Respiratory diseases (RD) represent one of the most urgent issues in Russian health care and have high socio-economic significance.

The aim. To study the dynamics of total morbidity and mortality in the Russian Federation, as well as the mortality associated with RD in the working-age population in 2015 – 2019.

Methods. The official statistical data of the Ministry of Health of the Russian Federation and the Federal State Statistics Service were analyzed.

Results. In 2019, the total RD-associated morbidity increased by 5.4%, and the prevalence of pneumonia increased by 29.0% compared to 2015. In 5 federal districts (FD), the morbidity exceeded the average Russian morbidity in 2019 (40,694.7). The maximum level was observed in the North-Western FD (50,224.1). The prevalence of pneumonia (Russia – 524.4) in 4 FDs exceeded the average Russian prevalence. The maximum level was reported in the Far Eastern FD (749.2 cases per 100 thousand of the total population). The RD-associated mortality rate in Russia was 51.8 cases per 100 thousand in 2015 and 41.6 cases per 100 thousand in 2018 (–19.7%). In 2018, the highest RD-associated mortality was observed in the Siberian FD (68.0) and Far Eastern FD (57.8 per 100 thousand people). From January to December 2019, the highest mortality associated with pneumonia in the working-age population was observed in the Far Eastern FD (28.2 per 100 thousand people). The RD-associated mortality rate in the male population was 4.2 times higher than in the female population (26.7 and 6.3, respectively, per 100 thousand persons of matching age).

Conclusion. The highest morbidity was found in 2018 and 2019 in the Northwestern FD and Far Eastern FD. The RD-associated mortality in the Siberian FD and Far Eastern FD exceeded the average Russian values. This last observation requires additional research to improve the quality of medical care.

Despite the impressive progress in diagnosis and management of acute COVID-19, data regarding the consequences of this infection are just emerging. The World Health Organization has proposed the term post-COVID condition (PCC) to describe the wide range of sequelae of acute COVID-19. With more than 200 million confirmed cases of COVID-19, PCC may develop into a major problem for many years to come for the millions of COVID-19 survivors worldwide. Few studies were conducted in primary care, and very few studies have focused exclusively on children and adolescents.

Objective. To review existing data on PCC. Analysis of manuscripts published in peer-reviewed journals and clinical protocols. PCC is characterized by a wide range of systemic, cardio-pulmonary, gastrointestinal, neurological, and psychosocial symptoms.

Conclusion. Although PCC prevalence is difficult to estimate due to methodological limitations of the existing studies, there is no doubt that this problem is a significant healthcare burden. There is a need for further observational and interventional studies to establish optimal PCC prevention and management strategies.

World literature is paying increasing attention to the long-term course of COVID-19 and symptoms that appear after the acute coronavirus infection. The symptoms, functional state of the lungs, and the X-ray changes are assessed. Nevertheless, post-COVID lung histology has not been described yet.

The aim of this article is to study the long-term pathological changes in the lungs after acute COVID-19. Methods. We analyzed autopsy lung material from 19 deceased who had COVID-19. The average age of the deceased was 68.82 ± 14.6 years. All patients were found to have IgG to SARS-CoV-2. The median time to death following viral interstitial pneumonia was 72 days. Results. The causes of death and thrombotic complications (infarctions of various organs and venous thrombosis) were analyzed. Histological examination revealed thrombosis of small pulmonary arteries and capillaries of interalveolar septa, microinfarctions, hemorrhages, foci of organizing pneumonia, and nonspecific interstitial pneumonia.

Conclusion. The first assessment of histological changes in human lungs showed that the most common post-COVID pathologic changes are microcirculation disorders combined with small areas of acute lung damage. The obtained data are essential for understanding the pathogenesis of post-COVID syndrome, necessitate diagnostic of microvasculature disorders using laboratory tests, scintigraphy, and CT imaging, as well as search for the therapeutic strategies.

The end of the acute period of COVID-19 does not mean complete recovery. Observation of patients in the post-COVID-19 period showed that a significant number of people experience shortness of breath, fatigue, muscle weakness, sleep disorders, cough, palpitations, so the term post-COVID-19 syndrome was coined. The examination to identify the causes of complaints of COVID-19 convalescents should include lung function assessment.

The aim of the study was to assess the dynamics of lung function 4 months after hospitalization for COVID-19.

Methods. 31 patients (26 males, the median age was 49 years) underwent traditional pulmonary function tests (PFTs) (spirometry, body plethysmography, test of diffusing lung capacity) and impulse oscillometry (IOS). Results. During the 1^st visit, the average PFTs and IOS parameters were within the normal range in the whole group, apart from the diffusing lung capacity (DL_CO), which was reduced mildly (on the border with moderate) in 77% of patients. During the 2^nd visit, which was conducted on average 102 days after the 1^st one, 58% of patients demonstrated abnormal lung diffusion capacity. The second assessment revealed a statistically significant increase in the slow and forced vital capacity (VC and FVC), the forced exhalation volume in 1 second (FEV₁), total lung capacity (TLC), DL_CO, and a decrease in the ratio of FEV₁/FVC and the residual lung volume to TLC ratio.

Conclusion. Post-COVID-19 patients show a statistically significant improvement of their lung function 4 months after hospital discharge. A systematic follow-up is essential for such patients to detect lung function abnormalities and correct them.

The endothelium is a tissue most vulnerable to the SARS-CoV-2 virus. Systemic endothelial dysfunction leads to the development of endothelitis which causes the main manifestations of the disease and systemic disturbance of microcirculation in various organs. Pulmonary microcirculatory damage, the most striking clinical manifestation, was the reason to perform SPECT to detect microcirculation disorders.

Aim. To assess microcirculatory changes in the lungs of patients who had no previous respiratory diseases and had a COVID-19 infection at different times from the onset of the disease.

Methods. SPECT data were analyzed in 136 patients who had a proven coronavirus infection of varying severity from May 2020 to June 2021.

Results. All patients showed changes in microcirculation in the lungs in the post-COVID period. The severity of microcirculation disorders had a significant correlation (r_s = 0.76; p = 0.01) with the degree of damage to the pulmonary parenchyma and an average correlation (r_s = 0.48; p = 0.05) with the timing of the post-COVID period and the degree of residual lesions on CT (r_s = 0.49; p = 0.01). The examined patients with persistent clinical complaints had pulmonary microcirculatory lesions, which may indicate the development of vasculitis, at all stages of the post-COVID period. Despite regression of the lesions confirmed by CT in 3 to 6 months after the acute COVID-19 infection, specialists from Russian and other countries report that 30–36% of patients develop pulmonary fibrosis. Similar changes were identified in 19.1% of the examined patients in our study.

Conclusion. Microcirculation disorders are detected in all patients in the post-COVID period, irrespective of the severity according to CT. Progressive decrease in microcirculation in the lower parts of the lungs, local zones of hypoperfusion with the critically low accumulation of radiopharmaceuticals, persistent areas of compaction of the lung tissue (so-called “ground glass”), reticular changes, and the development of traction bronchiectasis, a decrease in the diffusion capacity of the lungs and alveolar volume may indicate fibrotic lesions with subsequent development of virus-associated interstitial lung disease.

The post-COVID symptom complex is wide enough and requires special vigilance during clinical examination of patients after the novel coronavirus infection.

The aim of the Multidisciplinary Expert Board study was to develop a standardized questionnaire for initial self-assessment by patients who had had COVID-19 before the expanded medical check-up.

Methods. The existing validated international and national questionnaires and scales were analyzed to assess their relevance, convenience, and ease of filling out. Results of the analysis were used to set up a screening for post-COVID symptoms.

Results. The work of the Multidisciplinary Expert Board in June-August 2021 resulted in a new screening questionnaire for the initial assessment of the health status of patients who have COVID-19. The questionnaire is intended for self-filling before the further clinical examination.

Conclusion. A new standardized patient questionnaire to screen for post-COVID symptoms may significantly optimize the doctor’s working time, increase the efficiency of diagnosis, improve the principles of selection and formation of risk groups of patients during an expanded medical check-up.

Asthma management approaches are improving yearly, but the problem of asthma control is still acute. Combinations of inhaled glucocorticosteroids (ICS) and long-acting β₂-agonists (LABA) play a crucial role in asthma therapy, but their effectiveness in real practice can be insufficient, and asthma control level in the population remains low. Optimizing the use of these drugs, changing the usual therapy regimens, and implementing upgraded inhalers can improve adherence to treatment and inhalation technique, which affects the effectiveness of the therapy.

The study aimed to describe the key characteristics of the patient population getting asthma treatment in real clinical practice and assess factors influencing asthma control, including adherence to therapy.

Methods. A single-stage cross-sectional observational study in 124 primary health care centers in 22 cities of the Russian Federation included 3,214 patients > 18 years old, with a clinical diagnosis of asthma for at least 1 year, who were able to perform a spirometry test and fill out the ACQ-5 and TAI-12 questionnaires.

Results. Assessment of asthma control with the ACQ-5 questionnaire showed that most patients had uncontrolled asthma (56%). Controlled and partially controlled asthma was diagnosed in 21 and 19% of patients, respectively. 4% of patients had severe uncontrolled asthma. The TAI questionnaire revealed low adherence to therapy in more than half of the patients (53.6%). The rate of patients with controlled asthma and the average annual frequency of exacerbations were significantly lower in subgroups of patients who received therapy with extrafine ICS/LABA and ICS/formoterol in single inhaler regimen, compared with controller therapy using fixed and free combinations of ICS and LABA.

Conclusion. The main causes of insufficient asthma control are low adherence to treatment, inhalation errors, monotherapy with ICS, asthma with small airways dysfunction, and adverse events associated with ICS. Prescribing the combinations of ICS/LABA in the form of extra-fine aerosol and using it in the Maintenance and Reliever Therapy (MART) regimen can significantly increase asthma control, reduce the risk of adverse events, and increase patient adherence to treatment. A potential alternative to improve asthma control is administering ICS-LABA combinations once daily.

To evaluate the effectiveness of benralizumab in patients with the eosinophilic phenotype of severe asthma in real clinical practice after a year of therapy.

Methods. During Benralizumab therapy, 13 patients with severe eosinophilic asthma (average age – 55.44 ± 7.18 years old) were examined twice: before the treatment and after 1 year of benralizumab therapy. The assessment included collection of complaints, medical history, current therapy, Asthma Control Questionnaire (ACQ-5) test, absolute blood count of eosinophils, spirometry.

Results. All patients initially had pronounced eosinophilia of 577.5 ± 356.4 cells/μl. After 1 year of using benralizumab, the eosinophil count decreased by 96.15%. During therapy, the ACQ-5 index decreased from 1.63 ± 0.62 to 0.73 ± 0.41 in the study patients, which corresponded to the achievement of asthma control. The forced expiratory volume in 1 second (FEV1) increased by 23 %. The number of exacerbations decreased by 58.09%. 12 (92.31%) patients were on oral corticosteroids (OCS) (10 ± 2.17 mg of prednisolone daily) before benralizumab therapy. All subjects noted a decrease in night and day symptoms over time and were able to reduce the use of OCS. 5 (38.46%) patients achieved complete elimination of daily OCS use, 7 (53.84%) patients were able to reduce their daily OCS dose.

Conclusion. Benralizumab therapy as an add-on maintenance treatment in patients with eosinophilic phenotype of severe asthma contributes to a significant decrease in peripheral blood eosinophils, which mediates an improvement in asthma control, an increase in FEV₁, a reduction in the number of exacerbations, and a decrease in the need for the OCS usage. Careful monitoring of long-term adverse events is necessary during treatment with benralizumab.

Aim. To propose a new type of antiviral treatment for COVID-19, pending the rollout of the developed vaccines and bypassing vaccine resistance of the new upcoming mutated virus variants. Aiming for prophylaxis and early therapy, the search focused on small molecules or repurposed, safe, oral and inexpensive drugs, also suitable for low-income countries.

Methods. A search in peer-reviewed literature for preclinical antiviral mechanisms highlighted at last two clinical studies for further detailed clinical analysis: 1) High dose N-acetylcysteine (NAC) was successfully applied in very severe COVID-19-pneumonia; 2) The discovery of serum level H₂S (hydrogen sulfide) as a prognostic host factor.

Results. Combining of these two findings resulted in a step-by-step approach with 3 perspectives that describes how H₂S works in viral respiratory diseases, how H₂S targets at least three vulnerabilities in the SARS-CoV-2 virus; finally, how H₂S can be generated and with which drugs. More than 3 dozen successful, clinically well-documented applications have already been found.

Conclusion. By using NAC as the H₂S donor, the generated endogenous antiviral H₂S reactivates the collapsed innate immunity, providing a therapy regimen for COVID-19. Further randomized controlled trials are warranted, considering antiviral H₂S for inclusion in some master trial protocols.

Chronic obstructive pulmonary disease (COPD) is associated with significant healthcare and socioeconomic burden. International guidelines recommend a personalized approach to treatment and management that aims to reduce symptom burden and exacerbation risk. Numerous recently published clinical trials have investigated efficacy and safety of single-inhaler triple therapy (SITT) with a long-acting muscarinic antagonist (LAMA), long-acting β₂-agonist (LABA), and an inhaled corticosteroid (ICS) for patients with COPD.

Aim of the publication: to review the findings of randomized controlled trials that showed the benefit of single-inhaler triple therapy and compare this benefit with the known risk of pneumonia associated with ICSs.

Conclusion. The key benefits reported with SITT are significant reductions in exacerbations and hospitalizations; the trials also suggest reduced all-cause mortality. The benefits of SITT outweigh the known risk of pneumonia with ICS use that is reported as the class-effect in COPD patients.

The aim: review scientific research to find out whether the new coronavirus infection (NCI) causes fibrotic changes in the lungs and, if any, how long they persist and whether functional disorders of the respiratory system accompany them. Disruption of the functional state of the lungs in patients with severe novel coronavirus disease (COVID-19) is still seen 6 months after completion of inpatient treatment. High-resolution computed tomography (HRCT) demonstrates persistent pathological changes in the lungs, some of which are fibrosis-like. Pathomorphological features of the COVID-19 course, as well as the ability of the virus to activate connective tissue growth factor (CTGF) and enhance the signaling of transforming growth factor-beta (TGF-β), can contribute to lung tissue fibrosis. Increased titers of antinuclear autoantibodies and specific autoantibodies indirectly reveal dysregulation of the immune response leading to the progression of organizing pneumonia and fibrotic changes in the lung tissue. These increased titers can also indicate the need to prescribe immunosuppressive and antifibrotic drugs. Researchers are considering the possibility of including antifibrotic drugs in combination therapy for severe COVID-19 in the early stages of treatment in patients with risk factors for developing pulmonary fibrosis. However, further monitoring and determination of the role of antifibrotic drugs are required. Sometimes patients with COVID-19 develop severe, irreversible fibrotic lung disease, and lung transplantation is the only treatment option.

Conclusion. There is no unequivocal opinion among researchers concerning the clinical significance and further prognosis of COVID-19 so far, which is a reason for further studies.

The emergence of a new disease COVID-19 (coronavirus disease 2019), caused by the coronavirus named SARS-CoV-2, has significantly changed the usual interaction pattern between a doctor and a patient. Previous large studies have identified risk factors for a severe course of COVID-19, including old age, hypertension, diabetes, cardiovascular diseases, and chronic obstructive pulmonary disease. However, asthma and respiratory allergy have not been identified as risk factors for the severe disease. These factors give clues to the pathogenesis of COVID-19, approaches to the controller medications, target therapy, allergen-specific immunotherapy (ASIT) in patients with various phenotypes and endotypes of asthma during the pandemic.

The purpose of this review is to summarize the currently available knowledge about SARS-CoV-2, T2-endotype of asthma, eosinophilic inflammation. The article provides an overview of the data from studies of COVID-19 patients with asthma, the main recommendations of the Global Initiative for Asthma (2021) and the Ministry of Health of the Russian Federation. It shows that targeting the endotypes and phenotypes of asthma can influence the management of COVID-19 patients with asthma. The influence of the imbalance of the immune system, pro-inflammatory cytokines, and effector cells in patients with asthma on the development and progression of COVID-19 is considered. Recommendations are given for the controller medications, targeted therapy, allergen-specific immunotherapy during the pandemic.

Conclusion. The current recommendations for asthma treatment, based on the latest research of COVID-19, deepen our understanding of the course of COVID-19 in patients with different phenotypes and endotypes of asthma, approaches to traditional methods of treating asthma according to clinical guidelines during the pandemic.

The novel coronavirus (COVID-19) pandemic announced by the World Health Organization in March 2020 has brought new tasks to the medical community that require immediate solutions. Recent studies have shown that invasive aspergillosis associated with coronavirus infection caused by COVID-19 often aggravates the course of the disease and leads to death. The article presents a clinical case of acute invasive aspergillosis in a COVID-19 patient with chronic somatic pathology but no risk factors for developing invasive pulmonary aspergillosis. The disease was progressing rapidly and led to a fatal outcome.

Conclusion. In the case presented, invasive pulmonary aspergillosis was diagnosed with the help of histological examination of autopsy material.