Chronic  bronchitis (CB) is one of the most common  respiratory diseases. An important  risk factor of CB is tobacco smoking which is highly prevalent in the Russian Federation (RF). In 2013, a Federal Law about health protection against second-hand tobacco smoke exposure and consequences of tobacco consumption came into the legal force in the RF. This law resulted in a significant reduction in the prevalence of active and passive tobacco smoking. The aim of the present  research was to analyze an impact  of the governmental  tobacco  control  policy on CB incidence  in the RF. Methods: The incidence of CB was analyzed using the official statistics for the period of 2009 – 2017 and was defined as number of newly diagnosed CB patients per 100,000. To evaluate an impact of the Federal Law on CB incidence,  primary morbidities were compared between the years 2009 – 2013 (before adoption of the Law) and 2014 – 2017 (after adoption of the Law). Results. Before the year 2013, the CB incidence had tended to a substantial increase followed by its reduction after the year 2014. A relative reduction in the CB incidence in 2014 – 2017 was ≥ 36%. Conclusions: The current analysis demonstrated a steady downward trend in CB incidence in RF after the adoption  of the Federal Law on tobacco control policy in 2013. This is probably related to decreasing prevalence of active smoking and to second-hand smoking reduction  as well. Therefore,  the comprehensive governmental tobacco control strategy positively inf luenced on the health status of Russian population.

This is clinical recommendations for the diagnosis of idiopathic  pulmonary  fibrosis (IPF). The document  was developed by American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society. Methods: The evidence syntheses were discussed and recommendations formulated  by a multidisciplinary  committee  of IPF  experts. The evidence was appraised and recommendations were formulated,  written, and graded using the GRADE  approach.  Results: The guideline panel updated the diagnostic criteria for IPF. Previously defined patterns of usual interstitial pneumonia (UIP)  were refined to patterns of UIP,  probable UIP,  indeterminate, and alternate  diagnosis. For patients with newly detected interstitial lung disease (ILD)  who have a high-resolution computed  tomography scan pattern of probable UIP,  indeterminate, or an alternative diagnosis, conditional recommendations were made for performing BAL and surgical lung biopsy; because of lack of evidence, no recommendation was made for or against performing transbronchial lung biopsy or lung cryobiopsy. In contrast,  for patients with newly detected ILD who have a high-resolution computed  tomography scan pattern of UIP,  strong recommendations were made against performing surgical lung biopsy, transbronchial lung biopsy, and lung cryobiopsy, and a conditional recommendation was made against performing BAL. Additional recommendations included a conditional  recommendation for multidisciplinary  discussion and a strong recommendation against measurement  of serum biomarkers for the sole purpose of distinguishing IPF from other ILDs. Conclusions: The guideline panel provided recommendations related to the diagnosis of IPF.

Authors of this review described gene polymorphism  involved in the development  of the immune  response in sarcoidosis. Gene background could determine not only the subject’s susceptibility to sarcoidosis, but also a clinical course of the disease. Currently,  allele variants that could be used as prognostic markers to reveal subjects susceptible to sarcoidosis and to predict a clinical course of sarcoidosis are investigated. Published data on a relationship between the carriage of certain allele variants and the subject’s susceptibility to sarcoidosis are scarce and controversial. Nevertheless, those data could be used to detect potential goals for targeted therapy of sarcoidosis and to develop measures to prevent this disease.

Frequency and clinical manifestations of respiratory disease in systemic connective tissue diseases (CTD) differ significantly including clinical course and outcomes. Pulmonary  abnormalities  are seen in 20% to 95% of patients with CTD ranging from subtle to life-threatening disease and could be fatal. Commonly, CTD-related interstitial lung disease (ILD)  is crucial for prognosis. Interstitial  pneumonias  are the most frequent variant of respiratory disease in patients with CTD.  CTD-related ILDs comprise 15% to 25% of all ILDs. Usually, respiratory disease develops in symptomatic CTD,  but in some cases, ILD can be the first appearance  of CTD which precedes systemic symptoms that could significantly impede early diagnosis. Therefore,  diagnostic workup in ILD should consider extrapulmonary  manifestations  of CTD.  Moreover,  an intrinsic part of diagnostic algorithm should be specific laboratory assessment including measurement  of autoantibodies.  Combination of specific antibodies and clinical features provides higher probability of CTD diagnosis.

Аcute respiratory infection (ARI) is one of the most prevalent diseases worldwide. The disease occurs in any age, so its course could be associated with complications  and poor outcome.  Prevention  and treatment of ARI and complications  are important  problems in clinical practice.  Recent researches of human microbiome  composition  and functions have aroused a great interest to this field in order to prevent ARIs.

In this review, the authors discuss non-specific  mechanisms  of human  innate antiviral defense and available data about a role of symbiontic intestinal microf lora for ARI prevention. Typically, main biological properties of probiotic bacteria are considered in the context of modulating effects on the inf lammatory immune response. Published data demonstrated reduction in the risk, severity and duration of ARI under the treatment with probiotic agents both in the children and in adults. The strain-specific effect and potential molecular antiviral mechanisms of probiotics enhancing the antiviral response of symbiontic bacteria are also discussed in the review.

This epidemiological survey was aimed at investigation of prevalence of bronchial asthma, allergic rhinitis and atopic dermatitis in adult population of Moscow. Methods. This study was a part of Global Allergy and Asthma European  Network (GA2LEN). Moscow families having children of 15 to 17 years of age (n = 2 397) were interviewed using a validated Russian GA₂LEN  questionnaire. The responders were stratified into groups according to age: 15 to 24 years of age (group 1; n = 1 252; 85% responded)  and 25 to 74 years of age (group 2; n = 1 145; 76.6% responded).  Statistical processing of data was carried out using Statistica.10 and EPINFO.7 (WHO) software. Results. Prevalence of wheezing, chest tightness, waking up shortness of breath and asthma attacks at rest was higher in group 1 responders compared to group 2 (25.8 vs 18.8% (p < 0.001), 41.9 vs 20.0% (p < 0.001); 15.8 vs 5.7% (p < 0.001); and 10.6 vs 2.6% (p < 0.001), respectively). Asthma was confirmed  in 4.1% and 8.5% in groups 1 and 2, respectively (p < 0.001). Asthma attacks were reported  by 37.3% and 65.6% of respondents  in groups 1 and 2, respectively (p < 0.001), in previous 12 months. Medications  for asthma were administered  to 33.3% and 60.0% of respondents,  respectively (p = 0.002). Symptoms of allergic rhinitis and atopic dermatitis were reported  more frequently by group 2 respondents  compared  to group 1. On contrary,  symptoms of allergic sinusitis were reported more frequently by group 1 respondents compared to group 2. Smoking, NSAID intolerance  and acute respiratory viral infection rate were higher in group 2; food allergy was more frequent in group 1. Conclusion. Asthma prevalence and severity in adult population  increase with age. This could be caused by different rates of risk factors in various age groups.

The first aim of this study was to compare an incidence  of sarcopenia in patients with chronic obstructive pulmonary disease (COPD) when using updated (2018) the European  Working Group on Sarcopenia in Older People (EWGSOP)  algorithm compared to the previous version (2010). The second aim was to determine relationships between clinical and functional parameters of COPD  and parameters of sarcopenia. Methods. The study involved 86 stable COPD  patients (68 males; mean age, 66.6 ± 8.7 years). The diagnosis of COPD  was made according to GINA 2019. Sarcopenia was diagnosed according to EWGSOP guidelines 2010 and 2018. Muscle mass was assessed using dual-energy Xray absorptiometry  (DXA). Results. Walking speed was measured in all patients according to EWGSOP guideline 2010. Additionally, hand muscle strength was measured in patients with walking speed > 0.8 m/s (n = 25). DXA was required to 72% of patients to confirm the diagnosis of sarcopenia. Sarcopenia was defined in 38 (44.1%) patients including severe sarcopenia in 20 (23.3%). According to results of SARC-F  questionnaire, further hand muscle strength measurement  was required to 64 patients and DXA was required to 51 (59.3%) patients. As a result, sarcopenia was confirmed in 38 (44.1%) patients including severe sarcopenia  in 34 (39.5%) patients.  The incidence  of sarcopenia  was higher in patients  with more  severe symptoms  of COPD  and more  severe bronchial obstruction  (р = 0.001), and in patients with emphysema (р < 0.03). Conclusion. The incidence of sarcopenia in COPD  patients did not differ when used different diagnostic algorithms (EWGSOP, 2010 vs 2018) and was 44.1%. The need in additional tests, including expensive tests, was lower and the incidence  of sarcopenia was higher (39.5% vs 23.3%) following the EWGSOP  algorithm,  2018, compared  to that of 2010. The incidence  of sarcopenia  increased  in more  severe COPD, in patients  with emphysema,  severe clinical symptoms,  severe and very severe bronchial obstruction.  The incidence of sarcopenia was not related to the patient’s age.

The aim of the study was to analyze a diagnostic value of respiratory muscle (RM) strength indicators to assess severity of chronic obstructive pulmonary disease (COPD) using machine learning methods and artificial neural networks (ANN). Methods. One hundred and fifteen males with acute exacerbation  of COPD  were involved in the study. RM strength indicators (MEP,  MIP,  and SNIP), demographic  parameters,  spirometry,  blood gases, dyspnea with mMRC and CAT scales were measured. Statistical analysis was performed using Mann-Whitney’s, Fisher’s and Tukey’s tests and correlation  analysis. RM strength model was performed  using linear and nonlinear  regression analysis. COPD  stratification  model was performed using ANN. Results. RM strength models in healthy males and COPD  patients allowed estimation  the impact of different factors on the RM functional status. Comparison  of COPD  stratification  for severity using the mathematical model or expert diagnosis showed that combination of FEV1 with other indicators could increase the accuracy of ANN model. MIP,  the total body mass, partial CO2  tension in the arterial blood and serum fibrinogen concentration were the most valuable indicators.  Moreover,  MIP  was considered  as the universal predictor  increasing the accuracy of all models. Conclusion. Practical application  of ANN models in telemedicine  projects is related to the improvement  of ANN architecture and development of informational services which would allow a real-time assessment of the patient's condition.

The aim of this study was to investigate arterial wall stiffness and its relationship with right ventricle systolic function (RVSF) in patients with interstitial lung disease. Methods. Fifty patients with chronic hypersensitivity pneumonitis (HP) and 26 patients with idiopathic pulmonary fibrosis (IPF) were included. Spirometry,  body plethysmography  were performed,  lung diffusion capacity for carbon monoxide (DLCO), blood gases and arterial wall stiffness were measured. High resolution computed  tomography (HRCT) of the chest was assessed using Kazerooni  scale. Results. The aortic pulse wave velocity (PWV, m/s) was increased in 26 (52%) patients with HP and in 14 patients with IPF. Correlation  analysis showed statistically significant  association  between  PWVАo  and DLCO  (p < 0.05),  partial  oxygen pressure in the arterial  blood (PaO2)  (p < 0.05),  pulmonary  fibrosis (p = 0.001), and the extension of ground glass opacities (p < 0.05). Tricuspid annual plane systolic excursion (TAPSE),  right ventricular myocardial performance  index (MPI)  and tricuspid annular systolic velocity (S’) were significantly related to PWVАo, ambulatory arterial stiffness index (AASI) and augmentation index (AIx) (p < 0.05). Conclusion. Increased arterial stiffness was often found in patients with HP and IPF. The increased arterial stiffness is associated with hypoxemia, pulmonary fibrosis and decreased lung diffusion capacity. The arterial stiffness is also related to the right ventricular systolic dysfunction.

The purpose of this study was to investigate trends of morbidity  and course of pulmonary  tuberculosis  in healthcare  workers at the North-West Federal District during the period of 2000 – 2017. Methods. This is a retrospective study. Medical records of North-West  Federal Research Center of Hygiene and Public Health from the years 2000 – 2017 were analyzed. Results. Cases of pulmonary tuberculosis in healthcare workers were included in the analysis. The highest morbidity of pulmonary tuberculosis was registered in 2006 (19%), 2007 (16%) and 2010 (21%). Information on habitation of tuberculosis patients was of particular interest. Physicians (34%), nurses (54%), cleaning personnel (7%) and technicians (5%) were among healthcare  workers with pulmonary tuberculosis. Tuberculosis was diagnosed during preventive examination  in 48% and at presentation in 52% of cases. Conclusion. Majority of new cases of pulmonary  tuberculosis in healthcare  workers were diagnosed at presentation  with advanced clinical symptoms. This situation is associated with an increased risk of the infection spread. Preventive measures should be developed in order to diagnose tuberculosis in an earlier stage.

The current Russian guideline on diagnosis and treatment of pulmonary hypertension  (PH) includes several diagnostic algorithms allowing diagnosis of PH and estimation of PH functional class in accordance  to PH clinical classification; such approach is aimed the optimal management  of the patient. Authors of this publication described the clinical case of a female patients with idiopathic PH and probable secondary in situ thrombosis at a large pulmonary  artery branch.  The correct diagnosis and the treatment choice require a detailed diagnostic work-up  to assess PH type in the patient with pulmonary artery thrombosis.

Two clinical cases of severe eosinophilic asthma taking long-term  therapy with mepolizumab  (38 and 45 months are described in the article. Both the cases demonstrate  the effectiveness of the drug both in allergic and non-allergic  (aspirin-induced) asthma. Significant clinical improvement  was achieved in both cases under the treatment with mepolizumab  during ≥ 3 years. Important results of the treatment were improvement  in symptoms of severe asthma, reduction in exacerbation rate, and, additionally,  overcoming corticosteroid  addiction in patients. The therapy with mepolizumab was highly safe.

According to current evidence, therapy with inhales corticosteroids (ICS) is unsuccessful in majority of patients with chronic obstructive pulmonary disease (COPD). Moreover,  long-term  therapy with ICS significantly increases the risk of adverse events. According to recent  international and Russian guidelines, there is a limited role of ICS in the management  of COPD  patients. The optimal risk/benefit ratio could be achieved in specific populations  of COPD  patients only. Therefore,  an therapeutic  algorithm for COPD  patients in Russia needs to be updated. A strategy of ICS with-drawal in patients who would not benefit from ICS should be included in the algorithm.  Based on actual findings, experts of Russian Respiratory Society updated the Russian algorithm for management  of COPD  patients including possibility of ICS withdrawal.