Obstructive sleep apnea syndrome (OSAS) is a common pathology of the respiratory system characterized by upper airway blockage during sleep. The blockage is caused by intermittent throat collapse and thereby no lung ventilation with preserved respiratory efforts. Earlier we demonstrated that telomeres at the end of chromosomes shorten during intermittent nocturnal hypoxia and sleep fragmentation in OSA patients; the elimination of OSA triggers contributed to an increase in relative telomere length (RTL). The search for the relationship between telomeres and the telomerase complex activity with the sleep stages, as well as indicators of blood oxygen saturation in OSA, seems relevant.

Aim. To evaluate the activity of the telomerase complex main components and to determine its relationship with the sleep phases and the level of desaturation in patients with OSA.

Methods. The main group included 32 men (age 51.2 ± 3.1 years) with complaints of snoring, respiratory arrest during sleep, and increased daytime sleep. The control group consisted of 26 matched volunteers without clinical manifestations of OSA. Patients of both groups did not have any exacerbations of their chronic conditions at baseline. The study included questionnaires, polysomnography monitoring, analysis of the RLT by PCR, ELISA to determine activity of the telomerase complex components, and statistical analysis.

Results. Differences were revealed in the functioning of telomeres and the TERT, TEP1. A positive relationship between the oxygen blood saturation, telomere length and TER1 activity was found in OSA patients.

Conclusion. We have identified the decrease in RTL and the telomerase complex activity and proved their positive relationship with the oxygen saturation during intermittent nocturnal hypoxia in OSA patients.

Spirometry is the most common method to assess respiratory function. It is widely used to obtain objective information for the diagnosis of respiratory diseases and monitoring the functional state of the respiratory system. In 2014, the Russian Respiratory Society approved the technical standards for performing spirometry. Improvements in measuring devices have necessitated updating technical standards and standardizing the result interpretation algorithm.

Methods. This document on spirometry was prepared by a joint group of experts from the Russian Respiratory Society and the Russian Association of Specialists in Functional Diagnostics, who have experience in performing spirometry in accordance with quality criteria, analyzing the results of the study, and developing national standards.

Results. The 2014 Spirometry Technical Standards were revised, including the addition of quality criteria for measurements and test quality assessment. Where necessary, evidence was provided to support the change. The experience and knowledge of the expert group members were used to develop these recommendations.

Conclusion. Standards for spirometry and bronchodilator test and the result interpretation algorithm are presented to improve the measurement quality and consistency of data interpretation.

In recent years, the number of electronic cigarettes (ES) users has been growing steadily around the world. ES heat and vaporize components of a mixture of propylene glycol, vegetable glycerin, nicotine, and flavors. Reports of severe forms of lung injury caused by the use of ES, some of which have resulted in death, urge studying the pathogenetic mechanisms of such complications. One of the mechanisms is the activation of nonspecific proteolysis accompanied by the destruction of connective tissue components of the blood-air barrier.

Aim of the study. To study the dynamics of the proteinase-inhibitor system indicators and its role in the morphological changes of lung tissue in experimental modeling of the effects of ES.

Methods. Experimental studies were performed in 24 white male Wistar rats weighing 160 – 180 g. ES use of was simulated by intermittent exposure to smoke mixture vapors using a POD system connected to a two-channel compressor.

Results. Analysis of the state of the nonspecific proteinase inhibitory system in rat broncho-alveolar lavage and blood serum and the results of morphological studies indicate activation of trypsin-like proteinases and depletion of the local antitryptic potential, leading to biochemical changes with subsequent structural changes in lung tissue. The latter are characterized by congestion, leukocyte infiltration, and stromal proliferation. In addition, exposure to nicotine-containing mixtures has been shown to affect the proteinase inhibitory system and blood serum composition, which is associated with a compensatory increase in antitrypsin activity.

Conclusion. The results of the study indicate the activation of trypsin-like proteinases in broncho-alveolar lavage, which have a damaging effect on lung tissue, leading to disturbances in tissue hemodynamics, extravasation of leukocytes, remodeling and thickening of the blood-air barrier.

Globally, pneumonia complicated by exudative pleurisy is often recognised too late and inadequately treated in senile patients.

Purpose. To study the clinical manifestations, diagnosis, and treatment of community-acquired pneumonia complicated by exudative pleurisy in the senile.

Methods. Archived case histories from the period 2006 – 2022 were used to conduct a comparative study of these clinical manifestations and the outcomes of treatment of community-acquired pneumonia complicated by pleurisy was carried out in 33 patients aged 75 – 88 years and 50 patients aged   18 – 34 years.

Results. Acute onset of pneumonia complicated by pleurisy was less common in senile age than in young people (60.6% vs 82.0%; p < 0.05), pneumonia proceeded without an increase in body temperature more often than in young people (24.2% vs 4.0%; p < 0.01), chest pain was less common (60.6% vs 90.0%; p < 0.01), rales in the lungs were heard more often on auscultation (48.5% vs 22.0%; p < 0.05). In the analysis of peripheral blood in senile age, leukocytosis (33.3% vs 66.0%; p < 0.05) and a leftward shift in the leukocyte formula (6.1% vs 24.0%; p < 0.05) occurred less frequently in senile patients. Pneumonia occurred against diseases of cardiovascular system(84.9% vs 8.0%; p < 0.01), gastrointestinal tract (42.4% vs 18.0%; p < 0.05) and urinary system(27.3% vs 4.0%; p < 0.01), and lingered more often in senile people (36.4% vs 10.0%; p < 0.05) than in young ones. In senile age, pneumonia was combined with pericarditis in 6.06% of cases, and in 21.2% it occurred against a background of residual changes after previous respiratory tuberculosis, which was not observed in young age.

Conclusion. Antibacterial therapy, taking into account the sensitivity of sputum microflora to drugs, combined with regular aspiration of pleural exudate, made it possible to cure all senile patients without surgical intervention. The severity of residual pleural changes was similar to that in young people.

Differential diagnosis of pulmonary mass lesions is one of the most difficult tasks not only in pulmonology but also in phthisiology, because clinical manifestations, data from visual and laboratory examinations are undifferentiated in the early stages. In the case of an unclear diagnosis, morphological verification of the process played a crucial role. Urgent intraoperative examination is the most difficult option for morphologic verification of lung lesions, which requires a quick, detailed, and accurate answer.

The aim of this study was to evaluate the clinical significance and efficacy of urgent intraoperative cytologic examination in the differential diagnosis between granulomatous (tuberculosis, sarcoidosis), tumor and tumor-like lesions of the lung.

Methods. The results of urgent intraoperative cytologic examination of 173 tissue specimens from lung masses were retrospectively analyzed. Cytologic specimens were stained by the May – Grunwald – Giemse and Ziehl – Neelsen methods and then visualized on a Zeiss Lab A1 microscope (Carl Zeiss, Germany). The obtained data are compared with the results of histological examination. To evaluate the effectiveness of intraoperative cytologic examination, the accuracy, sensitivity, and specificity were calculated.

Results. Analysis of the results of urgent cytological examinations (n = 173) shows that granulomatosis (tuberculosis/sarcoidosis) was established in 64.7% of cases, malignancy – in 31 cases (cancer – 9.2%, carcinoid tumor – 2.9%, malignant neoplasm of unclear etiology – 4%, suspected malignant lesion – 1.7%); benign process – in 9.2% of cases (hamartoma + chondroma – 5.2%, chronic inflammation – 4%). 1.2% of the cases had no diagnostic material. When comparing the obtained results, there was a discrepancy between the histological picture (2.9% of cases) and the primary clinical diagnosis (5.7% of cases). Sensitivity, specificity, and accuracy of cytologic examination of intraoperative material amounted to 95.9, 71, and 98%, respectively.

Conclusion. The high sensitivity and accuracy (> 90%) of urgent cytologic diagnosis of pathologic processes in the lung under intraoperative conditions were demonstrated by the correct assessment of morphologic signs of a given lesion and by their comparison with the clinical picture and the results of additional examinations. Analysis of cytological specimens showed that urgent cytological examination significantly complements the morphological picture of lung lesions and can be considered as the first stage of phenotypic diagnosis.

In recent years, an increase in the number of patients with chronic infection with nonfermenting gram-negative bacteria (NFGNB) in adult patients with cystic fibrosis (CF) has increased. The genotype and phenotype characteristics, NFGNB structure, changes in sensitivity and the development of antibiotic resistance in adult patients have not been adequately studied.

Aim. To determine the impact of genotype severity and Achromobacter xylosoxidans sensitivity to carbapenems on the functional and nutritional status of adult cystic fibrosis patients over a period 2016 – 2021.

Materials. Retrospective analysis of genotypic and microbiological data from 54 adult CF patients and their effects on FEV1 and BMI over a period 2016 – 2021. Sputum cultures were confirmed by MALDI-TOF mass spectrometer. Depending on the severity of the mutation, the patients were divided into 2 groups: group 1 (“severe” genotype) – patients who had 2 mutations of class I – III; group 2 (“soft” genotype) – at least 1 class IV – VI mutation.

Results. The group of patients with “mild” mutations had a higher BMI (kg / m2) than the group with severe mutations for a longer period of follow-up from 2018 – 2021 than in the group with severe mutations: BMI (2016) – 21.14 ± 3.55 / 19.28 ± 3.13 (p = 0.163); BMI (2017) – 21.27 ± 3.43 / 18.31 ± 2.05 (p = 0.123); BMI (2018) – 21.17 ± 4.00 / 18.80 ± 2.12 (p = 0.025); BMI (2019) – 21.01 ± 4.20 / 18.55 ± 2.53 (p = 0.049); BMI (2020) – 20.94 ± 4.12 / 18.41 ± 2.15 (p = 0.050). Age at diagnosis was 20.36 ± 2.18 years for “mild” genotypes and was higher (p = 0.042) than for “severe” genotypes (6.27 ± 1.53 years). All 7 patients who died (100%) were in the “severe” genotype group (23.3%). Functional status assessment showed no differences in FEV1 over 6 years between the “severe” and “mild” genotype groups: FEV1 (2016) – p = 0.51; FEV1 (2017) – p = 0.39; FEV1 (2018) – p = 0.51; FEV1 (2019) – p = 0.35; FEV1 (2020) – p = 0.48. Nonfermenting Gram-negative bacteria accounted for 49.9% of the isolated microorganisms. The group of carbapenem-resistant Achromobacter xylosoxidans lost the FEV1 level faster every year for 6 years (p < 0.05) compared to the group of the sensitive variant.

Conclusion. In general, patients with the “mild” genotype have higher nutritional status and do not differ from patients with the “severe” genotype in terms of FEV1. The survival rate of patients with the “mild” genotype patients survival rate is higher, despite the later diagnosis and start of treatment. Development of carbаpenem resistance in Achromobacter xylosoxidans is associated with an unfavorable prognosis of the functional status decline.

Systematizing clinical experience in the use of biological treatments in patients with severe bronchial asthma in real world settings with assessment of clinical outcomes and quality of life level is of great interest and value in practical pulmonology.

The aim of the BEST study (Real World Evidence of Benralizumab in Eosinophilic Severe AsThma in Russia) was to evaluate effectiveness of benralizumab by control and quality of life associated with respiratory status in patients with eosinophilic phenotype of severe asthma in real clinical practice in Russia.

Results. The results obtained through 16 weeks of benralizumab therapy in patients with severe eosinophilic asthma (SEA) were analyzed. All 59 enrolled patients showed significant improvement in the asthma control questionnaire (ACQ-5) score, the quality of life associated with respiratory status according to the St. George Respiratory Questionnaire (SGRQ), and subjective assessments of the well-being of patients and the disease severity (PGIC and PGIS). Treatment with benralizumab contributed to a reduction in the oral glucocorticosteroids intake throughout the study period.

Conclusion. In real clinical practice, treatment with benralizumab results in significant improvement in disease control and the quality of life in patients with severe eosinophilic asthma and is characterized by a favorable safety profile.

The relevance of studying psychosomatic disorders in somatic clinical practice (including pulmonary practice) stems from the significant prevalence of these disorders, as well as the difficulties in making a differential diagnosis and choosing the most effective tactics for patient management.

The aim of this review was to analyze the available publications on the problem of psychosomatic functional disorders in pulmonary practice, such as hyperventilation syndrome (HVS), including HVS associated with Severe Acute Respiratory Syndrome-related CoronaVirus 2 (SARS-CoV-2) infection, vocal cord dysfunction, and psychogenic cough. The article discusses clinical features of different variants of functional disorders and accompanying psychopathological symptoms (panic attacks, generalized anxiety, etc.), as well as psychogenic factors of their manifestation and changes in the clinical features over time. The corresponding section briefly summarizes current ideas about approaches to effective treatment of this group of disorders and prevention of their chronification.

Conclusion. The clinical heterogeneity of psychosomatic functional disorders in pulmonological practice has been demonstrated, as have important aspects of the diagnosis and treatment of these disorders.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic disease that can be classified as both a hypereosinophilic condition and an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and is characterized by granulomatous inflammation. The pathogenesis of EGPA is not completely understood. It is likely that this disease is Th2-mediated, and blood and tissue eosinophilia serves as the main diagnostic criterion. The hallmarks and main effectors of organ damage in EGPA include asthma-associated necrotizing vasculitis of small-to-medium vessels and eosinophilic proliferation. Endothelial injury and vascular inflammation in EGPA is caused by ANCA via activation of circulating neutrophils. Two clinical phenotypes of the disease have been described based on the detection of ANCA: ANCA-negative with manifestations of hypereosinophilia (for example, pulmonary infiltrates and cardiomyopathy) and ANCA-positive with clinical signs of vasculitis (for example, glomerulonephritis, purpura, and mononeuritis multiplex). Both phenotypes were confirmed by histological and genomic research. However, these two coexisting mechanisms cannot be separated in clinical practice.

The aim of the article is to present current knowledge of eosinophilic and ANCA-mediated aspects of the pathogenesis, classification and clinical phenotypes of EGPA, and consider prospects for future research.

Conclusion. The development of EGPA is based on eosinophilic dysfunction. This dysfunction means that patients with a genetically determined predisposition to recognize the ANCA antigen and with HLA-DQ (human leukocyte antigen DQ) alleles produce anti-myeloperoxidase autoantibodies and later develop an aberrant autoimmune process. Further comprehensive post-genomic studies are needed to identify the pathogenetic mechanisms and characterize molecular features of EGPA clinical phenotypes. The elaboration of molecular endotypes will lead to the identification of new activity biomarkers and therapeutic targets that can improve the diagnosis of EGPA and the treatment outcomes.

One of the most important areas of modern medicine is the search for molecular biomarkers that open up new possibilities in fundamental research of pathological processes, allowing to diagnose human diseases with high accuracy and to implement a personalized approach to prescribe effective therapy. Currently, one of the promising molecular biomarkers in respiratory medicine is club cell protein (CC16, or secretory globulin SCGB1A1). Club-shaped cells are known to be involved in pulmonary homeostasis and regulate the progression of acute and chronic inflammatory processes in the bronchopulmonary system. Immunomodulation and regulation of inflammation by club-shaped cells is mediated by secretion of CC16 protein, which has pronounced anti-inflammatory, anti-allergic, and anti-tumor properties.

The aim of the review is to collect and analyze data from recent domestic and foreign studies on the role of club-shaped cells and their CC16 protein in physiological and pathological processes in the airways.

Conclusion. Based on the data of domestic and foreign studies presented in the review, it can be concluded that club-shaped cells and their secretory globulin SCGB1A1 play an important role in the physiological and pathological processes in the respiratory tract. Thus, club cell protein may serve as a molecular biomarker for diagnosing and monitoring the progression of certain bronchopulmonary diseases, for individual assessment of the treatment efficacy, and as a basis for the development of new therapies in respiratory medicine.

According to statistics, chest injuries rank third in prevalence and are characterized by high mortality, which is 35 – 45%. This article presents a patient diagnosed and treated for bilateral pulmonary contusion with post-traumatic pneumonitis after a combined mine-explosive injury.

Purpose. Of particular interest to the clinician is the understanding of lung injury from the standpoint of interpretation of diagnosis, methods of diagnosis, and differential diagnosis with pneumonia, prevention of complications, and rational treatment tactics. The terms “pneumonitis” and “pneumonia” are not synonymous. In modern terminology, it is customary to use the term pneumonitis for a pathologic process in the alveoli without an infectious process in the vast majority of cases, and infectious forms of pulmonary inflammation are referred to as pneumonia. In this clinical case (and in similar situations), it is advisable to take into account the pathogenesis of changes in lung tissue after pulmonary contusion, leading to post-traumatic pneumonitis, which often requires additional specific therapy and rehabilitation for rapid recovery of lung function. Proper tactics in prescribing anti-inflammatory and antibacterial drugs are critical, as is treatment aimed at preventing complications, including prevention of fibrous changes in the lung.

Conclusion. Given the relevance of this topic, it is currently advisable to introduce monitoring of CRP and procalcitonin levels, coagulogram, and gas composition of arterial blood, if necessary, in the patient management. It is advisable to use computed tomography to clarify the nature of the changes. The problem of follow-up and rehabilitation of patients with chest injuries and pulmonary contusion is relevant.

Pandemic of the new coronavirus infection has presented the medical community with challenges that call for immediate action. An increase in the number of severe cases of COVID-19 requiring mechanical ventilation inevitably leads not only to an increase in the complication rates, but also to combined complications. A clinical case of a combined tracheal stenosis and diaphragm after severe COVID-19 is presented here.

The aim of this publication was to improve treatment outcomes of patients with multiorgan complications of post-COVID origin.

Conclusion. Combined complications of a severe coronavirus infection worsen the rehabilitation prognosis, and require surgical treatment.

Hypercapnic respiratory failure is a common cause of hospitalization and death in patients with chronic obstructive pulmonary disease (COPD).

The aim of this work was to analyze the pathophysiological mechanisms and clinical picture of hypercapnic respiratory failure and to discuss the tactics of managing a patient with COPD and posthypercapnic alkalosis that developed during treatment using a clinical case as an example.

Conclusion. To date, the search for new treatments for posthypercapnic alkalosis is still relevant, but there are few published studies on this topic. Acute problems in mixed metabolic disorders can be solved with an integrated therapeutic approach that includes the use of medical gases.

Sporadic lymphangioleiomyomatosis (LAM) is an orphan disease that primarily affects women of childbearing age. Increasing awareness of this disease among physicians can contribute to its timely diagnosis and treatment.

The aim of this work was to present a case of a young woman with a rare cystic lung disease. At the first visit to the clinic, the patient showed pronounced clinical, radiological and functional changes in the bronchopulmonary system, and a rare pathology was suspected. Establishing the definitive diagnosis in the shortest possible time was essential because pathogenetic therapy with an mTOR inhibitor had to be initiated as soon as the diagnosis of LAM had been clarified. Until 2010, a definitive diagnosis of LAM was made only by surgical lung biopsy. However, there is currently a shift in practice toward less invasive diagnostic methods that eliminate the need for surgical intervention in most patients.

Conclusion. An algorithm for making a definitive diagnosis (sporadic LAM) without morphologic examination of the lung is demonstrated.