Chronic obstructive pulmonary disease (COPD) remains one of the leading causes of morbidity and mortality worldwide. Over the past decade, international experts have introduced changes in the understanding of the etiology and definition of COPD, particularly with the launch of the Global Initiative for Chronic Obstructive Lung Disease (GOLD). However, the transfer of diagnostic interpretations into domestic practice without proper analysis has led to significant confusion in clinical recommendations and therapeutic decisions. The aim. This position paper examines the historical context of the development of the COPD concept in Russia, analyzes current contradictions between international and domestic approaches to defining the disease, and discusses the practical implications of these differences for patient management. Conclusion. Our position is that there must be a clear distinction between COPD as a nosological entity and the syndrome of reversible or irreversible bronchial obstruction, which may accompany other diseases and conditions.

Measuring of the diffusing capacity of the lung for carbon monoxide (DL_CO) is an important method for assessing the pulmonary gas exchange function. Diffusing capacity (synonym: transfer factor) is the ability of the lungs to transfer oxygen from the alveolar gas into the blood. Methods. This document on DL_CO measurement was developed by a group of experts from the Russian Respiratory Society and the Russian Association of Specialists in Functional Diagnostics. All experts have experience in conducting research in accordance with quality criteria, analyzing research results, and developing national standards. Results. Technical standards for DL_CO measurement were recommended, including criteria for the measurement quality and assessment of the study quality. The expert group members used their experience and knowledge to develop these guidelines. Conclusion. The article presents standards for DL_CO measurement and an algorithm to interpret the results, which should contribute to improving the quality of measurements and uniformity in data interpretation.

Accurate preoperative assessment of functional reserve in patients with lung diseases is critical for surgical risk stratification. The “gold standard” for functional reserve assessment, cardiopulmonary exercise testing (CPET), has limited availability. The 6-minute walk test (6MWT) is considered a simpler alternative tool; however, its clinically significant thresholds for patients with pulmonary tuberculosis (PTB) require validation. The aim was to determine 6MWT threshold values corresponding to clinically significant levels of peak oxygen consumption (VO_{2 peak}) measured by CPET for preoperative risk stratification in patients with PTB and lung cancer (LC). Methods. The study enrolled 81 patients with PTB and 89 patients with LC in the preoperative period. All patients underwent both 6MWT and CPET. The association between 6MWT parameters and VO_{2 peak} was assessed using low-risk (≥ 20 ml/kg/min) and high-risk (< 15 ml/kg/min) criteria. Threshold values were determined by ROC analysis, with AUC comparisons performed using the DeLong test. Results. The 6MWT distance (m) demonstrated a consistent correlation with VO_{2 peak} in both groups (r = 0.59 – 0.65; p < 0.05). A distance threshold of ≤ 434 m showed high accuracy for identifying high-risk patients (VO_{2 peak} < 15 ml/kg/min) with both PTB (AUC 0.91; sensitivity 92%, specificity 87%) and LC (AUC 0.82; sensitivity 89%, specificity 68%). Comparison of ROC curves revealed no significant differences between the groups in AUC for absolute distance (p = 0.19), whereas the percentage of predicted distance showed nosology-specific differences (p = 0.032). Conclusion. Absolute 6MWT distance is a valid screening tool with comparable accuracy in both medical conditions. The threshold of ≤ 434 m may serve as a universal criterion for high functional risk (VO_{2 peak} < 15 ml/kg/min), enabling optimized patient selection for comprehensive assessment (CPET).

The outpatient sector is a key area for antimicrobials’ (AMs) consumption and, therefore, a critical point of impact on patients’ safety, antibiotic resistance selection, and costs. Respiratory tract infections are considered to be the primary indication for antimicrobial therapy in outpatients, and this therapy can be inappropriate. The aim. To evaluate the patterns of antimicrobials’ prescription in outpatients with respiratory tract infections in different regions of the Russian Federation and to assess the compliance of prescription with quality indicators. Methods. This cross-sectional study was conducted in 14 outpatient clinics of 11 Russian cities in accordance with the outpatient protocol of international Global-PPS project during the period from January to April 2024. Results. The survey included 5,084 outpatients from 149 units, of whom 311 (6.1%) received at least one systemic antimicrobial agent to treat upper and/or lower respiratory tract infection. The main indications included acute respiratory viral infections (49.8%) and acute/exacerbation of chronic bronchitis (24.1%). Antibacterials and antivirals accounted for 53.4% and 46.3% prescriptions on average, respectively. Penicillins (26.1%) including combinations of penicillin and beta-lactamase inhibitor (19.5%) were the leaders among the prescribed antibiotics, umifenovir (35.6%) – among the prescribed antivirals. Only 79.2% of prescribed AMs complied with the national guidelines. “Watch” antibiotics according to the WHO AWaRe classification represented 51.1% of prescriptions. Conclusion. The proportion of patients with respiratory tract infections in Russian outpatient clinics is substantial, while the choice of AMs for their treatment does not always comply with clinical guidelines. High rate of “watch” antibacterials among the prescribed ones attests to increased risk of resistance selection in the participating institutions.

Ground glass opacity (GGO) foci are a frequent finding on chest computed tomography (CT) scans. These foci may indicate various diseases, including lung cancer (LC), necessitating differential diagnosis of the nature of the changes. The aim of the study was to develop a diagnostic complex of radiological signs that would indicate with high accuracy malignant lung neoplasms in patients with GGO signs on chest CT and magnetic resonance imaging (MRI) scans. Methods. Chest CT (n = 72) and MRI (n = 11) data were analyzed in patients with and without clinical manifestations of acute or chronic lung diseases and with GGO in the lungs. Results. The analysis allowed us to establish the frequency of structural features of benign and malignant GGO foci, which were used to identify 3 GGO groups: predominantly benign, malignant, and of uncertain nature. The most significant predictors of pulmonary leukemia were a multinodular structure, the presence of a soft tissue component (STC) with contrast agent (CA) accumulation, deformed bronchial and vascular structures, and peribronchovascular localization. The probability of malignancy during the initial CT examination (monitoring) was 95%. CT data were supplemented by MRI, which revealed decreased diffusion and CA accumulation in the GGO lesion. Conclusion. CT allows to identify malignancy of the GGO foci in the lungs with high accuracy. Dynamic CT monitoring is essential to clarify the nature of the GGO. The main CT signs of GGO malignancy are multinodular structure, CA accumulation in the GGO area, vacuoles, deformed bronchial and vascular structures, and spicules. MRI is used as an additional method for clarifying the nature of the MS foci in complex cases.

Assessment of asthma phenotype and endotype is essential for choosing personalized treatment. T2-high endotype is predominant in patient with asthma. Clinical characteristics of patients with T2-low asthma endotype need further investigation. The aim of study was to describe clinical features of T2-low asthma. Methods. We examined adult outpatients with asthma (n = 1,068, 37% male, 63% female, aged 18 – 81 years) in a cross-sectional cohort study in a single secondary care center. Lung function was assessed by spirometry using Vitalograph 2120 spirograph (Vitalograph, Great Britain). The sensitivity to common inhalant allergens (atopic status) was determined by positive skin prick-test and/or serum specific IgE. Blood eosinophils (EOS) were measured by impedance method using an automatic haemoanalyser. Exhaled nitric oxide (FeNO) was measured by a chemiluminescence analyzer (Logan 4100; Logan Research, Rochester, UK). Asthma control and quality of life were assessed by the Russian versions of Asthma Control Questionnaire (ACQ-5) and St. George’s Respiratory Questionnaire (SGRQ). T2-low asthma was defined as the absence of atopy and low T2-markers (Eos < 150 cells/mcl, FeNO < 20 ppb) in repeated measurements. Statistical analyses were performed using parametric and non-parametric methods in Statistica 10.0 (StatSoft Inc., USA). Results. The rate of T2-low asthma was 7%. Patients with T2-low asthma were older and used rescue medications more often. They had more asthma exacerbations during previous year and lower lung function and quality of life than patients with T2-high asthma. Late onset disease, asthma with fixed airflow obstruction and concomitant COPD were more often seen in subjects withT2-low asthma. Conclusion. T2-low asthma is relatively uncommon in clinical practice. It is often characterized by late onset, fixed airflow obstruction and/or concomitant COPD, low lung function and quality of life.

According to the current paradigm of Global Initiative for Asthma (GINA, 2026), the principal goal of treating patients with asthma is to achieve and maintain complete control of the disease. The level of asthma control directly determines the frequency and severity of exacerbations, the majority of which occur in patients with severe, partly controlled, or uncontrolled disease. Severe acute asthma exacerbations (SAAE) account for up to 10 – 20% of all annual asthma exacerbations and usually require hospitalization and complex therapy, including methods of respiratory support. New therapeutic approaches aimed at optimizing the management of patients with SAAE are being actively explored. One promising avenue is the use of a thermal helium–oxygen mixture (t-He/O₂) as a component of inhalation therapy. The aim was to evaluate the efficacy and safety of t-He/O inhalations as part of complex therapy in patients with SAAE and a long-standing history of severe asthma, in comparison with SAAE therapy administered in accordance with current clinical guidelines alone. Methods. The study included 26 patients with SAAE: 15 patients of the main group, who received inhalation t-He/O₂ therapy in combination with the standard therapy, and 11 patients of the control group, who received standard therapy alone. Inhalations were performed for 10 – 15 min twice daily as a 10-day course. The dynamics of vital signs (respiratory rate, heart rate, blood pressure, SpO₂ measured by pulse oximetry), clinical symptoms, pulmonary ventilation parameters (peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1 / FVC), arterial blood gases (PaO₂, PaCO₂, SaO₂), acidbase balance (pH, HCO₃–, base excess (BE), lactate), central hemodynamics (deviation of volemic status from normal, stroke index (SI), left ventricular ejection fraction (EF), cardiac output (CO), tidal volume (Vt)) and the oxygen delivery system (CaO₂, DO₂I) were assessed before treatment and after completion of the course. The safety and tolerability of t-He/O₂ were evaluated using adverse-event registration logs and individual patient diaries. The Mann – Whitney U-test was used for comparisons between independent groups, the Wilcoxon signed-rank test for within-group dynamics, and Fisher’s exact test for categorical variables. Results. By day 10 of treatment, the main group, which received complex therapy combined with t-He/O₂ inhalations, demonstrated statistically significant differences from the control group in the rate and magnitude of dyspnea reduction and in the improvement of pulmonary function (PEF (p = 0.016), FEV1 (p = 0.026), FVC (p = 0.002)), arterial blood gases (PaO₂ (p < 0.001), SaO₂ (p = 0.026), PaCO₂ (p < 0.001)) and acid–base balance (pH (p = 0.003), lactate (p = 0.038)). Significant between-group differences in favor of the main group were also observed for tidal volume (Vt) and for the oxygen transport system (CaO₂, DO₂I), as well as for key hemodynamic parameters (SI), whereas the therapy had no significant effect on cardiac output, left ventricular ejection fraction, or the deviation of volemic status from normal. Treatment with t-He/O₂ was characterized by a high safety profile and good tolerability. Conclusion. The use of t-He/O₂ as part of the complex therapy of SAAE contributes to a more pronounced and more rapid reduction of clinical symptoms, resolution of respiratory failure, effective restoration of pulmonary ventilation and gas exchange, correction of metabolic disturbances, and improved oxygenation and oxygen transport without imposing an additional load on the pumping function of the heart. The inclusion of t-He/O₂ in the complex therapy of SAAE is safe and is characterized by good tolerability.

Pulmonary hypertension (PH) is a common complication in patients with respiratory disease, aggravating clinical symptoms and significantly impacting prognosis. Chronic hypoxemia is considered the primary and best-studied cause of PH in this patient population. Recent studies have explored the role of inflammation in the pathogenesis of this vasculopathy. This article evaluates the potential clinical significance of the neutrophil-to-lymphocyte (Nf/Lf) ratio as a marker of systemic inflammation in patients with respiratory disease. The aim of this study was to determine the role of the Nf/Lf ratio in the diagnosis of pulmonary hypertension associated with respiratory diseases. Methods. This observational, single-center, cross-sectional study included 90 patients with various respiratory diseases, 69 of whom were diagnosed with PH. Patients were divided into two subgroups based on the presence of PH. A comprehensive examination was conducted in both groups, including: laboratory diagnostics, non-invasive hemodynamic assessment of pulmonary hypertension, a comprehensive study of pulmonary function, and multispiral computed tomography of the chest organs. Results. The obtained results demonstrated that the Nf/Lf ratio is statistically significantly higher and the absolute count of peripheral blood lymphocytes is statistically significantly lower in patients with PH. A univariate logistic regression analysis of potential predictors of PH showed that the absolute lymphocyte count and the Nf/Lf ratio in peripheral blood, as well as the partial oxygen tension in arterial blood (PaO₂) were associated with PH. In multivariate logistic regression analysis, the Nf/Lf ratio was identified as a statistically significant predictor of PH; an increase in the Nf/Lf ratio by 1 increases the chances of having PH by 2.4 times. ROC analysis determined the diagnostic significance of PaO₂ and the NF/Lf ratio for predicting PH: The AUC was 0.635 (95% confidence interval (CI) 0.506 – 0.765; p = 0.062) for PaO₂ and 0.726 (95% CI 0.612 – 0.841; p = 0.002) for the Nf/Lf ratio. The sensitivity and specificity for the presence of PH were 54.4% and 90.5%, respectively, with an Nf/Lf ratio ≥ 2.2. Conclusion. The Nf/Lf ratio can be considered an additional marker of PH in patients with respiratory pathology.

The available scientific research does not sufficiently describe the specific polysomnographic (PSG) characteristics of obstructive sleep apnea (OSA) in obese patients. The aim was to determine the clinical and PSG characteristics of OSA in obese patients. Methods. The study included retrospective analysis of medical histories, assessment of the frequency of concomitant and previous diseases, and analysis of PSG results (Сomet PSG, Grass Technologies, USA). Results. The study included 2 groups of patients: the main group with OSA and BMI > 30 kg/m2 (n = 100) and the control group with OSA and BMI 18 – 25 kg/m2 (n = 44). In the main group, the Charlson comorbidity index (p = 0.012), the likelihood of hypertension (OR 6.4 (95% CI 2.9 – 14.2)), type 2 diabetes mellitus or impaired glucose tolerance (OR 29.9 (95% CI 3.9 – 225.7)), dyslipidemia (OR 2.4 (95% CI 1.1 – 4.9)), and ahistory of pneumonia (OR 3.2 (95% CI 1.1 – 8.9)) were higher than in control group. The PSG analysis revealed that severe OSA was detected in mostpatients (52%) of the main group and in none of the patients in the control group. Duration of SpO₂ < 90% was longer in the main group (42.4 min), than in the control group (0.9 min). The apnea-hypopnea index was increased in the REM sleep stage and in supine position in the main group. Duration of sleep stages was different: stage 1 was longer in the main group and stage 2 was longer in the control group. There were no differences in REM and stage 3. Obese patients had more frequent arousals, due to episodes of apnea and hypopnea and snoring. Conclusion. Our study identified certain characteristics of PSG in OSA and obesity, which may explain the higher incidence of concomitant severe diseases that may be associated with cardio-renal-metabolic syndrome.

Gonadotropin-releasing hormone (GnRH) medications are used to treat a wide range of reproductive disorders. GnRH regulates not only the maturation and growth of the gonads, but also the immune system and metabolism, thereby affecting non-reproductive, somatic tissues. GnRH affects the lungs, but research findings are limited and not generalized. The aim was to summarize the effects of GnRH on the lungs based on a literature review. Results. The presence of specific receptors for GnRH (GnRHR) in various lung cells and in the cells of some forms of cancer allows the use of GnRH-agonists and antagonists for the treatment of pulmonary disease and for both malignant tumors and their metastases to the lungs, especially those originating from the reproductive organs. The presence of GnRHR in tumor cells impels binding GnRH both to antitumor drugs for their targeted delivery and to magnetic nanoparticles for magnetic resonance imaging of cancer. Various forms of cytostatics conjugated with GnRH are less toxic and more effective than the cytostatics themselves. A large surface area with good vascularization and the ability to exchange various substances allow for systemic delivery of GnRH via inhalation into the lungs. Inhalation administration of anticancer drugs associated with a GnRH analogue is promising for the treatment of lung cancer with GnRHR expression. One of the pulmonary complications that develops when using both GnRH analogues and antagonists is interstitial lung disease, which can lead to death. An increased risk of classical pneumonia has been described after androgen deprivation therapy. Also, GnRH can enhance the development of lung pathology during radiation exposure. However, some publications report the absence of negative effects of GnRH on the pulmonary system in the experiments and in clinical practice and report that an increased level of GnRH even protects the lungs from edema and inflammatory damage, reduces the severity of sclerosis and fibrosis. Pulmonary macrophages, type 1 and 2 alveolar cells can be directly involved in the degradation of GnRH and have the necessary enzyme complexes. Conclusion. The obvious scarcity and inconsistency of publications on all aspects of GnRH action on the lungs indicates the need for further continuation of not only applied research, but also fundamental research, due to the high prospects. The GnRH drugs have advantages and disadvantages. Hormonal therapy should be prescribed with caution, taking into account all indications and contraindications, as well as the endocrinologist’s experience, aiming for the most favorable long-term result.

The elderly population is growing. It is projected to reach 20% or even higher percentage of the population by 2050. Respiratory system diseases rank second among the causes of death worldwide. To date, several signs of aging have been described which underlie the structural morphological and functional changes that lead to a gradual decline in the functions of the entire organism and disruption of adaptive mechanisms. This article describes some mechanisms of cellular senescence, provides morphofunctional characteristics of the senile lung, outlines the features of the course of certain respiratory diseases in elderly individuals, and presents some research results in the field of senotherapeutic drug development. Structural morphological, functional, and immunological age related changes, combined with external damaging factors and comorbidities, contribute to the development of oncological processes, chronic obstructive pulmonary disease, emphysema, respiratory infections, idiopathic pulmonary fibrosis, and other conditions. The development and study of senotherapeutic drugs are actively underway. However, these studies have a short follow-up period, and there is still insufficient research specifically in pulmonology. Due to the relevance of health in citizens over 65 years of age and the active longevity, the Russian Federation has a number of social programs, while the scientific community is seeing a growing number of related studies and developments. The aim is to update scientific understanding of age-related changes in the respiratory system from the molecular to the systemic level and their relationship with the characteristics of respiratory pathology in the elderly. Conclusion. Age-related changes occurring at the molecular and cellular level lead to various disorders of organs and systems, including the respiratory system. The development of comorbid pathology makes an elderly person vulnerable to external influences, reduces the quality of life, complicates the course of diseases, and complicates their treatment. The possibility of using senotherapeutic drugs and their effectiveness requires confirmation in clinical studies.

The effect of carbohydrate metabolism disorders on interstitial lung diseases is poorly understood. Diabetes mellitus (DM) is a chronic metabolic disorder with growing global prevalence. The progression of DM is accompanied by the development of microvascular and macrovascular complications, which significantly contribute to morbidity and mortality. Microvascular complications typically manifest as retinopathy, neuropathy, and nephropathy, whereas macrovascular complications primarily affect the cardiovascular system. In addition to these well-recognized complications, DM also affects the lungs, owing to their extensive vascular network, rich blood supply, and abundance of connective tissue components (collagen and elastin). Chronic hyperglycemia has been shown to induce microangiopathy and excessive extracellular matrix deposition in the pulmonary interstitium, resulting in a restrictive pattern of ventilatory impairment. Interstitial lung diseases (ILDs) comprise a heterogeneous group of disorders characterized by varying degrees of inflammation and fibrosis within the lung parenchyma. Among them, idiopathic pulmonary fibrosis (IPF) is one of the most common forms of idiopathic interstitial pneumonia and is associated with a high mortality rate. IPF is a chronic, progressive fibrotic disease leading to progressive respiratory failure. The aim of the review was to consider the lungs as a target organ in diabetes mellitus and to analyze the possible relationship between DM and ILDs, with particular emphasis on IPF. Сonclusion. Diabetic pneumopathy represents a progressive pulmonary disorder resulting from microvascular complications associated with diabetes. Early recognition of this complication and strict glycemic control may help prevent disease progression and alleviate debilitating pulmonary symptoms associated with diabetic lung involvement.

Severe community-acquired pneumonia (SCAP) remains a global medical and social problem, consistently ranking as a leading cause of admission to intensive care units (ICUs) and mortality. The severity criteria for pneumonia, as defined by international guidelines (IDSA/ATS) and Russian clinical recommendations, include the need for respiratory support, the presence of septic shock signs, and organ dysfunction. These factors necessitate a shift in treatment strategy, typically involving a revision of systemic antibiotic therapy and the implementation of measures to support vital bodily functions. Of particular significance are SCAP complications involving lung tissue destruction, such as the formation of lung abscesses, pleural empyema, and bronchopleural fistulas, which require a multidisciplinary approach to management. The aim was to present and analyze clinical experience in managing patients with severe community-acquired pneumonia complicated by suppurative processes. This includes evaluating the efficacy of applied diagnostic and therapeutic algorithms utilizing systemic antimicrobial and efferent therapy alongside invasive drainage procedures. Conclusion. Successful management of severe community-acquired pneumonia with suppurative complications requires a multidisciplinary approach. Key factors include timely adjustment of antibacterial therapy, the use of detoxification methods (e.g., lipopolysaccharide sorption), and early surgicaldrainage. The integration of conservative and invasive methods within a collaborative teamwork can improve outcomes in this category of patients.

Ceftobiprole medocaril is a fifth-generation cephalosporin antibiotic with expanded activity against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus, and the activity against Gram-negative bacteria characteristic of third- and fourth-generation cephalosporins. The aim was to determine the role of ceftobiprole medocaril in the treatment of patients with community-acquired and nosocomial pneumonia in the context of increasing antibiotic resistance and post-infectious immune disorders based on an analysis of current literature and our own clinical experience. Results. The first clinical case demonstrates the efficacy of empirical ceftobiprole therapy in a hospitalized patient with community-acquired pneumonia and signs of lung tissue destruction, clinical predictors of challenging pathogens, and predictors of the ineffectiveness of initial antibacterial regimens in the prehospital setting. The second case demonstrates the successful use of the drug in a patient with severe neurological deficit requiring tracheostomy and gastrostomy, recurrent nosocomial lower respiratory tract infections associated with pan-resistant gram-negative bacteria, and exhaustion of various antibacterial treatment options. Ceftobiprole medocaril is included in our clinic’s internal empirical antibacterial therapy protocols for community-acquired and early nosocomial pneumonia, and extensive experience has been accumulated in this patient population. Conclusion. We recommend scaling up our experience in using ceftobiprole in patients with community-acquired pneumonia and the risk of challenging pathogens. The approach described in the second case study can be considered in complex clinical situations associated with exhaustion of antibacterial treatment options and requires further research.