Slowly-resolving pneumonia is an important medical problem in spite of current knowledge on etiology, pathogenesis and therapeutic approaches. In Russia, uniform approach to this disease is lacking. Risk factors for the slowly-resolving pneumonia are comorbidity, age, severity of the disease and certain pathogens. A wide range of infections and non-infection diseases resemble slowly-resolving pneumonia, such as autoimmune systemic diseases, interstitial lung diseases, drug-induced lung toxicity, thoracic tumours, tuberculosis, etc. A diagnostic algorithm has been described in the article aimed at identification of the pathogen causing the pulmonary inflammation and at exclusion of diseases mimicking slowly-resolving pneumonia.

The guidelines have been developed by the Russian Respiratory Society (RRS) based on analysis of papers published during the last 5 years in MEDLINE and ENBASE databases and the Cochrane library. The results of the analysis were subsequently reviewed by independent experts with consideration of the opinion of physicians and general practitioners. A quality and a strength of the evidence were assessed using worldwide criteria. The guidelines are focused on epidemiology and social burden of chronic obstructive pulmonary disease (COPD), pathogenesis, clinical signs, characterization of phenotypes and severity, current diagnostic and differentiating methods and therapeutic approaches including long-tern oxygen therapy
at home, long-term respiratory support at home, surgical treatment, pulmonary rehabilitation, treatment of complications and acute exacerbation of COPD.
The guidelines are fully consistent with requirements of the Healthcare Ministry of Russia for federal guidelines on principal nosologies and treatment
techniques

The aim. A review of published articles has been made to highlight new data on antimicrobial defensive mechanisms in the respiratory system, to discuss clinical diagnostic methods and future research directions on this field.
Methods. This is a review of published data on antimicrobial peptides and their role in respiratory disease.
Results. Novel antimicrobial factors such as defensins and other cationic peptides are synthesized by neutrophils and epithelial cell in human.
Antimicrobial peptides are thought to play an important role in daily defense of the skin and the mucus membranes against gram negative flora. This
fact could explain quite rare occurrence of infections caused by these pathogens in human. In patients with disorders of liver protein-synthesizing activity, the defensins' production could decrease that could be a risk factor of pneumonia, tuberculosis and other lower respiratory infections.

Inhaled corticosteroids (ICS) are the basic medication providing long-term control of asthma. They have a significant antiinflammatory effect leading to decreased mortality, improved lung function, relief of symptoms, reduced exacerbation rate and improved quality of life. Different ICS molecules have different therapeutic index but they act equally in equipotent doses. The maximal effect of ICS is generally seen even in mild to moderate doses which are preferable for regular treatment. Adequate use of mild to moderate doses of ICS is typically accompanied by lower rate of adverse events but the risk of adverse events increase as the dose increase.
Pharmacokinetic properties and mechanism of ICS action, potential systemic and local adverse events and ways to prevent their occurrence have been described in the article.

A new product which is an electronic cigarette acting as nicotine delivery has been marketed at early 2000s. An electronic cigarette generates nicotine aerosol from a solution comprised of several basic substances, nicotine and flavours. The electronic cigarettes were widely promoted by a manufacturer like a safe product substituting tobacco smoking during quitting period. As a result, their consumption has been increasing progressively worldwide. Investigators of the aerosol content reported that it mainly contains ultrafine particles which easily penetrate into alveoli and blood vessels. The aerosol also contains nitrosamines, toxic substances and heavy metals. Strong evidence has been made about the aerosol cytotoxicity that could lead to serious injury and diseases. Nicotine dependence was demonstrated to develop as a result of an electronic cigarette smoking. While smoking an electronic cigarette, the indoor air concentration of toxic substances could reach hazardous levels. Electronic cigarettes do not have any advantage and cannot be considered as a mean to quit tobacco smoking. Moreover, electronic cigarette consumers were shown to quit smoking significantly harder. A large body of scientific confirmation of hazardous effect of electronic cigarettes on a human either during active or passive smoking have been obtained. It is no doubt that further investigations are needed especially with regards to rapid change in the market of electronic cigarettes. To minimize adverse effect of electronic cigarettes both on an individual and on population at whole certain measures should be undertaken intended to limitation of demand and supply of electronic cigarettes in the country similar to those for typical tobacco products.

The aim was to study epidemiology of chronic respiratory disease in populations living at different climatic and geographic regions of Russia in order to develop targeted preventive programs.
Methods. This was a cross-sectional randomised epidemiological study. A comparative analysis of mortality from respiratory diseases was conducted according to the European standards in population aged 25–64 years living in Russia and certain regions of Russian Arctic. Data from a national multi-centre population-based study and of randomly selected subjects from certain climatic and geographic regions were analysed.
Results. A respiratory mortality rate was much higher in most Russian Arctic regions compared to average national values. Although a death rate of chronic respiratory disease in most Arctic regions and in Russia at whole was higher than that in the EU the population in the northern regions died more often from pneumonia. Despite a significant difference in smoking prevalence there was significantly higher COPD prevalence in Arctic regions (Yakutsk) compared to other regions in the study. Among all risk factors, the Northern climate greatly contributed to morbidity of chronic respiratory disease.
Conclusion: The regional difference in the prevalence and mortality from chronic respiratory disease should be considered when designing preventive programs for chronic non-infection diseases in these regions.

Aim. The aim of the study was to investigate luminol-dependent and lucigenin-dependent neutrophil granulocyte chemiluminescence in patients with community-acquired pneumonia (CAP).
Methods. Forty-eight patients with moderate CAP and 40 patients with severe CAP were examined during two-week treatment. Primary and secondary reactive oxygen species (ROS) production was investigated using the chemiluminescence assay.
Results. Patients with moderate CAP maintained a high-level ROS production for 2 weeks of the treatment; a trend towards improving neutrophil functional activity was seen after 7 days of the treatment. In patients with severe CAP superoxide radical production improved to the end of the study, whereas secondary ROS synthesis remained elevated during the entire treatment period with slowing secondary ROS accumulation rate to the end of the study which adversely affected neutrophilic granulocyte reactivity.
Conclusion. Thus, neutrophil granulocyte chemiluminescence disorders as well as clinical risk factors could be considered as predictors of severe CAP.

The aim of the study was to investigate TLR-4 gene polymorphism in adult patients with atopic and non-atopic bronchial asthma in the Crimea population.
Methods. TLR-4 gene polymorphism (Asp299Gly) was studied in 275 patients with atopic asthma and 56 patients with non-atopic asthma; a control group included 285 healthy residents of Crimea. The allele-specific polymerase chain reaction with electrophoretic detection of polymorphism was used.
Results. In the control group, genotype frequency distribution (AA 85 %, AG 14 %, GG 1 %) was significantly different (c2 = 6.598, p = 0.037) from that in the atopic asthmatics (AA 76 %, AG 22 %, GG 2 %). In patients with non-atopic asthma, genotype frequency distribution (AA 91 %, AG 9 %, GG 0 %) did not differ significantly (c2 = 1.721, p = 0.423) from that in the control group. The results have shown that the risk of atopic asthma development was associated with increase in G-allele and decrease in A allele frequency (OR = 1.634, c2 = 6.08, p = 0.014).
Conclusion. Thus, TLR-4 gene polymorphism (Asp299Gly) is related to occurrence of bronchial asthma in the Crimea population. The AA genotype (Asp299 Asp) of this gene plays a protective role against asthma occurrence. The G allele frequency in patients with atopic asthma was significantly higher than it was in patients with non-atopic asthma.

Aim. The aim of this study was to investigate virulent properties of the genus Candida spp. in patients with persistent bronchial asthma and long-term treatment with inhaled steroids.
Methods. In this study, virulent properties of the genus Candida spp. were investigated in oropharyngeal smears of 30 patients with persistent asthma treated with moderate-to-high dose inhaled corticosteroids (ICS) for at least 1 year. A control group included 15 steroid-naive asthmatic patients. Fungi were identified by conventional methods (morphology, presence of germination tubes, chlamydospores, fermentation of carbohydrates). Sensitivity to antibiotics was determined by disk method on the Saburo agar medium. Adhesion was assessed in a model with nitrocellulose film and immobilized hemoglobin. Proteinase activity was measured by the ELISA method in supernatant at two pH values: acidic (pH = 4.5) or weakly alkaline
(pH = 7.8). CD cell leukocyte receptor proteolysis was evaluated by the cytofluorometrics method.
Results. An incidence of fungal colonization of the pharynx in ICS-treated patients with bronchial asthma was 76.7 %. Most strains were highly virulent as they had significantly higher adhesive and enzymatic activity and multi-drug resistance to antifungals compared to control group.
Conclusion. The ability of these strains to secrete proteolytic enzymes against CD4+ T-lymphocyte surface receptors could provide an additional immunomodulatory mechanism in Candida albicans invasion.

The aim of this study was to assess effects of non-thermal microwave electromagnetic radiation (NMER) on asthma control and quality of life of patients with bronchial asthma (BA).
Methods. Sixty outpatients with moderate BA aged 18 to 60 years were treated with NMER using the "Aster" device, 4 courses for 10 days of each Results. Clinical and spirometry parameters, asthma control and quality of life were significantly improved in comparison with BA patients receiving the standard therapy only.
Conclusion. Thus, NMER in BA outpatients allowed increasing efficacy of therapy and prevention.

The aim of this study was to investigate effects of low-intense laser irradiation (intravenous, intrapleural and combined) on adenosine deaminase (ADA) concentration in the pleural fluid of patients with pleural effusion of various etiology.

Materials and methods. We examined patients aged 30 to 80 years with pleural effusion (n = 45; 25 males (55.6 %), 20 females (44.4 %); the mean age, 67.6 ± 13.9 years). The cause of the pleural effusion was pneumonia (n = 14), trauma (n = 2) or chronic heart failure (n = 29). All patients were randomly divided in a control group (n = 17) or laser treatment group (n = 28). The control group patients received standard treatment according to etiology of the effusion. The laser group patients were treated with laser and medications. Laser was applied using "Matrix-VLOK" device (Matrix, Russia) with the wave length of 0.365 μm and output of 1.0 – 1.5 mWt. Laser therapy was administered in continuous irradiation mode; course duration was 3 to 7 sessions in dependence on a rate of the fluid accumulation in the pleural cavity, in every other day. Intravenous laser irradiation was performed for 10 min after cubital vena puncture with a needle with KIVL-01 light-guide fiber. Intrapleural laser irradiation was performed for 10 min after pleurocentesis with the needle and light-guide fiber following pleural fluid suction and instillation of a wide-spectrum antibiotic solution. The pleural fluid was centrifuged during 10 min in 1,500 g and then was freezed in –20 °С until the examination. Studied parameters were measured before and after the treatment.

Results. The laser group patients demonstrated a significant decrease in ADA concentration compared to baseline (25.30 ± 1.56 and 18.70±1.94МЕ × l–1 before and after treatment, respectively). The laser therapy in addition to the standard treatment was also related to clinical improvement. In controls the standard medication therapy did not lead to any change in ADA concentration (25.70 ± 1.63 and 22.80 ± 1.98 МЕ × l–1 before and after treatment, respectively).

Conclusion. The results showed that in patients with pleural effusion the laser therapy in addition to the standard treatment was related to decrease in ADA concentration, slower fluid accumulation in the pleural cavity and shorter treatment duration. Time to the second pleural puncture was longer, the need in drug therapy was diminished and the treatment efficacy was higher in the laser treatment group. These effects led to improving quality of life and was thought to make the laser therapy rational in patients with pleural effusion of various etiology.

Background. Increased oxidative stress and inflammation has a role in the pathogenesis of chronic obstructive pulmonary disease (COPD). Drugs with antioxidant and anti-inflammatory properties, such as N-acetylcysteine, might provide a useful therapeutic approach for COPD. We aimed to assess whether N-acetylcysteine could reduce the rate of exacerbations in patients with COPD.

Methods. In our prospective, randomised, double-blind, placebo-controlled, parallel-group study, we enrolled patients aged 40–80 years with moderateto-severe COPD (post-bronchodilator forced expiratory volume in 1 s (FEV1) / forcedvital capacity < 0.7 and FEV1 of 30–70 % of predicted) at 34 hospitals in China. We stratified patients according to use of inhaled corticosteroids (regular use or not) at baseline and randomly allocated them to receive N-acetylcysteine (one 600 mg tablet, twice daily) or matched placebo for 1 year. The primary endpoint was the annual exacerbation rate in patients who received at least one dose of study drug and had at least one assessment visit after randomisation. This study is registered with the Chinese Clinical Trials Registry, ChiCTR-TRC-09000460.

Findings. Between June 25, 2009, and Dec 29, 2010, we screened 1 297 patients, of whom 1 006 were eligible for randomisation (504 to N-acetylcysteine and 502 to placebo). After 1 year, we noted 497 acute exacerbations in 482 patients in the N-acetylcysteine group who received at least one dose and had at least one assessment visit (1.16 exacerbations per patient-year) and 641 acute exacerbations in 482 patients in the placebo group (1.49 exacerbations per patient-year; risk ratio 0.78, 95% CI 0.67–0.90; p = 0.0011). N-acetylcysteine was well tolerated: 146 (29 %) of 495 patients who received at least one dose of N-acetylcysteine had adverse events (48 serious), as did 130 (26 %) of 495 patients who received at least one dose of placebo (46 serious). The most common serious adverse event was acute exacerbation of COPD, occurring in 32 (6 %) of 495 patients in the N-acetylcysteine group and 36 (7 %) of 495 patients in the placebo group.

Interpretation. Our findings show that in Chinese patients with moderate-to-severe COPD, long-term use of N-acetylcysteine 600 mg twice daily can prevent exacerbations, especially in disease of moderate severity. Future studies are needed to explore efficacy in patients with mild COPD (GOLD I).

Aim. The aim of this study was to investigate exocrine gland cysts occurrence in the tracheal and bronchial walls of patients with chronic lung diseases.
Methods. We examined 68 patients with lung carcinoma, pulmonary tuberculosis and chronic non-specific lung disease. The airway mucosa was visualized using an original device for powder spraying (Patent RF ‡‚ 2053801) and aerosol of 5 g of bioinertial tantalum particles with a size of Ѓ’ 1 ѓКm. X-ray images made immediately and in 24 and 48 hours after the spraying showed the tantalum particle sedimentation on the mucosa surface and in excretory ducts of the exocrine glands. A presence of "risk zones", their location, size, and borders were identified as well as the particle concentration in these zones.
Results. We have shown that multi-layer bands up to 3 mm in thickness were found just after spraying; duct dilation and retentional cysts 3.10 mm in size were observed in the exocrine glands. The number of the cyst differed between patients from 1 to 6.
Conclusion. It seems to be reasonable that these changes could be considered as different stages of cyst development in the tracheal and bronchial
wall exocrine glands.