The aim of this study was investigation of cellular and humoral immunity and of systemic inflammation in patients with COPD + asthma phenotype. Methods. The study involved 115 patients (60 males) including 44 patients with stable COPD stage I–II, 39 patients with mild controlled or partially controlled asthma and 12 patients with COPD + asthma phenotype. Twenty healthy nonsmokers were included as controls. Results. Immune disorders in patients with COPD + asthma phenotype included increased numbers of T-helpers, cytotoxic T-lymphocytes and B-lymphocytes and increased IgE level. Increased serum concentrations of TNF-α and IL-4 and decreased IFN-γ concentration were also found in these patients. Conclusion. Th2-type of the immune response was observed in patients with COPD + asthma phenotype; these findings could underlie persistent inflammation. 

This guidelines are focused on the principal method of lung function examination which is spirometry. Spirometry is a non-invasive method for measuring airflow and air volumes as a function of time using forced maneuvers. This guidelines are based on international documents on spirometry standardization and interpretation and considered opinions of primary care physicians and general practitioners about comprehension and importance of these guidelines as an everyday practical tool. Spirometry is widely used for diagnosis, monitoring, expertise of invalidity, in epidemiological surveys and clinical trials. Spirometry could be performed under tidal breathing or forced maneuvers. All spirometers should fit minimal technical requirements and should be calibrated daily. Main spirometric parameters and their changes in patients with obstructive, restrictive or mixed ventilation disorders have been reviewed in the guidelines. Bronchodilator test has also been described. 

Exacerbation is a typical feature of the natural history of chronic obstructive pulmonary disease (COPD). The leading role of bacteria substantiates use of antibacterial therapy in this disease. Antibacterial therapy of COPD exacerbation has been shown to shorten the length of exacerbation, to improve lung function and prognosis. Amoxicilline, newer macrolides, such as azithromycin, clarithromycin, or the 3rd generation of cephalosporins, such as cefixime, etc., are recommended for patients with uncomplicated exacerbation of mild to moderate COPD without risk factors. Amoxicilline / clavulanate or newer quinolones (levofloxacin or moxifloxacin) are recommended for patients with severe COPD and complicated exacerbation or with risk factors. Amoxicilline / clavulanate is highly effective in COPD exacerbations and significantly increases time to the first exacerbation compared to placebo. Dispersible tablets of amoxicilline / clavulanate could reduce a rate of adverse events in patients with exacerbation of COPD. 

Recently, there is a progressive growth in new drugs and combinations for treatment of chronic obstructive pulmonary disease (COPD) that, on the one hand, promotes therapeutic opportunities but, on the other hand, impedes the best choice of the drug. Bronchodilators have been still the cornerstone of the pharmacotherapy of COPD. Anticholinergics as monotherapy or in combination with other drugs, such as long-acting beta-2-agonists, inhaled steroids, or roflumilast, are widespread therapeutic approach for these patients. A huge body of evidence has been accumulated about the safety and efficacy of long-acting anticholinergic tiotropium bromide which has been successfully used worldwide for more than 10 years. Longacting anticholinergics are one of the most actively developed and highly efficient drugs for management of COPD. There is limited evidence regarding clinical efficacy and safety of novel anticholinergics mostly obtained from phase III clinical trials which did not involve the real-life population of COPD patients; this fact prevents considering new long-acting anticholinergics as a definitive alternative for tiotropium bromide. 

Major advances of GINA (Global Initiative for Asthma) 2014 pertinent to definition, phenotypes and stepwise approach for adjusting treatment of asthma have been viewed in the article. The attention was focused on combinations of low-dose inhaled steroid (ICS) / formoterol (FOR) both as maintenance and reliever therapy (single inhaler strategy) or ICS / long-acting β2-agonist (LABA) as maintenance therapy plus short-acting β2-agonist (SABA) as-needed that are preferred options for treatment steps 3–4 in adults and adolescents. GINA experts emphasize that the single inhaler strategy is the treatment of choice for asthma patients with steps 3–4 experienced ≥ 1 exacerbation during the previous year. Administration of budesonide (BUD) / FOR as a single inhaler is recommended for patients > 18 years old with insufficient asthma control and frequent need in SABA. BUD / FOR as a single maintenance and reliever inhaler could reduce frequency of severe asthma exacerbations requiring hospitalizations and use of systemic steroids, improve asthma symptoms and lung function when compared to other treatment regimens. Preventive effects of BUD / FOR combination are provided by anti-inflammatory effect which is timely amplified by additional inhalations of the drug. 

A phenotype-based approach to treatment of bronchial asthma draws the growing attention of experts worldwide. One of asthma phеnotypes is comorbidity of asthma and overweight (including obesity). Some features of this phenotype have recently been described in molecular studies. An intensive search of relationships between phenotype, genotype and pathogenic mechanisms of the disease is suggested to be useful for development of effective therapeutic algorithm with the highest predictive value in this cohort of patiens. 

Asthma is a chronic inflammatory disease with the growing prevalence over the last 50 years. Some endocrine disorders including diabetes mellitus and obesity were identified as important factors affecting asthma course. Currently, controversial data on probable role of Th2-imbalance for pathogenesis of type 2 diabetes mellitus have been published. Diabetes and asthma could have similar pathogenic mechanisms which are poorly understood. There is a lack of Russian publications on this problem. Comorbidity of asthma and diabetes could be synergic or antagonistic. Conclusion. Further investigations of comorbidity of asthma and diabetes is necessary. 

Lactate (lactic acid) is an end product of glycolysis and cell anaerobic metabolism indicator. Reducing oxygen delivery to the cells leads to increased lactate production and blood concentration. Blood lactate concentration is usually measured to monitor tissue hypoxia and to assess oxygen transport efficacy in critically ill patients (with severe pneumonia, acute respiratory distress-syndrome, shock, etc.) Change in the blood lactate level could also indicate training intensity and post-exertional recovery and allows increase in peak work rate and endurance, individual training schedule, prevention physical overload and sport injuries. Exhaled breath condensate (EBC) is a complex mixture under influence both of respiratory pathology and environmental factors. Key metabolites concentration in EBC including lactate is much lower than that in the blood. This provides a need in novel diagnostic methods including biosensors with high stability, sensitivity and selectivity. Recently, biosensors are the leading methods in this field so as substrate specificity of lactate dehydrogenase underlying biosensor technique allows direct measurement in a biological sample without previous handling. Biosensors based on ferric ferrocyanide as an electrocatalizator have been developed in the M.V.Lomonosov Moscow State University; they have maximal selectivity for lactate and other markers exceeding that of platina-based biosensors used worldwide.

The aim. The objective of this study was to analyze effects of chronic heart failure (CHF) and obesity on systemic inflammatory and hemostatic response in patients with acute infective exacerbation of chronic obstructive pulmonary disease (COPD). Materials and methods. This cohort study involved 65 patients with infective acute exacerbation of chronic obstructive pulmonary disease (AECOPD) meeting 2 or 3 Anthonisen's criteria. Patients with (n = 53) or without (n = 12) co-morbid CHF and with (n = 20) or without (n = 25) co-morbid obesity were analyzed separately. Markers of systemic inflammation and hemostatic activation were measured. Results. Increased serum concentrations of C-reactive protein, IL-6, endothelin-1, von Willebrand factor, homocysteine, thrombin-antithrombin complex, plasminogen activator inhibitor type 1 were found in AECOPD patients of all subgroups; serum level of tissue factor pathway inhibitor (TFPI) was also increased. These proinflammatory and hypercoagulatory shifts were not related to CHF and obesity. Increased TNF-α level in blood was found only in CHF patients.

The aim of this study was to investigate blood neutrophil functional properties and the relationships to systemic inflammation in order to better understand a role of systemic inflammation for PH occurrence in COPD patients. Methods. This was a local open comparative study involving 30 patients with COPD (15 patients with PH and 15 patients without PH). The blood neutrophil functional properties (cell membrane stiffness and adhesion force) were measured using the atomic force microscopy. The power spectroscopy was used to quantitatively assess the adhesion force and neutrophil cell membrane stiffness (the Young's modulus). Results. Blood neutrophil and thrombocyte numbers, CRP and fibrinogen levels were significantly higher in patients with COPD + PH compared to COPD patients without PH. Relationships were found between systemic inflammation biomarkers and systolic pulmonary artery pressure. Conclusion. The results demonstrated that the membrane stiffness and the adhesion force were significantly increased in COPD patients with PH compared to controls and to COPD patients without PH. These neutrophil parameters were closely related to systemic inflammation.

The aim of this study was to develop a new diagnostic tool for Streptococcus identification and simultaneous macrolide resistance genetic marker detection in chronic obstructive pulmonary disease (COPD) patients. Methods. The "Streptopol +" experimental diagnostic panel (Lytech Ltd) was used to test laboratory collection of Streptococcus strains and DNA samples isolated from oropharyngeal swabs of 89 patients with stable COPD with length of disease ≥ 12 months, smoking history ≥ 10 pack / years, no exacerbations during the previous 4 weeks and no antibiotic therapy during the previous 12 weeks prior to study entry. Resluts. The "Streptopol +" experimental set allowed detection of drug resistance genetic markers and Streptococcus species identification based on a multiplex real-time PCR. Streptococcus was determined reliably in 83 (83 / 89; 93.3 %) samples obtained from COPD patients; Streptococcus was not found in one sample; 5 samples were in a "gray" zone with low DNA titers. Mainly, Streptococcus was identified as S. viridans, mitis group which was revealed to be as a reservoir for macrolide resistance genetic determinants. This increases a risk of macrolide resistance and therapeutic failure of these drugs. The mef genes were detected in all samples (89 / 89; 100 %), ermB gene was less frequent (81 / 89; 91.0 %). Conclusion. The "Streptopol +" experimental diagnostic panel has shown a high specificity and sensitivity to diagnose Streptococcus infection in COPD patients. 

The aim of this study was to compare functional status of patients with chronic obstructive pulmonary disease (COPD) vaccinated by combined vaccine vs single vaccine against influenza and a control group. Methods. The study involved 170 patients with COPD stage I to IV. Of them, 50 patients were vaccinated with a combined vaccine against pneumococcus, Haemophilus influenzae type b and influenza; 80 patients with equal COPD severity were not vaccinated and were treated with basic therapy; 20 COPD patients were vaccinated with a single vaccine against influenza, and 20 COPD patients were not vaccinated. Lung function and physical tolerability at 6-min walk test were assessed at baseline and in 12 months. Results. A significantly higher FEV1 (57.4 ± 2.0 % vs 50.4 ± 2.8 %) was found in COPD patients vaccinated with a combined vaccine compared to unvaccinated COPD patients; the difference between baseline FEV1 and FEV1 in 12 months after vaccination was 3.5 % vs 2.11 %, respectively. The improvement in 6-min distance was + 34 m (+ 7.4 %) in combined vaccine group compared to + 13 m (+ 3.7 %) in influenza vaccine group. Conclusion. COPD patients vaccinated with a combined vaccine against bacterial pathogens plus influenza better improved their lung function and physical tolerability compared to COPD patients vaccinated with a single vaccine against influenza.

Respiratory diseases are the leading cause of morbidity of aluminum industry workers. Aim. Given this fact the authorities of LLC RUSAL decided to vaccinate aluminum industry workers using PPV. Methods. This study included 200 workers (157 males) with a history of frequent (three or more episodes per a year) acute respiratory infection (ARI) or community-acquired pneumonia (CAP) or with stable COPD. The participants' age was 22 to 65 years, the length of work was 2 to 44 years. Results. In a year after the vaccination, there was 5-fold decrease in frequencies of both ARI episodes and COPD exacerbations. The average duration of exacerbations decreased from 23.7 ± 2.5 to 14.8 ± 1.3 days. No-one case of CAP was diagnosed in vaccinated patients during 12 months after the vaccination. Conclusion. Vaccination with a single-dose PPV-23 could reduce respiratory morbidity both in term of rate and duration of COPD exacerbations. Vaccination was safe and effective. 

Aim. This study was performed in order to investigate clinical spectrum of immune deficiency syndrome (IDS) and its influence on the course of tuberculosis in HIV mono-infected or co-infected children. Methods. We analyzed historical data and carried out a randomized prospective study involving 125 children. Results. Infection-related IDS was diagnosed in all HIV-mono-infected children, children with HIV-associated tuberculosis and children with tuberculosis, i.e. in one third of the cases. Children with HIV and tuberculosis co-infection frequently had a history of respiratory diseases, such as recurrent tracheobronchitis and recurrent pneumonia, and extended and / or complicated pulmonary tuberculosis. Conclusion. Therefore, infection-related IDS could be a predictor of tuberculosis in children and should be considered in diagnosis of HIV monoinfection and co-infection together with other clinical and historical data.

This review discusses alpha-1-antitripsin (AAT) deficiency that is a wide-spread autosomal-recessive monogenic enzymopathy related to PI gene mutations. The most serious injury related to AAT deficiency is primary emphysema. A role of AAT for normal growth and functioning of the lungs as well as for occurrence of various structural and functional disorders is reviewed in the articles. The authors' own findings about AAT deficiency prevalence in Russian population are also shown. Clinical features of AAT deficiency and diagnostic methods are described. Finally, a clinical report of primary pulmonary emphysema due to congenital AAT deficiency is demonstrated.

Cystic fibrosis (CF) is the commonest monogenic autosomal recessive disease. CF pathogenesis is based on systemic injury of exocrine glands due to CFTR gene mutation. CF case in an adult patient with "severe" genotype and multiple complications, such as chronic hypercapnic respiratory failure, diabetes mellitus, hepatic cirrhosis, cholelithiasis, pulmonary hypertension, and an episode of bowel obstruction, is described in the article. Despite of a number of complications this case demonstrated good efficacy of home respiratory support during 2.5 years. Novel methods of respiratory support, supplemental oxygen and intensive basic therapy have allowed stabilization his clinical status.