Withdrawal of inhaled corticosteroids in COPD patients: rationale and algorithms

COPD; Treatment algorithm; Guideline adherenceEPOC; Algoritmo de tratamiento; Adherencia a la guía clínicaMPOC; Algoritme de tractament; Adherència a la guia clínicaObservational studies indicate that overutilization of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD). Overprescription and the high risk of serious ICS-related adverse events make withdrawal of this treatment necessary in patients for whom the treatment-related risks outweigh the expected benefits. Elaboration of an optimal, universal, user-friendly algorithm for withdrawal of ICS therapy has been identified as an important clinical need. This article reviews the available evidence on the efficacy, risks, and indications of ICS in COPD, as well as the benefits of ICS treatment withdrawal in patients for whom its use is not recommended by current guidelines. After discussing proposed approaches to ICS withdrawal published by professional associations and individual authors, we present a new algorithm developed by consensus of an international group of experts in the field of COPD. This relatively simple algorithm is based on consideration and integrated assessment of the most relevant factors (markers) influencing decision-making, such a history of exacerbations, peripheral blood eosinophil count, presence of infection, and risk of community-acquired pneumonia

Current opportunities of inhaled corticosteroid therapy in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is the leading cause of death in the structure of respiratory diseases. The problem of rational pharmacotherapy of COPD have attracted attention of the medical scientific society for many years. The understanding of the pathogenesis of the disease has deepened and approaches to the therapy have changed. Some COPD patients need regular fixed-combination therapy: long-acting bronchodilators (LABD) and inhaled corticosteroids (ICS) in order to prevent exacerbations and reduce the severity of symptoms of the disease. Blood eosinophils count is one of criteria for choosing regular therapy. The appearance of fixed triple combinations of ICS/LABD increased the effectiveness of COPD therapy, and a new delivery device for fixed combination of budesonide/formoterol makes it possible to use ICS successfully in the most severe patients.Хроническая обструктивная болезнь легких (ХОБЛ) является лидирующей причиной смерти в структуре болезней органов дыхания. Проблема рациональной фармакотерапии ХОБЛ привлекает к себе внимание медицинской научной общественности в течение многих лет. С течением времени понимание патогенеза болезни меняется, корректируются и подходы к терапии. С целью профилактики обострений и снижения выраженности симптомов заболевания некоторые пациенты с ХОБЛ нуждаются в регулярной комбинированной терапии длительно действующими бронходилататорами (ДДБД) и ингаляционными глюкокортикостероидами (иГКС). При выборе регулярной терапии одним из критериев является уровень эозинофилов в периферической крови. С появлением фиксированных тройных комбинаций иГКС / ДДБД повышается эффективность лекарственной терапии у больных ХОБЛ, а новая ингаляционная форма доставки фиксированной комбинации будесонид / формотерол позволяет успешно применять иГКС у пациентов с наиболее тяжелой формой заболевания

Беродуал в лечении бронхообструктивного синдрома: классика и современность

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Comparative analysis of tissue reactions during implantation of endoprostheses made of polytetrafluoroethylene in the anterior abdominal wall

The objective of this research was a comparative study of the reaction of the tissues of the anterior abdominal wall to the PTFE-endoprosthesis with a DLC-coating at long-term experimental stage

PATHOGENIC POTENTIAL AND MUTUAL INTERACTION OF MICROFLORA OF MUCOUS MEMBRANES OF OPEN CAVITIES OF DIFFERENT BIOTOPES IN WOMEN AS IMPORTANT FACTORS OF THEIR REPRODUCTIVE HEALTH

Micro-ecological interrelation between intestinal, vaginal and nasopharyngeal biocoenoses as parts of microbiome of a macroorganism was determined by the latest researches. The research included 44 women with inflammatory diseases of genital tract and reproductive disorders and 28 healthy women. Genospecies structure of enterococcus for each biotope (intestinal, vaginal and nasopharyngeal) had original differences with the most full spectrum of species in intestinal biotope. The contract between the groups is evident at the conclusion of the pathogenicity genes tests

Strategies for Abatement of Contamination of Tableted Live Plague Vaccine at Different Stages of Manufacturing

Nowadays, problem of tableted drug form contamination with extraneous micro-flora is in the spotlight of scientists, as the specific share of these medical preparations in the world market amounts to more than 60 % and has a tendency to increase. Thus, objective of the study is to investigate the degree of contamination of the basic and auxiliary raw materials at different stages of live plague vaccine manufacturing, rapid dissolving tablets, and the ways to reduce it. Materials and methods. Utilized has been lyophilized Y. pestis live culture of the vaccine strain EV NIIEG, and the live plague vaccine, rapid dissolving tablets. Carried out has been assessment of “microbiological purity” at different stages of tableted live plague vaccine manufacturing: grinding, mixing, granulation, sublimation, and palletizing. Results and conclusions. Identified is the dynamic pattern of quantitative micro-flora composition of the mentioned above drug. Established is the alteration of microbial impurity at separate technological manufacturing steps. Specified is the technological stage with the most expressed contamination. Analysis of factors, which affect vaccine impurity, has revealed that finished dosage-form quality improvement is impossible without incoming control of stock and auxiliary materials, as well as enhancement of manufacturing procedure up to the level, complying with applicable pharmaceutical production standards. It is experimentally proved that series of tableted live plague vaccine, obtained using modernized technological equipment, provide for 3-fold reduction of contamination

Актуальные вопросы дифференциальной диагностики острого кашля у детей и взрослых

Cough is one of the most common causes of seeking the primary medical care, especially during the autumn and the spring. This article is a review of literature  aimed at differential diagnosis of possible causes of acute cough in children and  adults. Given a vast majority of diseases associated with cough, differential diagnosis  have to consider several issues. The key issue is cough duration and possible  anatomical location of the pathological changes. An algorithm of differential diagnosis  of acute cough in children and adults and description of most common diseases  associated with acute cough are given in the review. Further diagnostic work-up  should be driven by the duration of cough as soon as the acute cough could be first  manifestation of a chronic disease.Одной из самых частых причин обращения к врачу первичного звена, особенно в осенне-зимний период, является кашель. В свою очередь спектр возможных причин кашля достаточно широк, и для точной диагностики следует использовать ряд принципов, знание которых  облегчит проведение дифференциального диагноза. За основу взят принцип разделения  кашля по длительности проявления и предполагаемой анатомической локализации  патологического процесса. В данном обзоре представлены методика дифференциальной диагностики острого кашля (ОК) у детей и взрослых и разбор частных  патологий, сопровождающихся ОК, с которыми приходится сталкиваться врачу-интернисту.  Установлено, что дальнейший диагностический поиск будет определяться в первую очередь  продолжительностью кашля, т. к. существует вероятность, что ОК является дебютом хронического заболевания

Влияние контроля над бронхиальной астмой на кардиоваскулярные нарушения у детей раннего школьного возраста

The course of bronchial asthma (BA) is accompanied by pathological changes in the bronchopulmonary and cardiovascular systems. The severity of heart functional disorders depends on the severity of the BA Course, the level of control and the frequency of application of short-acting β2 -agonists (SAβ2A). The aim of the study was to analyze the impact of BA control on the development of cardiovascular disorders in children of early school age. Methods. Children (n = 95) aged 7–12 years with BA of varying severity and different levels of control were examined. The analysis of indicators of the clinical and functional state of the vegetal nervous system (VNS) and cardiovascular system tone using standard electrocardiography, echocardiography with calculation of the left ventricular myocardial mass index, сardiointervalography was performed. Results. Changes in VNS with signs of its depletion and decrease in adaptive capacity, cardiac rhythm and conduction disorders, connective tissue dysplasia syndrome, hemodynamic disorders and signs of adaptive heart remodeling have been detected. Conclusion. Lack of control over BA and the use of SAβ2A promote cardiovascular disorders.Течение бронхиальной астмы (БА) сопровождается патологическими изменениями бронхолегочной и сердечно-сосудистой систем (ССС). Степень выраженности нарушений со стороны сердца функционального характера зависят от тяжести течения БА, уровня контроля, кратности применения короткодействующих β2 -агонистов (КДБА). Целью исследования явился анализ влияния контроля над БА на развитие кардиоваскулярных нарушений у детей раннего школьного возраста. Материалы и методы. Обследованы дети (n = 95) в возрасте 7–12 лет с БА различной степени тяжести и уровнем контроля. Проведен анализ показателей клинико-функционального состояния тонуса вегетативной нервной (ВНС) и ССС с использованием стандартной электрокардиографии, эхокардиографии с вычислением индекса массы миокарда левого желудочка, кардиоинтервалографии. Результаты. Выявлены изменения ВНС с признаками ее истощения и снижения адаптивных возможностей, нарушения сердечного ритма и проводимости, синдром соединительнотканной дисплазии сердца, нарушения гемодинамики и признаки адаптивного ремоделирования сердца. Заключение. Отсутствие контроля над БА и использование КДБА способствует развитию кардиоваскулярных нарушений

Development of a technology for the preparation of a dry nutrient medium for anthrax vaccine production

Currently, submerged cultivation of the Bacillus anthracis STI-1 strain for live anthrax vaccine production requires liquid nutrient media, which have disadvantages of a short shelf life (no more than one month) and a narrow range of storage temperatures (2–8 °С). Dry media, in contrast, have a number of indisputable advantages: such media are transportable and easy to use, have a standard capability to retain properties, and can be stored without preservatives at 2–30 °С for 2–5 years. The aim of this work was to develop a technology for the preparation of a dry nutrient medium for anthrax vaccine production. Materials and methods: The study used the Bacillus anthracis STI-1 vaccine strain and a nutrient medium for its cultivation, containing a 70:30 mixture of an enzymatic digest of casein and a pre-processed corn extract solution. Drying of the nutrient medium was carried out on a spray-drying unit. The authors evaluated physicochemical parameters of experimental medium batches. The shelf life was determined by an accelerated stability study. The dry nutrient medium was used to produce a live anthrax vaccine. Quality attributes of the vaccine were assessed for compliance with regulatory requirements. Results: The authors developed the dry media production technology. According to it, the liquid nutrient medium is fed to the drying unit at a rate of 20–25 dm3/h. The spray air pressure is 0.02 MPa. Temperatures at the drying chamber inlet and outlet are 118–122 °С and 85–90 °С, respectively. The technology was used to obtain 3 experimental batches of the dry medium. The study results demonstrate that the technology is reproducible, and the tested quality attributes of experimental medium batches are consistent with the requirements. According to the accelerated stability study, the shelf life of the dry nutrient medium at 2–30 °С is at least 3 years. Experiments demonstrated the possibility of using the dry nutrient medium for live anthrax vaccine production. Critical quality attributes of the vaccine obtained with the medium met regulatory requirements. Conclusions: The developed technology allows for the production of a standard dry nutrient medium with a prolonged shelf life, which is convenient for live anthrax vaccine production