N. V. Gordeeva

ACOS: Clinical and functional features The Russian formulation mesalazine (kansalazine) in the therapy of ulcerative colitis

AIM To investigate the clinical and functional parameters in patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) versus those with chronic obstructive pulmonary disease (COPD) and asthma. SUBJECTS AND METHODS A total of 129 people were examined. 51 patients with ACOS were followed up in Group 1; Group 2 included 38 patients with severe asthma; Group 3 consisted of 40 patients with severe COPD. All the patients underwent clinical examination: history data collection, physical examination, evaluation of disease symptoms, and study of respiratory function (spirometry, body plethysmography). RESULTS ACOS is clinically characterized by considerable demands for emergency drugs and by more frequent asthmatic fits and exacerbations, which require hospitalization. The parameters of bronchial resistance in ACOS were established to be increased throughout the follow-up period and to be comparable with those in patients with COPD. In the patients with ACOS, the severity of pulmonary hyperinflation was associated with increased demands for emergency drugs (r=0.59; p=0.015). Fixed bronchial obstruction in ACOS can be caused by smoking intensity and duration associated with increased bronchial resistance in expiration (r=0.51; p=0.003) and intrathoracic volume (r=0.71; p=0.0001); as well as increased body mass index (p<0.001) and disease duration, which were interrelated with a reduction in the forced expiratory volume in one second/forced vital capacity ratio (r=-0.63; p=0.001 and r=-0.71; p=0.0034, respectively). CONCLUSION Patients with ACOS show more severe clinical manifestations and a substantial increase in functional residual capacity and intrathoracic volume throughout the follow-up period, suggesting that the distal bronchi are impaired and pulmonary hyperinflation develops.

Features of laboratory, functional and radiological parameters at ACOS

Purpose: To study features of parameters of function of external respiration, X-ray pattern and level of neutrophylic elastase at ACOS. Materials and Methods: 129 people were examined in total. The 1st group included 51 patients with asthma-COPD overlap syndrome (ACOS), into 2nd group - 38 patients with severe asthma, in the 3rd - 40 patients with severe COPD. The control group was made by 40 volunteers. Assessment of function of external respiration, results of a computer tomography of high resolution, quantity of neutrophils was carried out. In the blood plasma determined the content of the neutrophylic elastase. Results: Rising of the level of neutrophylic elastase was interconnected with the maintenance of neutrophils of the peripheral blood at patients with ACOS (r=0.56, p=0.035) and severe COPD (r=0.51, p=0.04) that can demonstrate formation of mainly neutrophylic type of an inflammation in these groups. At patients with severe COPD and patients with ACOS rising the volume of pulmonary tissue with formation of emphysema according to computer tomography of high resolution was observed. At patients with severe bronchial asthma emphysematous changes were expressed least. Formation of emphysema at patients with severe bronchial asthma and severe COPD was interconnected with rising of an indicator of the relation of bronchial resistance of exhalation to the bronchial resistance of inspiration (r=0.79; r=0.81 respectively, р˂0,001). At patients with ACOS the level of neutrophylic elastase in blood plasma was interconnected with rising of volume of a pulmonary tissue according to computer tomography of high resolution (r=0.90, р =0.03) and requirement in short-range s-agonists (r=0.76, р =0.02).

Организация обеспечения лекарственными препаратами больных хронической обструктивной болезнью легких в амбулаторных условиях на территории Красноярского края

The aim of this study was to analyze drug supplying for outpatients with chronic obstructive pulmonary disease (COPD) at Krasnoyarsk kray. Methods. Federal and regional regulatory documents and databases of Healthcare Ministry of Krasnoyarsk kray and of the Regional Compulsory Health Insurance Fond were analyzed including the period of 2009 – 2014. We assessed number of receipts prescribed for COPD patients. Results. Despite the growing morbidity of COPD in the Krasnoyarsk kray, number of COPD patients received subsidized treatment has reduced annually and decreased by 14.3% during 2009 – 2014. The cost of subsidized treatment of COPD increased twice: from 2.1 thousand rubles in 2009 to 4.2 thousand rubles in 2014 and a recipe cost increased in 1.8 times: from 522.9 rubles in 2009 to 965.2 rubles in 2014. Every COPD patient receives 4 prescriptions per year in average. Conclusion . The results of this study necessitate thorough analysis of concordance with current guidelines for the prescribed drugs.

EVALUATION OF RATIONALITY OF EXPENSES ON TREATMENT OF SEVERE COMMUNITY-ACQUIRES PNEUMONIA IN MULTI-PROFILE HOSPITAL

Purpose — to study rationality of financial expenses on the treatment of patients with the severe pneumonia. Materials and methods. It was selected 30 medical histories of patients with severe community-acquires pneumonia passing hospitalization in pulmonology department and department of intensive care in 2004, 2011 and 2014. The frequency analysis was applied to studying the structure of the carried-out drug treatment and identification of frequency of the separate medicinal preparations. We have data about the cost of drug which were received from the database of «1C: Drugstore» of regional clinical hospital. Results. Expenses on the treatment of severe community-acquires pneumonia according to 2014 year are rational, 92.23% of expenses are vitally necessary drug entering into modern clinical references. According to the ABC/VEN analysis during the period from 2004 till 2014 we found positive dynamics of increase of expenditure of money at category V. The appreciable attention should be paid to the treatment of accompanying pathology in the therapy of severe communityacquires pneumonia which can make heavier a current of basic disease and become the reason of complications, often fatal. Costs of the medicinal preparations for treatment of the accompanying pathology in 2014 year was made 6.27% that it is necessary to consider at advance planning of provision of medicines in pulmonology department. Conclusion. The results received by us testify about rational use of financial costs on treatment of patients with severe community-acquires pneumonia.

THE REMODELING FEATURES OF RIGHT AND LEFT PARTS OF THE HEART IN PATIENTS WITH BRONCHIAL ASTHMA

ОСОБЕННОСТИ РЕМОДЕЛИРОВАНИЯ ПРАВЫХ И ЛЕВЫХ ОТДЕЛОВ СЕРДЦА У БОЛЬНЫХ БРОНХИАЛЬНОЙ АСТМОЙ И. В. Демко, Е. А. Собко, А. Ю. Крапошина, И. А. Соловьева, Н. В. Гордеева, М. М. Локтионова ГБОУ ВПО Красноярский государственный медицинский университет имени проф. В. Ф. Войно-Ясенецкого Министерства здравоохранения РФ, ректор – д. м. н., проф. И. П. Артюхов; кафедра внутренних болезней No 2 с курсом ПО, зав. – д. м. н., проф. И. В. Демко; Краевое государственное бюджетное учреждение здравоохранения «Краевая клиническая больница», гл. врач – Е. Е. Корчагин.

CLINICAL EFFICIENCY AND THE PHARMACOECONOMIC ANALYSIS OF ALLERGEN IMMUNOTHERAPY AT PATIENTS WITH MILD AND MODERATE ALLERGIC BRONCHIAL ASTHMA

Purpose: an assessment of clinical efficiency and carrying out the pharmacoeconomic analysis of allergen immunotherapy at patients with mild and moderate allergic bronchial asthma. Materials and methods. 108 patients were examined with mild and moderate allergic bronchial asthma, of both sexes who were divided into 4 groups depending on their therapy. The period of observation was 12 months. The 1st group were included 35 patients of mild allergic bronchial asthma receiving allergen immunotherapy in combination with antiinflammatory therapy; the 2nd group were consisted of 22 patients of mild allergic bronchial asthma using only basic therapy; in the 3rd group 17 patients of moderate allergic bronchial asthma receiving allergen immunotherapy in combination with antiinflammatory medicine were observed; the 4th group was made by 34 patients of moderate allergic bronchial asthma receiving only basic therapy. At all patient were investigated the function of external respiration, scarification tests, test АСТтм. For the pharmacoeconomic analysis we used the cost-effectiveness ratio. Results. Our analysis showed that the scheme of treatment at patients of the 3rd group was economically more profitable in comparison with the scheme of treatment at patients of the 4th group. So at the 3rd group in the end of the period of observation was noted significant improvement of the following indicators: FEV1, decrease of day and night dyspnea attacks, quantity of exacerbations, increase of total point of АСТтм test. Despite the larger value of coefficient of expensive efficiency at patients of the 1st group in comparison with the 2nd group, it is necessary to consider that the allergen immunotherapy interferes the progressing of the disease that will compensate the cost of this method of treatment in the future. Conclusion. We received the results that showed the efficiency of the timely done allergen immunotherapy at patients with the mild and moderate allergic bronchial asthma, and is able tto reduce financial expenses considerably.

HYPERSENSITIVE PNEUMONITIS (DIFFICULT CLINICAL CASE)

The article presents a case of hypersensitive pneumonitis in young 21-year-old patient. Currently there are no accurate data on the prevalence of this pathology. The complexity of the diagnosis of hypersensitive pneumonitis is explained by the low awareness of the doctors about this disease and the need for special high-tech methods of examination.

THE LEVEL OF ADIPOCINES IN PERIPHERAL BLOOD OF YOUNG PATIENTS wITH BRONCHIAL ASTHMA

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