The right-sided heart failure (RSHF) is a complex clinical syndrome including different pathogenic mechanisms and processes resulted from the right ventricle (RV) dysfunction and manifested with signs of heart failure (HF). Recently, there is a growing scientific interest in the right-sided acute and chronic heart abnormalities; this is due to growing knowledge in this field and development of novel diagnostic, therapeutic and pharmacological approaches to treatment of pulmonary hypertension that is a common cause of RSHF. Cardiac embryogenesis, anatomic particularities, difference and interdependence of RV and the left ventricle (LV) are described in the article in order to improve the knowledge on structure and function of both the right heart and the left heart. Discussion on pathophysiology, causes and clinical manifestations of acute RSHF (aRSHF) and chronic RSHF (cRSHF) should consider the right heart physiology. Pharmacological treatment should be targeted to ventricle pre-load, myocardial contractility and RV post-load, correction of pulmonary circulation and LV volume resulting in post-load reduction and improvement in the LV function. Patients with biventricular dysfunction should be treated according to current clinical guidelines on therapy of chronic HF. Vasoactive agents and diuretics have an important role for the treatment of RSHF as this is the basic therapy of pulmonary congestion both in aRSHF and cRSHF. Step-by-step therapeutic algorithm is given in the article.

This document is updated technical standards of European Respiratory Society (ERS) and American Thoracic Society (ATS) for single-breath carbon monoxide diffusing capacity measurement. The previous version of this document was published in 2005. Both terms used to describe the uptake of carbon monoxide in the lungs, DLCO (diffusing capacity) and TLCO (transfer factor), are equally valid, but the term DLCO is used in this document. The document was developed by joint ATS/ERS taskforce and was based on a survey of published evidence. Expert opinion was used for issues for which evidence was not available or was insufficient. Principal changes in the technical standards are related to new systems with rapidly responding gas analyzers for carbon monoxide. Additional materials are available at erj.ersjournals.com.

The aim of this study was to evaluate economic burden of respiratory diseases and chronic obstructive pulmonary disease (COPD) in Russian Federation (RF) in 2016 including direct costs and economic losses caused by decreased labor efficiency. Methods. The analysis included direct cost, such as healthcare expenses and disablement payout, and economic losses due to decreased labor efficiency by the reason of morbidity and premature mortality. Data of Federal State Statistics Service, annual State Statistical Reports, the State Guarantee Program of Free Medical Care for Citizens of Russian Federation, and statistical data on respiratory diseases and COPD were used. Costs of medical care (ambulatory, hospital, and emergency care) were calculated based on compulsory health insurance tariffs. The amount of disability benefits payments was calculated based on number of disabled persons in each group and the size of the disability benefit. Indirect costs (or economic losses) included losses from non-produced products due to premature mortality and disability of working-aged adults. Results. In 2016, there were 623,000 years of potential life lost (YPLL) due to respiratory diseases, mainly in males. Of this, 35% of deaths and 22% of YPLL were related to COPD. Healthcare costs for COPD treatment included hospital care costs (83.9%), ambulatory care costs (11.1%) and emergency care costs (5%). In 2016, the economic burden of COPD in Russian Federation reached 170.3 billion ₽, or 18.8% of all losses and expenditures from respiratory diseases. This is 0.2% of the gross domestic product (GDP) in the same year. Conclusion. The economic burden of COPD in Russia in 2016 was 170.3 billion ₽, or 0.2% of GDP. The burden of COPD predominantly consisted of economic losses caused by premature mortality of working-aged subjects. These data suggest that priority should be given to measures aimed at preventing the occurrence and slowing down the progression of this disease, probably by increase the investment in the prevention and treatment of COPD. Such measures could reduce clinical and economic consequences of COPD.

The aim of the study was to investigate relationships between the respiratory burst in blood and sputum neutrophils and intracellular enzyme activity in patients with pneumonia. Methods. The study involved 82 patients with moderate to severe community-acquired pneumonia (CAP). The chemiluminescent assay was used to investigate synthesis of primary and secondary reactive oxygen species (ROS). The bioluminescent method was used to examine NAD(P)-dependent dehydrogenase activity in neutrophils. Results. Low-intensity respiratory burst in blood neutrophils and its predominant relations to the state of mitochondrial metabolism and malic enzyme activity were observed in healthy subjects. Blood neutrophils in patients with CAP were activated; the anaerobic respiration and mitochondrial metabolism increased in the cells. Additionally, intensity of the respiratory burst was related to terminal glycolysis reactions and the key reaction of the pentose phosphate cycle. Sputum neutrophils in patients with CAP were also activated. Conclusion. Abnormalities of metabolic support of the respiratory burst, such as decreased production of primary and secondary ROS, could appear under unfavorable conditions. Peroxidation increased in the cells, the intensity of terminal glycolysis reactions decreased, and substrates transferred from the citric acid cycle to amino acid exchange reactions. Under these conditions, malic enzyme remained the only substrate that stimulated the respiratory burst in sputum neutrophils, while substrate transfer from the tricarboxylic acid cycle inhibited synthesis of the secondary ROS.

The aim of the study was to assess inflammatory and coagulation disorders in patients with idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH) in dependence on dyslipidemia. Methods. The study involved 22 patients with IPAH and 6 patients with inoperable CTEPH complicated by hypercholesterolemia (total cholesterol (TC) level > 5.8 mmol/L). Healthy volunteers with normal TC level (n = 20) were included in a control group. We measured serum cytokine concentrations, such as interleukin (IL)-2, IL-4, IL-5, IL-6, IL-10, IL-12, and interferon (INF)-γ, using a multiplex fluorescent analyzer GEN-PROBE (Luminex 200) with Bio-Plex Precision Pro set. Von Willebrand factor was measured using an immunoturbidimetric assay with STA-Liatest VWF: Ag set. D-dimer, fibrinogen, C-reactive protein, and the total blood cell count were also measured. Results. CTERH patients had lower IL-2 level and more prominent signs of chronic heart failure (CHF) compared to patients with IPAH. Serum levels of IL-10, IL-4, and IL-12 were significantly related to syncope frequency, INF-γ level and cardiac index (CI). High density lipoprotein (HDL) level was inversely related to mean pulmonary arterial pressure (mPAP) in IPAH/CTEPH patients with TC > 6.5 mmol/L. Decreased thrombocyte count and decreased thrombocrit were associated with increased mPAP and mean right atrium (RA) pressure in patients with dilated right pulmonary artery. Increased D-dimer level was associated with enlarged RA area, enlarged right ventricle size, tricuspid regurgitation and decreased CI. Conclusion. Serum concentrations of the inflammatory and coagulation markers, excepting LI-2, did no differ significantly in patients with IPAH and CTEPH. Dyslipidemia was associated with activation of inflammation. Further studies are needed to estimate a predictive value of decreased HDL in patients with IPAH and CTEPH.

This study was aimed at investigation of relationships between bronchial washing culture in post-transplant recipient and bronchial flora of the lung donor. Methods. A comparative analysis of bronchial washing cultures from 30 post-transplant lung recipients was performed. All lung donors were stratified to ideal, suboptimal and marginal donors according to the lung transplant suitability. Results. As a result, development of post-transplant pulmonary complications was directly related to bacterial flora of the donor lung. The incidence of pneumonia in post-transplant patients was 3.3% after transplantation of ideal donor lungs, 20% after transplantation of suboptimal donors lungs and 100% after transplantation of marginal donor lungs. Conclusion. The rate of pneumonia in transplanted lungs was directly related to bronchial flora in the donor lungs. This should be taken into account when planning antibacterial therapy after lung transplantation.

The first goal of this study was to analyze a relationship between 1-year outcomes and respiratory comorbidity in patients with coronary artery disease (CAD) underwent scheduled coronary artery bypass grafting (CABG); the second goal of the study was to determine the most significant predictors of fatal outcome in these patients. Methods. The study involved 251 patients underwent CABG. They were stratified according to having comorbid chronic obstructive (n = 62; 24.7%) or non-obstructive lung disease (n = 65; 25.9%) or not having chronic respiratory disease (n = 124; 49.4%). Cardiovascular events during 1 year were registered. Results. An expected decrease in functional classes of CAD and chronic heart failure (CHF) was noted over 1 year. Number of non-fatal significant cardiovascular events didn’t differ in patients with or without chronic obstructive pulmonary disease (COPD). Seven patients (2.78%) died during the year; the cause of death was cardiovascular disease in all cases. Factors predicting poor outcomes included age, occupational exposure to chemicals > 3 years, incomplete myocardial revascularization, FEV1/FVC ratio, and left ventricular ejection fraction < 40%. Conclusion. COPD is a predictor of poor outcome of myocardial revascularization in patients with CAD.

Recently, therapeutic options for treatment of chronic obstructive pulmonary disease (COPD) has been significantly extended, mainly due to new double and triple drug combinations in a single inhaler. Double combinations for treatment of COPD include long-term acting beta-2-agonists (LABA)/long-term acting muscarinic antagonists (LAMA) and LABA/inhaled corticosteroids (ICS); a triple combination is a combination of LABA, LAMA and ICS in a single inhaler. A review of consensus statements, national guidelines and recently published data about use of triple therapy in COPD, efficacy and safety of a triple combination is given in the article.

Physical activity plays an important prognostic role in patients with chronic obstructive pulmonary disease (COPD). According to published data, decreased physical activity is associated with higher frequency of COPD exacerbations, higher mortality, and lower quality of life in COPD patients. As the airflow limitation is an underlying mechanism of COPD, double bronchodilators can reduce lung hyperinflation and improve exercise tolerance in patients with COPD. According to the robust evidence on the efficacy of tiotropium/olodaterol combination, double bronchodilators can increase exercise duration and time before dyspnea occurrence on exertion. However, further studies are needed in the field of rehabilitation and a role of physical activity in the management of patients with COPD.

Bronchial asthma is a heterogeneous disease with variable course. Identification of pathobiological mechanisms of asthma phenotype, also called as asthma endotypes, is an urgent task to optimize treatment of asthma, especially of severe asthma. Although the author recognizes that T2-low asthma is a serious problem, this article is devoted to the T2-high asthma endotype. Currently, biological agents are available for T2-high asthma only, so the focus on T2 high asthma is important. Current characteristics of uncontrolled, difficult-to-treat and severe asthma, mechanisms of eosinophilic inflammation in T2-high asthma, main cells and mediators involved in the disease, and biomarkers of T2-high asthma were discussed in the article.

Diagnostic criteria of vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA) are of limited usefulness as they involve resembling conditions and do not make possible distinguishing nosology of vasculitis. A challenging clinical case of an elderly female patient with ANCA-associated vasculitis, diffuse alveolar hemorrhage syndrome, cardiac injury and blood eosinophilia, but without bronchial asthma, is described in the article.

Targeted therapy for cystic fibrosis (CF) is a novel approach to CF treatment that can restore and potentiate CFTR channel activity. Lumacaftor/ivacaftor combination therapy is related to significant clinical and functional benefits in CF patients who are homozygous for F508del CFTR mutation. The authors described a case of effective treatment with lumacaftor/ivacaftor combination in a homozygous F508del CF patient with severe lung disease. This experience demonstrates an urgent need to make this pathogenic treatment available for patients with this genotype in Russia.

This article is devoted to a remarkable data, the 90th anniversary of Academician of Russian Academy of Science, Hero of Socialist Labour of the Soviet Union, Evgeniy I. Chazov. His multifaceted personality has been formed under an influence of Dmitriy D.Pletnev, who founded of a Russian therapeutic school at the middle of 20th, the 20th century. Evgeniy I. Chazov is known not only as a scientist and a physician, but also as a talented public health manager. He was at the head of Healthcare Ministry of Soviet Union from 1987 to 1990. Under his leadership and with his direct participation, the Soviet healthcare system acquired novel modern features: a network of diagnostic centers and pediatric healthcare facilities was organized that led to decrease in child mortality, healthcare provision in extreme conditions, development of control measures against human immunodeficiency virus, and updating the legislation on psychiatric care. Novel business principles were implemented in the country by Evgeniy I. Chazov; high tech diagnostic equipment was supplied to medical institutions.