The aim of this study was to estimate diagnostic value of virtual bronchoscopy (VB) in patients with trachea neoplasms.

Methods. Results of multidetector computed tomography with virtual bronchoscopy (MDCT"VB) were analyzed in 31 patients with neoplastic lesions of the trachea according to an original method developed in our institution.

Results. The method allowed complete evaluation of location and extension of tumors, differentiation between benign and malignant tumors including those complicated by stenosis precluded from bronchoscopic examination. A sessile tumor with destructed underlying tissue, a rough surface, infiltrated tracheal wall, tumor extension outside the trachea, and infiltration of the mediastinum were considered as malignant signs. Similar signs were seen in metastatic lesions of the trachea from lung carcinoma: the carina and the distal trachea were injured if the tumor grew from a main bronchus, a tracheal wall was injured if a lung tumor penetrated the mediastinum.

Conclusion. MDCT"VB appears to be the optimal diagnostic method in tumors of the trachea. In cases of trachea stenosis, MDCT"VB is the preferable method for evaluation of the tumor extension. Virtual modeling of an intratracheal tumor could help to make a decision about radical treatment.

Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide. An acute exacerbation of COPD greatly contributes to worsening lung function, impairment in quality of life, need for urgent care, and use of medical utilities. Last decade, our understanding of the pathogenesis and treatment of COPD has significantly improved. The guideline accumulated recent information about the prevention of acute exacerbations of COPD.

Methods. The American College of Chest Physicians and Canadian Thoracic Society developed evidencebased guideline to describe the current knowledge on the prevention of acute exacerbations in a clinically useful manner. The PICO approach (population, intervention, comparator, and outcome) was used which involved nonpharmacologic therapies, inhaled therapies, and oral therapies. To select the most appropriate studies, to extract evidencebased data and to grade the level of evidence, evidencebased document assessment tools were applied.

Results. The guideline was designed as a systematic review and critical evaluation of the published literature by clinical experts and researchers in the field of COPD and recommendations were developed to help clinicians in their management of the patient with COPD.

Conclusion. This guideline provides an uptodate, rigorous, evidencebased analysis of current randomized controlled trials on the prevention of COPD exacerbations.

Pleural empyema is one of the most serious septic diseases. Despite favorable outcome, therapeutic and prognostic strategies in empyema are needed to be improved. Further investigation of pathology and diagnostic histological criteria of acute and chronic purulent pleural inflammation and fibrosis is a perspective research direction, as morphological characteristics are important for prognosis and the optimal treatment choice. However, complete histological examination of the lung tissue and the visceral pleura is difficult in real clinical practice, because any lung damage can cause bronchial fistula. Nevertheless, histological features of the visceral pleura and the lungs are closely related to macroscopic characteristics of the pleura. Detailed study of this relationship and the search of morphological similarity of lesions in parietal pleura, visceral pleura, and the lung in patients with empyema could improve the diagnostic value of thoracoscopy, contribute to a rapid histological diagnosis and improve therapeutic approach to empyema. Current approach to the basic mechanisms and risk factors of remodeling of the extracellular matrix in pleural fibrosis was reviewed in the article. Analysis of this process could determine new mechanisms of extracellular matrix remodeling and ways to avoid fibrosis development in the adjacent lung tissue that, in turn, could underlie staging the empyema.

The aim of this review was to introduce readers to technical characteristics and advantages of recently available inhalers used for treatment of chronic obstructive pulmonary disease. Such inhalation devices as Breezehaler, Ellipta, Genuair, NEXThaler, and Respimat were described in details in this article.

Chronic obstructive pulmonary disease (COPD) is an actual healthcare problem. Inflammation is a part of pathogenesis of COPD; therefore, antiinflammatory agents including inhaled corticosteroids (ICS) play an important role in therapy of this disease. Favorable effects of ICS on outcomes of COPD were confirmed, but treatment with ICS in these patients is associated with an increased risk of adverse events, particularly pneumonia. Results of clinical trials demonstrated long"term effects of ICS and long"acting β2"agonists (LABA) in patients with different stages of COPD. Efficacy and safety of novel fluticasone furoate / vilanterol once"daily combination have been discussed in this review. Data on pneumonia as the most troubling adverse effect of ICS / LABA treatment and recent evidence on class specificity of this effect have been reviewed. Blood eosinophilia is considered as a biomarker that potentially could distinguish patients who would have more benefit from ICS prescription.

This review provided recent information about treatment of patients with comorbid respiratory and cardiovascular disease. Cardiorespiratory comorbidity is associated with cross"deterioration of the disease course given similar pathogenic components. This could decrease effects of treatment, worsen prognosis and actually requires new approaches to diagnosis and therapy. While choosing the treatment strategy for a patient with comorbid chronic obstructive pulmonary disease (COPD) and cardiovascular disease, a physician should be aware of the pooled risk of adverse events. Some agents widely used for treatment of cardiovascular diseases could worsen the course of COPD and, vice versa, bronchodilators that are the essential component of therapy of chronic obstructive bronchitis could adversely affect the cardiovascular system. Therefore, medication choice could be significantly limited due to comorbidity.

A growth in prevalence of chronic obstructive pulmonary disease (COPD) is mainly related to continuing exposure of risk factors. COPD is a major and growing global health problem with great economic burden. Therefore, there is an urgent need to study molecular mechanisms of pathogenesis of COPD and to develop a new treatment strategy. Recent studies have revealed geroprotectors which could discover new therapeutic possibilities for COPD. Thus, use of melatonin could be an effective approach to treatment of COPD which could prevent the premature aging of the lungs. Melatonin is a neurohormone which regulates the human’s biological rhythm, metabolism, and immuno"neuroendocrine processes. Melatonin is produced mainly at night. At the same time, there is the peak activity of the immune system. One of the important functions of melatonin is its antioxidant activity. Oxidative stress occurs during acute exacerbations of asthma and COPD, whereas leukocyte number, and antioxidant enzymes and melatonin levels decrease. Exogenous melatonin could improve the oxidative stress and dyspnea and cause 1.6"fold reduction in 8"isoprostane concentration in COPD patients. Melatonin could also inhibit ERK phosphorylation and expression of Sp1 and MUC5AC due to inhibition of MAPK signaling pathway phosphorylation. Melatonin could improve sleep quality in COPD patients with concomitant sleep disorders. Furthermore, melatonin does not cause daytime sleepiness and respiratory disorders compared to conventional hypnotics which may worsen nighttime hypoxemia and respiratory failure in severe cases. Obviously, melatonin could be a potential agent for treatment of chronic airway diseases such as asthma and COPD. However, further long"term large"scale studies are needed to develop recommendations for safe use of melatonin in patients with COPD and sleep disorders.

The aim of the study was to evaluate a role of transforming growth factor"β1 (TGF"β1) gene rs1800470 single nucleotide polymorphisms (SNPs), cytotoxic T"lymphocyte"associated protein 4 (CTLA4) gene rs231775 SNPs and hedgehog"interacting protein (HHIP) gene rs1828591 SNP for predisposition to bronchial asthma (BA) in Krasnoyarsk residents.

Methods. The study involved 100 asthma patients and 338 control subjects. The control group included a representative population sample of Siberian urban residents without respiratory diseases who had participated in the WHO MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) and the HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) projects.

Results. There was a significant difference in genotype and allele frequency distribution of the TGFβ gene in patients with non"allergic BA vs controls. Therefore, A allele carriers with heterozygous genotype AG and homozygous genotype AA of rs1800470 polymorphism of the TGF"β1 gene were at high risk of non"allergic BA. We also found an increase in the GG genotype frequency in BA group compared to the control group. The GG genotype of CTLA4 gene rs231775 polymorphism was associated with high risk of allergic BA (ОR = 2.036; 95% CI = 1.16–3.58; р = 0.012). Genotype and allele frequency distribution of HHIP gene rs1828591 polymorphism did not differ significantly between BA patients and the control group.

Conclusion. An association was revealed between BA, TGF"β1 gene rs1800470 SNPs and CTLA4 gene rs231775 SNPs. An association between BA and HHIP gene rs1828591 SNPs was not found.

The aim of this study was to analyze medical reports of patients treated at the Federal Central Research Institute of Tuberculosis in 2011 to 2014.

Methods. One hundred of medical reports have been analyzed. Nontuberculosis mycobacteria (NTM) were searched in sputum, bronchoalveolar lavage fluid or resected tissue samples. Microscopy of samples stainedmatographic rapid test for Mycobacterium tuberculosis complex antigen detection were used. Nontuberculous mycobacteriosis was diagnosed according to ATS criteria.

Results. The patients were 20 to 78 years of age. Most patients had pulmonary tuberculosis (44%) and chronic non"specific inflammatory respiratory diseases (45%). Common clinical symptoms were cough (98.2%), dyspnea (72.4%), haemophtysis (10.3%), fatigue (68.5%), loss of appetite (32.3%), and weight loss (12.5%). Radiological signs were in line with the underlying disease and were as follows: pulmonary nodules (6%), disseminated lesions (6%), tuberculomas (7%), cavities (12%), pulmonary infiltrates (8%), bullae (42%), ground glass opacities (5%), honeycombing (2%, bronchiectasis (20%), intrathoracic lymph node enlargement (5%), cirrhotic pulmonary lesions (19%), and combination of various radiological signs (32%).

Conclusion. Patients with chronic respiratory diseases, such as chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, pneumoconiosis. etc.; patients on long"term therapy with systemic steroids, patients with pulmonary tuberculosis or with a history of pulmonary tuberculosis are at risk of having nontuberculous mycobacteriosis.

This study was aimed at analysis of own experience of differentiation between pulmonary tuberculosis and sarcoidosis.

Methods. We evaluated VATS biopsy samples from 250 patients with disseminated lesion of the lungs and/or intrathoracic lymph nodes of unknown origin. Previous examination excluded any known granulomatosis excepting pulmonary tuberculosis and sarcoidosis. The biopsy samples were collected in different regions of Russia in 2010–2014.

Results. Typical epithelioid cell granulomas with giant multinucleated cells were seen in lymph nodes and the lung tissue in all cases. Necrosis and/or presence of acid"fast mycobacteria were necessary and sufficient sign of tuberculosis. Granulomas without necrosis and mycobacteria in slice series, but not in one or two incident slices, were considered as highly specific for sarcoidosis.

Conclusion. We suppose that differentiation between tuberculosis and sarcoidosis should be based on complex clinical and morphological analysis with the determinant role of morphological examination

The purpose of the study was to evaluate efficacy and safety of systemic corticosteroids (SCS) in 245 patients with sarcoidosis in a real clinical practice.

Methods. This was a retrospective analysis of outpatients with pulmonary sarcoidosis who visited a pulmonologist in 2000 to 2015. The analysis involved 166 females and 79 males, mean age, 44.9 ± 0.8 years. The diagnosis was verified by biopsy in 74.7% of cases.

Results. Prednisolone improved symptoms and objective parameters of sarcoidosis in 90.2% of cases; 55.9% patients had a relapse after treatment. Three"month treatment with SCS was not associated with complete regression of the disease. The stage IV sarcoidosis developed in 8.8% of the patients despite the adequate dose of prednisolone and duration of the treatment; 56.8% of the patients had a relapse at the end of the therapy. Achieving remission of pulmonary disease was not always associated with remission in other involved organs. In some cases, treatment with SCS was complicated by type 2 diabetes mellitus or hypertension.

Conclusion. GCS should be prescribed as the first"line therapy only to patients with progressive course of pulmonary sarcoidosis or with involvement of other organs and after assessment of contraindications to this therapy.

The aim of this study was to evaluate clinical efficacy and safety of selective phosphodiesterase"4 inhibitor roflumilast in patients with COPD and metabolic syndrome.

Methods. In this prospective study, patients with stage III – IV COPD, frequent exacerbation phenotype (≥ 2 per a year) and metabolic syndrome (n = 42) were treated with roflumilast (Daxas) 500 mg q.d. additionally to the basic therapy for 12 months. Clinical investigation, mMRC scale and CAT questionnaire, pulse oxymetry, spirometry, 6"min walking test, measurement of glucose, lipids and C"reactive protein in blood were used in all patients.

Results. Exacerbation rate decreased in patients with COPD treated with roflumilast. FEV1 and quality of life improved in patients treated with roflumilast. Therapy with roflumilast was associated with statistically significant reduction in the waist circumference without significant change in the body weight, waist"to"hip ratio or body mass index.

Conclusion. Therapy with roflumilast was associated with improvement in clinical, laboratory and functional parameters and reduction in exacerbation rate in patients with COPD and metabolic syndrome.

The aim of this study was to investigate a relationship between the myocardial structure and function and respiratory parameters in patients with coronary artery disease (CAD) and respiratory disease.

Methods. We performed spirometry, body plethysmography, lung diffusing capacity test and measured the left ventricle (LV) systolic and diastolic function in patients with CAD with or without respiratory diseases and ventilation disorders.

Results. Patients with CAD (n = 662) participated in the study. The LV systolic dysfunction was found only in 60 patients (9.1%), while diastolic dysfunction was found in 387 patients with CAD (58.4%). Most patients with obstructive ventilation disorders had the systolic or diastolic LV dysfunction (40 patients (66.7%) and 197 patients (79.4%), respectively). Flow and volume lung function parameters and the lung diffusing capacity were associated with some echocardiographic and pulsed wave Doppler parameters.

Conclusion. Comorbidity of CAD and lung obstructive disease was associated with more frequent systolic and diastolic LV dysfunction. The relationship between respiratory and cardiac parameters could indicate the cross impact that could deteriorate the course of both the diseases.

The purpose of this study was to investigate an association between lung hyperinflation and the risk of bone fracture in patients with chronic obstructive pulmonary disease (COPD).

Methods. The study involved 125 smokers with COPD. The patients treated with systemic steroids were excluded from the study. Lung function and bone mineral density were measured in all the patients. The risk of osteoporotic bone fractures was calculated by FRAX tool.

Results. Lung hyperinflation increased according to the COPD stage. The highest total lung capacity (TLC) was observed in patients with 4 stage COPD (131.43 ± 38.99%pred.) followed by 126.68 ± 21.58%pred. in 3 stage COPD and 115.39 ± 23.68%pred. in 2 stage COPD (p < 0.05). The highest risk of hip fracture (> 3) was calculated for 24.24% of patients with residual lung volume (RV) < 200%pred. and for 45.71% of patients with RV > 200%pred. 

Conclusions. The risk of hip fracture was significantly associated with the severity of hyperinflation in COPD patients. The highest risk of fractures was found in patients with 4 stage COPD.

The aim of this study was to estimate the diffusing capacity of the alveolar"capillary membrane (Dm) and the alveolar volume of the lungs (Va) based on measured CO concentration and basic spirometric parameters.

Methods. Previously, we calculated CO concentration in the exhaled air during tidal and forced breathing. Experimental data of a healthy volunteer were analyzed with presumable predicted values of Dm = 60 and Va = 7.0. Then, the real Dm and Va were estimated.

Results. We determined an equation for the present case (male; 176 cm of height; 50 years of age). This equation was too intricate for the routine use, so we developed an online calculator to estimate values in the real"time regimen on the basis of DELPHI platform.

Conclusion. Our findings could make reasonability for further investigation to develop a new method for Dm and Va estimation that could be more feasible because it do not need test gas mixtures.

The aim of this study was to evaluate prevalence, clinical and functional markers of obstructive sleep apnoea syndrome (OSAS) and to develop the optimal therapy for this disease in patents living at high altitude.

Methods. The study protocol included physical examination, special respiratory questionnaires, 6"min walk test, spirometry, echocardiography, capnography and polysomnography. The trial treatment included CPAP therapy, acetazolamide or combination of both.

Results. A male patient, 62 years of age, with OSAS associated with pulmonary artery hypertension (PAH) was reported in the article according to the study protocol. The combined therapy with CPAP + acetazolamide was the most effective and resulted in improvement in the sleep quality, oxygen saturation, dyspnea, РtcСО2, hypertension, and the heart beat rate.

Conclusion. The combined therapy with CPAP + acetazolamide could be considered as the optimal treatment for patients with OSAS and PAH. OSAS in patients living at high altitude requires further investigations.