The use of noninvasive ventilation (NIV) of lungs during the last two decades significantly improved the results of management of severe COPD patients with acute or chronic respiratory failure during both periods of exacerbation and stability. At present, NIV is considered to be the first-line therapy for acute exacerbation of COPD with hypercapnia and respiratory acidosis. This method of airway support turned out to be effective in patients after extubation both for the relief of excommunication from a respirator and for prophylaxis and treatment of postextubation respiratory failure. NIV was proven to be successful in patients with a combination of COPD and obstructive sleep apnea (overlap syndrome), in COPD with pneumonia and in postoperative COPD patients who have undergone lung resectional surgery. The efficacy of NIV under intensive care and intensive therapy unit conditions has stimulated the interest to the use of mask ventilation in hospitals and out-patient departments (for a prolonged domestic therapy). This article presents a review of NIV use in patients with COPD during both periods of exacerbation and stability. 

Bronchial asthma is a chronic inflammatory disease of the airways. Ineffective treatment can significantly reduce the quality and duration of life of the patients. The article presents a review of current research devoted to the study of genetic determinism of the response to the treatment with inhaled corticosteroids, β2 -agonists of short-effect and antagonists of leukotriene receptors in patients with bronchial asthma. The contribution of genetic factors to the variability of therapeutic response in patients in each class of these antiasthmatic drugs is discussed in this article.

Data describing Gly16 allele participation in phenotype formation with poor bronchial asthma course and decreased effectiveness of β2 -agonists therapy and inhaled glucocorticosteroids are also presented. The association of Gly16 genotype gene of β2 -adrenergic receptor with the decreased effect of broncholith therapy of β2 -adrenomimetric receptor of short effect has been determined in this study. It was shown that ALOX5 gene promotor polymorphism is linked with variations of response to antileukotriene drugs. Thus, it can be concluded that multiform gene variants can change the bronchial asthma patients’ response to the conducted therapy and the genetic information can be used to determine the probable prognoses of individuals’ reactions to definite anti-asthmatic remedies. The authors consider the pharmacogenetic test to help to identify the patients that are torpid to the treatment.

Currently one of the factors of allergy predisposition is the increase in barrier permeability of the mucous membranes of the respiratory system and the gastrointestinal tract (GIT). It defines the probability of an emergence of an allergic response. To understand the mechanisms of the interaction of the mucous membranes of different systems that explain their common function is undoubtedly necessary for discussion of this problem. The features of microbiome influence and the changes of the microbiome state during the formation of the immune response to the contact with allergens are of particular interest. The structure of the epithelial barrier of the airwaysand GIT, and mechanisms of allergen transport through barrier systems with the subsequent interaction with the cells (?) associated with barrier fabrics have been considered. The possible role of the barrier function of mucous membranes in conducting sublingual allergen-specific immunotherapy (SLIT) is discussed. 

In the last few decades the content of diagnostic information provided by ultrasound examination of the chest in a wide spectrum of diseases (pneumonia, peripheral tumors, pleural diseases, pneumothorax) has been widely discussed. The advantages of ultrasound examination (the lack of radiation exposure, image in real time, the distinct visualization of pulmonary subpleural portions and costal diaphragmatic sinuses) provide the possibility to use ultrasound in pediatric practice for frequent monitoring of pneumonia dynamics. The use of ultrasound examination in the diagnostic algorithm in adult patients with pneumonia is not widely used in Russian clinical practice.

The article gives the details about the technique of ultrasound examination of the chest, ultrasound anatomy, the impact of the morphological substrate of the pathological formation on the ultrasound picture, and its localization and length. The review of bibliography data about ultrasound semiotics of pneumonia depending on the type of inflammatory infiltrate (hypo and hyperechoic structure of various shapes, length, artifacts, A-line, -line). The necessity of ultrasound use for monitoring pneumonia in order to assess the therapy efficacy has been proven (this is a very strong statement, I would say it “has been supported”.

It is indicated that the possibility of ultrasound examination depending on morphological forms of inflammation has not been disclosed and there are no data about the comparison of ultrasound, X-ray and computed tomography. The recommended frequency of the ultrasound monitoring of different inflammatory lung diseases has not yet been determined (this makes it sound like there are no results).

This article indicates that ultrasound examination can take its important place as an option in the diagnosis in patients with inflammatory lung diseases due to the safety and wide availability of this method in combination with the CDK. 

The nosocomial pneumonia is one of the most (or just “is a”) common hospital infections complicating the disease course and resulting in a fatal outcome. In 2016 the revised version of “Russian national recommendations for Nosocomial pneumonia in adults” was published. The new methods of diagnostics, preventative measures and hospital pneumonia treatment were systematized there. The international association of clinical pharmacologists and pharmacists introduced the new information on the epidemiology of hospital infections as well as their sensitivity to antibacterial therapy, dosage and introduction regime.  The current management guidelines of the patients with nosocomial pneumonia is based on these actual internationally recognized recommendations. It consists of an action algorithm to be used when the nosocomial pneumonia diagnosis is suspected and as tables which provide the tactics of treatment. It also helps to systematize the details of the anamneses, the data of functional and microbiological diagnostics and to develop an optimal scheme of empirical introduction of therapy and its further correction when necessary after receiving the results of microbiological diagnostics. The project is intended for physicians of internal medicine departments, emergency rooms in hospitals, as well as for resident medical practitioners. The quick introduction of management guideline algorithm of the patients with nosocomial pneumonia and the precise indication of the dose regime into clinical practice will allow doctors to decrease the death rate and improve the quality of medical service. 

Background. The importance of psychosocial factors in the management of bronchial asthma (BA) is discussed in clinical guidelines, including in international and national clinical guidelines. However, a specific evaluation of their role as a cause of poor asthma control in susceptible patients is required. Aim. Assessment of psychological health of women with different levels of asthma control.

Materials and methods. The study included 108 women with asthma observed in Saratov center for Allergology who were stratified into 3 groups according to the control level (good, partial, uncontrolled, according to GINA). In establishing a diagnosis of asthma, standard methods were used (medical history, symptoms, spirography). To assess the level of control, ACQ-5 (Asthma Control Questionnaire 5 items-self-administered) was used, to assess the quality of life, questionnaires AQLQ-S (Asthma Quality of Life Questionnaire S); SF-36 (36-ltem MOS Short-Form Health Survey), a standardized and validated Russian version of the women’s health questionnaire WHQ (Women’s Health Questionnaire) were used; for psychological diagnosis and evaluation of social and personal competencies that contribute to the preservation and improvement of human health (the intellectual, personal, emotional, physical, social, creative, spiritual aspects), integrated multimodal questionnaire was used. The comparison was conducted with a control group of men with bronchial asthma, comparable in age and level of control.

Results. Women with poorly controlled asthma had worse performance of AQLQ-S (combined median score of 3,43 instead of 5,13 in the group of good control; p < 0,05); all scales of the SF-36, including the general condition (43,48 against 55,07), role of physical (25,93 against 57,76) and emotional problems (43,83 against 64,37); at p < 0.05. According to the WHQ questionnaire (the inverse relationship: the higher the score, the lower the quality of life) in the group with poor control there is a high level of depression (mean 0,36 versus 0,24; p < 0,05); physical health problems are marked (0,47 against 0,27; p < 0,05). There is a very low selfestimation of their attractiveness in BA (0,71 and 0,64 for bad and good control, respectively). According to the integrated multimodal questionnaire, in both men and women with asthma almost identical results were obtained on the scales sensitive to manifestations of anxiety-depressive symptoms, emotional balance, scales of emotional skills, correlating with severe alexithymia and low capacity for reflection. Among women the proportion of individuals with high scores of intellectual functioning, strong-willed competence, goal-setting, and ability of making contacts was higher.

Conclusion. The severity of asthma and disease control are closely linked with the psychological condition of the patient. Psychological dysfunctions are correlated with suboptimal BA control. It is important to understand psychological differences in women and to educate patients in both effective BA control and in establishing individualized asthma management strategies.There is a need for a multidisciplinary approach aimed at the identification and effective correction of asthma. The study of the psychological characteristics of personality and motivational sphere of the patient can help to optimize therapy, improve monitoring and prognosis of the disease. 

Background. Nowadays little data related to the hemostatic system and fibrinolysis in patients with chronic obstructive pulmonary disease (COPD) are available. This is due to the lack of standardized methods for studying the hemostasis system, as well as to the lack of a single functional test that allows the evaluation of the complete fibrinogenesis cycle in whole blood.

Aim. The aim of our study was to develop a functional test capable of analyzing the blood gas composition in the “point-of-care test” method for the evaluation of the hemostatic potential in patients with COPD, based on a standardized test stimulus, which is tissue hypoxia. The current level of clinical and laboratory diagnostics requires personification and research of the hemo-coagulation system in real time (point-of-care test), which allows low-frequency piezotromboelastography(NVTEG) to be performed.

Materials and methods. NVTEG was chosen to estimate the state of the hemocoagulation system. Ten patients with COPD and 10 healthy volunteers were examined. Hypoxia was selected as a standardized test stimulus. Hypoxia conditions were caused by smoking one standard cigarette (composition: resin 10 mg/cig., nicotine 0,7 mg/cig., CO 10 mg/cig.). The degree of tissue hypoxia was assessed with the GASTAT-navi blood gas analyzer.

Results. The study has shown that in response to the standard test stimulus, which is the tissue hypoxia caused by smoking of a standardized cigarette, two types of haemostatic potential reaction were detected both in patients with COPD and healthy volunteers. The first type of reaction – “hypercoagulation” – is characterized by the formation of chronometric and structural hypercoagulation at all stages of fibrinogenesis and increased coagulation activity by 25–30% compared with the response in healthy individuals. The second type of reaction – “hypocoagulation” – is characterized by the formation of chronometric and structural hypocoagulation, a decrease in coagulation activity by 25–30% compared with the response in healthy individuals.

Conclusion. Test stimulus, which acts as tissue hypoxia, causes a uniform spectrum of changes in the blood gas composition and hemocoagulation system in both healthy volunteers and patients with COPD. The possibility of online assessment of all stages of fibrinogenesis makes it possible to stratify patients with COPD by type of reaction, which is certain to have an important diagnostic and prognostic value and in the future will allow a more personified approach for choosing the treatment tactics. 

Background. The synthetic opioid analgesic fentanyl is widely used for prophylaxis and therapy of traumatic shock associated with massive bleeding. Its side effects – skeletal muscle rigidity and respiratory center depression – are especially pronounced with repeated administration. It is rational to apply fentanyl in diminished doses in combination with non-opioid analgesics in order to reduce respiratory disturbances risk.

Aim. The aim of the work is to justify the influence of opioid analgesic fentanyl and α2 -adrenomimetic dexmedetomidine combination on external respiratory functions in acute hemorrhage model.

Materials and methods. Acute loss of 35–40% of circulating blood volume was modeled in experiments on 75 white mongrel male rats. The external respiratory functions (respiratory rate, respiratory volume, breath volume per minute) were estimated in animals of 5 groups: 1 – rats without analgesic help (controls); 2–3 – rats receiving a single fentanyl intramuscular injection (ED99 98,96 mcg/kg) or fentanyl together with dexme detomidine (ED99 of combination 67,94 mcg/kg) 15 min after acute blood loss; 4–5 – rats receiving the same drugs 15 min, 30, 45 and 60 min later.

Results. In experimental acute loss of 35–40% of circulating blood volume, 15 min later a secondary acute respiratory failure developed with a drop of respiratory rate, respiratory volume and volume of breath per minute by 30%, 21 and 47% (p < 0,05). The external respiratory functions recoverеd after 4 h mainly due to the increase of respiratory volume. A single intramuscular injection of fentanyl caused respiratory depression 15 min after experimental blood loss which resulted in the decrease of breath volume per minute to 30–61% (p < 0,05) for 90 min. Four intramuscular injections of fentanyl 15 min, 30, 45 and 60 min after hemorrhage caused a severe respiratory dysfunction, accompanied by apnea periods and Biot’s respiration. Respiratory rate was reduced to 45–60%, breath volume per minute – to 21–44% (p < 0,05). The respiration improved after 24 h. The addition of central α2 -adrenomimetic dexmedetomidine to the analgesic therapy with fentanyl reduced respiratory depression with the decrease of breath volume to 37–62% (p < 0,05) and an earlier, after 4 h recovery.

Conclusion. The repeated injections of fentanyl in diminished dose together with dexmedetomidine in experimental acute hemorrhage caused a pronounced analgesic effect with lower than in fentanyl alone respiratory depression. 

Background. The relevance of work is warranted by the necessity of a personalized approach to the rehabilitation of bronchopulmonary syndrome patients with connective tissue dysplasia (CTD). Aim. To assess the effectiveness of medical rehabilitation in patients with different clinical phenotypes of bronchopulmonary syndrome and CTD on the basis of the analysis of quality of life indicators.

Materials and methods. 174 patients aged 18–40 years were divided into subgroups depending on the predominant clinical respiratory option syndrome. The results of a survey of 75 patients, matched by sex and age, with no signs of CTD were used as controls. Rehabilitation activities were carried out under outpatient conditions three times a week for 12 weeks, 2 times a year. The effectiveness of individual rehabilitation programs for each patient was evaluated after two courses of medical rehabilitation. The SF-36 questionnaire was used to assess the quality of life.

Results. Before the start of rehabilitation programs integral indicators in persons with CTD were significantly lower than in persons without CTD. After carrying out of rehabilitation programs, the most significant increase of mean values was observed for the parameters of the psychological health component: mental health (+40 points), vitality (+23 points), role of emotional functioning (+25 points) and social functioning (+21 points). The parameters of the physical health component increased to a lesser extent, their gains ranged from +7 points for the parameters of the overall perception of health to +19 points for the intensity of pain parameters. The effect on the physical health components was limited by the variety of irreversible structural changes of various organs and systems, suggesting a longer monitoring period. However, during rehabilitation significant positive effects were reported for physical health as well. Different parameters of values of quality of life were identified in patients with different clinical variants of bronchopulmonary syndrome.

Conclusion. A personalized approach that takes into account the clinical variant of the syndrome can significantly increase the reserve for improving the functional capacity and also for psychological and social adaptation of the patient. 

Aim. To analyze the peculiarities and mechanisms of receptor-mediated T-lymphocytes disorders in different clinical forms of pulmonary tuberculosis.

Materials and мethods. The study involved 116 patients with first diagnosed infiltrative and disseminated drug-sensitive and drug-resistant pulmonary tuberculosis. The key stages in receptor-mediated activation of T-lymphocytes, isolated from blood, after their CD3/CD28-induction in vitro with addition of intracellular transport blocker were analyzed. Their immunotyping was carried out with the method of two- and threecolor flow cytofluorometry. The obtained results were statistically analyzed.

Results. The breach of extracellular and intracellular stages of T-lymphocytes activation, shown by reduction in total number of CD3- and CD28-positive cells, and CD3+CD28+IL2+, CD3+CD28+IL2–, CD3+NF-kB+, CD3+NFAT2+ lymphocytes, and increase in number of CD3+CTLA4+ cells, was identified with most of their manifestations in disseminated drug-resistant pulmonary tuberculosis. It was shown that the content of CD3+AP-1+ lymphocytes is variable in drug-resistant pulmonary tuberculosis: it increases in the infiltrative form and decreases in the disseminated form.

Conclusion. The results showed different mechanisms leading to a deficiency of IL-2-positive lymphocytes and T-lymphocytopenia: from “functional reserve” exhaustion of T-cells in drug-sensitive pulmonary tuberculosis to immunosuppression under the influence of suppressive cytokines (in case of the infiltrative form) and inhibitory protein CTLA4 (in case of the disseminated form) in drug-resistant pulmonary tuberculosis. 

Background. According to the World Health Organization, chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in the world. COPD with frequent exacerbations is a most challenging variant of the disease. Currently it is not clear how respiratory microbiota can modify the immune response in this disease.

Aim. To establish the role of bacterial oligonucleotides in modification of the immune response in patients with COPD.

Materials and мethods. In accordance with the protocol of the study, 10 patients with stable COPD with frequent exacerbations and 10 patients without frequent exacerbations were included. Immature dendritic cells were obtained by culturing the monocyte fraction of the peripheral blood of patients with COPD. The cells were stimulated by addition of bacterial lipopolysaccharide and small oligodeoxynucleotides (CpG-ODN) of A or B classes. Then the immunophenotypical profile of the obtained cells was determined by flow-cytometry with the use of monoclonal antibodies to antigens CD40, CD83, CD86. To determine the antigen-presenting properties, these dendritic cells were cultivated with CD4+, and then the phenotypic profile of the obtained T-lymphocytes was evaluated by using antibodies to CD4, CD25, CD127, and CD45RO.

Results. Cultivation of stimulated dendritic cells by СpG-ODN of A class with T-cells in COPD patients without exacerbations leads to an increase of the amount of lymphocytes of CD25+CD45RO phenotype (15% increase after stimulation), in contrast to the group of patients with frequent exacerbations of COPD (p = 0,018). It may indicate inadequate control of persistent inflammation, mediated by CD25+CD45RO pool of cells in the group of COPD patients with frequent exacerbations.

Conclusion. This study demonstrated the presence of discoordination of the immune response of a bidirectional nature in patients with COPD with frequent and infrequent exacerbations. 

Background. Visualization of infiltration in lung tissue surrounding the globular formation of the lungs (GFL) determined by X-ray is one of the important points in the differential diagnosis of primary lung cancer, specific and non-specific inflammatory processes. At CT gauge body phantoms test facilities are widely used for evaluating the performance of scanners that allow the evaluation of scanner characteristics : noise, contrast sensitivity, positioning accuracy, stiffness of the radiation beam, the layer thickness, spatial resolution, etc.

Aim. To develop a methodology for assessing the GFL outlines of the dynamics of multislice computed tomography (MSCT) by selecting the optimal image processing algorithms.

Materials and methods. The visual analysis of two- component physical model images of the electronic window level (WL) and electronic window width (WW) was installed on the basis of the best conditions for studying a specific group of tissues. In the case of indistinct, poorly defined outlines of globular formations, visual assessment is operator-dependent and requires development and application of quantitative methods of analysis. For a quantitative description of the outlines of the image of the GFL model, a vector in a polar coordinate system coming from the center of the figure mass bounded by the outline was used. The following outline complexity measures were adopted: modified Shannon information entropy H(S(k)) for k harmonics of the normalized spectral power density S(k) of the length of oscillation of loop radius vector R(n); the number of local maxima L of signature radius vector R(n); the maximum value of the normalized power spectral density S(k); product (multiplicity) of the entropy H(S) and the number of local maxima L.

Results. “Multiplicity”, “the number of local maxima” of the outline depend on the GFL geometric dimensions and cannot be used for diagnosis without first normalizing for GFL outline length. The parameters, such as “entropy” and “maximum value of the normalized power spectral density” are invariant under GFL geometric sizes and can be used for differential diagnosis at any phase of the disease. 

Background. Combined airway hyper responsiveness to cold and hypoosmotic stimuli in asthma patients results in impairment of lung respiration function and poor disease control compared to patients with isolated airway hyper responsiveness to only one of the stimuli or without such responsiveness that can be connected with edema or mucus hypersecretion.

Aim. The purpose of the study is the estimation of the processes of mucin secretion, plasma exudation and oxidative stress in response to cold air in asthma patients with combined airway responsiveness to cold and hypoosmotic stimuli using nasal mucosa as a model.

Materials and methods. 23 patients with asthma participated in the study. For the nasal lavage procedure, a nasal cavity was pre-washed at least three times in 5-min intervals with 5 ml saline solution (~36 °C). A control nasal lavage was done 5 min after the last washing with a dwelling time of 1 min in the nasal cavity. Directly after the control lavage, a cold air nasal challenge was done: a participant was asked to breathe deeply at the pace of a metronome to ensure hyperventilation inhaling cold air (–20 °C) through the nose and exhaling through the mouth for 5 min. Nasal lavages were taken at 1 min, 15, and 30 min after the challenge. Mucin secretion was estimated on the basis of total protein (TP) content, total carbohydrates (TC), and water-soluble forms of mucins MUC5AC and MUC5B in the lavage fluids. For the estimation of plasma exudation, the concentration of α2-macroglobulin (α2-MG) was measured. Oxidative stress was estimated by the content of thiobarbituric acid-reactive substances (TBARS) in lavage fluid. Lung function and airway responsiveness were studied by the forced expiration spirometry method and the bronchial challenge tests with isocapnic cold air hyperventilation (CAHV) and distilled water inhalation (DWI).

Results. According to the bronchial challenge tests, the patients were divided into groups: 1) without airway responsiveness to the cold and osmotic stimuli (n = 6); 2) combined airway responsiveness to both stimuli (drop in FEV1 by 10% or more after CAHV and DWI) (n = 11); 3) isolated airway responsiveness to only one of the stimuli (n = 6). In the total group of asthma patients, the mean content of TP, TC, α2-MG, and TBARS increased by 63%, 109, 47, and 68%, respectively, after the cold air nasal challenge, whereas MUC5AC and MUC5B decreased by 15 and 20%, respectively. Secretion and exudation in the nasal mucosa were more pronounced in asthma patients of group 2 in comparison with other groups. Oxidative stress was lower in group 1. There were two interesting correlations between bronchi responsiveness to CAHV and DWI and changes in the content of the biomarkers after the cold air nasal challenge in group 2: 1) ∆FEV1 after CAHV and TC level at 15 min (r = –0,65; р = 0,0401) and at 30 min (r = –0,82; р = 0,0034); 2) ∆FEV1 after DWI and the change of α2-MG at 1 min after the cold air nasal challenge (r = –0,67; р = 0,0242).

Conclusion. In accordance with the unified airway model, the found correlations may indicate that prolonged mucin secretion after cold air breathing is a negative factor for the bronchi response to cold air, whereas enhanced plasma exudation determines the bronchi responsiveness to a hypoosmotic stimulus. Nasal mucosa is a promising model for the simultaneous investigation of molecular processes of airway secretion, exudation and oxidative response in asthma patients. 

Background. Excessive airway reaction to combined effects of environmental factors is very common in patients with asthma. The understanding of the molecular-cellular mechanisms of this hyperresponsiveness is very important.

Aim. The aim of the work was to study granulocyte segment of bronchial inflammation in correlation with cytokine regulation and lipid peroxidation in patients with airway hyperresponsiveness to cold and osmotic stimuli.

Materials and мethods. In 43 patients with partially controlled and uncontrolled persistent asthma with cold and osmotic airway hyperresponsiveness (group 1) asthma symptoms and lung function were assessed, the level of IL-5, IL-12 in exhaled breath condensate (EBC) and the total amount of myeloperoxidase (MPO) in induced sputum (IS) were measured; the number of neutrophils and eosinophils in smears of IS was counted. Basing on cytological and cytochemical analysis of smears of IS, the activity coefficients of MPO in granular leukocytes, the degree of cell destruction and the intensity of cytolysis were calculated. The contents of lipid hydroperoxide (LHP) and MPO in the blood serum were measured. A control group (group 2) consisted of asthma patients without airway reaction to cold and osmotic stimuli (11 people).

Results. In the first group in comparison with the second one high levels of IL-12 were found (2,94 ± 0,09 vs. 2,53 ± 0,13 pg/mL; р = 0,024), IL-5 (3,64 ± 0,37 vs. 2,15 ± 0,14 pg/mL; р = 0,0001); the increase of neutrophils in IM (35,4 ± 3,5 vs. 17,2 ± 2,0%; р = 0,014); higher granulocytes cytolysis (0,38 ± 0,02 vs. 0,26 ± 0,02; р = 0,013), which correlated for neutrophils with the level of IL-12 (r = 0,46; р = 0,026); there was found out the increase of MPO concentration in IS (199,7 ± 49,0 vs. 81,4 ± 26,2 pixels; р = 0,039). The increased level of LHP in the blood serum correlated with the level of MPO in IS (r = 0,48; р = 0,039) and IL-5 in EBC (r = 0,71; р = 0,031).

Conclusion. Airway hyperresponsiveness to cold and osmotic stimuli in patients with asthma is characterized by the relationship between the nature of Th1 and Th2 cytokine profile, the structure of granulocyte segment of bronchial inflammation, the enzymatic function of granulocytes, MPO activity and systemic formation of suboxidized lipid peroxidation products. Activation of granulocyte segment of inflammatory pattern in patients with asthma may be considered a factor of influence on the development and maintenance of airway hyperresponsiveness due to the escalation of oxidative stress and persistent inflammation. 

Aim. To analyze the immune mechanisms of activation of virus-induced and allergen-induced bronchial asthma phenotypes in children.

Materials and мethods. We have performed an integrated assessment of parameters of innate and acquired immunity in 98 children with bronchial asthma (BA) at the age of 3–11 years in groups with virus-induced (n = 49) and allergen-induced (n = 49) phenotypes. Bronchial asthma phenotypes were verified in accordance with PRACTALL international consensus report (2008). Study exclusion criteria were: severe course of bronchial asthma and application of immunocorrecting drugs during preceding six months. To analyze immune competent cells we used flow cytofluorometer COULTER EPICS XL by Beckman Coulter Inc. Cytokine levels were identified using immunoenzyme method and reagents by R & D Diagnostics Inc. (USA); IgE – using reagents by Alkor Bio company (Saint-Petersburg); production of cytokines – using reagents by VektorBest (Novosibirsk city). Statistical processing of data was performed by Statistica. 10 program with critical significance level p < 0,05, correlations were analyzed using Spearman rank correlation coefficient.

Results. Children with bronchial asthma showed enhanced expression of T-lymphocyte activation marker HLA–DR+(р < 0,05) with reduced level of CD3+CD95+- (р < 0,01), high level of serum IgE (р < 0,01), the inverse correlation between serum levels of IFNγ and IgE (r = –0,16), IFNγ and IL-13 (r = –0,25), direct correlation between IL-17A and IgE (r = 0,48), IgE and IL-13 (r = 0,56). The children with allergeninduced BA phenotype showed low expression of CD95+ on T-lymphocyte cells, predominance of Тh-2 profile cytokines, high mitogen-induced production of IL-4 and low induction of IFNγ production. Levels of cytotoxic T-lymphocytes, natural killers, expression of activation markers and CD95+ on T-lymphocyte cells and mitogen-induced synthesis of IFNγ by cells in children with virus-induced BA phenotype were lower than the same indices in healthy children (at р < 0,05; р < 0,01; р < 0,05; р < 0,01; р < 0,01). Levels of leucocytes, neutrocytes, absolute number of T-lymphocytes, T-helpers, B-lymphocytes (р < 0,001) and Th-2 – Th-17 cytokine profile in blood serum in this group were higher than the same indices in children with allergen-induced phenotype.

Conclusion. Children with virus-induced BA phenotype showed presence of immune-mediated factors predisposing them to persistent viral infections and initiation of body sensibilization with development of eosinophilic inflammation, such as impairment of cellular cytotoxicity, predominance of Th-2 – Th-17 profile cytokines, inhibition of induction of IFNγ production by blood cells. The changes of thr adaptive response system in children with activation of allergen-induced BA phenotype are characterized by enhanced proliferation, inhibition of negative regulation processes, activation of synthesis of Th2 profile cytokines, and enhanced synthesis of IgE. 

Plastic bronchitis (PB) is a rare disease that causes airway obstruction with large «rubber» bronchial casts in adults and children, mainly due to concomitant cardiac or pulmonary pathology. It involves the organization of exudate or transudate, which takes the form of the respiratory tract. Mortality with PB reaches 50%. Exact epidemiological data are not known. In most patients, PB occurs in the context of major diseases, which can be conditionally divided into two groups: heart and vascular disease and secondary complication of pulmonary diseases. Usually PB manifests with episodes of dyspnea, tachycardia, hypoxia, fever and cough associated with airway obstruction. Sometimes the symptoms resemble asthma or obstructive bronchitis, accompanied by wheezing and the symptoms of respiratory failure, decreasing of saturation (of what?), the development of pneumothorax. All existing methods of treatment are symptomatic. Promising methods of therapy are the use of inhaled unfractionated heparin and a recombinant tissue plasminogen activator (TAP). The article presents a clinical case of PB in a girl of 5 years with the background of corrected cardiac anomaly.

Systemic lupus erythematosus (SLE) and a high-dosage corticosteroid therapy both are risk factors of tuberculosis development. The clinical case presented demonstrates the difficulties of diagnostics and simultaneous therapy of comorbid diseases, which are followed by a multisystemic tuberculosis on the one hand, and a highly active SLE resulting from tubercular regimen on the other. Our experience shows the importance of antituberculosis drug prescription in accordance with a personal chemotherapy acceptability. 

Histocytosis X is a rare disease of unknown etiology involving the reticuloendothelial system. We present a case of a 32 year-old man diagnosed with Pulmonary Histocytisis X. The CT image of the lungs showed disseminated disease with the formation of cyst-like cavities, which were histologically verified using lung biopsy. 

Ludmila Pavlovna Nazarenko (To 70th birthday).

Valery Pavlovich Puzyrev (To 70th birthday).