The parameters of peak flow measurements of patients with normal spirogram indices did not differ from those in the control group and were within 95% of the proper values in the morning and 100% in the evening, the daily fluctuations averaged up to 5% of the initial value. The PSV data of patients who had a moderate decrease in FEV 1 during spirography were lower than in the control group, averaging 65% D in the morning and 75% D in the evening. Daily changes in HRP throughout the study did not change and were within 10%.
In group I patients, the value of bronchial resistance (R aw ) on inspiration (2.78 ± 0.1 cm water / l / s) and on expiration (3.06 ± 0.08 cm water / l / s) did not significantly differ from similar indicators in the control group (2.8 ± 0.1 and 3.0 ± 0.06 cm. water.st / l / s, respectively; P> 0.05). In group II, the value of bronchial inspiratory resistance (3.1 ± 0.2 cm. Water / l / s) did not change (P> 0.05), R aw during exhalation was increased (3.9 ± 0.2 see water.st / l / s; P <0.001). In patients with group III, a significant increase in bronchial resistance was noted: R aw on inspiration – 4.2 ± 0.15 cm water / l / s and R aw on expiration – 4.5 ± 0.26 cm. water / l / s (P <0.001). In patients of group II, plasma-cell and lymphoid infiltration of the bronchi, edema and sclerosis of the bronchial mucosa are already taking place. The leading cause of a pronounced increase in bronchial resistance in patients with group III is nephro genic edema of the lungs and bronchial mucosa, as a manifestation of renal failure.
Diagnostic fibrobronchoscopy was performed on 60 patients with MM who did not abuse smoking and did not have concomitant COPD (20 patients of group I, 20 patients of group II, and 20 patients of group III). All patients of group I had a bronchoscopic picture of a normal tracheobronchial tree. No hypersensitivity of the bronchi was observed.
In 10 patients of group II, bilateral diffuse atrophic endobronchitis was diagnosed. The bronchial mucosa in these patients was atrophied, pale, thinned. In the lumen of the bronchi mucous secret was absent or was very scarce. A bronchoscopic picture of a normal tracheobronchial tree was diagnosed in 10 patients. In all patients, contact bleeding of the bronchial mucosa was noted.
Bilateral diffuse atrophic endobronchitis was diagnosed in 12 patients of group III. The bronchial mucosa was atrophied, pale, thinned. In 8 patients of this group, there was a picture of a normal tracheobronchial tree. As in patients of group II, in all patients of group III, contact bleeding of the bronchial mucosa was observed, due to impaired hemostasis in the later stages of tumor progression in patients with MM . Thus, when conducting fibrobronchoscopy in 50% of patients with MM IIIA and in 60% of patients with renal insufficiency, bilateral diffuse atrophic endobronchitis occurs (40% of the total number of patients with MM).