An analysis of mortality from respiratory diseases in population of Russian Federation in 2014 and January to September, 2015, has been done in the article based on the official statistics of Healthcare Ministry of Russian Federation and the Federal Service of State Statistics. Mortality from respiratory diseases was 54.4 per 100,000 including mortality from pneumonia of 27.2 per 100,000 in 2014 in Russian Federation (not including data for Crimea Federal District). The highest mortality from pneumonia in 2014 was registered in the Far Eastern Federal District (40.5 per 100,000). In 2014, pneumonia accounted for 49.9%; chronic lower respiratory diseases, 43.2%; chronic obstructive pulmonary disease, 40.39%; and asthma, 2.3% of the total mortality from respiratory diseases. In nine months of 2015, mortality from respiratory diseases was 52.9 per 100,000; from pneumonia, 24.6; from flu and other acute respiratory infections, 0.3 per 100,000. Pneumonia accounted for 46.5% of the total mortality from respiratory diseases in nine months of 2015.

This article contains clinical guidelines and current approaches to diagnosis and treatment of idiopathic pulmonary fibrosis (IPF). The aims of development this guidelines were to improve early detection and efficacy of pharmacological and non-pharmacological therapy of IPF. Achieving these goals indicates improvement in medical care quality for these patients. These guidelines are intended to pulmonologists, therapeutists and other medical specialists, healthcare managers and other healthcare providers

This is a review of published data on community-acquired pneumonia (CAP) in adult HIV-infected patients. Morbidity of bacterial pneumonia in HIV-infected patients is 5- to 10-fold higher than that in general population. Wide use of antiretroviral therapy (ARVT) is associated with a reduction in morbidity of CAP in HIV-infected patients, but this reduction is not as significant as for other opportunistic infections. The most important risk factors for CAP are drug abuse, tobacco smoking, HIV-associated immunosuppression, hepatic cirrhosis, not to be treated with ARVT or ARVT withdrawal. Severe, complicated and invasive course of CAP and poor outcomes are seen more often in HIV-infected patients compared to general population. Bacterial pneumonia should be differed from pneumonia caused by Pneumocystis and from tuberculosis, especially in endemic countries and in patients with insidious onset of the disease. The standard therapy of CAP is applied in all patients independently of HIV status. However, administration of fluoroquinolones is restricted in regions with high prevalence of multi-drug resistant tuberculosis in HIV-infected patients before tuberculosis is excluded. Several studies have demonstrated that, in case of false initial diagnosis, 10-day monotherapy with a fluoroquinolone could form the resistance of Mycobacteria tuberculosis against this drug; this significantly complicates further treatment of tuberculosis and increases the treatment cost. Beta-lactams are not effective against tuberculosis; in 2016, WHO excluded macrolides from the list of medications for therapy of tuberculosis due to their low activity against M. tuberculosis. Therefore, empirical therapy of CAP in HIV-infected patients should be started with combination of beta-lactam antibiotic and newer macrolide. A strong protective effect of PPV23 vaccine against CAP was confirmed in HIV-infected patients, but the highest protective efficacy was seen in patients with relatively preserved immunity compared to patients with CD4 < 200 cells × µL^-1.

A review of efficacy of budesonide/formoterol fixed combination in obstructive lung diseases has been done in the article. The efficacy of this combination in chronic obstructive pulmonary disease (COPD) and asthma has been supported by high-level evidence. Clinical effect of inhalation therapy depends on proper use of the inhaler. Information on a new dosing dry powder inhaler DuoResp Spiromax® is given in the review. The ease of use of this inhaler is close to intuitive use. According to comparative trials, DuoResp Spiromax® is a promising inhaler which could improve the therapeutic efficacy and reduce cost of treatment of COPD and asthma.

The aim of this study was to characterize chronic respiratory infection in cystic fibrosis (CF) patients in Russia according to the National Russian CF Register. Methods. The National Russian CF Register included 2,131 patients from 74 Russian regions (2,092 alive patients and 39 died patients) in 2014 (the median age, 10.2 (15.2) years; 29.2% were adults ≥ 18 лет). Microbiological findings of CF patients (chronic infection caused by Staphylococcus aureus, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Burkholderia cepacia соmplex, non-tuberculous mycobacteria (NTM), non-Pseudomonas Gram negative pathogens including Achromobacter spp., and frequency of intermittent P. aeruginosa infection) have been analyzed in this article. Results. The tested pathogens were not found in 18.0% of patients. The prevalence of pathogens in descending order was as follows: S. aureus, 54,5%; P. aeruginosa, (chronic infection), 32,1%; P. aeruginosa (intermittent infection), 14,1%; B. cepacia complex, 7,3%; Achromobacter spp., 3,5%; Stenotrophomonas maltophilia, 3,3%; NTM, 0,8%. Other non-Pseudomonas Gram negative pathogens including Achromobacter spp., Escherichia coli, Acinetobacter spp., Klebsiella spp., Citrobacter spp. caused chronic airway infection in 11.8% of patients. Children were infected more frequently by S. aureus and adult patients infected were frequently by P. aeruginosa, В.сepacia complex, Achromobacter spp., and NTM. No geographic prevalence of pathogen distribution was found. Russian CF patients were more often infected by S. aureus and B. cepacia complex compared to European CF patients. P. aeruginosa was yielded with equal rate in Russia and in Europe. S. maltophilia and NTM were found less frequently in Russia compared to Europe. Conclusion. According to the National Russian CF Register, the airways of 18.0% of CF patients in Russia are not colonized by respiratory pathogens. As the patient's age increases, the rate of Gram negative respiratory infection is growing. The most harmful infections are thought to be B. cepacia complex and Achromobacter spp.

The World Health Organization (WHO) searches influenza virus circulation in community and in natural biocenosis, studies virus strains and their properties, develops diagnostic methods and preventive measures since 1940^th worldwide because of epidemic actuality and high pandemic potential of the influenza virus. The Federal Influenza Center (including Federal Research Institute of Influenza, Saint-Petersburg, and the Center of Virus Ecology, D.I.Ivanovskiy Virology Institute, Honorary Academician N.F.GamaleyaFederal Research Center of Epidemiology and Microbiology, Federal Research Center for Epidemiology and Microbiology, Moscow) performs similar work in Russia in close cooperation with WHO within the framework of the International Programme of Influenza Monitoring. A(H1N1)pdm09 influenza virus dominated in the Northern Hemisphere in the 2015 – 2016 epidemic season. Morbidity growth was noted from the end of January, 2016, to the beginning of March, 2016. The peak morbidity at the 5th week of the year exceeded the epidemic threshold (132 cases per 10,000 of population) and morbidity in the 2014 – 2015 season significantly and approached to the peak morbidity of the 2009 – 2010 epidemic season. The epidemic growth in Russian Federation was provided by three influenza viruses: A(H1N1)pdm09, В and A (H3N2). A(H1N1)pdm09 virus caused 18% of all acute respiratory diseases and accounted for 84% of circulating influenza viruses.

Flu was diagnosed in patients of different age with maximal frequency in 3- to 6-year old children. Peak admission number was registered at 5 and 6 weeks (3,538 and 4,109 cases, respectively); this number exceeded the similar parameter of the 2009 – 2010 season. Patients of 15 to 64 years old were admitted more often including those with acute respiratory infection. Two hundred and thirty nine deaths were registered to the 5^th of April, 2016, according to data from the Federal Influenza Center and the Center of Virus Ecology. The diagnosis of A(H1N1)pdm09 flu was confirmed in 97.9% of deaths. Molecular analysis of isolated strains of A(H1N1)pdm09 influenza virus revealed amino acid substitutions in receptor binding site and SA site of hemagglutinin and in genes coding intrinsic proteins PA, NP, M1, and NS1. Influenza virus strains resistive to anti-neuraminidase drugs were encountered in #< 1% in the Northern Hemisphere countries. No strains studied were sensitive to adamantine derivates.

The aim of this study was to monitor in-hospital influenza virus infection during 2015 – 2016 epidemic flu season. Methods. Influenza virus was searched in patients hospitalized to a clinical infectious diseases hospital with acute respiratory viral infection during 2015 – 2016 influenza seasonal growth period using real-time RT-PCR method. Influenza virus was isolated from nasal swabs and autopsy material using canine kidney cell line. Other laboratory methods used included complete blood count, blood chemistry, blood gas analysis, urinalysis, and chest X-ray examination. Results. We examined 1,491 patients (375 adults, 546 children, 570 pregnant women with early gestational age). The proportion of hospitalized patients with confirmed A / H1N1pdm09 influenza in January – February, 2016, was 91.3%. A / H3N2 influenza virus was diagnosed in 5.7%, influenza B virus was isolated in 1.2% of patients. Totally, influenza virus was detected in 35.2% of samples, of which 30.1% of samples were obtained from adults, 33.7% of samples were obtained from children, and 39.8% of samples were obtained from pregnant women. The prevalent patient’s age was 15 to 60 years (76.1%) in adults and 3 to 6 years in children. Moderate course of influenza with a high rate of hospital admission was seen more often and was similar to that of 2009 – 2010 epidemic season. Proportion of patients with flu complicated by pneumonia was higher than that in 2014 – 2015 epidemic season. Bilateral lung injury was diagnosed in 48.4% of patients. High mortality in ICU (46.4%) was due to delayed start of antiviral treatment and late admission to a hospital. Conclusion. In 2015 – 2016 epidemic flu season, higher morbidity, complications and poor outcomes were related to predominant infection of A – H1N1pdm09 influenza virus. Risk factors of complications and death were delayed care seeking, lack of modern antiviral medications and comorbidity.

The aim of this study was to determine diagnostic radiological signs of atypical parasitic lung injury that could help differentiate it from tumors and inflammatory diseases. Methods. We analyzed radiological findings of 28 patients with atypical manifestations of parasitic lung diseases admitted with initial diagnosis of pneumonia, pulmonary alveolar proteinosis, idiopathic pulmonary fibrosis, lung abscess, pulmonary tuberculous, canrcinoma, or metastatic lung lesion. Results. Common imaging signs of some parasitic lung diseases were fluid-containing cysts and septal structures (echinococcosis, alveococcosis, cysticercosis), absence of bronchial injury, no or slight contrast enhancement of pathological changes on bolus contrast-enhanced CT (paragonimiasis, schistosomiasis, toxoplasmosis, pneumocystosis). Conclusion. CT-monitoring is one of the main differentiating methods in atypical manifestations of parasitic lung diseases.

The aim of this study was to analyze our own experience of diagnosis and treatment of pulmonary endometriosis. Methods. Females with endometriosis (n = 11) has been described in the article. The patients’ age ranged from 16 to 61 year, the mean age was 37.7 ± 2.7 years. Results. Serious difficulties were encountered in all cases in differential diagnosis of pulmonary lesions. Clinical, laboratory and radiological findings were not sufficient for diagnosis. Diagnostic surgical interventions were required in all cases. Pulmonary endometriosis was diagnosed using histological and immunohistochemical examination of lung biopsy specimens. Diagnostic workup has been illustrated by two case reports of pulmonary endometriosis in patients of 52 and 19 years of age. Conclusion. The management of patients with extragenital endometriosis depends on pathological and immunohistochemical findings, location and extend of injury. Such patients should be managed together by a gynecologist and a thoracic surgeon.

This study was aimed at investigation of clinical efficacy and safety of high frequency chest wall oscillation (HFCWO) method in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods. This was a prospective randomized controlled comparative study. Patients hospitalized for AECOPD (GOLD III or IV stage; mean FEV 1, 37% pred.) were included. In first two days of admission, all patients were randomized to HFCWO treatment (VestÒ Airway Clearance System; 15–25 min b.i.d.; oscillation frequency, 10–15 Hz; pressure, 4–6 cm H2O) or standard therapy (the control group). Results. Fifty patients completed the study: 25 patients in HFCWO group and 25 patients in the standard therapy group. Therapy with HFCWO was associated with increasing sputum volume to the 3^rd and the 7^th days of the study (р < 0.001) and more significant reduction in symptom intensity compared to the controls (р = 0.006). Symptom severity measured with the BCSS score decreased by 3.4 and 1.5, respectively (р = 0,006). Therapy with HFCWO was also associated with more significant improvement in oxygenation parameters and reduction in C-reactive protein (CRP) level (р = 0,001 for both). Conclusion. Therefore, treatment with HFCWO was associated to improved sputum clearance, significant improvement in clinical symptoms, earlier oxygenation improvement and CRP reduction.

This study was aimed at assessment of vaccination effects on quality of life and main prognostic scores in COPD patients. Methods. The study involved 362 male patients with COPD. Vaccination was done using13-valent conjugate pneumococcal vaccine Prevenar-13 (PCV-13) and polyvalent pneumococcal vaccine Pneumo-23 (PPV23). Quality of life was assessed using the Russian version of SRGQ and CAT questionnaire. Prognostic BODE, DOSE and ADO scores were calculated. Results. Vaccination with PCV13 and PPV23 was associated with improvement in quality of life in 1 year after vaccination, though this effect of PPV23 decreased to the 3^rd year. Quality of life questionnaires help to assess the therapeutic strategy chosen both in early and delayed follow-up. BODE, DOSE, and ADO scores have demonstrated a reliable and statistically significant decrease in 1 year after vaccination; for PCV13, this effect maintained in 3 years after vaccination. Conclusion. Vaccination with PCV13 could reduce total 3-year healthcare expenses to 11,357 RUB (78%), partly due to long-term maintenance of the effect of vaccination. This is an important advantage of PCV13 over PPV23 both from economic and clinical points of view.

The aim of this study was to evaluate efficacy of vaccination against pneumococcal infection using Pneumo23 vaccine in workers of metallurgical industry. Methods. The study involved workers of mining and metallurgical enterprises who exposed to occupational hazard factors regularly. The lung function was assessed using spyrometry. The severity of COPD was evaluated using the CAT questionnaire. Number and duration of day off periods due to respiratory diseases were also considered. All parameters were measured at baseline and in 12 and 24 months after vaccination. Results. The number of work off days due to respiratory diseases significant decreased in a year after vaccination with Pneumo 23 vaccine. Functional parameters and well-being improved and the impact of the disease on daily life decreased in 12 and 24 months after the vaccination. Conclusion. The results of the study confirmed the high efficacy and safety of vaccination with Pneumo 23 vaccine in workers of metallurgical enterprises.