FREQUENCY OF ALBUMINURIA IN PATIENTS WITH BRONCHIAL OBSTRUCTIVE DISEASES

Цель исследования - изучение частоты и особенностей альбуминурии у пациентов с хроническими бронхообструктивными заболеваниями легких. В проспективном исследовании приняли участие 219 пациентов с ХОБЛ (GOLD 1-4) и 201 пациент с персистирующей бронхиальной астмой (БА) различной степени тяжести, проходивших обследование в 2018-2019 гг. Контрольную группу составили 48 добровольцев, сопоставимых по возрасту и полу. Помимо общеклинических исследований, всем пациентам производили расчет ИМТ и диагностику висцерального ожирения на основе соотношения объем талии/объем бедер (ОТ/ОБ), расчет индекса курящего человека (ИКЧ). Альбуминурию (АУ) определяли на основе расчета альбумин/креатининового соотношения в разовой утренней порции мочи. Частота оптимальной/незначительно повышенной АУ (А1) составила 28,7% (63) у больных ХОБЛ и 9% (18) - у больных БА. Количество больных ХОБЛ с клинически значимой АУ (А2, А3) составило 24,2% (53) пациентов, что статистически значимо выше, чем у больных БА (5,5% пациентов; χ=22,3, p=0,01). Факторами, вносящими статистически значимый вклад в развитие АУ у пациентов с ХОБЛ, явились частота обострений за предшествующие 12 мес, ИКЧ, уровень фибриногена и С-РБ, объём форсированного выдоха за 1-ю секунду (ОФВ); у больных БА - ОТ/ОБ, ИКЧ. У больных бронхообструктивными заболеваниями неоспорим вклад курения в развитие и потенцирование почечной дисфункции. Остается спорным вопрос рассмотрения БА как фактора риска почечной дисфункции, учитывая многоликость БА как по фенотипам заболевания, так и по тяжести течения и разнообразию терапевтических подходов. The aim of the study was to study the frequency and features of albuminuria in patients with chronic bronchoobstructive lung diseases. The prospective study involved 219 patients with COPD (GOLD 1-4) and 201 patients with persistent bronchial asthma (BA) of varying severity, who were examined in 2018-2019. The control group consisted of 48 volunteers, comparable in age and gender. In addition to General clinical studies, all patients were calculated BMI and visceral obesity detection based on the waist-hip ratio (WHR), and the Smoking index (HCI) was calculated. Albuminuria was determined based on the calculation of the albumin / creatinine ratio in a single morning portion of urine. The frequency of optimal / slightly elevated AU (A1) was 28,7% (63) among COPD patients and 9% (18) of BA patients. The number of COPD patients with clinically significant AU (A2, A3) was 24,2% (53) of patients, which is statistically significantly higher than among BA patients (5,5% of patients; χ=22,3, p=0,01). The factors that make a statistically significant contribution to the development of AU in patients with COPD were the frequency of exacerbations over the previous 12 months, ICP, fibrinogen and CRP levels, FEV; in BA patients - WHR, ICP. Smoking contributes to the development and potentiation of renal dysfunction in patients with bronchial obstructive diseases. The issue of considering BA as a risk factor for renal dysfunction remains controversial, given the diversity of BA both in terms of disease phenotypes, severity, and variety of therapeutic approaches.

Levels of serum lithium in manic depressive patients with mild persistent bronchial asthma

Background: Lithium, widely used in manic depressive (MD) patients, might protect the airways against constrictor stimuli in bronchial asthma (BA), through its effects on cell signal transduction and ion transport pathways.Methods: Serum lithium levels were studied in MD patients with better controlled mild persistent BA (group A) and MD patients with not so well controlled BA (group B).Results: Serum lithium levels were highly significantly more in group A compared to lithium levels in group B.Conclusions: Lithium may inhibit the contractile response of airway smooth muscle and can be used in treatment / monitoring of BA.

CLINICAL AND SPIROGRAPHIC FEATURES OF BRONCHIAL ASTHMA IN SCHOOLCHILDREN DEPENDING ON THE DIFFERENT REGIMENS OF BASIC ANTI-INFLAMMATORY THERAPY

The aim: To study the clinical and spirographic features persistence of the bronchial asthma in schoolchildren against the background of the alternative daily doses of inhaled corticosteroids to increase the effectiveness of anti-inflammatory therapy for this disease. Materials and methods: A complete comprehensive clinical-paraclinical examination of 65 schoolchildren with persistent asthma was conducted. According to the average daily dose of inhaled corticosteroids (ICS) the patients were divided into two clinical groups. The first (I) group consisted of 46 children who received ICS in the regimen of low-to-medium equipotent doses (253.95±9.98 μg per day), and the second (II) comparison group was formed of 19 patients who controlled the pBA using high doses of ICS (494.74±5.56 μg per day). Results: The patients of the І clinical group compared to patients of the ІІ group have a higher risk of the mild bronchial obstructive syndrome during asthma attacks. In assessing the level of control of persistent bronchial asthma using the CIA-scale, it was found that in II group cases of the controlled course of the disease were observed almost two times less than in children of the I group of comparison. In conducting spirography in children of comparison groups, it was shown that the ratio of indices of bronchospasm (FEV1/ FVC) was worse in patients receiving high doses of ICS. Conclusions: So, сharacteristic clinical feature of asthma controlled by high doses of ICS is more severe nature of bronchial obstructive syndrome during the period of exacerbation (OR=1.9-3.0). In the management of persistent bronchial asthma, the Gensler index which has high specificity (94.4%) and accuracy (92.2%) should be used for disease control verification.

Laboratory Dynamics in Children With Mild Persistent Bronchial Asthma

Study Objective: to track the laboratory dynamics in children with mild persistent bronchial asthma (BA) at various stages of disease with or without baseline therapy. Study Design: prospective cohort study. Materials and Methods. The study included 42 patients with mild persistent BA aged 5 to 16 years. Each child was followed up for 3 years. At initiation of the study and during each visit, all patients had their blood eosinophils, nasal discharge (ND) and induced sputum (IS), as well as serum eosinophil cation protein (ECP) tested; and their respiratory function was assessed. All children were prescribed baseline therapy with low doses of inhalative glucocorticosteroids (GCS); 18 children also received allergen-specific immunotherapy (ASIT). Study Results. Inhalative GCS for BA exacerbations facilitated normalisation of sputum, ND and blood eosinophils. During periods of BA remission, ND and IS eosinophil levels increased, but patients did not have rhinitis and BA symptoms. Eosinophil levels in IS were higher vs. BA control (р = 0.05) and lower vs. disease exacerbations (р < 0.05). We did not find any differences in laboratory results in children with or without ASIT who were treated with low doses of inhalative and nasal GCS. Conclusion. Eosinophile inflammatory phenotype in patients did not charge depending on disease duration and control therapies. According to the study data, eosinophile levels in IS, when BA exacerbation was recorded, were 8.0% [3.0–16.0%]. This value can be used as an additional predictor for the need in increased therapy (a step forward). Irrespective of the disease stage and therapy, there was correlation between blood eosinophile level and IS eosinophile level and between IS eosinophile level and blood ECP concentration. Keywords: bronchial asthma, children, eosinophiles, induced sputum, inflammatory phenotype.

Efektivitas Pemberian Oksigen Posisi Semi Fowler Dan Fowler Terhadap Perubahan Saturasi Pada Pasien Asma Bronkial Persisten Ringan

Mild persistent bronchial asthma is a chronic inflammatory airway that cause the low oxygen saturation value (91-95%). Administering oxygen therapy, setting the position of the semi fowler and fowler can reduce the risk of a decreased chest configuration. This research aims to assess the difference of effectiveness of administering oxygen at semi fowler with fowler position to the saturation changes in mild persistent bronchial asthma patients in Ratu Zalecha Martapura Hospital. This research method is quasy Experiment. The population research are all patients who experience mild persistent bronchial asthma attack, the sample of this research are 20 respondents with purposive sampling technique and analyzed with independent T test. The results is at semi fowler position the average of oxygen saturation before the treatment is 93.10%, after administering oxygen therapy with semi fowler position the average saturation is 98.00%. At the fowler position the average of oxygen saturation before the treatment is 92.60%, after administering oxygen therapy with fowler position the average saturation is 98.00%. The independent T-test result showed no difference of effectiveness of administering oxygen at semi fowler with fowler position to the saturation changes in mild persistent bronchial asthma patients,so teh patients can be given both positions.