The objective of this study was to investigate a role of fatty acid content in leukocyte membranes, oxylipin level and membrane potential of leukocyte membranes in the pathogenesis of immune cell membrane abnormalities in patients with comorbidity of asthma and chronic obstructive pulmonary disease (COPD).

Methods. The study involved 39 patients with COPD, 41 patients with asthma, and 18 patients with comorbidity of COPD and asthma, and 28 healthy volunteers as controls. Fatty acid content of leukocyte membranes was investigated using gas-liquid chromatography. Thromboxane B2 and leukotriene B4 levels were measured using enzyme immunoassay. Mitochondrial membrane potential in leukocytes was measured ex tempore by cytofluorimetry. Statistically significant difference between mean values was determined by Student's t-test.

Results. The comorbidity of COPD and asthma was characterized by accumulation of saturated fatty acids (12 : 0; 16 : 0; 18 : 0; 20 : 0) in leukocyte membrane and reduction in n-6 and n-3 polyunsaturated fatty acids (PUFAs) (18 : 2n-6; 20 : 3n-6; 20 : 4n-6; 20 : 5n-3; 22 : 4n-6; 22 : 6n-3). Changes in leukocyte lipidome contribute to development of structural and functional abnormalities of the cells and to the synthesis of oxylipins. This is confirmed by increased number of cells with reduced mitochondrial membrane potential and increased level of proinflammatory mediators, such as thromboxane B2 and leukotriene B4.

Adopted from: Woolhouse I., Bishop L., Darlison L., De Fonseka D., Edey A., Edwards J., Faivre-Finn C., Fennell D.A., Holmes S., Kerr K.M., Nakas A., Peel T., Rahman N.M., Slade M., Steele J., Tsim S., Maskell N.A. British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma. Thorax. 2018; 73 (Suppl. 1): i1–i30. DOI: 10.1136/thoraxjnl-2017-211321

The aim of the present study was to investigate the significance of complete blood count, lymphocyte subpopulations, and cytokines in the peripheral blood in order to evaluate steroid resistance in patients with chronic obstructive pulmonary disease (COPD).

Methods. Forty five patients with acute exacerbation of COPD (AECOPD) who underwent bronchoscopy the next day after hospital admission were included in the study. The patients were considered as steroid-sensitive or steroid-resistant according to the ability of dexamethasone to inhibit 50% of interleukin-8 production by alveolar macrophages. Complete blood count, lymphocyte subpopulations, cytokines, immunoglobulin E, and hormone level were measured in the peripheral blood of all patients with COPD.

Results. Macrophage migration inhibitory factor (MIF) level, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were higher, and absolute and relative eosinophil numbers were lower in steroid-resistant patients with COPD compared to steroid-sensitive COPD patients. Absolute eosinophil number below the cut-off value of 0.126 × 109/L was predictive for steroid resistance with the sensitivity of 83.3%, the specificity of 55.6% and the area under ROC curve (AUC) of 0.677. Relative eosinophil number below 1.2% predicted steroid resistance with sensitivity, specificity and AUC of 83.3%, 63.0%, and 0.751, respectively. NLR, PLR, and MIF higher than 2.75, 116, and 2.24 ng/mL, respectively, predicted steroid resistance with the sensitivities of 66.7%, 61.1%, and 72.2%, respectively; the specificities of 74.1%, 77.8%, and 70.4%, respectively; and the AUCs of 0.731, 0.678, and 0.740, respectively. The combination of relative eosinophil number, NLR and PLR increased the sensitivity to 83.3%, specificity to 77.8%, and AUC to 0.805. The combination of relative eosinophil number, PLR and MIF increased the sensitivity to 83.3%, specificity to 88.9%, and AUC to 0.889.

Conclusion. Steroid-resistant and steroid-sensitive COPD patients differ in absolute and relative eosinophil numbers, LNR, PLR, and MIF level. These parameters could be used to predict steroid resistance in COPD.

The aim of the study was to evaluate anti-inflammatory effects of extrafine aerosol of beclomethasone dipropionate/formoterol (Foster) in a model of COPD.

Methods. A model of COPD was developed in rats using 60-day intermittent exposure to nitrogen dioxide. Then, within 30 days, a test group was treated with inhaled Foster, and a control group was treated with placebo. Cytokines and enzymes, secretory immunoglobulin A (sIgA), and surfactant proteins B and D (SP-B and SP-D) were measured in bronchoalveolar lavage fluid (BALF) using ELISA method. Histological examination of lung tissue samples was also performed.

Results. Neutrophil and lymphocyte numbers, and concentrations of proinflammatory mediators increased significantly in BALF of the control group. Bronchial epithelium damage was associated with deterioration in production of SP-B, SP-D, and sIgA by bronchial epithelial cells. Treatment with Foster was related to a clear decrease in neutrophilic and lymphocytic inflammation and normalization of BALF pro-inflammatory cytokine and enzyme levels. The injured bronchial and alveolar epithelium repaired; this was associated with improvement in the production of sIgA, SP-B and SP-D by epithelial cell.

Conclusion. The treatment with extra-fine aerosol of Foster was associated with significant decrease in inflammation and activation of lung repair in COPD rat model. This could result in improvement in immune defense and production of sIgA, SP-B and SP-D by bronchial and alveolar epithelial cells.

The aims of the study were to examine age-related features of immune response to measles virus in staff of a large city hospital and to define groups at risk for measles outbreaks.

Methods. The study involved 1,855 staff members of a large city hospital aged ≥ 19 years old who had documented vaccination against measles or a history of measles. The participants were divided into age groups with 5-year intervals starting from 19 years of age; there were 11 groups in total. The immune response to measles virus was measured in sera by ELISA using Vector-Best IgG-Kor test system (Russia).

Results. Young employers of 19 to 23 years of age were most susceptible to measles; protective antibody level was not detected in 38.5% of them. They were followed by young-to-middle-aged workers (24 to 48 years old) who were negative for anti-measles antibodies or had non-protective level of antibodies in 16.7% to 27.5%. The anti-measles antibody level was low (42.3 % to 60.0 %) in employers of 19 to 43 years of age and gradually increased to 46.3% – 92.2% in the group of 44 to 68 years old.

Conclusion. Herd immunity against measles in employers of a large city hospital did not meet requirements for successful infection control which implicates ≤ 7% of seronegative individuals. This means that measles outbreak could occur at any time because the proportion of seronegative individuals (11.5%) twice exceeded the cut-off value; the antibody level was controversial in 3.2% of individuals. Therefore, monitoring anti-measles antibody level in hospital staff is necessary to detect groups at risk who should be vaccinated against measles.

The aim of this study was to investigate long-term change in health-related quality of life (HRQL) in patients with asthma in real clinical practice and in relation to emotional disorders, cooperativeness (cooperation between the patient and the physician, and adherence to treatment), and cold air-provoked bronchial hyperresponsiveness (BHR).

Methods. This observational study involved 32 patients with mild to moderate asthma. The study duration was 7.5 to 10 years. HRQL was assessed using SF-36 questionnaire and Asthma Quality of Life Questionnaire (AQLQ); emotional disorders were diagnosed using Hospital Anxiety and Depression Scale (HADS). Patients’ cooperativeness assessment was based on number of a patient’s scheduled visits to a physician during the study. The asthma control level was evaluated using the Asthma Control Test (ACT).

Results. A significant worsening was found in the social activity domain of HRQL in the total group of the patients. According to AQLQ, a significant improvement was seen in the activity and symptoms domains and in the total score of quality of life (QoL). Long-term pharmacological treatment of asthma decreased anxiety and depression levels. The asthma control (ACT score) increased from 13.2 ± 1.0 to 19.7 ± 1.1 (р = 0.00003). Anxiety and depression decreased in patients with high cooperativeness during the long-term follow-up, while the total QoL and the specific QoL were unchanged excluding the social activity domain. A significant worsening in the activity scale and in the emotional scale of specific QoL together with growing depression and decreasing control of asthma were found in patients with lower cooperativeness. The cold air-provoked BNR slowed down the long-term improvement in the social activity domain. The cold air-provoked BNR also decreased patient-reported evaluation of daily activity.

Conclusion. The long-term basic therapy of asthma provides a positive trend in HRQL in the real clinical practice independently on worsening of the disease. Lower cooperativeness of a patient could decrease specific QoL, which, in turn, worsens the control of asthma and contributes to negative emotional background and destructive behavior.

Chest computed tomography (CT) helps better understanding clinical and pathological features of respiratory diseases. However, interpretation of CT images is difficult without information on clinical course of the disease in the given patient. Therefore, the definite diagnosis could be reached through cooperation of a clinician and a radiologist. This publication presents a lecture aimed at improving a physician's knowledge on interpretation of lung computed tomography (CT) patterns including imaging, structure and extension of abnormal signs. This information is believed to help the clinician to diagnose and differentiate pulmonary diseases based both on CT syndromes and clinical signs. A particular attention is paid on lung tissue attenuation pattern as the most common chest CT abnormality that includes five key entities, such as ground glass opacity, mosaic attenuation, consolidation, atelectasis, and soft-tissue mass.

Comorbidity in asthma encompasses different respiratory system disorders including dysfunctional breathing and vocal cord dysfunction. Such comorbidity is referred to as "asthma-plus" syndrome. This condition is not fully investigated resulting in its late diagnosis and inadequate treatment. This article is a review of clinical signs, differential diagnosis, and key issues of management of "asthma-plus" syndrome.

Until recently, compensatory erythrocytosis related to impaired renal blood circulation, treatment with some pharmacological agent, smoking, etc., was considered as one of the obligatory signs of advanced chronic obstructive pulmonary disease (COPD). Currently, normochromic normocytic anemia in COPD patients was diagnosed according to results of several studies. Prevalence data on anemia in COPD differ significantly from 7.5% to 33%. It is unclear, if anemia is a systemic feature of COPD or comorbidity. This article is a review about relationship between COPD and anemia. Most authors consider anemia in COPD as a condition associated with chronic disease, but mechanisms of its development are not fully investigated. There are few studies of effective treatment of anemia in COPD and their results are controversial. New experimental and clinical studies on mechanisms of anemia in COPD are required to improve management of such patients, their quality of life and outcomes.

A review of protocols and staging of cardiopulmonary exercise testing (CPET) used in clinical practice is done in the article. CPET is proposed to assess the functional status and to diagnose early reserve abnormalities in patients with sarcoidosis as far as functional tests at rest are mostly insufficient in sarcoidosis. Physiological processes at anaerobic threshold at peak exercise are described in the article. The authors reviewed current approach to terminology and determination of anaerobic threshold, methods for calculation of cut-off points and their clinical role. Diagnostic values of CPET parameters, such as maximal and peak oxygen uptake and oxygen consumption ratio, parameters of gas exchange and ventilation, such as ventilatory equivalent, breathing reserve, alveolar-arterial gradient in oxygen, and ventilation-perfusion ratio, in patients with sarcoidosis were also discussed.

This article is a review highlighting the current role of preventive immunization in patients with cystic fibrosis (CF). Clinical, pathogenic, and epidemiological aspects supporting the preventive immunization were described in the article. Different approaches and results of different vaccination schedules according to the respiratory pathogens were also analyzed. Based on this analysis, the authors developed the optimal schedule of preventive vaccination. Published results confirm the efficacy of vaccination against respiratory infections in CF patients not only as a preventive measure but as an important part of combined therapy of this disease. This is an attractive approach to improve the efficacy of the treatment and survival of CF patients.

Chronic rhinosinusitis with nasal polyps (CRS NP) is the most prevalent ear, nose, and throat (ENT) disorder in cystic fibrosis (CF) patients. CRS NP can occur in CF children at the age of ≥ 8 months and becomes the chronic disease. Tenacious secret and bacterial infection cause obstruction, edema and hypoxia of paranasal sinuses and contribute to significant morbidity in CF patients. The active monitoring and treatment of CRS NP aimed at improvement of the aeration of paranasal sinuses, mucociliary clearance, and the control of chronic upper airway infection are necessary. Functional Endoscopic Sinus Surgery (FESS) may be the method of choice if surgical treatment is considered. FESS facilitates paranasal sinuses drainage. Due to recurrent course of CRS NP in most CF patients, lifelong follow-up by an ENT specialist and postoperative management using topical steroids and/or antibiotics are required.

A clinical case of 23-year old female with pulmonary tuberculosis is described in this article. The patient was admitted to a hospital with preliminary diagnosis of community-acquired pneumonia and negative TB test. Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia is often difficult and could be more difficult in patients with co-existing specific (Mycobacterium tuberculosis) and non-specific infection in the lungs.

Forty-year history of Department of Pulmonology and Clinical Allergology, Tashkent Institute of Postgraduate Physician Training, Healthcare Ministry of the Uzbekistan Republic, and a history of development of pulmonology service at the Uzbekistan Republic are described in this article. The Department of Pulmonology and Clinical Allergology was established by Academician Abdulla M. Ubaydullaev in 1978. Long-term research has determined a high morbidity of respiratory diseases not in cotton growers, but also in other agriculture workers. The results of the research underlied a system of preventive measures and treatment of respiratory diseases in this population.