Data on asthma remission in adults are scarce worldwide and have not been searched in Russian Federation.

The aim of the study was to describe clinical course and remission rate in adult patients with atopic asthma in Chelyabinsk.

Methods. A retrospective analysis of 313 outpatient records of patients with atopic asthma aged 18 to 70 years was carried out. The patients were followed from 1992 to 2018. The median duration of the follow-up was 8 (5; 15) years. Then, the patients were surveyed by phone. Asthma Control Test (AСT) was used in 181 (58%) of 313 respondents. Clinical remission of asthma was determined as being symptom-free with no need in inhaled corticosteroids (ICSs) and short-acting β2-agonists (SABAs) during ≥ 1 year.

Results. The median age of asthma onset was 14.5 (8; 2) years in males and 28 (24; 36) years in females (p < 0.001). The diagnosis was made 5 years after the onset of symptoms. Asthma severity was related to gender: mild asthma was seen more often in males compared to females (p = 0.008). Allergic rhinitis and asthma comorbidity was found in 78% of patients. The proportion of patients sensitized to pollen was 72%; tree pollen allergens were the main cause of seasonal allergy (in 51% of patients). Different combinations of sensitization to indoor, animal, and pollen allergens (polysensitization) were detected in 80% of patients. Clinical remission of atopic bronchial asthma was determined in 22.7% of cases. Asthma remission was not related to the patient’s gender or age of symptom onset. The median age of the remission group patients was 33 (28; 39.5) years vs 40 (29; 51) years in patients without remission (p = 0.015). Asthma remission was associated with normal body mass index (23 (21; 24) kg / m2 vs 25 (22; 29) kg / m2 (p = 0.007); allergen elimination (p < 0.001) and allergen-specific immunotherapy (p < 0.001).

Conclusion. Predicting the probability of asthma remission and identifying conditions required to achieve the remission could improve our knowledge about asthma natural course and could increase treatment efficacy and adherence of patients to the treatment. 

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.

Adopted from: Graham B.L., Brusasco V., Burgos F., Cooper B.G., Jensen R., Kendrick A., MacIntyre N.R., Thompson B.R., Wanger J. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur. Respir. J. 2017; 49 (1): pii: 1600016. DOI: 10.1183/13993003.00016-2016.

Chronic heart failure (CHF) is one of the most common comorbidities in elderly patients with community-acquired pneumonia (CAP).

The aim of this study was to investigate etiology of CAP in patients with concomitant CHF.

Methods. This prospective observational study involved adult hospitalized patients with CAP and concomitant CHF. CAP was confirmed by chest X-ray. Sputum samples or oropharyngeal swabs, blood and urine samples were collected in all eligible patients before starting the therapy with systemic antibiotics. Sputum was cultured for «typical» bacterial pathogens, such as Streptococcus pneumoniae, Staphylococcus aureus, Enterobacterales, etc., in accordance with standard methods and procedures. Mycoplasma pneumoniae, Chlamydophila pneumoniae and respiratory viruses in sputum or oropharyngeal swabs were identified using the real-time polymerase chain reaction (PCR). Urine samples were used to determine serogroup 1 Legionella pneumophila and S. pneumoniae soluble antigens using bedside immunochromatography.

Results. Fifty patients were enrolled in the study. The mean age was 72.2 ± 9.5 years, 27 (54%) were females. The etiology of CAP was identified in 23 cases (46%). S. pneumoniae was the most common pathogen (16/23; 69.7%) followed by respiratory viruses (3/23; 13.1%), such as type 3 parainfluenza virus, coronavirus, human metapneumovirus; Haemophilus influenzae (1/23; 4.3%), S. aureus (1/23; 4.3%), and Klebsiella pneumoniae (1/23; 4.3%). S. pneumoniae and parainfluenza virus co-infection was diagnosed in one of 23 patients (4.3%).

Conclusion. S. pneumoniae and respiratory viruses were predominant causative pathogens of CAP in hospitalized adults with concomitant CHF. Therefore, bedside tests for urine pneumococcal antigens should be used more widely considering difficult sputum expectoration in elderly. Atypical bacterial pathogens (M. pneumoniae, C. pneumoniae, L. pneumophila) were not identified in this study, so the routine PCR-test and urine tests for L. pneumophila antigens are thought to be not useful. 

The aim of this study was to investigate efficacy and safety of released-active antibodies against interferon-gamma, CD4-receptor, and histamine in adult patients with acute respiratory viral infection (ARVI).

Methods. This multicenter, randomized, double-blind, placebo-controlled clinical trial in parallel groups was carried out in 2011 – 2012. Data of 161 ambulatory patients from 4 centers at Russian Federation were included in the analysis. The patients' age was 18 to 60 years. Patients with ARVI signs duration ≤ 48 hours were enrolled in the study. The patients were randomly assigned for the treatment with released-active antibodies against IFN-γ, CD4-receptor, and histamine (the active treatment group; n = 76), or placebo (placebo group; n = 85) for 5 days at 1:1 ratio. The randomization was made using the block randomization method. The treatment efficacy was evaluated according to number of patients with normal body temperature (≤ 37.0 °C) over 5 days of the treatment. Additionally, we evaluated the need in antipyretics, duration and severity of clinical symptoms and complications.

Results. During the treatment period, the number of patients with normal body temperature was higher in the active treatment group. Additionally, patients of this group needed antipyretics less often compared to the placebo group. Deterioration and complicated course of the disease were not registered in the active treatment group compared to the placebo group.

Conclusion. The results of this multicenter, randomized, double-blind, placebo-controlled clinical trial in parallel groups demonstrated therapeutic efficacy and safety of released-active antibodies against IFN-γ, CD4-receptor, and histamine in adult patients with acute respiratory viral infection. 

The aim of this study was to evaluate prevalence of chronic rhinosinusitis (CRS) and nasal polyps in adult patients with cystic fibrosis (CF) in Russian Federation. Additionally, we investigated the clinical course of CRS and developed the optimal therapeutic strategy.

Methods. Three hundred and forty eight CF patients were involved in the study. Physical examination, computed tomography (CT) of paranasal sinuses and audiometry, if needed, were used. CRS and bilateral nasal polyps were diagnosed in 28 patients. Nasal endoscopy, SNOT-20 questionnaire, rhinomanometry, micro - biological examination of sputum and mucus from paranasal sinuses (obtained during puncture or surgery), spirometry, and measurement of serum markers of inflammation were used. Endoscopic sinus surgery was used in 14 patients (the group 1) and others were treated non-surgically (the group 2). Both group were treated during 6 months using intranasal mometasone, mucolytics and antibiotics via PARI SINUSTM nebulizer.

Results. An improvement in symptoms, CT signs, rhinomanometry parameters and endoscopic signs was seen in both groups after treatment and was more prominent in the surgical treatment group compared to the non-surgical treatment group. Bacterial load reduction in nasal sinuses, decrease in the rate of pulmonary disease exacerbations, and an improvement in oxygen blood saturation were found in the surgical treatment group only. Treatment of CRS did not affect lung function, sputum microbiology and serum inflammatory markers.

Conclusion. Endoscopic sinus surgery followed by intranasal mucolytics and antibacterials is an effective and well-tolerated treatment in adult CF patients with CRS. 

The aim of the study was to investigate new methods for pulmonary tuberculosis (TB) detection at a pulmonology inpatient department.

Methods. Pulmonary TB cases (n = 49) newly diagnosed at a pulmonology department of a hospital were involved in the study; among them, 69.4% of patients were infected with human immunodeficiency virus (HIV). All patients were asked if he/she had previously contacted with other TB patients, and if he/she was diagnosed with TB previously. The patients were also about family history. Posteroanterior and lateral chest X-ray and laboratory analyses were performed in all patients. Mycobacteria tuberculosis (MBT) were searched using smear microscopy, GeneXpert MTB/RIF molecular method and culturing (BACTEC MGIT) of sputum and bronchoalveolar lavage fluid (BALF) obtained during bronchoscopy. Patients with positive results only were included in the analysis in order to investigate and to compare diagnostic value of the methods.

Results. Questioning patients at admission was useful to diagnose TB in 4% of patients. Sputum smears were positive in 12 patients (27.3%). BALF was obtained in 18 patients (36.7%); among them, MBT was identified in 52 (5%). Molecular testing was positive in all 49 patients (100%); among them, BACTEC MGIT culturing yielded MBT in 48 patients (97.9%). In patients with negative sputum smears during the first 3 days after admission, GeneXpert required 10.4 ± 5.3 days.

Conclusion. GeneXpert method was highly useful to diagnose TB and was comparable with BACTEC. Routine sputum and BALF smear microscopy was significantly less rapid and less sensitive method. The diagnostic accuracy could be increased with the use of molecular methods in patients with negative sputum smears obtained at a general hospital. Therefore, molecular methods could be used in patients highly suspected for TB. 

Morbidity of chronic obstructive pulmonary disease (COPD) is consistently increasing last decades in Russian Federation. Similarly, the total morbidity is also increasing together with annual healthcare costs. The main risk factor of COPD is tobacco smoking. Therefore, the encouragement of smokers to quit smoking and medical care for nicotine withdrawal should be considered as main factors to control COPD morbidity. Bronchial hyperreactivity could occur early in smokers and COPD could develop in smokers with longer smoking history. Mild to moderate COPD is diagnosed in > 20% of smokers seeking medical aid for nicotine withdrawal. Typically, bronchial hyperreactivity becomes worse after quitting the smoking. This should be considered by a physician and long-acting bronchodilators should be used during nicotine withdrawal. Therefore, an individual plan is necessary for every smoking patient with COPD including quitting the smoking with consideration the severity of nicotine dependence and motivation to quit smoking. The individual plan should also include initiation or optimisation of bronchodilator therapy to prevent worsening of bronchial hyperreactivity. Quitting the smoking is the most effective intervention to slow COPD progression.

According to current clinical guidelines, a role of inhaled corticosteroids (ICS) in the management of patients with COPD is limited. The optimal benefit/risk ratio could be achieved only in specific populations of patients with COPD. In a real life, physicians often do not follow clinical guidelines, and ICS are overprescribed. In addition to the lack of effectiveness, there are possible risks of ICS use. Regarding to this, there is a need to develop a simple and convenient algorithm for ICS withdrawal in the population of COPD patients who do not fit criteria for therapy with ICS. Clinical studies on efficacy and safety of ICS and available data on ICS withdrawal in patients with COPD are analyzed in this article. An international expert panel developed a simple and convenient algorithm for withdrawal of ICS in patients with COPD based on published data.

Asthma control is still difficult to achieve. One of main tools for evaluating asthma control is a well-known Asthma Control Test (ACT). Common causes of insufficient asthma control include poor adherence to treatment and non-compliance of the patient with the dosing regimen. Correct inhalation technique significantly contributes to better adherence to treatment. Elliptа is a multi-dose powder inhaler with dose counter and indication of remaining dose number. Actuation of Ellipta inhaler requires only one movement. Inhaled glucocorticosteroids (ICS) and long-acting β2-agonists (LABA) are the key agents in the maintenance pharmacological therapy of asthma. A novel vilanterol/fluticasone furoate (VI/FF) combination is a highly effective combination for maintenance treatment of moderate to severe asthma with 24-hour effect providing once-daily dosing. The Salford study demonstrated advantages of VI/FF combination over ICS monotherapy and other combination of ICS/LABA in real clinical practice in patients with asthma out of dependence of asthma severity or comorbidities.

Percutaneous vertebroplasty (PVP) is a minimally invasive intervention widely used for relief of pain caused by osteoporotic, traumatic, or neoplastic vertebral fractures. During PVP, polymethyl methacrylate (bone cement) is injected directly into the vertebral body via a vertebral pedicle to partially restore the vertebral body height, to stabilize bone trabeculae and to alleviate pain. Though the procedure is minimally invasive, complications are not rare; however, mostly, they are not clinically significant. Potentially serious complications of PVP include pulmonary embolism with polymethyl methacrylate with variety of manifestations ranging from asymptomatic postoperative x-ray findings to life-threatening extravasation (cement "leakage") which is quite rare and fatal. Epidemiology, pathogenesis, clinical and radiological signs of pulmonary embolism in PVP and approaches to treatment are discussed in this review of literature. The article also describes two clinical cases of pulmonary embolism in patients underwent PVP for hemangioma of the vertebral body with severe pain syndrome are also described.

Yellow nail syndrome is a rare disorder of unknown etiology that usually affects older adults. The classic clinical presentation includes nail discoloration, lymphedema and pulmonary manifestations (e.g. pleural effusion, sinusitis, bronchitis, bronchiectasia, recurrent pneumonia). Although the diagnosis of yellow nail syndrome is essentially a clinical one and based on the presence of characteristic findings, the disorder often remains undiagnosed for many years due to occasional occurrence. The present article describes the clinical case of yellow nail syndrome and a brief literature review on this issue.

Minimizing the risk of exacerbations of chronic obstructive pulmonary disease (COPD) along with symptoms control are the most important therapeutic tasks in COPD. The effective solution of this problem is still being discussed. The prevention of COPD exacerbations is of social and economic importance and should be the primary concern in the treatment of this disease. Unresolved problems in the treatment of COPD are low patient compliance to therapy and side effects of medication. According to recent guidelines, in case of persistent COPD exacerbations with patients receiving long-acting bronchodilators (LABA), the use of inhaled corticosteroids (ICS) must be considered; this reduces the incidence of moderate and severe COPD exacerbations, especially if a patient has a history of bronchial asthma or blood and/or sputum eosinophilia. Availability of LABA/LAMA and ICS/LABA fixed combinations in Russia provides two possible options to administer a free triple combination consisting of a single LAMA plus ICS/LABA or ICS plus LAMA/LAMA. According to multiple trials, the use of fixed combinations could provide twice improvement in the patient adherence to the therapy, which therefore leads to higher efficiency. The main complaint about ICS with COPD patients is an increased risk of pneumonia as well as the development of systemic adverse reactions typical for corticosteroids. However, the use of extra-fine ICS could significantly reduce the risk of pneumonia compared with fine-particle inhalators and also increases the effectiveness of therapy as the pathological process in COPD mainly involves the small airways.