Authors of this article have been studying clinical and pathogenic features of bronchial asthma for about 40 years. As a result, 10 clinicopathological variants of asthma have been described. This classification is based on a type of the airway inflammation, age at the disease onset, triggers and risk factors, presence of upper airway disease, endocrine and immune pathology, psychological characteristics of the patients, clinical features and course of asthma. An algorithm of diagnosis has been developed for each clinicopathological variant. Recently, according to a tendency to describe different asthma phenotypes the authors propose the term “clinicopathological phenotypes of asthma” in order to bring Russian terminology in line with international consensuses.

This consensus statement provides practical recommendations for specific inhalation challenge (SIC) in the diagnosis of occupational asthma. They are derived from a systematic literature search, a census of active European centres, a Delphi conference and expert consensus. This article details each step of a SIC, including safety requirements, techniques for delivering agents, and methods for assessing and interpreting bronchial responses. The limitations of the procedure are also discussed. Testing should only be carried out in hospitals where physicians and healthcare professionals have appropriate expertise. Tests should always include a control challenge, a gradual increase of exposure to the suspected agent, and close monitoring of the patient during the challenge and for at least 6 hours afterwards. In expert centres, excessive reactions provoked by SIC are rare. A positive response is defined by a fall in forced expiratory volume in 1 so15 % from baseline. Equivocal reactions can sometimes be clarified by finding changes in nonspecific bronchial responsiveness, sputum eosinophils or exhaled nitric oxide. The sensitivity and specificity of SIC are high but not easily quantified, as the method is usually used as the reference standard for the diagnosis of occupational asthma.

Introduction. Probe-based confocal laser endomicroscopy (pCLE) of distal airways is a new technology allowing visualization of cells and structures that have autofluorescence. Endomicroscopic features of a number of rare lung diseases including pulmonary alveolar proteinosis (PAP) has not been yet investigated. The purpose of the study was to describe endomicroscopic features of PAP before and after the whole lung lavage (WLL). Methods. pCLE was performed during bronchoscopy in 6 PAP patients before and after the WLL. In certain lung segments, pCLE was done under the HRCT control. More than 1300 endomicroscopic images have been evaluated using a semiquantitative method. Results. We found floating fluorescent amorphous aggregates sticking with alveolar macrophages in all the patients. These changes reduced after the WLL. pCLE allowed to reveal PAP characteristic features not only in lung segments with «crazy paving» HRCT sign but also in lung zones without any HRCT changes. Conclusions. pCLE can detect specific PAP features both at presence and absence of HRCT signs that confirms diffuse injury of the lung parenchyma. pCLE could be a helpful tool for diagnosis and assessment of treatment efficacy in patients with PAP.

The aim of this study was to analyze causes of pre-hospital misdiagnosis of interstitial lung disease (ILD) in patients admitted to the Pulmonology Department of the Territorial Clinical Hospital N1 in 2011–2014. Methods. A retrospective analysis of medical records of patients with ILD (n = 258) was performed. Results. Despite of typical clinical manifestations and chest X-ray features of ILD the diagnosis was prevalently late. Reasons for late ILD diagnosis were limitations of the primary care management and insufficient knowledge of physicians and radiologists of this disease. Conclusion. Further education and administration work are necessary to improve healthcare for patients with ILD.

The aim of this study was to investigate a role of the exhaled air analysis as a simple and non-invasive diagnostic method for chronic obstructive pulmonary disease (COPD).

Methods. EBC samples were analyzed in 26 patients with acute exacerbation of COPD and in 19 healthy volunteers using a photoacoustic gas analyzer ILPA-1 based on CO₂ laser spectral analysis. The data obtained were used for integral estimation (IE) within two spectral ranges.

Results. IEs of COPD patients and healthy subjects differed significantly and were not related to gender. IE values in both spectral ranges were related to forced vital capacity of COPD patients and were inversely related to the heart beat rate of COPD patients in 10P spectral range.

Conclusion. This method is useful in diagnosis of COPD including early stage of the disease.

The objective of this study was to investigate large peripheral vessel (the common carotid arteries (CAA) and common femoral arteries) remodeling and elastic properties to identify their relationships with hypoxia and markers of systemic inflammation in patients with chronic obstructive pulmonary disease (COPD) and with co-morbidity of COPD and arterial hypertension (AH). Methods. The study involved 60 patients with COPD (stage III–IV, GOLD 2011) including 25 patients with COPD + AH (n = 80). Structure and functional status of peripheral vessels were investigated by measuring the intima-media thickness (TIM); artery elasticity indices were calculated for CCA and both CAA and common femoral arteries. Results. TIM and artery stiffness increase and a the CAA and common femoral arteries elasticity decrease were found In COPD patients compared to controls. Conclusion. AH in COPD patients could be a predictor of further remodeling of large peripheral vessels under hypoxia and systemic inflammation.

Exacerbation of chronic obstructive pulmonary disease (COPD) negatively influences on mortality, health-related quality of life and lung function decline. Systemic corticosteroids are used to treat acute exacerbations of COPD. Aim. This randomized parallel-group study was performed to evaluate short-term efficacy and safety of nebulized budesonide (n = 40) and budesonide via a dry powder inhaler (DPI) (n = 40) compared with intravenous (IV) prednisolone (n = 40) in patients with acute non-severe COPD exacerbations requiring hospitalization. Methods. The efficacy of treatment was assessed from the study entry to the Day 10. Clinical improvement was assessed according to an improvement in FEV₁, FVC, FEV / FVC, Borg scale, 6-minute walking test (6-MWT), SGRQ-C and occurrence of adverse events. Results. Systemic prednisolone, budesonide DPI and nebulized budesonide improved lung function in patients with acute exacerbation of COPD. Inhaled corticosteroids did not demonstrate systemic activity compared to systemic prednisolone. Conclusion. Our study suggests that nebulized budesonide and high-dose budesonide DPI could be an alternative treatment to systemic steroids in patients with acute non-severe exacerbation of COPD.

Pulmonary rehabilitation is one of ways to improve systemic features of chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate depressive disorders in patients with severe COPD and to evaluate effects of pulmonary rehabilitation. Methods. The study involved 47 patients with severe COPD. Of them, 26 patients were treated with the standard therapy and physical rehabilitation and 21 patients were treated with the standard therapy only. The CES-D questionnaire was used to diagnose depressive disorders. The MOS SF-36 questionnaire was used to evaluate quality of life. Interleukin-6 (IL-6) as a marker of systemic inflammation was measured in blood. Results. According to results of questioning, severe depression was found in 29.2 % of patients, moderate depression was in 33.3 %, mild depression was in 25 %; 12.5 % of the patients did not have depressive disorders. Depressive symptoms were less prominent (scored as 17.4 ± 6.3 vs 26.8 ± 10.2 that corresponds to the absence of depression) in the patient group involved in a physical training programme. Depression was related to IL-6 blood level and quality of life. Conclusion. Physical rehabilitation could reduce systemic inflammation and depressive disorders in patients with severe COPD.

The aim of this study was to estimate prevalence of allergic disease in young adults. Materials and methods. The study involved 231 medical students in their fourth or fifth year aged 20 to 38 years: 62 males and 169 females (the response rate was 82.2 %). To study prevalence of allergic disease, we used the standard international questionnaire GA2LEN with additional questions about risk factors, anthropometric data and functional tests. The data were analyzed using statistical software packages Statistica 7 and Epinfo (WHO, version 5). Results. Prevalence of risk factors in young adults was as high as 27.7 % for smoking, 37.7 % for father’s smoking, 15.4 % for mother’s smoking, 8.8 % for obesity, and 15.2 % for overweight. A half of responders (54.5 %) experienced food allergy, 27.7 % had poor living conditions, and 35.9 % had acute respiratory infections (two or more episodes per year). Wheezing during the previous 12 months was reported in 22.6 % of males and 22.6 % of females. Bronchial asthma (BA) confirmed was diagnosed in 4.9 % and 4.1 %, respectively. Symptoms of allergic rhinitis were reported more often by females (45.0 % vs 25.8 % in males; p = 0.029), rhinitis during last 12 months was in 40.2 % and 16.1%, respectively (p = 0.045), rhinitis and conjunctivitis were in 27.8 % and 11.3 %, respectively (p = 0.009). Frequency of chronic sinusitis symptoms was not related to gender; nasal congestion longer than 12 weeks was reported by 12.9 % of males and 13.7 % of females, facial pain was noted by 4.8 % and 6.0 %, respectively; running nose was noted by 11.3 % and 21.4 %, respectively; impaired smelling was reported in 9.7 % and 4.2 %, respectively. Diagnosis of sinusitis was confirmed in 11.3 % of males and 8.9 % of females. Itchy rash whenever was reported by 14.5 % of males and 22.5 % of females, including this during the previous 12 months by 9.7 % and 17.2 %, respectively. Eczema was diagnosed in 12.9 % and 18.4 %, respectively. Conclusion: The results showed a high prevalence of allergic diseases in medical students especially in females. These results require further research to develop preventive measures.

The aim. A prevalence of symptoms and bronchial asthma diagnosis in children have been studied at the Republic of Belarus using an example of the Grodno region. Methods. The results were adjusted to gender and were compared to those from other regions according to the ISAAC program (phase I). Results. One thousand nine hundred and eighty five school children were questioned. It was established that bronchial asthma symptoms are widespread in school children at the Grodno region. Conclusion. These results obtained under ISAAC program (phase I) are in line with the results of similar studies conducted at other regions.

The aim of this study was to analyze lung function parameters and lung diffusing capacity in servicemen with pulmonary sarcoidosis. Methods. The study involved 45 patients with newly diagnosed active pulmonary sarcoidosis which was determined by biopsy. The mean age of the patients was 39.4 ± 10.9 years. Spirometry, body plethysmography, and single-breath measurement of lung diffusing capacity for carbon monoxide (DL_CO) were performed in all the patients. Results. Normal forced spirometry parameters were found in 66.7% of the patients. Meanwhile, 13.3% of the patients had restrictive ventilation disorders, 23.3% had reduced RV without any changes and 33.3% had reduced DL_CO. Conclusions. The results demonstrated a little diagnostic value of the standard spirometry in patients with pulmonary sarcoidosis. In these patients, the spirometry should be added by measurement of lung volume and lung diffusing capacity.

Bronchopulmonary dysplasia is related to several risk factors. Proinflammatory and antiinflammatory cytokines play the key role in the lung tissue inflammation by activation of free radical oxidizing, proteolisis–antiproteolisis imbalance and the oxidative stress.

The aim of this study was to identify risk factors of bronchopulmonary dysplasia in infants, to assess oxidant-antioxidant status and to determine immunological and biochemical markers of inflammation. Methods. Forty-five hospitalized children aged 1 to 4 months were involved: 25 children (of them, 15 males) with bronchopulmonary dysplasia and 20 children (9 males) without respiratory pathology. Results. The authors revealed proteolisis–antiproteolisis imbalance and increase in proinflammatory (IL-1b, TNF-#a) and antiinflammatory (IL-4) cytokine and TGF-#b levels in children with bronchopulmonary dysplasia compared to controls. Conclusion. Diagnosis of bronchopulmonary dysplasia should take into account antenatal and neonatal status of neonates. This disease is related to proteolisis–antiproteolisis imbalance, high oxidant and lower antioxidant activity.

Treatment with fixed combinations of a long-acting anticholinergic (LAMA) glycopyrronium and a long-acting #b₂-agonist (LABA) indacaterol is characterized by high clinical efficacy when compared to single components. Published results of clinical trials are in line with the pharmacological theory about synergy of bronchodilators with different mechanisms of action such as LAMA and LABA. Importantly, an additional therapeutic effect could be achieved without increasing risk of adverse events. This allows conclusion that administration of indacaterol and glycopyrronium could achieve the optimal and maximal bronchodilation in most patients with chronic obstructive pulmonary disease (COPD) who fail to improve bronchial obstruction with a single bronchodilator. A combined therapy with indacaterol and glycopyrronium (QVA149) was shown to significantly improve clinical symptoms, lung function, quality of life and decrease in number of exacerbations in COPD patients.

Russian and international data on community-acquired pneumonia (CAP) morbidity were analyzed. At Sverdlovsk region, mortality of CAP was reduced in all age groups after CAP monitoring system had been implemented but morbidity of CAP is still growing. Analysis of published data showed that cardiovascular system is often affected in patients with pneumococcal CAP due to direct pneumococcus invasion to the myocardium. One of the main measures for CAP control is still immune prevention with conjugate pneumococcus vaccines which is primary intended for high-risk groups.

This aim of this review was an analysis of rational approaches to development and implementation of immunomodulating drugs for therapy of respiratory infections. One of the most explored immune substances is inosine pranobex (Groprinosin).

Inability to control many infectious diseases effectively using chemotherapeutic drugs determined the need to search for alternative methods based particularly on modulation of the immune system. Rational approaches to immune therapy of respiratory infections have been analyzed in this review. Groprinosin could be used for prevention and therapy of respiratory infections. Reasonable algorithms involving this agent have been demonstrated.

Beta-2-adrenoreceptor agonists (#b₂-АA) are one of the key drugs used for treatment of chronic obstructive pulmonary disease (COPD) and asthma. Recently, novel #b₂-АA with ultra-long half-life which allows once-day administration have been developed such as indacaterol, olodaterol, vilanterol, carmoterol, PF-610355 and AZD-3199. Pharmacodynamics, pharmacokinetics and clinical effects of these drugs in COPD and asthma are reviewed in the article. Published data suggest that the rational and individualized use of novel ultralong-acting #b₂-АA could increase safety and efficacy of treatment in patients with COPD and asthma.

To the memory of Lev M. Klyachkin. To the 90th birthday 

Author index of articles published in the "Pulmonology" journal in 2014 

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