Challenges in the differential diagnosis of SARS-CoV-2-induced viral pneumonia and interstitial lung diseases (ILD), especially those that were previously undiagnosed, newly-onset or acute, have been identified based on data from the COVID-19 pandemic. Viral infections are known to be a risk factor for the development and exacerbation of ILD. In COVID-19, acute lung injury occurs with the development of inflammatory changes in the pulmonary interstitium, which may lead to the fibrotic formation of the lung tissue. Currently, the problem of ILD and COVID-19 remains extremely urgent, given the difficulties in differential diagnosis of the acute phase of COVID-19, post-COVID-19 changes, and various nosological forms of ILD, and the significant impact of COVID-19 on the course of an underlying ILD. The aim of this review was to highlight the features of the differential diagnosis of ILD and viral pneumonia caused by SARS-CoV-2, and to investigate the impact of COVID-19 on the course of ILD. Conclusion. The differential diagnosis of ILD and COVID-19 viral pneumonia should consider a combination of features of the disease onset, clinical findings, changes on high-resolution computed tomography (HRCT), laboratory data, and identification of SARS-CoV-2.

Hypersensitivity pneumonitis (HP) is an inflammatory and/or fibrotic lung disease that occurs in response to repeated inhalation of broad-spectrum aerosol antigens. The prevalence of HP ranges from 0.3 to 0.9 cases per 100,000 population. The basis treatment of HP therapy includes glucocorticoids, immunosuppressants, and antifibrotic drugs. The target audience of these clinical recommendations are general practitioners, pulmonologists, pathologists, radiologists, and medical rehabilitation specialists. Methods. Each thesis-recommendation for diagnostic and therapeutic measures is evaluated on a scale of evidence reliability from 1 to 5 and a scale of the recommendation persuasiveness with the categories A, B, C. The guidelines also contain comments and explanations to these thesis-recommendations, algorithms for the diagnosis and treatment of idiopathic pulmonary fibrosis, and reference materials. Conclusion. The presented clinical guidelines cover current information about the etiology and pathogenesis, clinical manifestations, diagnosis, and treatment of hypersensitivity pneumonitis. These guidelines were approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation in 2023.

Dry cough is one of the most common complaints of patients with COVID-19, so it must be treated with antitussives. The effectiveness of prescribed therapy can be controlled by using questionnaires and spectral analysis of cough sounds. The aim was to assess the use of spectral tussophonobarography for monitoring the effectiveness of cough treatment in patients with COVID-19. Methods. The main group consisted of 60 patients with COVID-19 (45% men, 55% women, average age 38.6 (30.1; 49.6) years) with mild or moderate severity and strong complaints of cough. The disease was treated in accordance with clinical recommendations, and antitussives were also used. Cough on the 1st and 8th days of therapy was studied using a visual analogue scale and spectral tussophonobarography, then compared with the induced cough of 30 healthy individuals making up the comparison group (43.3% men and 56.7% women; average age of 36.3 (28.4; 44.8) years). Cough recordings were subjected to a fast Fourier transform algorithm. The following cough characteristics were assessed: duration (ms), ratio of low and medium frequency energy (60 – 600 Hz) to high frequency energy (600 – 6000 Hz), and frequency of maximum sound energy (Hz). Not only of the coughing act as a whole was assessed, but also of each phase separately. Results. On the 8^th day of treatment, significant changes in cough characteristics were seen compared to the 1^st day, especially in the 2^nd phase of the cough act. The duration of cough increased (T = 355.0 (276.0; 407.5) – on the 1st day; T(c) = 432.0 (386.0; 556.0) – on the 8^th day; p = 0.0000), lower frequencies began to predominate (Q = 0.281 (0.2245; 0.408) – on the 1^st day; Q(c) = 0.4535 (0.3725; 0.619) – on the 8^th day; p = 0.0000), the frequency of maximum sound energy decreased (F_max = 488.5 (282.0; 1220.5) – on the 1^st day; F_max = 347.0 (253.0; 488.0) – on the 8^th day; p = 0.0064). No statistically significant differences were found in the studied parameters on the 8^th day of treatment as compared with those in healthy individuals. Conclusion. Spectral tussophonobarography revealed that characteristics of cough sounds during treatment of COVID-19 were close to those of healthy individuals.

The aim was to study changes in the respiratory system, cardiovascular system, functional and psychoemotional status of adult patients after inpatient treatment for COVID-19 (COronaVIrus Disease 2019). Methods. This cohort prospective observational study recruited patients with COVID-19 and lung damage. Transthoracic echocardiography, lung ultrasound, ECG, dyspnea assessment using mMRC and Borg scales, 6-minute walk test, and pulmonary function tests were performed 3 months after discharge from hospital. Psychoemotional status was assessed using MFI-20 international asthenia test, Spielberger–Hanin situational anxiety scale, Beck depression scale, MMSE cognitive function assessment scale. A standard set of statistical tools was used to describe and compare the data. The differences were considered statistically significant at p < 0.05. Results. A total of 51 patients were enrolled, including 29 (55.8%) women, the median age 64.5 (60.0 – 70.0) years. The most frequent complaints at 3 months after the hospital discharge were weakness (88.2%) and mild (62.7%) to moderate (29.4%) dyspnea. There was a decrease in the lung tissue lesions compared to inpatient treatment (14.5 vs 23.0 points), but the lung ultrasound found consolidates in 78.4% of the patients. The degree of lung tissue lesions correlated with the functional status of the patients. Decreased diffusion lung capacity (DL_CO) was the most frequent functional disorder. It was detected in 23.1% of the patients and accompanied by decreased 6-minute walk test distance and increased volume of lung lesions according to the ultrasound. The threshold value of ultrasound score indicative of the abnormal lung diffusion capacity was 24.5 at the stage of inpatient treatment and 15.5 points at 3 months after discharge from hospital. A mental status assessment at 3 months after discharge from hospital showed that asthenia persisted in all patients. Their anxiety and depression statistically significantly decreased, and the cognitive status improved. Conclusion. The majority of adult patients who had COVID-19 with lung damage still have complaints, lung tissue changes of varying severity at 3 months after discharge from hospital. A significant proportion of the patients also had psychoemotional disorders, abnormalities in the performance of functional tests, and impaired DL_CO. Lung ultrasound can be considered an informative non-invasive method of assessing severity of the lung tissue damage, allowing to predict impaired gas transport function of the lungs.

Nosocomial pneumonia is the most common infectious complication following cardiac surgical procedures. The aim was to assess the efficacy and safety of repeated inhalation sessions of 200 ppm nitric oxide for nosocomial pneumonia following cardiac surgical procedures. Methods. The pilot single-center prospective randomized study included spontaneously breathing patients with cardiovascular diseases, operated on under artificial circulation, with a complicated postoperative period in the form of nosocomial pneumonia. These patients (n = 40) underwent surgical procedures under cardiopulmonary bypass and developed nosocomial pneumonia in the postoperative period. The control group (n = 20) received standard antibacterial therapy, the experimental group (n = 20) received additional inhalation of 200 ppm nitric oxide (iNO) for 30 minutes 3 times a day before the completion of antibacterial therapy, but no more than 7 days later. We assessed the duration of antibacterial therapy, the changes in temperature, blood pressure, respiratory rate and heart rate, the oxygenation index SpO2/FiO2 and PO2/FiO2, the level of leukocytes, C-reactive protein, procalcitonin, presepsin, ferritin, and the quality of life questionnaire EQ-5D-5L score. The frequency of changes in antibacterial therapy regimens due to their ineffectiveness and the duration of hospitalization were compared. Results. iNO therapy was well tolerated, did not have a significant effect on systemic hemodynamics, and was not accompanied by a clinically significant increase in the level of methemoglobin and NO2. Its duration was 6.2 ± 0.8 days. In the iNO treatment group, there was a shorter time of antibacterial therapy (p < 0.001), a shorter duration of fever (p = 0,008), and a shorter frequency of changing antibacterial treatment regimens due to their ineffectiveness (p < 0,001). Under the influence of iNO, higher rates of oxygenation indices SpO2/FiO2 were noted on Day 3 (p = 0,034) and on the day of completion of antibacterial therapy (p = 0,009); higher PO2/FiO2 were observed on Day 3 (p = 0,002), Day 5 (p < 0,001) of the therapy and the day of the completion of antibacterial therapy (p = 0,004). In the iNO treatment group, a decrease in the level of leukocytes, procalcitonin, and the neutrophil-to-lymphocyte ratio was detected on Day 3 of the treatment, as well as lower neutrophil levels in the blood on the day of the completion of antibacterial therapy in comparison with the control group. Conclusion. iNO at a dose of 200 ppm 3 times a day in patients with nosocomial pneumonia following cardiac surgical procedures is safe, leads to a reduction in the duration of antibacterial therapy, a decrease in the frequency of changes in antibacterial therapy regimens, the improvement of oxygenation, and faster changes in the laboratory markers of inflammation. The data obtained serve as a prerequisite for the use of iNO for the treatment of nosocomial pneumonia in cardiac surgical patients.

Assessment of pulmonary gas exchange is essential in patients with respiratory diseases. However, the diffusing capacity of the lung cannot be assessed in some patients due to their physical condition or cognitive limitations. Impulse oscillometry requires minimum patient cooperation, is easy for patients, and allows for quick, reproducible measurements. The aim of the study was to determine the relationship between impulse oscillometry parameters and diffusing capacity of the lung in patients with pulmonary tuberculosis. Methods. This was a retrospective observational study in adult patients with a confirmed diagnosis of pulmonary tuberculosis. We evaluated their spirometry, body plethysmography, Carbon Monoxide Diffusing Capacity (DLCO), and impulse oscillometry measurements. The study did not include patients with smoking experience of more than 10 pack-years, nonspecific respiratory diseases, chest surgery, and extrapulmonary causes of chest mobility restriction. The Kruskal – Wallis criterion, the χ2 criterion, Spearman rank correlation, and ROC analysis were used. Results. A moderate relationship was revealed between DLCO and IOS parameters: with frequency dependence of resistance (Rrs5–20), resonant frequency (Fres), deviation of reactance at 5 Hz from the predicted value (∆Xrs5), and reactance at 5 Hz (Xrs5) (–0.32; –0.33; –0.34; 0.32, respectively, p < 0.05). The reactance area (AX) showed a considerable relationship with DLCO and alveolar volume (VA) (–0.51; –0.57, respectively, p < 0.05) and a moderate relationship with the poorly Poorly Communication Fraction (PCF) 0,31 (p < 0,05). The ROC analysis showed that if DLCO was less than 75%, the cut-off level of AX was 0.30 kPa/l (AUC = 0,746), and if DLCO was less than 50%, the cut-off level of AX was 0.41 kPa/l (AUC = 0,840). Conclusion. The diffusing capacity of the lung in patients with pulmonary tuberculosis correlates with the changes in total respiratory resistance and its components.

Chronic obstructive pulmonary disease (COPD) is one of the most common respiratory diseases in the world. Correct treatment of this disease shall account for many additional factors, which can be difficult for primary care physicians. In 2023, the International Primary Care Respiratory Group (IPCRG) developed a new tool for primary care physicians – the COPD “Wheel” that allows for determining the treatment tactics quickly and consulting COPD patients about the main causes and consequences of the disease. The aim of the work was to evaluate whether the innovative tool ensures the integration of physician and patient efforts in achieving COPD control. Conclusion. The COPD Wheel tool ensures timely prescription of drugs suitable for a specific clinical case, as well as significantly improves the patient’s adherence to therapy. As a result, patients with COPD should be expected to have improved quality of life and prognosis.

Now the role of the receptor for advanced glycation endproducts (RAGE) and its isoforms in the pathogenesis of asthma is discussed. The aim was to review national and foreign literature on the role of RAGE in the pathogenesis of asthma. The search was performed in the PubMed and RISC databases. Results. The available literature data allow considering RAGE as a possible biomarker of the disease or to use the ligand-RAGE axis as a target for therapeutic intervention. Conclusion. This subject requires further experimental and clinical studies for the possible development of new approaches to the management of patients with asthma.

Osteochondroplastic tracheobronchopathy (tracheobronchopathia osteochondroplastica) is a rare benign disease of the trachea and large bronchi of unknown etiology. It is characterized by an overgrowth of cartilage and/or bone in the submucosal layer with varying degrees of narrowing of the lumen. Due to the nonspecific symptoms and low awareness among doctors, this disease may remain undiagnosed for a long time. The aim of the study was to present a clinical case and a review of the literature on modern methods of diagnosis of osteochondroplastic tracheobronchopathy. Conclusion. The above clinical case and the literature review confirm that the main methods to suspect and verify osteochondroplastic tracheobronchopathy are computed tomography of the chest organs and bronchoscopy with biopsy. Confocal laser endomicroscopy can serve as an additional research method to exclude oncopathology and concomitant tracheobronchial amyloidosis.

EVALI (e-cigarette or vaping product use-associated lung injury) is a relatively new disease with complex differential diagnosis, as it mimics the clinical and pathological picture of various pulmonary diseases. The diversity of clinical manifestations of the disease described in the literature necessitates for treating EVALI as a diagnosis of exclusion and requires accumulation and understanding of the data to develop effective methods for diagnosis and patient management. The aim of the work was to present a clinical observation of vaping-associated lung injury (EVALI) in an adolescent as a diagnosis of exclusion. Conclusion. The presented clinical case demonstrates vaping-associated lung injury in a 15-year-old girl and the importance of high-quality collection of medical history for timely and correct diagnosis.

Fundamentally new approaches to the therapy of respiratory insufficiency (RI) have been developed based on the modern understanding of its pathogenesis. A new structure “Respiratory Salon” has been designed to solve the most important clinical and methodological problems facing public health in the field related to the use of medical gases in respiratory diseases. The aim of the work was to create “Respiratory Salon” for the complex treatment of respiratory insufficiency by medical gases. Conclusion. Fundamentally new approaches to the therapy of RI have been developed based on the modern understanding of its pathogenesis and a new structure named “Respiratory salon” has been created. The positive experience of the organization of “Respiratory Salon” for correction of respiratory insufficiency by medical gases in inpatient, outpatient and, therapeutic resort conditions is presented.

The article describes a clinical case of pulmonary-renal syndrome in a 41-year-old man. A brief review of the scientific literature is presented together with the discussion of the differential diagnosis and the diagnostic features. It is important to remember that pulmonary-renal syndrome combines diffuse alveolar hemorrhage and glomerulonephritis and is a life-threatening condition with the development of acute renal injury and possible pulmonary bleeding which can lead to death.