Community-acquired pneumonia (CAP) is one of the most common infectious diseases in developed countries. Chronic heart failure (CHF) is an independent risk factor for unfavorable course and poor outcome of CAP. Objective difficulties of CAP diagnosis in elderly and very elderly patients with CHF require more active implementation of chest multi-slice spiral computed tomography and serum inflammatory biomarkers measurement in routine clinical practice. Systemic antibacterial therapy in these patients should be prescribed according to generally accepted recommendations. However, therapeutic approach should consider various risk factors and be more personalized in this heterogeneous population.

This European Respiratory Society (ERS) statement provides a comprehensive overview on physical activity in patients with chronic obstructive pulmonary disease (COPD). A multidisciplinary Task Force of experts representing the ERS Scientific Group 01.02 ‘‘Rehabilitation and Chronic Care’’ determined the overall scope of this statement through consensus. Focused literature reviews were conducted in key topic areas and the final content of this Statement was agreed upon by all members. The current knowledge regarding physical activity in COPD is presented, including the definition of physical activity, the consequences of physical inactivity on lung function decline and COPD incidence, physical activity assessment, prevalence of physical inactivity in COPD, clinical correlates of physical activity, effects of physical inactivity on hospitalisations and mortality, and treatment strategies to improve physical activity in patients with COPD. This Task Force identified multiple major areas of research that need to be addressed further in the coming years. These include, but are not limited to, the disease-modifying potential of increased physical activity, and to further understand how improvements in exercise capacity, dyspnoea and self-efficacy following interventions may translate into increased physical activity.

Modern methods of inhaled drug delivery to the respiratory tract were discussed in this analytical review. Significance of spirometry and the importance of spirometric results for the inhaler choice were substantiated. Advantages and disadvantages of different inhalation devices were described. Efficacy of inhalational combination of long-acting anticholinergics and beta-agonists was also reviewed.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) significantly reduce quality of life and increase a cost of disease treatment. Apart from antibiotics and bronchodilators, mucolytic agents play an important role in treatment and prevention of AECOPD. A literature review showed that erdosteine has significant antioxidant, antiadhesive, antiinflammatory and mucoregulatory properties and could effect clinical signs and symptoms of COPD. Use of erdosteine in patients with AECOPD could reduce durations of AECOPD, hospitalizations due to AECOPD and work-off periods.

The aim of this review was to analyze morbidity and mortality from respiratory diseases in employable population of Russia in 2010–2012. Methods. For this purpose, we used statistical data of the Healthcare Ministry of Russian Federation and of the Federal State Statistics Service. Results. Respiratory morbidity in adults of Russia ranked the 2nd among the general morbidity (20209.7 per 100,000 in 2012). The highest total and primary morbidities were registered at the North-Western Federal district and at the Volga Federal district. Respiratory diseases were the 5th cause of mortality in adult employable population in Russia (up to 26.9 per 100,000). The highest mortality rate was registered at the Far Eastern Federal district. Men had 4.6-fold higher mortality rate than women. Pneumonia caused 75.1% of all deaths due to respiratory reasons in 2012. Conclusion. In general, mortality in employable population tended to decrease in this period.

The aim of the study was to analyze pitfalls in the management of patients died of community-acquired pneumonia (CAP) in 2014. Methods. The stage 1 of our study included an analysis of statistical findings according to ICD codes J12–J18 in 2010–2014. A retrospective analysis of 1419 medical records of both outpatients and inpatients died of pneumonia in 2014 was carried out at the stage 2 of our study. Of 1419 registered patients died of pneumonia, 88.4% died of CAP and 11.6 % died of nosocomial pneumonia. Diagnosis of pneumonia was confirmed by autopsy in 86% of cases. Statistical analysis was made using Statistica 7.0 software. Results. Mortality from CAP has grown by 49.4% in 2010–2014 including 11% in working-age population. Mortality rate was extremely different in different areas of Krasnodarskiy Krai; the range was 4.6 to 44.9 per 100,000 of adult population. The proportion of patients died at home in 2010-–2014 increased from 50.1% to 53.4%. The pitfalls of early-stage management of patients with CAP were as follows: 1) national standards were not adhered in 76% of cases; 2) severity of pneumonia was underestimated. Physicians did not use scores for pneumonia severity assessment. Pulse oximetry that is typically used to estimate the respiratory failure severity was not performed. Chest X-ray was made only in 26.6% patients died of pneumonia at home. Inappropriate antibacterial therapy was administered in 68% of cases. Other pitfalls included misdiagnosis of the patient’s severity in admission (78.7%), non-use of pulse oximetry (88.3%), and late admission to ICU (84.7%). Conclusion. Improvement in therapists’ knowledge on pneumonia, close adherence to the national guidelines on management of pneumonia, availability of pulse oximetry and improvement in quality of intensive care of severe pneumonia could reduce mortality from CAP.

The aim of this study was to analyze CAP epidemiology and morbidity in the Amur region, to evaluate anti-epidemic measures for prevention of pneumococcal infections in flooded areas and medical and socioeconomic benefits of vaccination of children with risk factors for pneumococcal disease. Material and methods. Common morbidity of pneumonia was analyzed in the Amur region. To evaluate clinical and epidemiological efficacy of pneumococcal vaccination with PCV13 in 2014–2017, 5,000 children aged 2 to 5 yrs with high risk of pneumococcal infection were involved into a special follow-up programme. Clinical, epidemiological, social, hygienic, economic and statistical analyses were used. Results. The total incidence of pneumonia in population of the Amur region reached the peak value (897.3 per 100,000) in 2009; this was associated with influenza pandemic. CAP incidence decreased by 43.8% in 2010–2014. Morbidity of CAP had certain age-related and seasonal differences and was closely related to morbidity of acute respiratory viral infection. Results of microbiological monitoring of CAP pathogens in the Amur region were also discussed. Morbidity of pneumonia and acute respiratory infections decreased in 2014 in 69.4% of children vaccinated with PCV13. Morbidity of CAP reduced by 2,014 cases in 2014 that prevented economic loss of 94 billion RUB. Conclusion. Clinical and economic monitoring of CAP and pneumococcal vaccination with PCV13 in the Amur region have significant medical and socioeconomic efficacy.

The aim of this study was prospective evaluation of clinical and economic efficacy of vaccination with conjugate pneumococcal vaccine PCV13 in patients with chronic obstructive pulmonary disease (COPD) and with comorbidity of COPD and coronary heart disease (CHD) during two consecutive years. Methods. The study involved 306 male patients (mean age, 62.09 ± 9.22 yrs). Clinical and laboratory examination was performed in all patients. Dyspnea was assessed using MRC scale. Hospitalisation rate related to COPD exacerbation and number of pneumonia were analyzed. Patients were vaccinated with PCV13. The study was conducted in 2012–2014. Results. COPD exacerbation rate became 8 times lower and hospitalisation rate became 4 times lower after vaccination in patients with comorbidity of COPD and CHD. Healthcare cost saving was 64% in one year after vaccination and 70% in 1.5 years after vaccination. Healthcare cost saving in patients with comorbidity of COPD and CHD was 82.1% in two years. On contrary, effect of vaccination with PPV23 declined with time; the healthcare cost saving was 55% and 47% in 1 year and 1.5 years after vaccination, respectively. Conclusion. Vaccination of patients with COPD and CHD using pneumococcal vaccine PCV13 could reduce healthcare costs.

The aim of this study was to evaluate cost structure and rationality of pharmacotherapy of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in a pulmonology department of a multiprofile Krasnoyarsk hospital in 2014. Methods. This was a retrospective 1-year study evaluating pharmacotherapy of AECOPD according to electronic medical reports. Medication therapy and frequency of administration of certain drugs were evaluated using frequency analysis. Rationality of medication therapy and treatment expenses were analyzed with ABC/VEN analysis. Results. One hundred and thirty one electronic medical reports were analyzed. Frequency analysis showed that all patients received the combined bronchodilator Berodual and the expectorant bromhexine. Moreover, 81.7% of patients received antibiotics, 75.6% received systemic steroids and 41.2% received inhaled corticosteroids. This is consistent with current scientific trends and recent recommendations. ABC/VEN-analysis showed a rational pharmacotherapy expenditure of funds in patients with AECOPD. The main expenses were associated with vital drugs (58.2%) followed by pharmacotherapy of comorbidity (41.8%) which was administered to 87.8% of the patients. Anticoagulants had the highest cost (22.5% of the total pharmacotherapy of AECOPD). Second-line drugs were not used in the treatment of AECOPD. Conclusion. The main portion of cost of AECOPD pharmacotherapy was related to pathogenic treatment followed by treatment for comorbidity and prevention as the former greatly effects severity and outcomes of COPD.

The purpose of the study was to investigate effects of roflumilast on the level of control, systemic inflammation markers, general and mucosal humoral anti-endotoxin immunity in patients with asthma–COPD overlap syndrome (ACOS). Methods. Forty patients with ACOS were involved. All the patients were treated with a standard therapy. Of them, 20 patients received roflumilast additionally during 1 month. Clinical parameters were analyzed using ACQ Elizabeth Juniper questionnaire, mMRC scale and spirometry. Anti-endotoxin antibodies A, M, G classes and C-reactive protein were measured by ELISA. Results. Additional administration of roflumilast significantly improved control of the disease, reduced systemic inflammation and improved mucosal anti-endotoxin immunity in patients ACOS with neutrophil inflammation. Six-month follow-up showed that the effect prolonged in 15.8% of the patients. Conclusion. Efficacy and duration of effects of roflumilast in ACOS patients requires further research.

The purpose of this study was to investigate a role of osteopontin for development of right heart diastolic dysfunction in patients with atopic bronchial asthma (ABA). This is important for early diagnosis of pulmonary hemodynamic disorders. Methods. The study involved 188 subjects: 148 ABA patients who were divided into 3 groups according to asthma severity and 40 healthy volunteers as controls. We measured right ventricle functional parameters and blood osteopontin concentration. Results. While increasing ABA severity blood osteopontin concentration increased and the right ventricle diastolic function decreased in comparison to the healthy controls. Osteopontin concentration was higher in patients with right heart dysfunction. Conclusion: More severe course of ABA was associated with higher blood osteopontin concentration. More significant right heart dysfunction was seen in patients with moderate to severe ABA. Right heart dysfunction in ABA was associated with systemic inflammation, particularly with osteopontin concentration.

The objective of this study was to define pathologic mechanisms of primary spontaneous pneumothorax in patients with connective tissue dysplasia (CTD). Methods. We followed-up 42 young patients with CTD and bullous emphysema in the lung CT without history of primary spontaneous pneumothorax. Results of clinical, functional, radiological and molecular testing were compared with morphological examination of resected lung tissue specimens from 165 patients underwent lung surgery for primary spontaneous pneumothorax. Results. Two mechanisms underlying emphysema in CTD patients were defined. Conclusion: The results supported a hypothesis of causative relationship between congenital CTD and bullous emphysema in young patients.

The aim. Investigating morphological and molecular characteristics of injury and reparation of the stem cell niche (SCN) zones in the respiratory acini and determining a role of these changes for the pathogenesis of idiopathic pulmonary fibrosis (IPF) / usual interstitial pneumonia (UIP). Methods. Surgical transthoracic (n = 71) and transbronchial (n = 47) lung biopsy specimen from 118 patients were investigated. Bronchiolar carcinoma occurring against the background of ILF was diagnosed in 13 cases. Serial paraffin sections were stained with hematoxylin and eosin and Van Gieson picrofuchsin; immunohistochemical reactions were used to detect MMP-1, -2, -7, TIMP-4, PCNA, PDGF, EGF, FGF-b, desmin (Dsm), vimentin (Vimentin), SMA (LabVision, 1 : 100), Apo-Cas (Novocastra, 1 : 100), TGF-b, TNF-a, CD 34, CK-7, -18, Oct-4 and CD-117 (DAKO, 1 : 50), CD68, (DAKO, 1 : 100), CK-5 (Biogenesis, 1 : 200), CK-6, -19 (Uni-Heidelberg, 1: 100). Biotinylated antibodies against mouse and rabbit immunoglobulins (Dako LSAB + KIT, Peroxidase) were used as secondary antibodies. All quantitative and semi-quantitative data were analyzed with variational statistics. Results. Involvement of NSC zones of the lung tissue plays the key role in pathogenesis and morphogenesis of IPF / UIP. This leads to deficient reparation. Disorders of mesenchymal-epithelial transformation / epithelial-mesenchymal transformation (MET / EMT) are likely to be a basis for insufficient reparation in UIP. This is supported by appearance of cells with myofibroblast phenotype expressing both markers of mesenchymal and epithelial differentiation and stem cell markers in the SCN zones. Conclusion. Cells with myofibroblast phenotype could be considered as markers of pathologic reparation following MET program failure. Subsequently, MET program failure in UIP could lead to the development of «honey-comb» disorders in the lungs and also to lung carcinoma development.

The aim of the study was to describe tissue, cellular and molecular particularities of the bronchial mucosa in smokers with chronic obstructive pulmonary disease (COPD). Methods. Morphological investigation of bronchial wall biopsy in smokers with and without COPD was made. Results. Bronchial wall structural disorders were seen in smokers without clinical manifestations of the disease which were considered as compensatory changes. Morphological features of hemodynamic abnormalities, perivascular fibrosis of the lamina propria, squamous cell metaplasia, atrophy of the bronchial epithelium associated with endothelial dysfunction and dysregeneration of the epithelial cells were found in smokers with clinically significant COPD. Conclusion. Morphological changes in bronchial wall are thought to be related to COPD severity.

The aim of this study was to determine diagnostic value of an algorithm for restrictive ventilation disorders recommended by the American Thoracic and European Respiratory Society. Methods. We analyzed pulmonary function tests of 148 patients with interstitial lung disease with increased lung elasticity and without airways obstruction. A specific type of restrictive disorders referred to as «non-classic», because it does not match existing diagnostic criteria, was observed in most patients (n = 86). The recommended diagnostic algorithm had low sensitivity (0.42) mainly due to a low informative value of spirometry (VC was within a normal range in 80% of patients with non-classic restrictive pattern).

This is a review of published data on pulmonary ossification and a description of case report of a miner with pulmonary ossification considered as a manifestation of pneumoconiosis. Diagnosis was confirmed by immunohistochemical investigation of lung biopsy specimens that revealed epithelial-mesenchymal transformation. Foci of pulmonary fibrosis with bone tissue accumulation, periosteal coal dust accumulation and heterotopic type of ossification suggesting an excessive morphogenic response of fibroblastic phenotype cells that is a typical sign of pneumoconiosis were considered as ossification which in turn was a manifestation of pneumoconiosis. The presence of vimentin as a marker of the less differentiated mesenchymal cells showed that fibrosis was related neither to resident progenitor cells nor circulating bone marrow stem cells but to specialized bronchial epithelium cells with changed phenotype.