Recent systematic reviews and meta-analysis on pneumonia have been discussed in the article.
Morbidity of pneumonia is 5 to 10 per 1 000 of population in Europe and Northern America. Mortality of pneumonia is as high as 10 % and continues to grow. The leading pathogen is Streptococcus pneumoniaе, particularly in severe disease. Last years, highly specific rapid diagnosis tools for identifying Streptococcus pneumoniaе infection have been developed such as Binax and urine antigen test. Prevalence of pneumonia caused by Streptococcus is significantly lower in patients vaccinated with 13-valent conjugate vaccine against this pathogen. Particular attention is paid to healthcare-associated pneumonia which is close to nosocomial pneumonia in term of spectrum and properties of causing pathogens (gram-negative flora, methicillin-resistant Staphylococcus aureus, high antibacterial resistance). Obesity, hypotrophy, gene-related susceptibility to infectious disease, in particular, TNF-#a gene polymorphism, co-morbidity, mainly COPD, are discussed as risk factors for severe pneumonia. Duration and optimal combinations of antimicrobials are still under debate.

Relevant indications for tiotropium Respimat in adult patients with bronchial asthma (BA) were reviewed. This consensus represents a collaborative effort of members of the Executive Group of Russian Respiratory Society. The Group consisted of clinicians, pharmacologists and researchers with recognized expertise in therapeutic field. The draft of the recommendations was prepared by initiative group. Each point of the recommendation was discussed during Executive group meeting and was accepted by vote of majority members. Final version of the consensus statement was approved by each member of Executive group. As concluded, tiotropium Respimat could be recommended for adult patients with bronchial asthma as: 1) add-on therapy in patients with severe and moderate severe non-controlled BA on GINA step 3–5 (ICS and LABA, including oral steroids or other controllers, or high doses ICS monotherapy); 2) add-on therapy in patients with asthma-COPD overlap syndrome (ACOS); 3) add-on therapy to ICS in case of side effects, contraindications for use or individual intolerance of LABA; 4) additional indications to consider use of tiotropium Respimat may include: smoking, positive SABA reversibility test, predominant nocturnal asthma symptoms.

Pulmonary hemorrhage is a life

This article contains a review of a new concept of chronic cough. Recently, specific TRP receptors were investigated and the key role of increased sensitivity of these receptors for chronic cough development was described. Recent scientific data underlay a pathogenic concept of chronic cough as an independent pathological entity referred to as chronic cough hypersensitivity syndrome. Gender and age-related difference in pathogenesis and prevalence of chronic cough and cough receptor hypersensitivity have also reviewed in the article.

This pilot study was aimed at evaluation of ADRB2 and CHRM3 gene expression in COPD. Methods. We evaluated ADRB2 and CHRM3 gene expression in blood leukocytes from 29 patients with acute exacerbation of COPD (GOLD stage II to III, Group D) before and after 2-week combined therapy including antimicrobials, tiotropium bromide, formoterol and an inhaled steroid. ADRB2- and CHRM3-specific mRNA content was determined in leukocytes using real-time PCR. Results. Mean gene expression levels did not differ before and after treatment. However, we found a significant correlation between changes in ADRB2 and CHRM3 gene expression, change in FEV1 and post-treatment C-reactive protein level.

Conclusion. The results confirm a possibility to affect adrenoceptors using beta agonists and inhaled steroids and to inhibit M-cholinoreceptor expression with M3-cholinolytics and inhaled steroids.

The aim of this study was to investigate morphological changes in the bronchi and the pulmonary arteries in the natural course of COPD and under treatment with angioprotective agents. Methods. COPD was modelled in rats by intermittent nitrogen dioxide inhalations for 60 days. Agents with angioprotective activity, such as rosuvastatin or sulodexide, were administered after the 30^th day of the exposure. Histological examination included morphometry. Results. The vascular wall thickness due to the media and the intima area enlargement was seen during COPD development without change in the vessel lumen. The Intima / media index also increased that is a typical sign of atherosclerotic lesion of the vascular wall. Pulmonary arteries diameter and the lumen size reduced under the treatment with sulodexide and rosuvastatin without any change in the vascular wall thickness but the intima / media index approached to the normal value. Conclusion. Ventilatory disorder progression in COPD is thought to be due to bronchial wall and lung remodeling such as sclerosis of the bronchial smooth muscle layer and occurrence of panacinar emphysema. Rosuvastatin improved pulmonary circulation and reduced lymphocytic infiltration of the large bronchi wall and the interalveolar septae. Positive effect of sulodexide on the pulmonary artery wall could be related to the presence of highly active heparin fraction in the drug structure that can improve the endothelial cell function. Agents with antithrombotic and angioprotective activity could slow COPD progression and of severe complication development.

The aim of this study was to evaluate an impact of 13-valent conjugate pneumococcal vaccine (PCV-13) and 23-valent polysaccharide pneumococcal vaccine (PPV-23) on quality of life of patients with chronic obstructive pulmonary disease. Methods. We estimated quality of life from baseline to 12 months after the vaccination using the COPD Assessment Test (CAT). Results. The study involved 58 patients with COPD vaccinated with PCV-13 (n = 33) or PPV-23 (n = 25). The CAT score reduced by 10.3 in patients vaccinated with PCV-13 and by 8.8 in patients vaccinated with PPV-23 (p < 0.05). Conclusion. Vaccination of COPD patients with PCV-13 or PPV-23 could significantly improve quality of life. The conjugate vaccine PCV-13 is more preferable. Further studies of microbiological, immunological and other effects of PCV-13 and PPV-23 in COPD patients are needed.

The aim of this study was to evaluate diagnostic value of capnography for early detection of lung function disorders in smokers. Methods. We compared results of capnography and spirometry and selected the most informative capnographic parameters in three groups of patients (n = 25 each): in non-smokers with normal spirometry, in smokers with normal spirometry and both in smokers and non-smokers with airway obstruction. Curves were obtained for continuous measurement of CO2 partial tension (PCO2) against time and volume. Results. A significant increase in the slope of capnographic alveolar phase during both tidal and deep expiration and a tendency to alveolar hyperventilation were found in obstructive patients. Similar, but less prominent results were obtained in smokers with normal spirometry. Conclusion. Capnography could be useful for early detection of lung function disorders in smokers before preceding occurrence of spirometric abnormalities (airway obstruction). PCO2 measurement against time was the most valuable parameter.

The aim of this study was to investigate antioxidant activity and clinical efficacy of parenteral ambroxol in obese patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods. Malondialdehyde (MDA), oxidative modification of proteins (MBP) and antiradical activity of (ARA) were measured in blood sera of 98 patients with acute exacerbation of COPD and obesity and in 23 healthy subjects. MDA was measured using thiobarbituric acid. MBP was detected using interaction between oxidized amino acid residues (aldehyde and ketone groups) with 2,4-dinitrophenylhydrazine (2,4-DNPH) and formation of 2,4-dinitrophenylhydrazone. Blood serum antiradical activity was detected by spectrophotometry of epinephrine autooxidation. Patients were divided into two groups: 48 COPD patients were treated with conventional therapy (bronchodilators via nebulize, glucocorticoids, antibiotics, oxygen, if necessary, mucoactive drugs orally) and ambroxol 30 mg q.d. IV; 50 patients were treated with similar conventional therapy and saline solution IV as placebo. Results. OMB level was significantly higher in COPD patients compared to that of healthy subjects. Antiradical activity in patients with acute exacerbation of COPD was significantly lower compared to healthy subjects. Intravenous ambroxol had antioxidant activity, improved clinical manifestations of acute exacerbation of COPD and contributed to faster recovery.

Acute respiratory distress syndrome (ARDS) is an actual problem of the modern medicine. Despite current progress in management of such patients, an all-cause mortality is still very high. Mandatory approach to all ARDS patients is mechanical ventilation (MV). There are several additional ways to increase oxygenation rate in ARDS; inhaled nitric oxide (iNO) is one of them. Aims: The aim of our study was to determine a role of iNO in therapy of ARDS. Methods. We involved 30 patients with moderate to severe ARDS, PaO₂ / FiO₂, 113.3 ± 33.7; Qs / Qt, 40.5 ± 12.9 %; APACHE II score, 20.3 ± 1.9; Lung Injury Score, 2.7 ± 0.7. iNO was administered to all patients in a starting dose of 5 ppm titrated to get positive response with PaO2 / FiO2 increase > 20 % from baseline. Results. 62 % of patients positively responded to the therapy. We observed an increase in PaO₂ / FiO₂ from 107.5 to 172.5 (p < 0.05) and a decrease in Qs / Qt from 39.3 to 27.9 (p < 0.05). Responders had statistically significantly worse oxygenation and better hemodynamics (cardiac output) parameters comparing to non-responders. iNO did not alter survival rate; patients treated with iNO had median survival time 3 days longer but this difference was not statistically significant. Conclusions. iNO is an effective way to improve oxygenation in ARDS patients. Better response was seen in patients with severe ARDS and stable central hemodynamics.

The aim of this study was to assess efficacy of physiotherapeutic device BKB-01 for chest compression-vibration in treatment of community-acquired pneumonia (CAP) in young patients. Methods. The study involved 80 inpatients with CAP treated with standard medications; 40 patients additionally received chest compression-vibration using BKB-01 device. CAP was diagnosed according to according to national and international guidelines; CAP severity was assessed using SMART-COP and SMRT-CO scales. Results. Chest compression-vibration contributed to more rapid clinical and radiological resolution of pulmonary infiltration, improvement in laboratory parameters and shortening the length of hospitalization by 5 days in average independently of CAP severity. Chest compression-vibration improved the bronchial drainage by stimulating expectoration of bronchial secret. Conclusion. The results showed the clinical efficacy of the BKB-01 device in treatment of CAP.

The aim of the study was to investigate effects of low-level laser blood irradiation on nitric oxide (NO) in patients with community-acquired pneumonia (CAP). Methods. The patients were divided into two groups: the control group receiving medication treatment only and the study group additionally receiving low-level laser blood irradiation (LLBI). NO was detected as a sum of its end products using immunoenzyme assay. Results. A significant improvement in NO level after LLBI was seen both in patients with baseline increased or decreased concentration of NO metabolites. Conclusion. LLBI in patients with community-acquired pneumonia was accompanied by improvement of endothelial function.

The aim of this study was to develop a radiological model for visual assessment of morphology and function of the ciliated epithelium of the upper and lower airways and mucociliary clearance at whole in healthy and in patients with pulmonary tuberculosis, COPD and lung carcinoma. Methods. We examined 65 patients aged 23 to 58 years, of them 26 patients with limited lung lesions and normal airway mucosa as controls and 39 patients with extended lung lesions due to tuberculosis, chronic obstructive pulmonary disease or lung carcinoma as the study group. The airway mucosa functional properties were investigated using spray coating of tantalum microparticles. Results. In the control group, the time of complete clearance was 15 to 20 min for larynx and pharynx, 45 to 60 min for trachea and 1–3 to 20–24 h for different bronchi. Bronchial clearance of the particle was decreased in the study group. The airway clearance disorders were considered as moderate (in patients with acute inflammation such as tuberculous, non-specific pneumonia, acute bronchitis, etc.), severe (in patients with chronic bronchial and pulmonary disease such as cavitary fibrocaseous tuberculosis, chronic bronchitis, bronchiectasis) and very severe (in patients with lung carcinoma). The clearance time in these disorders was 24 to 48 h, 48 to 72 h and #> 72 h, respectively. Conclusion. Normally, the airway clearance rate is 60-65 times lower in small airways than in the upper airways (pharynx and laryngx). Clearance local disorders caused by tobacco smoking, pollutants, etc., greatly decrease bronchial mucus transport and prolong the complete airway clearance time that could provide occurrence and progression of inflammatory and neoplastic pulmonary diseases.

This study was aimed at analysis of pedigrees of adult patients with primary immunodeficiency (PID). Methods. We examined 94 adults with primary immunodeficiency and 217 adults without this disease. Genealogy analysis was made at least for four generations in all patients. Results. Relatives of most PID patients (75 %) had autoimmune disorders. Relatives of near all (99 %) of PID patients had allergic diseases. Sixty nine per cent of PID patients had cases of infant death due to infectious or oncological diseases in ancestors. Conclusion. Genealogy analysis of patients with confirmed or suspected PID could be an important diagnostic measure. Data about relatives with atypical infectious, inflammatory or autoimmune diseases are the most valuable.

The aim of this study was to investigate efficacy and safety of early supplemental administration of inhaled tobramycin for prevention and treatment of hospital-acquired pneumonia (HAP) in patients with severe multiple trauma. Methods. Fifty four patients with severe multiple trauma were divided into 2 groups: the study group (n = 27) who took inhaled tobramycin added to systemic antibiotics and the control group (n = 27) who took standard systemic antibacterial treatment. Baselines characteristics did not differ between the groups. The patients' status was assessed daily using APACHE II and CPIS scales. Results. Frequency of HP in the study group was as twice as rare compared to the controls with correspondent reduction in days in ICU. The groups did not differ in mechanical ventilation parameters and frequency of sepsis. CPIS and APACHE II scores did not increase in the inhaled tobramycin group whereas CPIS total score increased and APACHE II score did not improve in the control group. To the 5^th day, significant between-group difference was found in CPIS (p = 0.0028) and APACHE-II (р = 0.0004). Conclusion. Early administration of inhaled tobramycin 600 mg daily added to the standard systemic antibacterial therapy is safe and effective in prevention and treatment of HAP in patients with severe multiple trauma. Such therapy decreased frequency of pulmonary infectious complications and significantly reduced duration of treatment in ICU.

Abu Ali Ibn Sina (Avicenna) was the great scientist of the medieval East, whose writings have provided an active influence on development of the Eastern and European science and culture over several centuries. His medical opinion was based on a philosophical approach. In his main medical work "The Canon of Medicine", Ibn Sina described the chest structure, signs and treatment of respiratory diseases. He paid special attention to inflammation and pulmonary edema, purulent lung diseases, asthma, pleuritis and pulmonary tuberculosis. His diagnostic and therapeutic approaches described long ago has been still actual and could be applied in the current medicine. Abu Ali Ibn Sina laid the basis for the current pneu

We presented a clinical case of 43-year woman with relapsing course of sarcoidosis affecting the lungs and the skin. The diagnosis was confirmed by biopsy. The initial treatment included systemic corticosteroids which then were withdrawn due to insufficient efficacy with subsequent administration of methotrexate. This case demonstrates a personalized approach to treatment based on modern clinical guidelines and highlights difficulty to develop standard therapeutic strategy for a disease with unknown etiology.

Community-acquired pneumonia (CAP) is a widespread acute respiratory infectious disease. The aim of this article was to analyze recent achievements in diagnosis, management and prevention of CAP. Methods. A search of abstracts on pneumonia published at abstract books of the 24th Russian Congress on Respiratory Diseases and the 24^th Annual Congress of the European Respiratory Society was performed using "community acquired pneumonia" keyword. Results. A total of 28 Russian and 92 European abstracts were found. The majority of abstracts were dealt with etiology and pathogen identification methods; rapid tests (urine antigen test for Streptococcus pneumoniae and polymerase chain reaction for identification of bacteria and viruses) are actively implementing in the clinical practice. Data on antibacterial resistance of typical and atypical pathogens and data on pathogen influence on the outcome of CAP have also been shown.

European investigators paid particular attention to nosocomial pneumonia. Clinical scales, both classic (CRB-65 / CURB-65 criteria IDSA / ATS, etc.) and novel, for assessment of CAP severity and prognosis were introduced. Clinical evaluation of the patient with CAP and use of instrument diagnostic methods were also presented. Predictors of poor outcome were determined based on inpatient and outpatient data analysis. In some studies, investigations on routinely used biomarkers and new molecules and reactive oxygen species metabolism were described. Several papers have been published about CAP and comorbidity including cardiovascular diseases, COPD, diabetes, etc. Empirical antibiotic therapy and its change in randomized clinical trials both in the CAP and in hospital acquired pneumonia and ventilator-associated pneumonia, non-antibacterial and intensive therapies of pneumonia were widely discussed. An analysis of quality of care was done in some Russian and European abstracts. Conclusion. Pneumonia today is a crucially important problem involving a wide range of specialists.