Chronic obstructive pulmonary disease (COPD) is characterized by a high level of morbidity and mortality and is associated with significant social and economic losses for the health care system and society.

Aim. To predict the socio-economic burden of COPD in the Russian Federation in 2022, including the cost of drug treatment.

Methods. The socio-economic burden of COPD in the Russian Federation in 2022 was predicted with and without taking into account the impact of COVID-19. The analysis of the cost of illness included the calculation of direct and indirect costs due to COPD. Data of Federal State Statistics Service, the State Guarantee Program of Free Medical Care for Citizens of Russian Federation, and data from the regional register of drug treatment of patients with COPD were used. Costs of medical care (ambulatory, hospital, and emergency care) were calculated based on compulsory health insurance tariffs. The disability benefits payments were calculated based on number of disabled persons and the amount of the disability benefit in each group. Indirect costs (or economic losses) included losses from products which were not produced due to disability and premature mortality of working-aged adults.

Results. The predicted total economic losses due to COPD in 2022 will be 428.5 billion rubles when taking into account the impact of COVID-19, and 378.9 billion rubles when not accounting for COVID-19. Losses in the economy due to decreased labor productivity because of premature deaths (86%) are major part of the main burden. The cost of drug therapy for patients with COPD in outpatient settings will amount to over 17 billion rubles.

Conclusion. Potential economic burden of COPD in 2022 depends on the incidence of COVID-19 and could be 0.34% of the GDP. Priority should be given to measures aimed at preventing the occurrence of COPD by correcting risk factors in the population, early diagnosis, slowing the progression of the disease and preventing exacerbations. Prevention of respiratory infections including COVID-19 in patients with COPD plays a special role.

Primary ciliary dyskinesia (PCD) is a rare hereditary disease from the group of ciliopathies, which is based on a defect in the cilia ultrastructure of the respiratory epithelium and similar structures (sperm flagella, villi of the fallopian tubes, ventricular ependyma, etc.), leading to motor function impairment. The prevalence of the disease varies significantly around the world and is not known reliably in the Russian Federation.

The aim of the review was to analyze literature data on modern approaches to the diagnosis and treatment of PCD.

Methodology. The data of 90 articles and the opinions of experts providing care to patients with PCD were used.

Results. The classic manifestations of PCD depend on age. The leading manifestations of the disease in patients with PCD are recurrent inflammatory diseases of the upper and lower respiratory tract (bronchitis, pneumonia), with the formation of bronchiectasis, damage to the ENT organs (chronic rhinitis, rhinosinusitis, nasal polyposis, repeated otitis media, progressive hearing loss). Currently, there is no single method which could serve as a “gold” standard for diagnosing PCD. The diagnosis of PCD is based on the characteristic clinical picture in combination with the results of special tests (nitric oxide in exhaled air, DNA diagnostics, high-speed video microscopy, transmission electron microscopy). The genetic diagnostics has not been developed sufficiently in the global practice yet and is unavailable in our country. The approach to the treatment of a patient with PCD should be multidisciplinary due to multiple organ lesions. According to the European consensus, the goal of PCD therapy is to restore or maintain normal lung function. There have been no randomized trials of treatment for PCD, and therefore all treatment recommendations are based on very low-level evidence or extrapolated from cystic fibrosis guidelines. Recommendations on mucolytic, antibacterial and anti-inflammatory therapy of PCD are given with consideration for the international and domestic experience.

Conclusion. The development of a new version of clinical guidelines containing up-to-date relevant information will improve the diagnosis and treatment of PCD in the Russian Federation.

It is hard to make a conclusion about relationship between Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and Bronchoobstructive Syndrome (BOS) in the postcovid period based on the literature.

The aim. To determine the optimal treatment approaches by conducting a comprehensive assessment of clinical, laboratory and functional parameters, taking into account the risk factors for the development of BOS.

Methods. 10,456 patients with Coronavirus Disease-19 (COVID-19) were examined, and 7,459 patients were randomized into 2 groups with a newly diagnosed BOS. Group 1 (n = 3,245) was prescribed beclomethasone/formoterol (BDP/FORM) as Maintenance And Reliever Therapy (MART). Group 2 (n = 4,252) was prescribed budesonide suspension (BUD) and salbutamol solution (SAL). The study assessed severity of COVID-19, presence of atopy and frequency of acute respiratory viral infections (SARS) in the medical history, spirometric parameters, blood eosinophils, Asthma Control Questionnaire-5 (ACQ-5) score, use of pro re nata medications, and adverse events.

Results. Patients who had mild COVID-19 were diagnosed with BOS at weeks 8 – 24 (73.3%), while patients with moderate or severe COVID-19 were diagnosed at week 4 (54.9%). Virus-induced BOS (VI BOS) was diagnosed in 71.8% of the cases. 13% of the patients with BOS in postcovid period were diagnosed with asthma.

Conclusion. The incidence of BOS is significantly higher in patients with atopy and history of frequent SARS who had moderate or severe COVID-19. A fixed combination of extrafine BDP/FORM as MART was superior to nebulized BUD + SALM in the treatment of VI BOS.

Cough is one of the most common symptoms of COVID-19 (COronaVIrus Disease-2019), occurring in more than 70% of cases. The cough associated with the new coronavirus infection tends to be non-productive and requires symptomatic antitussive therapy. However, at present, there is insufficient data on the effectiveness of various antitussive agents in COVID-19.

The aim. Analysis of the clinical and economic efficiency and safety of the use of levodropropizin in comparison with standard symptomatic therapy of patients with a new coronavirus infection COVID-19 in the real-life clinical setting.

Methods. An open observational multicenter study was conducted in Moscow, Krasnodar, Kazan, Voronezh, and Rostov-on-Don. The study enrolled 250 inpatient COVID 19 patients (1 875 years) with complaints of dry unproductive cough which required symptomatic treatment. The main group included 150 people who received levodropropizine according to the label. The comparison group received other antitussive drugs. Each patient was examined on days 1, 4 and 8. The examination included collection of the current complaints and medical history, physical examination and assessment of the intensity of cough using day and night cough assessment scale using a 6-point scale for assessing daytime and nighttime cough and a visual analog scale (VAS).

Results. In the main group, significant differences were revealed between the baseline and Day 4 in the form of a significant decrease in the severity of daytime cough (р = 0.002); significant differences were found between Day 4 and Day 8 for both daytime (р = 0.002) and nocturnal cough (р = 0.0001). The comparison group showed positive dynamics, but significant differences were seen only between the baseline and Day 8 at night (р = 0.001). The severity of cough on VAS scale in the main group differed significantly on Day 8 as compared to baseline (р = 0.001), as well as between Day 4 and Day 8 (р = 0.002). No significant differences were seen in the comparison group. No adverse effects were observed during treatment with levodropropizine.

Conclusion. Levodropropizine has shown high efficacy and safety in the treatment of dry unproductive cough in comparison with standard symptomatic therapy in the form of a significant decrease in cough intensity according to both scales, starting from the 4^th day.

Since the beginning of the pandemic, COVID-19 (COronaVIrus Disease-2019) has been viewed as a respiratory disease with characteristic symptoms including cough, shortness of breath, and difficulty breathing. However, some patients still have respiratory complaints and post-inflammatory changes in the lung tissue according to high-resolution computed tomography of the chest organs (CT scan) even after discharge from the hospital.

The aim. To assess the functional changes in the respiratory system in patients who had COVID-19-associated lung injury using a comprehensive testing of the respiratory function (spirometry, body plethysmography and diffusion test) in the first 6 months after discharge from the hospital.

Methods. The study included 434 patients (252 men and 182 women, aged 20 to 79 years), who were divided into 3 groups depending on the time interval between discharge from the hospital and the respiratory function test: Group 1 – 15 – 45 days; Group 2 – 46 – 93 days; Group 3 – 94 – 183 days. All patients underwent a comprehensive testing of respiratory function.

Results. The average pulmonary ventilation indicators remained within the normal range both in the general group and in separate groups. A decrease in DL_CO was found in most patients: in 53% of people in the general group, in 54, 54 and 51% of cases in Groups 1, 2 and 3, respectively. Restrictive ventilation disorders (reduction of TLC below the lower limit of normal (LLN)) were detected in 29 % of people in the general group, 33, 27 and 26% in Groups 1, 2 and 3, respectively. Obstructive ventilation disorders (decrease in FEV₁/FVC below LLN) were detected in 2 % in the general group, and in 3, 1 and 1% in groups 1, 2 and 3, respectively. Statistically significant correlations were found between the maximum volume of lung tissue damage in the acute period of COVID-19, the age of the patients, and the respiratory function indicators.

Conclusion. The pulmonary ventilation indicators normalized within 6 months after COVID-19, while a decrease in lung diffusion capacity persisted in most patients and required further active follow-up.

Community-acquired pneumonia (CAP) is a common acute infectious disease in adults. Diabetes mellitus (DM) increases the incidence of CAP and worsens the prognosis. In this regard, the assessment of the current practice of CAP management in patients with concomitant DM and its compliance with clinical guidelines is of great interest.

Purpose. To study the current practice of CAP treatment in adult patients with concomitant type 2 DM in a multidisciplinary hospital and evaluate its compliance with the national clinical guidelines.

Methods. A cross-sectional observational study was carried out in a pulmonology department of a republican clinical hospital. The study recruited adult patients with a confirmed diagnosis of CAP and previously diagnosed type 2 DM. For each case, demographic characteristics, the severity of CAP, the presence and nature of complications, systemic antibiotic therapy (ABT) and compliance with 16 quality indicators (QI) were recorded. The quality indicators described the adequacy of examination, treatment and secondary prevention of CAP in the presence of concomitant DM. QIs were chosen based on the national clinical guidelines for CAP and algorithms for specialized medical care for patients with DM.

Results. Altogether, 48 patients with the average age of 63.9 ± 10.5 years were enrolled. 81% of patients had mild CAP. The severity criteria were assessed in 60% of the patients, prognosis – in 17% of the patients. X-ray examination, pulse oximetry and complete blood count were performed on time in 100% of the cases. A total of 19% of patients had a culture of respiratory specimens. A blood culture was performed in 11,11% of the cases of severe CAP (SCAP). Rapid urine tests for pneumococcal and legionella antigens have not been used. Glycemia was monitored daily in 27% of the patients. ABT was initiated on time in 100% of the patients.

Conclusion. Low adherence to many QIs, insufficient control of glycemia and correction of sugar-lowering therapy in the treatment of hospitalized patients with CAP and concomitant type 2 DM were observed, which can worsen clinical outcomes.

Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia remains an urgent problem in primary health care despite the improvement of radiological and laboratory diagnostic methods.

The aim of study was to evaluate the possibility of using a skin test with recombinant tuberculosis allergen (Diaskintest^®, Generium, Russia) for the differential diagnosis of pulmonary tuberculosis and pneumonia.

Methods. 119 cases of pulmonary tuberculosis first detected in the pulmonology department during differential diagnosis were analyzed. The diagnosis was verified by a liquid media culture in the BACTEC MGIT 960 system (BD, USA). All patients with suspected tuberculosis had a skin test with recombinant tuberculosis allergen upon admission. Statistical analysis was carried out using the statistical software package IBM SPSS Statistics 22.0. The differences were considered statistically significant at p < 0.05.

Results. Most patients were of working age and had aggravating social risk factors 49 (41.2%), HIV-infection 75 (63.0%), drug addiction 44 (36.9%), or viral hepatitis C 33 (24.2%). As for the clinical forms, infiltrative and disseminated tuberculosis prevailed. Evaluation of the results of the «fast» methods of the diagnostic minimum showed that a positive result of the test with Diaskintest^® was almost three times more likely than the positive result of bacterioscopy of a sputum smear with Ziehl–Neelsen staining. Mycobacterium tuberculosis DNA was detected in sputum using the GeneXpert MTB/RIF cartridge technology in 92.6% patients with a positive result of Diaskintest^® skin test and a negative sputum bacterioscopy analysis.

Conclusion. Is advisable to use Diaskintest^® skin test in patients of a pulmonological hospital in the early stages and confirm the positive result with GeneXpert MTB/RIF to reduce the time for diagnosing tuberculosis and the patient’s bed-days in a non-specialized medical institution.

Computed tomography (CT) guided percutaneous procedures like the fine needle aspiration cytology (FNAC) and fine needle aspiration biopsy (FNAB) are reliable techniques for diagnosing various thoracic diseases. These modalities are used for diagnosis in suspicious lung, pleural, mediastinal and vertebral and pulmonary lesions.

The aim. We conducted a study in a Pulmonary Medicine Department of tertiary care hospital to study the efficacy and safety of CT guided FNCA/FNAB in thoracic diseases.

Methods. A retrospective study was conducted at a tertiary care center with Information and Ethics committee permission within a total duration of two years. The study included patients presenting with following: 1) mediastinal mass lesions, 2) pulmonary solitary pulmonary nodules/masses, 3) pulmonary cavity, cyst and consolidation of undiagnosed etiology, 4) pleural mass, nodules, loculated collections, 5) extra-pulmonary and spinal tuberculosis suspects with pre/paravertebral abscess. Procedure details, radiological images and pathological and microbiological reports were retrieved from case record book of patients available in department.

Results. Study population consisted of 108 patients. Neoplastic diseases were 85 (78.70%) and Non- neoplastic diseases 23 (21.29%). In neoplastic diseases 78.82% patients had lung Cancer of which 85.07% non small cell carcinoma and 14.92% small cell lung cancer. Out of non small cell lung cancer adenocarcinoma of lung was the commonest. The most common non neoplastic diseases was tuberculosis. CT guided biopsy procedure was performed without any complications in 61.11%. The most common complication was pneumothorax (27.77%). The yield of CT guided biopsy was 98.14%.

Conclusion. Percutaneous CT-guided lung biopsy is an effective, highly accurate, and safe method of obtaining tissue for the diagnosis of indeterminate pulmonary lesions especially in neoplastic diseases and tuberculosis.

The incidence of asthma and obesity is constantly increasing. It is commonly acknowledged that obesity can make asthma more severe and poorly controlled. Conventional spirometry, despite of being a “gold standard” in diagnostics of lung diseases, cannot provide information on residual lung volume and bronchial resistance, which can be a key to understanding the mechanics of spirometric deviations found in asthma-obesity phenotype.

The aim. To evaluate pulmonary function in patients with asthma and obesity by non-invasive and safe clinical method – body plethysmography.

Methods. 46 women with asthma were enrolled into the study, of which 21 were obese and 25 had normal body weight. 18 women with obesity and 20 women with normal body weight were selected as controls. All the patients were postmenopausal. Body plethysmography was performed with MasterScreen Body device, CareFusion, Germany.

Results. Asthma is associated with a decrease in forced vital lung capacity and an increase in residual volume. Also, Gensler index and peak expiration flows at 25, 50, and 75% expiration were decreased. Interestingly, specific effective resistance in patients with asthma without obesity was 30 – 40% higher than in the control group. In patients with asthma and obesity, specific effective resistance was 2,5 times higher than in the control group. Residual volume and bronchial resistance were found to have a strong positive correlation.

Conclusion. despite of similar spirometric changes, only asthma in obesity was marked by an increase of specific bronchial resistance. This finding can be related to higher energy load of breathing process in obese asthma.

Aim. Differential diagnosis of vocal cord dysfunction (VCD) and asthma.

Methods. 105 patients with partially controlled asthma were examined. We used specific examinations for VCD: psychological scales , questionnaires for monitoring symptoms of VCD, transnasal fiberoptic laryngoscopy, conventional and electronic lung auscultation with the analysis of the amplitude-frequency characteristics (AFC) of wheezing in the chest and in the region of the larynx on the left and right. Spirometry was performed using Vitalograph ALPHA spirometer (England). The patients were divided into three groups: group 1 included patients with asthma; group 2 included patients with asthma and VCD (asthma-plus syndrome); group 3 included patients with VCD.

Results. Conventional auscultation revealed wheezing over the lungs with a decrease in its intensity on the neck surface in group 1. In groups 2 and 3, the maximal wheezing was observed on the anterior surface of the neck and less intense wheezing was heard over the lungs. Electronic auscultation found mid-tonal wheezing over the lungs and over the larynx in group 1; high-pitched wheezing over the larynx and mid-tonal wheezing over the lungs in groups 2 and 3. Score of dyspnea according to the Borg scale was highest in the asthma-plus group – 4,8 (5,2 – 6,5) points, and lowest in the 1^st group – 4,2 (3,7 – 4,9) points. The sensation of wheezing is maximal in VCD – 7,1 (6,5 – 7,9) points. The scores of symptoms of VCD were strongly correlated with the intensity of wheezing, dyspnea, and AFC of wheezing. Spirometry was close to normal in the group of patients with VCD; obstructive disorders were noted in groups 1 and 2. Transnasal laryngoscopy demonstrated paradoxical movement of the vocal cords during inspiration in groups 2 and 3. The triggers of episodes of VCD in the subjects were numerous; vocal loads predominated. Specific treatment of VCD in groups 2 and 3 improved the respiratory performance significantly.

Conclusion. The primary diagnosis of asthma cannot be made without an examination for VCD. Psychological questionnaires and VCD questionnaires should be used. It is important to use electronic auscultation over the larynx for diagnosis. Correction of treatment in accordance with VCD in patients with asthma can significantly reduce the doses of inhaled and oral corticosteroids.

A personalized approach to the treatment of a polygenic disease, such as pulmonary emphysema, provides unique opportunities for selection of effective treatment in each clinical case. Progress of understanding molecular mechanisms behind emphysema allows to take a new look at classification, causes of phenotype variability, prognosis and preventive measures before clinical manifestation.

The aim of this review was to bring together the available data of genetic mutations impact to lung emphysema, its endotypes characteristics, and determine the personalized treatment approaches.

Results. The attention of clinicians in the diagnosis of essential emphysema is focused on measurement the level of α₁-antitrypsin in serum and mutations of SERPINA1 gene in exons 3, 4, 5 and 6. This is important, though not complete information about the causes and disease prognosis. This routine approach do not take into account the influence of genes-modifiers and gene-gene interactions. At the same time, intact SERPINA1 does not guarantee a zero risk of primary emphysema. To date, a wide range of genetic defects has been identified. These defects are capable, to a varying degree, to cause the disease, determine its clinical manifestations, severity and frequency of exacerbations.

Conclusion. Wholeexome sequencing with the identification of affected metabolic pathways makes it possible to see a complete molecular portrait of emphysema, determine the endotype and select targeted therapy for each clinical case.

Further study of the distribution, pathogenesis of viral infection, the role of respiratory viruses in the formation and exacerbation of chronic lung diseases will allow the development of new methods of protection, the creation of modern pharmaceutical approaches for the treatment and prevention of COVID-19.

The aim. The article presents an analytical review of the scientific literature in PubMed, Google Scholar, medRxiv, bioRxiv which was conducted to study and evaluate the mechanisms, pathogenesis, and clinical picture of respiratory viral infections, including Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-СoV-2).

Conclusion. Understanding the specific mechanisms of the development of the host’s immune response to respiratory viruses allows a better understanding of the course of a new coronavirus infection, including in patients with COPD, since respiratory tract infections are closely associated with the formation and exacerbation of COPD. Respiratory viruses activate immune responses and exacerbate underlying inflammation in COPD. SARS-СoV-2 leads to a dysregulated immune response and, in severe cases, an overactive immune response, causing the development of a cytokine storm and acute respiratory distress syndrome (ARDS). Unlike seasonal respiratory viruses, SARS-СoV-2 circulates throughout the year and can be a source of frequent and severe exacerbations in patients with COPD which require further monitoring and research.

Smoking-related interstitial fibrosis (SRIF) is a recently described disease which is common finding in a long-term cigarette smokers.

Aim. To acquaint readers with relatively unknown interstitial disease. We describe a case of a smoking patient with a long smoking history and squamous cell carcinomas of the larynx and lung who complained of an unproductive cough, sore throat, hoarseness, difficulty in nasal breathing, and shortness of breath during exercise. Obstructive disorders, lung hyperinflation, and a severe decrease in diffusion capacity reflected the signs of severe emphysema in combination with fibrotic changes found by high resolution computed tomography (CT). X-ray picture and characteristic histological changes made it possible to diagnose SRIF.

Conclusion. Diagnostics of the disease should be based on CT-signs, histologic picture and functional data. The prognosis is relatively favorable.

The diagnosis of idiopathic interstitial pneumonia (IIP) remains one of the most challenging issues in pulmonology. The article demonstrates the capabilities of the method of probe-based confocal laser endomicroscopy (pCLE) in diagnosing various forms of IIPs and provides comparisons with CT and the histological picture. According to the data obtained, it is difficult to distinguish most IIPs from each other using pCLE. Among the specific signs, a large number of alveolar cells in pCLE in a nonsmoking patient with desquamative interstitial pneumonia is not typical for other IIP in nonsmokers. Also, pCLE can be used to differentiate between IIP and other conditions, in particular, malignant lesions.