, Rin, Rex; altered lung volumes and capacities manifested by increased RV, TGV, and TLC, and by decreased VC and FVC; pulmonary gas exchange dysfunction showed up as lowered PaO2 and DLCO-SS, as decreased or increased PaCO2. The observed bronchial patency disorders varied from significant to severe; functional changes in lung volumes and capacities were mild to severe.

[Lung dysfunction in patients with mild chronic obstructive bronchitis]. / Nuarusheniia funktsii legkikh u bol'nykh s legkim techeniem khronicheskogo obstruktivnogo bronkhita.

VC, FVC, FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, TCL, TGV, RV, Ravt, Riin, Rex, DLCO-SS, PaO2, and PaO2 were determined in 33 patients with mild chronic obstructive lung disease (FEV1 > 70% of the normal value). All the patients were found to have impaired bronchial patency; most (63.6%) patients had lung volume and capacity changes, almost half (45.5%) the patients had pulmonary gas exchange dysfunction. Impaired bronchial patency mainly appeared as decreased MEF50, MEF15, and FEV1/VC%; altered lung volumes and capacities manifested chiefly by increased RV and decreased VC; pulmonary gas exchange dysfunction showed up primarily as lowered PaO2. The magnitude of the observed functional changes was generally slight. MEF50, MEF75, FEV1/VC%, and VC dropped to 59-20 and 79-70% of the normal value, respectively. RV increased up to 142-196% of the normal value; PaO2 reduced up to 79-60% mm Hg.

[Impaired lung function in patients with moderate chronic obstructive bronchitis]. / Narusheniia funktsii legkikh u bol'nykh so srednetiazhelym techeniem khronicheskogo obstruktivnogo bronkhita.

VC, FVC, FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, TLC, TGV, RV, Raw, Rin, Rex, DLCO-SS, paO2 and paCO2 were determined in 22 patients with moderate chronic obstructive bronchitis (FEV1, 79-50% of the normal value). All the patients were found to have impaired bronchial patency, 90.9% of the patients had lung volume and capacity changes; pulmonary gas exchange dysfunction was present in 72.7%. Bronchial patency impairments were manifested by a decrease in FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, and an increase in Raw, Rin, Rex. Changes in the lung volumes and capacities appeared as higher RV, TGV, TLC, lower VC and FVC. Pulmonary gas exchange dysfunction showed up as a reduction in pO2 and DLCO-SS a reduction and an increase in paCO2. The magnitude of the functional changes observed in most patients was low. Significant and pronounced disorders were seen in one third of the patients.

[Dynamics of changes in lung function in patients with recurrent tuberculosis and ineffective primary treatment in intensive phase of controlled chemotherapy]. / Dinamika funktsii legkikh u bol'nykh s retsidivami tuberkuleza i neudachami pervichnogo lecheniia v intensivnoi faze kontroliruemoi khimioterapii.

In 51 patients with recurrent tuberculosis and ineffective primary treatment in intensive controlled chemotherapy, VC, FVC, FEV1, FEV1/VC%, PEF, MEF25, MEF50, MEF75, Pa02, PaCO2 were measured before, during, and after intensive controlled chemotherapy. Lung function improved in 51.0% of the patients and deteriorated in 19.6%. There was a combination of better and worse lung function in 9.8% of the examinees. The improvement of lung function was observed only during effective chemotherapy, its deterioration was seen mainly during ineffective chemotherapy, rarely during successful chemotherapy. The main cause of better lung function was the resolution of fresh inflammatory changes and that of worse lung function is the cicatricial transformation of lung tissue.

[Significance of bronchospasm in the development of bronchial obstruction in lung diseases]. / Znachenie bronkhospazma v razvitii bronkhial'noi obstruktsii pri zabolevaniiakh legkikh.

VC, FVC, FEV1/VC%, PEF, MEF25, MEF50, MEF75 were studied in 254 patients with lung diseases with bronchial obstruction before and after berotec and antrovent inhalation. Bronchospasm was detected in most patients with bronchial asthma, in a half with exogenous allergic alveolitis, in more than a third with chronic bronchitis and pulmonary tuberculosis, and in a fifth with pulmonary sarcoidosis. In most examinees with bronchospasm, the proportion of the latter in bronchial obstruction amounted to 61-100%.

[Role of bronchospasm in development of bronchial obstruction in chronic bronchitis]. / Rol' bronkhospazma v razvitii bronkhial'noi obstruktsii pri khronicheskom bronkhite.

AIM: To clarify the role of bronchospasm in impairment of bronchial permeability in chronic bronchitis. MATERIALS AND METHODS: Lung capacity (LC), forced lung capacity (FLC), forced expiration volume for 1 second (FEV1), FEV1/LC%, peak volume rate (PVS), maximal volume expiration rate (MVER) at the level of 25, 50 and 75% of LC were measured in 62 patients with chronic obstructive bronchitis before and after inhalation of 1 dose of berotec and 1 dose of atrovent. RESULTS: Bronchospasm was present in 42% of the patients, being the only cause of obstruction in 5% of patients. Other reasons added in 37%. Bronchospasm contribution to obstruction reached 21-40, 41-80, 81-100% in 5, 10 and 27% of patients, respectively. CONCLUSION: An important role of bronchospasm in development of bronchial obstruction in chronic bronchitis is proved.

[The clinico-physiological manifestations and the pathophysiological mechanisms of respiratory failure in tuberculosis and nonspecific lung diseases]. / Kliniko-fiziologicheskie proiavleniia i patofiziologicheskie mekhanizmy dykhatel'noi nedostatochonosti pri tuberkuleze i nespetsificheskikh zabolevaniiakh legkikh.

One hundred and forty-seven patients with tuberculosis and nonspecific lung diseases underwent comprehensive clinical and physiological studies at rest and during exercises of 0.5 and 1.0 W per kg body weight of the examinee. Respiratory failure was found in more than half of them, which was due to pulmonary insufficiency in the vast majority of cases and due to cardiopulmonary insufficiency in much fewer cases. In the two respiratory failures, impaired mechanics of respiration and distributive function of the lung play the leading role in the development of respiratory function. The contribution of the impaired diffusion capacity of the lung as a cause of arterial hypoxemia increases with the severity of diffusive disorders and during exercises.

[The assessment of bronchial patency by conducting broncholytic and loading tests in patients with pulmonary pathology]. / Otsenka bronkhial'noi prokhodimosti pri provedenii bronkholiticheskikh i nagruzochnykh prob u bol'nykh s legochnoi patologiei.

Reproducibility of the parameters of bronchial patency was studied in 31 patients with nonspecific pulmonary diseases, changes in the parameters of bronchial patency during the berotek and loading tests--in 28 healthy subjects, the dynamics of bronchial patency in these tests and the value of separate methods of study of bronchial patency--in 119 patients with active pulmonary tuberculosis. The parameters of spirography, forced expiration flow-volume and general plethysmography were used. Assessment of the results of the pharmacological and loading tests require consideration of reproducibility of the parameters and their changes in healthy subjects in connection with a broncholytic action on the tone of bronchial muscles. The table of limited diagnostically insignificant functional changes in bronchial patency in given. When evaluating the results of functional tests, it is expedient to use a combination of the parameters of spirography, the curve of forced expiration flow-volume and general plethysmography and in the choice of method preference should be given to the registration of the curve of forced expiration flow-volume. The most sensitive parameters of the dynamics of bronchial patency in the broncholytic and loading tests have been developed.

[Pulmonary function of patients with bird-breeders' exogenous allergic alveolitis]. / Funktsiia legkikh u bol'nykh ékzogennym allergicheskim al'veolitom ptitsevodov.

A total of 59 bird fanciers suffering from alveolitis were examined, of them 23 with alveolitis of bronchitis type, 24 with alveolitis of pneumonic type and 11 alveolitis of fibrosing type. In all 3 variants of a course of alveolitis the obstructive syndrome was the main sign of functional disturbances. Intrapulmonary gas exchange disturbances slightly expressed in alveolitis of bronchitis type and pneumonic type, acquired greater importance in fibrosing alveolitis. The absence of restrictive changes in the patients could result from weakly expressed fibrosing of the pulmonary tissue, its combination with emphysematous-dystrophic changes as well as with lung hyperinflation as a result of disturbances in bronchial permeability.