The aim of this study was to assess growth factor genes involvement in the pathogenesis of asthma. Methods. Associations between Arg25Pro polymorphic loci of transforming growth factor β growth (TGF β1) gene, A2073T epidermal growth factor receptor (EGFR) gene, C634G vascular endothelial growth factor (VEGFA) gene and a risk of bronchial asthma development were analyzed. DNA samples were isolated from peripheral blood leukocytes of 30 children with asthma and 27 healthy subjects. Gene polymorphisms were determined by the allele-specific polymerase chain reaction. Results. The study revealed an association between Arg25Pro polymorphism of TGF β1 gene, C634G polymorphism of VEGFA gene and increased risk of asthma in children. The majority of patients were homozygous for 2073T allele of EGFR gene or carriers of ArgArg genotype of TGFβ1 gene. Frequencies of C634G polymorphism of VEGFA gene did not differed significantly between healthy children and asthma patients. Conclusion. The results of this study could help to select patients predisposed to asthma and to develop preventive measures taking into account individual characteristics of each patient.

Noninvasive mechanical ventilation (NIV) is widely used in patients with acute respiratory failure (ARF) of different etiology. European Respiratory Society/American Thoracic Society developed evidence-based clinical recommendations on NIV. This document summarises the current knowledge regarding the role of NIV in ARF including exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, hypoxaemic respiratory failure, immunocompromised patients, chest trauma, palliation, post-operative care, weaning and post-extubation.

Adopted from: Rochwerg B., Brochard L., Elliott M.W., Hess D., Hill N.S., Nava S., Navalesi P., Antonelli M., Brozek J., Conti G., Ferrer M., Guntupalli K., Jaber S., Keenan S., Mancebo J., Mehta S., Raoof S. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur. Respir. J. 2017; 50 (2): 1602426. DOI: 10.1183/13993003.02426-2016

The purpose of the study was to analyze results of 2-year follow-up of patients with idiopathic pulmonary fibrosis (IPF). Methods. Medical records of 83 patients admitted to the Pulmonology Department of the Territorial Teaching Hospital in 2013–2017 were analyzed retrospectively. Results. IPF patients were predominantly males (63.86%) over 50 years of age (90.37%). Two-year mortality rate was 26.5%. Died patients had significantly lower SpO2 and lung function (FVC and FEV1) and significantly higher serum C-reactive protein level at first admission compared to survived patients. Honeycomb lungs were seen at HRCT in 72.5% of died patients. In survived patients, SpO2 and 6-minute walk distance significantly decreased after 2 year of the follow-up. Proportion of patients with honeycomb lungs at HRCT increased from 20.8% to 75.0%. The diagnosis was revised in 8.4% of patients after 2 years of the follow-up. Conclusion. Patients with IPF should be referred to a multidisciplinary center as soon as possible in order to confirm the diagnosis, to be included in the register and to be regularly followed.

The purpose of our work was to describe clinical and functional predictors of uncontrolled asthma. Methods. Two hundred and eighty patients with mild to severe asthma have been selected in 2009 – 2011. A comprehensive examination was performed at baseline and 5 years later. The odds ratio and confidence intervals for potential causative factors of uncontrolled asthma were calculated. Results. Inadequate asthma therapy, smoking and upper airway diseases were significant factors in patients with moderate asthma. Age > 60 years, comorbid ischaemic heart disease (IHD) and hypertension, and inadequate asthma therapy were statistically significant predictors of asthma control in patients with severe asthma. In 5 years of follow-up, prevalence of IHD and hypertension has increased. Conclusion. Poor asthma control is unusual in patients with asthma. Potential reasons of uncontrolled asthma course were determined.

The aim of this study was pharmacoeconomic evaluation of treatment with reslizumab compared to omalizumab in severe eosinophilic asthma. Methods. The study was based on indirect comparison between omalizumab and reslizumab in patients with severe asthma using published data. Costs of treatment with omalizumab, reslizumab, combinations of inhaled corticosteroids and long-acting beta-agonists (ICS/LABA), outpatient treatment, treatment of exacerbations and adverse events were also compared. Cost-efficacy analysis and budget impact analysis were used. Results. According to results of cost-efficacy analysis, therapy with reslizumab dominated over therapy with omalizumab in patients with severe asthma in term of rate of exacerbations requiring treatment with systemic steroids. According to results of budget impact analysis, switching of 100 patients from omalizumab to reslizumab could save RUB 51.99 million per a year that corresponds to 36.6% reduction in general direct costs for treatment of severe asthma. Conclusion. The results of this study demonstrated economic advantage of reslizumab over omalizumab in patients with severe eosinophilic asthma.

This study was aimed at clinical and economic assessment of feasibility of inclusion glycopyrronium bromide/indacaterol fixed combination in the State Program for providing necessary drugs to patients. Methods. This retrospective study was based on previously published clinical data. Change of economic burden was assessed using budget impact analysis. Cost-efficacy was assessed using cost minimization analysis and lost opportunities analysis. Results. Switching COPD patients from free combination of long-acting bronchodilators (LABD) to glycopyrronium bromide/indacaterol fixed combination has led to 20.44% decrease in the economic burden. The 3-year cost reduction of COPD therapy has reached RUB 2,416 bln. Conclusion. The results demonstrated higher cost-efficacy of glycopyrronium bromide/indacaterol fixed combination compared to the standard therapy of COPD. Inclusion of glycopyrronium bromide/indacaterol combination into the State Program for providing necessary drugs to COPD patients could be rational and ecomonically feasible.

The aim of the study was to investigate prevalence and types of sleep-disordered breathing (SDB) in patients with acute stroke. Methods. We prospectively enrolled 56 patients with acute stroke and 28 age- and gender-matched controls. The assessment included physical examination, brain computer tomography or magnetic resonance imaging or both, and full polysomnography. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) and outcomes ere assessed by the modified Rankin scale (mRS). Results. SDB was more prevalent in stroke patients than in control subjects (67.9% vs 10.7%, respectively; p = 0.001). Median apnea-hypopnea index (AHI) was higher in stroke patients compared to the control group (p = 0.001). SDB prevalence did not differ significantly between patients with ischemic or hemorrhagic stroke (p = 0.487). Compared to stroke patients without SDB, stroke patient with SDB were older (p = 0.031), more often were male (p = 0.04), more often had chronic heart failure (p = 0.016) and had higher mRS score 1 year after stroke (p = 0.033). No correlation was found between the prevalence of SDB and lesion location. SDB was predominantly obstructive in 65.8% and predominantly central in 34.2% of patients. Patients with central sleep apnea were older (p = 0.005), had lower BMI (p = 0.014) and more often suffered from atrial fibrillation (p = 0.005) and chronic heart failure (p < 0.001). Conclusion. SDB is highly prevalent in patients with acute stroke. Patients with SDB have worse functional outcome one year after stroke.

Amyloidosis is an orphan disease. Amyloidosis is uncommonly associated with respiratory disorders. The present article is a review of recently published data on pulmonary amyloidosis and a case report of alveolar and septal amyloid lung injury. Clinical heterogeneity of lung lesions in systemic and limited AL amyloidosis (precursor proteins are light chains of immunoglobulins, λ dimer and κ monomer), AA amyloidosis (inflammatory acute-phase proteins), and ATTR amyloidosis (senile and inherited amyloidosis; precursor protein is transthyretin) have been discussed. One chart of the review has been devoted to the pathogenesis of diffuse parenchymatous (unilateral and bilateral) amyloidosis, nodular and tracheobronchial amyloidosis (with amyloid deposits in proximal, medium and distal airways, intrathoracic lymph node involvement (amyloid lymphadenopathy), amyloidosis of the pleura and the diaphragm, and differential diagnosis of these types of pulmonary amyloidosis.

Mild asthma is characterized by infrequent and slight clinical manifestations and, therefore, is paid lack of attention both from patients and physicians. Physicians tend to underestimate risk of severe exacerbations including asthmatic status in patients with mild asthma. Patients with mild asthma are often poorly adherent to treatment. Also, certain difficulties are related to timely and correct diagnosis and the choice of the optimal treatment by primary care physicians who are first physicians encountering such patients. The paradoxus of asthma and use of short-acting β2-agonists (SABA) to treat chronic airway inflammation lead to excessive dependence on rescue inhalers and insufficient adherence to maintenance anti-inflammatory therapy. This could trigger acute exacerbations and even fatal outcomes in patients with mild asthma. Therefore, SABA monotherapy has to be limited. Easy-to-use questionnaires, algorithms and treatment protocols accessible for primary care physicians could improve detection of mild asthma. Favorable results of clinical trials on as-needed use of budesonide/formoterol Turbuhaler® could change the management paradigm for mild asthma regarding risk of exacerbations, control of asthma symptoms, airway inflammation, and cost-efficacy.

The aim of this review was to summarize recently published data on dual bronchodilation in patients with chronic obstructive pulmonary disease (COPD). Four fixed combinations of long-acting β2-agonists (LABA) and long-acting muscarinic receptor agonists (LAMA), vilanterol/umeclidinium, olodaterol/tiotropium, glycopyrronium/indacaterol, and formoterol/aclidinium, have been approved by regulatory organs of Russia, Europe, and USA. Indirect comparisons of effects of these combinations on forced expiratory parameters showed equal bronchodilation. Inhalational devices for each combination are different. Respimat soft-mist inhaler was characterized by high and effective drug deposition in the lungs, Ellipta dry powder inhaler was easy-to-use and was characterized by a low rate of crucial mistakes with the inhaler technique. We found three published direct comparative studies of LABA/LAMAs. An open-label direct non-inferiority study of vilanterol/umeclidinium vs olodaterol/tiotropium showed advantages of vilanterol/umeclidinium Ellipta inhaler. Two similar direct comparative trials of glycopyrronium/indacaterol 27.5/15.6 µg b.i.d. vs vilanterol/umeclidinium 25/62.5 µg q.d. did not reach the primary endpoint of non-inferiority; secondary endpoints were descriptive. Between-group differences were small and statistically insignificant. Conclusion. The results of meta-analyses and direct comparative trials are not sufficient to choose the best dual bronchodilator as the drug efficacy is determined by multiple factors. A direct open-label comparative trial that demonstrated superiority of vilanterol/umeclidinium Ellipta inhaler over olodaterol/tiotropium Respimat inhaler became the first step on this way.

This review presents information on severe acute exacerbation of COPD (AECOPD) as an independent negative prognostic factor. Mortality risk increases with the frequency of severe exacerbations, particularly if these require admission to a hospital.  Large epidemiological studies in the field of COPD provided sufficient data on potential indicators of increased mortality in COPD. Key predictors of poor prognosis in COPD are the patient’s age, lower forced expiratory volume in 1 second (FEV1), lung hyperinflation, respiratory failure (low PaO2, high PaCO2), pulmonary hypertension, low body mass index, decreased physical tolerance, frequent exacerbations, and comorbidity. Thus, the management of patients with acute exacerbation of COPD still remains as an actual clinical problem.

Pulmonary rehabilitation (PR) is an important part of management of patients with chronic respiratory diseases. Physical exercise is a key issue of rehabilitation programs in patients with chronic respiratory diseases. The aim of this review was to describe potential ways to organize effective physical rehabilitation programs for patients with chronic respiratory diseases in a medical institution with limited resources. The choice of rehabilitation mode is related to the needs and the goals of the patient and available equipment. Medical facilities are often limited in their resources and failed to use all modern rehabilitation techniques. Nevertheless, the most physiological and inexpensive rehabilitation techniques, such as (breathing techniques, dosed walking, strength training, could improve functional status and daily activity of patients with chronic respiratory diseases and encourage them to wellness management.

Clinical signs and course of pulmonary disease of Fedor M. Dostoevskiy (1821 – 1881) has been analyzed in the article on the basis of memoirs of contemporaries and physicians who followed the writer up to the end of his life. Diagnostic hypotheses of the disease and the cause of death have been discussed.