We aimed to assess the criteria used by physicians in routine clinical practice to assess severity of communityacquired pneumonia (CAP) in adults. Methods. A survey of 165 physicians from multiprofile hospitals was performed at six Russian cities. Results. Chest Xray data were considered by 80% of respondents as an important marker to identify severe / non-severe CAP. Clinical features, comorbidity, laboratory abnormalities, and history data were noted by 78.8%; 66.1%; 55.8% and 23.6% of physicians, respectively. Severe dyspnea or tachypnea and confusion were the most often mentioned clinical criteria of severe CAP (78.8% of respondents for each, respectively). Lung tissue destruction was chosen as radiologic criterion of severe CAP in 80.6% of cases. Hyperleukocytosis and leukopenia were pointed as the most frequent laboratory abnormality related to severe CAP(89.7%). Only 10.3% of respondents used CAP prognostic scales. CAP prognostic scales recommended by national guidelines for adult patients (e.g. PORT и CURB/CRB65) were not usually used. Conclusion. Generally, physicians are aware of CAP prognostic criteria and key risk factors of poor prognosis. Additional efforts are needed for more efficient implementation of CAP prognostic scales recommended by national guidelines.

Some patients with idiopathic interstitial pneumonias (IIPs) have extrathoracic signs and symptoms suggestive for coexisting autoimmune disease that, however, do not meet criteria for any connective tissue disease (CTD). Currently, there are no unique terms and criteria for these cases. The European Respiratory Society and the American Thoracic Society created the Task Force Group on Undifferentiated Forms of CTD Associated with Interstitial Lung Disease in order to develop consensus on terminology and diagnostic criteria for patients with IIP and clinical features of an autoimmune disorder. The Task Force created the term «interstitial pneumonia with autoimmune features (IPAF)» and diagnostic criteria based on three groups of signs: clinical signs including specific clinical extrathoracic features; serological features including specific autoantibodies and morphological features including imaging, histology and respiratory physiology. Experts supposed that the term IPAF should facilitate identification patients with IIP and specific autoimmune signs but without a definitive CTD. This term should also provide involvement a uniform cohort of patients in clinical studies.

The aim of this study was to analyze drug therapy of patients with cystic fibrosis (CF) in Russia. Methods. Findings of the Russian National Register of CF patients, 2014, were used in this study. The 2014 Register included data for 2,131 patients (2,092 alive and 39 died) from 74 regions of Russia. The median age was 10.2 (15.2) years, 29.2% of patients were aged 18 years and older. We analyzed administration of bronchodilators, inhaled corticosteroids (ICS), systemic steroids, dornase alfa, hypertonic saline solution, macrolides, systemic and inhaled antibiotics, pancreatic enzymes, ursodeoxycholic acid, and fat-soluble vitamins. Results. Drug administration rates were as follows: bronchodilators, 65.9%; ICS, 21.7%; systemic steroids, 5.5%; macrolides, 32.4%; dornase-alfa, 92.8%; hypertonic saline solution, 45.9%; intravenous antibiotics, 62.3%; oral antibiotics, 73.3%; inhaled antibiotics, 41.3%; pancreatic enzymes, 93.3%; ursodeoxycholic acid, 91.4%; and fat-soluble vitamins, 88.3%. Conclusion. Compared to treatment of CF patients in the Western Europe, there is higher rate of administration of pancreatic enzymes, ursodeoxycholic acid, dornase alfa, hypertonic saline solution and intravenous antibiotics in Russia. Compared to treatment strategy in USA, there is higher rate of administration of pancreatic enzymes and lower rate of administration of bronchodilators, hypertonic saline solution and inhaled antibiotics in Russia.

 

 

The aim of this study was to determine a rate of Clostridium difficileassociated colitis in patients with cystic fibrosis (CF). Methods. Qualitative and quantitative bacteriological examination with identification of C. difficile toxins A and B production was done in 61 intestinal contents samples from CF patients who previously received antibiotics. Results. Various disorders of qualitative and quantitative composition of the intestinal microflora were found in 100% of patients. Testing for C. difficile toxins A and B production was positive in 5 (15.2%) of patients. Conclusion. These patients could have a high risk of pseudomembranous colitis development.

 

 

The aim of the study was to identify current epidemiological patterns of pertussis and to assess the need to improve immunization against this infection. Methods. A comparative retrospective epidemiological analysis of pertussis incidence in Russian population, in several European countries and in certain social and age groups has been performed considering vaccination coverage, immunization strategy, and diagnostic tests. A comparative analysis of gen eral and agerelated morbidity of and mortality from infectious and respiratory diseases in Russian population and in some European countries has also been performed. Data on morbidity, mortality and vaccination were obtained from databases of WHO and the Federal State Statistic Service of Russian Federation. Results. The epidemiological situation evolving pertussis is not good in Russia. The morbidity growth including high morbidity in infants and growing morbidity in children of 7–14 years old reflects active pathogen circulation in population. There is higher mortality from infectious and respiratory diseases in general population and in infants in Russia compared to European countries. Conclusion. The current approach to epidemiological surveillance on pertussis in Russia needs to be improved. Implementation of molecular and other new laboratory methods for pertussis diagnosis could improve identi fication of the infection sources, etiological diagnosis and treatment efficacy. The morbidity of pertussis could be decreased by a wide use of acellular vac cine and additional revaccinations.

 

The aim of this study was to investigate cardiovascular effects of the inhaled betaagonist indacaterol in COPD patients. Methods. In this prospective reallife nonrandomized study, 25 patients with moderate COPD were treated with indacaterol for 3 months. Lung function testing, echocardiography, measurements of arterial stiffness, pulse wave velocity, heart rate variability and compliance were done. Results. Tendencies to the heart size reduction, decrease in the pulmonary artery pressure, improvement in the heart contractility and autonomous functions were seen after 3 months of the therapy. The lung function parameters did not change reliably. These changes were more significant in compliant patients (18 of 25). Conclusions. Therapy of COPD patients with indacaterol 150 mg daily improved the cardiovascular status.

The aim of the study was to investigate a relationship between frequency of exacerbations of chronic obstructive pulmonary disease (COPD) and renal dysfunction in patients with COPD. Methods. We examined 200 patients with COPD diagnosed according to GOLD, 2015. The patients were divided into 4 groups according to a rate of exacerbations of COPD and severity of symptoms. A and B groups had rare exacerbations (≤ 1 per year), C and D groups had frequent exacerbations (≥ 2 per year). Patients in A and D groups experienced less symptoms of COPD and patients in B and C groups had more symptoms. To investigate the renal function, glomerular filtration rate (GFR) was calculated in all patients twice during 6 months using the СKDEPI formula; also, albuminuria (AU) was measured and renal ultrasonography was performed. Results. Pathological kidney disorders were found in 106 patients (53%). Positive correlations were found between the renal resistance index (RI) and FEV1 and between RI and age of the patients. Inverse correlations were found between FEV1 and increased AU and between frequency of exacerbations and AU. Chronic kidney disease (CKD) was diagnosed in 105 patients with COPD (52.5%). A persistent decrease in GFR < 60 ml/min/1.73m2 was revealed in 74 patients with COPD (37.0%). Stage I – II CKD was diagnosed in 31 of 126 COPD patients with normal or slightly decreased GFR (15.5%). Thus, stage I CKD was diagnosed in 13 patients with COPD (6.5%), stage II CKD was diagnosed in 18 patients (9.0%), stage III A CKD was diagnosed in 54 patients (27.0%), stage III B CKD was diagnosed in 16 patients (8.0%), and stage IV CKD was diagnosed in 4 patients (2.0%). Conclusions. CKD was diagnosed in 52.5% of patients with COPD. The prevalence of CKD was significantly higher in C and D groups. Stage III – IV CKD was diagnosed in patients with frequent exacerbations of COPD significantly more often. Clinically significant AU could be related to higher cardiovascular risk. Renal dysfunction in COPD patients could be due to endothelial dysfunction and systemic effects of COPD.

Outcomes and prognosis in cystic fibrosis (CF) are generally related to severity of respiratory system injury. That is why new therapeutic methods are in focus. Mucolytic agents play an important role along with antibacterial therapy and kinesiotherapy. Hypertonic saline solution (HSS) is one of the most important mucolytic agents though it should be referred to as sputum rehydratant. A systematic review of safety and clinical efficacy of inhaled HSS (alone or in combination with hyaluronic acid) has been done in this article. A long-term treatment with inhaled HSS in combination with dornase alfa as a basic therapy of CF in various age groups of patients has been also discussed.

Acute exacerbation is a typical event in the natural course of chronic obstructive pulmonary disease (COPD). Acute exacerbation of COPD (AECOPD) is one of the most frequent causes for seeking the emergency aid by patients. Frequent AECOPD could deteriorate lung function and gaz exchange, cause more rapid progression of the disease and significant worsening of the patient's quality of life for long time (up to several weeks). AECOPD is associated with severe economic burden. Current therapeutic approaches can greatly reduce the risk of AECOPD. Effect of the basic therapy on exacerbation rate are related to such factors as the exacerbation cause (infection, spontaneous deterioration of inflammation, bronchoconstriction, etc.), severity of the disease (usually, therapy can decrease the risk of exacerbation in more severe patients), COPD phenotype, etc. Results  of clinical trials aimed at the reduction of exacerbation rate are also related to many of factors such as patients' population involved in the study, the previous rate of exacerbations, the study length, etc. Currently, no one therapeutic approach can completely eliminate the risk of exacerbations. The efficacy of different therapeutic methods in preventing AECOPD is 15% to 50%. Methods for preventing AECOPD can be divided to pharmacological and non-pharmacological ones. There is a need to search for target pharmacological approaches for preventing AECOPD including currently available drugs.

Progressive airflow limitation is a principal sign of chronic obstructive pulmonary disease (COPD) which leads to pulmonary hyperinflation, progressive exertional breathlessness, reducing physical activity in daily life, deconditioning and significant decrease in quality of life. This phenomenon is noted in early stage of COPD. The earliest disruption of this 'vicious circle' is thought to result in better clinical outcome. Current combined bronchodilator therapy, such as a fixed combination of tiotropium/olodaterol, can significantly improve clinical status, dyspnea, physical limitation, deconditioning and quality of life of the patients due to improvement in bronchial obstruction and pulmonary hyperinflation. Therefore, the most promising approach today and in the nearest future is to start the optimal combined dual bronchodilator therapy at earlier stage of the disease.

Chronic obstructive pulmonary disease (COPD) is currently considered as a systemic disease with multiple extrapulmonary manifestations which can negatively affect the prognosis. Cardiovascular abnormalities are main systemic manifestations of COPD. Cardiovascular diseases and COPD have common pathogenic features that include the systemic inflammatory response, oxidative stress and endothelial dysfunction. Main pathogenic mechanisms of this comorbidity were discussed in this review.

Current guidelines consider timely diagnosis, treatment and prevention of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) as an important goal of the management of patients with COPD. Frequent AECOPD accelerate lung function declining and decrease quality of life. AECOPD are essentially associated with worsening of the mucociliary clearance and are caused unfrequently by respiratory infection. A case report is included in the article. A male with AECOPD was treated with inhalation therapy without systemic antibiotics. Thiamphenicol, glycinate acetylcysteinate (Fluimucil antibiotic IT) was used along with the standard therapy of AECOPD due to its antibacterial, antioxidant and mucolytic activity. Dyspnea, sputum expectoration, physical tolerance of the patient and rhonchi on auscultation improved in 3 days of treatment. The authors have concluded that administration of this drug allowed reduction drug load and decrease a risk of adverse events associated with systemic drug exposure.

The aim of this review was to analyze an experience of treatment of pneumonia in hospitals of Bashkortostan during the Great Patriotic War, 1941 – 1945. Methods. Archive materials of the Bashkir State Medical University and Ufa hospitals, attestors' recollections, original scientific papers and articles published in Soviet academic medical journals of the time and later historical issues about the medicine of Bashkortostan at the wartime have been used in this review. Results. Clinical course and pathogenesis of pneumonia, treatment and rehabilitation of wounded militaries with pneumonia have been described including specific features of pneumonia during the 1943 – 1944 influenza pandemics. Typically, diagnosis of pneumonia was based on clinical signs, chest X-ray, and sputum microscopic examination. A common treatment included intravenous antibiotic therapy with Sulfidine, physiotherapy, physical and psychological rehabilitation, and nutritional support. These medical interventions could reduce mortality from pneumonia from 30% to 4%. Conclusion. Basic principles of diagnosis and treatment of pneumonia developed by Soviet clinicians during the Great Patriotic War have being currently used both in the national Russian medicine and worldwide.