One of the directions in the study of diseases is their phenotyping. Thus, understanding the peculiarities of bronchial asthma (BA) and various types of obesity phenotypes combination will not only provide a differentiated approach to treatment, but also achieve maximum therapeutic effect. The aim of this study was to evaluate clinical and laboratory features of various obesity phenotypes in BA patients at a young age in order to optimize antiasthmatic therapy and early diagnosis of cardiovascular complications. Methods. Patients with BA of different severity were examined (n = 164); the control group was made up of relatively healthy subjects (n = 40). The subjects were divided into groups with BMI (Body Mass Index); the 1 st group (n = 93) included patients with BMI 18.5–24.9 kg/m²; the 2 nd group (n = 80) included BA patients with BMI 30–34.9 kg/m² (1st degree obesity). Overweight patients were detected, clinical and functional examination was performed, epicardial adipose tissue thickness (EATT) was measured by standard two-dimensional echocardiography (EchoCG), obesity degree, cytokine, adipokine, insulin levels, insulin resistance indices were determined. Results. According to the results of the study in patients with BA and metabolic fat obesity phenotype (MFOP) a significant disorder of adipokine balance was revealed, carbohydrate metabolism disorder was noted, and significantly higher insulin levels were observed, insulin resistance index (Homeostasis Model Assessment of Insulin Resistance – НОМА-IR) and decrease in insulin sensitivity index (ISI) relative to the group of patients with metabolically healthy obesity phenotype and control. Conclusion. It has been established that the EATT determined by the EchoCG method can serve as a predictor of MFOP and a risk factor for cardiovascular diseases.

The pathogenesis of bronchial asthma (BA) is based on chronic allergic inflammation of bronchi, which affects not only microcirculation disorders, activation of lipid peroxidation, but also tissue remodeling. Matrix metalloproteinases (MMP) and epithelial growth factor (EGF) play a significant role in bronchial remodelling processes. This paper attempts to investigate the effect of gene mutations ММР and EGFR on the development of BA as well as evaluate the role of intergenic interaction. Methods. Polymorphic variants were studied in BA patients and control group patients by allelspecific polymerase chain reaction (using SNP-express reagent kits). 2073A>T gene EGFR, 320A>C gene MMP20, 837Т>C gene MMP20 и -8202A>G gene MMP9. Results. The analysis of the genetic study results showed statistically significant differences in the frequency of alleles and genotypes in polymorphism. 2073A>T gene EGFR among BA patients and control group children (p < 0.05). Significantly increased allel frequency is registered. 2073T gene EGFR in the group of BA patients (82.5%) compared to the control group (55.8%) (p = 0.003). In the study of genes polymorphisms of matrix metalloproteinases no statistically significant differences were revealed. However, the analysis of intergenic interaction shows that polymorphisms -8202A>G gene MMP9 and 2073A>T gene EGFR have a synergistic effect on each other, increasing the risk of developing BA in children. Conclusion. According to the results of studies it was found that the risk of BA development is significantly increased in homozygotes on T-allel polymorphic variant 2073A>T gene EGFR, with the frequency of occurrence of genotypes and alleles of this polymorphism statistically significantly different from the control group (p < 0.05).

The course of bronchial asthma (BA) is accompanied by pathological changes in the bronchopulmonary and cardiovascular systems. The severity of heart functional disorders depends on the severity of the BA Course, the level of control and the frequency of application of short-acting β₂ -agonists (SAβ₂A). The aim of the study was to analyze the impact of BA control on the development of cardiovascular disorders in children of early school age. Methods. Children (n = 95) aged 7–12 years with BA of varying severity and different levels of control were examined. The analysis of indicators of the clinical and functional state of the vegetal nervous system (VNS) and cardiovascular system tone using standard electrocardiography, echocardiography with calculation of the left ventricular myocardial mass index, сardiointervalography was performed. Results. Changes in VNS with signs of its depletion and decrease in adaptive capacity, cardiac rhythm and conduction disorders, connective tissue dysplasia syndrome, hemodynamic disorders and signs of adaptive heart remodeling have been detected. Conclusion. Lack of control over BA and the use of SAβ₂A promote cardiovascular disorders.

The purpose of the work was to evaluate the frequency and severity of lung functional disorders, the relationship between respiratory function (RF) and clinical symptoms in patients with idiopathic pulmonary fibrosis (IPF). Materials and Methods. The National Registry registered IPF patients (n = 127; 90 (71%) men, 37 (29%) women; average age 69.5 ± 8.5 years), by March 2019 lived in Moscow and Moscow region; at the time of inclusion in the register the duration of the disease was 3.3 ± 3.1 years (22 (17%) < 1 year). The diagnosis of IPF is based on the clinical picture of the disease, the results of high-resolution computed tomography and/or histological examination of the material obtained by surgical lung biopsy. The data of the complex RF examination (spirometry, Body plethysmography, lung diffusion capacity by carbon monoxide – DL_CO), 6-minute walking test (6-MWT) and dyspnea evaluation according to the modified dyspnea scale (Modified Medical Research Council – mMRC) at the moment of inclusion in the register are analyzed. Results. Average value of forced vital capacity (FVC) was 78 ± 22% debt, ratio of forced expiratory volume for 1 s/FVC – 83 ± 9%, total lung capacity (TLC) – 77 ± 17% debt, DL_CO – 47 ± 18% debt. DL_CO, TLC, FVC were reduced in 97.5, 63 and 59% of patients respectively. In patients with a disease duration of less than 1 year, DL_CO was significantly higher than that of less than 1 year. The median distance covered by the 6-MWT was 317.5 m, dyspnea according to the mMRC scale – 2 points. Statistically significant correlations between RF values and shortness of breath, tolerance to physical activity have been revealed. Conclusion. In patients with IPF, included in the National Register, restrictive disorders of pulmonary ventilation were detected in the majority of cases, reduced DL_CO – in 97.5%. Statistically significant higher DL_CO values are noted for a disease duration of less than 1 year.

Chronic obstructive pulmonary disease is a significant problem for Russian healthcare. The identification of different clinical phenotypes of the disease may allow individualizing approaches to the treatment of patients with this pathology, while there is insufficient data on the phenotypic characteristics of patients with COPD in Eastern and Central Europe. Methods. The article presents data from 356 outpatient patients with COPD with a smoking history of more than 10 pack/years, who were included in the study randomly without prior selection or invitation. 57.6% of persons were patients without frequent exacerbations. Patients with frequent exacerbations were 33.7% (without the presence of chronic bronchitis – 9.3% and with the presence of chronic bronchitis – 24.4%). An overlap of bronchial asthma and COPD was revealed in 8.7% of the included patients. According to the GOLD (2011), 7% of patients belong to group A, 26.4% to group B, 4.2% to group C, and 63.4% to group D. Results. This paper presents the results of the Russian part of the international POPE-study (Phenotypes of COPD in Central and Eastern Europe), which contains data on COPD clinical phenotypes in Russian patients with a verified diagnosis of COPD. A detailed description of spirometric data, comorbid pathology, and prescribed medications depending on clinical phenotypes is given. A high level of administration of inhaled glucocorticosteroids was revealed, which even patients without frequent exacerbations received in 54% of cases. Conclusion. The obtained data will help to develop optimal approaches to eliminate discrepancies between clinical recommendations for managing patients with COPD and actual clinical practice in Russia.

The aim of this study was to study the relationship between heart rate variability (HRV), 6-minute walking test (6-MWT) and ergoreflex to assess the functional status of patients with chronic obstructive pulmonary disease (COPD). Methods. The study included men with COPD (n = 64; mean age 64.98 ± 8.67) and control group volunteers without respiratory disease (n = 41; mean age 61.68 ± 9.21). Spirometry, 6-MWT, HRV analysis before, during, and after the external peripheral vascular occlusion test were performed in all patients and subjects of the control group to evaluate ergoreflex (reflex regulation of the body by means of the reaction of ergoreceptors located in muscles to the accumulation of metabolic products and mechanical muscle stretching). Results. The distance covered during the 6-MWT differed significantly between patients with COPD and those in the control group (p < 0.01). In 22 (34.4%) of the 64 patients with COPD, a decrease in saturation rate (SpO₂) of ≥ 4% (p < 0.01) was observed during 6-MWT, while no data for SpO₂ reduction at rest were obtained. During evaluation of ergoreflex by HRV changes in patients with COPD the data testifying to its hyperactivity, causing persistent predominance of the sympathetic VNS in patients with COPD, that is reflected in "deterrence" of HRV changes during the external peripheral vascular occlusion test. Correlations between 6-MWT, spirometry and HRV have been found, indicating a high level of adherence to 6-MWT in assessing the functional status of patients with COPD. Conclusion. Differences in results of external peripheral vascular occlusion test in COPD patients and healthy subjects are interpreted by hyperactivation of ergoreflex in COPD patients, which is consistent with the increase of muscle fatigue during 6-MWT. The data of 6-MWT correlate with HRV indices, and when the techniques are applied together, the possibilities of estimating the functional status of patients during the load tests are extended. Evaluation of ergoreflex is recommended for objectification of ideas about functional status of patients with COPD before implementation of basic rehabilitation programs.

The purpose of the study was to evaluate the protective effect of the inhaled glucocorticosteroids of beclomethasone dipropionate (BDP) using the experimental model of chronic obstructive pulmonary disease (COPD). Materials and Methods. The COPD model was reproduced in rats (n = 30) during a discrete 60-day exposure to nitrogen dioxide, 9 individuals formed an intact group. Inhalation of BDP (50 micrograms per day) and control (n = 15) placebo inhalation were performed for 60 days in the rats in the experimental group (n = 15). The cell composition and cytokine enzymatic profile of bronchoalveolar lavage fluid (BALF), its content of secretory immunoglobulin A (sIgA) and surfactant protein D (SP-D) were determined by ELISA. Histological and morphometric lungs examination was performed. Results. Typical for COPD pathomorphological changes in the lungs were determined in the placebo group, the content of inflammatory cells and pro-inflammatory mediators in BALF increased, the functional activity of bronchoalveolar epithelium (SP-D, sIgA) deteriorated. There was a clear trend in the activity of neutrophilic-lymphocytic inflammation decrease with normalization of the profile of pro-inflammatory cytokines and enzymes in BALF In the group of animals receiving BDP; there was also a restoration of the morphological structure of the bronchoalveolar epithelium and improvement of its functional activity. Conclusion. The using of BDP in rats with the experimental COPD model had an expressed anti-inflammatory effect associated with the activation of physiological repair processes in the lungs, manifested by the restoration of structural, immune barrier integrity and functional activity of the bronchoalveolar epithelium.

The questions not only about the optimal choice of antibacterial therapy in case of infection exacerbation of chronic bronchitis (CB), but also about the place of topical antibacterial drugs (TAD) are considered in this article. The aim of the study was to evaluate the clinical efficacy of combined inhalation TAD with mucolytic effect of thiamphenicol glycinate acetylcysteinate in patients with infectious exacerbation of CB. Methods. The study included patients (n = 99) with the CB, observed at the City Consulting and Diagnostic Pulmonology Center (Chelyabinsk). Two groups of patients were formed: 1^st group (n = 44; mean age 46.3 ± 3.5 years) – subjects who received systemic ABD (amoxicillin/clavulanic acid 500/125 mg 2 times a day) and mucolytic drugs (acetylcysteine 600 mg 1 time per day); 2^nd group patients (n = 45; mean age 45.9 ± 3.6 years) were administered Fluimucyl Antimicrobiotic IT at a dose of 500 mg per day by inhalation with nebulizer for 6 days. Results. According to the data of the conducted study the significant advantages of the use of inhalation ABD with mucolytic effect in the treatment of patients with acute CB in comparison with systemic ABD in combination with tableted acetylcysteine in the form of shortness of breath, cough, sputum excretion, improvement of patients quality of life in general are demonstrated. Conclusion. In most cases, when used in outpatient practice safe, with a good profile of sensitivity and resistance of inhalation ABD with mucolytic effect significantly improves the quality of management of patients with infectious CB exacerbation.

Surgical biopsy – an invasive procedure that may be accompanied by an increased risk of complications and lethality is required in approximately ⅓ cases when diagnosing interstitial lung diseases (ILD). The article summarizes the experience of using surgical diagnostic methods in patients with ILD. Methods. A retrospective analysis of the medical records of patients (n = 104: 61 (59%) men, 43 (41%) women; at the age of 20–78 years) who were operated on for ILD for histological verification of the disease was carried out. The method of choice was video-assisted thoracic edge resection of the lung (VATER). If there are contraindications to VATER, thoracotomy was performed. Patients with spontaneous pneumothorax (SP) episodes had an anamnesis of costal pleuralectomy in order to prevent recurrence. Results. According to the examination data, the average rate of forced expiratory volume in the 1^st second during the preoperative examination was 73.8%, lung diffusion capacity – 63.2% VATER was performed for 99 (95%) patients, OPD – 4 (4%), access conversion – 1 (1%). In 10 (10 %) cases in the anamnesis or at admission is noted by SP. Postoperative complications were observed in 5 (5%) cases. All complications are eliminated without invasive procedures. There were no lethal outcomes. Conclusion. In 94% of cases of ILD, an accurate diagnosis was made using surgical methods, which was significantly reflected in the development of treatment tactics in 82 (79%) patients and allowed for effective anti-relapsing treatment in case of complication of the main disease – SP. This fact testifies to the high diagnostic significance of surgical methods in patients with ILD, and the low level of complications – about their relative safety in properly selected patients.

The bronchoectasia (BE) is a chronic heterogeneous lung disease characterized by recurrent infection, inflammation, persistent cough and sputum discharge. The early BE diagnosis is one of the main recommendations of the European Respiratory Society (ERS) guidelines, which requires medical history collection and multispiral computed tomography (MSCT) of thoracic organs. Despite the complex examination, in most patients BE is classified as idiopathic. The minimum set of tests, including serum immunoglobulins, allergic bronchopulmonary aspergillosis tests and hematology is proposed in ERS guideline for detection of BE causes. Other examinations are recommended to perform based on disease history and radiological characteristics, indicating the importance of BE clinical phenotype identification by different healthcare specialists, for which special examinations are required. Initial examination algorithms and management of patients with BE, in particular, MSCT-semiotics and clinical features, which could help to identify specific reasons are presented in the article.

The analysis of the literature data on perfusion computed tomography (PCT) in lung diseases is presented. The description of the research method, the method role in the differential diagnosis of the changes nature in the lungs based on the data of the PCT is given. The issues that require further research are being clarified. It was noted that a PCT can become a method of choice in cases when the computed tomography data do not provide the answer to the question about the nature of detected changes in the lung.

Interstitial lesion is one of the most common lung pathologies in patients with systemic scleroderma (SS) In most cases, interstitial lung disease (ILD) is formed during the detailed clinical picture of SS, but it can manifest from interstitial lung disease, which significantly complicates early nosological diagnosis. Patterns of non-specific and common interstitial pneumonia are most often found among the variants of interstitial lung lesion at SS Clinical manifestations of ILD-SS are non-specific and vary significantly between patients from asymptomatic to rapidly progressing respiratory failure. Early diagnosis of subclinical interstitial pulmonary lesion at SS is carried out using high-resolution computed tomography. Active immunosuppressive therapy is required for timely diagnosis of progressive forms of ILD-SS The presented clinical study demonstrates a case of late diagnosis of ILD-SS

Placental site trophoblastic tumor (PSTT) is the 3rd most frequently encountered gestational trophoblastic tumor after destructive cystic mole and choriocarcinoma. Currently, according to the literature, just over 600 cases are described in the world. The low incidence of this tumor, the non-specific clinical picture and the lack of changes in the overall clinical analysis pose significant challenges for clinicians in terms of reliable preoperative diagnosis. Clinical observation is made of a 34-year-old patient with PSTT manifested by hemoptysis due to bilateral metastatic lung injury. The diagnosis was verified histologically using immunohistochemical methods of investigation after an open biopsy of pulmonary tissue (lung resection). Then the patient underwent courses of adjuvant chemotherapy, surgical intervention on the opposite lung to remove the remaining tumor deposits Chemotherapy after the second surgery was continued. The patient at the time of writing (within 1 year and 6 months after the first lung operation) is alive, hysterectomy was not performed, clinical and radiological signs of tumor progression are absent.

Idiopathic pulmonary haemosiderosis (IPH) is one of the causes of alveolar hemorrhagic syndrome in adults; it is extremely rare. The results of clinical observation of a 42-year-old IPH patient with recurrent pulmonary hemorrhage in dynamics (within six months) are presented. The examination revealed anemia, bilateral infiltration process in the lungs, respiratory failure (SpO₂ – 82% in the air). Differential diagnosis was made with autoimmune and non-immune causes of alveolar hemorrhagic syndrome. IPH confirmed by a percutaneous lung parenchyma biopsy. The patient has been successfully treated with systemic glucocorticosteroids in high doses.