Chronic obstructive pulmonary disease (COPD) ranks third in the global mortality structure, with up to 80% of cases remaining undiagnosed due to the limitations of spirometry and the subjectivity inherent in interpreting clinical and laboratory­instrumental data. The heterogeneity of the disease necessitates a transition toward personalized medicine, in which artificial intelligence technologies play a key role.

The aim. To analyze the current state and prospects of artificial intelligence technologies in the diagnosis, prediction, monitoring, and patient education for COPD. Methods. A search for scientific publications was conducted in the electronic databases PubMed, Cochrane Library, eLibrary.ru, and CyberLeninka for the period 2013 – 2026. Original studies focusing on the application of machine learning, deep learning, natural language processing, and generative models in COPD were selected for analysis.

Results. It has been established that AI models based on neural networks achieve a differential diagnostic accuracy for COPD of up to 96.84%. Multimodal systems integrating clinical, imaging, and text data predict exacerbations (AUC – 0.77) and mortality with accuracy exceeding the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric severity classification. NLP algorithms extract information on dyspnea severity from physician notes, while sensor­based platforms (TOLIFE, RE­SAMPLE) predict exacerbations up to 7 days before a probable event. In patient education, chatbots demonstrate high response intelligibility but fall short in accuracy and adherence to readability standards, necessitating the validation of specialized AI systems.

Conclusion. Artificial intelligence is forming the foundation for personalized COPD patient management, improving the accuracy of screening and disease course prediction. The main barriers to the implementation of this type of technology are a lack of external validation, algorithmic opacity, and data fragmentation. The priority is the development of explainable and validated clinical decision support systems.

The global prevalence of chronic bronchitis (CB) ranges from 3.4% to 22%, while it ranges from 10% to 20% in the Russian Federation. These variations reflect differences in definitions and the association with the chronic obstructive pulmonary disease (COPD) phenotype. Among patients with COPD, the frequency of CB reaches 14 – 74% and is associated with a more severe disease course, including accelerated lung function decline, frequent exacerbations, reduced quality of life and increased mortality. CB also occurs in individuals without airway obstruction and increases the risk of developing COPD. Overdiagnosis represents a significant challenge: up to 88.4% of patients diagnosed with CB do not meet the diagnostic criteria, whereas the true prevalence of COPD remains underestimated.

Aim. This study aims to assess, through a retrospective analysis of medical records, the extent to which the diagnosis of chronic bronchitis aligns with standard criteria in real­world clinical practice, and to analyze potential reasons for discrepancies.

Methods. We conducted a retrospective cohort study of 185 medical records with a final diagnosis of chronic bronchitis from 2018 to 2025, extracting anamnestic, clinical, laboratory and instrumental data. We divided the patients into four groups: CB, chronic lung diseases, acute respiratory diseases, and other diseases. We performed statistical analysis using StatTech software.

Results. The retrospective analysis confirmed the diagnosis of CB in 9 out of 185 patients (4.9%; 95% CI: 2.2 – 9.0). In 177 patients (95.1%), we revised the initial diagnosis, indicating low diagnostic accuracy for CB in clinical practice.

Conclusion. The key to improving diagnostic accuracy lies not so much in applying high­technology methods, but rather in meticulously collecting the medical history and evaluating the duration of symptoms. The diagnosis of CB should remain a diagnosis of exclusion, requiring a systematic process of ruling out more common causes of chronic cough.

Acute bronchitis is a common respiratory tract disease, the key pathogenetic mechanism of which is abnormal rheological properties of bronchial secretions. Despite the availability of various mucolytic agents, their comparative effectiveness remains insufficiently studied.

The aim. To evaluate the efficacy and safety of Elmutsin® (erdosteine) as part of combination therapy for acute bronchitis in real­world clinical practice.

Methods. The study included 120 outpatients (3 groups of 40 patients each): erdosteine (capsules 300 mg), ambroxol (tablets 30 mg), and acetylcysteine (powder 200 or 600 mg). Demographic and clinical data were collected; efficacy was assessed using patient diaries, the Bronchitis Severity Score (BSS), the Breathlessness, Cough and Sputum Scale (BCSS), a visual analogue scale (VAS) for cough intensity, and the Clinical Global Impression (CGI) scale. The primary endpoint was the proportion of patients achieving clinical improvement by Visit 3 according to patient diary data. Descriptive statistics were used for analysis, with a significance threshold of p < 0.05.

Results. By Visit 3, clinical improvement was achieved in the vast majority of patients across all three groups. Despite initially higher disease severity in the erdosteine group compared with the ambroxol group (BSS, VAS, CGI­S; p = 0.037, 0.027, and 0.002, respectively), differences between groups were no longer significant by Visit 3. Compared with acetylcysteine, the erdosteine group showed statistically significantly lower scores for BSS (0.88 ± 0.85 vs 1.75 ± 1.35; p < 0.001), BCSS (1.03 ± 0.97 vs 2.00 ± 1.52; p = 0.002), VAS (5.56 ± 5.86 vs 11.75 ± 12.70; p = 0.003), and CGI­I (1.30 ± 0.46 vs 1.60 ± 0.50; p = 0.013). According to patient diary, symptom regression in the erdosteine group was faster starting from day 4 – 5 of therapy. One adverse reaction (epigastric pain, acetylcysteine group) was recorded; no serious adverse reactions occurred.

Conclusion. Erdosteine holds a leading position among the studied mucolytic agents in the treatment of acute bronchitis. Its multifaceted pleiotropic action on pathogenetic mechanisms of the disease, combined with a favorable safety profile and rapid onset of clinical effect, makes it the drug of choice in patients with acute bronchitis.

Incorrect inhalation technique is one of the main causes of ineffective inhaled therapy in patients with chronic obstructive pulmonary disease (COPD), leading to increased frequency of exacerbations and hospitalizations. Measuring peak inspiratory flow (PIF) and determining its optimal values for a specific dry powder inhaler (DPI) can significantly assist in selecting COPD maintenance therapy.

The aim of this study was to determine the frequency and predictors of suboptimal PIF among patients hospitalized due to COPD exacerbation.

Methods. The study included 100 patients with COPD exacerbation requiring hospitalization. The analysis comprised basic demographic, clinical, and functional patient characteristics at admission and discharge. PIF was assessed using an IngalOk device at resistance levels corresponding to the DPIs used by patients as maintenance therapy. Measurements were taken before and after training on proper inhalation technique upon hospital admission, as well as before discharge.

Results. At admission, suboptimal PIF values were initially recorded in 46% of patients. However, this rate decreased to 20% (p < 0.0001) after training in proper inhalation technique. ROC analysis identified independent predictors of suboptimal PIF such as age > 70 years, FVC < 70% pred., FEV 1 < 30%pred., RV/TLC > 70%pred.. The most significant predictors were age (OR – 0.79; 95% CI – 0.68 – 0.91; p = 0.001) and FEV1pred. (OR – 1.15; 95% CI – 1.09 – 1.25; p = 0.002).

Conclusion. The likelihood of suboptimal PIF values should be considered when selecting an optimal inhalation device for maintenance therapy in patients with COPD exacerbation, especially in the elderly, among patients with very severe bronchial obstruction and patients with pulmonary hyperinflation.

Pulmonary sarcoidosis progresses to fibrosing sarcoidosis with the development of respiratory failure in 5 – 20% of cases. Molecular predictors of this phenotype remain largely unstudied, necessitating transcriptome analysis of accessible patient biological material – peripheral blood mononuclear cells.

The aim of this study was to evaluate the expression profile of messenger RNA (mRNA) for 14 genes involved in the regulation of cellular inflammation, immune response, cell cycle, and apoptosis in peripheral blood mononuclear cells from patients with non­fibrosing and fibrosing pulmonary sarcoidosis.

Methods. A longitudinal, prospective, non­randomized study included patients (n = 52) with pulmonary sarcoidosis (n = 28: with fibrosing (n = 5) and non­fibrosing (n = 23) variants) and apparently healthy volunteers (n = 24) as a control group. The mRNA expression level of 14 genes (TYMS, HJURP, UBE2C, BIRC5, KIF2C, CDKN1A, IRF5, IRF7, CIITA, IL1A, IL6, CXCL8, SFTPA1, SFTPB) was determined by two­stage realtime RT­PCR using the ΔΔCt method. ROC analysis was performed to assess the prognostic significance.

Results. All patients with sarcoidosis (n = 28) had similar mRNA expression patterns for 11 genes compared with the control group (n = 24). A statistically significant decrease in expression was recorded for 3 mRNAs: CDKN1A, IRF7, and CXCL8 (IL­8). CXCL8 (IL­8) mRNA turned out to be the most informative in the ROC analysis: AUC – 0.668 (95% confidence interval: 0.323 – 1.000), cutoff point 0.4 (sensitivity 95%, specificity 60%). AUC for CDKN1A (0.486) and IRF7 (0.527) did not reach the threshold of acceptable prognostic significance. All p values (0.925; 0.851 and 0.248, respectively) did not reach statistical significance (p < 0.05), consistent with the pilot nature of the study.

Conclusion. The level of CXCL8 (IL­8) mRNA expression in peripheral blood mononuclear cells is a promising noninvasive biomarker for stratifying the risk of sarcoidosis progression, requiring further validation in large cohorts.

Hypersensitivity pneumonitis (HP) is one of the most common interstitial lung diseases (ILDs) and is characterized by the potential development of progressive pulmonary fibrosis (PPF). Alongside established diagnostic criteria for PPF, the search for laboratory biomarkers enabling early detection of PPF in patients with ILD remains an important area of research.

The aim to develop a biomarker­based predictive model for the early diagnosis of PPF in patients with HP.

Methods. The study included 85 patients with HP. PPF was diagnosed according to the American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Latin American Thoracic Society (2022) criteria. Quantitative measurements of biomarkers in serum and bronchoalveolar lavage fluid (BALF) were performed using an Infinite M Nano automated spectrophotometer (Tecan, Austria). Statistical analyses were conducted using SPSS Statistics version 23. Multivariable logistic regression analysis was used to develop predictive models for PPF risk, while the diagnostic performance of biomarkers and derived models was assessed using receiver operating characteristic (ROC) analysis.

Results. In patients with HP and PPF, the optimal BALF biomarker cut­off values were 6.37 ng/mL for MMP­7 and 521.29 pg/mL for MCP­1 (CCL2). The serum biomarker cut­off values were 6.79 ng/mL for MMP­7, 17.56 ng/mL for SP­D, and 643.59 pmol/L for periostin. The combined BALF index consisting of MMP­7 and MCP­1 (CCL2) predicted the risk of PPF with a sensitivity of 87.5% and a specificity of 83.0%. The combined serum index including MMP­7, SP­D, and periostin demonstrated a sensitivity of 84.4% and a specificity of 92.5%.

Conclusion. The combined BALF biomarker index MMP­7 + MCP­1 (CCL2) and the combined serum biomarker index MMP­7 + SP­D + periostin are highly sensitive and specific tools for the early diagnosis of PPF in patients with HP.

The combination of asthma and bronchiectasis is associated with more severe disease, chronic sputum production, and frequent infectious exacerbations.

Aim. To evaluate the effect of long­term azithromycin therapy on clinical manifestations and laboratory markers of inflammation in patients with severe asthma and concomitant bronchiectasis experiencing frequent infective exacerbations.

Methods. The study included 60 adult patients with severe asthma and bronchiectasis. Patients were divided into two groups: the control group received standard asthma therapy; the main group received standard therapy combined with azithromycin at a dose of 500 mg two times a week for 6 months. All patients also received N­acetylcysteine at a dose of 600 mg/day. Symptoms, exacerbation frequency, pulmonary function tests, and laboratory inflammatory markers in blood and sputum were assessed before treatment and after 6 months.

Results. Baseline characteristics were comparable between groups. After 6 months, the azithromycin group, compared to the control group, showed less severe dyspnea on the mMRC (modified Medical Research Council dyspnea scale – mMRC) scale – 2.0 (1.0 – 2.0) vs 3.0 (2.0 – 3.0), p = 0.003; higher asthma control according to ACT (Asthma Control Test) – 21.0 (18.0 – 21.0) vs 16.5 (15.0 – 17.0), p < 0.001; and a lower exacerbation rate over 6 months – 1.0 (0.0 – 2.0) vs 2.0 (1.0 – 2.0), p = 0.001. Reduced laboratory markers of inflammation were also observed: blood leukocytes (p = 0.012), neutrophils (p = 0.004), C reactive protein (p = 0.006), sputum leukocytes (p = 0.010), and the degree of sputum purulence – 1.0 (1.0 – 2.0) vs 3.0 (1.3 – 3.0), p = 0.007. Forced expiratory volume in 1 second (FEV1) was higher in the azithromycin group – 1.5 (1.1 – 1.7) L vs 1.1 (0.9 – 1.5) L, p = 0.021.

Conclusion. Long­term azithromycin therapy in patients with severe asthma combined with bronchiectasis was associated with improved asthma control, reduced symptom severity, decreased exacerbation frequency, increased FEV1, and reduced sputum purulence.

Nontuberculous mycobacterial pulmonary disease (NTM­PD) is clinically and radiologically heterogeneous and may mimic destructive pulmonary tuberculosis, especially in the cavitary form.

The aim of the study was to assess the clinical significance of the medical history, clinical, laboratory, microbiological, and radiological features of the cavitary and nodular bronchiectatic forms of pulmonary NTM­PD.

Methods. A retrospective analysis included 151 HIV­negative patients examined in Federal State Budgetary Institution “National Medical Research Center for Phthisiopulmonology and Infectious Diseases” of the Ministry of Health of the Russian Federation (2023 – 2025). The patients had both cavitary form (n = 68) and nodular bronchiectatic form (n = 83). The diagnosis was established according to American Thoracic Society/European Respiratory Society/European Society of Clinical Microbiology and Infectious Diseases/Infectious Diseases Society of America (2020) criteria with NTM species identification. Risk factors, clinical and laboratory parameters, computed tomography findings, fluorescent acid­fast bacilli (AFB) sputum smears, NTM species distribution, and the frequency of an initial diagnosis of tuberculosis before microbiological verification were compared. Associations were assessed using odds ratio (OR) with 95% confidence intervals; statistical significance was calculated using Fisher’s exact test and the Mann – Whitney U test.

Results. The cavitary form was more often associated with smoking (35.3% vs 10.8%; OR 4.49; p < 0.001) and emphysema (OR 4.19; p = 0.002). The nodular bronchiectatic form was more often characterized by bilateral changes (OR 0.30; p = 0.028), bronchiectasis (OR 0.51; p = 0.048), and a treein­bud pattern (OR 0.34; p = 0.007). AFB­positive sputum smears were more frequent in the cavitary form (63.2% vs 21.7%; OR 6.21; p < 0.001). Mycobacterium avium complex predominated in both groups (61.8% and 90.4%), whereas M. kansasii was relatively more frequent in the cavitary form (25.0% vs 3.6%). An initial diagnosis of tuberculosis was made more often for the cavitary form (38.2% vs 8.4%; OR 6.72; p < 0.001).

Conclusion. The two phenotypes differ in risk factors, CT patterns, and microbiological characteristics. Cavitation together with frequent AFB­positive smears in the cavitary form may lead to an initial diagnosis of tuberculosis and warrants expanded microbiological testing for NTM.

The frequency of detecting nontuberculous mycobacteria (NTM) in respiratory samples has increased in recent years, which is associated both with improvements in laboratory diagnostics and with the growing prevalence of mycobacterial diseases. At the same time, there is no standardized approach in clinical practice to the interpretation of the initial NTM isolation and indications for repeat microbiological testing, which complicates diagnosis and patient management.

The aim of the study was to assess the detection rate and analyze the species composition of non­tuberculous mycobacteria (NTM) in respiratory samples from patients with suspected tuberculosis referred to a Regional State Autonomous Healthcare Institution “Tomsk Phthisiopulmonology Medical Center”.

Methods. A retrospective study of microbiological assays of 254 patients referred to the Regional State Autonomous Healthcare Institution “Tomsk Phthisiopulmonology Medical Center” in 2023 – 2025 for exclusion of pulmonary tuberculosis was conducted. Patients with at least one positive NTM result from respiratory samples were included. Species identification was performed using Matrix­Assisted Laser Desorption/Ionization Time­of­Flight Mass Spectrometry (MALDI­TOF MS). Depending on the frequency of detection, patients were stratified into three groups: single detection without follow­up, unconfirmed detection upon repeat testing, and confirmed repeated detection. Statistical analysis was performed using the chi­square (χ2) test and Fisher’s exact test with Bonferroni correction.

Results. In the majority of patients (78.4%), NTM were detected once or the detection was not confirmed. Repeated detection was confirmed in 21.7% of cases. Slowly growing NTM predominated (69.3%), with the Mycobacterium avium complex (MAC) being the most common (53.1%). The proportion of MAC increased with repeated detection. These findings support the need to standardize repeat microbiological testing after initial NTM detection to improve diagnostic accuracy and optimize patient management.

Conclusion. The data obtained justify the need for standardization of repeated microbiological control after the first positive result in order to increase diagnostic accuracy and optimize patient routing.

Chronic obstructive pulmonary disease (COPD) is a widespread disease that often leads to disability and death. Pulmonary emphysema (PE), a morphological component of COPD, causes hyperinflation, disturbances in the ventilation­perfusion ratio, and progressive respiratory insufficiency. The ineffectiveness of conservative therapy determines the need to find surgical treatment strategies. Lung volume reduction surgery in patients with severe emphysema is aimed at removing the least functional part of the lungs to improve airflow, diaphragm and chest wall mechanics, as well as alveolar gas exchange.

Aim. The aim of the review is to systematize data on surgical reduction of lung volume to improve severe PE, taking into account current complex treatment of COPD and PE based on an analysis of global and domestic literature.

Methods. Sources from the international databases Scopus, PubMed, Google Scholar as well as the domestic system eLibrary were used for literature analysis.

Conclusion. Modern technologies allow extending the traditional criteria of emphysema surgery, including bronchological methods. Indications for intervention are now considered for both severe and early stages of the disease, including homogenous form, in order to slow its progression. Early diagnosis and multidisciplinary selection of patients plays a key role. Of particular interest is the treatment of young patients to maintain their activity.

This lecture explores the history of the discovery of the mechanisms of hemoglobin oxygenation and carbon dioxide transport, their mutual regulation, which ensures oxygen saturation in tissues and carbon dioxide metabolism, and the biography of the Russian scientist Bronislav Fortunatovich Verigo, who was the first to present the results of his research on these reactions. The lecture also explores the historical development of the Russian scientific school of respiratory physiology in the late part of XIX and early period of XX century, with the key figures including D.I.Mendeleev, I.M.Sechenov, and B.F.Verigo. The lecture is based on an analysis of the scientific publications of B.F.Verigo and H.Bohr, archival materials from the Perm Krai State Archives, and the archive of the Department of Normal Physiology at the State Budgetary Educational Institution of Higher Professional Training “Perm State Medical University named after Academician E.A.Wagner” of the Ministry of Healthcare of the Russian Federation, founded by Professor B.F.Verigo. The lecture explores the conditions which shaped scientists whose discoveries changed the world and human life on the planet and defined the modern level of medical science.

Pulmonary sclerosing pneumocytoma is a rare benign epithelial lung tumor. Differential diagnosis of this lesion with adenocarcinoma and lung carcinoid tumors remains challenging due to nonspecific radiological findings and histological heterogeneity. Despite extensive study over many years, pulmonary sclerosing pneumocytoma continues to pose significant diagnostic difficulties due to its polymorphic histological pattern that requires an extensive differential diagnostic workup. Studying this tumor is relevant due to the need for its precise verification to prevent inadequate aggressive treatment, as this tumor is often mistaken for malignancy.

The aim of this work is to present a clinical case of pulmonary sclerosing pneumocytoma with detailed analysis of morphological and immunohistochemical features, along with a literature review to illustrate diagnostic challenges and differential diagnosis with malignant lung tumors.

Methods. Analysis of literature on pulmonary sclerosing pneumocytoma was performed in PubMed and Medline systems with the search depth of 10 years. We also present a clinical case of a 51 y.o. woman with a subpleural focal consolidation area 10 × 9 mm with smooth contours in the lingular segments of the left lung detected by chest CT. Video­assisted thoracoscopic precision resection of segment V (S5) with margin resection of segment 2 of the left lung was then performed. Histological examination of the surgical specimen was performed with immunohistochemistry (thyroid transcription factor (TTF­1), epithelial membrane antigen (EMA), Vimentin, CD31, CD34, CK 8/18, CK Cocktail, Chromogranin A, Synaptophysin).

Results. Pulmonary sclerosing pneumocytoma was diagnosed by typical biphasic morphology, TTF­1/vimentin expression and focal CK Cocktail, CK 8/18, and EMA expression.

Conclusion. Diagnosis of pulmonary sclerosing pneumocytoma requires comprehensive histological and immunohistochemical assays. Application of an expanded panel of antibodies is recommended to exclude morphologically similar malignant lung neoplasms, which determines the correct treatment strategy, as emphasized in the presented clinical case.

Cystic fibrosis (CF) is the most common inherited autosomal recessive disorder, caused by mutations in the CFTR gene. The introduction of CFTR modulators has fundamentally changed the prognosis and quality of life of patients. However, the presence of complex alleles may significantly affect the efficacy of targeted therapy, necessitating a personalized approach to the selection of pharmacological strategies.

The aim. To present a clinical observation of a 16­year­old female patient with cystic fibrosis carrying the genotype [L467F;F508del]/CFTRdele2,3, which illustrates the challenges of selecting CFTR modulator therapy in the presence of a complex allele, and the possibility of successful treatment adjustment using next generation targeted agents based on an intestinal organoid test (forskolin­induced swelling).

Conclusion. This clinical case demonstrated that therapy with elexacaftor+tezacaftor+ivacaftor may provide only a partial clinical response in a patient with a complex CF allele. Despite the improvement in nutritional status and the frequency of bronchopulmonary exacerbations, high sweat chloride concentrations (119 – 121 mmol/L) persisted and there was no improvement in pulmonary function tests. An adverse reaction developed upon the attempt to switch to a generic formulation of elexacaftor+tezacaftor+ivacaftor. Given the identified complex allele, targeted therapy was discontinued. Subsequently, the positive result of the intestinal organoid functional assay demonstrated sensitivity to the novel triple combination vanzacaftor+tezacaftor+ivacaftor and prompted therapy re initiation that led to a significant clinical improvement.

Triple CFTR modulator therapy with ivacaftor + tezacaftor + elexacaftor and ivacaftor (ITE) has substantially changed the clinical course and prognosis of cystic fibrosis. The expanding use of the bioequivalent generic Trilexa® highlights the need to summarize evidence on its clinical efficacy and safety, including outcomes after switching from the originator Trikafta®.

The aim of this study was to summarize and systematize national and international data on the efficacy and safety of triple CFTR modulator therapy with ITE, including the experience of using the original drug and the generic drug, in children and adults with cystic fibrosis.

Results. The triple ITE combination is the most widely studied and the most effective of the available methods of pathogenetic therapy for cystic fibrosis. In randomized clinical trials and observational programs, the originator provides an increase in FEV 1, a marked reduction in sweat chloride concentration, improvement in nutritional status, and a significant decrease in the rate of pulmonary exacerbations. Bioequivalence of the generic drug has been confirmed. Russian multicenter and regional studies convincingly show that switching from the originator to bioequivalent generic is accompanied by maintenance of FEV1, FVC, nutritional status, and surrogate markers of CFTR function, while preserving a favorable safety profile. The accumulated clinical experience includes the first documented case of a successfully completed pregnancy and delivery under treatment with a generic ITE regimen. Data from studies evaluating the efficacy and safety of deutivacaftor + tezacaftor + vanzacaftor as a new option for triple CFTR modulator therapy were additionally reviewed.

Conclusion. The body of evidence from international randomized clinical trials, registry studies, and Russian regional experience indicates clinical comparability between the originator and bioequivalent generic when switching from one to another. The use of a bioequivalent generic is a justified strategy to improve the availability of pathogenetic treatment with the goal to expand access to targeted therapy.

Bronchiectasis is a chronic respiratory disease characterized by structural changes of the bronchial tree, impaired mucociliary clearance, chronic bacterial infection, and recurrent exacerbations. Inhaled antibacterial therapy allows localized treatment of chronic infection in the airways.

The aim was to evaluate the efficacy and safety of inhaled antibacterial therapy in bronchiectasis.

Methods. An analytical review of the scientific literature on the efficacy and safety of inhaled antibacterial therapy in bronchiectasis was performed. Publications were searched in PubMed, Scopus, Web of Science, Cochrane Library, and eLibrary databases. Data on exacerbation frequency, time to first exacerbation, bacterial load, pathogen eradication, lung function parameters, quality of life, treatment tolerability, and adverse events were assessed.

Results. Tobramycin has been shown to be associated with a reduction in bacterial load and an improvement in respiratory symptoms, with a safety profile comparable to placebo. The use of colistimethate sodium leads to a decrease in bacterial load. However, the evidence regarding its effect on exacerbation frequency remains inconsistent. Aztreonam has shown a predominantly selective effect on certain bronchitic symptoms, including cough, sputum characteristics and production, without comparable improvement in other respiratory manifestations. Inhaled ciprofloxacin is associated with a longer time to first exacerbation, a lower frequency of exacerbations, and a reduction in bacterial load.

Conclusion. Inhaled tobramycin and ciprofloxacin therapy is associated with reduced bacterial load and exacerbation frequency in bronchiectasis. Clinical efficacy and tolerability differ across drugs and patient populations.