No 15 (2013)

The article is devoted to the evaluation of potentials for the use of ß-adrenoblockers (BAB) in the treatment of cardiovascular diseases (CVD) in patients with chronic obstructive pulmonary disease (COPD), including coronary heart disease, hypertension, inherited connective-tissue diseases, etc. Currently, the use of cardioselective beta blockers: bisoprolol, metoprolol succinate, nebivolol, as well as α 1-and β-blocker carvedilol is recommended for the treatment of patients with CVD and COPD. The control of respiratory function (RF) is necessary against the background of use of these BAB. In the case of worsening bronchial obstruction and adverse influence on respiratory function parameters, the dosage of beta blockers should be reduced, and in the case of depression of respiratory function, the use of these drugs should be discontinued. In general, the use of cardioselective beta blockers and carvedilol in patients with CVD and COPD is safe, and benefits of this group of drugs overweigh the risks of exacerbation of COPD.

The article is devoted to the new drug riociguat, which is used for the treatment of patients suffering from two forms of pulmonary hypertension - pulmonary arterial hypertension and chronic posttromboembolic pulmonary hypertension. The mechanisms of action of this drug, the results of clinical studies on the efficacy and safety, and prospects for the use of riociguat in the clinical practice are described.

In Russia, a new fixed combination of mometasone furoate/formoterol with the original dosing aerosol inhaler with a dose counter was registered for the treatment of bronchial asthma. The article presents the key randomized clinical trials on the use of this drug in bronchial asthma and chronic obstructive pulmonary disease, and evaluation of ergonomics and safety of use of the inhaler. The review of these works allows to recommend this fixed combination for the clinical practice as having a sufficient evidence base for the effectiveness and safety in bronchial asthma.

Bronchial asthma (BA) is one of the most common diseases in modern society: in adult population it occurs in more than 5 % of cases, in children more frequently - up to 10 %. At present time, the combination of inhaled glucocorticosteroids (IGCS) with an inhaled long-acting P2-agonist forms the basis for the treatment of bronchial asthma in adults with moderate to severe disease and in children with severe disease. These classes of drugs (IGCS and long-acting β 2-agonists) should be considered as synergists due to their complementary effects on the molecular and receptor levels. Regular background therapy, including the use of combined drugs, should provide adequate asthma control in many patients. Currently, new combination of fluticasone propionate and salmeterol with the trade name Tevacomb was developed; the dosage of this drug corresponds to the original drug in metered dose inhaler.

The article discusses the etiopathogenic mechanisms of various forms (chronic, acute and sudden) of neurosensory hearing loss (NSHL). Modern approaches to the treatment of NSHL and three phases of therapy for acute forms are presented. It is emphasized that complex therapy of any form of NSHL should include drugs that can improve metabolism, enhance the regenerative processes in the neuroepithelium and slow the progression of neuropathy, particularly those containing B vitamins (Milgamma® , Milgamma® compositum). In addition to drug therapy of chronic NSHL, the use of physical methods of treatment, such as endo-aural electrophonophoresis, intra- and supravessel laser blood irradiation, and fluctuating currents is reasonable.

The article discusses the basic position of the last revision of the Global Initiative for Chronic Obstructive Pulmonary Disease (COPD) -GOLD-2011. GOLD-2011 revision offers a new classification of COPD with the identification of the four categories of patients (A, B, C, and D) depending on the severity of the clinical symptom, frequency and severity of exacerbations of bronchial obstruction. The new revision of the GOLD divides all medical drugs into first- and second-line therapy. Therapy is determined by clinical course of the disease, that is, belonging to a particular category - A, B, C or D. Approaches to the choice of treatment of COPD depending on the category of the patient are presented. In general, pharmacotherapy should be aimed at reducing the symptoms of COPD, reducing the frequency and severity of exacerbations, improving exercise tolerance and general state of patent.

Influenza epidemics cause huge economic damage and remain the most serious medical and socio-economic problem. The most effective way to prevent the spread of infection with airborne transmission mechanism is an improvement of specific and non-specific resistance of the organism. Now, the main reasonable method for the prevention of influenza is vaccination. In addition to immunization with the influenza virus vaccine, physicians have a wide arsenal of drugs used for the prevention of influenza and acute respiratory viral infections (ARVI): antiviral chemotherapy etiotropic chemotherapeutic agents, immunotropic agents for the non-specific prevention. Development of drugs for the prevention and treatment of influenza and other acute respiratory viral infections and their introduction into clinical practice remain a topical issue. An important principle of the system of measures to protect the population against influenza and other viral respiratory infections includes the complexity, the use of all effective drugs and methods for prevention in different settings and different populations.

At current level of clinical medicine, effective impact on the course of chronic obstructive pulmonary disease (COPD) is feasible. Long-acting bronchodilators (LABD), including tiotropium, which refers to the disease-modifying drugs for long-term maintenance treatment of COPD, occupies a special place among the drugs used in the therapy of stable period of COPD. Tiotropium improves pulmonary function parameters, symptoms, physical performance, quality of life in patients with COPD, and reduces the number of exacerbations of disease.

In infants, inflammation of the upper respiratory tract captures both the nasal mucosa and nasopharynx, and any rhinitis should be considered as nasopharyngitis at this age. Up to 6 months, the child can not breathe through the mouth, because the language of the baby takes up the entire oral cavity, and air can enter the body through the mouth only by muscular efforts, such as crying. Also, the child cannot clean his nose independently, he can not close his mouth and make an expiratory act, which will send air through the nose outwards. In recent years, manufactured preparations for the care of the mucous membranes of the nose are widely available; their composition includes primarily sea water; it is sterilized, the salt content is adjusted to isotonic concentration and packaged in convenient spray bottles. For children up to one year old, a drops as a form of preparations are available. Irrigation of isotonic solution on nasal mucosa contributes to normalization of rheological properties of mucus and has easy decongestant effect, improving nasal breathing.