No abstract

Standartnaya terapiya bronhial'noj astmy (BA) vklyuchaet naznachenie β2-agonistov. Izmenenie funkcional'noj aktivnosti β2-adrenoreceptora associirovano s polimorfizmom gena ADRB2 i svyazano s nizkim terapevticheskim otvetom na β2-agonisty. Vyyavlenie nositelej klinicheski znachimyh variantov gena pomozhet izbezhat' neeffektivnogo lecheniya i posluzhit osnovaniem dlya naznacheniya al'ternativnoj terapii. Cel'yu issledovaniya bylo ocenit' klinicheskuyu znachimost' associirovannyh s terapevticheskim otvetom na β2-agonisty polimorfnyh variantov gena ADRB2 (Arg16Gly i Gln27Glu) dlya gruppy pacientov s BA. Provedeno klinicheskoe i geneticheskoe obsledovanie nebol'shoj gruppy vzroslyh nekuryashchih pacientov (n = 21) s BA srednej stepeni tyazhesti (III–IV stupen' po GINA), v tom chisle pacientov novogo teratipa, dlya kotoryh harakterny plohoj otvet na β2-adrenergicheskie sredstva, no znachimyj otvet na M-holinergicheskie sredstva. V pervuyu gruppu byli opredeleny pacienty s podtverzhdennoj effektivnost'yu primeneniya sal'butamola, kotorye v to zhe vremya imeli horoshij otvet na ipratropiya bromid. Vo vtoruyu gruppu voshli pacienty s nizkoj effektivnost'yu terapii sal'butamolom i polozhitel'nym testom s ipratropiya bromidom. Analiz raspredeleniya polimorfnyh variantov Arg16Gly i Gln27Glu pokazal otsutstvie dostovernoj svyazi allelej i genotipov s effektivnost'yu primeneniya β2-agonistov (0,52 — dlya varianta rs1042713, p = 1,0; i 1,0 — dlya varianta rs1042714, r = 0,74 sootvetstvenno). Pri etom pacienty s otsutstviem otveta na sal'butamol imeli genotip libo Arg16Gly, libo Gly16Gly. Neobhodimy dal'nejshie issledovaniya s bol'shim chislom pacientov i rasshireniem perechnya testiruemyh polimorfnyh variantov.

Standard asthma therapy includes prescription of β2-agonists. Changes in the functional activity of β2-adrenergic receptor are associated with ADRB2 genepolymorphism and related to the low therapeutic response to β2-agonists. Identification of carriers of the clinically significant gene variants will help to avoidineffective treatment and prescribe an alternative therapy. This study aimed to assess clinical significance of the ADRB2 gene polymorphisms (Arg16Gly andGln27Glu) associated with the therapeutic response to β2-agonists in the group of asthma patients. We subjected a small group of adult nonsmoking patients(n = 21) with moderate asthma (III–IV stage of GINA) to clinical and genetic examination. The group included patients with the new theratype, those that poorlyrespond to β2-adrenergic drugs but significantly to M-cholinergic agonists. The first group included patients responding well to both salbutamol and ipratropiumbromide. The second group was comprised of the patients for whom salbutamol was not effective but who tested positive for response to ipratropium bromide. Theanalysis of distribution of polymorphic variants of Arg16Gly and Gln27Glu revealed no significant relationship between alleles and genotypes and the efficacy of β2-agonists(0.52 for the rs1042713 variant, p = 1.0; 1.0 for the rs1042714 variant, p = 0.74, respectively). The genotype of patients that did not respond to salbutamol waseither Arg16Gly or Gly16Gly. Further studies are needed that would involve a larger number of patients and an expanded list of the tested polymorphic variants.

According to WHO at last 50% of the patient don't follow doctor’s recommendations. Ultimately, this leads to a decrease or absence of the treatment effect. In this regard, all the latest international and national guidelines mention the need to take into account the patient’s preferences in the choice of therapy. Allergen-specific immunotherapy (AIT) is one of the main methods of treatment of allergic diseases such as allergic rhinitis, allergic conjunctivitis and atopic asthma, and has disease modifying properties and the long-term efficacy after stop treatment. AIT refers to a preventive and long-term method (recommended for at least 3 years), that is often the cause of reduced adherence to therapy. Various studies have confirmed the dose-dependent effect of AIT, and, consequently, changes in regimens or shortening of therapy may affect the end result. In case of insufficient effectiveness of AIT, the probability of low compliance should be considered first of all. Sublingual AIT (SLIT) requires the patient to be highly involved in the treatment process. The task of the doctor in this case is increasing therapeutic cooperation, as one of the most important factors to ensure the effectiveness of SLIT. The main methods in this case are to improve the patient’s understanding of the purpose of the therapy and regular monitoring by the doctor.

Background. The aim of this study was to analyse the group of patients with asthma, who prefer to use short-acting anticholinergics (SAMA) for relief of asthma attacks. At the same time, these patients are prescribed inhaled glucocorticosteroids (ICS) in combination with long-acting P2-agonists (LABA) as a basic therapy according to the standards. Tha aim. To study the cause of low efficacy of LABA in patients with asthma who do not have a sufficient response to SABA, as well as the probability of reducing of bronchial obstruction with LAMA. Materials and methods. 12 non-smoking adults with moderate to severe asthma (III-IV stage of GINA), receiving medium or high doses of ICS in combination with LABA as a basic therapy without adequate control over asthma symptoms were included in the study. First group of patients showed the efficacy of salbutamol (FEV1 reversibility was more than 12% and more than 200 ml after 400 ^g of salbutamol) and ipratropium bromide (SABA+SAMA+). Second group included patients with low response to salbutamol and positive test (FEVt reversibility) with ipratropium bromide (SABA-SAMA+). Spirometry was performed at baseline point and in 5, 10, 15, 30, 60, 120 and 240 min after inhalation of bronchodilator (salmeterol 50 ^g, formoterol 12 ^g and tiotropium bromide 18 ^g in the different days). Results. It was shown that SABA-SAMA+ phenotype asthma patients demonstrated low response to LABA: FEV1 increased up to 7.64±1.67%, 156.0±16.0 ml after salmeterol inhalation and up to 9.4±5.8%, 166.7±103.1 ml after formoterol inhalation (compared with a group of SABA+SAMA+, where the response to salmeterol was 20.81±2.42%, 551.43±93.94 ml and the response to formoterol was 30.21±6.75%, 718.57±140.78 ml, p