We aimed to assess an impact of different prehabilitation schemes on a risk of postoperative cardiorespiratory complications after coronary artery bypass graft surgery (CABG) in patients with coronary artery disease (CAD) and comorbid chronic obstructive pulmonary disease (COPD). Methods. Two groups of patients with CAD and comorbid COPD who were planned for CABG were recruited in the study using the pairwise testing. A criterion of difference was the treatment with tiotropium/olodaterol (Tio/Olo) as one of prehabilitation components. An occurrence of postoperative cardiorespiratory complications was analyzed according to prehabilitation schemes used. Results. The patients with CAD + COPD treated with Tio/Olo during 12.4 ± 5.4 days prior to CABG surgery demonstrated improvement in clinical and laboratory parameters characterizing the severity of COPD just before surgical coronary revascularization. A risk of postoperative cardiovascular and respiratory complications was higher in patients not receiving bronchodilator therapy before the surgery.

Alfa-1-antitrypsin deficiency (AATD) is the most common hereditary disorder in adults. It is associated with an increased risk of developing pulmonary emphysema and liver disease. The lung injury in AATD is closely associated with smoking, but progressive lung disease could occur even in never-smokers. A number of individuals with AATD remain undiagnosed and therefore do not receive appropriate care and treatment. The most recent international document on AATD was the joint statement of the American Thoracic Society and the European Respiratory Society published in 2003. Thereafter, there has been a continuous development of novel, more accurate and less expensive genetic diagnostic methods. Furthermore, new outcome parameters have been developed and validated for use in clinical trials and a new series of observational and randomized clinical trials have provided more evidence concerning the efficacy and safety of augmentation therapy, the only specific treatment available for the pulmonary disease associated with AATD. As AATD is a rare disease, it is important to createnational and international registries and to collect information prospectively about the natural history of the disease. Management of AATD patients must be supervised by national or regional expert centres and inequalities in access to therapies across Europe should be addressed.

The article provides a review on prevalence, phenotypes, endotypes, and the control of severe bronchial asthma. Severe asthma is a widespread, heterogeneous disease that affects 5 – 20% of patients with bronchial asthma. Prevalence of severe asthma in Russia significantly exceeds the official statistics data, therefore it is necessary to maintain a national register of patients with severe asthma. The conventional therapy for severe asthma is not always effective due to the uncontrolled course of the disease and eosinophilic airway inflammation. The identification of asthma phenotype/endotype is reasonable to develop a personalized approach to treatment. This approach allows achievement better control of the disease and minimization the risk of asthma exacerbations, fixed airway obstruction, and adverse effects of the pharmacological therapy. The main changes in the Global Strategy for Asthma Management and Prevention (GINA, 2018) concerning severe asthma therapy are highlighted in this article. It is also emphasized that the use of monoclonal IL-5 and IgE-antibodies could contribute to successful treatment of patients with uncontrolled severe asthma. Currently, two immunobiological drugs have been registered in Russia, omalizumab (anti-IgE antibody) and reslizumab (anti-IL-5 antibody).

This is a review of experimental and clinical studies investigated effects of obesity on clinical course of chronic obstructive pulmonary disease (COPD); pathophysiological mechanisms of this effect, and relationships between melatonin level and the course of COPD have been also discussed. Associations between severity of COPD, rate of exacerbations and blood levels of most important adipokines, such as leptin and adiponectin, and relationships between melatonin levels and those adipokines were published. Conflicting results were obtained in studies of effects of obesity on clinical course of COPD. The "obesity paradox", that is a reduction in mortality and milder bronchial obstruction in obese COPD patients, has been identified in several studies. Despite contradictory results, obesity is likely to improve prognosis of COPD due to decrease in the systemic inflammation. Levels of leptin and adiponectin increase in acute exacerbation of COPD and then decrease to the baseline. Moreover, melatonin is suggested to play a great role for COPD course, mostly due to antiinflammatory and antioxidant activities. According to results of several studies, melatonin could affect blood levels of adiponectin and lectin; this could indirectly influence on the systemic inflammation in COPD. Further studies are needed to elicit these relationships.

The aim of this study was a comparative analysis of course and treatment of cystic fibrosis (CF) in patients living at Moscow Region or at Republic of Belarus’. Methods. This was a comparative analysis of CF patients living at Moscow region (n = 197) or at Republic of Belarus’ (n = 110). The following clinical data were evaluated: sweat chloride test results if available, sputum microflora, nutritional status, complications of CF, and the current treatment. Results. The patient samples did not differ in gender, age, and lung function and had similar rates of F508del and CFTRdele2,3 mutations and Pseudomonas aeruginosa infection. Similar methods were used in both groups to confirm the diagnosis. The groups differed significantly in prevalence of Staphylococcus aureus, Burkholderia cepacia complex, and non-tuberculosis mycobacteria infections. Adult patients living at Moscow Region have lower forced expiratory volume for 1 sec compared to those living at Republic of Belarus’. CF patients younger 18 years of age who lived at Moscow Region had higher body mass index that those living at Republic of Belarus’. CF patients living at Republic of Belarus’ had hepatic cirrhosis and nasal polyps more often that those living at Moscow Region. Conclusion. CF patients living at Moscow Region and at Republic of Belarus’ had similar health status. Children and adolescents from those regions did not differ in key parameters predicting life expectancy and quality of life in CF. The groups differed in the prevalence of hepatic cirrhosis and nasal polyps. Modern ambulatory management using novel inhaled mucolytic and antibacterial agents, and regular follow-up every 3 months allow maintaining the lung functional status and P. aeruginosa infection rate close to that of the patients managed with regular in-hospital intravenous antibacterial and steroid therapy.

The objective of this study was to investigate reactive oxygen species (ROS) generation and the total antioxidant status (TAOS) in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP). Methods. Fifty-five hospitalized patients with COPD were involved in the study. The patients were divided into two groups: patients with acute exacerbation of COPD (COPD group; n = 28), and patients with COPD and CAP (COPD + CAP group; n = 27). Severity of symptoms, clinical and laboratory findings were analyzed. ROS generation was assessed using the luminol-dependent chemiluminescence (ChL) of the blood. TAOS was evaluated in the blood serum using TAS RANDOS kit (RANDOX laboratory Ltd., GB). Results. Both spontaneous and pyrogenal-induced ChLs in the blood were reduced in all patients that indicated reduced ROS generation. TAOS was also decreased. The intensity of ChL and TAOS were related to lung function and serum level of C-reactive protein. After treatment, the inflammation has not been resolved and abnormal TAOS and ROS were still detected. Conclusion. CAP in patients with COPD and the acute exacerbation of COPD were associated with reduction in ROS generation and TAOS in the blood. Clinical symptoms were more prominent, C-reactive protein level was higher, and TAOS was lower in COPD + CAP patients compared to patients with acute exacerbation of COPD.

The aim of the study was to increase the efficacy of treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) using concomitant noninvasive ventilation (NIV) and inhalational nebulized therapy (INT). Methods. Patients with COPD were treated with concomitant NIV and INT (n = 50) or with NIV followed by INT after weaning the patients from ventilator (n = 49). Duration of the patient’s stay in the intensive care unit (ICU) was used to assess the efficacy of the treatment. The two therapeutic approaches were compared using blood gas analysis (partial pressure of oxygen (PO2) and carbon dioxide (PCO2) in the arterial blood and pulse oximetry. The target blood gas value indicating the efficacy of the therapy was pO2 > 60 mm Hg. Results. In 1 hour of the treatment, this outcome measure was achieved in 86% (n = 43) and in 59% (n = 29) of patients in the groups of concomitant vs consequent NIV + INT treatment, respectively (χ2 = 8.98; p = 0.0027). PO2 differed insignificantly in both groups and was < 45 mm Hg in 31 (62%) and 36 (73%) of patients, respectively (χ2 = 1.49 p = 0.22225), after 1 hour if the treatment. Pulse oximetry did not change in patients with the increase in PO2; this could be due to a low informative value of SaO2 during the intensive care of AECOPD. Conclusion. The concomitant use of NIV + INT in patients with AECOPD allowed 1.5-fold improvement in blood gas parameters during the first hour of the treatment. This could improve the treatment efficacy, avoid the need in invasive ventilation, and shorten the patient’s stay in ICU. Therefore, the blood gas parameters are more preferable for the choice of the type of respiratory support compared to the pulse oximetry in patients with AECOPD.

The study was aimed at evaluating efficacy of inhaled combination of hypertonic saline solution and hyaluronic acid in patients with chronic obstructive pulmonary disease (COPD). Methods. Male patients with COPD (n = 99) were involved in the study. Of them, 50 patients were treated with the standard therapy including bronchodilators and mucolytics and 49 patients were treated with bronchodilators and the inhaled combination of 7% hypertonic saline solution and 0.1% solution of hyaluronic acid via a nebulizer, 5 ml b.i.d. during 5 days. Both groups were additionally divided into B, C, and D categories according to severity of symptoms and a rate of exacerbations. The patients were followed-up for 6 months. Clinical and functional parameters including number of exacerbations of COPD and number of hospitalizations were analyzed. Results. Treatment with the inhaled combination of hypertonic saline solution and hyaluronic acid allowed decrease in number of exacerbations of COPD and number of hospitalizations due to exacerbations. Conclusion. The inhaled combination of hypertonic saline solution and hyaluronic acid allowed better control of COPD and could substitute therapeutic bronchoscopy. The combination is well tolerated, has acceptable safety profile without serious adverse events and is convenient to use.

The aim of this study was to investigate a role of impulse oscillometry (IO) for diagnosis of restrictive abnormalities in patients with idiopathic pulmonary fibrosis (IPF). Methods. Seventy two patients with restrictive ventilatory disorders diagnosed with spirometry and body plethysmography were involved in the study. The patients were divided into two groups: the group 1 (n = 34) comprised IPF patients, the group 2 (n = 38) comprised patients with respiratory diseases without extended pulmonary fibrosis. Data of spirometry, body plethysmography, lung diffusion test, and IO were analyzed. Results. IO was the most informative method for diagnosis of restrictive abnormalities in IPF patients: abnormal values, predominantly deltaXrs5, were found in 68% of the patients. IO was less useful in patients with non-fibrotic respiratory diseases where abnormal basic IO values were found in 39% of the patients. Decreased Xrs5, increased fres, unchanged Rrs5 and Rrs20, and abnormal absolute frequency dependence of Rrs were found in IPF patients with restrictive abnormalities; these changes could be seen in any respiratory disease with TLC ≤ 69%pred. Moreover, abnormal relative frequency dependence of Rrs (D(Rrs5–Rrs20)/Rrs20%) was detected. Conclusion. IO could be used as additional method for detecting restrictive abnormalities in patients with significant fibrotic lesions of the lungs.

The goal of this study was to analyze qualitative and quantitative changes in pulmonary ventilation and gas exchange early after endobronchial valve (EBV) placement intended to induce artificial local collapsed lung in patients with cavitary pulmonary tuberculosis. Methods. The study involved 74 patients with cavitary pulmonary tuberculosis underwent EBV placement to achieve cavity closure. As a result of EBV placement, one to two lung segments were blocked in 25 patients, three lung segments were blocked in 37 patients, and four to five lung segments were blocked in 12 patients. Pulmonary function and blood gases were measured in all patients before and 4 to 6 weeks after placing EVB. Results. Pulmonary ventilation and gas exchange parameters changed early after EBV placement in > 50% of patients. FVC and blood gas parameters changed more often than spirometry parameters. Functional improvement was considered in cases of blood gas improvement and, less frequently, in cases of VC improvement. Functional worsening was considered in cases in lung function decrease and development of mixed (coexisting obstructive and restrictive) abnormalities. Conclusion. In patients with cavitary pulmonary tuberculosis, EBV placement caused functional worsening more likely in patients with normal lung function at baseline. Functional worsening after EBV placement was 3- to 10-fold less likely in those with pulmonary ventilation abnormalities, such as VC decrease or bronchial obstruction, at baseline. Functional improvement after EBV placement was more often seen in moderately decreased lung functional parameters at baseline but not in patients with normal lung function.

An impact of acute exacerbation of COPD (AECOPD) on the course and the prognosis of chronic obstructive pulmonary disease depends on severity of the exacerbation. Moderate and severe exacerbations are considered as clinically significant events. Clinical studies investigating a role of inhalational therapy for the risk of AECOPD differed significantly in important parameters and the patients involved were not fully described in the real clinical practice. Tiotropium alone did not demonstrate any benefit over other inhalational therapies, such as inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) combinations and long-acting muscarinic antagonist (LAMA)/LABA combinations, for risk reduction of moderate to severe exacerbations. A benefit of tiotropium/olodaterol combination over tiotropium for the reduction of risk of clinically significant exacerbations was first shown in DYNAGITO study; patients’ groups in this study did not differ in a rate and a spectrum of adverse events including cardiovascular events. An efficient bronchodilating therapy should be administered to all patients with COPD as it could improve dyspnea and prevent exacerbations. Further escalation of treatment in patients with frequent exacerbations of COPD should be personalized according to clinical course and causes of AECOPD.