Patients with a combination of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) crossed phenotype (CP) BA and COPD are a separate nosological group. CP BA and COPD is a multifactorial disease. There is a hypothesis that genetic control of CP BA and COPD development at the posttranscriptional level is carried out by regulation of gene expression involving microRNA (miR) miR-21 and miR-146a; these molecules can be considered as potential diagnostic markers of CP BA and COPD.

The purpose of this study was to evaluate the expression of miR-21, miR-146a in male with a combination of BA and COPD compared to those with isolated BA and COPD.

Materials. We examined male patients (n = 65) (n = 48: 19 patients with CP BA and COPD; 14 patients with BA and COPD) and control group (n = 17). All the patients underwent a comprehensive clinical-laboratory and instrumental examination. The expression of miR-21, miR-146a was estimated in peripheral blood by a real-time polymerase chain reaction.

Results. CP BA and COPD have lower levels of miR-21 and miR-146a than the BA, COPD, and control groups. CP BA and COPD patients have low levels of miR-21 and miR-146a associated with shorter duration of the disease and the presence of comorbid pathology (hypertension, angina pectoris), revealed in patients with the disease debut at an older age. Low miR-21 was associated with lower reversibility of bronchial obstruction in these patients, despite eosinophilic inflammation in the bronchi.

Conclusion. It has been demonstrated that within the framework of complex diagnostics of CP BA and COPD in males it is reasonable to evaluate miR-146a and miR-21 expression in peripheral blood. MicroRNA miR-146a and miR-21 are promising molecular targets for phenotype-specific therapy in males with CP BA and COPD.

In the severe or fatal course of COVID-19, rapid virus replication gives rise to exuberant inflammatory response including cytokine storm, characterized by elevated plasma concentrations of proinflammatory cytokines that support neutrophil activity and stimulate endothelial cells. Рost mortem examinations confirm these data, indicating extensive neutrophil infiltration and accumulation of neutrophil extracellular traps (NET)s in lung tissues of patients who have died from COVID-19. In this paper the possibility of therapy with dornase-alfa in COVID-19 patients is discussed. Designed to treat cystic fibrosis lung disease, this drug can reduce neutrophil activity, slow down the NET release and accelerate the NET clearance in the airways of COVID-19 patients. The authors also present the protocol of COVID-19 therapy with dornase-alfa produced by Russian manufacturer.

“Legionnaire's Disease” is an acute infectious disease caused by Legionella of the Legionellaceae family. Clinical forms of legionellosis are diverse, but the risk of severe community-acquired pneumonia (СAP) is the main clinical significance. Unfortunately, as technological progress increases, epidemiological risks of foci of infection associated with artificial water systems (favorable habitat for Legionella) are increasing, which has led to numerous epidemic outbreaks and group cases of legionellosis infection recorded in the world recently. There are no pathognomonic symptoms and signs that allow it to be reliably differentiated from CAP by another etiology for “Legionnaire's disease”. An important role in the early verification of the disease is assigned to taking into account known risk factors of infection (a recent trip accompanied by possible contact with a water spray of a centralized air conditioning system) – age over 40 years, male sex, smoking, chronic concomitant diseases (diabetes mellitus, etc.), immunosuppression and timely laboratory diagnosis. The most accessible and convenient methods of primary diagnostics of community-acquired legionellosis are tests based on the detection of soluble antigen L. pneumophila serogroup-1 in urine. The treatment of Legionellosis CAP is based on antibacterial therapy, levofloxacine and macrolides are the drugs of choice. In this article, a series of clinical observations (2017 – 2019) in one of the multidisciplinary hospitals of Moscow is given as a confirmation of the clinical significance of legionella in the etiology of CAP in hospitalized patients and the need for timely diagnosis of the disease. 

The aim of the study was to assess the situation related to tobacco consumption among adolescents aged 13 – 15 in the Kyrgyz Republic.

Materials and Methods. The study used a two-stage selection of schoolchildren in grades 7 – 9 (teenagers 13 – 15 years old) to conduct the survey. At the 1^st stage, information was collected about all schools of the republic, where children of the target group study. the schools in which the survey was subsequently conducted were selected by the statistical sampling method according to the number of students in grades 7 – 9. The grades whose students participated in the questionnaire were set at stage 2 by random sampling in each school The survey includes 43 questions from the Standard main Questionnaire of the Global Youth Tobacco Survey (GYTS) and 30 supplementary questions (73 in total) with multiple choice of answers. The statistical processing was performed using the SUDAAN software package (US Centers for Disease Control and Prevention); a 95% confidence interval was calculated to calculate weighted prevalence estimates and standard errors (SE).

Results. The survey found that 6.0% of schoolchildren (9.5% of boys and 2.4% of girls) currently use various types of tobacco; 4.4% of schoolchildren currently use tobacco (6.8% of boys and 2.0% of girls); 2.4% of schoolchildren smoke cigarettes; 2.4% use smokeless tobacco, 2.8% use other tobacco products (hookah); 2.8% of schoolchildren smoke electronic cigarettes (3.9% of boys and 1.7% of girls). Tobacco use most often begins before age 7 or after age 12. 16.8% of schoolchildren are exposed to tobacco smoke at home, of which 14.2% are in closed places and 14.8% in open public places. 87.2% of schoolchildren purchase cigarettes in a shop, kiosk, from a street vendor, and in the market. During the visit to the point of sale 26.7% noticed tobacco advertising and promotions; 49.7% saw anti-tobacco messages in the mass media. Definitely think that smoking tobacco by other people is bad for them, 71.2% of schoolchildren.

Conclusion. A high percentage of teenagers consuming e-cigarettes, hookah, and smokeless tobacco products has been noted, although > 50% of them are aware of the dangers of tobacco use. Every 6^th student is a passive smoker. The vast majority of schoolchildren aged 13 – 15 who try to quit smoking do not receive professional help in quitting tobacco use, and are exposed to protobacco media marketing campaigns.

One of the main pathogenetic mechanisms combining chronic obstructive pulmonary disease (COPD) and arterial hypertension (AH) is a persistence systemic inflammation leading to the formation of endothelial dysfunction (ED), which serves as an independent predictor of the adverse prognosis of most cardiovascular diseases (CVD), while the treatment of patients with COPD in combination with AH requires the inclusion of drugs that have a beneficial effect on these pathological conditions. Prolonged-release indapamide has a number of pleiotropic effects, but most studies to study its effect on the state of endothelium and the intensity of systemic inflammation were conducted in patients with AH without associated bronchial obstructive diseases. The works carried out in conditions of comorbidity with COPD and according to the data of which the influence of diuretic drugs on the markers of systemic inflammation and ET in patients would be evaluated, were not found out, in this connection the present research was initiated and carried out.

The aim of the study was to evaluate the dynamics of markers of systemic inflammation and ET in the inclusion of diuretics in the complex therapy of patients with COPD in combination with BA.

Materials. Patients (n = 65: 50 men and 15 women) with stage I – IV COPD suffering from arterial hypertension (AH) I – III with initially elevated levels of systemic inflammation markers and ET, in whom the antihypertensive therapy performed was not effective enough, were included in the study.

Results. The results of the research on estimation of dynamics of markers of system inflammation – highly sensitive C-reactive protein (hsСRP), an intercellular adhesion molecule of type 1 (sICAM-1) and ET – endothelin-1, sP-selectin at the inclusion of diuretics in the therapy of patients with COPD with AH are presented. When analyzing the dynamics of the studied markers, a decrease in their level was noted, but statistically significant changes were obtained only in patients against the background of prolonged-release indapamide treatment. Additional pleiotropic effects of indapamide, consisting in reduction of activity of markers of systemic inflammation and ET, are also shown. Its high efficiency in achieving and maintaining the target AH levels compared to hydrochlorothiazide has been demonstrated.

Conclusion. The expediency of the inclusion of prolonged-release indapamide in the complex therapy of patients with COPD in combination with AH on the first line of antihypertensive therapy has been demonstrated due to its additional pleiotropic properties, which consist in the influence on the general pathogenetic links of the formation and progression of AH in COPD and its high antihypertensive efficiency in comparison with hydrochlorothiazide.

Impulse oscillometry (IO) is an innovative method of diagnosing respiratory mechanics. However, there are many unexplored and contentious issues concerning changes in IO parameters, particularly in chronic obstructive pulmonary disease (COPD).

The aim of the study was to compare IO with traditional pulmonary functional methods and to study its possibilities for diagnostics of respiratory mechanics disorders in patients with COPD.

Methods. A cross-sectional cohort study was carried out, which included patients with COPD (n = 146: 137 (94%) men, 9 (6%) women; average age – 65 ± 9 years) from 2 medical institutions of Moscow – Acad. N.N.Burdenko The Main Military Clinical Hospital, Ministry of Defense and Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia. Patients were divided into 4 groups depending on the severity of COPD according to the criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD): stage I was diagnosed in 8 patients, stage II – in 43, III – in 54, IV – in 41. The parameters of IO (resistive resistance at an oscillation frequency of 5 Hz (R_rs5) and 20 Hz (R_rs20), (R_rs5 – R_rs20), reactive resistance at an oscillation frequency of 5 Hz (Xrs5), area of reaction (A_X), resonance frequency (f_res) are analyzed; spirometry – forced expiratory volume in the 1st second (FEV₁), forced vital capacity (FVC) and FEV₁/FVC; Body plethysmography (total lung capacity, intrathoracic gas volume, residual volume, total respiratory resistance), lung diffusion capacity.

Results. The parameters of IO (R_rs5, R_rs5 – R_rs20, A_X, ΔXrs5, and f_res) progressively increased from stage I to stage IV (GOLD) of airway obstruction, while statistically significant changes of R_rs20 were not detected. The parameters of the traditional methods of investigation of respiratory mechanics and IO were mainly moderately and strongly correlated. Conclusion IO can be used as an alternative method for assessing respiratory mechanics in COPD.

According to international guidelines in recent years, it has been proposed that bronchial asthma (BA) with fixed airflow obstructions (FAO) be identified as a separate phenotype.

The aim of the study was the clinical and functional characterization and identification of risk factors for the formation of the phenotype BA with FAO.

Materials. We examined adult outpatients with BA (n = 432) and a combination of BA and chronic obstructive pulmonary disease (COPD) without exacerbation (n = 58). Anamnesis collection, objective examination, spirometry with the assessment of obstruction reversibility (spirograph 2120 Vitalograph, UK), atopic status assessment (skin samples or specific IgE in serum) were performed. The level of eosinophils and neutrophils in peripheral blood was determined (by the impedance method on the automatic haemoanalyzer). Nitric oxide of exhaled air was measured by a chemiluminescent gas analyzer (Logan 4100, UK). BA control and quality of life of patients were evaluated using the Russian language versions of the Asthma Control Questionnaire (ACQ-5) and the St. George's Hospital Respiratory Questionnaire (St. George's Respiratory Questionnaire – SGRQ) respectively. Statistical analysis was carried out using parametric and non-parametric methods using the application program package Statistica 10. The value of bilateral p < 0.05 was considered statistically significant.

Results. Among patients with BA without COPD, the incidence of FAO was 31%, with the most frequent (60%) FAO was found in severe BA and less often – in the mild (7%) and medium (36%) course of the disease. Among patients with a combination of BA and COPD, a severe course of the disease prevailed – 77%. Patients with FAO were older and had a longer duration of disease. The presence of FAO was accompanied by lower rates of pulmonary function, a higher frequency of positive markers of eosinophilic inflammation, worse indicators of control over BA and quality of life, a higher need for “emergency” drugs and drugs to support the treatment of BA, including biological therapy, increased use of healthcare resources. The risk factors for FAO in patients with BA include the debut of BA under 25 years of age (odds ratio (OR) – 1.6), sensitization to ticks of house dust (OR – 1.8), passive smoking (OR – 6.5), suffered during the life of pneumonia (OR - 3.0).

Conclusion. The combination of BA + FAO can be considered as a separate phenotype of the disease with a more severe course and less favorable prognosis.

The purpose of the present work was to study the problem of tuberculosis detection in patients with chronic obstructive pulmonary disease (COPD) in the anamnesis and the role of Mantoux test and Diaskintest in diagnosing tuberculosis in patients hospitalized in the pulmonary department of the multidisciplinary emergency hospital.

Materials. According to the results of analysis of 122 medical records of inpatient patients (form 003/u) hospitalized are divided into 2 groups: 1^st – patients admitted to hospital with the diagnosis of community-acquired pneumonia (CAP), 2^nd – patients with acute COPD, CAP at the follow-up of which was diagnosed in 73% of cases.

Results. The age of patients with acute COPD was found to be 48.0 ± 1.9 and 69.9 ± 2.7 years respectively (z = –1.44; p = 0.149). Acute onset, duration and intensity of coughing, and pronounced shortness of breath were observed in patients with COPD in the clinical picture, but a CAP was detected in the follow-up survey. Coughing, fever, leukocytosis and accelerated sedimentation rate were more common symptoms in patients without COPD. Tuberculosis was detected in 10.7% of patients in the pulmonary department, while DNA of mycobacteria tuberculosis in the epithelial lining fluid was found in 30.8% of cases. Positive results of simultaneous immunodiagnostics (Mantoux test and Diaskin-test) were recorded in 76.9% of cases.

Conclusion. Patients with COPD exacerbation, as well as patients with CAP, are a potential risk group for tuberculosis, need additional examination in the pulmonology department of the hospital according to the CAP standard to exclude or early diagnosis of pulmonary tuberculosis. If 2 diagnostic tests are used simultaneously (Mantoux test with 2 tuberculin units and Diaskintest), the accuracy and timeliness of tuberculosis diagnosis increases, including in case of exacerbation of COPD.

Chronic Obstructive Pulmonary Disease (COPD) is highly lethal and has a pronounced impact on the patient's quality of life (QoL), representing a serious public healthcare problem. According to various studies, the prevalence of obesity in COPD, which can have a significant effect on the course of the disease, reaches 50%.

The aim of the study was to assess the disease course characteristics, symptom severity, QoL, concomitant diseases, and lung function in obese COPD patients.

Materials. Patients included in the study (n = 176) of COPD patients (GOLD II – IV, group D) were divided into 2 groups: 1^st (n = 88: 71 men, 17 women; mean age 62.40 ± 8.83 years) – normal weight COPD patients; 2^nd (n = 88: 64 men, 24 women; mean age 62.94 ± 5.96 years) – obese COPD patients. The number of COPD exacerbations in the last 12 months has been estimated. Visual analogue scale (VAS) was used to assess the severity of coughing, sputum production, shortness of breath, general weakness. Modified shortness of breath severity scale (Medical Research Council – mMRC), COPD Assessment Test (CAT) and the Chronic obstructive pulmonary disease control Questionnaire (CCQ) were also used, spirometry, 6-minute step test (6-MST) was performed, QoL was assessed using the SF-36 questionnaire, and BODE index was determined.

Results. It was shown that the frequency of exacerbations of COPD for the previous year, which did not require hospitalization, and hospitalizations to the inpatient department for exacerbation of COPD, in patients of the 1st group was significantly higher and was 1.21 ± 0.83 and 0.96 ± 0.42 (p = 0.016) and 1.82 ± 0.94 and 1.5 ± 0.81 cases (p = 0.0145) respectively. In patients of the 2^nd group the dyspnea severity, sputum production and general weakness according to VAS and the dyspnea according to mMRC scale were significantly lower. In patients of the 2^nd group reliably higher indices of the forced expiratory volume in the 1^st second (FEV1), forced vital capacity (FVC) and Tiffno index were noted. Patients of the 1^st group also have higher index BODE – 6.23 ± 2.81 and 4.53 ± 2.11 respectively (p = 0.0000).

Conclusion. It was found that patients with COPD with obesity have low indices of symptom severity at relatively high values of FEV1, FVC, relatively low risk of acute COPD and hospitalization, and low BODE index at frequent combination with diabetes mellitus and hypertension.

The need to find ways to improve the effectiveness of antibacterial therapy is due to the dramatic escalation of resistance to antibacterial drugs (ABD), with the growth rate of resistance of ABD microorganisms ahead of the new drugs development. According to available data, the pathway of ABD administration may correlate with the phenomenon of resistance development to ABD. Actual data on existing inhalation ABDs, allowing to estimate their efficiency and safety, are considered in the article. In the treatment of patients with infectious respiratory diseases, an alternative to the systemic use of ABD may be inhalation administration of a number of ABDs, whose activity depends on concentration.

The main objectives of chronic obstructive pulmonary disease (COPD) therapy are to reduce the severity of symptoms and the risk of exacerbations. The article discusses the role of local and systemic inflammation in the pathogenesis of COPD as well as various mechanisms of pharmacological influence on it. Approaches to prescribing basic therapy for patients with COPD, recommended by various national and global guidelines (clinical recommendations of the Russian respiratory society, criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), guidelines of the National Institute for Health and Clinical Excellence (NICE)), as well as recommendations on the therapy frequency review are considered. Currently, so-called triple combinations – fixed combinations of double bronchodilators with inhaled glucocorticosteroids – are being developed and registered in the world, and their place and significance in the treatment of COPD raise many discussions. The paper discusses the role of fixed triple combinations in reducing the incidence of COPD exacerbations, the impact on functional and patient-reported outcomes, and provides recommendations for the use of triple combinations in patients with COPD, taking into account the benefit/risk ratio.

Clinical observation of multi-cavity lung cancer in a patient with chronic recurrent laryngeal papillomatosis in a 23-year-old patient who underwent annual surgical treatment (papillomatous laser removal) is presented. Pulmonary cavities have been detected and differential diagnosis has been carried out at the annual fluorographic examination. The tactics of surgical intervention is due to the rare occurrence of this pathology, the lack of clinical manifestations and the peculiarities of the radiological picture.

In 2020, the Research and Clinical Department of Cystic Fibrosis of the Academician N.P.Bochkov Federal Medical Genetic Academic Center, Russian Academy of Science celebrates 30^th anniversary from the start of its activities. The article demonstrates the main achievements in the organization of medical care for patients with cystic fibrosis in Russia.