Currently, chronic obstructive pulmonary disease (COPD) is a global problem and one of the leading causes of death worldwide. COPD therapy includes pharmacological and non-pharmacological approaches that can significantly reduce clinical symptoms and decrease the frequency of exacerbations of the disease. Methods. The updates of guidelines for the diagnosis and treatment of COPD is expected to have a significant impact on patients with COPD in clinical practice. Simplification of the treatment algorithms and inclusion of triple therapy will help clinicians provide appropriate and timely treatment to patients with COPD with a focus on reducing the risk of future exacerbations. Recognition of mortality reduction as a treatment goal in COPD supports the increased use of triple therapy, the only pharmacologic intervention shown to improve survival in patients with COPD. Conclusion. Although further guidance and clarification are needed in some areas, such as the use of blood eosinophil count in treatment decisions and the implementation of post-hospitalizaton treatment protocols, the recent guideline updates will help clinicians address current gaps in patient care.

Frailty is considered a high risk for falls, disability, hospitalization, and mortality in geriatric and certain chronic-disease populations. So, this study was planned to determine the prevalence of frailty phenotype in Chronic obstructive pulmonary disease (COPD) patients. Methods. 70 stable COPD patients were included in this study. Age, comorbidities (The FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale, BODE index, and modified Medical Research Council dyspnea score (mMRC) were recorded. In addition, each patient performed the Six-minute walk test (6-MWT) and underwent a pulmonary function test. Results. Frailty was detected in 37.3% of studied patients. However, 43.1% were classified as pre-frail. The presence of frailty was not significantly associated with the age of studied patients (p = 0.7). Comorbidities were significantly associated with frailty (p = 0.009). Also, the BODE index was significantly higher among patients with frailty (p < 0.001). Frailty was significantly associated with forced expiratory volume in 1 second, residual lung volume/Total Lung Capacity, and GOLD (Global Initiative for Chronic Obstructive Lung Disease) classification of COPD (p = 0.001; p = 0.003; p = 0.003 respectively). Frailty was significantly associated with 6-MWD and Borg scale difference (Lowest 6-MWD, highest Borg scale difference were detected in frail patients (p = 0.008; p = 0.001). Conclusion. Frailty is frequent among COPD patients. The presence of frailty is related to disease severity and functional impairment. Evaluation of frailty should be considered as a part of COPD assessment in clinical practice.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is often associated with asthma. This combination aggravates the course of both conditions, including the frequency and severity of asthma and CRSwNP exacerbations. Currently, the main strategy in the treatment of severe asthma is the use of biologicals, which may also impact CRSwNP symptoms, considering the similarity of pathogenic mechanisms of these diseases. The aim of our study was to evaluate the impact of biological therapy on CRSwNP in combination with severe asthma. Methods. 49 patients with CRSwNP and severe asthma were included in a single-center prospective cohort study. Patients were divided into 4 groups: dupilumab (n = 20), benralizumab (n = 15), mepolizumab (n = 7), and omalizumab (n = 7). Patients received the biologicals for at least 12 months (min – 12.0 months; max – 52.2 months). Asthma control (ACT, FEV₁, the number of asthma exacerbations) and CRSwNP control (SNOT-22, the number of nasal and sinus surgeries) were evaluated at baseline and during treatment. The safety of therapy was assessed by the examination results and the reported adverse events. Results. We observed statistically significant improvements in asthma control, respiratory function, and a decrease in the number of asthma exacerbations with the use of biologicals in all groups. However, there were no statistically significant differences between the groups (p > 0.05). As for CRSwNP, we found the statistically significant improvements in symptoms (ΔSNOT-22 – (–67,3) ± 23,7, p < 0,001; (–26,1) ± 24,6, p < 0,001; (–34,0) ± 23,5, p = 0,016; (–35,1) ± 25,1, p = 0,025) and a decrease in the number of surgeries after therapy (Δ number of surgeries – (–5,2) ± 8,6, p < 0,001; (–3,7) ± 3,3, p = 0,002; (–3,6) ± 2,4, p = 0,036; (–1,6) ± 1,4, p = 0,010). in all groups. At the same time, dupilumab showed a greater improvement of CRSwNP control according to the SNOT-22 questionnaire than benralizumab (p = 0.001) and mepolizumab (p = 0.034). Conclusion. Biologicals currently used to treat severe asthma have a beneficial effect on concomitant CRSwNP. However, not all biologicals are characterized by an effect on the processes of polyposis tissue remodeling and formation. Our study confirms the relevance of searching for other potential targets for the development of the new biologicals to address the identified clinical needs.

Morphological examination reveals microcirculation disorders in combination with small areas of lung damage in the long term after COVID-19. Therefore, the function of the respiratory system should be assessed after COVID-19. Aim of this study was to evaluate the dynamics of respiratory dysfunction in patients with COVID-19-associated lung injury using a complex examination of lung function (spirometry, body plethysmography, and lung diffusion testing) one year after hospital discharge. Methods. 60 patients (38 men/22 women, aged 39 to 80 years) with a diagnosis of “COVID-19-associated interstitial process in the lungs” were examined. Lung function (spirometry, body plethysmography, and lung diffusion capacity testing) was examined in all patients twice, at 1 – 6 months (visit 1) and at 12 – 24 months (visit 2) after hospital discharge. Results. At visit 1, 60% of patients had restrictive pulmonary ventilation disorders. Obstructive ventilation disorders were detected in only 1 patient. Decreased lung diffusion capacity (D _{CO corr.}) was found in 78% of patients. At visit 2, obstructive disorders were detected in 1 patient, and the frequency of restrictive ventilation disorders was 29%. Decreased DL_{CO corr.} was noted in 57% of cases. The parameters of pulmonary ventilation and pulmonary gas exchange function differed significantly between visits. Significant correlations were found between changes in the functional parameters of the respiratory system and disorders identified at visit 1 after hospital discharge. Conclusion. Thus, there is a decrease in the lung diffusion capacity and the rate of restrictive ventilation disorders even one year after severe COVID-19-associated lung injury. However, our results suggest a marked improvement in respiratory system function over time.  

The COronaVIrus Disease 2019 (COVID-19) is a common infectious disease characterized by hyperactivation of the immune response and the development of a “cytokine storm” upon progression. The aim of this study was to obtain additional information about the efficacy of the drug olokizumab in comparison with the Janus kinase inhibitor upadacitinib in real clinical practice in patients with mild to moderate COVID-19 and combined risk factors for disease progression. Methods. A single-center, non-interventional, prospective study was conducted in specialized day hospital patients (n = 125) who received therapy with olokizumab (n = 62) (64 mg once intravenously) and the Janus kinase inhibitor upadacitinib (n = 63) (orally, according to selected dosing regimen). The primary endpoint was the frequency of hospitalizations in the 24-hour hospital over the entire observation period. We also analyzed the frequencies of intensive care unit (ICU) transfer, prescription of respyratory therapy, use of “rescue” therapy (monoclonal antibodies/therapeutic proteins acting on interleukins (IL) and their receptors: IL-6 receptor inhibitors and Janus kinase inhibitors (baricitinib, tofacitinib, upadacitinib, etc.)), mortality, dynamics of laboratory and instrumental parameters, as well as frequency of negative and positive changes according to the clinical progression scale of the World Health Organization. Results. All study subjects showed rapid clinical improvement and recovery. Patients in both groups did not experience any negative clinical events, such as admission to a 24-hour hospital, prescription of respyratory therapy, use of “rescue” therapy, etc. Thus, the hyperinflammatory reaction and adverse clinical outcomes are effectively prevented by the timely use of both drugs. Those who received olokizumab had slightly higher levels of C-reactive protein (CRP) at baseline than those who received upadacitinib (p < 0.001). The median CRP value returned to normal on the 4^th day in both groups. Patients treated with olokizumab showed a more pronounced change in CRP levels relative to baseline values. A similar trend was also established in body temperature. Conclusion. The study confirmed that early administration of olokizumab in patients with mild to moderate COVID-19 with several risk factors for the severe course is as effective a method of preemptive anti-inflammatory therapy as the use of Janus kinase inhibitors but more stronger suppression of markers and symptoms of intoxication.

The treatment of sarcoidosis remains uncertain despite 70 years of studies. The conventional approach is to initiate corticosteroids in individuals who require treatment. However, to date, there are no strict dosing regimens for systemic corticosteroids (SСS), and patients who were treated with SСS develop relapses more frequently than those who have not received these drugs. The aim of this work was to evaluate the course and outcomes of pulmonary sarcoidosis in patients who were prescribed systemic corticosteroids. Methods. The study was retrospective and noninterventional. 493 (32.5%) of 1,518 patients with sarcoidosis were prescribed corticosteroids during follow-up. Only 333 cases were selected because they had histologic confirmation and follow-up of 1 year or more. The data at the time of diagnosis and at the time of analysis were compared (patients remained under the supervision of the same physicians thereafter). Results. After at least one year of follow-up, the positive effect of SCS (resolution or stabilization of the process) was achieved only in half of the cases, while the rest of the patients required more courses of SCS or the use of alternative drugs. Worsening was more common when multiple organs were involved, when SCS were administered immediately after diagnosis without a follow-up period, and when the duration of the first course of hormone therapy was less than 7 months. 33.6% of patients treated with SCS had clinically significant adverse events (AEs), and 13.2% had to discontinue or replace one hormonal drug with another. Older age and repeated courses of SCS were associated with the development of fibrosis, whereas transition to second-line drugs was not. Conclusion. SCS remain the first-line drugs in the treatment of sarcoidosis. The analysis performed allows us to recommend them after an observation period (if the patient’s condition allows it) and for at least 6 months. In case of exacerbation or recurrence of sarcoidosis after treatment with SCS, subsequent therapy with second-line drugs is more effective that a repeated course of SCS.  

Recent studies have shown that the respiratory bacterial microbiome has an impact on the development of pulmonary tuberculosis. Changes in the composition of the microbiome have been associated with the pathogenesis of Mycobacterium tuberculosis infection, response to therapy, and clinical outcomes of the disease. To date, the composition of the respiratory microbiome has not been studied in patients with localized forms of pulmonary tuberculosis. Methods. In the present study, the taxonomic composition of the sputum microbiome of 14 patients with localized forms of pulmonary tuberculosis (tuberculomas) and 14 healthy donors in the comparison group was analyzed by sequencing (NGS) of the V3 – V4 region of the bacterial gene encoding 16S rRNA. Results. The sputum microbiomes of the patients and the control group did not have significant differences in the species richness index (Shannon). However, the patients showed a decrease in the uniformity index, another parameter of alpha diversity. Bacterial community structures (beta diversity) did not differ significantly between patients with localized forms of tuberculosis and healthy subjects. In patients with limited forms of tuberculosis, contrary to the decrease in the content of representatives of the phyla Fusobacteria, TM7, Tenericutes, Spirochaetes, and SR1, and of the genera Dialister, Mycoplasma, and Filifactor in the sputum, no clear dominance of any bacterial taxon was observed. Conclusion. Certain alpha and beta diversity parameters that characterize the sputum microbiome of patients with localized forms of pulmonary tuberculosis need to be confirmed in independent large-scale studies to further understand the role of the sputum microbiota in the development of localized forms of pulmonary tuberculosis. Determination of Prevotella titers in the sputum of these patients holds promise for the diagnosis of localized forms of pulmonary tuberculosis and the search for their genomic markers.

The significant prevalence of asthma and asthma-COPD overlap (ACO) necessitates further rationalization of diagnostic and treatment approaches and emphasizes importance of studying the pathogenesis of bronchial obstructive diseases. Well-known markers of allergic and infectious inflammation such as periostin and procalcitonin, respectively, have shown their utility in pulmonology. The aim of this study is to analyze the diagnostic value of blood periostin/procalcitonin index as a complex parameter reflecting both allergic and non-allergic inflammation. Methods. First, we calculated blood periostin/procalcitonin index. Then we compared this index between two groups using the Mann – Whitney test. Results. Patients with non-allergic asthma had lower blood periostin/procalcitonin index compared to the patients with allergic asthma (p = 0.003). Blood periostin/procalcitonin index correlated well with diagnosis in patients with asthma and ACO in our clinical cases. Conclusion. Blood periostin/ rocalcitonin index has demonstrated its clinical utility as a complex inflammatory parameter. Its high values indicate active allergic inflammation. This index can be used to correct glucocorticoid and antibacterial treatment.

The intestinal microbiota is one of the most abundant of the human body biotopes. Its metabolic activity, as well as the antigenic composition, largely determine the metabolism and immunological status of the macroorganism, which, in turn, affect the local immunity of lung tissues. The pulmonary local immunity prevents the development of exogenous infections, opportunistic infections, and non-infectious diseases. The aim of the study was to identify the mechanisms of interaction of the intestinal microbiota with the components of the immune system and the pulmonary microflora, as well as the influence of intestinal microorganisms on the development of lung pathology. In this regard, the review presents data on how dysbiotic changes in the intestine affect the course of bronchial asthma, cystic fibrosis, acute respiratory distress syndrome, chronic obstructive pulmonary disease, and respiratory viral infections. The role of the intestinal microbiota in the formation of immunological resistance to Mycobacterium tuberculosis infection and maintenance of anti-oncogenic processes in lung tissues is considered. Conclusion. The gut microbiota contributes greatly to the development of respiratory conditions through immunological and metabolic mechanisms. A detailed study of these mechanisms will help understand the pathogenesis of lung diseases and identify points of application of pharmacological therapy.

With the development of the coronavirus pandemic and its decline, bacterial pathogens will again play a significant role in the epidemiology of community-acquired pneumonia (CAP). Numerous studies have already examined clinical, laboratory, and instrumental indicators that allow differential diagnosis between viral infection and bacterial pneumonia. The role of conventional (e.g., C-reactive protein, procalcitonin, leukocytes) and novel laboratory markers (e.g., MxA1 protein, progranulin, copeptin) was revealed. Differences in lung CT and ultrasound findings were noted. The aim of this publication is to present data on the differential diagnosis between pulmonary involvement in viral infections, including COVID-19 (COronaVIrus Disease 2019), and bacterial CAP. Conclusion. Despite numerous studies, distinguishing bacterial CAP from viral lung injury, including that associated with COVID-19 infection, without microbiologic testing is a challenging task that requires a combined assessment of clinical data, laboratory data, and modern imaging studies. Obviously, express testing will be of particular interest in this case.

N-acetylcysteine (NAC) is a mucolytic and antioxidant with a variety of properties. The clinical use of NAC spans more than 35 years, during which the emphasis has been on a multifaceted action and broad spectrum of therapeutic indications. Information is available on the efficacy of NAC in the prevention of contrast-induced nephropathy, studies on the role of NAC in the treatment of pulmonary and coronary disease, etc. The purpose of this review is to analyze the efficacy and safety of NAC in respiratory clinical practice. Conclusion. NAC is a drug with a unique variety of properties and treatment options. The drug has proven its efficacy and safety in real pulmonology practice.

Congenital lung malformations account for 2.2 – 6.6% of all congenital abnormalities of the lungs. This is a pretty rare problem as compared to acquired lung diseases. Pulmonary sequestrations account for 0.15 – 1.8% in the incidence of all lung malformations, occupying the second place after the complex abnormalities called “lung agenesis-hypoplasia”. Pulmonary sequestrations are common in children and adolescents so one could encounter them in pediatric practice. But pulmonary sequestrations may be associated with insignificant symptoms or even be asymptomatic in selected pediatric cases. Thereby, adult general practitioners, pulmonologists, and thoracic surgeons may encounter such patients. The aim. Review had the purpose to inform the general practitioners, pulmonologists, and thoracic surgeons about pulmonary sequestrations and their diagnostic, clinics course, and treatment. Conclusion. There is a wide range of congenital abnormalities of human body. Pulmonary sequestrations are only a part of this huge problem. But modern medicine has a vast selection of methods for revealing and treating these conditions (including minimally invasive surgery).

Bronchopulmonary sequestration (BPS) refers to a rare congenital lung malformation with a nonventilated dysplastic fragment of parenchyma separated from the main bronchial tree. This segment has a systemic blood supply through aberrant arteries and venous outflow into the systemic venous bed or pulmonary veins and has a common with the rest of the lung (intralobar BPS) or an independent (extralobar BPS) visceral pleura. Purpose of the study is to describe an unusual late onset of right-sided intralobar BPS characterized by a pseudopneumonic course in a patient with concomitant anomalies of the thoracic spine and diaphragm; to discuss the issues of formation, manifestation, diagnosis, differential diagnosis, complications, and treatment of intralobar BPS, and to consider its combination with other developmental anomalies. Conclusion. BLS should be considered in patients with an unusual course of pulmonary anomalies, especially localized in the basal segments of the left (more common) or right (less common) lung and characterized by abnormal blood supply and other malformations.

Invasive pulmonary mycoses are a common complication of severe COVID-19 (COronaVIrus Disease 2019) and are characterized by rapid spread and high mortality. It is especially important to study the epidemiology and pathomorphology of fungal superinfection in order to understand the main vector of the diagnosis and treatment of this complication. The aim of this paper is to consider aspects of the epidemiology, pathomorphologic picture, and clinical manifestations of invasive pulmonary mycoses associated with COVID-19. Clinical cases of fungal superinfections (candidiasis, aspergillosis) associated with COVID-19 in patients receiving appropriate therapy were presented. Results of autopsy examination and light microscopy with routine staining were analyzed. Macroscopic assessment of lesions and histological examination revealed morphological multiorgan changes typical of the combination of fungal (candidiasis, aspergillosis) and viral infection (COVID-19). Conclusion. The presented data of post-mortem examination are important for both science and clinical practice as they form the basis for finding new ways of treating patients with comorbid pathology and developing a prognostic algorithm.

Currently, among all pathologies of the respiratory system, bronchiectasis receives special attention. This is due to its increasing incidence and the improvement of diagnostic methods. Williams – Campbell syndrome is a congenital form of bronchiectasis characterized by a defect or complete absence of bronchial wall cartilage in the subsegmental bronchi. In view of this, medical personnel should be familiar with the basics of differential diagnosis and treatment, as well as the prognosis of this disease. The aim of this paper is to present a clinical family case of Williams – Campbell syndrome. The father of the family was diagnosed with WCS at the age of 3 years by bronchography, and his daughter has all clinical signs of this disease today. To date, the question remains as how to diagnose WCS and monitor the patient’s health in the future. Conclusion. Physicians of all specialties should be informed about rare diseases.