NEW POSSIBILITIES FOR MODIFYING THE COURSE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: THE EFFECT OF TIOTROPIUM BROMIDE ON CERTAIN PATHOGENETIC LINKS OF NEOCOLLAGENOGENESIS AND LOCAL IMMUNE DEFENCE OF THE BRONCHIAL TREE.

OBJECTIVE: The aim: To evaluate the dynamics of the interferon and collagen-IV systems in bronchoalveolar lavage in the treatment of chronic obstructive pulmonary disease using the tiotropium bromide medication. PATIENTS AND METHODS: Materials and methods: The study involved 60 COPD patients with bronchial obstruction of the II degree before and on days 30 and 60 of therapy using conventional treatment regimens and inhalations of tiotropium bromide a the dose of 18 mcg once a day. The collagen-IV levels in bronchoalveolar fluid were determined by means of enzyme-linked immunoassay using "StatFax 303 Plus" analyzer and "Biotrin Collagen IV EIA" reagents. The level of IFN-γ was identified with the help of enzyme-linked immunoassay using "StatFax 303 Plus" analyzer and "ProKon" reagents (LLC "Protein Contour", Russia) in bronchoalveolar fluid obtained during fiber-optic bronchoscopy. RESULTS: Results: When examining Group I patients on the 30th day we found out that the content of collagen-IV in the bronchoalveolar fluid had decreased by only 10.29% (p <0.05). Detection of collagen-IV indices in Group II patients on the 30th day of tiotropium bromide use showed the 29.43% (p <0.05) decrease in its content as compared to the initial indices. In Group III patients, the concentration of collagen-IV had a maximum tendency to normalize and made up (24.72 ± 1.15) ng/ml, and decreased by 2.44 times (p <0.05) as compared to the initial indices. Our examination of 12 patients from the comparison group I on the 60th day of treatment revealed even a slight increase in the content of collagen-IV in the bronchoalveolar fluid, as compared with the data obtained on the 30th day. The identified IFN-γ deficiency is indicative for the COPD of the II degree of bronchial obstruction, and its indices were 2.29 times lower than those observed in people from the control group. On day 30, we found out that the content of IFN-γ in Group I patients increased by only 10.29% (p>0.05). Detection of IFN-γ in Group II patients showed 42.27% (p<0,05) increase in its content as compared to the initial indices. The most favorable dynamics of IFN-γ levels in bronchoalveolar contents was observed in Group III patients, and at the time of observation it made up (1.16 ± 0.08) pg/ml, having 2 times (p<0.05) increased as compared to the initial indices. However, in contrast to those taking tiotropium bromide, we examined 12 patients from Group I on the 60th day of treatment and found no significant positive dynamics of IFN-γ content in bronchoalveolar fluid as compared to the indices obtained on day 30. CONCLUSION: Conclusions: The obtained findings indicate the effect of tiotropium bromide on the reduction of interferon-γ and reduce of collagen-IV levels, which depend on the duration of its use.

NITRIC OXIDE METABOLISM IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA ASSOCIATED WITH CORONARY HEART DISEASE AND THE POSSIBILITY OF ITS MEDICAMENTOUS MANAGEMENT.

OBJECTIVE: The aim: To assess the metabolic by-products of nitric oxide in peripheral blood before and after the medicamentous management in patients suffering from community-acquired pneumonia associated with coronary heart disease. PATIENTS AND METHODS: Materials and methods: We have examined 102 patients with community-acquired pneumonia aged from 50 to 65 years, of which 58 patients were diagnosed with coronary heart disease (CHD). The complex treatment of patients with coronary heart disease was supplemented by the additional use of tivortin aspartate, which was taken orally with food at the dose of 5 ml (1g) 3 times a day for 15 days. The NO content in blood plasma was assessed by the concentration of the amount of final NO metabolites (NO3 + NO2), identified by means of the photocalorimetric method. RESULTS: Results: The content of (NO3 + NO2) in peripheral blood of patients with CAP was slightly higher (6.83 ± 0.29) µmol/l as compared to the group of apparently healthy individuals (5.19 ± 0.14) µmol/l, while in patients with CAP associated with CHD it has markedly increased to (12.74 ± 1.09) µmol/l. Against the background of administered treatment, the index of (NO3 + NO2) in patients with coronary heart disease has decreased to (5.76 ± 0.33) µmol/l, while in the group of patients who were not given tivortin aspartate additionally, this index has even slightly increased (7.01 ± 0.40) µmol/l. CONCLUSION: Conclusions: Marked increase of (NO3 + NO2) levels in blood pointed to destabilization of the course of coronary heart disease with CAP, which was eliminated by the involvement of tivortin aspartate (15 days) to the main course of treatment.