Bronchoobstructive Diseases Research Articles

Determine The Risk Of Long-Term Complications In Patients With Acute Coronary Syndrome

The article is devoted to one of the current topics of modern healthcare - acute coronary syndrome (ACS). Most patients had associated and comorbid diseases, primarily such as stable angina, chronic heart failure, broncho-obstructive diseases and diabetes mellitus, which in some cases required treatment adjustments [1]. The article provides information on the etiology of acute coronary syndrome, clinical symptoms and risk factors that may develop in patients.

Bronchopulmonary system within the confines of post-COVID-19 syndrome: literature review

The purpose of this review is to describe the available scientific data on the post-COVID-19 syndrome, formulate the main approaches to classification, determine the potential mechanisms of its pathogenesis, as well as determine the mechanisms of the occurrence of bronchopulmonary system pathology within the framework of the post-COVID-19 syndrome. It is known that long-term persistence of COVID-19 symptoms significantly reduces the quality of life of patients through the direct or indirect effect of the SARS-CoV-2 virus on a number of organs and systems. The review examines in detail the possible pathogenetic mechanisms of the post-COVID-19 syndrome, describes and studies the most common consequences of acute COVID-19, taking into account the severity of the disease, including diseases of the respiratory system, in particular interstitial and broncho-obstructive diseases. Particular attention is paid to the above problems in order to describe and structure the available scientific data on lung diseases within the framework of the post-COVID-19 syndrome. It should be noted, however, that there are very few studies on pathogenesis of changes in the bronchopulmonary system in the post-COVID-19 period. The bulk of them affect only individual manifestations of diseases of the respiratory system, in particular cough and shortness of breath, and are not aimed at determining causeand-effect relationships and the relationship of these symptoms to a specific nosology. Taking into consideration the continued high incidence of COVID-19, there is no doubt that additional studies of bronchopulmonary manifestations of post-COVID-19 syndrome should be conducted. Information from the databases PubMed, eLibrary, Scopus, Jstor was used as literary sources.

МЕТОДИ ДОСЛІДЖЕННЯ ФУНКЦІЇ ЗОВНІШНЬОГО ДИХАННЯ В ДІАГНОСТИЦІ ТА МОНІТОРИНГУ ХРОНІЧНОГО ОБСТРУКТИВНОГО ЗАХВОРЮВАННЯ ЛЕГЕНЬ (СПІРОМЕТРІЯ, БОДИПЛЕТИЗМОГРАФІЯ, DLCO) З УРАХУВАННЯМ ЗМІН ДО GOLD-2024

Pulmonary function testing (PFT) is an integral component in the diagnosis of broncho-obstructive diseases. Spirometry is a mandatory method of pulmonary research, and chronic obstructive pulmonary disease (COPD) is the only respiratory nosology, the diagnosis of which is based on a change in functional indicators, which are measured precisely with the help of spirometry. With the help of spirometry, only the obstructive type of PFT violations can be clearly determined. But one can also suspect restrictive and mixed (presence of both restrictions and obstruction) types. To diagnose these disorders, an indicator of Total Lung Capacity (TLC) is required, which cannot be determined by spirometry, as it consists of TLC and Residual Lung Volume (RES), which is also not determined by spirometry. More complex and less widespread methods of investigation can determine these missing indicators: bodyplethysmography — it is a method of a wider study of lung volumes and capacities and makes it possible to measure general and specific bronchial resistance (Rtot, sRaw). It is not an indispensable condition for confirming obstructive disorders, but it can be useful for identifying underlying diseases and their functional consequences — an increase in TLC, RV or RV/TLC above the upper limit of normal variability allows to suspect the presence of emphysema, severe bronchial asthma, and also to assess the severity hyperinflation. Another important study for a more complete assessment of PFT — diffusion capacity of the lungs for carbon monoxide (DLCO); performed after forced spirometry (determination of FVC, VC) or bodyplethysmography (VC) and determination of the structure of static volumes. It is used in patients with restrictive and obstructive diseases, for the diagnosis of emphysema or pulmonary fibrosis. With the help of this study, the diffusion capacity of the lungs (DLCO) and the alveolar volume (Va) are determined. The article presents the results of research in which these methods were used and provides justification for their application. Conclusion. Different methods of PFT are important and complement each other in clinical practice Key words: chronic obstructive pulmonary disease, diagnosis, spirometry, bodyplethysmography, diffusion capacity of the lungs, Global initiative chronic obstructive pulmonary disease (GOLD).

Detection of chronic bronchoobstructive diseases in the Republic of Moldova according the prism of the recommendations of international guidelines

Chronic obstructive pulmonary disease is an important public health problem. According to literature data, chronic lung diseases are underdiagnosed and there are many medical, psychological, social and economic barriers. In order to highlight the barriers and facilitating factors for the detection of chronic obstructive pulmonary disease at the level of primary care, a mixed qualitative-quantitative study was carried out, with a survey of 1190 participants and focus groups with doctors. Every fourth patient with respiratory symptoms does not report them to the family doctor and every second symptomatic patient does not perform a spirometry test. The most important barriers are low addressability after medical assistance, underestimation of respiratory symptoms, lack of doctors, professional overload and low access to spirometry at the primary care level.

Analysis of drug provision for patients with broncho-obstructive diseases in the Russian Federation

Introduction. The article presents data from an analysis of drug provision for patients with bronchial asthma and chronic obstructive pulmonary disease, both in inpatient conditions and at the stage of outpatient treatment. The object of the study was the provision of medications to patients with broncho-obstructive diseases in the constituent entities of the Russian Federation. The purpose of our study was to study drug provision for patients with broncho-obstructive diseases. Why the following research methods were used: purchases of medicines in federal districts and some constituent entities of the Russian Federation in 2019–2022 were analyzed, the amount of funds per patient diagnosed with bronchial asthma or chronic obstructive pulmonary disease was calculated. Separately, we analyzed the purchases of short- and long-acting bronchodilators, as well as mono- and combination drugs and monoclonal antibody drugs for the treatment of patients with bronchial asthma. Data on drug purchases were analyzed using the website zakupki.gov.ru; information on the number of patients in federal districts and constituent entities of the Russian Federation was taken from statistical materials of the Russian Ministry of Health. Results. We found a multiple difference between federal districts in the amount of funds per patient in both 2019 and 2022, and differentiation between federal districts also turned out to be the case when analyzing preferential drug coverage. The dynamics of the amounts of funds spent by entities on the purchase of drugs for the treatment of patients in outpatient settings turned out to be multidirectional: some entities not only did not increase these amounts in 2012 compared to 2019, but, on the contrary, decreased them. At the same time, the difference between the subjects of the same federal district reaches tenfold values. Conclusion. Patients with broncho-obstructive diseases living in different federal districts of the country have different drug coverage both in outpatient and inpatient treatment settings. To improve the drug supply for these patients, it is necessary to introduce a unified methodology for calculating the planned need for drugs and oblige the subjects to provide patients with chronic obstructive pulmonary disease with drugs at the expense of the budgets of the subjects.

При коморбидной кардиореспираторной патологии инициальное назначение β2-агонистов снижает риск бронхоспазма, вызванного β1-адреноблокаторами

In the treatment of patients with cardiorespiratory pathology, it is often necessary to simultaneously administer drugs that affect β-adrenergic receptors: β1-adrenoblockers and β2-agonists. β1-blockers can trigger a bronchospasm in patients with bronchoobstructive diseases, therefore, practitioners often decide not to prescribe them. This work aimed to evaluate functional parameters of patients with cardiovascular and bronchoobstructive diseases in the context of different sequences of administration of selective β1-blockers (bisoprolol) and long-acting β2-agonists (formoterol). This prospective, single-center 2-week pilot study involved 30 individuals suffering the aforementioned diseases. Using the envelopes method, we divided the patients into two groups of 15 people each. First group started therapy with a long-acting β2-agonist, second group — with a selective β1-adrenoblocker. While taking the β1-adrenoblocker, patients underwent a four-hour spirometric test enabling assessment of the external respiration function parameters. The tests and assessments have shown that the value of FEV1 went down in 33.3% of those who started therapy with a selective β1-adrenoblocker (bisoprolol 2.5 mg), and in the group that first took a long-acting β2-agonist for a week and then added bisoprolol 2.5 mg to the regimen the said value dropped in 7% of patients only. Thus, preceding long-acting β2-agonists, formoterol in particular, reduced the risk of bronchospastic incidents triggered by selective β1-adrenoblocker (bisoprolol) in patients with cardiorespiratory pathology.

Assessment of inhalation technique in patients with bronchial asthma and chronic obstructive pulmonary disease

Investigate inhalation techniques using different inhalers types and their effect on the course of disease. This cross-sectional study included 110 patients with asthma, chronic obstructive pulmonary disease using the inhaler at least one month. Inhaler errors performed during demonstration were evaluated for each patient and entered in the check-lists. We also collected information about co-morbidities, education, mMRC dyspnea score, rate of exacerbations, and performed spirometry. 80.9% of patients used metered-dose inhaler, 20.9% - single-dose and 21.8% - multiple-dose dry powder inhaler, 22.7% - soft-mist inhaler. Inhaler errors were made by 80.9% patients. The mean number of mistakes in metered-dose inhaler use was 2±1.6, single-dose powder inhaler -1.5±1.3, multiple-dose dry powder inhaler - 1.25±1.4, soft-mist inhaler - 0.68±0.7 (р=0.003). Age, diagnosis, duration of disease, education level, inhalers usage by relatives have no influence on the inhalation technique. A number of errors was related to female gender (р=0.007) and usage of more than 2 inhalers (r=0.3, p=0.002), previous instruction about inhalation technique (r=0.3, p=0.001). On the other hand, there were correlations between the number of errors and degree of bronchial obstruction, asthma control, severity of dyspnea by mMRC score, exacerbation rate. Patients with bronchoobstructive diseases perform many inhaler errors, that substantially influences the severity and course of asthma and chronic obstructive pulmonary disease.

The role of microRNA in the pathogenesis of bronchoobstructive diseases

The review analyzes the role of microRNAs in the pathogenesis of bronchopulmonary diseases. The universality of the mechanisms underlying epigenetics causes a continuously growing interest in research in this field in various fields of medicine. Research in the field of epigenetics not only allows us to expand knowledge in the field of etiology and pathogenesis, but also helps to explain the heterogeneity of the disease. Currently, biomarkers used in determining the phenotype of bronchial asthma or COPD are not able to display the variety of pathological processes involved in the pathogenesis of the disease at the molecular level. It is noteworthy that microRNAs retain their stability in various body environments, are resistant to high temperatures, pH fluctuations, and freeze-thaw cycles, which greatly simplifies the process of detecting these molecules in biological fluids. The amount of detected microRNA is highly specific for a particular pathological process occurring intracellularly. Currently, biomarkers used in determining the phenotype of bronchial asthma or chronic obstructive pulmonary disease are not able to reflect the variety of pathological processes involved in the pathogenesis of the disease at the molecular level. For both diseases, the key links are known to be inflammation, airway remodeling, and an abnormal response of epithelial cells to external stimuli. Thus, there is a great potential for using microRNAs in clinical practice: as noninvasive biomarkers reflecting key points of pathogenesis, as a prognostic biomarker predicting response to therapy, and possibly in the future as new therapeutic targets.

Simple and effective solutions in the correction of anxiety and stress

Acute and chronic stress conditions have an adverse effect on human health at any age and are related to the psychosocial risk factors for chronic non-communicable diseases, increasing the risk of occurrence and development of not only cardiovascular, but also other common diseases such as diabetes mellitus, obesity, broncho-obstructive diseases, ulcerative lesions of gastrointestinal tract, etc. The negative effect of stress on the human health is effectuated both through endogenous pathophysiological changes and through behavioural disorders such as physical inactivity, malnutrition, smoking, alcohol intake, etc. It has also been shown that psychosocial risk factors significantly aggravate the clinical course of existing diseases, significantly reduce adherence to treatment, worsen quality of life, increase the risk of disability and expenditures paid in the healthcare system in patients with chronic non-communicable diseases. Thus, acute and chronic stress have a negative effect on the physical, mental and emotional health, that's why the right choice of both preventive measures and timely management is very important. The combination of non-pharmaceutical effect, including training in stress resistance skills, proper response and emergency self-help in a stressful situation, with the prescription of effective pharmacological therapy can be considered as the optimal strategy. Valocordin® available in the form of drops or tablets represents a combination of low doses of phenobarbital with ethyl bromisovalerianate and plant components, which enhances the positive effects of the combination due to functional.

A pilot study to determine the relationship of changes in the characteristics of β1- and β2-adrenoreceptors against the background of the use of β2-agonists with clinically significant parameters in patients with cardiovascular pathology

Background: Comorbid cardiovascular and bronchoobstructive diseases worsens disease course and prognosis and causes difficulties in therapy. Effectiveness 2-agonists (cornerstone of bronchoobstructive pathology treatment) depends on -adrenoreceptors state. Therefore, a detailed study of the functional state of beta-adrenoreceptors is necessary. Aim: to evaluate the relationship of changes in the characteristics of 1- and 2-adrenoreceptors, against the background of the use of 2-agonists in patients with cardiovascular and bronchoobstructive diseases with clinically significant parameters. Methods: In the pilot single-center prospective study during 2.5 years 45 patients (15 with cardiovascular and 30 with bronchoobstructive diseases) were included. Anamnestic data and complaints were collected and laboratory and instrumental studies were performed. Modified radioligand analysis on blood T-lymphocytes using radiolabeled Cyanopindolol and unlabeled selective ligands (ICI 118551, CGP 20712) before and after salbutamol and formoterol was performed and the binding activity of 1- and 2-adrenoreceptors was determined. Results: The correlation analysis between clinically significant parameters and changes in the specific binding index of 1- and 2-adrenoreceptors confirmed its clinical relevance. In test with beta-agonists in cardiovascular and bronchoobstructive diseases patients, an increase in the specific binding index of 1-adrenoreceptors is associated with clinical, laboratory and instrumental parameters of a favorable course of the disease, and an increase in the specific binding index of 2-adrenoreceptors is associated with negative. In the cardiovascular group without bronchoobstructive diseases with salbutamol an increase in the specific binding index of 1-adrenoreceptors was associated with parameters of unfavorable disease course, while an increase in the specific binding index of 2-adrenoreceptors did not have a clear associative relationship with clinical characteristics. Conclusions: The association of changes in the specific binding index of 1- and 2-adrenoreceptors in patients with cardiovascular and bronchoobstructive diseases with clinically significant parameters during acute tests with short- and long-acting 2-agonists was revealed, which in the future may provide an opportunity to identify patients with an unfavorable course of the disease.

РОЛЬ СУБЪЕКТИВНЫХ И ОБЪЕКТИВНЫХ КРИТЕРИЕВ В ОЦЕНКЕ СОСТОЯНИЯ БОЛЬНЫХ БРОНХООБСТРУКТИВНЫМИ ЗАБОЛЕВАНИЯМИ В УСЛОВИЯХ УДАЛЕННОГО МОНИТОРИНГА

Introduction. Wearable or home electronic devices with the function of transmitting information at a distance are used for the purpose of remote dynamic monitoring of the condition of patients. Aim. To determine the effectiveness of the use of "new" criteria for assessing the health status of patients with broncho-obstructive diseases in order to monitor remotely. Material and methods. 28 patients with broncho-obstructive diseases who were admitted for inpatient treatment were examined. Most of them had comorbidities, mainly cardiovascular pathology. A general clinical examination and special research methods were performed: an interactive survey using the respiratory module of the Electronic Polyclinic program, remote monitoring of vital signs using a smart watch and a mobile application for recording and transmitting information, a 6-minute walk test with simultaneous recording of vital signs with using a smart watch, a questionnaire and a scale for assessing the usability of the System usability scale system. The analysis of the results was performed by using the Statistica 13.0 software package. Results and discussion. Interactive survey corresponded to the severity of dyspnea according to the mMRC and Borg scales. The 6-minute walk test showed a significant limitation of physical activity and an increase in heart rate. The deep sleep phase has been limited. The CRP index averaged 7.78±8.48 µg/l. More than 85% of patients expressed their willingness to continue observation. The results of the correlation analysis demonstrated a direct relationship with the patient's physical activity assessment and the results of the 6-minute walk test, and an inverse relationship with the 6-minute walk test result and the patients' age, severity of respiratory failure and CRP concentration. The duration of deep sleep is inversely correlated with the SpO2 value. Our studies made it possible to compare the obtained data with the results of traditional methods of examining a patient, to confirm the position that the physical activity of a patient with broncho-obstructive disease is connected with indicators of the function of external respiration, and also that the total duration of sleep of COPD patients mainly consists of light sleep with a decrease in the duration of deep sleep. An inverse relationship was found with the duration of deep sleep and the concentration of CRP and the value of SpO2. The described monitoring system allows you to timely adjust the treatment regimen, reduce the number of hospitalizations, the risk of exacerbation or death.Conclusion. Additional instrumental control of vital parameters increases the efficiency of the system of long-term remote monitoring of patients with broncho-obstructive diseases. the indicators represent the severity of the symptoms of the disease and the degree of violations of the indicators of the function of external respiration.

The frequency of detection of comorbid broncho-obstructive pathology in patients with arterial hypertension admitted to a specialized cardiological hospital

Objective: To determine the frequency of detection of chronic obstructive pulmonary disease (COPD) and Asthma in patients who are admitted to specialized cardiological hospital with arterial hypertension (AH), including AH with chronic heart failure (CHF), coronary heart disease (CHD), cardiac arrhythmias. Analyze the possibility of early diagnosis and the validity of the modified questionnaire for screening risk factors and symptoms of broncho-obstructive pathology in patients with arterial hypertension.Materials and methods: The sample (n = 1000) consisting of individuals over the age of 18 who continuously arrive for inpatient treatment at the admission department of the National Medical Research Center of Cardiology with arterial hypertension, incl. AH with CHF, IHD and arrhythmias in the period from 2018 to 2019. Active identification of broncho-obstructive pathology among all persons was carried out (history taking, complaints), analysis of medical documents provided by patients (conclusions from outpatient and reference cards of the patient), screening of risk factors and symptoms of broncho-obstructive pathology (a modified questionnaire was used), external respiration function was assessed (computer spirometry), filled out the specialized respiratory questionnaires (CAT, mMRC, ACT).Results: The undiagnosed broncho-obstructive diseases was demonstrated against the background of their high occurrence in patients with hypertension, incl. CHF, coronary artery disease, NRS entering a specialized cardiological hospital. The study established the most likely predictors of airway obstruction in patients with hypertension, which signal the need to assess the function of external respiration (computed spirometry).Conclusions: The development and validation of a modified questionnaire makes it possible to identify specific symptoms and risk factors for bronchoobstructive diseases against the backdrop of their high prevalencre among patients who are admitted to cardiology hospital with arterial hypertension.

Льготное лекарственное обеспечение пациентов в Федеральных округах и субъектах Российской Федерации

In the Russian Federation, the obligations of federal and regional authorities for Subsidized Pharmaceutical Provisionfor patients are legally defined, the issues of providing patients with drugs for the treatment of a particular nosology are analyzed with varying degree of detail, however, a comprehensive assessment of Subsidized Pharmaceutical Provision for patients with the most common diseases in the Federal Districts and federal subjects was not carried out. This was the aim of this study. We analyzed the purchase of medicines for the treatment of patients with cancer, broncho-obstructive diseases (bronchial asthma and chronic obstructive pulmonary disease) and diabetes in the Federal Districts and federal subjects of Russia though regional and federal budgeting and recalculated the total spendings per 1 patient living in the Federal District or federal subject. We found that both the federal districts and the constituent entities differed in the budget spendings for purchase of medicines for the treatment of the analyzed nosologies. In addition, we found inconsistency in the sum of funds spent on the subsidized Pharmaceutical Provision from year to year. The availability of medicines at the outpatient stage of treatment of cancer, broncho-obstructive diseases and diabetes mellitus differs greatly between the different Federal Districts and on the federal subject level. This creates unequal access to drug treatment for patients at the outpatient stage of treatment. Health authorities do not use a unified methodology for planning the demand of medicines at the outpatient stage of treatment, nor a unified strategy for Subsidized Pharmaceutical Provision xecution.

Скринінг бронхіальної астми як ефективний метод вчасного її виявлення у дітей шкільного віку

Проведене епідеміологічне дослідження бронхіальної астми шляхом анкетування батьків і дітей міської та сільської місцевості Тернопільської області з метою вивчення поширеності, визначення та репрезентації основних маркерів захворюваності серед дітей старшого та середнього шкільного віку. Дітям проводилися детальний збір анамнезу, анкетне опитування, розроблене згідно з методологією ISAAC, та об’єктивне клінічне обстеження. Даний фрагмент епідеміологічних досліджень засвідчив, що показники поширення бронхообструктивних захворювань у регіоні (5,62 %) суттєво відрізняються від показників офіційної статистики (1,7 %).

The use of short-acting bronchodilators in patients with chronic bronchoobstructive pathology at the present stage

Inhaled short-acting bronchodilators (beta-agonists and M-anticholinergics) have been used for a long time in patients with bronchoobstructive diseases, the main representatives of which are chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA). Given the fact that most patients with COPD and BA are treated with long-acting bronchodilators, the question arises about the place of short-acting drugs in modern treatment algorithms for bronchoobstructive pathology. The data on how many patients take short-acting beta-agonists and M- anticholinergics in real-life clinical practice, and how appropriate it is to use these drugs on top of prolonged drugs are provided. The Russian part of the international POPE-study analyzed the characteristics of outpatients with COPD. It was found that the vast majority of patients have short-acting bronchodilators as part of their therapy, and more than 50% of patients receive a combination of SABA and SAAC, and in most cases this is represented by a combination of fenoterol + ipratropium. Taking into account that the majority of patients with COPD and asthma receive prolonged bronchodilators, important from a practical point of view is the question of the effectiveness of short-acting drugs on the background of prolonged ones. The article discusses these aspects of therapy and provides evidence that the use of SABA and SAAC provides an opportunity to achieve additional bronchodilatation when used against the background of prolonged bronchodilators. Thus, symptomatic use of SABA and SAAC on demand in bronchoobstructive pathology have sufficient justification even in the presence of a combination of prolonged bronchodilators in patient therapy. At the same time, it is necessary to take into account the increased probability of side effects with such drug regimen. The article also discusses the issues of different types of inhalation devices for short-acting bronchodilators (nebulizers and metered-dose aerosol inhalers), provides data on their comparative effectiveness and safety.

Treatment of exacerbation of bronchoobstructive diseases during COVID-19

Treatment of exacerbation of bronchoobstructive diseases during COVID-19

ТОНКОЩІ ВИКОРИСТАННЯ ІНГАЛЯЦІЙНИХ ПРИСТРОЇВ В ДИТЯЧІЙ ПРАКТИЦІ

SUBTLETIES OF USING INHALATION DEVICES IN PEDIATRIC PRACTICE O. Katilov National Pirogov Memorial Medical University, Vinnytsya, Ukraine Abstract. Inhalation therapy plays an important role in the treatment of a number of respiratory diseases. Due to the direct delivery of drugs to the respiratory tract, the development of systemic side effects is minimized, which is extremely important for pediatric patients. Today, inhalation therapy is the basic method of treating bronchial asthma. But about 1/3 of patients with bronchoobstructive diseases perform inhalations with serious technical errors. As a result of improper inhalation technique, the drug enters the respiratory tract in insufficient quantities, which leads to poor disease control and frequent exacerbations. Particular difficulties in the use of inhalation devices arise in pediatric practice. Children under 3 years of age are usually unable to perform specific breathing maneuvers. Therefore, for children under 5 years of age, the best choice among delivery devices is metered-dose inhaler (MDI) with a valve spacer. An alternative method of drug delivery is nebulizer therapy. Children older than 5 years can already use dry powder inhalers (DPI). This literature review presents the classification and types of DPI, considers their main technical characteristics, the criteria of the “ideal” delivery device. Based on the literature, it is established that the most optimal inhalation device for children older than 5 years is Easyhaler, which has a number of advantages. It is easy to use. The MDI-like design contributes to the commitment and correct, without technical errors, use of the inhaler. Easyhaler has the appropriate aerodynamic characteristics of the released dose, safe and efficient delivery of the drug. Key words: inhalation therapy, delivery devices, dry powder inhalers, children, bronchial asthma.

Beta-adrenergic and M-cholinergic receptor interactions characteristics in the pathogenesis of bronchial obstructive pulmonary diseases

Crosstalk between beta-2-adrenoceptor and M- cholinoreceptors in the airway plays one of the main role in the pathogenesis of bronchoobstructive diseases. The interaction of M3-cholinergic receptors and beta2-receptors in the lungs can be characterized as functional antagonism. M3 activation can lead to desensitization of beta2 receptors. Beta2 receptors also limit the action of M3 receptors in various ways. In this case, M2 cholinergic receptors act as autoreceptors. On the one hand, they limit bronchoconstriction caused by a change in the conformation of the M3 cholinergic receptor, and on the other hand, they are able to suppress the excessive bronchorelaxating effect that occurs when beta2 receptor is activated. Knowledge of the crosstalk mechanisms can help to understanad the pathogenesis of bronchial obstructive diseases, optimize existing treatment regimens for chronic obstructive disease (COPD) and bronchial asthma (BA)

APPROACHES TO COMBINED TREATMENT OF PATIENTS WITH CARDIOPULMONARY PATHOLOGY

Treatment and control of hypertension is an important clinical problem, especially in the case of concomitant risk factors and bronchoobstructive diseases. The use of antihypertensive drugs in the patients with bronchoobstructive pathology has certain features. The use of β−blockers for the treatment of hypertension in the patients with cardiopulmonary pathology helps to reduce mortality, the number of visits to the doctor, those to the emergency rooms and exacerbations of chronic obstructive pulmonary disease. Angiotensin II receptor antagonists are the preferred choice for the patients with chronic obstructive pulmonary disease, requiring the treatment with renin−angiotensin−aldosterone inhibitors compared with angiotensin−converting enzyme inhibitors. Statin therapy improves a shortness of breath, reduces exacerbations, hospitalizations and mortality in the patients with cardiopulmonary pathology. The use of anticoagulants and anti−platelet agents in this category of patients helps to reduce the future morbidity and mortality associated with thrombotic diseases. There are no safety concerns or contraindications to the use of calcium channel blockers or aldosterone receptor blockers (including spironolactone) in the patients with cardiopulmonary pathology, but high doses of diuretics should be used with caution. Pulmonary rehabilitation programs, which included either strength training or a combination of general exercise, were effective for both the patients with bronchoobstructive disease and comorbid conditions. However, the indications, components, regimen, and end goals of such programs for "complex patients" with several comorbid conditions that complicate each other are remained poorly understood. Key words: cardiopulmonary comorbidity, drug treatment, physical rehabilitation, hypertension, chronic obstructive pulmonary disease.

Inhaladores de acción larga

Hoy día, en el mundo, los inhaladores de acción larga son herramientas fundamentales para el tratamiento de las enfermedades broncoobstructivas. Su uso está avalado por consensos internacionales ampliamente difundidos y reconocidos mundialmente, como son las Guías GINA 2017 y las Guías GOLD 2017, entre otros. En Colombia, desde hace varios años, la comunidad médica dispone de varias presentaciones comerciales de inhaladores solos o en diferentes combinaciones. Por tanto, se consideró pertinente realizar una revisión de los conceptos fisiológicos fundamentales, de los principios farmacológicos, de los mecanismos de acción, de la farmacodinamia y farmacocinética. Igualmente, con base en la evidencia disponible al momento de la realización de este artículo, se revisarán las indicaciones clínicas para su uso en las diferentes enfermedades broncoobstructivas.