No 8 (2018)

The article is dedicated to the chronic obstructive pulmonary disease (COPD), and considers alternative causes of the disease, which can contribute to the onset and development of COPD along with already recognized and proven risk factors. The possible influence of nutritional status and metabolism on the formation of COPD phenotypes is discussed, as evidenced by the results of the presented studies, although the problem has not been sufficiently studied.

The presented literature review considers the historical aspects of the use of bronchodilators (β2-adrenoagonists and cholinoblockers) in the treatment of chronic obstructive pulmonary disease (COPD). Mechanisms of the action of β2-adrenoagonists and cholinoblockers of various generations, including long-acting drugs (LABAs and LACBs) are discussed; the possibilities of use of long-acting drugs have significantly expanded in recent years. According to GOLD experts’ opinion, fixed-dose combinations of LABAs/LACBs should be considered as first-line drugs for most patients with symptomatic COPD and for almost everyone who needs regular supportive therapy. Great expectations are related to the introduction of triple fixed-dose combinations (LABAs, LACBs and inhaled glucocorticoids) into the practice of COPD pharmacotherapy. Obviously, the accumulation data from real clinical practice in the near and medium term, supplemented by the results of a number of direct comparative studies, will make it easier for the doctor to choose the «right drug» for the «right patient» with COPD.

Clinical practice shows that adequate control of bronchial asthma (BA) is absent in more than 50% of patients. The cause of unsatisfactory BA control may be insufficient suppression of inflammation in the respiratory tract, including distal airways. Inhalation therapy remains the leading method of treatment of BA. One of the important properties of the inhaled medication, which determines the severity of its anti-inflammatory and bronchodilating action, is the level of deposition in the airways. To achieve small airways, «responsible» for an insufficient level of control in certain BA phenotypes, it is necessary to use drugs, including combined drugs, containing extrafine dispersed aerosol forms. During the last decade, a significant database on the positive effects of beclomethasone dipropionate/ formoterol (BDP/F) on everyday BA symptoms, respiratory function, and the frequency of exacerbations has been accumulated. Currently, the evaluation of the effectiveness of BDP/F continues primarily in those groups of patients with asthma, where the impact of the pathology of small airways can adversely affect the ability to achieve control: in smokers, in patients with a long history of asthma, in patients with detected «air trapping» phenomenon. BDP/F provides the most significant effect, incl. pronounced reducing the frequency of exacerbations, specifically in such patients.

Background. Chronic obstructive pulmonary disease (COPD) is an environmentally mediated disease and is one of the five leading causes of mortality in the world. Rapid changes in the rearrangement of patients with COPD in the new GOLD classifications caused much discussion in the literature. Objective: Evaluation of the actual clinical practice and distribution of COPD patients according to different criteria. Methods. In hospital settings, 142 patients with COPD were examined - 140 men and 2 women, with mean age 64.8 ±0.7 (8.2) years. All patients underwent a physical examination, survey using standardized CAT and mMRC questionnaires, as well as spirography. Results. According to the GOLD-2007 classification, patients were distributed as follows: GOLD I - in 7%, GOLD II - in 31%, GOLD III - in 41.5%, and GOLD IV - in 20.5%. According to ABCD GOLD-2011 classification, 5.6% of patients were classified as type A, 10.6% - as type B, 1.4% - type C, and 82.4% - type D, and after redistribution according to ABCD GOLD-2017 - 6.3%, 13.4, 0.7 and 79.6%, respectively. Such a factor as hospitalization has changed the distribution of patients in ABCD groups. 93.7% of respondents have received short-acting bronchodilators (SABs), 60.6% - long-acting adrenomimetics, 23.9% - long-acting anticholinergics, 55.6% - inhaledglucocorticosteroids with long-acting bronchodilators, 14.8% - double bronchodilation, and 13.4% - triple therapy. 27.5% of patients had good treatment compliance. 72.5% of the patients were well trained by the health care providers for the correct use of their inhalers. Among all medications, patients preferred SABs and pressurized metered-dose inhalers, and they would like to use them only on demand. Most patients called morning the worst time of the day. Conclusion. The study reflects the dynamism in the diagnosis and treatment of COPD, the change of priorities from clinical physiology to anamnestic data, as well as the impact of spirometry refusal on ABCD classification. The main directions that will improve the quality of treatment of patients with COPD in the studied region were revealed: increasing the adherence of doctors to national clinical recommendations, and patients - to the prescriptions of attending physicians.

Background. The urgency of the problem of voice disorders in persons of voice-speech professions (doctors, educators, psycho-logists) is in no doubt. The voice quality for them is one of the components of successful work, so early detection of its violation can prevent the transition of the existing disorder into a chronic/recurrent form and prevent the occurrence of subsequent problems with the use of voice in professional activity. Objective: to determine the frequency of voice disorders among persons of the voice-speech professions, the most common factors provoking voice disorders among the persons of this group, the relationship of voice quality with the health status and stress level, and the readiness of the population to seek medical help in the case of the development of voice disorders. Methods. A questionnaire was developed and posted on the Internet, and was offered to respond to everyone interested. The answers were analyzed and processed using methods of simple variation statistics. The survey involved 307people, including 250 (81.4%) residents of the Russian Federation and 57 (18.6%) residents of other countries. Results. Recurrent voice problems were noted by 2% of the Russian respondents and 1.8% of foreigners; frequent (monthly - several times a month) - in 1.2-3.6% of Russians, 0-1.8% of foreigners. Overall, 6.9% of women, women in Russia and other countries, and 4% of men (4.1% for Russians and 3.9% for foreigners) were found to have frequent voice disorders. The most common causes of the voice disorders were infectious and inflammatory diseases (91 people, 62.3%), which correlates with the cold weather in countries where the overwhelming majority of the respondents live); the second most frequent cause was a sharp increase in the load on the voice apparatus (screams at concerts, sports competitions, amateur singing - 33 people, 22.6%); the next - long conversations or public speaking (12 people, 8.2%). Conclusion. The causes of dysphonia can be different, and only endoscopic examination of the larynx will allow to assess the condition of its structures, the features of phonation, diagnose and prescribe treatment (if necessary). Also, representatives of voice-speech professions should not neglect the elimination of factors that provoke violation of voice, issues of its hygiene and improvement techniques for successful and full-fledged professional activity.

Background. Chronic obstructive pulmonary disease (COPD) is a widespread acquired disease, accompanied by irreversible bronchial obstruction and significantly impaired quality of life. Tobacco addiction, as well as comorbid conditions, complicating the health of patients in the second half of life, often make it difficult to individually select the drug therapy for COPD. Undoubtedly, optimal bronchodilation is a key part of the pharmacotherapy of this disease, while the expanded range of drugs allows individual approach to the choice of therapy for each patient. Description of the clinical case. The article presents several clinical examples of the course of COPD, in which the condition was stabilized with glycopyrronium bromide, an anticholinergic drug with 24-hour duration of action, as a background therapy. Conclusion. The unique pharmacological as well as clinical properties of the molecule described in this article allow this bronchodilator to be used in various clinical situations of the COPD course - against smoking cessation, as a monotherapy, and as an addition to the available background therapy in the presence of concomitant pathology. Stabilization of the clinical condition of patients against the background of improvement of spirometric parameters proves the high clinical effectiveness of glycopyrronium in COPD therapy.