Respiratory symptoms and functional disorders are registered in patients who suffered from COVID-19 (COronaVIrus Disease 2019). Aim. Clinical and functional evaluation of the respiratory system during 6-month follow-up in patients who had moderate and severe COVID-19. Methods. 80 patients were included in the cohort observational prospective study. Patients were examined in 46 (36 - 60) days from the onset of symptoms of COVID-19 and in 93 (89 - 103) and 180 (135 - 196) days at the 2^nd and 3^rd stages respectively. At all stages, symptoms, dyspnea level, and quality of life were analyzed using validated questionnaires, and a 6-minute step test was performed. At the 2^nd and 3^rd stages, we assessed spirometric parameters, total lung capacity, carbon monoxide diffusing capacity (DL_CO), and high resolution computed tomography scans of chest organs. Results. At the 1^st stage of the study, 62% of patients complained of fatigue, muscle weakness, 61% of patients had dyspnea of variable severity. At the 3^rd stage of the study, 43% and 42% of patients had the same complaints respectively. The prevalence of moderate COVID-19 form in patients with 35 (25 - 45)% lung damage and severe COVID-19 form with 75 (62 - 75)% of lung damage was established. At the 2^nd stage, a DL_CO < 80% level was recorded in 46% of patients with 35 (25 - 45)% lung damage and in 54% of patients with 75 (62 - 75)%. At the 3^rd stage, DL_CO < 80% was diagnosed in 51.9% and 48.1% of patients with of 35 (25 - 45)% and 75 (62 - 75)% lung damage respectively. The level of DL_CO < 60% was found in 38,5% and 35,5% of patients with moderate and severe lung damage at the 2^nd and 3^rd stages of the study respectively. Conclusion. The symptoms were reported less frequently during the 6-month follow-up after COVID-19. 77% and 87% of patients had DL_CO < 80% in 93 (89 - 103) and 180 (135 - 196) days after the disease onset, respectively. 38.5% and 35.5% of those patients, predominantly having suffered COVID-19 in severe form, had DL_CO < 60% at 93 (89 - 103) and 180 (135 - 196) days, respectively. This calls for a continuous observation and regular examinations after COVID-19.

Sarcoidosis is a multi-organ granulomatosis  of unknown  origin. Modern  diagnostic methods  allow detecting  this disease at an early stage. The absence of specific markers requires a comprehensive  approach  to diagnosis based on comparison  of radiation,  clinical, morphological  and functional data. The course of sarcoidosis without damage to the respiratory system presents significant difficulties. It is extremely important  to understand the time and means of starting Sarcoidosis’s treatment to avoid the early initiation  of hormones  and cytostatics and, on the other hand,  to timely respond to progression and threatening  conditions.  Methods. Clinical recommendations are based on the analysis of Russian and English publications of the latest sarcoidosis research. The target audience of these clinical guidelines are therapists, general practitioners, pulmonologists, TB doctors, rheumatologists,  dermatologists,  radiation diagnosticians,  immunologists,  and clinical pharmacologists.  Each thesis-recommendation for diagnosis and treatment is evaluated on an 1 to 5 scale of levels of evidence and an A, B, C scale of the grades of recommendations. The clinical guidelines also contain comments and explanations for the theses-recommendations, diagnostic algorithms, treatment strategies, reference materials on the use of recommended drugs. Conclusion. Current information  on epidemiology, clinical manifestations,  diagnosis and management  strategies for patients with sarcoidosis are covered in the presented clinical guidelines. Approved by the decision of the Scientific and Practical Council of the Ministry of Health of the Russian Federation (2022).

Cough is a frequent manifestation  of COVID-19  (COronaVIrus Disease 2019), therefore,  it has an important  diagnostic value. There is little information  about the characteristics  of cough of COVID-19  patients in the literature.  To perform a spectral analysis of cough sounds in COVID-19 patients in comparison  with induced cough of healthy individuals. Methods. The main group consisted of 218 COVID-19  patients (48.56% – men, 51.44% – women, average age 40.2 (32.4; 50.1) years). The comparison group consisted of 60 healthy individuals (50.0% men, 50.0% women, average age 41.7 (31.2; 53.0) years) who were induced to cough. Each subject had a cough sound recorded,  followed by digital processing using a fast Fourier transform algorithm. The temporal-frequency parameters of cough sounds were evaluated: duration (ms), the ratio of the energy of low and medium frequencies (60 – 600 Hz) to the energy of high frequencies (600 – 6 000 Hz), the frequency of the maximum sound energy (Hz). These parameters  were determined  in relation  to both the entire cough and individual phases of the cough sound. Results. Significant differences were found between some cough parameters  in the main group and in the comparison  group. The total duration  of the coughing act was significantly shorter in patients with COVID-19, in contrast to the induced cough of healthy individuals (T = 342.5 (277.0; 394.0) – in the main group; T (c) = 400.5 (359.0; 457.0) – in the comparison  group; p = 0.0000). In addition,  it was found that the cough sounds of COVID-19  patients are dominated by the energy of higher frequencies as compared  to the healthy controls (Q = 0.3095 (0.223; 0.454) – in the main group; Q (c) = 0.4535 (0.3725; 0.619) – in the comparison  group; p = 0.0000). The maximum frequency of cough sound energy in the main group was significantly higher than in the comparison  group (F_max = 463.0 (274.0; 761.0) – in the main group; F_max = 347 (253.0; 488.0) – in the comparison  group; p = 0.0013). At the same time, there were no differences between the frequencies of the maximum energy of cough sound of the individual phases of cough act and the duration of the first phase. Conclusion. The cough of patients with COVID-19 is characterized  by a shorter duration and a predominance of high-frequency energy compared to the induced cough of healthy individuals.

The COVID-19 (COronaVIrus Disease 2019) caused more than 3.5 million deaths all over the world. Patients who have underlying comorbidity, such as cardiovascular and pulmonary diseases have shown worse prognosis. In view of this, undivided attention was focused on patients with such rare conditions as pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). There is currently limited data available regarding COVID-19 infection in CTEPH patients. The available data are mostly case studies or small case series. The aim of this publication was to describe the course of COVID-19 in patients with previously diagnosed CTEPH. Methods. The study included 92 patients with an established diagnosis of CTEPH, who were managed in the Federal State Budgetary Institution National medical research center of cardiology named after academician E.I. Chazov, Ministry of Health of the Russian Federation. 62 patients with CTEPH and confirmed COVID-19 were enrolled, including 62% women. The mean age was 55.8 ± 14.8 years. Results. The duration of COVID-19 was 14 [10; 30] days. The fever, general weakness, anosmia, and dyspnea were the most frequent presentations at diagnosis of COVID-19 in CTEPH patients. According to the multispiral computed tomography (CT) chest scans, more than half of the patients (54.2%) had mild disease (category CT-1). Most of the patients were under specific therapy (92%), mainly riociguat at an average daily dose of 5.75 ± 2.2 mg/day. All patients received anticoagulants. No need for long-term respiratory support and no lethal outcomes were registered in the study group. Conclusion. Small pilot studies demonstrated favorable clinical course of COVID-19 in CTEPH patients. This finding could be explained by the protective effect of anticoagulation and specific treatment.

Clinical presentation is an undependable prognostic indicator of COVID-19 (COronaVIrus Disease 2019). So, a more objective predictor is needed to precisely evaluate and classify the prognosis. Immune dysregulation to lymphocytes, mainly T-lymphocytes, have been noticed between COVID-19 patients. The aim. This study was planned to determine the role of platelet-to-lymphocyte count ratio and neutrophil-to-lymphocyte ratio in assessment of COVID-19 prognosis. Methods. 70 hospitalized patients with confirmed COVID-19 were included in this study. All included patients underwent a consistent clinical, radiological and blood examination. Laboratory analysis was made by means of a commercially accessible kit. Blood cells ratios were computed by dividing their absolute counts. Results. Non-significant association was found between laboratory data and COVID-19 clinical severity. A significant association between CT classification and platelet-to-lymphocyte count ratio (higher value in L type; p = 0.001) was detected. Platelet-to-lymphocyte count ratio was significantly higher among intubated cases. However, Non-significant association was found between neutrophil-to-lymphocyte ratio and need of endotracheal intubation. Conclusion. Routine blood values are abnormal in patients with COVID-19. Platelet-to-lymphocyte count ratio ratios could be used as more meaningful biomarker than other values in predicting the prognosis of COVID-19. LMR helpful in COVID-19 severity.

Aim. To assess the impact of chronic obstructive pulmonary disease (COPD) on the outcomes of myocardial revascularisation and the self-reported quality of life (QoL) during long-term follow-up. Methods. This prospective cohort study included 454 consecutive patients who underwent scheduled myocardial revascularisation. The follow-up continued for 3 years after the surgery. All patients underwent pulmonary functional tests before the surgery. The diagnosis of COPD was verified according to the Global Initiative for Obstructive Lung Disease criteria. QoL assessment was performed before and 3 years after the surgery using the 36-Item Short-Form Health Survey (SF-36). Results. In the study group, the diagnosis of COPD was verified in 14.5% of cases. The mortality rate was 5%, and was significantly higher in patients with COPD. The baseline QoL level was reduced in all patients, regardless of the presence of COPD, with an average of 50 points both in the physical and mental health scores of the SF-36 questionnaire. COPD had a significant negative impact on the QoL physical health score after myocardial revascularisation (odds ratio (OR) 0.95 (0.91 - 0.99), p = 0.043). The forced expiratory volume in the first second (OR 1.02 (1.00 - 1.07), p = 0.048) and new-onset atrial fibrillation in the early postoperative period (OR 0.54 (0.33 - 0.88), p = 0,036) were predictors of lack of QoL improvement. COPD did not correlate with the changes in the psychoemotional component of QoL. Conclusion. COPD has an independent negative impact on the clinical outcomes of myocardial revascularisation, including survival and health-related QoL (physical health score). Thereby, preoperative assessment of the respiratory function is important in these patients.

The frequency of exacerbations of chronic obstructive pulmonary disease (COPD) is one of the main factors determining the outcome. The search for biomarkers which reflect the risk of exacerbations is one of the urgent scientific and practical objectives. Aim. The study aimed to analyze the relationship between the serum concentration of hyaluronic acid (HA) and the frequency of exacerbations of occupational COPD caused by exposure to silica dust and to substantiate the use of HA as a predictor of exacerbations of COPD. Methods. 78 individuals with a diagnosis of occupational COPD were examined. Respiratory function was assessed based on forced vital capacity of the lungs (FVC, %), the forced expiratory volume in 1 second (FEV₁, %) and the calculated ratio of these parameters (FEV₁/FVC, %), i.e., modified Tiffno index. The serum concentration of hyaluronic acid (ng/ml) was determined in all individuals using solid-phase enzyme-linked immunosorbent assay (ELISA). The absolute blood level of eosinophils (cell/μl) was determined by a unified method of morphological study of hemocytes with white blood cell differential count. Results. Serum HA concentration in patients with occupational COPD with frequent exacerbations was 25% higher than in the patients with rare exacerbations (the difference was statistically significant; р = 0,004). The analysis of the obtained data showed that the most significant moderate correlation was found between the level of HA and the frequency of COPD exacerbations (direct relationship, r = 0.32; p < 0.05), and FEV₁ and the frequency of COPD exacerbations (feedback, r = -0.32;p < 0.05). A weak relationship was found between the relative number of eosinophils and the frequency of COPD exacerbations (direct relationship, r = 0.2; p < 0.05). Weak correlations were also found between the level of HA and FEV1 (feedback, r = -0.23; p < 0.05), between the level of HA and the relative number of eosinophils (direct relationship, r = 0.18; p < 0.05). Conclusion. Quantitative analysis of serum HA in patients with occupational COPD can be used in clinical practice as a biochemical marker for assessing the risk of exacerbations and progression of bronchopulmonary pathology.

According to the WHO, tobacco use is currently the leading cause (16%) of all adult deaths. Studies conducted in many countries and in the Russian Federation have revealed the association between smoking and pulmonary tuberculosis (PT). Due to the negative impact of tobacco smoking on the course of tuberculosis and the effectiveness of treatment, there is a need to develop approaches to smoking cessation in patients with PT. Aim. To evaluate the effectiveness of the treatment of PT in smoking patients in combination with nicotine replacement therapy in an inpatient setting. Methods. The study included 27 patients with a confirmed diagnosis of PT. The inclusion criteria for the study were: age 18 years and older, patients who are currently active smokers, and a confirmed diagnosis of PT. The exclusion criteria were the presence of asthma and oncological diseases, unconfirmed diagnosis of PT, and earlier history of tobacco use. In the study group, an analysis of the smoking status was carried out. This status was based on the length of smoking period, number of cigarettes per day, and calculation of the smoking patient index. The degree of nicotine addiction, the presence of withdrawal symptoms, and the motivation of patients to quit smoking were assessed. The principle of nicotine dependence treatment was to prescribe nicotine-containing drugs in a dose depending on the degree of nicotine addiction. The duration of treatment was 12 weeks. Results. After 4 months of PT treatment, the cessation of bacterial excretion was detected 2 times more often, the closure of decay cavities in the lung tissue - 2.5 times more often, the relief of systemic inflammatory reactions - 2 times more often in patients who quit smoking than in patients who continue to smoke. Conclusion. This study showed that the treatment of PT in smokers was more effective in combination with nicotine replacement therapy for smoking cessation than when the patients continued to smoke.

The human respiratory tract is a complex system characterized by a series of niches colonized with specific microbial communities. Until recently, researchers were mostly interested in lung microbiomes associated with acute and chronic infections. The upper respiratory tract microbiota has gained attention during COVID-19 (COronaVIrus Disease 2019) pandemic because it was suspected to influence the course and the outcome of viral infections. Aim. In this two-part review (see part 1, Pul’monolog;iya. 2022; 32 (5): 745-754), we summarize current knowledge of the microbial communities at each upper respiratory tract location, considering the proposed barrier function of the respiratory microbiome. Conclusion. Based on the evidence presented in this review, we can see how the respiratory microbiome is involved in the pathogenesis of viral respiratory infections, including SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus 2).

The problem of etiologic diagnosis of bilateral pleural effusions is important because of the relatively large number and variety of diseases accompanied by this syndrome, the complexity of diagnosis verification, and the frequent diagnostic errors. The aim of this review is to describe the spectrum of diseases causing bilateral pleural effusion and to consider a set of diagnostic measures to clarify the etiology of the process. Analysis of 60 literature sources showed that the most common causes of bilateral transudative pleural effusions are cardiac, hepatic, and renal insufficiency. Exudative bilateral pleural effusions are found in inflammatory processes in the pleura, including tuberculosis, and develop when inflammation is transmitted by contact or lymphohematogenous routes from the lungs or other organs. Bilateral localization of pleural effusion in tumor processes is observed in 5.7% of cases. Bilateral pleural effusion is seen in pulmonary embolism, diffuse connective tissue diseases, acute idiopathic pericarditis, postinfarction Dressler syndrome, after pericardotomy, and after pacemaker placement. It may be observed in such rare diseases as sarcoidosis, yellow nail syndrome, and Meigs syndrome, and may be induced by some drugs. Conclusion. The choice of therapeutic measures for bilateral pleural effusion is determined by an accurate etiological diagnosis of the underlying disease. The diagnosis should be based on the patient's clinical data and cytologic, microbiologic, and biochemical analysis of pleural fluid obtained by pleural puncture. In some cases, additional examination methods such as pleural biopsy, bronchoscopy, ultrasound, computed, magnetic resonance imaging of the chest and abdomen, and positron emission tomography are required.

D-hypovitaminosis in the working-age population is quite common in industrialized countries, especially when it comes to patients with chronic diseases, including respiratory ones. The role of vitamin D in calcium and bone homeostasis is well known. In recent years, vitamin D has been recognized to modulate many processes and regulatory systems involved in the immune response and reparative processes, in addition to the classic function of this vitamin. Aim. A review of the prevalence of D-hypovitaminosis in the working-age population with respiratory diseases was conducted using the PubMed, Web of Science, Scopus, clinicaltrials.gov databases for 2014 - 2019. Results. Epidemiological and experimental studies have shown that low serum vitamin D is associated with impaired lung function, an increase in the incidence of inflammatory, infectious, or neoplastic diseases, which include asthma, COPD, and cancer. Conclusion. Knowledge of direct pathogenetic relationships between vitamin D levels and lung diseases is currently limited, although there is a number of studies that highlight the relevance of this relationship. A number of studies are contradictory in their results, which requires further study of the role of vitamin D levels in the pathogenesis of respiratory diseases and the need for its inclusion in the essential therapy to improve the effectiveness of treatment and accuracy of the prognosis. However, large-scale screening studies of vitamin D level for the purpose of its correction are costly, even with a single measurement.

The condition of patients with chronic lung diseases is gradually deteriorating despite modern drug therapy and often progresses to severe respiratory failure. Thus, it is important to consider other options, including surgical methods, to help such patients. The aim of the study is to demonstrate potential additional pharmacological and surgical treatment algorithms for chronic obstructive pulmonary disease (COPD) associated with α₁-anti-trypsin (A₁AT) deficiency. Results. The analysis of long-term medical history (from the onset to the terminal stage of the respiratory failure) of a patient with A₁AT deficiency was performed. Conclusion. Patients with COPD associated with A₁AT deficiency require combination inhaled controller therapy and augmentation therapy with a1-proteinase inhibitor. Patients with terminal stage of the disease need lung transplantation unless they have any contraindications.

Diaphragm dysfunction is a rare cause of respiratory distress with a variety of clinical manifestations that complicate diagnosis and treatment. The given clinical case demonstrates the possibility of detecting bilateral diaphragm paralysis using available general clinical and instrumental diagnostic methods. Among the physical data, high standing of the lower borders of the lungs with limited mobility and paradoxical movement of the diaphragm during the Mueller test have a high diagnostic value. Chest X-ray demonstrates the high standing of both domes of the diaphragm and subsegmental atelectasis in the basal parts of the lungs. Severe hypoxemia developed: oxygen saturation in clino- and orthostasis was 72 and 96%, respectively. The tests of pulmonary function showed significant restrictive impairments, a decrease in the vital capacity of the lungs was also determined. Ultrasound examination of the diaphragm revealed hyperechogenicity, lack of inspiratory thickening, and respiratory mobility of the domes of the diaphragm. Electromyography confirmed gross right and left phrenic nerve axonopathy. An idiopathic variant of diaphragm dysfunction can be assumed based on the patient stabilization during CPAP therapy, physiotherapy exercises, chest massage, followed by the disappearance of signs of bilateral diaphragm paralysis. Conclusion. The presented case demonstrates the difficulties of diagnosing bilateral diaphragm paralysis. The final diagnosis was made through the use of specific research methods recommended for suspected diaphragm dysfunction. The prognosis of the idiopathic variant of bilateral diaphragm paralysis, as in this case, is favorable. Spontaneous remission was observed.

Bilateral lung resections are performed  for various pathologies: pulmonary  emphysema,  parasitic diseases, metastatic  lesions, and bronchiectasis. In clinical practice, sequential or staged interventions  are more common.  Surgical treatment of bronchiectasis is currently carried out only in cases with complications  of localized forms and, as a rule, consists of resection of the affected part of the lung. The percentage of such patients is not large and amounts to about 5%. Taking into account the chronic course of bronchiectasis and certain successes of the conservative treatment, indications for resection operations  may arise at different periods of the patient’s life. Sometimes,  up to several decades can pass between the surgeries. Aim. To demonstrate  a rare clinical case of staged lung resection for bronchiectasis in a patient who had 4 lung lobes removed with an interval of 52 years. Results. History of the disease was described. Indications  for staged surgical interventions  were identified. The main characteristics  of the health status after the surgeries were described. Conclusion. The presented case illustrates the place and role of surgical methods in the treatment of bronchiectasis, as well as the compensatory  capabilities of the lung tissue in the case of staged resection interventions.

SARS-CoV-2 (Severe Acute Respiratory Syndrome-related CoronaVirus 2) infection is characterized by multi-comorbidity, which increases the severity of the disease. The aim of the study was to identify the relationship between the length of stay in the hospital and the comorbidity and the severity of lung damage. Methods. 72 patients with COVID-19 (COronaVIrus Disease 2019) infection were studied, including 33 women and 39 men who were treated in the city hospitals. The average age was 67.4 ± 12.02 years. The SARS-CoV-2 RNA virus was identified by PCR in 46 (63.8%) patients. Results. The most common comorbidities in chronic obstructive pulmonary disease (COPD) patients with COVID-19 included arterial hypertension (in 32%), coronary artery disease (17%), and type 2 diabetes (10%). The majority of patients (48.7%) had the CT II stage. The total proportion of patients with an advanced damage (corresponding to CT III - IV) was 36.2%. Mean hospitalization length was 13.8 ± 7.9 days. Conclusion. COPD patients with COVID-19 infection included a significant percentage of patients with arterial hypertension, which required additional treatment.