SOME FUNCTIONAL FEATURES OF COURSE OF BRONCHIAL ASTHMA COMBINED WITH ESSENTIAL HYPERTENSION

One of the frequent conditions which accompany bronchial asthma is essential hypertension. The authors compared the functional characteristics of patients with isolated asthma and bronchial asthma combined with essential hypertension. As a result the parameters of spirometry in group ofcomorbid disorders are significantly more decreased than in the group of isolated bronchial asthma: FEV1 [% predicted) before the testwith bronchodilator84,3 ± 1,28 and 85,7 ±2,63 (p < 0,05); the percent of increase in FEV1 after bronchodilator testis 6,5 ± 0,8 and 7,45 ± 0,3 (p < 0,05); fraction of exhaled nitric oxide (ppb) is 24,6 ± 1,15 and 27,6 ± 1,8. Exhaled NO level is higher in patients with bronchial asthma and arterial hypertension and in patients with atopy

INTRAVITAL AND POST-MORTEM DIAGNOSIS OF MYOCARDIAL INFARCTION: URGENT CARDIOLOGY DEPARTMENT LETHAL CASES ANALYSIS

To estimate an accuracy of methods of myocardial infarction diagnostics (ECC, echocardiography, biomarkers) 41 case history reports of patients with Q(+) and Q(-) myocardial infarction and lethal outcome were analyzed. ECG and echocardiography were proved to be most accurate in case of anterior (67 % and 67 %), lateral (71 % and 67 %) and inferior (46 % and 79%) localizations of myocardial infarction. Interventricular septum and posterior localizations were not detected on ECG (0%). Complete coincidence of ECG and echocardiography with autopsy results was detected only in 4 %. CPC and CPC-МВ levels were elevated in 97%, troponins were positive in 70 %. Risk factors of lethal outcome in case of myocardial infarction include sex (male), comorbid pathology (arterial hypertension, cerebrovascular disease, diabetes mellitus type 2), complications (rhythm disorders, cardiogenic shock, congestive heart failure), absence of thrombolytic therapy and its inefficacy. Myocardial infarction hypo- and hyperdiagnosis were detected

Clinical and immunological characteristics of chronic obstructive pulmonary disease with frequent exacerbations associated with obliterating atherosclerosis of lower limb arteries

Chronic obstructive pulmonary disease (COPD) is often associated with atherosclerotic cardiovascular disease (ASCVD), of which obliterating atherosclerosis of lower limb arteries or peripheral arterial disease (PAD) is an important component. The aim of the study was to evaluate the clinical, functional and immunological characteristics of COPD with the phenotype of frequent exacerbations in combination with PAD. Materials and methods. Four groups of COPD patients were included: 20 COPD patients with infrequent exacerbations without ASCVD, 20 COPD patients with frequent exacerbations without ASCVD, 20 patients with frequent exacerbations and PAD, and 20 COPD patients with a phenotype of frequent exacerbations and PAD. Data from 20 healthy controls were analysed for comparison. Clinical and spirometric data were evaluated. General clinical laboratory data and immunological markers (interleukin 1 beta (IL1b) and tumor necrosis factor (TNF) in exhaled breath condensate (EBC) and serum were analysed. Results. Higher levels of IL1b and TNF in EBC and serum were found in patients with COPD and PAD compared to COPD patients without ASCVD (p&lt;0.05) and healthy controls (p&lt;0.001). The high prevalence of COPD exacerbates the clinical and immunological characteristics of disease severity both without ASCVD and with concomitant PAD. Conclusions. COPD with the phenotype of frequent exacerbations and PAD is characterized by greater severity of local and systemic inflammation, which corresponds to increased inflammatory markers in EBC and serum

Cardiac arrhythmias in patients with bronchial asthma

Introduction. According to modern data, bronchial asthma (BA) is an independent risk factor for the development of cardiac arrhythmias (CA), and the use of long-acting β2-agonists (LABA) in basic therapy may further increase the risks of CA.Aim. To study the structure and risk factors of cardiac arrhythmias in patients with bronchial asthma. Materials and methods. A retrospective study included 181 patients aged 69.4 ± 0.8 years, hospitalized for asthma, with the presence a CA in medical documentation.Results. Among BA patients with CA, supraventricular CA were found in 71.3% (129) patients, ventricular CA in 16.6% (30), combined CA in 12.2% (22). In 52.5% (95) patients, supraventricular extrasystole was detected, in 35.9% (65) – atrial fibrillation, in 28.7% (52) – ventricular extrasystole, in 1.1% (2) – paroxysmal supraventricular tachycardia, in 0.6% (1) – paroxysmal ventricular tachycardia. It was found that supraventricular CA was significantly more frequent among women (χ2 = 5.974, p = 0.05). The severity of BA and the level of control are not related to the type of observed CA (χ2 = 0.755, p = 0.685 and χ2 = 3.003, p = 0.557, respectively).Discussion. The use of a combination of ICS and LABA in basic BA therapy versus the use of ICS alone does not have a significant effect on the frequency and structure of cardiac arrhythmias (χ2 = 1.172, p = 0.556).Conclusion. In hospitalized BA patients, supraventricular cardiac arrhythmias are most often detected, among which supraventricular extrasystole and atrial fibrillation take the main place

Сложности дифференциальной диагностики дисфункции вокальных хорд и бронхиальной астмы

Aim. Differential diagnosis of vocal cord dysfunction (VCD) and asthma.Methods. 105 patients with partially controlled asthma were examined. We used specific examinations for VCD: psychological scales , questionnaires for monitoring symptoms of VCD, transnasal fiberoptic laryngoscopy, conventional and electronic lung auscultation with the analysis of the amplitude-frequency characteristics (AFC) of wheezing in the chest and in the region of the larynx on the left and right. Spirometry was performed using Vitalograph ALPHA spirometer (England). The patients were divided into three groups: group 1 included patients with asthma; group 2 included patients with asthma and VCD (asthma-plus syndrome); group 3 included patients with VCD.Results. Conventional auscultation revealed wheezing over the lungs with a decrease in its intensity on the neck surface in group 1. In groups 2 and 3, the maximal wheezing was observed on the anterior surface of the neck and less intense wheezing was heard over the lungs. Electronic auscultation found mid-tonal wheezing over the lungs and over the larynx in group 1; high-pitched wheezing over the larynx and mid-tonal wheezing over the lungs in groups 2 and 3. Score of dyspnea according to the Borg scale was highest in the asthma-plus group – 4,8 (5,2 – 6,5) points, and lowest in the 1st group – 4,2 (3,7 – 4,9) points. The sensation of wheezing is maximal in VCD – 7,1 (6,5 – 7,9) points. The scores of symptoms of VCD were strongly correlated with the intensity of wheezing, dyspnea, and AFC of wheezing. Spirometry was close to normal in the group of patients with VCD; obstructive disorders were noted in groups 1 and 2. Transnasal laryngoscopy demonstrated paradoxical movement of the vocal cords during inspiration in groups 2 and 3. The triggers of episodes of VCD in the subjects were numerous; vocal loads predominated. Specific treatment of VCD in groups 2 and 3 improved the respiratory performance significantly.Conclusion. The primary diagnosis of asthma cannot be made without an examination for VCD. Psychological questionnaires and VCD questionnaires should be used. It is important to use electronic auscultation over the larynx for diagnosis. Correction of treatment in accordance with VCD in patients with asthma can significantly reduce the doses of inhaled and oral corticosteroids.Целью исследования явилась дифференциальная диагностика дисфункции вокальных хорд (ДВХ) и бронхиальной астмы (БА).Материалы и методы. Обследованы пациенты (n = 105) с частично контролируемой БА, у которых применялись специфические методы обследования на ДВХ – психологические опросники и анкеты мониторинга симптомов при ДВХ, трансназальная оптическая ларингоскопия, традиционная и электронная аускультация легких с анализом амплитудно-частотных характеристик (АЧХ) хрипов на грудной клетке и в области гортани слева и справа. Проводилась спирометрия при помощи спирометра Vitalograph ALPHA (Англия). Пациенты были разделены на 3 группы: 1-я – пациенты с БА; 2-я – больные БА с ДВХ (синдром «астма плюс»); 3-я – лица с ДВХ.Результаты. При традиционной аускультации у больных 1-й группы выслушивались хрипы над легкими с уменьшением их интенсивности на поверхности шеи; максимум выслушивания хрипов у пациентов 2-й и 3-й групп – передняя поверхность шеи с уменьшением их интенсивности над легкими. При электронной аускультации у больных 1-й группы выслушивались среднетональные хрипы над легкими и гортанью, 2-й и 3-й групп – высокотональные хрипы – над гортанью и среднетональные – над легкими. Наибольшая выраженность одышки по шкале Борга – 4,8 (5,2–6,5) балла отмечена у пациентов группы «астма плюс», наименьшая – 4,2 (3,7–4,9) балла – у пациентов 1-й группы; максимальное ощущение свистящего дыхания при ДВХ – 7,1 (6,5–7,9) балла. Выявлена прямая сильная корреляционная зависимость показателей опросников симптомов ДВХ и степени интенсивности хрипов, одышки и АЧХ хрипов. Близкие к нормальным показатели спирометрии отмечены при ДВХ. Обструктивные нарушения выявлены у пациентов 1-й и 2-й групп. При трансназальной ларингоскопии у больных 2-й и 3-й групп продемонстрировано парадоксальное движение голосовых связок во время вдоха. Триггеры эпизодов ДВХ у обследуемых многочисленны, преобладали голосовые нагрузки. При специфическом лечении ДВХ у больных 2-й и 3-й групп заметно улучшились респираторные показатели.Заключение. Продемонстрировано, что для установления первичного диагноза БА необходимо обследование на наличие ДВХ. Актуально использование психологических опросников и анкет по диагностике ДВХ. Отмечено, что в процессе диагностики важно применять электронную аускультацию над гортанью, а коррекция лечения с учетом наличия ДВХ у пациентов с БА позволяет значительно снизить дозы ингаляционных и пероральных глюкокортикостероидов