Radiation-induced lung injury is one of the most serious complications of radiation therapy in patients with malignant thoracic neoplasms. It results from accumulation of radiation dose in the lung tissue and can lead to development of various pathological changes in the lungs, such as fibrosis, pneumonitis and pulmonary hypertension. Post-radiation lung injury can significantly reduce the patient’s quality of life and worsen the prognosis. Aim. This literature review analyzes the causes of radiation-induced lung injury, describes the main clinical manifestations and diagnostic methods, and also discusses the possibilities of treatment and prevention of this complication. Conclusion. In recent years, significant progress has been made in understanding the multifactorial pathophysiological mechanisms of radiation-induced lung injury. There is still a need for further studies of the specific prognostic factors. Non-invasive methods to diagnose the functional state of the respiratory system also deserve attention. Promising areas of future research and development include individual clinical monitoring and monitoring of lung function, specific methods of treatment, prevention and reduction of the consequences of radiation-induced lung injury. Development in this areas will help to create a unified system of prevention and rehabilitation of radiation-induced lung injury as part of complex treatment.

Sarcoidosis is a multisystem disease of unknown origin that is characterized by formation of granulomas in various organs, predominantly lungs and lymph nodes. The approaches to evaluation and treatment of patients with sarcoidosis are controversial. Differential diagnosis of sarcoidosis is most often carried out with tuberculosis (TB). The aim of the study was to determine the characteristics of patients with sarcoidosis diagnosed using invasive diagnostic methods and assessment of these characteristics for differential diagnosis with tuberculosis. Methods. The medical histories of patients admitted to the thoracic surgery department to verify the diagnosis of sarcoidosis were studied. Videothoracoscopy was chosen to obtain biopsy samples as the safest and the most valuable diagnostic procedure. Sarcoidosis was diagnosed when a characteristic granuloma was detected by pathology. Results. Of the 64 cases, 42 (65.6%) were women and 22 (34.4%) were men. The mean age was 48.4 ± 11.6 years. Of the 64 patients studied, 26 (40.6%) people had a preliminary diagnosis of tuberculosis. In 19 (73.1%) of these cases, tuberculosis was excluded by a tuberculosis specialis, and in 7 (26.9%) cases TB was excluded after the anti-tuberculosis treatment course. Baed on the histology, the most common types of sarcoidosis were pulmonary (30/64, 46.9%) and combined lymph node and pulmonary sarcoidosis 25 (39.1%). Sarcoidosis of the lymph nodes 5 (7.8%) and sarcoidosis of other locations 4 (6.3%) were much less common. The largest group of patients were women with sarcoidosis of the lymph nodes and lungs 20 (31.3%) aged 35–64 years. Conclusion. Diagnosis of sarcoidosis is difficult. When examining a patient with newly identified changes in the lungs and lymph nodes and dissemination syndrome, the anti-tuberculosis treatment not justified in the absence of convincing evidence for tuberculosis, a negative test for HIV infection, in the absence of inflammatory changes in the blood, in the presence of prolonged contact with dust and when the patient is female. Morphological verification of the diagnosis will reduce the time required for diagnosis and eliminate the incorrect prescription of chemotherapy.

Sarcoidosis is a systemic epithelioid cell granulomatosis of unknown origin. The specialized commission on pulmonology of the Russian Ministry of Health recommended creating a register for sarcoidosis in the beginning of 2023. The aim of the study was to assess the main characteristics of newly identified patients with sarcoidosis according to the register created in the Republic of Tatarstan as a pilot project. Methods. Information on the newly identified patients was collected from 1996 to 2023. Statistical processing of 3,037 cases of sarcoidosis was carried out using the SPSS-18 program (IBM, USA). The p-value < 0.05 was considered statistically significant. Results. From 1 967 to 2 023, 3,037 cases of sarcoidosis were entered in the registry, including 2 094 women (68.9%) and 943 men (31.1%). The median age was 45 (34; 55) years, with 36 – 55 years of age being associated with the highest incidence. The men were much younger than the women. There was an increase in detection in 2017 (161 patients) with a subsequent decrease during the COVID-19 pandemic and recovery in subsequent years. 18 (0.6%) patients had X-ray stage 0, 1,162 (38.3 %) – stage I, 1,527 (50.3%) – stage II, 302 (9.0%) – stage III, and 28 (0.9%) – stage IV. Löfgren’s syndrome was present in 387 (12.7%) patients, and extrapulmonary manifestations were found in 576 patients (19.0%). Identification rate in different regions of Tatarstan correlated with the size of the population. Overall, 44.7% patients had biopsy results, along with 47.3% before COVID-19 pandemic and 72.5% after the pandemic. After identification, a combination of pentoxifylline with vitamin E was prescribed in 32.9%, and vitamin E alone in 30.3%. Systemic corticosteroids were prescribed in 17.5%, and active monitoring without treatment was recommended in 15.8% cases. Postponing of immunosuppression was compliant with the clinical guidelines in Tatarstan. Conclusion. Analysis of data from the sarcoidosis register of the Republic of Tatarstan revealed an increase in detection before the COVID-19 pandemic, a decrease during the pandemic, and a resumption of growth together with an increase in biopsies afterwards. Management of patients after the diagnosis was characterized by the predominant active surveillance and immunosuppression strictly according to the therapeutic indications.

The course of interstitial lung diseases (ILD) is characterized by high variability. The extent and heterogeneity of ILDs inevitably leads to diagnostic difficulties. The aim of the study was to analyze misdiagnosis of ILD in patients included in the Irkutsk register. Methods. 270 patients aged 18 – 88 years with various ILDs were followed in the register. The diagnosis of ILD was based on clinical, laboratory, functional, radiological (high-resolution computed tomography (HRCT)) and, if necessary, histological findings. All diagnoses were discussed by a multidisciplinary team. Results. The time from the first signs of interstitial lesions to the diagnosis of ILD varied from several months to several years (0 – 22 years), with a median of 12 (3; 36) months. Only half of the 155 (57.4%) patients with ILD were diagnosed within one year from the first symptoms. Misdiagnoses in patients with respiratory symptoms and/or HRCT changes prior to ILD verification included various forms of pneumonia (recurrent, prolonged course) in 24.4%, pneumosclerosis in 12.6%, obstructive lung disease in 12.6%, and tuberculosis in 10.7%. The main causes of misdiagnosis were underestimation or misinterpretation of clinical, radiological and functional data. Late diagnosis is one of the factors determining progressive pulmonary fibrosis: time to diagnosis ≥ 12 months – odds ratio (OR) of 4.1 (95% confidence interval (CI) 2.4 – 7.1); p < 0.001. Conclusion. To overcome the misdiagnosis of ILD, it is necessary to inform and alert general practitioners, to maximize the effectiveness of the examination of a patient with suspected ILD, and to immediately refer such a patient to a competent specialist to diagnose ILD and verify the diagnosis with a multidisciplinary team.

Partially controlled or uncontrolled adolescent patients with mild or moderate asthma are common in real clinical practice. The current guidelines provide several options for their controller therapy correction. Further evaluation of clinical features of patients who may benefit from inhaled corticosteroids (ICS) is needed. Thе aim of the study to examine response to 8-week treatment with ciclesonide in adolescents with previously not well controlled BA. Methods. 46 patients (mean age 14.8 ± 2.5 years, 73.9% boys) with asthma were included in the open prospective non-comparative study of the real clinical practice. They were treated with ciclesonide 160 μg/day in a pressurized metered dose inhaler (pMDI) for 8 weeks and all had completed the 10 week. Changes in asthma control test (ACT) results, number of exacerbations, number of days without symptom-reliver inhalations, number of days of school absence due BA symptoms, spirometry results and adverse events were investigated between date of inclusion and after 8 weeks of treatment with ciclesonide 160 μg. Results. All patients had controlled BA after 8 weeks of treatment; there was statistically significant improvement of ACT median score (Q25; Q75), from 14 (12; 17) to 22 (21; 23) points. No school days were missed and no exacerbations were reported during 4 weeks before the end visit date. Number of patients with forced expiratory volume in 1st second (FEV₁) was greater than 80%_pred. (91.3%) and had increased by Visit 3 both compared to Visit 1 (37%, р = 0.0001) and archive data from previous year (67.4%, р = 0.001). Number of patients with positive bronchodilation test and median of FEV₁ change had decreased. There were no adverse events of clinical interest during the study. Conclusion. Ciclesonide 160 μg/day (Asmalib®Air pMDI) is effective and safe and allows achievement and maintenance of controlled asthma course in adolescents.

Mannitol for inhalation is recommended for the treatment of cystic fibrosis in children over 6 years of age and adults. Because of the risk of bronchospasm, a challenge test to assess the drug tolerability should be performed prior to prescribing inhalation mannitol. Aim. Tо evaluate the tolerability of the first dose of inhaled mannitol in children with cystic fibrosis. Methods. The mannitol challenge test (according to the instructions for use of the Bronchitol (inhaled mannitol), Pharmaxis Ltd, Australia) was assessed in 81 children aged 6 to 18 years (11.6 ± 3.2 years). The patients were observed in the centers of the Novosibirsk region, the Moscow region, and the Perm region. The patient’s general state, forced expiratory volume in the first second (FEV₁), and SpO2 were monitored. Results. Baseline FEV₁ data in patients ranged from 30 % to 146 % (87.8 ± 25.7%), and SpO2 was 94 – 99% (97.7 ± 1.3%). 73 (90.1%) patients passed the test. In 8 (9.9%) patients, the following symptoms were observed: bronchospasm (6), laryngospasm (1), and vomiting (1). Bronchial obstruction was treated by inhalation of a bronchodilator, and the children were under observation until the restoration of FEV₁. In patients who passed the test, FEV1 ranged from 33 to 149 % (85.4 ± 24.5%), and SpO2 spanned from 95 to 99% (96.7 ± 1.7%). The children who did not pass the test were monitored. One patient passed the test later when targeted therapy was added. Two children did not tolerate other mucolytic drugs (one child – NaCl solution in various dilutions, and the second patient suffering from asthma – dornase alfa). During follow-up, one patient was diagnosed with allergic bronchopulmonary aspergillosis at 12 years of age and with asthma at 13 years of age, which may have influenced the decrease in mannitol tolerability through formation of bronchial hyperreactivity. Thus, true adverse drug reaction in the form of bronchospasm occurred in three children out of 81 (3.7%). Conclusion. 90.1% of patients passed the inhalation mannitol challenge test, and 9.9% of patients did not pass the test. Analysis of adverse drug reactions revealed that only 3.7% of patients experienced true adverse reactions in the form of bronchospasm. During the test, patients were taught the correct technique for inhaling the drug. All the supplies to relieve bronchospasm should be readily available during the test.

Primary lymphomas are classified according to the WHO general classification system. Despite the fact that more than half of patients with nodular lymphomas have lung lesions, primary pulmonary lymphomas account for less than 0.5% of all primary lung neoplasms. In addition, the most common primary lung lymphoma, non-Hodgkin’s B-cell marginal zone lymphoma (MALT lymphoma), accounts for less than 10% of extranodal lymphomas. Hodgkin’s lymphomas (LH) are only rarely considered primary lung lymphomas, even if the lungs are the main affected organ. Moreover, in most cases of primary pulmonary MALT lymphoma, in-depth examination reveals other extranodal sites (for example, stomach, colon, thyroid gland, bone marrow) that can be identified as sites of subclinical clonal lymphoid proliferation. Secondary lung damage in lymphomas is found in half of the cases and is more common than primary pulmonary lymphoma. However, it is difficult to morphologically determine the difference between primary pulmonary lymphoma and secondary lung damage in malignant lymphoproliferative diseases (LPDs). The aim was to present an overview of the clinical and diagnostic features of primary and secondary lung lesions in malignant lymphoproliferative diseases. Conclusion. Lung lesions in lymphoproliferative diseases can be primary and secondary. Primary lung and pleural lesions in LPDs are rare, while lymphomas that secondary lung lesions are identified in 20% of the cases during autopsy. In most patients, the diagnosis is based on the results of light microscopy, immunohistochemical and molecular assays.

Lung diseases are among the leading causes of death. Patients with malignant lung tumors often have terminal stage of the disease at the time of diagnosis because of long absence of clinical manifestations of the condition and late diagnosis. The aim of the work was to analyze literature devoted to the problems of identifying the nature of focal lung lesions and reliable assessment of the degree of tumor process. The authors also aimed to evaluate the importance of ongoing monitoring with radiology methods for clarification of the nature of focal changes in the lungs and for selection of methods with greater specificity regarding the nature of the process. Conclusion. Radiological methods are crucial in screening and detection of lung tumors, but ongoing monitoring is carried out in most cases to determine the nature of the changes. Further research on a comprehensive assessment of radiological diagnostic data using artificial intelligence (AI) in order to determine the nature of small lung lesions is relevant.

According to world statistics, lung cancer (LC) ranks 2nd in the cancer incidence among women. Management of pregnancy-associated LC presents a clinical dilemma, as it is necessary to consider possible risks not only for the mother, but also for the fetus. The aim of the work was to study the existing literature data on diagnosis, management tactics and treatment approaches for pregnancy-associated cancer. The literature sources and presented clinical observations show disappointing findings: there was practically no response to chemotherapy (CT) in patients who received chemotherapy with platinum in combination with vinorelbine, paclitaxel, and etoposide during pregnancy and after childbirth, and a preliminary conclusion was made that change in the pharmacokinetics of chemotherapy drug may jeopardize the treatment of cancer during pregnancy. The use of surgical and radiation treatment methods depends on the individual clinical situation, stage and histotype of the tumor, as well as the gestational age. Conclusion. Thus, both diagnostic and therapeutic measures for pregnant women with LC should be personalized and performed by a special multidisciplinary team that includes a chemotherapist, radiotherapist, surgical oncologist, and obstetrician-gynecologist.

Uterine sarcomas account for 3 – 5% of all malignant neoplasms of the uterus, and they occur 3 times more often in the body than in the cervix. Leiomyosarcoma, endometrial stromal sarcoma (ESS), mixed mesodermal tumors, carcinosarcoma, and undifferentiated sarcoma are the most common in clinical practice. When choosing the tactics of treatment and prognosis of the disease, the stage of the process is taken into account. The aim of the article is to describe a clinical case of a 37-year-old woman with ESS. The tumor was initially diagnosed during a biopsy of lung tissue and was confirmed only after extirpation of the uterus. Immunohistochemical assay revealed strong expression of estrogen and progesterone receptors, CD10, moderate expression of caldesmon and vimentin in the absence of desmin expression in the ESS cells. The expression of SMA and CD34 was detected in blood vessels. The expression of S100 and bcl-2 was found in a few isolated cells. Epithelial lining cells expressed EMA, CK7, and napsin A. Conclusion. The peculiarity of the presented case is that the disease was diagnosed based on the histological examination of a lung metastasis.

Diffuse Idiopathic Pulmonary NeuroEndocrine Cell Hyperplasia (DIPNECH) is an understudied rare disease that should be taken into account in the differential diagnosis of therapy-resistant bronchial obstruction combined with focal pulmonary lesions and mosaic attenuation on chest CT. The aim of this article is to discuss the aspects of clinical and morphological diagnosis, therapeutic options, prognosis assessment, and the need for follow-up using a clinical case as an example. The article describes a clinical case of DIPNECH in a 55-year-old woman, and also provides a brief review of the scientific literature on DIPNECH. DIPNECH is a rare disease that most often affects non-smoking women aged around 60 years. The most frequent clinical manifestations are cough, dyspnea, stridor, and broncho-obstructive syndrome. Only histological and immunohistochemical assays can confirm the diagnosis. DIPNECH should be considered as part of the differential diagnosis in patients with prolonged cough, dyspnea of unclear genesis and changes on chest CT in the form of pulmonary focal lesions and mosaic attenuation. Conclusion. The presented clinical case shows the challenges and importance of timely diagnosis.

Invasive aspergillosis is a disease that occurs mostly in people with a compromised immune system. The most important pathogen is Aspergillus fumigatus (it accounts for about 90% of the patients). The risk group includes patients who have primary and secondary immunodeficiencies, people receiving immunosuppressive therapy, cancer patients, etc. However, the incidence of this disease among COVID-19 (COronaVIrus Disease 2019) patients have been reported recently. The aim of our work is to present a patient with invasive aspergillosis after COVID-19 who was not in a standard risk group and did not receive immunosuppressive therapy. Conclusion. Patients who had COVID-19 are under a risk of developing invasive pulmonary aspergillosis. Therefore, it is important to exclude this disease in a patient with prolonged pneumonia that does not respond to standard therapy.

The purpose of publishing the resolution of the Interdisciplinary Council of Experts in the fields of pulmonology, allergology, pediatrics, and clinical pharmacology was to discuss the effectiveness and safety of a new short-acting β₂-adrenergic receptor agonist in the Russian Federation – levosalbutamol. The Interdisciplinary Council of Experts in the fields of pulmonology, allergology, pediatrics, and clinical pharmacology took place on March 19, 2024 in Moscow. Results. According to the research results, the following advantages of using levosalbutamol have been demonstrated: the affinity for β₂-adrenergic receptors is 2 times higher compared to salbutamol; the drug affects the sensitization of β₂ receptors to a lesser degree; levosalbutamol does not cause increased airway hyperresponsiveness; levosalbutamol has a more pronounced anti-inflammatory effect; greater safety for the cardiovascular system was noted. Conclusion. According to the presented data, the inclusion of levosalbutamol in clinical guidelines for asthma (age category “children, adults”) and chronic obstructive pulmonary disease (age category “adults”) is justified.

The purpose of the study was to assess the clinical and functional parameters of patients with severe asthma to optimize drug therapy in order to improve the control. Methods. We examined 45 patients diagnosed with severe asthma: 34 (75%) women and 11 (25%) men. The median age was 56 (30; 70) years. 37 (82%) respondents had an allergic asthma phenotype, while 8 (18%) patients had non-allergic asthma. As for the comorbidities, allergic rhinitis was the most common (56%), intolerance to NSAIDs was observed in a third of the studied patients, and chronic polypous rhinosinusitis (CPRS) was diagnosed in 20 (44%) patients. Results. Each respondent was diagnosed with at least 1 marker of T2 immune response. Before the initiation of biologics, the patients experienced frequent asthma attacks daily, and a high need for SABA was determined. None of the patients had asthma symptoms under control. After 4 months, the control indicator, AST test score, improved to 22 [20; 25] points. The low FEV₁ of 65.5% (48.6; 76.8) and FEV₁/FVC of 61.4% (43.9; 72.1) before the initiation of biological therapy should be noted. However, the pulmonary function parameters improved after 4 months – the FEV₁ increased to 82% (51.0; 93.4), and FEV₁/FVC raised to 71.3% (51.2; 74.4). Conclusion. All patients were diagnosed with at least 1 marker of T2 immune response. Thus, the correct selection of patients with T2 immune response markers makes it possible to prescribe personalized drug therapy, which, in turn, ensures the achievement of control over asthma. After 4 months biological therapy, the patients noted the absence of exacerbations, a decrease in the need for SABA, and an improvement in pulmonary function.

The purpose of the study was to compare the results of an interactive survey and the traditional method for collecting active symptoms and medical history in patients with respiratory diseases. Methods. The study included 82 patients with respiratory conditions: 45 patients with broncho-obstructive diseases and 37 patients with community-acquired pneumonia, who were divided into subgroups depending on their scores on the Morisky-Green rating scale and the Toronto Аlexithymia Scale. The interactive survey was conducted using the respiratory module of the automated system for preliminary syndromic diagnosis “Electronic Clinic”. Statistical analysis of the study results was carried out using the Statistica 10.0 program. Results. The interactive survey identified the following symptoms of diseases more often than the traditional collection of active symptoms and medical history: productive cough, feeling of chest congestion, wheezing (p < 0.05), and shortness of breath (p > 0.05). Conclusion. An interactive survey allows identifying more details about the patient-reported symptoms and minimize the risk of missing important medical information when the doctor is pressed for time or the patients are non-cooperative or have difficulty communicating their feelings and sensations.

Pulmonary veno-occlusive disease (PVOD) is a rare pathology of unknown etiology when the development and progression of pulmonary arterial hypertension (PAH) is associated with damage to small pulmonary veins and venules, including thrombotic lesions. The prevalence of the disease is 1 – 2 cases per 10 million people. PVOD is characterized by rapid progression and poor prognosis. The aim of the work was to demonstrate a rare clinical case of PVOD in a 43-year-old woman who had a predisposing risk factor for the development of the disease and a verified mutation in the EIF2AK4 gene. Conclusion. This clinical case illustrates the difficulties of diagnosing PVOD and choosing the further patient management. It is noted that timely diagnosis and initiation of therapy are critically important for patients with PVOD, while the use of PAH-specific therapy might complicate course of the disease by provoking pulmonary edema.

Arteriovenous malformation is a rare and difficult to diagnose cause of chronic hypoxemia. Pulmonary arteriovenous malformation (PAVM) is an abnormal connection between pulmonary arteries and veins. Frequent clinical manifestations of this abnormality include hypoxemia, hemorrhage and complications from distant embolization, including stroke and brain abscesses. The aim of our work was to demonstrate a clinical case of this rare and potentially fatal disease. Conclusion. This clinical observation demonstrates the difficulties of diagnosing PAVM. The diagnostic search for chronic hypoxemia has to include an abnormality of the pulmonary vessels.

Currently, nitric oxide (NO) is considered a signaling molecule that acts as a universal regulator of many physiological processes in the body. The purpose of this research was to study the effects of exogenous NO on microcirculatory vessels and their blood flow under experimental conditions for the pathogenetic justification of NO therapy and correction of microcirculatory disorders. Methods. Effects of exogenic NO on microvessels of cranial pia mater were studied in white Wistar rats. Another set of experiments was carried out in hamsters to correct microcirculatory disorders caused by inflammatory-destructive lesions of the oral mucosa of the cheek pouch with NO therapy. Results. The effectiveness of the complex treatment of inflammatory-destructive diseases of the oral mucosa has increased with the use of NO. Conclusion. It has been established that the key factor in the positive effect of exogenous NO in therapeutic doses on blood microcirculation is the activation of vasomotor activity of microvessels.