The aims of this study were to evaluate clinical course of community-acquired pneumonia (CAP) in patients with chronic heart failure (CHF) and to assess the time course of serum biomarkers, such as C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), and brain natriuretic peptide (BNP), at baseline and after treatment in patients with CAP and CHF. Methods. This was a prospective observational study. Adult patients with CHF admitted to a hospital due to suspected CAP were recruited in the study. The diagnosis of CAP was confirmed by chest computed tomography (CT). Subsequently, patients were assigned to the group 1 (with confirmed CAP) or the group 2 (with respiratory infections other than CAP). Echocardiography was performed in all patients at baseline and in follow-up visits. In addition to the routine clinical examination and laboratory tests, serum biomarkers were measured in all patients at admission (Visit 1), at days 10 to 14 (Visit 2), and at days 28 to 42 (Visit 3). Standard statistical methods were used for data analysis. Results. Seventy patients who met the inclusion criteria were enrolled in this study; of them, 35 patients had confirmed CAP and 35 patients had respiratory infections other than CAP. Both groups were similar for demographic and clinical characteristics, as well as for laboratory, echocardiographic and radiological findings. CAP did not affect the clinical course of CHF and echocardiographic parameters did not differ significantly between the groups. Clinical signs of both diseases improved after the treatment in majority of patients. Echocardiographic parameters also improved in both groups that indicates the improvement in cardiac dysfunction under the treatment. During the follow-up, the most prominent changes were seen in CRP level which was significantly higher at baseline in CAP patients compared to patients with other respiratory infections. CRP level decreased at Visit 2 in both groups and in Visit 3 in CAP group. CRP levels differed significantly between the groups both at Visits 1 and 2. Other biomarkers, such as PCT, IL-6, and BNP, were significantly higher at Visit 1 compares to Visit 2. TNF-α level did not change significantly neither in any group during the study nor between the groups at any study time. Conclusion. CAP did not affect the clinical course of CHF. Inflammatory biomarkers, such as CRP, PCT, and IL-6, could be used additionally to the routine diagnostic procedures to differentiate between CAP and other respiratory infections in patients with CHF. CRP is the most promising biomarker. Serum levels of the biomarkers decreased significantly under the standard hospital treatment of CAP and CHF; this could be considered to evaluate treatment success and prognosis.

The aim of the study was to evaluate prevalence and age-dependence of bronchial hyperresponsiveness (BHR) in cross country skiers. Methods. Twenty-nine cross-country skiers (14 males, 15 females aged 18 to 30 years; average age, 23.9 ± 3.4 years) were involved in the study. All athletes underwent pulmonary function tests (spirometry before and after inhalation of 400 μg of salbutamol, body plethysmography, diffusion test). Then, methacholine challenge test was performed. Results. In skiers, lung function data were higher compared to the reference vаlues calculated in accordance with the ECSC equations, 1993. Bronchial reversibility was found in 4 athletes (14%). Methacholine provocative concentration causing a 20% fall in FEV1 (PC20) was > 4 mg/ml in 9 skiers (31%). Significant relationships were found between the atheltes’ age and BHR. Conclusion. Cross-country skiers have a high prevalence of BHR to methacholine. BHR increases with age.

The objective of the study was to investigate prevalence, clinical and allergological features, and risk factors of bronchial asthma in pre-school children living in urban areas of Altay Krai. Methods. This was a cross-sectional study involving 3,205 children (age, 3 to 6 years) attending pre-school facilities in 5 cities of the Altay Krai. Asthma symptoms were defined using the ISAAC questionnaire. Asthma was diagnosed by clinicians according to GINA. Results. Prevalence of asthma in urban children aged 3 to 6 years was 5.7%; 62.7% of them were previously diagnosed with asthma. Majority of children (59.4%) had mild asthma. Sensitization was detected in 70.3% of children with asthma, most of them were sensitized to dust mites Dermatophagoides pteronyssinus (63.3%), birch pollen (46.6%), and cat epithelium (31.1%). Risk factors of asthma were family history of allergy [odds ratio (OR) 3.2; 95% confidence interval (CI) 2.2–4.6], male gender (OR 2.2, 95% CI 1.5–2.3), preterm birth (OR 2.1, 95% CI 1.3–3.3), smoking parents (OR 1.6, 95% CI 1.2–2.9), (contact with pets during the first year of life (OR 1.4, 95% CI 1.0–2.0). Conclusion. The prevalence of asthma in urban children aged 3 to 6 years living in urban areas of Altay Krai was 5.7%. Most common sensitizers were house dust mites, birch pollen and cat epithelium. The risk factors of pre-school asthma are family history of allergy, male gender, preterm birth, passive smoking and contact with pets during the first year of life.

According to the modern concepts, asthma is a heterogeneous disease characterized by chronic airway inflammation and respiratory symptoms, which vary in time and intensity and manifest together with variable obstruction of the airways. Asthma is responsible for the deterioration of health status and quality of life in approximately 339 million of adult patients and children worldwide. Despite the fact that asthma is a chronic inflammatory disease, patients with asthma generally inadequately receive anti-inflammatory therapy in real clinical practice and rely on short-acting beta2-agonists (SABA) too much; this can “mimic” worsening of asthma symptoms. SABA monotherapy “on demand” does not affect chronic airway inflammation, underlying asthma occurrence and progression. As a result, such patients still have the risk of asthma exacerbation and disease progression. Therefore, the need of a new therapeutic strategy for patients with milder asthma (steps 1 and 2), which would provide anti-inflammatory treatment considering the low adherence to the regular maintenance therapy and high dependency on SABA, is obvious. Such approach has become available after the SYGMA (SYmbicort® Given as needed in Mild Asthma) trial was completed. According to the results of this trial, budesonide/formoterol 160/4.5 µg/dose as needed was superior to as needed SABA in better asthma control and decrease in severe asthma exacerbation rate by 64% (p < 0.001). Results of SYGMA 1 and 2 trials also demonstrated that budesonide/formoterol 160/4.5 µg/dose as needed was noninferior compared to regular treatment with budesonide in preventing severe asthma exacerbations while the cumulative dose of budesonide was reduced by ≥75%.

Dust-related diseases are the most common occupational diseases with significant economic burden. The purpose of this study was to assess an impact of pneumococcal vaccination on exacerbation rate of occupational lung diseases. Methods. Patients with occupational lung diseases were vaccinated with pneumococcal polysaccharide 23-valent vaccine (PPV23) or pneumococcal conjugate vaccine (PCV13) and then were followed-up for long time. We analyzed the rate of exacerbations of occupational lung diseases at baseline and during 5 years after the vaccination. The immune status, anti-IgG antibodies and antibodies against PPV23 polysaccharides were measured in blood; lactoferrin and IgA were measured in saliva. Exacerbations were determined retrospectively based on outpatient medical records. Results. A rate of exacerbations significantly decreased over two years after the vaccination with PPV-23 followed by an increase to the end of the third year and a significant increase to the end the fourth year; the latter exceeded the pre-vaccination exacerbation rate. After re-vaccination with PPV23, the exacerbation rate decreased and reached the lowest rate two years after the revaccination. This result was maintained over five years with a slight transient decrease during the fourth year. This could be explained by lack of immune memory cells after the re-vaccination compared to primary vaccination and to the risk of B-cell pool depletion. When PCV13 vaccine was used for re-vaccination a year after primary vaccination with PPV23, the exacerbation rate sharply decreased a year after the re-vaccination with maintenance of the effect during three subsequent years and a significant decrease to the end of the fourth year. In a subgroup of patients with pneumoconiosis who were primarily vaccinates with PCV13 without further re-vaccination, the exacerbation rate significantly reduced a year after the vaccination with further reduction during five years. The exacerbation rates were similar in this subgroup and in patients vaccinated sequentially with PCV13 and PPV23. Conclusion. The long-term immune response could be provided by conjugation caused the memory cell formation compared to PPV23 vaccine.

The objective of this study was to assess clinical efficacy and safety of inhaled mannitol (Bronchitol-Pharmaxis) in cystic fibrosis (CF) children at Moscow region. Methods. The study was designed as a single centre, observational study. Inclusion criteria were age > 9 years, confirmed diagnosis of CF and tolerability of mannitol in the BIDA test (Bronchitol Inhaled Dose Assessment). Mannitol was administered in the dose of 400 mg (10 capsules, 40 mg each) b.i.d. after inhalation of a short-acting bronchodilator. The patients also received basic therapy excluding inhaled hypertonic saline. The treatment duration was 8 weeks. Patients visited a physician at the study beginning and over 8 weeks of treatment; lung function (FEV1, FVC) and blood oxygen saturation (SatO2) were measured at each visit. Results. Lung function was stable or tended to improvement during the study. Time spent to inhalations of mannitol shortened compared to previous treatment with inhaled mucolytics and hypertonic saline. Inhaled mannitol was well-tolerated. Conclusion. The study demonstrated good tolerability and clinical efficacy of inhaled mannitol in CF children. Dry-powder formulation is also beneficial due to shorter time required for inhalation.

The purpose of the study was to assess the efficacy of glutamyl-cysteinyl-glycine disodium (Glu) as adjuvant therapy in patients with isoniazid resistant pulmonary tuberculosis. Methods. This was a randomized placebo-controlled blind study. The study involved 67 patients who was randomly assigned to the treatment with Glu and antituberculosis cchemotherapy (group 1; n = 23), or placebo (group 2; n = 10), or antituberculosis chemotherapy (group 3; n = 34). All patients were positive for M.tuberculosis (MBT). The treatment included a standard intensive chemotherapy in a hospital (DOTS strategy) during 5 months (2S 3–5HRZE/5RSE). Glu was administered intramuscularly in the dose of 60 mg once daily during 10 days followed by 60 mg once daily every other day during 20 days; the total course included 20 doses. Results. Single-drug resistant MBT was detected in 26.1%, 20.0%, and 8.8% of patients in groups 1, 2, and 3, respectively. Multiple drug resistance was detected in 73.9%, 77.8%, and 91.2%, respectively. Sputum conversion was achieved in 26.1%, 52.2%, and 21.7% of group 1 patients in one, two and three months of the treatment, respectively. Sputum conversion in group 2 was achieved over 3 months of the treatment only (n = 3 at 3 months, n = 4 at 4 months, and n = 2 at 5 months); two patients were still MBT-positive to the end of the treatment. In group 3, sputum conversion was achieved in 18 patients (53.0 %) at 3 months, in 6 patients (18%) at 4 months, and in 5 patients (14.7%) at 5 months; 5 patients remained MBT-positive to the end of the treatment. Median time to sputum conversion was 62, 114, and 100 days in groups 1, 2, and 3, respectively. Conclusion. The adjuvant treatment with Glu in patients with isoniazid-resistant pulmonary tuberculosis was associated with earlier sputum conversion. This strategy can shorten the duration of the intensive treatment.

The objective of this study was to compare demographic, clinical, functional, laboratory data, and therapy in patients with chronic obstructive pulmonary disease (COPD) and asthma who seek for medical aid at medical institutions of Kazan’. Methods. The study involved 153 patients with COPD aged 33 to 89 years and 229 patients with asthma aged 18 to 87 years. Clinical status, rate of exacerbations, spirometric data, treatment and compliance during the previous year were analyzed. Statistical analysis was performed using the SPSS-18 software. Results. COPD patients were older (64.1 ± 0,7 vs 55.4 ± 0,9 years in asthma patients; p < 0,01), more often were males (98.7% vs 1.3%, p < 0.001) and smokers. Coronary heart disease (39.0% vs 25.3%; p < 0.010) and chronic heart failure (35.7% vs 17.5%; p < 0.001) were more common in patients with COPD, while rhinitis (42.4 % vs 3.9%; p < 0.001) and chronic kidney disease (13.1% vs 4.5%; p < 0.001) were more common in asthma patients. Allergic disease was 5-fold more often in asthma patients. Morning symptoms affected daily activity in 77.3% of COPD patients compared to 66.8% of asthma patients (p < 0.05). Generally, daytime activity was impaired in 55.2% of patients with COPD and in 12.7% of patients with asthma (p < 0.05). Excessive use of short-acting bronchodilators was noted at nighttime in 89.6% with COPD and 70.7% with asthma (p < 0.001). Other treatment was in line with guidelines for each the disease. The most convenient inhalational drug delivery device for COPD patients was a metered dosed inhaler, while patients with asthma preferred dry powder inhalers. Compliance of asthma patients was significantly higher than that of COPD patients (57.2% vs 27.8%; p < 0.001). The level of compliance did not change while fixed and free combinations of ICS and LABA or different inhalational devices were used in patients with COPD or asthma. Conclusion. There is a number of clinical signs to distinguish COPD and asthma quite easily in primary care facilities. Excessive use of short-acting bronchodilators and a low compliance of patients are issues requiring to be improved.

Recently, bronchial asthma is considered as a heterogeneous disease characterized by chronic airway inflammation and respiratory symptoms, which vary in time and intensity and manifest together with variable obstruction of the airways. Asthma is one of the most common chronic respiratory diseases in primary care. Patients with certain respiratory symptoms seek for medical aid initially in primary care physicians, such as therapeutists, general practitioners, and family physicians, who can suspect and diagnose chronic respiratory diseases such as bronchial asthma, chronic obstructive pulmonary disease (COPD), allergic rhinitis, etc. Currently, untimely diagnosis of asthma and late initiation of anti-inflammatory treatment are widespread, mainly due to insufficient knowledge of primary care physicians on diagnostic criteria and therapeutic standards for asthma. Feasible and convenient algorithms for asthma diagnosis and treatment in primary care were developed by experts of Russian Respiratory Society and Russian Association of Allergologists and Clinical Immunologists. A therapeutic algorithm for asthma treatment in primary care institutions uses an approach considering symptom severity both in patients with newly diagnosed and previously treated for asthma. Diagnostic tools, such as a questionnaire for asthma diagnosis and an algorithm for differential diagnosis between asthma and COPD are mainly intended to facilitate diagnosis of chronic respiratory disease, particularly bronchial asthma, by a primary care physician and to improve the healthcare quality for these patients.

Chronic obstructive pulmonary disease (COPD) is a major public health problem worldwide. COPD is closely related to comorbid cardiovascular diseases, which contribute to the worsening of COPD and increased mortality. The frequency and prevalence of cardiovascular diseases in patients with COPD is about 64%. Approximately 30% of patients with COPD die from cardiovascular complications. Recent evidence suggests an increased risk of acute myocardial infarction in severe exacerbations of COPD. Tachycardia, increased oxidative stress and systemic inflammation in patients with COPD may contribute to an increased risk of developing cardiovascular complications. Several studies may be useful for early diagnosis, including electrocardiography, imaging methods, and biomarker blood tests. Some drugs that have changed the prognosis for cardiovascular disease, in particular, cardioselective beta-blockers, are underused in patients with COPD, despite proven benefits. This review focuses on some aspects of COPD exacerbation and the risk of cardiovascular disease.

Current view on a relationship between particle pollution, morbidity and mortality of lung carcinoma were discussed in the article. Published epidemiological, clinical and laboratory studies suggest particle pollution, especially metal containing particulate matter (PM), to be a risk factor for lung carcinoma occurrence. PM-associated injury of epithelial cell genome and epigenetic lesions are an important part of pathogenesis of lung carcinoma. Systemic research findings and formalized reports could improve our knowledge on lung cancer pathogenesis and could be used in clinical practice for risk assessment, early detection and prognosis of lung cancer and improvement in treatment efficacy.

Idiopathic pulmonary fibrosis (IPF) is an irreversible progressive diffuse parenchymal lung disease with the median survival of 3 to 5 years. However, antifibrotic therapy can significantly reduce IPF progression rate. The natural course of the disease is difficult to predict in an individual patient. The prognosis and the response to therapy could differ in different IPF patients. Two clinical cases with modified rate of IPF progression under the treatment with nintedanib are described in the article. The late initiation of therapy with nintedanib in a patient with rapidly progressive disease did not slow down the progression rate, while a patient with a relatively favorable course of IPF demonstrated less rapid worsening in clinical and functional parameters under the treatment with nintedanib.

Conclusion. The time-course of clinical and functional parameters is individually related to the disease severity and the potential therapeutic efficacy. The rapidly progressive course of IPF should be considered as a criterion for early initiation of antifibrotic therapy as this treatment could improve the prognosis. Effects of antifibrotic therapy should be assessed using a complex of parameters described the disease severity because IPF can differ in clinical course and progression rate.

Hepatopulmonary syndrome (HPS) in a severe complication of advanced hepatic diseases. IHPS comprises the following triad of signs: 1) hepatic disease, 2) pulmonary vessels dilation, 3) hypoxemia without cardiorespiratory diseases. Clinical manifestations of HPS are cyanosis, finger clubbing, and platypnoea under the hepatic cyrrhosis. A clinical case of HPS in young woman with hepatic cyrrhosis is described in this article. HPS was resolved after the orthotopic liver transplantation.

Inhalation therapy is widely used for treatment of acute respiratory infections and asthma in children, and provides more rapid drug delivery in the airways. Treatment success in children with respiratory diseases is defined not only by an adequate choice of the drug and the dosage regimen, but also by inhalation drug delivery system. The choice of drug delivery device in children depends on the child's age and ability to carry out instructions related to the inhalation technique. Incorrect inhalation technique is associated with inappropriate distribution of the drug in the respiratory tract and an unreasonable increase in the volume of therapy, risk of adverse effects, and the total cost of the treatment. Currently, a great number of various drug delivery systems are commercially available, such as a pressurised metered dose inhaler (MDI), a MDI with spacer and facemask, a dry powder inhaler, and a nebulizer. The most optimal inhalation drug delivery device for children is a nebulizer. In this article, the authors discussed benefits and limitations of various drug delivery systems and modern nebulizers used for treatment of the upper and the lower airways including DuoBaby nebulizer 2-in-1 with a nasal aspirator.