Vol 28, No 5 (2021)

The review presents the characteristics of environmental allergens that can initiate the development of hypersensitive pneumonitis (HP). The pathogenesis of HP is considered from the standpoint of immunocomplex and T-cell hypersensitivity resulting in development of interstitial lymphocytic pneumonia with granulomas and coexisting bronchiolitis. There are acute and chronic course of disease; wthin chronic course a fibrotic phenotype is distinguished. The etiological, pathogenetic and clinical features of the disease underlie the diagnostic algorithm: assessment of exposure, characteristic signs of computed tomography of the lungs, lymphocytosis in bronchoalveolar lavage fluid, and, if necessary, pulmonary biopsy. Treatment is aimed at the main pathogenetic links of the HP and includes the elimination of the allergen, anti-inflammatory, immunosuppressive and antifibrotic therapy in the case of fibrotic variant.

The article discusses the problem of bronchodilator therapy for chronic obstructive pulmonary disease (COPD). The choice of bronchodilators as a priority in the treatment of patients with COPD is justified by their numerous sanogenetic effects, achieved mainly by a direct stimulating effect on β2-adrenergic receptors and indirectly by blocking the effect of acetylcholine on muscarinic cholinergic receptors (cholinergic blockers or anticholinergic drugs).

Background. The problem of the features of the course of allergic diseases against the background of the COVID-19 pandemic, as well as rational and safe approaches to their treatment, are in the focus of close attention of specialists. The article presents the results of the use of sublingual allergen-specific immunotherapy (SLIT) in the context of a coronavirus infection pandemic in patients with bronchial asthma (BA). Objective. Assessment of the clinical and immunological efficacy and safety of SLIT in the treatment of BA against the background of the COVID-19 pandemic. Methods. From 2017 to 2021, a retrospective study of the efficacy and safety of SLIT in comparison with the standard baseline therapy for patients with allergic BA caused by sensitization to the house dust mite was performed. The study included 72 patients with allergic BA, 42 of them received SLIT with Staloral “Tick Allergen" against the background of baseline anti-inflammatory therapy, 30 - only standard baseline anti-inflammatory therapy. Control of asthma symptoms and severity, demand for baseline therapy, the ACT test results, functional test data, allergic-immunological parameters (total IgE, asIgE to D. farinae and D. pteronyssinus allergens, diameter of scarification samples with etiotropic allergens) were assessed in over time. With the onset of the COVID-19 pandemic, namely from 2019 to 2021, the risk of COVID-19 infection was additionally assessed in all patients with BA. In the spring of 2019, patients were followed-up using telemedicine technologies. In the case of coronavirus infection, its severity and outcomes, as well as the effect on the course of BA, were evaluated. Parameters are presented as mean, median (Me) and quartiles [Р25%; P75%]. The results were considered statistically significant at p<0.05. Wilcoxon-test was used for the comparison of groups. Results. At the end of the three-year course of treatment, the clinical efficacy of SLIT with Staloral “Tick Allergen", taking into account the excellent and good results, was 92.8%. After 3 years, SLIT showed a statistically significant (p<0.05) decrease in the frequency of BA symptoms and exacerbations, and improvement of disease control. There was a decrease in the average dose of inhaled glucocortico-steroids by 1.7 times compared with the initial values (p<0.05). The frequency of exacerbations in patients of the first group decreased by 2.1 times, while in patients of the second group - by 1.1 times. In patients receiving SLIT, the BA control increased: the total ACT score decreased against the background of SLIT with Staloral “Tick Allergen" from 1.93 to 1.12 points, in patients of the second group this indicator was 2.1 (p<0.05). As a result of SLIT in BA patients, the total IgE level decreased by 1.8 times, asIgE to the house dust mite D. pteronyssinus - by 3.1 (from 4.21 to 1.37 kU/L), to the D. farinae mite - by 2 (from 5.90 to 2.89 kU/L), the diameter of skin tests - by 1.9 times (from 8.17 to 4.19; p<0.05). Mild local reactions to SLIT were recorded in 19.0% of cases. Since the start of the COVID-19 pandemic, SLIT has been temporarily withheld in 10 patients due to coronavirus infection. All infected patients had a mild clinical course of disease. No hospitalization and no BA exacerbation against the background of a viral infection was recorded. IgG antibodies were detected in 11 patients of both groups before the planned administration of the Sputnik-V vaccine, which indicated that they had an asymptomatic course of the disease. Thus, the results of this study demonstrate the need to use SLIT to optimize the treatment of allergic BA, and also indicate the safety and feasibility of this method in the context of the COVID-19 pandemic. Conclusion. SLIT is a safe, highly effective method of BA immunotherapy, which is possible despite the COVID-19 pandemic. BA patients receiving SLIT as part of baseline therapy are not at risk of developing severe COVID-19, which is associated with good BA control as a result of combined treatment.

Background. Coronavirus infection 2019 (COVID-19) is common worldwide. The significance of bronchial asthma (BA) for the course of COVID-19 is ambiguous. Objective. Retrospectively analysis of the course of COVID-19 infection in BA patients. Methods. The case histories of 1167 patients diagnosed with COVID-19, among them 82 (7.02%) patients suffered from BA, were analyzed. Results. Among BA patients who underwent COVID-19 infection, there were 11 (13.4%) men and 71 (86.6%) women. Among BA patients, diabetes mellitus was found in 5 (6.09%), arterial hypertension - in 70 (85.4%), coronary artery disease - in 8 (9.75%) patients. 5 BA patients died. There were 7 smoking BA patients. Conclusion. The analysis showed that the prevalence of BA was 7.02% of the total number of COVID-19 infections. Low mortality was revealed in BA patients infected with COVID-19.

Background. Continuous Positive Airway Pressure (CPAP) therapy is a fundamental therapeutic doctrine for patients with obstructive sleep apnea (OSA). The effects of long-term CPAP therapy significantly depend on comorbid conditions and are poorly predictable and understood, especially in the case of mild OSA patients. Objective: to study the effect of 12-month CPAP therapy on the metabolic profile mild OSA patients. Methods. In a one-year cohort study we included 102 patients (100 men [98%]), with a median age of 44 years (40,3-50,0), who had a verified mild OSA (apnea-hypopnea index (AHI) from 5/h up to 15/h) and metabolic disorders, who signed an informed consent to participate. All patients with OSA were on selected antihypertensive and lipid-lowering therapy. The nature and severity of sleep apnea was verified by performing computer somnography (CSG) on the WatchPAT-200 hardware complex (ItamarMedical, Israel) with the original software PATTMSW ver. 7.1.77.7 (ItamarMedical, Israel) by registering the main respiratory polygraphic characteristics in the period 11:00 PM - 7:30 AM. The patient’s metabolic status was compiled according to the results of the assessment of lipid, carbohydrate, hormonal profiles based on standardized laboratory data on 0 - 3 - 6 - 12 months of observation. All patients underwent targeted ambulatory CPAP therapy to achieve optimal correction of sleep apnea with AHI <5/h. Results. The effects of long-term CPAP therapy occurring at 12 months are associated with a decrease in ESS, with a decrease in visceral adiposity index, with a decrease in insulin resistance, a decrease in the level of LDL, a decrease in the Apo-B index, as well as an increase in testosterone levels with a decrease in leptin levels. Conclusions. The positive effects of CPAP therapy on the “metabolic profile" of patients with mild OSA are associated with the elimination of sleep fragmentation and nocturnal hypoxemia when performed for more than 12 months.

Background. Subantral plasty is widely known as a reliable way to compensate for the lack of bone tissue in severe atrophy of the alveolar process of maxilla. The main cause of odontogenic maxillary sinusitis after subantral plasty is considered to be insufficient work of the natural anastomosis of the maxillary sinus. Objective. Improvement of the effectiveness of prevention and treatment of odontogenic maxillary sinusitis during subantral plasty. Methods. The study included 113 patients undergoing treatment with a dentist for maxillary adentia (61 men and 52 women). The patients’ age ranged from 28 to 67years (mean age 43.5±3.2 years). The patients were divided into three groups. Results. In this study, we evaluated the results of computed tomography (CT) of the paranasal sinuses of patients who underwent and were planning for reconstructive surgeries on the alveolar process of maxilla. Comparing the results of CT scan of the paranasal sinuses and endoscopic examination of the nasal cavity of patients included in the study, it can be concluded that the most likely cause of odontogenic maxillary sinusitis after subantral plasty of patients was severe disturbances in the anatomical structure of the nasal cavity. Conclusion. A detailed patient’s medical history and assessment of the ostiomeatal complex using endoscopic examination of the nasal cavity are crucial for reducing postoperative rhinological complications after subantral plasty. It is necessary to assess the condition of the paranasal sinuses in patients who are planning for dental treatment for maxillary adentia.

Background. Bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) are heterogeneous diseases with different underlying pathogenetic mechanisms due to different types of respiratory tract inflammation, and therefore, different responses to therapy. The evaluation of the types of respiratory tract inflammation, the isolation of markers of eosinophilic and neutrophilic inflammation will provide a differentiated approach to the diagnosis and treatment of these pathologies. Objective. Determination of the markers of types of respiratory tract inflammation in patients with non-allergic bronchial asthma (NABA) and COPD. Methods. 99 patients were examined. They were divided into 2 groups: group 1 (n=49) - patients with NABA, group 2 (n=50) - patients with COPD. The cellular composition of induced sputum (IS) and blood, blood eosinophilic cationic protein (ECP), and neutrophil elas-tase (NE) levels were determined. Parameters are presented as median (Me) and quartiles (Q25; Q75%). Multivariate analysis to identify significant factors and ROC analysis were used. The results were considered statistically significant at p value <0.05. Results. A significantly high neutrophil level in IS was determined in patients with NABA (73%) and COPD (78%) in comparison with healthy individuals (p<0.05). A high eosinophil level in IS (more than 3%) was detected only in 12 (24.48%) patients with NABA and in 5 (10%) patients with COPD. A significantly increased blood neutrophil level, both in percentage and in absolute count, was revealed in patients with NABA (67% and 5.30*109/L, respectively) and with COPD (72% and 7.30*10>/L, respectively) compared with the control group (p<0.05). A high blood eosinophil level the (more than 3%) was observed in 10 (20.40%) patients with NABA and in 8 (16%) patients with COPD. High ECP values were found in 14 (28.57%) patients with NABA and in 6 (12%) patients with COPD. A high level of NE was found in 34 (69.38%) patients with NABA and in 41 (82%) patients with COPD. Significantly high NE level was observed in patients with NABA (150 ng/ml) and COPD (175 ng/ml) compared with the control group (80 ng/ml) (p<0.05). Threshold value for ECP was 19.92 ng/ml and higher, for eosinophils in IS - 3.50% and higher, for NE - 135 ng/ml and higher, for the absolute neutrophil count - 5.38x109/L and higher. Conclusion. Markers of eosinophilic inflammation in patients with NABA and COPD were ECP and eosinophils in IS, markers of neutrophilic inflammation in patients with NABA and COPD - NE and the absolute neutrophil count.

The syndrome of increased epithelial permeability (SIEP) of the mucous membrane of the gastrointestinal tract is one of the most studied pathogenetic syndromes in the 21st century. In February 2021, the first multidisciplinary Consensus was published on this topical issue, which comprehensively analyzed the pathophysiological, clinical and pharmacotherapeutic aspects of this syndrome as one of the basic mechanisms of the development of human pathology. To date, of the drugs proven to act on intestinal permeability, only rebamipide is available. In the framework of the presented review, the possible role of SIEP permeability in the development of respiratory diseases and diseases of the cardiovascular system has been demonstrated, which suggests the formation of new therapeutic strategies that reduce damage to tight junctions (TJ) during inflammation and/or support the restoration of TJ, which will improve clinical prognosis for diseases of the respiratory and cardiovascular systems. At the same time, the use of rebamipide not only protects the mucous membranes from the damaging effects of various agents, but also promotes the restoration of epithelial cells and the healing of the resulting damage, and this effect can be claimed and useful for protecting the mucous membranes of the respiratory tract and gastrointestinal tract from the penetration of the virus into the pandemic of COVID-19. In cardiological practice, the issues of drug safety are directly related to SIEP when taking antiplatelet and anticoagulants agents.