The objective of this study was to analyze an impact of melatonin on clinical course, cytokine profile and surfactant protein D level in patients with COPD. Methods. The study involved 88 patients (62 men and 26 women) with stable moderate-to-severe COPD (GOLD stages II – IV), the "frequent exacerbator" phenotype (group D), aged 40 to 80 years (mean age, 68.61 ± 0.72 years). The patients were divided into three groups according to COPD stage: 31 patients (22 men and 9 women; mean age, 67.42 ± 1.38 years) with COPD GOLD stage II); 29 patients (19 men and 10 women; mean age, 68.83 ± 1.21 years) with COPD GOLD stage III); and 28 patients (21 men and 7 women; mean age, 69.71 ± 1.09 years) with COPD GOLD stage IV. Clinical and laboratory parameters were assessed at baseline and in 1 year of the follow-up. Results. Severe COPD course with frequent exacerbations, prominent clinical signs and significant impact on quality of life was directly and statistically significantly related to lower melatonin level. This was also associated with different sleep disorders, high-grade chronic systemic inflammation, and lower surfactant protein D (SP-D) level. Conclusion. Lower melatonin level in COPD patients could cause sleep disorders, decrease the antioxidant defense and SP-D level, increase the pro-inflammatory activity and decrease the anti-inflammatory activity.

The Federal Guidelines on preventive vaccination against pneumococcal infections in adults were developed by experts of Russian Respiratory Society and National Non-profit Association of Specialists for Control Healthcare-Associated Infections. Studies published during the previous 5 years were selected from EMBASE, MEDLINE, and PubMed databases andthe Cochrane library and were reviewed by independent experts with consideration of practical physicians’ opinions. The results of this analysis underlay the guidelines. Quality of evidence and strength of recommendations were assessed according to widespread criteria. The guidelines include epidemiology, social burden, pathogenesis, and clinical course of pneumococcal infections, characteristic of vaccines used to prevent pneumococcal infections and special considerations of preventive vaccination in patients with comorbidity and in risk groups. The experts discussed efficacy of preventive vaccination and postvaccinal reactions. The guidelines meet the requirements of Healthcare Ministry of Russian Federation.

Bronchiectasis is a chronic airway disease. Currently, no evidence-based recommendations on pharmacological treatment of bronchiectasis have been developed in the world. Published data is not sufficient to clear assessment of efficacy of pharmacological and non-pharmacological treatment for those patients. The main goals of treatment of bronchiectasis are to prevent exacerbations, to control symptoms, to improve quality of life, and to slow down progression of the disease. This article is a review of published data on efficacy and a role of selected pharmacological therapies of bronchiectasis and bronchial clearance techniques in adult patients.

Lung involvement in IgG-related diseases is poorly investigated. The current approach to IgG-related diseases including IgG-related lung disease was discussed in the article. The authors described recent classification and diagnostic criteria of IgG4-related lung disease, including radiological, serological and morphological parameters, and therapeutic approaches. Two clinical cases of IgG4-related disease with involvement of the lungs (organizing pneumonia), lacrimal glands (dacryoadenitis), kidneys (tubulointerstitial nephritis), eyes (iridocyclitis), and salivary glands (sialadenitis) were described in the article. Immunosuppressive therapy was successful in both cases. 

Musculoskeletal disorders in patients with chronic obstructive pulmonary disease (COPD) were reviewed in the article. Main risk factors of osteoporosis and peripheral musculoskeletal dysfunction in those patients are smoking, low physical activity, chronic systemic inflammation, and treatment with glucocorticoids. Low levels of vitamin D could contribute to development and progression of musculoskeletal disorders in COPD patients. The authors described main diagnostic and differentiation criteria of sarcopenia and cachexia-frailty overlap syndrome. Recently, a new term "osteosarcopenia" is used and can also be applied to COPD patients.

Comorbidity of chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) is currently important and not fully investigated. The aim of this study was to analyze clinical signs, lung function, the central and the intracardiac hemodynamics, and predictors of outcome in patients with comorbidity of COPD and CVD. Methods. The study involved 118 patients with stage 3 to 4 COPD (GOLD, 2016) including 111 men and 7 women. The mean age was 59.5 ± 0.63 years, the smoking history was 23.1 ± 0.93 pack-years, and body mass index (BMI) was 27.2 ± 9.06 kg/m2. The patients were allocated into one of three groups: COPD group (n = 37), COPD + coronary heart disease (CHD) group (stable angina functional class (FC) II to III, n = 45), and COPD + hypertension (H) group, n = 36). Results. Patients with COPD and CVD were older, had higher smoking history and higher BMI. Clinical signs of COPD were more prominent and the lung function was lower in COPD patients with CVD comorbidity. Cardiac remodeling and right and left ventricular diastolic dysfunction were more severe in the groups with comorbidity. The 3-year survival in the groups with comorbidity clearly tended to be lower. Age, smoking history, the heart beat rate, the systolic blood pressure, the distance in 6-minute walking test, and the serum C-reactive protein and fibrinogen levels were independent predictors of mortality in both COPD + CHD and COPD + H groups. Conclusion. The comorbidity of COPD + CHD and COPD + H is characterized by more severe clinical signs and symptoms of COPD, and decreased physical tolerance. Hypoxemia, heart remodeling, left and right ventricular diastolic dysfunction, and higher mortality risk were seen in both groups with comorbidity.

The aim of this study was to improve efficacy of treatment of patients with comorbidity of chronic obstructive pulmonary disease and hypertension using laser and ultrasonic therapy (LUST). Methods. The study involved 68 patients with comorbid acute exacerbation of moderate COPD (AECOPD) and hypertension. Main clinical, laboratory and functional parameters, lung function, systemic blood pressure, and biomarkers of systemic inflammation were analyzed. The study group was treated with the standard pharmacological therapy and LUST, the control group was treated with the standard pharmacological therapy only. Results. Clinical symptoms, such as cough, sputum production and sputum volume, and dyspnea, significantly improved over 5 – 6 days of the treatment and maintained through all study period. Lung function and arterial blood pressure significantly improved in the study group compared to controls. Biomarkers of the systemic inflammation, such as IL-4,IL-8 and TNFα, were higher in both groups at baseline compared to healthy subjects and significantly decreased to the end of treatment in the study group compared to the control group. Conclusion. The combined standard pharmacological therapy plus LUST in patients with AECOPD was associated with significantly greater clinical improvement in clinical symptoms, lung function, arterial blood pressure and systemic inflammation.

The aim of this study was to investigate effects of stepping down the dose of inhaled steroid (ICS) or ICS withdrawal in patients with chronic obstructive pulmonary disease (COPD) treated with an adequate bronchodilating therapy and quitting smoking. Methods. The study was performed in real clinical settings. Patients with COPD (n = 41) involved in educational smoking cessation program were followed for 9 months in outpatient settings. Smoking cessation program included varenicline, adequate physical activity, nutritional counseling and bronchodilating therapy; one of the aims of the treatment was ICS dose reduction or complete withdrawal of ICS. Results. Long-acting beta-2-agonist (LABA) indacaterol and dual bronchodilators (indacaterol/glycopyrronium or indacaterol/tiotropium) were effective in patients with COPD quitting tobacco smoking. ICS dose was reduced more quickly in patients treated with indacaterol or dual bronchodilators compared to those treated with formoterol. Quitting smoking was associated with improvement in CAT score and reduction in COPD exacerbation rate. Conclusion. Treatment with indacaterol or indacaterol/glycopyrronium combination was associated with more rapid and safe stepping down the dose of ICS or ICS withdrawal in COPD patients quitting tobacco smoking compared to those treated with formoterol.

The aim of this study was to analyze lung function in athletes involved in endurance winter sports. Methods. Lung function was measured in 50 athletes including 30 skiers and 20 speed-skaters (24 men and 26 women aged 17 to 33 years; average age, 24.7 ± 3.8 years) using spirometry, body plethysmography and diffusion test. A control age- and sex-matched group consisted of medical students and junior physicians. Results. Lung function in athletes, both skiers and skaters, was significantly higher compared to that of the control group and to reference values (ECSC, 1993). The lung function was not related to the athletes' age. In the total group, the athletes' performance was significantly related to lung volume values (rank correlation). Conclusion. Thus, lung function of the athletes involved in winter sports, such as skiing and speed skating, and focused to building the physical endurance, is higher than in general population. The standard approach to interpretation of pulmonary function test results is based on a comparison of actual and reference values. This can lead to misdiagnosis of lung function impairments.

Nonspecific interstitial pneumonia (NSIP) is one of idiopathic interstitial pneumonias. NSIP is characterized by non-specific clinical, radiologic, and morphological patterns; thereby, multidisciplinary approach is most reasonable to diagnose NSIP. A clinical case of NSIP is reported in the article. The case demonstrated that the multi-slice computed tomography of the lungs is more valuable to diagnose NSIP compared to the lung tissue biopsy, as typical morphological signs are absent. The multidisciplinary approach was also very useful in this case.

An uncommon case of metastatic pleural lesion with pleural effusion in a patient with phyllodes breast tumor is reported in this article. This clinical case demonstrates that computed tomography and magnetic resonance imaging (MRI) with dynamic contrast enhancement is a highly valuable methods to diagnose malignant pleural lesions and to differentiate soft-tissue mass from fluid. MRI was the most useful as it allowed visualization tumor macrostructure and volume, and differentiation soft tissue from fluid, both visually and with diffusion weighted images.

Immunoglobulin G4-related disease is a recently recognized systemic immune-mediated condition characterized by lymphoplasmacytic infiltrate in various organs with IgG4 positive plasma cells. Isolated lung involvement is rare, difficult to diagnose and can mimic primary lung malignancy on imaging. We report the case of an isolated IgG4-related interstitial lung disease in a 16-year-old asymptomatic male adolescent with incidentally found bilateral nodular lesions by chest radiograph. The patient underwent surgical interventions for assumption of malignancy. Serum IgG4 levels was normal. Нistological examination revealed significant lymphoplasmacytic infiltrate with lymphoid follicle formation, peribronchial fibrosis, vascular obliteration. Prominent interstitial IgG4 positive plasma cell infiltrate was identified by immunohistochemistry. Isolated IgG4-related lung disease should be taken into account as a possible differential diagnosis of mass-forming lesions, even when no other organ manifestation is clinically apparent at the time of diagnosis.