Molecular hydrogen (H₂) has emerged as a therapeutic and prophylactic agent devoid of adverse effects. H₂ demonstrates multifaceted functionality across diverse cell types and organs, attributable to its interaction with oxidized hemes as a fundamental molecular mechanism. Given the abundance of various heme types both intracellularly and extracellularly, the broad-ranging effects of H₂ are comprehensible. Subsequent Pathways are mediated by end-or modified- products of lipid peroxide followed by free radical chain reactions. Notably, H₂ confers benefits not only to patients afflicted with diseases but also to individuals seeking to enhance health and wellness. The mission of hydrogen medicine encompasses addressing unresolved medical challenges, including cerebral infarction, post-cardiac arrest syndrome, advanced cancer, metabolic syndrome, and dementia. Transitioning from animal experiments to clinical studies is imperative to confront these formidable diseases effectively.

The aim of the review was to examine the main characteristics of hydrogen ion metabolism and its hemostatic function in the human body. For diagnostic purposes, molecular hydrogen (H2) is considered a biological marker. The results of the analysis of therapeutic programs for the clinical use of hydrogen are presented. The use of H2 as a drug in the treatment of more than 170 diseases is also discussed.

Conclusion. The use of H2 in various fields of medicine, including oncological diseases, is actively studied based on experimental biological experiments and clinical trials.

The aim of this scientific literature review was to find new solutions to urgent problems of treating respiratory diseases and reducing the associated temporary loss of ability to work and disability. The article presents the results of the analysis of 62 scientific papers published over 23 years (2001 – 2023) on mitochondrial dysfunction (MD), new methods of its diagnosis, and ways of its correction in respiratory diseases. Disorder of the energy function of mitochondria has been identified as an urgent scientific problem of respiratory medicine. It is noted that new methods of pathogenetic therapy for common and currently difficult-to-treat diseases are being developed to solve this problem. The key section of the review is devoted to the results of studies of mitochondrial dysfunction in patients with asthma, chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and pulmonary hypertension.

Conclusion. The article assesses MD diagnostic methods that are potentially applicable in real clinical practice. The results of studying the electric potential of the inner mitochondrial membrane, accumulation of active forms of oxygen, production of adenosine triphosphate in blood cells, alveocytes and epithelium of the respiratory tract, as well as bronchial smooth muscle cells, endothelium and vascular smooth muscle cells in the pulmonary artery system, determination of mitochondrial DNA in biological environments are compared. Proposed methods for the correction of MD syndrome in the clinical picture of respiratory diseases are briefly covered.

Molecular hydrogen (H₂) is a powerful antioxidant and anti-apoptotic agent. H₂ has been studied in a number of clinical studies in the recent years.

The aim of this research was to investigate the efficacy and safety of H₂ inhalation therapy in patients with hypoxemic and hypercapnic respiratory failure (RF) against exacerbation of chronic obstructive pulmonary disease (COPD) in the post-COVID (Corona Virus Disease 2019) period.

Methods. The randomized prospective parallel comparative study included patients (n = 60: 40 men aged 71.2 ± 1.8 years, 20 women aged 70.9 ± 2.8 years) with a post-COVID-19 exacerbation of COPD complicated by hypoxemic/hypercapnic RF. The patients were divided into 2 groups: group 1 (main) (n = 30: 18 men, 12 women), group 2 (control) (n = 30: 18 men, 12 women). To maintain arterial blood saturation ≥ 90 %, patients in both groups received respiratory support (non-invasive ventilation) using the Prisma 25ST device (Lowenstein Medical, Germany) in the BiPAP S/T mode (BiLevel Positive Airway Pressure Spontaneous/Time spontaneous/forced mode 20–24/4–6 cm H2O and O₂, respectively; the fractional oxygen concentration in the inhaled gas mixture was ≥ 24%). In addition to standard treatment, patients in the main group received additional H2 therapy (Suisonia device, Japan) through a nasal cannula for 90 minutes daily for 14 days.

Results. In patients of the main group, a decrease in the stiffness index was detected from 14.6 ± 1.2 to 6.2 ± 0.6 m/s, and the arterial blood lactate level – from 2.84 ± 0.1 to 0.02 ± 0.1 mmol/l (p < 0.001), the calculated shunt fraction Qs/Qt (venous admixture) – from 27.21 ± 3.4 to 7.14 ± 1.23 (p < 0.01) and an increase in the following parameters: reflection index – from 42.2 ± 2.0 to 66.2 ± 4.9% (p < 0.05), virus-specific IgG level – from 134 ± 125 to 669 ± 164 (p < 0. 05), blood flow velocity in arterioles – from 473 ± 108 to 868 ± 64 μm/s (p < 0.05), blood flow velocity in venules – from 299 ± 56 to 862 ± 69 μm/s (p < 0.05), the 6-minute walk distance – from 57.1 ± 4.4 to 328.9 ± 33.7 m (p < 0.05).

Conclusion. H₂ inhalations were safe and increased the therapeutic effect when added to standard therapy for patients with hypoxemic and hypercapnic RF during exacerbation of COPD in the post-COVID period.

The device for nitric oxide inhalation therapy TIANOX has been put into use in clinical practice. It produces NO in nonequilibrium plasma of a diffusive spark discharge in the air at atmospheric pressure. There is a tendency to use a therapeutic gas mixture with high NO concentration for inhalation in the developing medical treatment methods. Nitric oxide transition into active compounds such as nitric dioxide, peroxynitrite, and nitrotyrosine can lead to oxidative stress. The use of hydrogen as an antioxidant that decreases the levels of hydroxyl radicals and peroxynitrite can protect cells from oxidative damage. Positive effect of the nitric oxide mixture and hydrogen is shown in the experiments with animals.

The aim of the article is to describe development and performance the first hybrid system producing nitric oxide and hydrogen that was created in Federal State Unitary Enterprise “Russian Federal Nuclear Center – All-Russian Research Institute of Experimental Physics”. The system is based on the plasmochemical generator Tianox and the hydrogen generator, which is based on the electrolyzer with a solid polymeric electrolyte. It is fitted with H₂, NO, and NO₂ monitor and provides a continuous monitoring of concentrations of these gases and helps ensure safety of medical procedures by disconnecting NO and H₂ generators at the moment when the gas concentrations exceed maximum levels (H_2max, NO_max, NO_2max).

Conclusion. This hybrid system for nitrogen and hydrogen production passed the first study in human successfully. The preclinical studies also demonstrated its efficacy and safety.

Abstract Up-to-date data on patients with chronic obstructive pulmonary disease (COPD) in the Russian Federation are necessary to improve medical care effectiveness.

This article presents the results of the retrospective part and the cross-sectional assessment of the CORSAIR study, which aimed to assess the distribution of COPD patients in the Russian population by symptom severity and exacerbation risk as per GOLD (2020) classification groups A, B, C, D.

Methods. The observational multicenter study CORSAIR included a cross-sectional assessment with data collection during the previous 12 months (retrospective part) and subsequent follow-up for 12 months (prospective part). Data from 704 patients obtained at 18 study sites from August 2021 to November 2022 are presented. At the first visit, the physician recorded medical history, clinical data on the disease course, and COPD therapy, assessed compliance of treatment with national guidelines, and determined whether treatment change was needed considering the predominant treatable trait (dyspnea or exacerbation).

Results. Upon inclusion, most patients had severe COPD symptoms (mMRC score ≥ 2; САТ score ≥ 10) and severe and very severe airflow obstruction (GOLD III and GOLD IV; FEV1 < 50% оf predicted). More than half of the patients had at least one moderate or severe COPD exacerbation within the previous 12 months. As per the GOLD (2020) classification, 57.2% of patients belonged to Group B (severe symptoms and low risk of exacerbations) and 30.3% to Group D (severe symptoms and high risk of exacerbations). 58.8% of patients received treatment that was not compliant with national clinical guidelines in force at the study initiation. 31.7% of patients had not COPD control. Blood eosinophil count was above 300 cells/μL in 15.1% of patients.

Conclusion. In most cases, patients had severe COPD symptoms with frequent exacerbations, and the prescribed treatment did not comply with national clinical guidelines. These data will be analyzed alongside the prospective study results.

The aim of the study was to develop and perform clinical testing of the intrapulmonary electronic auscultation method for audio and video recording at various levels of the tracheobronchial tree for the diagnosis of asthma and chronic obstructive pulmonary disease (COPD).

Methods. We examined 31 patients with moderate (n = 17) and severe (n = 14) COPD with severe symptoms outside of exacerbation and 35 patients with moderate (n = 19) and severe (n = 16) partially controlled asthma. Traditional bronchoscopy was performed, including intrabronchial recording of acoustic noise with a microphone (introduced into the instrumental channel of the bronchoscope) at various levels of the tracheobronchial tree. Video recording in various modes revealed the causes of wheezing. At the same time, pulmonary sounds were recorded in the interscapular region of the chest at the projection points of the bronchoscope in the tracheobronchial tree using a 3M™ Littmann® 3200 electronic stethoscope (USA).

Results. The greatest intergroup differences between patients with moderate and severe COPD were demonstrated by intrapulmonary sound parameters (frequency and duration of wheezing, р < 0.0001) and frequency response (amplitude-frequency characteristics) of wheezing in the lumen of the 4th order bronchi (р < 0.0001), significantly exceeded the corresponding sound phenomena during auscultation from the surface of the chest (р < 0.01). The most significant intergroup differences in the groups of BA patients with moderate and severe disease were observed in the frequency response of wheezing during intrapulmonary auscultation in the lumen of the 3rd order (р < 0.0001) and 4th order (р < 0.0001) bronchi; smaller differences were observed in the frequency response during auscultation from the chest surface (р < 0.001).

Conclusion. Intrapulmonary auscultation is a modern auscultatory method which can improve the quality and efficiency of diagnosis of asthma and COPD in pulmonology.

Obesity is an important comorbidity in patients with asthma, and this combination is associated with increased cardiovascular risk.

The aim of the study was to evaluate 24-hour arterial stiffness in asthma patients with excess body weight and obesity.

Methods. The study included 100 patients with asthma who were divided into three groups according to their body mass index (BMI). The first group included 36 patients with normal BMI, the second – 40 patients with excess body weight, the third – 24 patients with obesity. The vascular stiffness parameters were evaluated in all patients using BPlab. Аоrtic pulse wave velocity, augmentation index, and arterial stiffness index were also assessed.

Results. The 24-hour arterial stiffness, daytime and nighttime arterial stiffness values were increased in the patients with asthma and obesity. More than 80% of the asthma patients with obesity have higher pulse wave velocity in the daytime.

Conclusion. Patients with bronchial asthma with obesity represent the risk of developing cardiovascular diseases and their complications.

According to recent studies, bronchial asthma is characterized by a wide variability of the mechanisms of occurrence and progression. This heterogeneity is caused by patterns of predominant cells and inflammatory mediators, which determine differences in immunological parameters observed in patients with certain endotypes depending on the dominant type of mediators (high and low T2 inflammation). In long-term observations, a substantial research base has been accumulated justifying the effectiveness of vaccination against pneumococcal infection in patients with asthma. The vaccination decreases the frequency of exacerbations of the disease and hospitalizations in the short and medium term. However, these studies evaluated the asthma patients as a wholesome population, and it remains unexplored whether the effect of pneumococcal vaccines on asthma differs depending on the endotype of the disease and what are the mechanisms of such a differentiated effect.

The aim of this work is to present the results of recent quality studies on changes in the profile of inflammatory asthma mediators under the action of immunobiological substances based on Streptococcus pneumoniae antigens, primarily from the vaccines.

Conclusion. The asthma heterogeneity can lead to different clinical outcomes in pneumococcal infection and, respectively, the clinical effects of immunization in patients differentiate according to the nature of inflammation. In other words, the uniformity of the clinical effect of vaccination against pneumococcal infection in all patients in ongoing studies may represent the combined effect of molecular mechanisms regulating the specific activity of Th1-, Th2-, Th17-, NKT-, and Treg-cells. The results of studies proving the ability of pneumococcal vaccines to modulate the Th1-, Th2-, Th17-, Treg immune response in patients with asthma contributed to increased interest in developing new immunoregulatory therapeutic agents based on S. pneumoniae antigens.

Pulmonary hyalinizing granuloma (PHG) is an extremely rare condition. Only 170-200 cases have been described until now all over the world. There have been no reports in the Russian medical literature. Etiology of the disease is unknown. The X-ray picture is very unspecific. Tumors of lungs and pleura and infectious diseases are included in the differential line. Patients with pulmonary hyalinizing granuloma have long stabile progression of the disease, and the treatment with glucocorticoids can lead to the long lasting remission.

The aim of the review was to inform pulmonologists, general practitioners, infectious disease specialists, thoracic surgeons, and oncologists about the existence of pulmonary hyalinizing granuloma, its diagnosis, clinical course, and treatment. Also we present one clinical case of patient with pulmonary hyalinizing granuloma.

Conclusion. Because of very low incidence of PHG, an internist or a pulmonologist can never encounter it in their professional life. However it is worth keeping this condition in mind and including it into the diagnostic process when focal and focused shadows are identified in the lungs during chest X-ray. Probably, the disease is caused by different immune-mediatory processes, but the exact pathogenesis is still unknown. Biopsy of the lung tissue by means of lung resection is crucial for the morphological verification of the diagnosis. The prognosis of the disease is favorable. The timely initiation of treatment can sufficiently prolong the remission.

Swyer – James syndrome, also called Swyer – James – MacLeod syndrome (SJMS), is a rare acquired disorder characterized by pulmonary artery hypoplasia, unilateral hyperlucent lungs, and usually also bronchiectasis. Adults with SJMS are often diagnosed with and treated for chronic obstructive pulmonary disease (COPD), bronchial asthma, pneumothorax, or pulmonary embolism due to the similar clinical manifestations. Underestimation of an important radiological sign – unilateral “impoverishment” of the pulmonary pattern and hyperlucent lung – leads to erroneous diagnosis and inadequate treatment. Diagnosis of SJMS involves a computed tomography scan of the chest.

The aim of this work was to familiarize readers with aspects of diagnosis and detail the clinical, radiological, and other characteristics of a patient with McLeod syndrome. The described adult man was diagnosed with SJMS at the age of 32. Some typical mistakes in examinations of such patients and the lack of vigilance of radiologists in case of unilateral hyperlucent lung are presented.

Conclusion. Using the example of a rare clinical case of SJMS, we demonstrated the need to consider this syndrome when diagnosing adults with unjustified shortness of breath and a history of frequently recurrent pulmonary infections, with radiological signs of unilateral pulmonary emphysema and hyperlucent lung. According to the literature and our observations, computed tomography of the chest organs is a fast and reliable method for establishing the diagnosis of SJMS.

Airway mucus hypersecretion is a pathophysiologic manifestation of acute and chronic airway inflammatory disease. Mucolytics can reduce mucus viscosity and promote mucus discharge and therefore can be considered pathogenetically based therapy.

The purpose of this publication with the resolution of the scientific forum of experts was to discuss pharmacological features, efficacy, and safety of erdosteine.

Results. Experts of thescientific forum not only reviewed the results of clinical trials, but also voted on the use of mucoactive drugs according to the principle of Delphi consensus. Comparison of the efficacy and safety of mucoactive drugs (erdosteine, acetylcysteine, carbocysteine, ambroxol) in patients with respiratory diseases by the experts during voting showed that the highest level of agreement among the experts was achieved for the drug Elmucin® (erdosteine) in terms of its mucolytic activity and other pharmacological features, as well as when discussing the safety of the compared drugs in the officially recommended doses. The highest level of agreement was also noted on the erdosteine efficacy in COPD patients in reducing the frequency and duration of disease exacerbations, as well as reducing the risk of hospitalization of COPD patients when used long-term as part of combination therapy. The demonstrated safety profile was the most beneficial among the reviewed mucoactive drugs.

Conclusion. Elmucin® is a mucolytic with pleiotropic effects such as complex mucoactive action, potent antioxidant, anti-inflammatory and antibacterial activity with anti-adhesive effect for pathogens that determine its clinical efficacy in the treatment of acute and chronic airway diseases.

Recently, new drugs for the treatment of bronchial asthma (BA) have been registered in the Russian Federation: fixed triple combinations, which include inhaled corticosteroids (ICS), long-acting β₂-agonists (LABA) and anticholinergics, high-dose combinations of beclomethasone dipropionate (BDP) and formoterol (FORM) in the form of an extrafine metered-dose aerosol, which allows prescribing 800 mcg of extrafine BDP and 24 mcg of FORM per day.

The aim of publishing the resolution of the Expert Council “Choice of therapy for patients who do not achieve control over bronchial asthma on basic therapy with medium doses of inhaled corticosteroids/long-acting β₂-agonists” was to compare possible ways of therapy optimization and propose criteria for choosing therapeutic alternatives based on the individual clinical and phenotypic characteristics.

Conclusion. If a patient does not achieve asthma control (or had asthma exacerbations over the past year) with alternative therapy at step 4, it is advisable to switch to a maintenance and relief therapy (MART) regimen with fixed combination of inhaled corticosteroids/formoterol and with medium doses of ICS in the maintenance part of the regimen. In patients with poor control on alternative therapy with a medium dose of ICS, it is advisable to consider increasing the dose of ICS as part of an ICS/LABA combination or as part of a triple combination instead of switching to MART. Switching to a medium- or high-dose triple combination is especially useful for patients with fixed obstruction and when bronchial asthma is combined with chronic obstructive pulmonary disease. In patients who require high-dose therapy, it is advisable to consider prescribing high doses of ICS using an extrafine combination of BDP/FORM (400/12 mcg in the morning and evening). If MART with a medium dose of ICS does not prevent exacerbations, provide normal spirometry results and/or good control of symptoms, MART in combination with an anticholinergic drug should be used at step 5. If triple therapy or high doses of ICS/LABA are insufficiently effective, biological therapy should be considered.

Prevention and successful treatment of the disease exacerbations are crucial for patients with chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD). At present, a sufficient number of efforts are being made to improve both prevention of exacerbations in patients with stable disease progression and treatment of the exacerbations. According to international and domestic recommendations, mucolytic drugs are among the key therapies for both bronchitis phenotype of COPD and chronic bronchitis, the main clinical manifestation of which is a long-term productive cough. The aim of the review is to analyze modern literature data that reflect the role of N-acetylcysteine (NAC) in prevention of exacerbations during the stable course and treatment of exacerbations of chronic bronchitis and COPD.