The objective of this study was to evaluate partial pressure of end tidal carbon dioxide (PetCO₂) over time on exertion (E) and its predictive value in evaluation of risk of unfavorable outcome in patients with low ejection fraction (EF) value.

Materials and Methods. Patients (n = 53) with pronounced chronic heart failure (CHF), included in heart transplantation waiting list, were enrolled in the prospective study. All patients underwent cardiopulmonary exercise testing (CPET). Mortality or INCOR left ventricle bypass system implantation according to vital indications within 1 year of follow-up were evaluated as an end-point.

Results. Patients with CHF and low EF were characterized by low parameters of E tolerance and peak oxygen consumption (10.4 (9.6–11.7) ml/min/kg). The average PetCO₂ level by group was 30.4 (28.3–33.0) mm Hg; in 32% of patients this value decreased or did not change in CPET compared with that in resting state. The significant relationship between increased risk of unfavorable outcome within 1 year of follow-up with low baseline PetCO2 value (odds ratio (OR) – 0.22 (0.05–0.87); p = 0.020) and absence of its increment in PE (OR – 0.16 (0.10–0.54); p = 0.009) was observed.

Conclusion. The significant predictive factors of unfavorable outcome within 1 year of follow-up in patients with pronounced CHF and low EF include PetCO₂ value in resting state, as well as PetCO₂ change over time after E challenge.

The difficult tasks of rapid diagnosis and clinical management of patients with this infection have been set for health care professionals and physicians with the emergence of diseases caused by the novel coronavirus (2019-nCoV) in December, 2019. At present time, there is limited information on epidemiology, clinical features, prevention and treatment of this disease. It is known that the most common clinical manifestation of the novel variant of coronavirus infection is pneumonia, the significant patients number have registered the development of acute respiratory distress syndrome. These recommendations in the document are largely based on evidence published by the World Health Organization, the Chinese and American Centers for Disease Control, the European Center for Disease Control specialists, and materials on the treatment and prevention of this infection. The guidelines are intended for physicians at infectious disease treatment and prevention facilities, as well as intensive care physicians at the intensive care departments of the infectious hospital.

Adopted from: Ministry of Health of the Russian Federation. Temporary guidelines for the prevention, diagnosis and treatment of the new coronavirus infection 2019-nCoV. Edition 1 (29.01.20). Available on the website: https://www.rosminzdrav.ru/news/2020/01/30/13236-vremennye-metodicheskie-rekomendatsii-po-profilaktike-diagnostike-i-lecheniyu-novoy-koronavirusnoy-infektsii-2019-ncov

The small respiratory passages dysfunction (SRPD) is found in the vast majority of patients with bronchial asthma (BA). The SRPD is currently recognized as the important pathogenetic feature of BA. The purpose of this review is to analyze the current scientific knowledge about the poorly studied aspects of the small respiratory passages (SRR) participation in the development of pathological process in BA, as well as the impact of small bronchial dysfunction on the clinical course, the exacerbation frequency and the disease control. The importance of SRPD diagnostics in BA patients for optimal and timely treatment is discussed. The modern methods of RPD pathology diagnostics are described; their informative use in the comparative study aspect is considered.

New findings and concepts on a role of so-called “ectopic” chemosensory receptors arise recently. The ectopic receptors are expressed outside their classical localization (nasal cavity) and referred to as extra-nasal olfactory receptors. Functional investigations of the ectopic olfactory receptors in the lungs are also ongoing. To date, it is well-known that molecules of odorous substances (odorants) bind to the G-protein-associated olfactory receptor (Gα_olf) that can activate type III adenylate cyclase and increase concentration of a secondary messenger, cyclic adenosine monophosphate (cAMP). In turn, this induces the opening of cAMP-dependent cationic channels including calcium channels. Olfactory receptor activation in neuroendocrine cells of the lungs affected serotonin release which decreased after the stimulation of those cells by an odorant. Amyl butyrate and burgenal, agonists of OR2AG1 and OR1D2 olfactory receptors, respectively, affect smooth muscle contractibility in human bronchi. Amyl butyrate inhibits histamine-induces muscle contractibility, whereas burgenal increases the smooth muscle contractibility. Both the processes are mediated by cAMP-dependent increase in the intracellular calcium concentration. Data have been published about the receptor expression on immune cells such as monocytes, natural killers, T- and B-lymphocites, and polymorphonuclears. Ectopic olfactory receptors are thought to participate in modulation (controlling) of intrinsic cell functions which provide a special role of inflammatory cells in asthma. In future, the olfactory receptor modulation could be probably used as a novel therapeutic approach in asthma and other chronic inflammatory lung diseases.

Cystic fibrosis (CF) is a severe hereditary disease associated with progressive impairment of respiratory organs. Pulmonary function test (PFT) in CF patients may be relevant for determination of therapy level and patient management strategy. However, PFT is particularly difficult in children aged below 6 years. Literature data concerning options for pulmonary function analysis in children aged below 6 years with CF for assessment of disease severity, progression and monitoring of treatment efficacy are provided in the article.

The purpose of this work was to study the effect of the obstruction level associated with pulmonary embolism (PE) on development of pulmonary infarction (PI) and infarction-related pneumonia.

Materials and Methods. Patients (n = 105) with PTE identified by results of multislice computed tomography (MSCT) with enhancement of pulmonary vessels were enrolled in the study. Among them patients with high risk PTE, survived the 1st week of the disease (n = 53), and with community-acquired pneumonia (n = 54) were present, and in these patients MSCT allowed to detect PTE was performed during week 1.

Results. PI was detected in 58 (95.1%) of 61 PTE patients with obstruction of segmental pulmonary artery (PA) branches and 15 (32.6%) of 46 patients without obstruction of segmental arteries (p < 0.001). In PTE patients with upper obstruction level in PA trunk region, the involvement of segmental branches and PI development were observed in 20.0% of cases, with upper obstruction level in main branches region it was reported, respectively, in 31.8 and 52.3% of patients, and with pulmonary branches involvement – in 80.0 and 100.0% of patients.

Conclusion. PI development is associated with obstruction of segmental branches of PA. The incidence of segmental branches involvement and risk of PI are increased in association with decreased upper obstruction level of PA.

Currently there is no convincing evidence concerning pathogenetic mechanisms of fibrous and sclerotic processes in pulmonary tissue as well as processes of bronchopulmonary system remodeling in patients with chronic obstructive pulmonary disease (COPD) of occupation etiology (OE).

The purpose of the study was to identify relationship between the serum hyaluronic acid (HA) level and severity of obstructive pulmonary ventilation impairment according to spirometry data in subjects with COPD associated with the impact of silica-containing dust and chronic occupational non-obstructive (common) bronchitis (CONB) of occupational etiology.

Materials and Methods. Patients (n = 153) with the diagnosis OE COPD (n = 92), OE CONB (n = 36) and healthy subjects participated in the study.

Results. The study data demonstrated that serum HA level in patients with OE COPD and CONB was 3–5 times higher than that in healthy subjects (p = 0.0001). In patients with OE COPD HA concentration was significantly higher, than that in subjects with OE CONB (p = 0.039). Negative correlation between HA concentration and forced expiratory volume in 1 second value was observed (p = 0.006; R = –0.31). There was statistically significant positive correlation between HA level and disease duration (р = 0.021; R = 0.21).

Conclusion. Serum HA level in patients with OE-related COPD and CONB may be used as a biomarker of fibrous and sclerotic process in pulmonary tissue, reflecting progression of obstruction and remodeling of small bronchi.

The purpose of this study was to determine detection rate and clinical and morphological characteristics of mediastinal lymphadenopathy (ML) in patients with respiratory system sarcoidosis (RSS), disseminated pulmonary tuberculosis (DPT) and exogenic allergic alveolitis (EAA).

Materials and Methods. Patients (n = 278) with established diagnosis RSS, DPT, EAA were investigated. The cumulative index parameters were determined, hematology test, assessments of pulmonary function, diffuse lung capacity, diffusion coefficient were performed in all patients. Computed tomography of chest organs and morphologic examination of mediastinal lymph node (LN) biopsy were performed.

Results. Subjects with newly diagnosed (n = 72) and recurrent (n = 104) disease were observed among patients with RSS (n = 176). ML was observed in 95% of cases, involved bronchopulmonary, bifurcation, paratracheal and paraaortal groups; dimensions of intrathoracic LN (ITLN) were 20.0 ± 1.9 mm. Epitheliocellular granulomas (EG) without necrosis, not fusing with each other, were established morphologically; they were determined in recurrent disease course in association with background fibrosis. In patients with DPT (n = 41), subacute (n = 28) and chronic (n = 13) disease course was noted. With subacute course of DPT in 28.6% of cases, ML of paratracheal and bifurcation groups (dimensions of ITLN – 13.1 ± 0.3 mm) was observed, with chronic course – the enlargement of paratracheal and bronchopulmonary LN (7.7% of cases). EG with necrosis and tendency to fusion was verified histologically; inflammatory process involved LN capsule and could be spread to fatty tissue. In patients with EAA (n = 76), acute (n = 10), subacute (n = 38) and chronic (n = 28) disease courses were observed. With acute EAA course, hyperplasia of ITLN of bifurcation and tracheo-bronchial groups up to 13.5 ± 0.6 mm was observed in 20% of cases. Follicular hyperplasia with widening and edema of hermintative centers was observed at morphological investigation. With subacute EAA course, increased ITLN in bifurcation and broncho-pulmonary groups up to 13.6 ± 0.6 mm were observed in 46% of cases. Formation of histiocytic-macrophagal granulomas without epithelioid cells and deposit precipitation in the plasma cell aggregation areas was found at morphological evaluation. With chronic EAA, ML in broncho-pulmonary and paratracheal groups was detected in 17.8% of cases (enlargement of LN up to 11 ± 0.9 mm). The formation of diffuse and focal fibrosis and hyalinosis was noted morphologically.

Conclusion. ML is observed in all granulomatous pulmonary diseases studied, however its rate and severity, composition of involved ITLN groups and character of morphological changes is different which is possible to use in diagnostics.

The article discusses the results of a phase III clinical trial to compare the pharmacokinetics, efficacy and safety of the biosimilar medicinal product Tigerase^® (dornase alpha) (Generium JSC, Russia) and the reference medicinal product Pulmozyme^® (F.Hoffmann-La Roche Ltd, Switzerland) with the purpose of establishing their comparability for symptomatic treatment of patients with cystic fibrosis (CF).

Methods. The study included 100 patients aged 18 years and older with a confirmed diagnosis of CF, who were divided into two groups by stratified randomization in a ratio of 1 : 1 based on the initial level of FEV₁ (40–60% or > 60–100% from due value). Tigerase^® or Pulmozyme® were used in a dose of 2.5 mg daily, once a day in the form of inhalations using a jet nebulizer compressor for 24 weeks.

Results and discussion: The analysis of the data regarding the primary efficacy endpoint – changes in FEV₁ – showed that in both groups (FAS population (Full analyses set) and PP population (Per protocol)), similar changes in FEV₁ were observed. The average value of changes in FEV₁ after 24 weeks of treatment compared with the initial level in the FAS population was –1.3% ± 9.8 % (95% CI (–4.1; 1.6)) in Group I (Tigerase^®) and –1.9% ± 10.0% (95% CI (–4.7; 1.0)) in Group II (Pulmozyme^®). The point estimate for the intergroup difference in changes in FEV₁ (Group I – Group II) was 0.6%. The calculated 95% CI for the difference in changes in FEV₁ in the FAS population was (–3.3; 4.6%]. In both populations studied, the intergroup difference in changes in FEV1 did not exceed 6%. During long-term treatment of patients with CF, no statistically significant differences were found in terms of efficacy (changes in FEV₁ and FVC; number of exacerbations of chronic pulmonary disease and the number of days before its development; change in body weight; quality of life) between medicinal products in both studied populations (FAS and PP).

Conciusion. A safety analysis demonstrated the comparability of medicinal products in terms of the incidence of adverse events. The frequency of detection of antibodies to dornase alpha during the study was similar in the treatment groups; the formation of antibodies did not lead to a decrease in the efficacy and safety of therapy.

The purpose of the study was to perform comparative assessment of circulating diene conjugant (DC, rel. u.) and Schiff's bases (SB, rel. u.) levels, intensity of chemiluminescence (I_max, rel. lum. u.) in serum and antioxidant activity (AOA) in patients with chronic obstructive pulmonary disease (COPD) exacerbation taking into consideration broncho-obstructive disorder severity.

Materials and Methods. Patients (n = 119; mean age – 62.0 ± 4.8 years) with COPD were studied. Forced expiratory volume in 1st second (FEV₁) in subjects, randomized in group 1 (n = 31), was ³ 80%, in group 2 (n = 43) – 79-50%, in group 3 (n = 45) – < 49%. The control group (n = 21) comprised of healthy non-smoking volunteers of matching age.

Results. It was established that changes in oxidative stress (OS) parameters in patients with COPD could be bidirectional depending on ventilation disorder severity. The level of SB was increased in association with disease severity increasing. High level of DC and I_max in all studied subjects was progressively decreased in association with increasing bronchial obstruction severity. There was 2-times increase of AOA at COPD exacerbation in patients of group 2 and significant decrease of this parameter in association with severe bronchial obstruction (FEV₁ < 49%) compared to controls.

Conclusion. The associations between levels of studied OS parameters and bronchial obstruction degree in patients with moderate and severe broncho-obstructive disorders.

Chronic obstructive pulmonary disease (COPD) is a disease holding a stable position in morbidity and mortality structure in patients aged over 40 years.

The aim of the study was to evaluate the condition of otorhinolaryngological (ENT) organs in patients with the COPD at different disease periods with subsequent analysis of COPD exacerbation rate based on the results of therapy regimen change according to the established comorbidity.

Materials and Methods. Examination of ENT organs was performed in patients with COPD (n = 99) Patients from group 1 (n = 50) were treated at Pulmonary Department of the Regional State Budgetary Health Institution "Vladivostok Clinical Hospital No.1" for disease exacerbation; outpatients from group 2 (n = 49) had stable COPD course. Control group (n = 50) included patients without history of smoking and without respiratory and hearing disorders. All patients were matched by age and sex. Repeated examination was conducted in patients (n = 72) with stable COPD after 6 months.

Results. It was observed that patients from groups 1 and 2 had different severity of disease symptoms, but equally high (> 2) risk of COPD exacerbation within 1 year. 50.0 and 42.9% of patients actively complained about the ENT organ-related conditions during the periods of COPD exacerbation and stable course, respectively. Among ENT organ diseases the most frequent were laryngeal diseases reported in 84.0 and 73.5% of patients with COPD exacerbation and stable course, respectively. The chronic catarrhal rhinitis and pharyngitis were revealed in 26 and 30% of patients with COPD exacerbation (p < 0.01). According to the data of 6-month study, the number of COPD exacerbations in high-risk patients with COPD using personal treatment plan for ENT-organ diseases was reduced by half, which had a positive effect on the condition of ENT-organs.

Conclusion. The study showed that patients with COPD often ENT-organ-related complaints – in the exacerbation period about 50% of patients, and at stable course – 43%. Patients most often complain on glottic incompetence with the most pronounced symptoms at COPD exacerbation. Decreased number of COPD exacerbations by 2 times in patients with high risk of their occurrence and improvement of ENT organ condition were noted if ENT diseases were timely treated. ENT specialist consultation should be provided at dispensary observation organization for patients with COPD in order to personalize the treatment plan depending on the clinical situation.

Computed tomography (CT) of chest organs is one of the most accurate diagnostic methods allowing the physician to assess the condition of lung parenchyma. Correct interpretation of CT results requires the clinician to recognize normal appearance of lung parenchyma on X-ray and know changes visualized in various bronchopulmonary diseases. It is important that the physician knows and understands underlying cause of a particular radiological pattern in order to discuss with the radiologist lung tissue changes that have been identified considering clinical symptoms. Descriptions of radiological patterns and discussion of corresponding typical clinical observations are presented in the article devoted to air cyst syndrome and cystoid changes in the lung tissue.

A clinical case of a female patient of 44 years old with chronic respiratory failure (CRF) and alveolar hypoventilation caused by congenital kyphoscoliosis is described in this article. Noninvasive ventilation was initiated using bilevel positive air pressure (BiPAP) with the controlled minimal respiratory rate (the ST mode). The respiratory support was preformed around-the-clock with short breaks for eating and taking hygienic procedures; later, the respiratory support was administered at nighttime only combined with low-flow oxygen 3 to 4 L followed by the decrease of the oxygen flow to 2 L. Such treatment allowed active lifestyle including travelling and teaching. The patient was followed-up for 4 years. Nighttime oxygenation disorders are typical in severe kyphoscoliosis and precede the development of CRF at daytime. Noninvasive respiratory support can improve pulmonary ventilation during night sleep and gas exchange at waking time. Unfortunately, respiratory support is used very rarely in patients with stable CRF, as some physicians consider this treatment only in critical and terminal conditions.