According to the World Health Organization (WHO), bronchial asthma (BA) is a major non-communicable disease which affects both adults and children and thereby impacts the economy.

The aim. To analyze the bronchial asthma morbidity and follow-up care in Russia in 2019 as compared with 2014.

Methods. The official statistical data of the Ministry of Health of Russia and the Federal State Statistics Service (Rosstat) on BA was used. BA was defined as class X J45 – J46 (asthma, asthmatic status) according to the International Classification of Diseases and Health-Related Problems, the 10th revision of 1 989 (ICD-10).

Results. The BA morbidity was 961.6 in 2014 and 1085.0 (+11.4%; p < 0,001) per 100 thousand of the total population in 2019 (1,592,596 people). BA accounted for 2.7% of all respiratory diseases (RD) morbidity. The BA morbidity in 2014 and 2019 were higher than average in 4 federal districts (FD) with the maximum rate in the Siberian FD (1,185.5 and 1,507.1 per 100 thousand of the total population, respectively). In 2019, the BA morbidity decreased among children aged 0 – 14 years, did not change among children aged 15 – 17 years and increased among the adults. In 2019, the highest rates among children aged 15 – 17 years were registered in the North-Western FD (2,943.7 per 100 thousand in the corresponding age group). 87.1% of BA patients received follow-up care. In 2019, 32.3% of all people with respiratory diseases (944.3 per 100 thousand of the total population) were under follow-up care. The highest number of BA patients under follow-up care was recorded in the Siberian FD (1,328.3 per 100 thousand of the total population), the lowest number – in the North Caucasian FD (288.3).

Conclusion. There was an increase of BA morbidity from 2014 to 2019 with the highest numbers reported in the total population of Siberian FD and the lowest – in adolescents aged 15 – 17 years in North-Western FD. The quality of medical care correlated with high coverage with follow-up care.

Short-acting β2 -agonists (SABA) overuse is associated with negative outcomes in asthma patients. There is a lack of actual data about patterns of SABA overuse in the Russian population with asthma.

The aim. To investigate patterns of SABA overuse in the Russian population with asthma.

Methods. Data from the Russian population of “SABA use IN Asthma (SABINA) III” study were analyzed. SABINA III was a cross-sectional observational study covering 24 countries. Adults and adolescents with a documented diagnosis of asthma for at least 12 months were enrolled in the study. Data on disease characteristics and asthma treatments during previous 12 months were collected using real-time electronic case report forms and were analyzed with methods of descriptive statistics.

Results. Majority of the Russian population (n = 618) consisted of patients with moderate/ severe asthma (78.5%). Asthma was uncontrolled or partly controlled in 70% of patients. SABA over-prescription (≥ 3 canisters per year) was seen in 37% of patients. The frequency of SABA over-prescription was similar in patients with mild (35%) and moderate/severe (38%) asthma. SABA was purchased over-the-counter (OTC) in the past 12 months by 30% of all patients, while 14% purchased ≥ 3 canisters of SABA per year. More than 90% of patients who purchased SABA OTC, already received prescriptions for SABA, of whom 59% were prescribed ≥ 3 canisters per year.

Conclusion. Russia is faced with very high level of SABA overuse. Over-prescription is the main cause for SABA overuse. To reduce SABA overuse, it is necessary to educate both patients and doctors, and actively implement up-to-date asthma treatments.

The accumulation of clinical experience in the use of biologic therapy in patients with severe bronchial asthma (SBA) in real-world clinical practice with the possible identification of additional, previously undescribed clinical outcomes is of practical interest.

The aim. To present the results of an observational study of using benralizumab in SBA in real clinical practice of pulmonologists in Saint-Petersburg.

Methods. We present the results of more than 1 year of follow-up of 18 patients with eosinophilic SBA (12 women, 6 men, age from 28 to 74, average age 55.0 ± 11.9 years). The patients received benralizumab in addition to standard treatment. Clinical, laboratory, and functional examination of the patients were performed, the frequency of exacerbations and additional clinical effects were assessed. Results. It has been shown that the inclusion of benralizumab in complex therapy resulted in a significant improvement in disease control, improved bronchial conduction, a significant decrease in blood eosinophilia, and a reduction in the number of exacerbations. A clinical example is given that indicates a stabilizing effect of this therapy on the course of recurrent nasal polyposis with an initially aggressive course (intracranial polyp growth).

Conclusion. The possibility of significant improvement in the control of SBA with the use of biological therapy has been confirmed in real clinical practice. At the same time, data have been obtained that will allow expanding the indications for the use of benralizumab in the future.

The aim. To determine the level of cathepsin S and to identify its possible relationships with clinical, functional and laboratory indicators in patients with severe bronchial asthma.

Methods. 114 patients with severe bronchial asthma were examined. 96 women (84.2%) and 18 (15.8%) men were divided into 2 groups: allergic and non-allergic severe bronchial asthma. The external respiration function was assessed with whole-body plethysmography (“Erich Jaeger”, Germany). The plasma concentration of cytokines IL-4, IL-5, IL-13, periostin, cathepsin S, TGF-β was estimated with ELISA (“eBioscience”, USA).

Results. Fixed obstruction is reported in 48% and 50% of cases of allergic and non-allergic severe asthma, respectively. Peripheral blood eosinophilia occurs in 41.5% of cases with allergic and in 25% of cases with non-allergic asthma. IL-5, IL-13, and cathepsin S levels were increased in both groups. An increase in IL-4 and TGF-β levels was revealed in non-allergic asthma. Periostin levels were increased in patients with allergic asthma as compared with the control and the second group. Positive correlation between cathepsin S and concentration of IL-4, IL-5 was established in both groups. We identified weak positive correlation between cathepsin S levels and clinical symptoms of the disease, such as frequency of SABA use and asphyxiation attacks, only in the allergic asthma group. A positive correlation between cathepsin S and TGF-β was established in both groups.

Conclusion. A positive correlation between serum cathepsin S and TGF-β was established in both allergic and non-allergic severe bronchial asthma. The found moderate relationship may indirectly indicate the involvement of cathepsin S in airway remodeling processes regardless of the disease type.

Lung protection during surgeries with artificial circulation (AC) is a vital task in clinical medicine.

The aim. Evaluation of the effectiveness of intraoperative administration of nebulized budesonide for correcting the volume status of the lungs and oxygen transport in patients with concomitant coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD) during coronary artery bypass grafting (CABG) with artificial circulation (AC).

Methods. The pilot clinical study included 40 patients with concomitant CHD and COPD who were admitted for scheduled CABG with AC. The first groups consisted of 20 patients who underwent low-volume artificial lung ventilation (AVL) with inhalation of nebulized budesonide in the process of AC; the second group consisted of 20 patients who underwent AC according to a routine technique with AVL off. Lung volemic status parameters were recorded by transpulmonary thermodilution using the Pulsion PiCCO in three stages: before the onset of AC, after its completion and one day after AC.

Results. It was established that after withdrawal from AC, indices of extravascular water in the lungs (IEWL) decreased by 23% in the first group and increased by 24% in the second group. After the completion of AC and a day after it, IEWL significantly decreased in patients receiving budesonide and increased with a maximum rise at the second stage of the study in the second group. The index of oxygen delivery and utilization over time was within the reference range in all patients. The index of oxygen consumption did not reach the physiologically normal lower limit. The maximum level of pulmonary bypass blood fraction (16 and 12%, respectively) and a significant decrease in oxygenation index (240 – 290 c. u.) were recorded in this cohort of patients at the 2nd and 3rd stages of the study. The duration of postoperative ventilation was significantly longer in the second group, while the duration of in-hospital treatment did not differ significantly before the groups.

Conclusion. The protective effects of the combination of aerosol therapy with budesonide and low-volume AVL were manifested by a decrease in the permeability of the pulmonary capillaries, the volume of IEWL, an improvement in the oxygenating function of the lungs, a decrease in the number of respiratory complications and the postoperative duration of AVL.

Two years after the onset of the COVID-19 pandemic, not only the diagnosis and treatment, but also rehabilitation of patients at different times after the disease became relevant.

The aim. To develop and analyze the efficiency of personalized hospital-based rehabilitation programs for COVID-19 patients.

Methods. Retrospective analysis of medical records of 109 patients with COVID-19 admitted to the rehabilitation department. A team of physiotherapist, pulmonologist and psychiatrist used simulators (bicycle ergometer, treadmill, motomed, and stepper), physiotherapeutic exercises, training of respiratory muscles with Threshold IMT (Philips, Netherlands) simulators, psychotherapy, and physiotherapy.

Results. A total of 109 patients, 59 (54%) men and 50 (46%) women, aged 56.54 ± 11.73 уears suffered from moderate (41%), severe (40%) and very severe (19%) COVID-19. 25% of the patients had concomitant diabetes mellitus, 65% – arterial hypertension, and 22% – ischemic heart disease. Patients with 5 rehabilitation points (5RP) on Rehabilitation Routing Scale walked a median distance of 110 [40; 248] m in the 6-minute walk test (6MWT), 4RP – 300 [240; 350] m in 6MWT, 3RP — 400 [360; 431] m in 6MWT. The difference in 6MWT distance was significant only between 4RP and 3RP groups (p < 0.001). By the end of rehabilitation program, 6MWT increased by 90 m in 5RP group, by 120 m – in 4RP group, and by 89 m in patients with 3RP (p = 0.036 between RPs and 4RP groups; р = 0.007 between 3RP and 5RP groups, respectively). SpO2 was over 95% in all patients by the end of rehabilitation.

Conclusion. Comorbid patients after severe COVID-19 demonstrated better rehabilitation potential seen as improvement of exercise tolerance and respiratory status. The original personalized rehabilitation programs improve significantly impaired body functions early on after severe COVID-19.

The operation of the oncological services of the Russian Federation were complicated by the spread of the Severe Acute Respiratory Syndrome CoronaVirus-2, which worsened the diagnosis of lung cancer and led to the reorientation of medical institutions to the anti-epidemic mode.

The aim. To evaluate the features of providing medical care for lung cancer to residents of the Magadan Region during the pandemic of COronaVIrus Disease-19 (COVID-19).

Methods. The analysis of the Magadan Region database on patients with lung cancer was carried out. The databased is filled in with the information from state statistical reporting forms No.7 and No.35. General problems of the Magadan Region healthcare system were identified using materials of publications from the Medline, CrossRef, Pubmed and Scopus databases for 2019 – 2021; the potential solutions were also suggested.

Results. The analysis of the incidence of malignant neoplasms in 2014 – 2020 yy. showed that lung tumors are in the lead among Magadan Region residents. The “rough” incidence rate of lung cancer in 2019 (58.8 per 100,000 inhabitants an increase from 2009 +20.74%) and the relative proportion of these tumors detected in 2020 in localized stages are ahead of the average values for the Russian Federation. In 2018 – 2021, the indicator of morphological verification of lung cancer and the proportion of advanced tumors continued to increase, but the one-year mortality rate was decreasing. In 2021, 10.3% of the residents of Magadan Region had low-dose computed tomography (CT) of the chest organs. 10 (1.8%) cases of lung cancer were detected. Localized lung cancer was detected in 32.5% of those cases (2020 – 24.5%, 2019 – 20.3%). The spread of the coronavirus infection has complicated work of the staff of the Magadan Region oncology service: remote medical consultations for patients living far from the regional center (Magadan) are to be developed. Insufficient number of low-dose CT machines in the medical institutions, understaffing in health facilities, insufficient use of chemotherapy in the treatment of patients with lung cancer, as well as problems of palliative care for patients with advanced stages of the tumor were identified.

Conclusion. The main problems of the oncological service of the Magadan Region are the shortage of personnel, lack of equipment and the lack of a single information field in the medical institutions. These problems of specialized medical care for patients with lung cancer will have to be solved by the regional Ministry of Health, scientific schools, and universities.

Immune defense mechanisms in survivors of the COronaVIrus Disease-19 (COVID-19) and development of their rehabilitation during the pandemic both portray a great scientific and practical interest.

The aim of the study was to explore effect of Immunovac-VP-4® (I-VP-4), a vaccine based on bacterial ligands, on the clinical and airway mucosal immunity parameters, along with systemic immune response in a group of medical workers in post-COVID period and in persons who did not develop the disease.

Methods. 82 healthcare workers aged from 18 to 65 years were included in a prospective open controlled study. The participants were divided into 4 groups: groups 1 (n = 20) and 2 (n = 27) included those with a history of COVID-19, and groups 3 (n = 18) and 4 (n = 17) included those who did not have the disease. Volunteers in groups 1 and 3 received I-VP-4. Samples of oral fluid, induced sputum, nasopharyngeal and oropharyngeal mucosa scrapings, and venous blood were examined. The levels of total secretory immunoglobulin class A (sIgA) and immunoglobulin G (IgG) were determined by enzyme immunoassay. The phagocytic index (PI) of leukocytes was assessed by flow cytometry.

Results. The group of patients who did not have COVID-19 and received IVP-4 (Group 3) showed a tendency to a smaller number of COVID-19 cases, as well as some reduction in days of incapacity for work due to the acute respiratory infections (ARI). The vaccine improved airway mucosal immunity parameters and innate immune response. sIgA increased in the induced sputum (p < 0.005) and unchanged in the oropharyngeal mucosa samples in Group 1. The PI of macrophages in oral fluid doubled (p < 0.05) in this group. At the same time, those parameters decreased in Group 2. In non-infected vaccinated patients (Group 3), a significant increase of PI of blood monocytes was found on the day 90 of the study (p < 0.05). Also, a four-fold increase of PI of macrophages in oral fluid in comparison with Group 4 (p < 0.05) was noted.

Conclusion. I-VP-4 improved airway mucosal immunity mechanisms and the systemic immune response. The vaccine can be recommended for rehabilitation programs for COVID-19 survivors and for prevention of ARIs.

The issue of physical rehabilitation of post-COVID patients stays relevant up to this day. Most publications discuss inpatient rehabilitation and only few publications describe outpatient physical rehabilitation of such patients.

The aim. Our study was performed to investigate efficacy of outpatient physical rehabilitation of post-COVID patients with lung injury.

Methods. This was a prospective non-randomized open controlled study. All patients with COVID-19-associated lung injury were referred to supervised outpatient rehabilitation program. We analyzed 6-minute walk test (6-MWT) results, evaluation of dyspnea using Borg scale and assessment of oxygen saturation (SpO₂) using pulse oxymeter before and after walking.

Results. The rehabilitation group included 24 patients and the control group included 6 patients. The baseline and demographic findings did not differ significantly between the groups. The 6-minute distance (6-MWD) (р = 0.000018), heat rate at rest (р = 0.017) and after walking (р = 0.017), dyspnea after walking (р = 0.017), oxygen saturation at rest (р = 0.030) and after walking (р = 0.0021) improved significantly in the rehabilitation group and did not change significantly in the control group. At the end of the study, 6-MWD increased by 63.2 ± 36.3 m in the rehabilitation group compared to 14.0 ± 28.8 m in the control group (р = 0,01) and exertional dyspnea score increased by 0 (0 – 1) compared to 1 (1 – 2) in the control group (p = 0.033).

Conclusion. Supervised outpatient physical rehabilitation in outpatient settings can accelerate physical recovery in post-COVID patients with lung injury.

Multidrug resistance of pulmonary pathogens in patients with cystic fibrosis (CF) requires new therapeutic solutions.

The aim. To assess the effect of ceftazidime/avibactam (cef/avi) on clinical outcomes of pulmonary exacerbation of cystic fibrosis.

Methods. This open single-group observational prospective non-interventional study was conducted in the routine clinical practice settings. Patients over 18 years with a confirmed diagnosis of CF and an exacerbation of a pulmonary infection were included into the study after physician’s decision to prescribe cef/avi. The examinations were performed at baseline and on Days 5 to 7, 21, and 30.

Results. The analysis included data from 32 patients, 12 (38%) males and 20 (63%) females. The mean age was 31.6 years. Symptoms of exacerbation persisted in 97 % of patients on Days 5 to 7 of therapy and only in 3% at Day 21. FEV₁, FVC, SpO₂ also improved by Day 21 of the study (all – p < 0.001). By Day 21, proportion of patients with CRP above 10 mg/ml grew from 71 to 9%. The average density of sputum contamination decreased from 7.2 to 5.5 CFU/ml. Quality of life according to Cystic Fibrosis QuestionnaireRevised (CFQ-R) questionnaire also improved.

Conclusion. In patients with CF, exacerbation of lung infection in most cases is caused by multidrug resistant strains of Pseudomonas aeruginosa sometimes in combination with Staphylococcus aureus. Infectious agents (P. aeruginosa) remain highly sensitive to cef/avi (up to 91%) in this population so this justifies the use of cef/avi in treatment of a CF exacerbation. cef/avi administration led to relief of the exacerbation symptoms in 97% CF patients, as well as to significant improvement in spirometry parameters, increase in the oxygenation index, decrease in CRP and density of sputum contamination, and improved the quality of life. cef/avi administration was not associated with lethal outcomes, ICU admission, or serious adverse drug reactions.

Human respiratory tract is a complex system with a specific microbiological profile. Until recently, researchers were mostly interested in lung microbial communities associated with acute and chronic infections. The upper respiratory tract microbiota has gained attention during COVID-19 pandemic as it was proposed to be one of the factors affecting the course and the outcome of viral infections. The aim. In this review, we summarized the current knowledge about microbial communities in each section of the upper respiratory tract, considering the proposed barrier function of the respiratory microbiome. Conclusion. The facts provided in the first part of this review give a modern perspective on the structure of microbial communities of each part of the upper respiratory tract and factors that affect their variability.

Recently, single studies have described the picture of COVID-19 in patients with chronic obstructive pulmonary disease (COPD). Further study of this comorbid condition will help to assess the course and prognosis of each condition correctly, develop an effective plan for the management of patients with COPD during the pandemic caused by SARS-CoV-2 infection.

The aim. The article is an analytical review of the scientific literature from PubMed, Google Scholar, medRxiv, bioRxiv in order to study the clinical features of COVID-19 in patients with COPD. The published studies of the new coronavirus infection showed that patients with COPD account for 2% among those infected with SARS-CoV-2. However, further studies are needed to study the course of COVID-19 in patients with COPD. The conducted studies indicate a high level of ACE2 receptors to SARS-CoV-2 in current smokers and patients with COPD, which may explain the easier penetration of SARS-CoV-2 into the host organism and the severe course of the disease in this population.

Conclusion. Although a number of clinical studies strongly suggest that men have more severe COVID-19 than women, the patient’s gender is not always taken into account. It is possible that the more severe course of COVID-19 is associated with the increased prevalence of smoking and COPD in men as compared to women to a lesser extent than with the high production of testosterone and X-linked inheritance of the androgen gene and the ACE2 gene.

Interstitial lung diseases (ILDs) is a wide group of diffuse parenchymal lung diseases that can lead to interstitial pulmonary fibrosis. Clinical course of all ILDs, in particular with chronic fibrosing phenotype, can be complicated by an acute exacerbation caused by infection. Today, data about clinical course of COVID-19 in patients with progressive interstitial lung diseases is limited. In this case we described the course of COVID-19 infection in a patient with an interstitial pneumonia with autoimmune features (IPAF) and a progressive pulmonary fibrosis (PPF). We also discussed the typical features of COVID-19 in this population and the directions for further research.