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Vol 26, No 5 (2019)

Articles

NEWS OF MEDICINE

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Pharmateca. 2019;26(5):6-9
pages 6-9 views

Inhaled glucocorticosteroids in the treatment of chronic obstructive pulmonary disease: the debate continues

Emelyanov A.V., Leshenkova E.V., Sergeeva G.R.

Abstract

Chronic obstructive pulmonary disease (COPD) is a common disease characterized by persistent bronchial obstruction. Chronic airway inflammation, which occurs under the influence of tobacco smoke and pollutants, is important in its development and progression. The place of inhaled glucocorticosteroids (IGCS) in the treatment of COPD is one of the most controversial issues in recent years. This article discusses the role of IGCS in the treatment of COPD. The available results of clinical studies allow to recommend these drugs in case of combination of bronchial asthma and COPD. They are also indicated for patients with frequent exacerbations of COPD, despite therapy with long-acting bronchodilators and their combinations. The most likely predictor of IGCS efficacy as a part of dual (IGCS/long-acting e2-agonists [LABA]) and triple therapy (IGCS/LABA/long-acting anticholinergic agents [LAAHA]) is the frequency of exacerbations and the eosinophil blood level. Risk/benefit ratio must be taken into account in case of administration of these drugs.
Pharmateca. 2019;26(5):10-16
pages 10-16 views

The concept of controlling chronic obstructive pulmonary disease

Belotserkovskaya Y.G., Sinopalnikov A.I., Romanovskikh A.G., Smirnov I.P.

Abstract

Given the significant heterogeneity of the disease, the treatment of chronic obstructive pulmonary disease (COPD) should be individualized, taking into account the different clinical characteristics and severity of the condition of each patient. That is why experts proposed a new concept for controlling COPD. Clinical COPD control may be a new step in determining the status of a patient after assessing the phenotype, severity of the disease, severity of symptoms, taking into account the degree of impaired respiratory function, associated diseases, prognostic parameters. The concept of COPD control is interpreted as maintaining the situation with the minimal clinical impact of disease symptoms in combination with a stable course characterized by a low risk of exacerbations over a long period of time adapted to the severity of the disease. Different clinical criteria for controlling require further research to confirm a high level of correlation with different clinical outcomes in a controlled or uncontrolled course of COPD. The authors of the concept suggest using the possibilities of drug therapy to correct the level of control. Modifying the amount of therapy based on the level of control implies periods of increasing the volume of therapy due to the addition of drugs of another class with insufficient control and periods of ongoing therapy with a good level of control. It is also possible to reduce the amout of therapy by canceling inhaled glucocorticosteroids in patients whose disease remains controlled for a certain period of time. The amount of bronchodilation therapy in COPD is not recommended to be reduced, since this is progressive disease and full normalization of the functional respiratory parameters is impossible. Such an approach would help to correct the treatment of each patient, avoiding both insufficient and excessive medication effects, and achieve the best possible course of the disease with a minimum amount of therapy.
Pharmateca. 2019;26(5):17-28
pages 17-28 views

Macrolide antibiotic roxitromycin - the main clinical and pharmacological aspects of application

Egorova O.A.

Abstract

Roxithromycin is a classic representative of 14-membered macrolides and has a number of clinically significant therapeutic features. Pharmacodynamic and pharmacokinetic properties of roxithromycin in combination with high safety have been confirmed in numerous clinical studies. The high efficacy of the antibiotic, regardless of the frequency of its administration, makes it possible to widely use roxithromycin in the treatment of infections in both adults and children.
Pharmateca. 2019;26(5):29-38
pages 29-38 views

Hospital-acquired pneumonia in adults: the structure of pathogens and new features of etiological diagnosis

Yanovich Y.A., Rachina S.A., Sukhorukova M.V., Savochkina Y.A., Vatsik M.V., Petrov A.A.

Abstract

Hospital-acquired pneumonia (HAP) is one of the most common infections associated with medical care. Due to the high prevalence of polyresistant, extreme resistant and panresistant bacteria, the choice of empirical antimicrobial therapy for HAP is a significant problem. The article highlights the etiological structure of HAP in adults, presents the main trends of antibiotic resistance among nosocomial pathogens in the Russian Federation, discusses modern methods of HAP etiological diagnosis, including promising areas based on nucleic acid amplification methods.
Pharmateca. 2019;26(5):39-46
pages 39-46 views

Antibiotics and community-acquired low respiratory tract infections. Who for? What preparation?

Sinopalnikov A.I.

Abstract

The article presents clinical recommendations on the use of optimal empirical antibiotic therapy for patients with lower respiratory tract infections (LRTI), based on the relevant evidence base and adapted to a particular region with regard to knowledge of the structure of local antibiotic resistance of key pneumotropic pathogens. In this context, along with the delineation of the key diagnostic and differential diagnostic signs of LRTI, the main task of the recommendations is the introduction of rational use of antibiotics into routine clinical practice, namely, the rejection of their use in viral/presumably viral infections of the respiratory tract, and non-use of less effective ones where antimicrobial therapy is indicated.
Pharmateca. 2019;26(5):47-60
pages 47-60 views

Exacerbation of chronic obstructive pulmonary disease: the role and place of antibiotics

Romanovskikh A.G., Sinopalnikov A.I., Belotserkovskaya Y.G., Smirnov I.P.

Abstract

Chronic obstructive pulmonary disease (COPD) is a widespread chronic disease, characterized by recurrent exacerbations, which are the main cause of health-seeking behavior, hospitalization, and deaths. Bacterial pathogens play a key role in the development of COPD exacerbations, which determines the advisability of the use of antimicrobial agents in this clinical situation. Presented article discusses the modern approaches to antibiotic treatment of COPD exacerbations.
Pharmateca. 2019;26(5):61-69
pages 61-69 views

Reasonable therapy for bronchial asthma: single inhaler strategy

Babak S.L., Gorbunova M.V., Malyavin A.G.

Abstract

Background. Therapy of patients with bronchial asthma (BA) depends on a variety of multidirectional factors, such as the phenotype of the disease, severity, the presence of concomitant diseases, the response to therapy. There are two most discussed main strategies: regular BA treatment with an established dose with stepwise correction (step up/down) or a single inhaler strategy with “quantum satis" dosing. The purpose of this publication is to present a new strategy and modern approaches for the reasonable treatment of BA with a single inhaler (fixed combination of budesonide/formoterol in the “turbuhaler" device) with the possibility of its implementation in actual clinical practice. Conclusion. In real clinical practice, therapy of asthma patient should not face serious difficulties of execution, if the practitioner has modern capabilities of combined pharmacotherapy and non-drug correction methods, and is able to successfully plan a therapeutic strategy. A modern rational therapeutic strategy for treating patients with asthma should recognize the reasonable dosing of fixed BUD/ FOR combinations in a single inhaler mode. The priority doctrine of treating patients with asthma should be “quantum satis" therapy, which allows achieving a long-lasting, positive effect.
Pharmateca. 2019;26(5):70-78
pages 70-78 views

Risk factors for fatal outcome in patients with community-acquired pneumonia

Shaymuratov R.I., Vizel A.A.

Abstract

Background. Community-acquired pneumonia (CAP) is the leading cause of death from infectious diseases. Despite the achievements in the organization and tactics of treating pneumonia, questions concerning identification of the most significant and modifiable risk factors for the development of fatal outcomes remain. Objective. Identification of risk factors for the unfavorable CAP outcome and their relationship with the criteria for the quality of medical care. Methods. A retrospective observational study of the medical records of deceased and recovered CAP patients using the method of group balancing (copy-pair) was carried out. Results. A total of 160 deaths and 160 favorable outcomes were analyzed in patients over 18 years of age who were admitted for treatment to the hospitals of the Republic of Tatarstan. The copy-pair method showed that precise correlation of pairs leads to the mutual leveling of selection criteria and the appearance of new regularities. Factor analysis identified variables that are leading in predicting the course of the disease. Conclusion. Patients with fatal CAP outcomes demonstrate more pronounced abnormalities in physical data, laboratory analyzes, results of special exams, and positive dynamics, on the contrary, is weaker than in those recovered. Criteria for the quality of medical care along with risk factors contribute to the CAP prognosis; it should be borne in mind that management of quality criteria is simpler than management of risk factors. Failure to follow recommendations for providing medical care to CAP patients can lead to death, even if patients do not have risk factors for fatal outcome.
Pharmateca. 2019;26(5):79-84
pages 79-84 views

Long-term compliance with CPAP therapy in patients with obstructive sleep apnea and hypertension

Gorbunova M.V., Babak S.L., Malyavin A.G.

Abstract

Background. Therapy with CPAP therapy (Continuous Positive Airway Pressure or CPAP therapy) is a fundamental therapeutic doctrine in patients with obstructive sleep apnea (OSA). However, the compliance of patients with OSA to CPAP therapy significantly depends on comorbid conditions and is poorly predictable and poorly understood during its long-term administration. Objective. The aim of the study was to investigate the compliance of patients with OSA to long-term (one-year) CPAP therapy with the function of auto-adaptation to the patient’s inhalation and exhalation (A-Flex therapy). Methods. To the prospective study were included 310 patients with OSA (273 male, 45,3±10,4 yr.) with apnea-hypopnea index (AHI) >5 events /hour. The night polygraphy study (PG) was performed to calculate AHI, oxygen desaturation index (ODI), mean nocturnal saturation (SpO2) by the rules of American Academy of Sleep Medicine (AASM). The target level of CPAP therapy was titrated at home. Compliance criteria markers were represent by indexes of using therapy (PDU, AU, PDU^4, PDU <4), therapeutic pressure levels (CMP, CPP), index of air leakage (LDU), value of corrected AHI (AHIcpap), assessed by original program of compliance analysis Encore Pro v.2.14 (Philips Respironics, USA). Results. Positive compliance dynamic to CPAP occurs after 6 months of therapy: PDU^4 increase by + 5.21% (95% Cl from 3.70 to 6.23; p=0.061), CMP decrease by - 1.32 mbar (95% Cl from -2.1 to -0.86; p=0.082), LDU decrease by -4.30% (95% Cl from -6.71 to -2.91; p=0.031) in the group of mild OSA patients. After 3 months of A-Flex therapy we found a significant increase PDU^4 by + 16,20% (95% Cl from 13,20 to 18,61; p=0,001), decrease CMP by-2,31 mbar (95% Cl from -3,6 to -1,91; p=0,001), decrease LDU by -4,41% (95% Cl from -7,21 to -3,75; p=0,01) in moderate OSA patients. After 6 months of A-Flex therapy we found a significant increase PDU^4 by + 17,91% (95% Cl from 15,80 to 21,11; p=0,001), decrease CMP by -3,31 mbar (95% Cl from -4,1 to -2,91; p=0,001), decrease LDU by -10,69% (95% Cl from -13,25 to -8,41; p=0,001) in severe OSA patients. Conclusions. The high compliance of patients with long-term targeted CPAP therapy, especially in the group of moderate to severe OSA, reliably depends on its effectiveness and the choice of interface that allows for the regular repeatability of the procedure on each therapeutic night.
Pharmateca. 2019;26(5):85-91
pages 85-91 views

Pathogenetic mechanisms for the treatment of the lumbar pain syndrome caused by osteoporosis of mixed genesis in patients with chronic obstructive pulmonary disease

Vasilyeva L.V., Evstratova E.F., Nikitin V.A., Latysheva M.N.

Abstract

Background. Chronic obstructive pulmonary disease (COPD) remains one of the most serious diseases in the twenty-first century. Associated osteoporosis (OP) is an important factor aggravating the course of COPD. Objective. Assessment of the reduction in the intensity of low back pain associated with OP and the dynamics of inflammatory markers in COPD patients treated with LLLR in combination with the muscle relaxant tolperisone. Methods. 32 patients with chronic obstructive pulmonary disease (COPD), with low back pain caused by associated osteoporosis (OP) of mixed origin were treated with low-intensity laser radiation (LLLR) in combination with the drug tolperisone. Results. It was shown that the combination of LLLR and tolperisone significantly reduces pain in the lumbar region, improves the clinical indicators of the underlying disease and systemic inflammation. Conclusion. The positive clinical effect is explained by the analgesic and anti-inflammatory effects of LLLR and its combined potentiating action with tolperisone on the musculoskeletal component of pain.
Pharmateca. 2019;26(5):92-96
pages 92-96 views

Enhanced recovery and early discharge of patients after septoplasty under sedation with dexmedetomidine

Leshchenko R.E., Davydova R.E.

Abstract

Background. Enhanced patient recovery after surgery and discharge on the day of hospitalization allows to avoid the development of a number of adverse events. Currently, there is no consensus on a sedative drug that can provide early discharge after septoplasty. In a clinical study, a comparative analysis of two groups of patients under sedation with dexmedetomidine and propofol was performed. Objective. Assessment of the possibility and determination of the causes of delay of enhanced recovery of patients after septoplasty under sedation with dexmedetomidine or propofol in the settings of multimodal anesthesia. Methods. A randomized, prospective study was conducted. Depending on the sedating medication used, the patients were divided into two groups: the group 1 (n=31) consisted of patients aged 35.09±11.13 years (M±S) treated with septoplasty using propofol; the group 2 (n=30) - patients aged 38.83±11.32 years (M±S) who underwent surgery under sedation with dexmedetomidine. Results. The duration of surgical intervention in the group 1 and group 2 was 58.35±16.43 and 41.13±16.25 minutes (M±S), respectively. In both groups, the time to reach a score of 9-10 with the Aldrete scoring system was 0 minutes. In the group 1, two patients were discharged with a delay, in the group 2, all patients were discharged on the day of surgery. The clinically significant level of pain in the group 1 was the cause of delayed discharge. Conclusion. Sedation with dexmedetomidine in combination with multimodal anesthesia provides for discharge of patients on the day of septoplasty.
Pharmateca. 2019;26(5):97-101
pages 97-101 views

Assessment of the basic knowledge about the bronchial asthma among senior students - the final results of the ASSA study

Bontsevich R.A., Mikhno A.V., Shchurovskaya K.V., Goncharova N.Y., Feoktistov Y.V., Popova E.A., Luchinina E.V., Barysheva V.O., Malkina M.I., Kompaniets O.G., Batishcheva G.A., Eliseeva E.V., Ketova G.G., Pokrovskaya T.G.

Abstract

Background. Bronchial asthma (BA) is one of the most common non-infectious pathologies in humans [1]. Clinical manifestations of the disease are known to doctors for a long time: for example, Hippocrates and Ibn Sina mentioned it in their works [2], and the Belgian doctor Van Helmont described the characteristic symptoms of the disease and linked the occurrence of BA to smoke and irritating substances [3]. However, allergic theory of the occurrence of BA and the use of steroid drugs for its effective treatment [4] has been developed only at the beginning of the XX century. Unfortunately, even in present time of evidence-based medicine, the level of practical knowledge in this area among health workers is often insufficient. Objective. Determination of the level of basic knowledge about BA among 5-year and 6-year students («General Medicine» and «Pediatrics» specialties) of medical universities. Methods. Analysis of an anonymous multicentre survey in the framework of the first phase of the ASSA project (a partial acronym of the «Assessment of senior medical students in the field of bronchial asthma» project), conducted in 2014-2016 in 7 cities of Russia. Results. The study revealed an average level of basic knowledge about the etiology, pathogenesis, clinical picture and treatment of BA. Only 56.8% of the students were able to choose the correct definition of BA from the proposed answers; the right combination of drugs in one delivery device was determined by 61.4% of respondents; 65.6% of students correctly indicated the main clinical laboratory markers of BA and 64.5% - selected the correct scheme of background therapy of BA depending on the severity. Conclusion. The results of the survey showed an insufficient level of basic knowledge about the key issues of BA among senior students. Statistically significant heterogeneity of knowledge levels between different centers may indicate the need for the introduction of uniform, standardized and profound training programs in this area.
Pharmateca. 2019;26(5):102-109
pages 102-109 views

Severe bronchial asthma. Current diagnostic and treatment options

Leshchenko R.E., Buladzhova T.Z.

Abstract

The article contains a review of literature data on diagnostic criteria and modern approaches to the treatment of severe bronchial asthma (SBA), which has high medical and social importance. To confirm the diagnosis, an assessment of the allergological status, the determination of biological markers of the disease is necessary. The modern possibilities of treatment with monoclonal antibodies of this form of the disease, as well as the most studied options for future treatment of SBA are discussed.
Pharmateca. 2019;26(5):110-121
pages 110-121 views

Adherence in bronchial asthma and chronic obstructive pulmonary disease: from a problem to a solution

Vizel A.A., Vizel I.Y., Salakhova I.N., Vafina A.R.

Abstract

Chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA) remain the leading chronic broncho-obstructive pathology requiring lifelong use of inhaled medicines continuously or as needed depending on the severity of the disease. The key element in the treatment is the patient’s compliance with doctor’s recommendations both on drug therapy and on lifestyle and behavior, that is, adherence. A review of current positions on classification, methods of detection and methods of correcting intentional and unintentional non-adherence, as well as the results of authors’ own research of229 patients with BA and 154 patients with COPD is presented. Authors’ own data showed higher adherence of patients with controlled BA (75.9% vs 51.2% with uncontrolled BA). In COPD, adherence was significantly lower, but patients with more pronounced impaired forced expiratory parameters had the highest frequency of adherence. According to the spiromet-ric data (GOLD-2006), only 9.1% of patients with I degree of severity adhered to medical prescriptions, with II degree - only 26.1%, with III - 25.4%, and with IV degree - 43, 3%. Treatment adherence in COPD and BA remains low, but there are methods for its improvement.
Pharmateca. 2019;26(5):122-126
pages 122-126 views

Cough in women

Klyachkina I.L.

Abstract

A description of the pathogenesis of chronic cough (CC) in women is presented. Gender and age differences in the prevalence of CC and the sensitivity of the cough receptors are shown. The role of the female sex hormones and their effect on the cough receptors in the pathogenesis of CC is formulated. Based on the data obtained, the pathogenetic concept of CC as an independent disease is defined. Considering the difficulties of using antitussive drugs with their limited focus on either central mechanisms or peripheral receptors, such drug as Rengalin is considered, which combines antitussive, anti-inflammatory and bronchodilatory actions with the possibility of effective treatment of any type of cough in acute and chronic infectious and inflammatory allergic diseases.
Pharmateca. 2019;26(5):127-132
pages 127-132 views

Integrated approach to the treatment of cough, inside and out. Features of the use of Eucabal

Ovchinnikov A.Y., Miroshnichenko N.A., Smirnov I.V.

Abstract

Cough is one of the most widespread respiratory symptoms, which is manifested in people, regardless of age, place of residence and social status; it often affects the lifestyle and activity of people. For example, in European countries over 30% of the population aged 23 to 50 years suffer from coughing, and the number of such patients increases every year. The urgency of the problem of treating cough is associated with the incorrect treatment of inflammatory diseases of the nasal cavity and upper respiratory tract, which leads to the development of complications and chronization of the process. At the requisition of the World Health Organization (WHO), over-the-counter drugs must meet the following requirements: the drug must be well known, often used in medical practice, be safe for children and not have a toxic effect on the human body. As an example of modern plant products, drug Eucabal can be considered. The article shows the values of the effectiveness of the drug Eucabal in the form of syrup and balsam. This drug may be recommended for the treatment of dry or wet cough. To achieve the best result, the drug should be used at the first sign of coughing.
Pharmateca. 2019;26(5):133-137
pages 133-137 views

Diagnostic algorithm and reasonable therapy of patients with obstructive sleep apnea and resistant arterial hypertension

Gorbunova M.V., Babak S.L., Malyavin A.G.

Abstract

Background. Obstructive sleep apnea (OSA), being an independent disease, is closely interrelated with comorbid pathology, such as obesity, arterial hypertension (AH), impaired carbohydrate metabolism, dyslipidemia. СРАР-therapy (Continuous Positive Airway Pressure or CPAP therapy) is the fundamental therapeutic doctrine of patients with OSA. However, the effects of CPAP therapy on normalization of blood pressure and dyslipidemia in OSA patients with resistant arterial hypertension (RAH) remain poorly understood and underused in practice of the therapist. Objective. The purpose of this publication is to demonstrate a reasonable diagnostic and treatment strategy of drug and drug-free treatment of OSA-patients, using the example of a comorbid patient OSA+RAH. Conclusions. Modern diagnostic algorithms for OSA patients are realistic and workable in everyday medical practice. They allow you to perform a reliable diagnosis of sleep apnea in a hospital or outpatient. Long-term CPAP therapy in patients with OSA+RAH is lifesaving technology with a high compliance and clinical effect. It is necessary to expand the boundaries of the early use of CPAP therapy, especially in OSA patients with comorbid pathology.
Pharmateca. 2019;26(5):138-143
pages 138-143 views

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