The objective of the research was to evaluate the influence of basic treatment of patients with chronic obstructive pulmonary disease with tiotropium bromide on the processes of morphological rearrangement and local barrier defence mechanisms in the bronchial mucosa.          Stage II chronic obstructive pulmonary disease is associated with the damage to the bronchi with proliferation of the connective tissue in its proper plate, clear identification of the basal membrane alteration, the presence of fibroblasts, the activation of fibroblasts/myofibroblasts and mucous glands, which is accompanied by the significant increase of type ІV collagen levels by 6.19 times (p<0.05) in bronchoalveolar lavage fluid as compared to the control group indices.          The elimination of stage II chronic obstructive pulmonary disease exacerbation and the use of tiotropium bromide within a month was accompanied only by partial improvement of morpho-functional state in relation to both cells of bronchial epithelial lining and adjacent connective tissue of mucosal plate. The prolongation of tiotropium bromide administration from 2 to 6 months, provided positive dynamics of structural morphological changes of the bronchial mucosa (the restoration of the ciliary apparatus of epithelial cells, the normalization of the secretory function of goblet cells, the inactivation of fibroblasts, the initial degeneration of myofibroblasts), thus leading to complete absence of morphological signs of edema or epithelial cell dystrophy.          Conclusions. In patients with stage II chronic obstructive pulmonary disease, complete absence of morphological signs of edema or dystrophy of epithelial cells, against the background of collagenolysis in the connective tissue of the proper mucous plate of the bronchi and the highest possible decrease in the number of myofibroblasts, with near-complete levels of type IV collagen normalization in the bronchoalveolar lavage fluid, were identified only within a 6-month treatment with tiotropium bromide.

The aim: To study the structure of adverse drug reactions and the effectiveness of treatment among patients with drug-resistant tuberculosis who follow the modified short-term and individualized treatment regimens. Materials and methods: The analysis of 138 inpatient medical records, outpatient health cards and electronic database of the patient register was conducted. Resistant strains of MTB were microbiologically verified in all the patients. All the patients underwent clinical-laboratory, instrumental microbiological, genetic-molecular (GeneXpert MTB / RIF) methods of examination, both for diagnosis and monitoring of the effectiveness of treatment. In order to prevent complications and control adverse reactions, all the patients were briefly screened for peripheral neuropathy, basic audiometry, the QTc interval was determined, visual acuity and color perception were checked. Results: At individualized treatment regimen of tuberculosis, adverse reactions were 3.5 times more common than in patients with modified short-term therapy, in 65 (68.4%) cases and in 8 (18.6%) cases, respectively. Accordingly, the effectiveness of treatment differed in both groups. Prevailing in long-term treatment were: treatment interruption treatment gap, treatment failure, continued treatment. In patients receiving short-term regimens, the cured rate was almost twice as common as in the second group. Conclusions: Timely detection cases of resistant tuberculosis and using linear probe analysis (LPA) - GenoType MTBDRplus for diagnosis of fluoroquinolone resistance, will allow the use of modified short-term treatment regimens for tuberculosis. Which in turn will reduce the number of side effects and improve the outcome of treatment.

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