The aim was to investigate an impact of different COPD phenotypes on clinical course of anemic syndrome.

Methods. This was a single-center prospective observational cohort study. Patients with stable COPD and anemia were involved (n = 215). COPD was diagnosed according to GOLD criteria and anemia was diagnosed according to WHO criteria. The control group included 90 healthy subjects. COPD patients with anemia were stratified according to pathogenic variants of anemia and serum erythropoietin level. COPD symptoms, exacerbations, lung function, pulmonary hemodynamics, the type of airway inflammation, hematology parameters, serum erythropoietin, hepcidin 25, vitamin B12, folate, and iron homeostasis were assessed. Statistical analysis was performed using SPSS 24 software. The groups were compared using chi square test for nominal variables and Kruskal-Wallis test for continuous variables. Logistic regression was used to explore the relationships between variables. Results. Anemia was diagnosed in 63 (29.3%) of patients including common pathogenetic variants of anemia in 12 (19.0 %) of patients: iron deficiency 9 (14.3%) and vitamin B12 deficiency 3 (4.8%). This anemia variants were associated with shorter duration of respiratory symptoms and was not related to COPD phenotype. The clinical course of anemia was modified due to comorbid COPD in 51 (81.0%) of patients. Anemia with normal / high erythropoietin level was found in 31 (49.2%) of COPD patients and was hypochromic, microcytic and hyperregeneratory. Those patients had low serum levels of iron, vitamin B12, and folate, low total and latent iron-binding capacity of serum, and high levels of ferritin and hepcidine. This type of anemia was associated with frequent COPD exacerbations. Anemia with low erythropoietin level 20 (31.7%) was normochromic, normocytic, and normoregeneratory, with normal serum iron and ferritin levels, low iron-binding capacity of serum, and low hepcidine level. This type of anemia was associated with combined pulmonary fibrosis and emphysema and with pulmonary hypertension. Conclusion. Anemic syndrome in COPD patients is associated with COPD phenotype.

Adult patients with bronchiectasis typically have poor quality of life and mostly frequent exacerbations. This is the first international guideline on this topic. This guideline is based on systematic search of published literature including clinical trials, systematic reviews, and observational studies. A multidisciplinary group of specialists including respiratory physicians, microbiologists, physiotherapeutists, thoracic surgeons, primary care physicians, methodologists and patients developed the guidelines on nine most important clinical questions relevant to bronchiectasis. The GRADE system was used to define the quality of the evidence and the level of recommendations. The guideline covers causes of bronchiectasis, management of exacerbations, pathogen eradication, long term antibiotic treatment, anti-inflammatory treatment, mucoactive drugs, bronchodilators, surgical treatment and physiotherapy.

The aim of this study was to investigate anti-inflammatory and regenerative effects of inhibited activation of hypoxic signaling in COPD model using cyclooxygenase-2 (COX-2)-dependent pro-inflammatory cascade inhibition. Methods. COPD was modelled in rats by nitrogen dioxide (NO2, 30-40 mg×m^–3) exposure for 90 days. Celecoxib was used as COX-2 inhibitor. The study group rats were given celecoxib (25 mg×kg^–1) through an esophageal probe after 30 days of exposure. Control rats were given saline solution. The group 3 rats were intact. The rats were put out of the experience using cervical dislocation after 60 and 90 days of NO2 exposure. Bronchoalveolar lavage fluid (BALF) cytology was analyzed. COX-2, hypoxia-inducible factor-1α (HIF-1α), interleukin-17 (IL-17), and surfactant protein D (SP-D) were measured in BALF using ELISA method. Histological examination of the lung tissue was also performed. Results. 90-day exposure of NO2 resulted in 7.7-fold increase in BALF neutrophil count compared to that in intact rats. Pro-inflammatory mediators (СOX-2, HIF-1α, and IL-17) significantly increased and SP-D level decreased in BALF. Administration of celecoxib was accompanied by normalization of BALF cytology profile and decrease in COX-2, HIF-1α, and IL-17 levels in BALF; this could indicate a reduction in the hypoxic signaling activity and in inflammation. The growth of SP-D concentration could be considered as a result of the alveolar epithelium restoration. This was confirmed by histological examination of the lung tissue. Conclusion. COX-2 inhibition suppressed HIF-1α-signaling and decreased the lung inflammation. The results confirm a functional and regulatory relationship between HIF-1α and COX-2 signaling cascades that could be a therapeutic target for preventing the progression of inflammation and airway remodeling in COPD.

The aim of the study was to investigate an efficacy of short-term treatment with acetazolamide (ACET) in patients with acute exacerbation of COPD (AECOPD) and noninvasive ventilation (NIV). Methods. This was a prospective case-control study. The study involved 20 patients. Inclusion criteria were as follows: AECOPD; pH > 7.33; PaCO2 > 48 mmHg; HCO₃– > 26 mmol/L; and treatment with NIV. Clinical characteristics, Charlson comorbidity index, APACHE II score, arterial blood gases, and serum electrolytes were recorded before inclusion. Patients were defined as cases when they had received ACET (500 mg per day) for 3 days; they were compared to a matched control group who did not receive ACET. Clinical parameters, arterial blood gases, serum electrolytes, potential adverse effects, and length of hospital stay were monitored daily. Results. No significant differences in baseline characteristics, comorbidities, or concomitant drugs used were found between the groups. Mean duration of hospital stay was significantly shorter in the ACET group (16.2 ± 8.4 days vs 19.1 ± 2.8 days; p = 0.023). An iIntra-group analysis showed a significant improvement in clinical and arterial blood gas parameters in both groups already in the first day of the treatment. In the ACET group, systolic blood pressure (SBP), respiratory rate (RR), and SpO2 significantly improved at day 4 (112.5 ± 4.9 mmHg vs 125 ± 7.1 mmHg (p = 0.001); 15.2 ± 1.1 min^–1 vs 17.1 ± 0.9 min^–1 (p = 0.001) and 94.7 ± 1.1% vs 92.3 ± 0.8% (p = 0.0001), respectively). There was a significant decrease in PaCO2, pH and HCO₃– at day 3 (48 ± 3.8 mmHg vs 52.4 ± 5.3 mmHg (p = 0.0288); 7.374 ± 0.4 vs 7.502 ± 0.17 (p = 0.0015) and 26.4 ± 2.8 mmol/L vs 36.9 ± 4.1 mmol/L (p = 0.00001), respectively) and day 4 (44 ± 2.4 mmHg vs 48.4 ± 4.6 mmHg (p = 0.0115); 7.387 ± 0.02 vs 7.480 ± 0.02 (p = 0.00001) and 24.2 ± 2.1 mmol/L vs 35.6 ± 3.0 mmol/L (p = 0.00001), respectively) in the ACET group. No adverse events were recorded in both groups. Conclusions. ACET adjuvant to NIV appears to be effective and could prevent post-NIV alkalosis occurrence and could reduce the length of hospital stay in patients with AECOPD and mixed metabolic disorders (respiratory acidosis and metabolic alkalosis).

This study was aimed at analysis of 5-year clinical efficacy and pharmacoeconomic effectiveness of conjugate pneumococcal vaccine in patients with chronic obstructive pulmonary disease (COPD). Methods. Male patients with COPD (n = 394) were involved in the study. Primary endpoints were changes in MMRC score, FEV1, number of exacerbations and hospitalizations, and a rate of pneumonia. The BODE index was calculated. Drug therapy of all patients was analyzed. 13-valent conjugate pneumococcal vaccine PCV13 and 23-valent polysaccharide vaccine PPV23 were used for vaccination. Results. Vaccination with PCV13 resulted in improvement in dyspnea and lung function both for short-term and 5-year follow-up. Therefore, PCV13 could be considered as a part of the basic therapy along with bronchodilators. Vaccination with PCV-13 could reduce risk of unfavorable events in the course of COPD and improve the patients’ survival. Conclusion. Vaccination with PCV13 in patients with COPD could reduce number of exacerbations, incidence of pneumonia, and the need in healthcare resources due to maintaining the effect during 4 years. Budget savings could reach 409.9 million rubles per a year.

The aim of this study was to assess long-term effects of pneumococcal vaccination with 23-valent polysaccharide vaccine (PPV23) and 13-valent conjugate vaccine (PCV13) in patients with bronchial asthma. Methods. One hundred and three patients with mild to severe asthma were involved. They were randomly assigned to vaccination with PCV13, or PPV23, or PPV23 followed by PCV13, or vice versa. Clinical efficacy of vaccination was evaluated using number of asthma exacerbation a year before and 1 and 4 years after the vaccination; need in antibiotics a year before and 1 and 4 years after the vaccination; and number of hospitalizations due to asthma exacerbation a year before and 1 and 4 years after the vaccination. Results. In a year after vaccination, number of patients who had not experienced asthma exacerbation increased significantly in PPV23, PPV23/PCV13, and PCV13/PPV23 groups (р < 0.01 to p < 0.001). In 4 years after vaccination, number of patients without exacerbations increased significantly in PCV13/PPV23 group only (48.1%; р < 0.01). Number of patients who did not require hospitalization due to asthma exacerbation increased significantly in PCV13 group only (81.8%; р < 0.05). Conclusion. The authors proposed a hypothesis of impact of pneumococcal vaccines on immunopathogenesis of bronchial asthma. The authors consider vaccination against pneumococcus using PCV13 followed by PPV23 should be a part of the basic therapy of asthma.

The aim of this study was to investigate the most significant poor prognostic factors of respiratory complications in patients with ischaemic heart disease (IHD) underwent coronary bypass surgery with artificial circulation. Methods. Patients with IHD (n = 662) were included in the study and were randomized in three groups according to presence of respiratory comorbidity: 48 (7.2%) patients with non-obstructive respiratory disorders, 248 (37.5%) patients with obstructive lung diseases, and 366 (55.3%) patients without respiratory comorbidity and without ventilation abnormalities. Given the baseline lung function, respiratory complications were analyzed with subsequent mathematic modelling to predict these complications. Results. Early post-surgery respiratory complications were diagnosed in 73 (11%) cases and were more likely in patients with baseline bronchial obstruction. In the latter group, respiratory complications were diagnosed in 20.9% of patients and were 2.5-fold more frequent compared to patients without ventilation abnormalities and 4.5-fold more frequent compared to IHD patients without respiratory comorbidity. The risk of respiratory complications was related to gender, age, functional class of IHD and chronic heart failure before the surgery, and stable atrial fibrillation. The risk of respiratory complications was higher in patients with lower FVC, FEV1, FEV1/FVC, ratio and higher total lung capacity and residual volume. Functional residual capacity and transfer-coefficient adjusted for hemoglobin were not related to the risk of respiratory complications. Patients with comorbidity of IHD and chronic obstructive pulmonary disease (COPD) had significantly higher risk of post-surgery respiratory complications. Conclusion. The prognosis of respiratory complications after coronary bypass surgery was worse in patients with stable IDH and obstructive ventilation abnormalities. Several demographic, clinical and functional respiratory parameters had high positive or negative prognostic values.

The objective of this study was to investigate radiological features of pulmonary tuberculosis in HIV-infected patients with different severity of immunosuppression and deviant behavior. Methods. This was a single-center total observational retrospective study. The study involved 257 patients with pulmonary tuberculosis and NIV-infection who was treated and followed at a penitentiary tuberculosis hospital. Results. Tuberculosis-associated lung lesions were diagnosed in 94.2% of patients. Extrapulmonary and generalized tuberculosis increased with worsening immunity. Majority of patients were 20 – 29 and 30 – 39 years old. Typical radiological features included lung root lesions due to hilar lymph node enlargement in patients with CD4 lymphocytes < 100 cells/µL. CD4 lymphocytes decrease < 100 cells/µL was more likely in patients with involvement of ≥ 3 lung lobes and less likely in patients with involvement of 1 or 2 lung segments. CD4 lymphocytes decrease < 100 cells/µL was associated with prominent lung tissue infiltration (39.0%); moderate infiltration of the lung tissue did not depend on immunosuppression. Cavitation ≤ 2 cm was frequent (76.9 – 96.0%), mostly in the right lung (36.4 – 53.8%) and did not depend on immunosuppression. Conclusion. The most prevalent pulmonary tuberculosis in HIV-infected patients was infiltrative tuberculosis independently on CD4 lymphocyte number.

Published data on a role of magnetic resonance imaging (MRI) in diagnosis of lung disease are reviewed in the article. Methodology, signs of inflammatory and malignant diseases, and differential diagnosis are also described. The authors compared a role of MRI and computed tomography (CN) for diagnosis of lung diseases. In conclusion, MRI is a useful method for diagnosis and differential diagnosis which could complement CT findings.

Long-acting bronchodilators (long-acting β2-agonists (LABA), long-acting anticholinergics (LAMA) and their combinations) are the basic drugs for treatment of stable chronic obstructive pulmonary disease (COPD). Indacaterol/glycopyrronium (IND/GLY) is the first fixed LABA/LAMA combination acquired significant evidence of its efficacy for improvement lung function, symptoms, and quality of life, and decrease in the rate of acute exacerbations of COPD. The aim of this review was to reassess clinical efficacy of IND/GLY in treatment of COPD with regard to recent data and to outline the further role of this combination in therapy of COPD.

General criteria for choosing basic pharmacotherapy (inhaled β-agonists, M-cholinolytics, inhaled steroids (ICS), and theophylline) for long-term treatment of patients with chronic obstructive pulmonary diseases (COPD) are given in the article. The authors described a role of ICS in the current management of COPD patients. Possibility of ICS withdrawal in COPD patients without increase in the risk of exacerbations and a clinical approach to revision of the therapy were discussed. The authors analyzed currently available evidence of efficacy of dual bronchodilation as the key point of modern therapeutic strategy for COPD. A choice of single or dual bronchodilation should be guided by certain criteria. Russian and international clinical algorithms of pharmacotherapy for COPD were also reviewed.

Mucormycosis (zygomicosis) is an invasive mycosis caused by fungi of the class Zygomycetes (order Mucorales). This infection could affect the lungs and has predilection for invading blood vessels resulting in generalized spreading. The disease is often difficult to diagnose. Culturing the respiratory tract samples is negative in up to 60% of patients, no reliable serologic test is available to confirm the diagnosis. Radiographic signs are similar to those of invasive aspergillosis. Therefore, the definitive diagnosis is commonly based on identification of hyphae in lung biopsy. A case of invasive mycosis caused by Zygomycetes is described in the article. This infection was diagnosed in a hospitalized patient with hepatic cirrhosis, acute pancreatic necrosis, secondary diabetes mellitus, hyperglycemia, and hepatocellular insufficiency. The clinical course of the disease was rapidly progressive. According to CT of the lungs, cavitation of pulmonary infiltrate developed in 11th day after the presentation. The diagnosis of pulmonary fungal infection was confirmed by bronchial biopsy and immunohistochemistry.

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.