An important role in airway inflammation in cases of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) is played by immune responses.

Methods. In order to identify the signs of impaired functioning of the immune system in patients with COPD (n = 39) and BA (n = 37), the number and activity of lymphocytes expressing CD20, CD23, CD25, CD71, CD72, HLA-DR antigens were studied in blood serum; their role in inflammation during the period of exacerbation and a stable course of diseases was evaluated.

Results. Examined patients, being in both stages of the disease, revealed a significant increase in the number of B-lymphocytes of all stages of differentiation. Insufficient apoptosis was also noted, which indicates the activation of the B-cell component of the immune system.

Conclusion. According to the study results, it was found that the increased activity of B-cells, on the one hand, protects the body from colonization by microorganisms and infection (in COPD), by blocking the formation of immunoglobulin E (in BA), on the other hand, the autoantibodies, which they produce, can damage their own tissue, and insufficient apoptosis process may lead to maintenance of the inflammation process.

The analysis of troponin T (TnT) blood levels in the patients with acute coronary syndrome (ACS) and the underlying chronic obstructive pulmonary disease (COPD) is relevant to assessment of the cardiovascular prognosis and the risk of respiratory complications.

The aim of the study was to investigate TnT levels in the patients hospitalized with ACS and underlying COPD in order to analyze the cardiopulmonary relationships.

Methods. 52 patients (29 men and 23 women) were divided into 2 groups depending on outcomes of ACS: the 1st group - 30 patients (57.7%) with acute myocardial infarction (AMI); the 2nd group - 22 patients (42.3%) without AMI. The acute exacerbation of COPD (AECOPD) was found in 33 patients (63.5%) upon admission to the hospital, and 19 patients (36.5%) did not have AECOPD. All patients underwent spirometry, the assessment of symptoms severity by COPD Assessment Test (CAT test) and the analyses for the level of TnT and oxygen saturation.

Results. AECOPD was found upon admission in the 1st group more often than in the 2nd group: 76.7% vs 45.5% (p = 0.022). The patients with AECOPD had significantly higher levels of TnT than patients without AECOPD in both groups: 0.78 ± 0.17 and 0.59 ± 0.14 ng/mL respectively (p = 0.014) in the 1st group vs 0.19 ± 0.08 and 0.11 ± 0.04 ng/mL respectively (p = 0.002) in the 2nd group. In the 2nd group, 8 patients (80.0%) with AECOPD and 4 patients (33.3%) without AECOPD had levels of TnT in the range of «a myocardial necrosis» (p = 0.029) in the absence of AMI. The inverse correlation between levels of TnT and forced expiratory volume in 1 second (FEV1) was also found (R = 0.376; p = 0.009).

Conclusion. Thus, the significantly increased levels of TnT in patients with ACS are associated with AECOPD upon admission, development of AMI and deterioration of the indexes of spirometry. It was shown that blood levels of TnT were significantly higher in the patients with AECOPD than in the patients with stable COPD in absence of AMI.

Aim. Тo determine independent predictors of unfavorable cardiovascular long-term prognosis after percutaneous coronary intervention in patients with acute coronary syndrome and concomitant chronic obstructive pulmonary disease.

Methods. 119 patients with acute coronary syndrome after percutaneous coronary intervention and concomitant chronic obstructive pulmonary disease were included in prospective cohort study. During follow-up up to 36 month the frequency of major cardiovascular events (cardiovascular death, myocardial infarction, stroke, repeat myocardial revascularization) were registered. The predictors of combined end point were identified by Cox regression through forward stepwise mode.

Results. Independent variables as major cardiovascular events predictors were determined: main coronary arteries stenosis number, ankle-brachial index, glomerular filtration rate according to the CKD-EPI formula, frequent COPD exacerbations, functional residual lung capacity, 6-minute walk test distance.

Conclusion. Functional residual lung capacity as a lung hyperinflation indicator and frequent COPD exacerbations are among independent predictors of major cardiovascular events in long-term follow-up period after percutaneous coronary intervention in patients with acute coronary syndrome and concomitant chronic obstructive pulmonary disease.

Objective. To study the “language” of whistling wheezing in patients with asthma, the relationship between verbal and amplitude-frequency characteristics (AFC) of wheezing and the severity of bronchial obstruction and dyspnea.

Methods. 72 patients with partially controlled asthma were examined. The patients described whistling breathing by comparison and evaluated the degree of intensity of wheezing and dyspnea (Borg CR-10 scale). Spirometry was carried out with Vitalograph ALPHA spirometer (England) according to the rules of ATS/ERS with a bronchodilator test and simultaneous recording of pulmonary sounds with the Littmann 3,200 electronic stethoscope.

Results. 2 groups of patients were formed based on verbal characteristics of the whistling wheezing. The 1^st group (38 patients) had wheezes of high-tone AFC (576 ± 33 Hz), 6.5 ± 0.7 points of wheezing intensity, and the degree of dyspnea intensity 4.8 ± 1.2 points on the Borg scale. The 2^nd group (34 patients) had wheezes of medium and low-tone AFC (368 ± 40.2 Hz), 3.8 ± 0.6 points of wheezing intensity, and degree of dyspnea intensity 3.7 ± 0.5 points according to Borg scale. Various “language” characteristics of whistling wheezing are obtained. The direct correlation between the degree of obstruction and subjective sensations of whistling breathing was found. The 1^st group had marked moderate and severe bronchial obstruction (FEV1 < 50%). The 2^nd group had mild and medium degree bronchial obstruction (50 > FEV1 < 80%). A positive bronchodilatator test was recorded in 100% patients in the 1^st group and 37% patients in the 2nd group. Postbronchodilator AFC of the wheezes were comparable between the groups. The decrease in the intensity of wheezing led to a reduced severity of shortness of breath. Dyspnea did not affect the subjective intensity of wheezing.

Conclusion. Verbal characteristics of whistling breathing in asthma patients are given. There was a direct strong correlation between the perception of wheezing with the severity of bronchial obstruction and a weak feedback between the intensity of perception of wheezing and shortness of breath before the use of bronchodilator. A direct moderate correlation was found after the bronchodilatator test. The severity of bronchial obstruction in patients with asthma plays a major role in the occurrence of wheezing high-tone AFC. A good response to beta2-agonist inhalation therapy should be expected in these patients.

Objective: to assess pulmonary hemodynamics and the presence of systolic and/or diastolic dysfunction of the myocardium of the right and left ventricles in patients with COPD, depending on the risk groups (A, B, C, D); to determine the possible directions of pharmacological correction.

Methods. Patients (n = 119, including 87 men, mean age - 62.5 ± 14.8 years) with COPD of risk group A (n = 21) and B (n = 98) (GOLD, 2019). In addition to the routine clinical and instrumental examinations, pulmonary and aortic pulse wave velocity was determined using MRI diagnostics.

Results. The right ventricular diastolic dysfunctions (DD) were revealed in all patients with COPD (E/A TV = 0.85 ± 0,03 vs 0.97 ± 0,03; groups A and B respectively, p < 0,05). 28.6% of patients of group B had a restrictive type of transtricuspid blood flow (p < 0,05). The pulmonary blood pressure was increased: 24.3 ± 7.6 mm Hg in patients with COPD group A, 17.2 ± 6.8 mm Hg - in group B. Patients of group B had a higher pulmonary pulse wave velocity (pPWV) (B: 3.13 [2.93-3.44] ms-1 vs A: 1.97 [1.62-2.68] ms-1, p = 0.005) and stroke volume of RV (B: 33.5 [27.3-37.9] mL vs A: 29.1 [24.0-35.7] mL, p = 0.005). The correlation between pPWV and the degree of bronchial obstruction, ejection fraction and end-diastolic volume of the RV, and mean pulmonary arterial pressure (mPAP) was strong for patients of group B and moderate for patients of group A.

Conclusion. Thus, patients with COPD risk group A have the borderline indicators of mPAP with DD of LV and RV. The progression of hemodynamic disorders is associated with the aggravation of of clinical symptoms and respiratory disorders, that were more pronounced in group B. This progression led to mandatory broncholytic drug correction.

Analysis of data of the National Cystic Fibrosis (CF) Register allows evaluating the quality of medical care for children and adults with CF in the whole country and in a single Federal District. The Siberian Federal District (SFD) has the third-highest number of CF patients in the Russian Federation (RF). The study aimed to determine the clinical and epidemiological characteristics of CF patients in the SFD in 2017 to improve the approaches to medical care in the region.

Methods. The National CF Register’s main sections for 2017 were evaluated: demographic data, diagnostics, genetics, airway microflora, lung function, nutritional status, complications of the disease, and treatment. The SFD data were compared with the data of the All-Russian Register in 2017.

Results. The information was provided on 433 CF patients from the SFD. No differences were found between the SFD and the RF in the incidence of the disease, F508del and CFTRdele2,3(21kb) mutations, the microbiological profile, lung function, and nutritional status. The SFD was characterized by the lower average age, the detection of rare mutations in patients from indigenous groups of the North, the predominance of “severe” genotypes, the noticeable variability in the frequency of chronic Pseudomonas aeruginosa infections, and a significant increase in the Burkholderia cepacia complex detection. An insufficient level of laboratory diagnosis of methicillin-resistant Staphylococcus aureus and non-tuberculous mycobacteriosis was noted.

Conclusion. Strict adherence to sanitary and anti-epidemiological measures is required to control the chronic respiratory infections in the regions of the SFD. Careful implementation of the national consensus recommendations on the diagnosis and treatment of CF is also required.

Adult CF patients often have upper airway involvement, and many develop chronic rhinosinusitis (CRS). There is a disagreement on which paranasal sinus CT features of CRS in CF patients should be considered essential. It is important to define the main criteria for evaluation of the paranasal sinus CT scans and signs of CRS associated with CF to improve CRS diagnosis in CF patients.

The aim of the study was to assess the main of paranasal sinus disorders in adult CF patients and increase the effectiveness of CRS diagnosis by CT.

Methods. CT features of CRS were assessed in 97 adult CF patients (range: 18 - 44 years, median: 25.8 ± 5.4) with no history of surgical treatment of CRS from different regions of the Russian Federation. The paranasal sinus CT scans performed in 2015 - 2019 were evaluated. Specific features of the paranasal sinus and middle nasal meatus structure and bony variants were found, and the prevalence of sinusitis with different paranasal sinus involvement was assessed.

Results. The analysis of CT scans of 97 adult CF patients showed that the main CT features of CRS are maxillary sinus hypoplasia, opacified maxillary and sphenoid sinuses, as well as the ostiomeatal complex changes: enlargement of ethmoid infundibulum, polypous hypertrophy of uncinate process, and medial bulging of the lateral nasal wall.

Conclusion. The characteristic CT features of paranasal sinuses in adult CF patients include agenesis of the frontal, maxillary, and sphenoid sinuses, opacification of the maxillary and ethmoid sinuses, and changes in the middle nasal meatus structures. Correct assessment of the listed paranasal sinus CT features will help to diagnose CRS and CF in adult patients.

There are results of a comparative phase III clinical study on the efficiency and safety of the biosimilar drug Genolar® (Generium JSC, Russia) and the reference drug Xolair® (Novartis Pharma AG, Switzerland) ((NCT04607629). The study is aimed to establish the clinical equivalence of the compared drugs for additional therapy of patients with moderate and severe bronchial asthma (BA) are considered in the article.

Methods. The study enrolled 191 patients aged 18 to 75 years with a moderate to severe atopic asthma for ≥ 1 year, the symptoms of which were insufficiently controlled by therapy corresponding to the 4^th stage of treatment (GINA, 2017) for ≥ 2 months before the screening. Patients were divided into the two groups in a ratio of 2 : 1 with the block randomization. 127 patients of the Group 1 were administered Genolar® for 52 weeks ± 3 days; 64 patients of the Group 2 were administered Xolair® for 26 weeks ± 3 days. The dose and frequency of the compared drugs administration were determined based both the initial IgE concentration (IU/mL) measured before treatment and the current body weight (kg) of the patient. The recommended omal-izumab dose was 75 to 600 mg once every 2 or 4 weeks. The primary efficacy endpoint was the patients’ percentage with a physician evaluation of “excellent” or “good” on the Global Evaluation of Treatment Effectiveness (GETE) scale after 26 weeks of comparative treatment.

Results. According to the data analysis results, the patients’ proportion with a GETE score of “excellent” or “good” after 26 weeks of therapy were no statistically significant differences between the groups in both investigated populations (PP-population (per protocol) and FAS-population (full analyses set)) (p > 0.05). Primary efficacy endpoint data analysis showed that the patients’ proportion of the PP population with a GETE score of “excellent” or “good” was 57.4% of the Group 1 and 45.2% of the Group 2 (p = 0.132). The calculated one-sided 95% CI in order to test the study statistical hypothesis showed that the investigated drug Genolar® (Generium JSC, Russia) is “non-inferior” than the reference drug. The PP population onesided 95% CI was from -0.5 to 25.0% (p = 0.116), the FAS population one was from -1.1 to 24.2% (p = 0.134). According to the safety analysis results, the comparability of the investigated and reference drugs in terms of the frequency of the adverse events was demonstrated. The analysis results of the anti-drug antibodies to omalizumab detection revealed the antibody production absence in response to the administration of the studied drugs.

Conclusion. The clinical study results have proved the equivalence of the biological analogue Genolar® (Generium JSC, Russia) and the reference drug Xolair® (Novartis Pharma AG, Switzerland).

Relevance. The incidence comorbidities increases and and types of comorbidities change with the patient’s age. The severity can be assessed using multiple scales. The aim of this study was to identify the specifics of surgical intervention tactics to be used for treatment of pleural effusions of various etiologies, depending on comorbidities.

Methods. Comorbid pathology was assessed in 424 patients with pleural effusions of various origins using three indices developed by Charlson, Karnovsky, and the European Joint Oncological Group (ECOG). Thoracentesis, drainage of the pleural cavity, and videothoracoscopy with pleural biopsy were used for diagnosis and treatment.

Results. HIV, chronic hepatitis, and diseases of the gastrointestinal tract represented the most common comorbid pathologies in patients below the age of 49; cardiovascular diseases and diabetes mellitus were the most common comorbidities in patients after the age of 50. The Charlson's index was 2.6 ± 2.5 for patients younger than 39, 7.9 ± 2.7 for patients in the age range between 60 and 69, and 9.5 ± 2.5 for patients who were older than 70. 34 patients underwent pleural punctures as treatment of small and medium effusions with the Karnowski index less than 40 % and ECOG of 3 — 4 points; 33 resuscitated patients with more severe pathology underwent pleural cavity drainage due to large effusions without fragmentation. 355 patients underwent video thoracoscopy with pleural biopsy; 135 patients received intraoperative pleurodesis by insufflation of talcum powder, and 19 patients had trichloroacetic acid applied to the pleura. 17 (4%) patients died from worsening of the underlying disease and decompensation, including one case of myocardial infarction. Patients with fatal outcome had the Charlson's index of 9.4 ± 3.9, and survivors — 6.9 ± 3.1.

Conclusion. Worsening of main pathology and comorbidities, age over 60, Charlson's comorbidity index higher than 8, and an unfavorable prognosis for pleural effusions of various origins serve as an indication for the most conservative diagnostic and treatment approach.

Pharmacotherapy for patients with chronic obstructive pulmonary disease is administered through various inhalation devices. The inhalers have different designs, principles of operation and activation methods, the number of steps necessary to prepare the device for use, the resistance that the patient has to overcome with inhalation, and many other characteristics. The suboptimal choice of an inhalation device may affect the clinical outcomes of the disease. Therefore, the guidelines consider replacement of the inhaler to be an alternative to escalation of therapy with treatment failure. When choosing an inhalation device, a number of the patient’s clinical features should be considered, including the patient's ability to induce an inspiration effort. Since devices that estimate the force of inspiratory effort at different resistances are not available in Russian Federation for routine clinical practice, the expert group described some clinical features that may be observed in patients with suboptimal inspiratory flow based on the existing data. Their final choice was made by voting according to the Delphi panel method that accounts for the opinion of each expert.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability and mortality. The paper discusses the role of single inhaler triple therapy in COPD maintenance treatment. Trelegy Ellipta - the first fixed triple combination registered in Russia - is taken as an example. Below we deliberate on classes of components and their mechanism of action, clinical effectiveness, influence on exacerbations' risk, functional and patient-reported outcomes, safety, and mortality reduction. We also discuss the approaches for triple therapy administration to COPD patients recommended by a row of national and global guidelines.

In the past years, we have seen a paradigm shift from symptomatic to disease-modifying approach to the treatment of chronic diseases. The treatment of asthma, which is a chronic disease, is no exception to this shift. Although the available therapies for asthma have been traditionally identified as either “controllers” or “relievers”, this dichotomous classification does not address the therapeutic potential to modify the underlying disease. The disease-modifying therapy for asthma can be defined either as airway remodeling or as modifying the disease's natural course. Among the biological therapies, the disease-modifying effect of omalizumab was studied most comprehensively. Some studies of other biological therapies for severe asthma (mepolizumab, benralizumab) also addressed the airway remodeling effect. A further study of the disease-modifying therapy should help gain a deeper understanding of its potential in managing asthma.

Cavity forms of sarcoidosis, which require differential diagnosis with other diseases, manifested by X-ray cavity patterns, polysegmental nodular formations, hilus and mediastinal lymphadenopathy, are extremely rare. The data of the world literature (1973 - 2018) on the studied problem are analyzed, the results of our own clinical and radiological observations of patients (n = 490) with various forms of sarcoidosis are presented. Cavity forms of sarcoidosis were detected in 31 (6.3%) cases — fibrocystic variants in stage IV sarcoidosis (n = 8); sarcoidosis on the background of cystic hypoplasia (n = 7); combined forms of primary cavity sarcoidosis and necrotic sarcoid granulomatosis in 6 (1.2%) patients; a combination of sarcoidosis and fibro-cavernous tuberculosis (n = 5); sarcoidosis with the pattern “reverse halo sign” (n = 5). Examples of our own clinical and radiological observations are presented. The modern methods of multispiral computed tomography have been optimized, the capabilities of the basic post-processing image processing programs have been demonstrated, the use of which significantly increases the sensitivity and specificity of tomographic research.

Shortness of breath, a subjective feeling of lack of air, is one of the most common complaints that patients present to a general practitoner or any other primary care doctor. The range of pathological conditions and diseases accompanied by shortness of breath is diverse and often poses a difficult diagnostic task for the doctor. These conditions may include such life-threatening pathologies as myocardial infarction or pulmonary embolism on the one hand, and conditions that are relatively “harmless” from a prognostic point of view, such as hyperventilation syndrome and detraining, on the other. The more experienced a doctor is, the wider this range will be. However, certain stereotypes are usually triggered in the management of such patients in the routine practice and the pathology that the general practitioner faces most often, prevails. Our clinical example clearly shows how the present cardiovascular condition (hypertension) masks other signs, and the shortness of breath is easily explained by a complication of hypertension - heart failure. Nevertheless, this case turned out to be more complicated. This clinical example shows the main problems of differential diagnosis of shortness of breath in the practice of a general practitioner or a family doctor. This case emphasizes that a multidisciplinary approach should be applied to the diagnosis and treatment of patients with dyspnea.