The article is devoted to an important event – the 30th anniversary of the scientific and practical journal “Pul'monologiya”, the leading Russian professional Journal on respiratory diseases and the official body of the Russian Respiratory Society (RRS). A brief history and the main stages of the evolution of the journal “Pul'monologiya”, its place in contemporary medical periodicals, the main bibliometric indicators and perspectives of development are presented. The history of the Journal is inextricably linked with the history of the Russian pulmonary service and the respiratory society (RRS). Currently, the Journal is closely integrated into the information network of periodic scientific medical literature, entering in the leading international and domestic bibliographic databases. The Chief-Editor Professor A.G.Chuchalin, Academician of the Russian Academy of Sciences, and the Editorial Board put a lot of effort into the development of new e-technologies in the development of the Journal, increasing the requirements for the quality of scientific publications, and the relevance of the topics discussed.

This review discusses the main statistical indicators for lung cancer (LC) in the Moscow region over the past 20 years from 1998 to 2018. Methods. The analysis of basic statistics was carried out on the basis of official statistics of the Moscow region in the period from 1998 to 2018. Results. A decrease in the incidence was revealed. The five-year survival rate increased. The morphological diagnostics of LC improved. The detection of the disease in the early stages improved. In addition, mortality has decreased, both overall, and one-year. Conclusion. The reduction of morbidity and mortality, as well as the improvement of early detection of patients with LC in the Moscow Region was facilitated by the introduction of tobacco control measures, the implementation of programs to fight cancer, improving the quality of diagnostics and improving the equipment of clinics and hospitals, as well as the use of new modern treatment methods, such targeted and immunotherapy.

The aim of the study is to study the gender-age aspects of the incidence according to the materials of the Republican Oncologic Dispensary.

Methods. For the observation period from 2010 to 2017 the incidence of lung cancer in men is more common – in some cities from 2 to 7 times in different age groups.

Results. For the first time, lung cancer in men and women is mainly recorded in the age group of 30 – 39 years. In other age groups, no clear gender-age dependence has been identified, in addition to the upward trend in morbidity rates in persons over 40 years.

Conclusion. It was found that the reduction of emissions of different groups of carcinogens in the air in Ufa and Sterlitamak led to a decrease in the incidence of respectively 9.72 and 31.17%, and an increase in emissions in Salavat and Oktyabrsky increased by 6.53 and 18.33%.

Bleomycin used as part of many chemo-therapeutic programs for treating Hodgkin lymphoma is associated with pulmonary toxicity. Development of complications after mediastinal radiotherapy is also well-known. However, the synergistic effect of the combination of radiotherapy and bleomycin is considered in the literature much less frequently and mainly when using the total focal doses (SOD) of 36 – 40 Gy. Since 1998 the chemo-radiotherapeutic regimens applied to the treatment of Hodgkin lymphoma in the MRRC (Obninsk) has involved subradical TTD of 20 – 30 Gy. The goal of the study is to evaluate pulmonary toxicity in Hodgkin lymphoma patients treated with chemo-radiotherapy involving ABVD and mediastinal treatment with TTD of 20 – 30 Gy.

Methods. A series of 142 Hodgkin lymphoma patients received ABVD and mediastinal radiotherapy at the TTD 20 – 30 Gy. Conventional film and digital chest X-rays, linear and digital tomograms taken at different stages of treatment and follow up were analysed.

Results. Changes in lungs in the form of a pathologic pulmonary pattern (interstitial pneumonitis) were seen in 39 (27.5%) of 142 patients. In 10 (25.6%) of 39 patients focal or confluent pneumonitis infiltration were found, that was 7% of the whole study group. Clinical evidence of bleomycin-induced pneumonitis was found in 6 (15.4%) of 39 patients. With follow-up terms up to 60 months fibrotic changes in lungs were absent. The occurrence of radiation pneumonitis was 17.6%, radiation fibrosis – 35.9%. Fibrotic changes were mainly grade 1 (94.1%). In HL patients with bleomycin-induced pneumonitis the occurrence of radiation pneumonitis was 43.6% (17 of 39 patients), radiation fibrosis – 58.9% (23 of 39 patients) while the corresponding figures for patients who did not have bleomycin-induced pneumonitis were 8.7% (9 of 103 patients) and 27.2% (28 of 103 patients), respectively (p < 0.001).

Conclusion. A statistically significant increase in occurrence of radiation pneumonitis and radiation fibrosis was defined in HL patients who suffered bleomycin-induced pneumonitis.

The aim of this study is to assessment of the rapid effects of t-He/O₂ in comparison with the effective level of high-flow oxygen therapy (HPO) on the main indicators of oxygen transport, central and pulmonary hemodynamics in patients with chronic obstructive pulmonary disease (COPD) with hypercapnic acute respiratory failure.

Methods. A total of 33 (29 male, 4 female) patients were included in a randomized, comparative study with exacerbation of COPD and acute respiratory failure, admitted to the department of anesthesiology and intensive care of D.D.Pletnev City Teaching Hospital, Moscow Healthcare Department, between March and May 2017. Patients were divided into two groups: the 1st group – 18 patients (15 male, 3 female) receiving t-He/O₂ (He – 70%, O₂ – 30% at a temperature of 70 °C; the 2nd group – 15 patients (14 male, 1 female) receiving high-flow oxygen therapy with FiO₂ – 30% through a Venturi mask for the treatment of ODN against the background of basic therapy of the underlying disease, according to the recommendations of GOLD 2016. Assessment of oxygen transport, central and pulmonary hemodynamics was carried out through the definition of indicators: saturation of hemoglobin of arterial blood with oxygen (SaO₂), saturation of venous blood hemoglobin with oxygen (SvO₂), partial pressure of arterial blood oxygen (РaO₂), partial pressure of arterial blood carbon dioxide (РaCO₂), partial pressure of mixed venous blood oxygen (РvO₂), partial pressure of mixed venous blood carbon dioxide (РvCO₂),mean pulmonary artery pressure (MPAP), cardiac output (SV), heart index (C_I), pulmonary vascular resistance (RVR_I), impact volume index (SV_I), pulmonary vascular resistance index (RVR_I), left ventricular shock index (LVSW), right ventricular shock index (RVSW), system speed of oxygen delivery (DO₂), the coeffiCIent of extraction of oxygen (ExO₂), shunt fractions (venous mixing) (Qs / Qt)).

Results. Short-term inhalation with a thermal helium-oxygen mixture in patients with COPD with hypercapnic acute respiratory failure is accompanied by an increase in SaO2 94,1 (92,8; 97,5) initially 86,1 (85,9; 88,1), РаО₂ (78,1 (74,8; 80,1) initially 55,2 (52,5; 65,3)), decline РаСО₂ (57,4 (54,2; 66.4) initially 65,4 (58,1; 67,2)). Thermal helium-oxygen mixture leads to stabilization of hemodynamics, improving the work of the right and left heart: decline MPAP 28,2 (24,3; 32,8) initially 43,3 (40,1; 49,5), RVRI (285,3 (258,4; 362,7) initially 592,1 (498,2; 623,5)), RVSW (16,2 (14,1; 21,4) initially 25,8 (21,8; 32)), HR 91,1 (86,4; 98,7) initially 115 ((105; 118) to increase LVSW (58,2 (49,8; 62,4) initially 35,5 (28,9; 42,1)), SVI 36,2 (31,8; 42,1) initially 31,5 (28,4; 36,2). Elimination of arterial hypoxemia and a positive effect on hemodynamics ensures adequate oxygen transport to tissues, which is expressed in the normalization of DO₂ values DO₂ (980,4 (858,45; 1208) initially 280,3 (270,34; 387,4)) и ExO₂ (27,8 (25,6; 34,5) initially 32,1 (30,7; 39,8) and decline Qs/Qt. (28,7 (18,6; 35,4) initially 42,8 (39,2; 49,1).

Conclusion. Short-term therapy of patients with COPD with hypercapnic acute respiratory failure using the t-He/O₂ method, in comparison with high-flow oxygen therapy, improves blood oxygenation and hemodynamics. Elimination of arterial hypoxemia and a positive effect on hemodynamics made it possible to ensure adequate oxygen transport to tissues, which was expressed in the normalization of transport values, oxygen delivery, and a decrease in the shunt fraction.

Changing the "portrait" of patients with idiopathic pulmonary hypertension (IPH) and chronic thromboembolic pulmonary hypertension (CTPH) over the past decade suggests the need to develop models of phenotypes in patients with this cohort.

The purpose of the study was to estimate the nature of the disease course and prognosis of patients with IPH and inoperable CTPH based on the formation of phenotypic groups depending on the comorbid status.

Materials and Methods. Patients with IPH (n = 88) and inoperable CTPH (n = 38) aged 38.5 [28.5; 51] and 53.5 [41; 58] years respectively were enrolled in the study. 6-minute step test (6-MST) and spiroveloergometry, transthoracic echocardiography (EchoCG), catheterization of the right side of the heart was performed at the moment of diagnosis verification and in 13 [12; 20] months. All patients were divided into 5 groups according to comorbid status: Group 1 (n = 29) – patients with IPH/CTPH without comorbid pathology; Group 2 (n = 23) with body mass index (BMI) ≥ 25 kg/m² ; Group 3 (n = 27) – with BMI ≥ 25 kg/m² and dyslipidemia; Group 4 (n = 30) with hypertension, BMI ≥ 25 kg/m² and dyslipidemia; Group 5 (n = 17) with the listed comorbid pathologies and carbohydrate metabolic disorders.

Results. Initially more severe functional status was observed in patients of the 4th and 5^th groups as compared to those in the 1^st and 3^rd groups. According to the data of the 3-dimensional EchoCG, in patients of the 4^th and 5^th groups a reliably more expressed increase in the volume of the right ventricle was revealed in comparison with such values in the 1^st and 3^rd groups. In IPH groups 1 and 3, the positive results of the vasoreactivity test (34.5% and 48.2%) were significantly more frequent in comparison with groups 4 (6.7%) and 5 (5.9%). The period from the diagnosis verification to adding the 2^nd specific drug was significantly shorter in patients with IPH/CTPH of the 5th group compared to patients of the 3^rd group. a high risk of lethal outcome after 13 [12; 30] months of treatment was significantly less frequently observed with IPH in Groups 1 and 3 as compared to Group 5.

Conclusion. The combination of BMI ≥ 25 kg/m², dyslipidemia, hypertension, as well as the additional presence of carbohydrate metabolism disorders is associated with a less favorable course of the disease in patients with IPH and inoperable CTPH.

Severe asthma is a heterogeneous disease consisting of several endotypes and phenotypes diagnosed due to different biomarkers. Frequency of different endotypes and phenotypes in real clinical practice needs further investigation.

The aim of this study was to assess biomarkers of T2-inflammation in patients with severe asthma in a single secondary care center.

Methods. We examined 96 adult outpatients (34% male) with severe asthma. Data collected included demographics, smoking history, asthma exacerbations during previous 12 months, medication use, comorbidities. Lung function tests were assessed by using the Spirograph 2120 (Vitalograph, Great Britain). Blood eosinophils (Eos) were measured by automatic haemoanalyser. Atopic status was determined by positive skin prick-test (> 3 mm) and/or serum specific IgE to common inhalant allergens. Serum total IgE levels were assessed by immunofluorescence assay. FeNO was measured by a chemiluminescence analyzer (Model LR4000; Logan Research, Rochester, UK). Presence of allergy, need for regular oral steroid use, blood Eos ≥ 150 cell/μl and FeNO ≥ 20 ppb were considered as markers of T2-driven inflammation. Asthma control and quality of life were assessed by using Russian versions of ACQ-5 and St. George's Respiratory Questionnaire (SGRQ). Statistical analyses were performed with Statistica Ver. 10.0 (StatSoft, Inc., USA).

Results. The majority of patients with severe asthma (93%) have at least one or more elevated markers (presence of allergy, need for regular oral steroid use, Eos ≥ 150 cell/μl or FeNO ≥ 20 ppb) of T2-inflammation. Biomarkers levels did not differ in non-steroid-dependent and steroid-dependent patients. The most frequent markers were allergy and blood Eos ≥ 150 cell/μl. Two or more elevated biomarkers were revealed in 72% of patients.

Conclusion. The majority of patients with severe asthma in real clinical practice have signs of T2-inflammation. It seems that many severe asthmatics have indications for prescription of biological and can be treated by more than one of monoclonal antibodies against major cytokines of T2-inflammation.

Diseases that manifest as Х-ray syndrome of pulmonary dissemination are one of the most complex differential diagnostic problems in pulmonology and Phthisiology. Literature data on the effectiveness of using a new intradermal test with tuberculosis recombinant allergen (ATR, Diaskintest®) for disseminated processes in the lungs are single and contradictory.

The aim. Тo study the diagnostic capabilities of intradermal test with tuberculosis recombinant allergen in disseminated lung processes of various etiologies.

Methods. The analysis of archival materials of 204 patients with disseminated lung processes of various etiologies who were admitted to diagnostic departments of the N.S.Pokhvisneva Voronezh regional anti-tuberculosis dispensary in 2011 – 2019 was carried out. There were 85 (41.67%) women and 119 (58.33%) men aged 19 to 87 years. The data of im mu no - logical examination of patients using intradermal Mantoux samples with 2 TE PPD-L and with ATR were studied, and their comparative analysis was performed.

Results. In disseminated pulmonary processes in tuberculosis, the proportion of individuals who respond positively to the Mantoux test was greater only in comparison with the group of people with sarcoidosis (p < 0.01) and did not significantly differ from the results in other groups of patients (p > 0.05). At the same time, the proportion of people who respond positively to a test with ATR in tuberculosis was greater than in patients with pneumonia, sarcoidosis (p < 0.01) and, to some extent, with a tumor. In healthy individuals, a lower proportion of positive reactions to ATR was established compared to the Mantoux test (p < 0.01). With active disseminated pulmonary tuberculosis, a hyperergic reaction (11.9%) was observed in the sample with ATR, which was not observed with the Mantoux test. In non-specific processes in the lungs, less often than negative reactions (p < 0.05) were detected on the sample with ATR less often than on the Mantoux test with 2 TE.

Conclusion. The ATR sample compared to the Mantoux test indicates that it is appropriate to use it in the differential diagnosis of tuberculosis and non-specific lung diseases in adult patients with radiological dissemination syndrome.

In the Russian Federation, after the adoption of Federal Law “On the Protection of Citizens' Health from the Effects of Tobacco Smoke and the Consequences of Tobacco Use”, the prevalence of smoking tobacco has significantly decreased. Reducing the consumption of smoking tobacco products led to the emergence of a new aggressive policy of tobacco companies, which resulted in the emergence of new “innovative” products and the concepts of “less harmful tobacco product” or “less harmful nicotine-containing product”. The undoubtedly aggressive advertising campaigns of tobacco companies and manufacturers of electronic cigarettes have affected the smoking behavior of tobacco consumers, which has begun to change in recent years.

The purpose of this study was to study new trends in the structure of consumption of tobacco and nicotine-containing products in various age groups of the Russian Federation, as well as among men and women.

Methods. Analysis of the structure of consumption of tobacco and nicotine-containing products was carried out as part of an online public opinion poll to study the level of awareness of measures to reduce the prevalence of tobacco products in the Russian Federation, initiated in 2019 by the Ministry of Health of the Russian Federation. A total of 1 282 respondents from 73 regions of the Russian Federation took part in the survey. Among the respondents there were 447 (34.9%) men and 835 women (65.1%) aged 18 years and younger to 70 years. To conduct a comparative analysis of the structure of use of tobacco and nicotine-containing products, the frequencies of their use in different age groups, among men and women, were calculated. A statistically significant difference between the groups was confirmed by analyzing the dependence in the contingency table using the χ² criterion.

Results. A total of 432 respondents reported the use of tobacco and nicotine-containing products, which amounted to 33.7% of all respondents. The most used products were smoking tobacco (57.64%), electronic cigarettes (34.03%) and waterpipe (33.80%). However, in different age groups, the structure of their use was significantly different (p < 0.05). The highest level of electronic cigarette use, including vapors containing nicotine and electronic nicotine delivery product, were found in the age group of 18 years and younger (58.82%). In the older age groups, a significant decrease in the level of consumption was observed. Chewing tobacco and snuff were consumed by consumers significantly less than other tobacco products. Smokeless tobacco was mainly consumed by consumers aged 18 years and younger, its level was 20.58%. The highest level of waterpipe consumption was found among consumers in the age group of 19 – 29 years (53.85%), it was slightly less in the group of 18 years and younger (44.11%). The higher level of waterpipe consumption was detected (40.35%) among women than it was among men (26.47%). Many consumers indicated that they consumed several types of tobacco and nicotine-containing products. The most popular combination of products was found among consumers under the age of 30, and 20.59% of consumers aged 18 and younger consumed at the same time almost all the types of tobacco and nicotine-containing products that were presented on the market.

Conclusion. The study revealed new trends in preferences for consumption of tobacco and nicotine-containing products. The new trends have significantly changed the structure of the consumption of these products among the population of Russian Federation.

Lung cancer is leading cause of death across oncological diseases. Nowadays, the therapy of lung cancer remains most serious problem of oncology. Targeted therapy including tyrosine kinase inhibitors (TKIs) is widely used in current clinical practice to treat advanced or metastatic non-small cell lung cancer. This paper reviews the clinical aspects of TKIs application in practical medicine. The article summarizes the results and outcomes of key clinical trials focused on efficiency and safety of TKIs, describes the results of analysis for TKIs need within the Moscow City Department of Healthcare system providing preferential medicines. The perspectives of future clinical developments of targeted treatments for lung cancer are postulated and discussed as well. Our previously unpublished data clearly demonstrate that gefitinib, erlotinib and afatinib turned out to be the most used TKIs for treatment of non-small cell lung cancer in the system of preferential medicine supply for Moscow population in 2018. The choice of targeted drugs directly depends on the molecular genetic profile of the tumor. To further improve the use of financial resources of the Moscow City Department of Healthcare it is essential to define accurately the molecular profile of the tumor specimens and prescribe the most effective TKIs for each individual case of lung cancer.

Based on the latest new international literature data, the article considers the possibilities of fixed combinations of long-acting β₂-agonist, long-acting muscarinic antagonist and inhaled corticosteroids in achieving the control of bronchial asthma (BA). Clinical advantages for a fixed combination of indacaterol, glycopyrronium and mometasone furoate one dosing regimen in the therapy of BA are presented based on the results of recently completed randomized clinical trials IRIDIUM and ARGON.

The article presents an overview of the problem of respiratory failure in patients with acute stroke, its prevalence, leading pathophysiological factors, clinical features, and diagnostic methods. Stroke is the third leading cause of death worldwide. Stroke survivors often experience medical complications that may be the direct cause of mortality. The syndrome of respiratory failure and respiratory complication are common after stroke. The syndrome of respiratory failure syndrome of varying severity is following after stroke in 44 – 90%, often remains undervalued, undiagnosed, due to the clinical features of this category of patients. The nature of these disorders depends on the severity and site of neurological injury. Abnormality of breathing control, respiratory mechanics, and breathing pattern are common and may lead to gas exchange abnormalities or the need for respiratory support. The leading symptom is hypoxemia, which is often hidden, and may be detected by examining of arterial blood gasses (PaO2, PCO2). Stroke can lead to sleep disordered breathing such as central or obstructive sleep apnea. Sleep disordered breathing may also play a role in the pathogenesis of cerebral infarction. Venous thromboembolism, swallowing abnormalities, aspiration, and pneumonia are among the most common respiratory complications of stroke. Neurogenic pulmonary edema occurs less often but may be very dramatic. Therefore, early diagnosis, prevention and treatment are important in reducing mortality and improving functional rehabilitation.

Nosocomial pneumonia (NK) is one of the most frequent complications of polytrauma leading to death. Meanwhile, the recommendations on prevention of NK in case of polytrauma have not been specified so far. This is due in large part to the lack of study of the pathophysiology of severe combined trauma. The review presents the results of modern experimental and clinical studies of the effect of shock, immune distress syndrome, posttraumatic immunosuppression, the phenomenon of mutual aggravation of lesions, age, sex, concomitant pathology on the risk of NK in polytrauma. The role of iatrogenic risk factors for NK in polytrauma – intubation of trachea and artificial lung ventilation (AVL), massive hemotransfusions, immobilization, the phenomenon of “second strike” after multiple surgeries has been determined. The most effective measures of NK prevention are reduction of the duration of AVL, prevention of oropharyngeal colonization and aspiration in case of AVL, use of inhalation antibacterial drugs, antishock measures, early mobilization of the patient, the earliest possible stable functional osteosynthesis by minimally traumatic methods. The data on the effectiveness of selective decontamination of intestines, probiotics and glucocorticosteroids for the prevention of NK in polytrauma are inconsistent. A promising area of NK prophylaxis may be the development of agents that regulate the complex mechanisms of immune response to polytrauma and prevent secondary acute lung injury and post-traumatic immunosuppression.

A rare observation of the isolated asymptomatic cysticercosis of the lungs is presented, in the diagnosis of which the leading role was played by magnetic resonance imaging of the lungs (MRI), according to which the fluid character of focal changes with scolexes inside, low blood flow in the foci was clarified, and lung malignancy was excluded. According to the results of computed tomography, signs of calcification of the cysticercus capsules were recorded on the 7th year of dynamic monitoring, while the initial diagnosis was finally confirmed.