Резюме В последнее время благодаря эффективности, доступности и появлению большого количества небулизированных лекарственных форм небулайзерная терапия приобретает все большую популярность в практической медицине. Сегодня в основе небулайзерной терапии положена современная технология, которая успешно применяется во всем мире и повышает эффективность лечения, а в некоторых аспектах стала незаменимой в различных областях медицины, особенно при оказании неотложной помощи, а также в пульмонологии и фтизиатрии, педиатрии и гериатрии. В статье подробно описаны виды небулайзеров, принципы их работы, основные недостатки и преимущества. Указаны основные показания и противопоказания к применению небулайзерной терапии. Даны практические рекомендации по технике и правилах проведения небулайзерной терапии и типичные ошибки, а также перечень основных препаратов, которые рекомендованы для применения с помощью небулайзера. Ключевые слова: небулайзер, небула, небулайзерная терапия, пульмонология.

Introduction: One-third of all the patients with chronic obstructive pulmonary disease (COPD) additionally take mucolytics as per GOLD recommendation due to complaints of productive cough despite their compliance with the basic treatment regimen. Aim: To assess the efficacy and safety of inhaled N-acetylcysteine (NAC) in comparison with oral NAC in patients with COPD. Material and methods: The study included 46 patients with stable COPD and difficult expectoration of sputum who were divided into two groups. The first group (n = 22) took 600 mg/day NAC orally, and the second one (n = 24) inhaled 600 mg/day NAC by a nebulizer for 10 days. In the beginning and after the 10-day treatment the questionnaires (CAT, mMRC, CCQ, SGRQ, SF-36), 6-minute walk distance test and day and night cough symptoms were evaluated, spirometry and sputum analysis were performed. Results and discussion: In the first group, CCQ showed improvement in the status of patients (by 9.7%). The severity of night cough also decreased. Other indices were not changed statistically. In the other group, positive changes in the CAT (by 13.1%) and SF-36 were reported, night cough decreased. Additionally, forced expiratory volume in 1 s (FEV1) values increased (by 10.3%). No changes in FEV1 2 hours after the first oral usage or inhalation of NAC were found. Conclusions: Both oral administration and inhalation of NAC by a nebulizer for 10 days has a similar positive effect on the manifestations of COPD, but the inhalation route of the drug is also accompanied by improved quality of life and lung function test (FEV1) as well.

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The practical recommendations describe the clinical symptoms and signs of bronchial obstructive syndrome, which is common in primary care physician practice. The main causes of bronchial obstruction are analyzed. Differential diagnosis of bronchial obstruction and upper airway obstruction are performed. Detailed attention is paid to the differential diagnosis of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD). Differences in clinical symptoms of these diseases are described. The main diagnostic criteria for BA and COPD are analyzed, which are determined by peak flowmetry and spirometry. It is emphasized that the diagnostic significance of the functional indicators of pulmonary ventilation are only in combination with typical clinical symptoms and risk factors. Clinical features of bronchial obstruction in patients with Churg-Strauss syndrome are described. Methods of diagnosis and two clinical cases of this syndrome are described. Key words: syndrome of bronchial obstruction, bronchial asthma, chronic obstructive pulmonary disease, peak flowmetry, spirometry, Churg-Strauss syndrome.

Background. Community-acquired pneumonia is a frequent complication of chronic obstructive pulmonary disease (COPD), especially in patients with small weight. Respiratory acidosis is a natural manifestation of COPD, which clinically is characterized by dominated obstructive pulmonary ventilation. Respiratory acidosis is a form of acid-base deviation which associated with insufficient excretion of carbon dioxide by the lungs. But in patients with comorbid pathology (COPD and community-acquired pneumonia) in addition to respiratory acidosis also can be evolved a metabolic acidosis (MA) conditioned by tissue hypoxia, intense systemic inflammation with next disturbances in correlation between pro-inflammatory and anti-inflammatory mediators, accelerating catabolic processes. The severity of acid-base deviation in patients with the possibility of developing decompensated acidosis depends not only on the degree of obstructive ventilation disorders, but also increasingly to the gravity of community-acquired pneumonia which causes severe acidotic metabolic changes. Objective. To evaluate the expediency of application 4.2 % buffered sodium bicarbonate solution (Soda-buffer) in the case of mixed acidosis in patients with comorbid pathology: COPD which is compounded by community-acquired pneumonia. Materials and methods. To all patients with comorbid pathology aged from 18 to 75 were prescribed the drug Soda-buffer manufactured by “Yuria-Pharm” (Ukraine), which contains 42 mg of sodium bicarbonate intravenously at a rate of 1.5 mmol/kg per hour (4.2 % Soda-buffer – 3 ml/kg per hour) under control of blood pH, acid-base and water-electrolyte (water-salt) balance of the body. Results and discussion. Qualified treatment of patients with comorbid pathology (COPD and community-acquired pneumonia) should be comprehensive and directed towards the struggle against the manifestations of obstructive ventilation disorders and hypoxemia, lower respiratory tract infection, intense inflammatory process in the lung parenchyma and bronchial tree. The complex treatment includes not only modern antibacterial drugs in combination with systemic glucocorticoids, but also methods of correction of metabolic, hemodynamic and coagulation disorders. With the aim of acidosis correction the most effective way is using infusion solutions which contain sodium bicarbonate. Due to dissociation of sodium bicarbonate has released a bicarbonate anion that binds hydrogen ions to form of carbonic acid, which then decomposes into water and carbon dioxide. In case of severe respiratory insufficiency oxidation of sodium hydrocarbonate can contribute increasing of hypercapnia by the connection with the accumulated CO2. It was found that 4.2 % buffered sodium bicarbonate solution in the comprehensive therapy of patients with comorbid pathology of COPD and community-acquired pneumonia helps to restore acid-base balance, reduce metabolic disorders and improve the clinical condition of patients. In the matter of normalization of the function of external respiration and reduction of the manifestations of respiratory insufficiency, usually substantially reduces not only respiratory, but also MA. Therefore, during correction of concomitant MA by Soda-buffer we should compensate the deficiency of bases not more than half percentage. In situation with rapid balancing of acidosis, particularly in the case of impaired pulmonary ventilation, the rapid release of CO2 may exacerbate cerebral acidosis. It’s a well known fact that small uses of Soda-buffer together with other infusion solutions with an acidic pH are provided a neutralizing agent and prevent the appearance of post-infusion phlebitis after administration of widely used infusion solutions (glucose fluids of different concentrations, chloride solution, ciprofloxacin and some other fluoroquinolones). Conclusions. Soda-buffer (4.2 % sodium bicarbonate buffered solution) is an effective infusion agent for the correction of MA in patients with comorbid pathology (COPD and community-acquired pneumonia) in condition of provided effective gas exchange. This solution is a physiological bicarbonate buffer that maintains a constant pH level, prevents abrupt alkalization of the blood and provides a smooth correction of acidosis at the same time with increasing alkaline blood reserves. The drug also increases the excretion of sodium and chlorine ions, osmotic diuresis, alkalizes urine.