Хроническая обструктивная болезнь легких и COVID-19: актуальные вопросы

The problem of comorbidity of new coronaviral infection (COVID-19) and chronic obstructive pulmonary disease (COPD) is acute, considering similarity of clinical manifestations, diagnostic difficulties, the potential severe disease course. Patients with COPD represent a vulnerable group of infected SARS-CoV-2, with a complicated disease course and frequent adverse outcome. Features of the spread of the virus limit treatment and diagnosis for patients with COPD, making it difficult to provide medical care during the pandemic. The negative results of some clinical studies of antiviral drugs for patients with COVID-19 indicate the need for a search for new drugs; for this reason, analysis of the anti-inflammatory effect on the lungs in infection COVID-19 of drugs of basic COPD therapy is promising.Актуальность проблемы коморбидности новой коронавирусной инфекции COVID-19 и хронической обструктивной болезни легких (ХОБЛ) обусловлена схожестью клинических проявлений, сложностью диагностики, потенциальной тяжестью течения и взаимоотягощением этих патологий. Больные ХОБЛ, инфицированные SARS-CoV-2, представляют собой уязвимую группу лиц с осложненным течением и часто неблагоприятным исходом болезни. Особенности распространения вируса накладывают значительные ограничения на многочисленные диагностические и лечебные мероприятия при ХОБЛ, затрудняя оказание медицинской помощи больным данной категории в период пандемии на всех ее этапах. Необходимость поиска новых терапевтических решений продиктована отрицательными результатами текущих клинических исследований по изучению эффективности применения ряда препаратов у больных COVID-19; перспективным представляется изучение действия на SARS-CoV-2 препаратов базовой терапии ХОБЛ с доказанным противовоспалительным действием на бронхолегочную систему

Оказание экстренной медицинской помощи на догоспитальном этапе пациентам с острым инфарктом миокарда и острым ишемическим инсультом в городе Москве: роль авиамедицинских бригад центра экстренной медицинской помощи (Территориальный центр медицины катастроф)

The increase in the number of patients with complications of cardiovascular diseases and the need for early diagnosis of such complications and the early initiation of treatment already at the prehospital stage leads to an increasing  need for more frequent use of helicopter medical equipment, as well as for equipping aviation medical teams with highly qualified specialists. The  formation of a network of vascular invasive centers in the Moscow region,  modern equipment and its use in air ambulance conditions require constant improvement of skills among medical workers. All this undoubtedly leads to positive results, the mortality rate from heart attacks and strokes decreases, the duration of treatment and the period of rehabilitation of patients are  reduced. It should be noted that even 10 years ago, medical helicopters were used in the elimination of medical consequences in road accidents, fires and emergencies. Today, aviation medical teams are involved in more than 50% of cases with cardiovascular diseases, which undoubtedly speaks of the  prospects for the development of medical aviation in large cities. Рост числа пациентов с сердечно-сосудистыми заболеваниями, необходимость быстрой транспортировки  пациентов в стационар с проведением ранней диагностики  и своевременного лечения на догоспитальном этапе обуславливают возрастающую потребность в более частом использовании вертолетной медицинской техники и  наличие специалистов высокой квалификации в составе  авиамедицинских бригад. Формирование сети сосудистых  инвазивных центров в московском регионе, современное оборудование и использование его в условиях санитарной авиации требуют постоянного повышения навыков среди  медицинских работников. Все это приводит к  положительным результатам, так как снижается смертность  от инфарктов и инсультов, сокращаются сроки лечения и реабилитации пациентов. Следует отметить, что еще 10 лет назад медицинские вертолеты использовались при дорожно-транспортных происшествиях, пожарах и чрезвычайных ситуациях. Сегодня авиамедицинские  бригады более чем в 50% случаев задействованы при  эвакуации больных с сердечно-сосудистыми заболеваниями,  что безусловно говорит о перспективе  развития санитарной авиации в крупных городах.

RENAISSANCE OF ARTERIAL HYPERTENSION MONOTHERAPY – THE POSITION OF THIAZIDE DIURETICS

The importance of the optimal choice of antihypertensive treatment strategy is currently widely recognised. The evidence obtained over the last five years justifies the revision of the traditional approach towards the tactics of mono- and combination antihypertensive therapy. It is essential to ensure that the patient-centred tactics of mono- and combination therapy choice is based on the detailed analysis of the clinical status

CORRECTION OF ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH CHRONIC COR PULMONALE BY ANGIOTENSIN II RECEPTORS ANTAGONISTS

Aim. To evaluate intensity of endothelial dysfunction, processes of apoptosis, state of central and peripheral hemodynamics and to evaluate how these characteristics are influenced by angiotensin II receptors antagonists (ARA II) – candesartan (Atacand) and losartan (Cosaar) in patients with chronic cor pulmonale (CCP) at different stages of disease.Material and methods. 100 patients with chronic obstructive pulmonary disease (COPD), complicated by CCP were included into the study. Caspase activity as apoptosis induction marker, von Willebrand factor, production of nitric oxide in blood plasma and condensate of breathing out air were assessed. 70 patients received ARA II (50 patients – candesartan 4-8 mg daily, 20 patients – losartan 50-100 mg daily), 30 patients received neither ARA II nor angiotensin converting enzyme inhibitors (ACEI).Results. Significant increase in intensity of endothelial dysfunction and activation of apoptosis processes were registered according to growth of CCP severity. After 6 months of therapy von Willebrand factor decreased by 25,2% and 27,7% in candesartan and losartan groups respectively (p<0.01 for both groups). In the control group only 13.2% of von Willebrand factor reduction was seen.Conclusion. ARA II added to common therapy of COPD complicated by CCP improves functional state of endothelium restricting hyperproduction of nitric oxide and its toxic effects and slowing down apoptotic cell death

CORRECTION OF ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH CHRONIC COR PULMONALE BY ANGIOTENSIN II RECEPTORS ANTAGONISTS

Aim. To evaluate intensity of endothelial dysfunction, processes of apoptosis, state of central and peripheral hemodynamics and to evaluate how these characteristics are influenced by angiotensin II receptors antagonists (ARA II) – candesartan (Atacand) and losartan (Cosaar) in patients with chronic cor pulmonale (CCP) at different stages of disease.Material and methods. 100 patients with chronic obstructive pulmonary disease (COPD), complicated by CCP were included into the study. Caspase activity as apoptosis induction marker, von Willebrand factor, production of nitric oxide in blood plasma and condensate of breathing out air were assessed. 70 patients received ARA II (50 patients – candesartan 4-8 mg daily, 20 patients – losartan 50-100 mg daily), 30 patients received neither ARA II nor angiotensin converting enzyme inhibitors (ACEI).Results. Significant increase in intensity of endothelial dysfunction and activation of apoptosis processes were registered according to growth of CCP severity. After 6 months of therapy von Willebrand factor decreased by 25,2% and 27,7% in candesartan and losartan groups respectively (p&lt;0.01 for both groups). In the control group only 13.2% of von Willebrand factor reduction was seen.Conclusion. ARA II added to common therapy of COPD complicated by CCP improves functional state of endothelium restricting hyperproduction of nitric oxide and its toxic effects and slowing down apoptotic cell death.</p