No 4 (2013)

The lecture presents the outlines of pulmonologist specialty. The main purpose of the lecture is representation of fundamental principles of SYLLABUS program for respiratory medicine, developed by the European Respiratory Society for helping young pulmonologists based on modern requirements for this specialty. Knowledge of pulmonologist can be divided into three broad areas. The first part of the program for respiratory medicine is based on the presentation of scientific principles, the second - includes the main diagnostic methods; and the third, most extensive section is clinical pulmonology.

Acute respiratory infections (ARI) are the most common infectious diseases in the developed countries. The search for best practices in the prevention and treatment of influenza and other acute respiratory viral infections in patients with chronic bronchopulmonary diseases has been underway for almost two decades. For 10 years Research and Manufacturing company “Materia Medica Holding" has been manufacturing Anaferon and Anaferon for children, i.e. the drugs containing release active antibodies widely used in clinical practice for the prevention and treatment of all types of flu and colds. In 2011, the company launched a brand new antiviral drug Ergoferon exerting intensify antiviral, anti-inflammatory and antihistamine effects. Ergoferon application in patients with chronic obstructive pulmonary disease promotes rapid relief of acute respiratory viral infection and prevents development of exacerbations of these diseases, thus reducing the need to use antibiotics.

More than half of patients with persistent bronchial asthma (BA) do not have control of the disease, despite the progress in pharmacotherapy. Modern management of BA requires the development of targeted treatments with account of clinical and biological phenotypes of the disease. Identification of BA phenotypes is performed on the basis of clinical and biological parameters and cluster analysis, and allows to identify five clusters of BA in adults, differing in clinical course, intensity and type of inflammation. Bio- or inflammatory phenotypes of BA reflect the type of respiratory tract inflammation: eosinophilic and non-eosinophilic. Allergen-specific immunotherapy and anti-IgE-therapy (omalizumab) are currently available types of phenotype-specific treatment of BA.

Exogenous allergic alveolitis (EAA) refers to a group of pneumoconiosis, which develop under influence of aerosols with toxic and allergic effects. The article discusses the etiology, pathogenesis, and clinical forms of the disease. Diagnostic criteria, information on differential diagnosis and principles of treatment of EAA are presented. Preventive measures, as well as criteria for determining disability of patients with EAA are described.

The article presents the results of evaluation of clinical and immunological efficacy of local use of recombinant interferon α-2β preparation (ointment Viferon®) in acute respiratory viral infections (ARvI) of various etiologies in 100 infants. It was shown that the use of local ointment form of the drug reduced the duration of symptoms of the disease and allowed to achieve the elimination of pathogens from port of ARVI without systemic effects on the immune system of the child. The protective effect of ointment Viferon® with regard to recurrent viral contamination in ARVI patients allows to use this drug for the prevention of re-infection of children in hospitals and in organized groups.

The article is devoted to the cough as one of the most frequent and persistent symptoms occurring in respiratory infections in children. The data on the pathogenesis are presented, clinical features of this symptom and principles of therapy are discussed. Currently, there is a large arsenal of antitussive drugs. In each case, the choice of drugs should be based on a complex of objective data (pathogenesis and clinical features of the disease, the individual characteristics of the child, pharmacodynamics and pharmacokinetics of the drug, etc.). Particular attention is paid to non-narcotic antitussive drug butamirate (Sinecod) having high clinical efficacy and safety for using in children from 2 months of age. Sinecod not only has antitussive effect, but moderate anti-inflammatory effect, and contributes to moderate bronchodilation and reduced airway resistance, which determines the potentiation of the therapeutic effect.

One of the most common side effects of antituberculosis drugs (ATD) is hepatotoxicity. The characteristics of the ATDs with the most pronounced negative effect on the liver, in terms of features of their metabolism, the impact on the incidence of drug-induced liver injuries (DILI), predisposing risk factors, and mechanisms of hepatotropic action are presented. A wide range of clinical-morphological variants of DILI caused by ATD, and difficulties in diagnosis and differential diagnosis with liver diseases of different etiology are emphasized. The relevance of use of hepatoprotectors is highlighted. Ademetionin (Heptral) should be considered as one of these drugs, which has pronounced therapeutic effects in liver disease of various origins. Clinical observations that show the high efficiency of Heptral during antituberculosis chemotherapy are presented.

To date, roflumilast is the first and single phosphodiesterase-4 (PDE-4) inhibitor registered as an adjunctive therapy in patients with severe chronic obstructive pulmonary disease (COPD), and frequent exacerbations, already receiving long-acting bronchodilator therapy. The main mechanism of action of roflumilast is associated with inhibition of airway inflammation in patients with COPD. In III phase clinical studies, it was shown that roflumilast improves functional parameters, symptoms, quality of life and reduces the number of exacerbations of COPD.