Bronchial asthma occurs in 0.9 – 17% of patients hospitalized with COVID-19. However, it is not clear whether asthma is a risk factor for the development and severity of COVID-19. Studies have shown that patients with asthma appear to be more susceptible to COVID-19 infection, but severe disease progression is not related to medication use, including asthma biologics, but rather to older age and comorbidities.

Aim. To evaluate the clinical course of SARS-CoV-2 infection in elderly patients with asthma, to examine the effect of asthma and comorbidities on COVID-19related outcomes, and to determine predictors of mortality.

Methods. Elderly patients [WHO, 2020] (> 60 years, n = 131, median age 74 (67; 80) years; 59 men, 72 women) with asthma hospitalized for COVID-19 were included in the study. COVID-19 was confirmed by laboratory tests (PCR smear) and/or clinical and radiological examinations. All patients had a history of a documented diagnosis of asthma (GINA, 2020).

Results. Out of 131 patients, 30 (22.9%) died in the hospital, and 15 (14.9%) died after discharge from the hospital (within 90 days). The group of patients with lethal outcome showed the following differences from those who recovered: values of Charlson index, respiration rate, degree of lung damage on CT scan, absolute number of leukocytes, neutrophils and neutrophils-to-lymphocytes ratio, C-reactive protein on the 5th day of hospitalization, and LDH were statistically significantly higher, while absolute number of eosinophils, total protein content, SpO₂ and SpO₂/FiO₂ levels were lower; steroid intake during the year and non-atopic asthma were more common. Multivariate and ROC analysis revealed the most significant predictors of hospital mortality and their thresholds: Charlson comorbidity index ≥ 6 points, neutrophil/lymphocyte ratio ≥ 4.5, total protein ≤ 60 g/l, eosinophil level ≤ 100 cells/μL.

Conclusion. The most significant predictors of hospital mortality in elderly patients with severe COVID-19 against asthma are Charlson comorbidity, neutrophil/lymphocyte ratio; lower eosinophil and total protein levels. Survival time of patients has an inverse correlation with the number of mortality risk factors present.

Although more than 2 years have passed since the beginning of the pandemic of the new coronavirus infection, treatment and prediction of the course of SARS-CoV-2 infection remain pressing global problems. In this regard, the search for additional links in the pathogenesis of SARS-CoV-2 is currently one of the most important tasks.

The Aim. To assess the level of lipopolysaccharide-binding protein (LBP) and presepsin (sCD14-ST) in patients with SARS-CoV-2 viral lung disease in Crimea.

Methods. We examined 121 patients with a positive PCR result for SARS-CoV-2 in the age group of 45 – 75 years who were hospitalized in the Department of Infectious Diseases, State Budgetary Healthcare Institution of the Republic of Crimea “N.A.Semashko Republican Clinical Hospital”. Patients were divided into 3 clinical groups according to the severity of SARS-CoV-2 infection: Group 1 – patients with moderate disease, Group 2 – patients with severe disease, and Group 3 – patients with fatal outcome. Peripheral blood levels of LBP, presepsin, ferritin, and C-reactive protein were determined upon admission to the infectious disease hospital.

Results. A significant increase in all studied parameters was observed in the 1st, 2nd and 3rd clinical groups of patients with coronavirus infection. This finding corresponds to the state of lipopolysaccharide-binding systems and systemic infection in patients with SARS-CoV-2 viral lung disease. The highest levels of LBP, sCD14-ST, and ferritin were registered in the 3rd clinical group. We found a direct correlation between LBP and sCD14-ST levels in the 2nd group (r = 0.523, p < 0.05) and the 3rd group (r = 0.748, p < 0.05).

Conclusion. Patients with SARS-CoV-2 lung disease were found to have an increased blood levels of LBP and presepsin upon admission. The highest values were observed in patients with fatal outcome. Severe SARSCoV-2 lung damage was associated with a direct correlation between levels of LBP and sCD14-ST. Presepsin, LBP, and ferritin are important prognostic markers for severe SARS-CoV-2 lung damage and risk of death in the early stages of hospital treatment.

The aim of the study was to explore the clinical, radiological, functional indicators of hypersensitivity pneumonitis (HP) in combination with arterial hypertension, to assess the effect of these diseases on each other.

Methods. The study included 50 patients with hypersensitivity pneumonitis (HP) and 49 patients with arterial hypertension (AH). The patients were divided into three groups. The main group included 24 patients with hypersensitivity pneumonitis combined with AH. The comparison group was 26 patients with HP without AH; the control group was 25 patients with arterial hypertension alone. Clinical symptoms, radiological findings, and results of instrumental tests were analyzed.

Results. The intensity of clinical symptoms (shortness of breath, cough) was significantly higher in the main group than in the control and comparison groups. Exercise tolerance estimated from the six-minute walk test was significantly lower in the main group. The clinical status correlated with the functional test

Results. Volumetric and velocity spirometry values tended to decrease more in the main group compared to the other two groups. The lung diffusion capacity was significantly lower in the group of patients with HP in combination with AH compared to the group of patients with hypertension only. A similar trend was observed when assessing the chest CT: significantly more pronounced changes were found in the main group. EchoCG showed a significant increase in pulmonary hypertension and volumes of the right heart in the main group compared to the group of patients with AH alone.

Conclusion. The present study provides evidence of the greater intensity of respiratory symptoms, decreased functional status, ventilation disorders, dilated heart cavities, greater risk of fatal vascular complications in patients with HP associated with hypertension.

Since 2004, the Russian Federation has been taking more and more active steps to reduce tobacco consumption, but the epidemiological situation still indicates a low effectiveness of tobacco control measures in several regions of the country. Magadan Region is one of the worst in Russia on the epidemiology of tobacco; its example can show gaps in the state’s tobacco control policy and help work out measures to improve the situation.

Aim. Analysis of the tobacco epidemiology in Magadan Region.

Methods. A wide survey of the population of the region aged over 15 was performed. A total of 341 people were involved in the survey. The collected data included general information about the respondent, information on tobacco use, tobacco cessation, secondhand smoke, the economy, the media, knowledge, attitudes and perceptions related to tobacco use. The type of the sample was quota based on gender, age and geographical distribution of the population.

Results. The study showed that 42% of the population of the region over 15 years old used tobacco regularly. About 90% of the respondents became addicted between 13 and 22 years. The modal consumption values are 10 or 20 cigarettes per day. The average spending on tobacco is about 42 thousand Rubles per year per smoker. Up to a 1/3 of smokers have tried but failed to give up their addiction over the previous year. At the same time, an extremely poor knowledge of the methods of anti-smoking therapy was observed. About 80% of the tobacco users would like to quit smoking in the future.

Conclusion. The relatively small costs of tobacco expenses in regions with a high level of income hinder the most effective method of tobacco control – raising taxes on tobacco products.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with disease progression and increased risk of death. We need to better understand the phenotypes of AECOPD to improve treatment strategies. The main triggers of COPD exacerbations are viral and bacterial infections.

The aim is to characterize the viral, bacterial, and viral-bacterial phenotypes of acute exacerbations in patients with COPD caused by industrial aerosol exposure or tobacco smoke.

Methods. 180 subjects with established moderate and severe COPD who met the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, 2020 – 2021, and were hospitalized with AECOPD, were enrolled in this prospective observational study. The virus-induced, bacteria-induced, and virus-bacteria-induced AECOPD strata (n = 60 each) were formed. Each stratum included 30 patients with occupational COPD and 30 patients with COPD caused by tobacco smoke. Virus-induced AECOPDs were diagnosed by PCR of bronchoalveolar fluid. Length of hospital stay, symptoms, lung function, mean pulmonary artery pressure (mPAP), and type of inflammation were assessed. Cox proportional hazard regression was used to examine the relationships.

Results. The length of hospital stay was highest in patients with virus-induced and virus-bacteria-induced exacerbations of occupational COPD, being equal to (Me, IQR) 16.5 (14 – 18) and 18 (16 – 20) days. The virus-induced exacerbations in occupational COPD and in COPD caused by tobacco smoke featured the highest bronchodilation coefficient, 10.9 (9.8 – 11,5)% and 9.2 (8.3 – 10.3)%, respectively, decrease in the diffusing capacity of the lungs (DLCO/Va) by 42 (40 – 45)% and 49 (47 – 52)%, increase in mPAP by 44 (39 – 45) и 33 (29 – 38) mmHg, and eosinophilic inflammation with blood eosinophil count of 425 (385 –527) and 350 (310 – 391) cells per μl (р > 0.01). Virus-bacteria-induced AECOPD in occupational COPD and in COPD caused by smoke were characterized by decrease in FEV1 by 40.2 (36.6 – 42.2)% and 31.0 (28.1 – 33.6%), decrease in DLCO/Va by 48 (44 – 50)% and 37 (35 – 41)%, increase in mPA by 43 (38 – 46) and 50 (45 – 54) mmHg, and eosinophilic-neutrophilic inflammation in 63.3 and 66.6% of patients. The mid-range FEV1, highest DLCO/Va, and neutrophilic inflammation were seen in patients with bacteria-induced AECOPD.

Conclusion. Exacerbations of occupational COPD are characterized by more severe functional impairment and inflammation with high eosinophil count when these exacerbations have viral origin.

The Interstitial lung diseases (ILD) are a wide heterogeneous group of disorders, different in many parameters, however having similar pathophysiological mechanisms. Idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), chronic hypersensitivity pneumonitis (CHP), ILD associated with autoimmune disorders (predominantly systemic sclerosis (SSc ILD) and rheumatoid arthritis (RA ILD), and other diseases may be accompanied by the formation of pulmonary fibrosis. Currently there are no generally accepted criteria for the fibrosing and progressive fibrosing ILD, and the information on the frequency of these conditions is limited.

The study aims to research the structure of fibrosing ILD and the frequency of the progressive fibrosing phenotype (PFP) according to the register of patients with ILD in Irkutsk, Russia.

Methods. At the first stage information letters were sent to all medical institutions of Irkutsk with recommendations on all referral patients with ILD for further examination. At the second stage, each ILD case was verified collegially (n = 270). All patients’ data were analysed in terms of clinical, functional, radiological and histological aspects. A register of ILD patients was formed based on this analysis. The follow-up period was 1 to 5 years.

Results. According to the results of a comprehensive assessment, HRCT signs of pulmonary fibrosis were detected by 104 patients (38.5%). fibrosing course was observed in 100% IPF and SSc ILD, in 90.9% of CHP, 71.4% of NSIP and 60% of RA ILD. 61 patients (22.6% of all ILD cases, 58.6% of fibrosing ILD) was diagnosed with PFP. The 5-year mortality for PFP ILD was 55.5%.

Conclusion. In the case of a PFP development, the evolution of ILD loses its nosological specificity, acquiring similarity with IPF. Due to the high mortality rate, it is necessary to actively identify the progressive fibrosing course of a wide range of ILD and to prescribe an antifibrotic therapy in a timely manner.

Physical intolerance is an important sign of many chronic respiratory diseases. The most useful tool for clinical evaluation of physical status is six-minute walking test (6-MWT), but sometimes its technical requirements are not feasible. By this reason, a search for alternative field tests have being going on in the last years, but the diagnostic yield of the new exercise tests for most chronic bronchopulmonary diseases is not clear.

The aim of this study was to compare results of 6-MWT and 30-seconds sit-to-stand (30-s-STS) test in patients with fibrosing interstitial lung diseases (ILDs) and restrictive abnormalities of lung function.

Methods. This was a cross-sectional non-randomized open comparative study. Patients with ILDs were asked to perform 6-MWT and 30-s-STS test with 30 min interval. We also analyzed medical history, lung function, and dyspnea assessed with Medical Research Council (MRC).

Results. The study included 25 ILD patients (11 males; 14 women); 75% of patients had restrictive lung function disorders. The mean distance walked in 6-MWT (6MD) was 380.4 ± 111.9 m (M ± SD), 14 (56%) patients desaturated during the test. The mean number of repetitions in 30-s-STS test was 12 (10 – 13) during 30 s; 5 (20%) patients desaturated during the test. 6MD showed moderate correlation with the number of repetitions in 30-s-STS test and to dyspnea on exertion. The number of repetitions in the 30-s-STS test was not associated with any clinical or functional parameters. To the end of exercise, the number of patients who desaturated increased, the desaturation was greater, and post-exercise SpO2 was lower in 6-MWT compared to 30-s-STS test.

Conclusion. 30-s-STS test was less informative in terms of reduced physical tolerance and desaturation on exertion compared to 6-MWT in patients with fibrosing ILDs and restrictive abnormalities of lung function.

Therapy with inhaled nitric oxide (iNO) in patients with hypercapnic respiratory failure (RF) and pulmonary arterial hypertension (PAH) is currently of scientific interest.

 The aim of this study was to evaluate the effects of iNO therapy on COPD patients with hypercapnic RF and PAH during exacerbation of the disease.

Methods. A randomized, prospective, controlled trial included 30 patients with COPD (age 65 (62; 75) years) with hypercapnic RF and pulmonary arterial hypertension (PAH) treated at the State Budgetary City Teaching Hospital “City Clinical Hospital named after D.D.Pletnev of Healthcare Moscow City Department” (2021). The inclusion criteria were: PaCO₂ ≥ 45 mm Hg and pulmonary artery systolic pressure PASP > 40 mm Hg as accessed by Doppler echocardiography. The patients were divided into two groups. Patients of the main group were administered iNO in the form of daily 90-minute sessons for two weeks using Tianoks device (Russian Federal Nuclear Center – All-Russian Research Institute of Experimental Physics, State Corporation “Rosatom”, Russia). Patients of the control group received treatment that corresponded to the severity of their COPD exacerbation according to the guidelines by Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2020 – 2021. Hemodynamics and gas exchange, exercise tolerance, vascular stiffness, and obstructive disorders were assessed at baseline, on Days 7 and 14.

Results. The main group demonstrated a decrease in PASP (38 (32; 43) mm Hg vs 47 (44; 54) mm Hg; p = 0.001), a decrease in stiffness index (SI) (7.03 m / s (5.3; 19.2) vs 12.2 m / s (5.7; 15.1); p = 0.01), decrease the pulmonary shunt fraction (Qs / Qt) (4.33% (3.7; 6.1) vs 9.12% (7.12; 11.3); p = 0.01), an increase in arterial vascular tone measured by reflective index (RI) (62.4% (51.2; 64.3) vs 58.5% (51.7; 63.8); p = 0.01), and increased exercise tolerance measured by 6-minute walking test (6MWT) (358.1 m (320.5; 368.2) vs 321.5 m (280.4; 329.1); p = 0.001) as compared to the control group.

Conclusion. Our study indicates that iNO-therapy effectively reduces hypoxemia, endothelial dysfunction, improves hemodynamics, walking distance, and exercise tolerance during the exacerbation of COPD in patients with hypercapnic RF and PAH.

Cystic fibrosis (CF) is a systemic congenital disease characterized by chronic bronchopulmonary infection of bacterial and fungal origins. Numerous antimicrobial peptides (AMP) play a special role in humoral immunity in CF patients. Each AMP was characterized in detail earlier. A new method has been developed recently in the Russian Federation for estimation of the cumulative antimicrobial activity of all AMPs in different bioliquids.

The aim of the study was the application of this method for the estimation of antimicrobial activity of whole sera and the AMP-containing low molecular serum fractions in patients with CF before and after lung transplantation.

Methods. Sera from 11 CF patients of 24 – 33 years old obtained before and after lung transplantation were used in the study. Antimicrobial activities of the whole serum and its fractions with the molecular mass under 100 kDa were estimated by the effect of the specimens on Candida albicans test culture cells and by spectrophotometric assay of dye, which was internalized by the killed cells, as compared to the control untreated cells.

Results. The total serum activity and AMP fractions activity in patients with CF were lower than in the healthy volunteers (medians): 82.3% vs 87.8 % (p ≤ 0.01) and 17.2% vs 41.9% (p ≤ 0.01). After the lung transplantation, both activities increased to 84.5% vs 33.3%, respectively. The improvement of AMP fractions activity was observed during 12 months after the transplantation. Serum albumin levels were lower in CF patients as compared to the reference values but normalized after lung transplantation.

Conclusion. Obviously, the activity of the serum components of humoral immunity, which are responsible for direct antimicrobial defense, is decreased in CF patients compared to the reference values. The lung transplantation increased their activity considerably.

Cough is one of the most frequent symptoms of the new coronavirus infection (COVID-19). It reduces the quality of life and contributes to the development of life-threatening conditions.

Aim. This article analyzes modern approaches to the pharmacotherapy of cough in patients with the new coronavirus infection from the standpoint of pathogenetic justification of the use of drugs. The main mechanisms of cough development in COVID-19 presented in the literature are considered. The cough is associated with virus-induced damage to the epithelium and subsequent release of biologically active substances that irritate the afferent endings of the vagus nerve. Approaches to cough management in COVID-19 with the possible use of antitussive (central and peripheral action) and mucoactive drugs (expectorants, mucokinetics, mucolytics, mucoregulators) are addressed.

Conclusion. Based on the literature data and pathogenesis, antitussive drugs play a crucial role in the treatment of cough in COVID-19.

Solid organ recipients represent a high risk group for all adverse outcomes associated with SARS-CoV-2 infection due to the immunosuppressive treatment and the presence of comorbidities such as cardiovascular disease, diabetes mellitus, and arterial hypertension.

The aim of the study was to assess the ability of solid organ recipients to form immune response after vaccination against a new coronavirus infection and safety of the vaccines in this population.

Conclusion. An analysis of the literature and the results obtained in Russia show that vaccines against SARS-CoV-2 do not cause unusual clinical events in recipients of solid organs. Levels of post-vaccination antibodies in these patients, especially in the elderly patients shortly after transplantation who take antimetabolites, are lower than in the general population. This group of patients needs alternative immunization schemes against the new coronavirus infection, which may include more than two booster doses or a combination of different types of vaccines, as well as doubling the vaccine dose.

Respiratory diseases such as asthma and chronic obstructive pulmonary disease are especially prevalent in elderly people and have become a significant problem for healthcare due to ageing of population. Frailty syndrome (FS) is a geriatric syndrome characterized by an age-associated declines in physiologic reserve and functions of multiple systems, including respiratory system. This syndrome leads to increased vulnerability of the elderly.

The aim of the study is to review the available data on modern understanding of FS, pathophysiological changes in the respiratory system associated with aging, the prevalence of FS, and its potential underlying mechanisms in elderly patients with respiratory diseases.

Conclusion. FS is strongly associated with respiratory diseases. On one hand, these pathophysiological processes are inherent in elderly patients. On the other hand, the condition itself causes additional changes that enhance the aging process. Undoubtedly, their association and the influence of FS on the course and outcomes of the respiratory disease should be studied to improve the prognosis of elderly patients. Early recognition of FS in patients with respiratory diseases will help prevent or delay decline in physiologic reserve and functions of multiple systems and lower the disability and mortality rates. Comprehensive assessment of “frail” patients can assist in developing a better risk stratification and provide a personalized approach to managing these risks, as well as improve the patient outcomes.

Exacerbations of COPD worsen health status, increase the frequency of hospitalizations, the likelihood of disease progression, and the risk of adverse outcomes. One of the main goals of the treatment of stable COPD today is to reduce the frequency of exacerbations of the disease. Thus, the expansion of suitable therapeutic options is extremely relevant for clinical practice. Use of mucolytic drugs with antioxidant and anti-inflammatory effects in COPD is justified by the pathogenetic mechanisms. These drugs are able to reduce the frequency of exacerbations, among other positive effects.

Aim. This article describes additional possibilities of pharmacotherapy using the mucoactive drug erdosteine as maintenance therapy for COPD aimed at preventing exacerbations of this disease.

Conclusion. The use of erdosteine in patients with stable COPD helps reduce the frequency and duration of exacerbations of the disease, primarily in the patients with stage II according to GOLD.

Recurrent respiratory papillomatosis (RP) is one of the most challenging benign tumors of the upper and lower respiratory tract. Dissemination of the tumor process and damage to the lung tissue not only increase the likelihood of malignancy, but also complicate the choice of treatment tactics, largely limit the surgical options, and necessitate a multidisciplinary approach.

Methods. The enrolled patients with RP have been treated (n = 190) in the Federal State Budgetary Educational Institution of Higher Education “Academician I.P.Pavlov First St. Petersburg State Medical University”, Ministry of Healthcare of Russian Federation, from 2000 to the present. Changes in the lung tissue were detected in 5 (2.6%) patients (2 men and 3 women) with aggressive course of the disease.

Results. The clinical characteristics of patients and the outcomes of lung damage in RP are presented. Four patients had malignant transformation of the tumor into verrucous carcinoma of the upper third of the trachea with invasion into the soft tissues of the neck (n = 1) or malignant degeneration of the lesion in the lung parenchyma (n = 3).

Conclusion. The presented rare observations suggest polymorphism of clinical and radiological symptoms of papillomatous damage to the tracheobronchial system and lungs.

Pseudomonas aeruginosa is the most common highly pathogenic flora in patients with cystic fibrosis. It is associated with severe lung damage and affects life expectancy. According to the register of patients with cystic fibrosis in the Russian Federation (2019), the incidence of P. aeruginosa pulmonary infection among them is 34.3%. Inhaled tobramycin is the drug of choice for the eradication of P. aeruginosa in patients with cystic fibrosis according to European and Russian recommendations. Clinical studies showed that Bramitob is highly effective against P. aeruginosa infection in patients with cystic fibrosis.

The aim of the study: to demonstrate the effectiveness and safety of eradication therapy with inhaled tobramycin in several clinical cases of children with cystic fibrosis.

Methods. The article analyzes 6 clinical cases of effective eradication of P. aeruginosa in patients with cystic fibrosis, including 1 clinical case that involved a new approach to assessing the resistance of P. aeruginosa. Positive culture of P. aeruginosa was confirmed in all patients in specialized laboratories (State Budgetary Healthcare Institution “Morozov Children’s City Clinical Hospital of the Department of Health of the City of Moscow”, Federal State Budgetary Institution “N.F.Gamaleya National Research Center for Epidemiology and Microbiology”, Ministry of Health of the Russian Federation). All patients received inhaled tobramycin 300 mg 2 times a day for 1 – 3 courses (a course of 28 days of inhalations/28 days – a break).

Results. All children tolerated tobramycin well, and two of them were younger than 6 years old. The effectiveness of eradication was confirmed by negative cultures of P. aeruginosa during 1-year follow-up that included quarterly microbiological control. The clinical case that involved assessment of resistance to inhaled tobramycin is especially important because of polyresistance of the pathogen.

Conclusion. The presented clinical cases of eradication of P. aeruginosa with the use of tobramycin confirm its clinical efficacy and wider application possibilities.

Aim. To demonstrate the course of sepsis and multiple organ dysfunction syndrome in a patient with decompensation of type 1 diabetes mellitus, to describe the applicable treatment. This case is relevant because of high mortality of patients with diabetes mellitus complicated by sepsis and multiple organ failure. The mortality is especially high when acute respiratory distress syndrome develops.

Results. The article presents a clinical case of a patient with diabetes mellitus complicated by acute kidney injury, hospital-acquired pneumonia, sepsis, and acute respiratory distress syndrome. The approach to treatment of multiple organ failure is also described.

Conclusion. Life support and intensive therapy (mechanical ventilation, regular tracheobronchial debridement, hemodiafiltration, and combined drug therapy, including drugs with hyaluronidase activity) led to successful resolution of sepsis in this patient.