COPD exacerbations occur in almost all patients, and half of patients in the Russian Federation (52%) have two or more exacerbations per year or require urgent admission to hospital. COPD exacerbations come from increased acute inflammation in the respiratory tract of a patient under the influence of many factors. Modern pharmacotherapy provides the physician with several options in reducing the number of exacerbations. This review provides evidence about the maximum reduction in exacerbation risk due to the administration of tiotropium/olodaterol combination or triple therapy.

At present time, long-acting bronchodilators are the main class of drugs for basis therapy of chronic obstructive pulmonary disease (COPD). COPD is characterized not only by a decrease in pulmonary function parameters, but also by a decline in cardiac contractility. The article presents the results of studies of four approved fixed long-acting anticholinergic drugs/long-acting beta2-agonists in the Russian Federation, according their effect on the cardiovascular system. The safety of LAMA/ LABA was proved in terms of relation to the cardiovascular system, additionally the positive effect on the pumping function of the heart was shown in patients with COPD, which confirms the value of dual bronchodilators for COPD treatment.

The use of bronchodilators (DB) remains up to the present day the leading therapeutic strategy for the treatment of chronic obstructive pulmonary disease (COPD), in which case administration of fixed-dose combinations of long-acting bronchodilators seem the most promising. At the same time, the issues of anti-inflammatory therapy of COPD are also actively discussed, first of which is feasibility for the wide use of fixed-dose combinations of inhaled glucocorticosteroids (IHGC) with long-acting β₂-agonists (LABA). Recent years are characterized by the launch of a significant number of new BDs, anti-inflammatory drugs and their combinations to the pharmaceutical market. The article considers the role and place of new drugs in the treatment of COPD having a stable course.

Exacerbations of bronchial asthma are specific not only for severe, but also for mild disease course. Analysis of the causes revealed paradoxes in the treatment that contribute to the uncontrolled course of mild asthma. A promising direction is the use of combination drugs containing a early-onset beta-2-agonist and inhaled glucocorticosteroid, which can significantly improve adherence to treatment and significantly improve control and reduce the number of exacerbations. The review discusses in detail the merits of the combination drug SabaComb, its place in the recommendations for the treatment of mild asthma.

Eosinophilic asthma is a common phenotype of severe asthma, occurring in at least half of patients. In recent years, there have been significant changes in the approaches to the treatment of severe bronchial asthma and, above all, eosinophilic asthma. The article discusses the role of eosinophils in the pathogenesis of severe asthma, the detection of the phenotype of severe eosinophilic asthma, and modern approaches to targeting severe asthma with an eosinophilic phenotype using biological agents. A special emphasis is placed on preparations of monoclonal antibodies to interleukin-5, in particular, mepolizumab, recently approved for clinical use in our country.

The article presents the results of comprehensive assessment of the efficacy of anti-IgE therapy in adult patients with severe IgE-mediated uncontrolled bronchial asthma in real clinical practice. Omalizumab added to the background anti-inflammatory therapy allowed to reduce the incidence of asthma exacerbations, achieve stable positive dynamics during severe asthma and associated allergic diseases, increase control of the disease, and improve the patients’ quality of life. The drug has a wellcharacterized long-term use safety profile.

According to official statistics, over 1.5 million people have BA in the Russian Federation. Direct costs associated with the treatment of BA in the Russian Federation amount to 8.5 billion rubles. The socioeconomic burden of BA put on society, along with temporary and permanent disability, is caused by not only direct, but also indirect costs, as well as costs associated with payments for temporary disability, which leads to a decrease in GDP and GRP (internal gross regional product). The pharmacoeconomic comparison of two alternative drug technologies in the studied groups showed a reasonable opportunity to transfer patients to the drugs that have alternatives produced within the country, confirming that the cost per efficiency unit in using Formisonide-Native and SalticasoneNative is lower than that of drugs produced by a foreign pharmaceutical company (Symbicort Turbuhaler and Seretide Multidisk)

The review discusses the problems associated with the treatment of patients with severe resistant to therapy asthma: prevalence, socio-economic burden, impact on quality of life. The phenotype of bronchial asthma with eosinophilic inflammation, frequency of occurrence, clinical features, and modern approaches to therapy are discussed in detail, including the use of a drug of monoclonal antibodies against interleukin 5-reslizumab.

The article is devoted to the role of inhibitor-protected aminopenicillins in the treatment of community-acquired infections of the lower respiratory tract. Data are provided on the relevance of LRTIs, the aetiology of CAP and infectious exacerbations of COPD, the pharmacological characteristics of amoxicillin /clavulanate, which allowed it to occupy a leading role in the antibiotic therapy regimens of these diseases. The paper presented modern ideas about the directions of antimicrobial therapy of CAP and its complications (lung abscess, pleural empyema). It considered the antibacterial therapy indications for exacerbations of chronic bronchitis /COPD, and presented the treatment regimens with due account for the current clinical guidelines.

Acute respiratory diseases (ARD) are widespread diseases and are of great social importance. Diagnosis of acute respiratory infections implies the damage to the respiratory system caused by a wide range of pathogens. Among the pathogens of acute respiratory infections are viruses of acute respiratory viral infection (ARVI) group, including influenza, as well as fungal and bacterial pathogens, which include intracellular bacteria: mycoplasma and chlamydia. Diseases caused by intracellular pathogens are treated by antibacterial drugs that can easily penetrate the cells and create there high concentrations.

Acute respiratory infections (ARI) and influenza are referred to the most common diseases among children and adults. Despite a wide choice of medications for this pathology, we still need ones that combine a multipurpose antiviral activity, have proven effectiveness and safety and enable application in patients from risk groups, including allergic diseases. The pharmacological activity of a release-active drug Ergoferon is determined by the complex action of its components on antiviral immune response and virus-induced inflammation in the respiratory tract. Each component at the same time has its own target modulating action, which is a distinctive property of release-active antibodies forms. The article presents an overview of Russian and foreign publications, summarizing the results of preclinical and clinical studies effectiveness and safety of the Ergoferon use for treatment and prevention of acute respiratory infections and influenza in patients of different age groups.

Chronic Obstructive Pulmonary Disease (COPD) is a disease characterized by air flow limitation that progresses over time and is not fully reversible, which, along with the severity of clinical symptoms and the frequency of relapses, is one of its key characteristics [1, 2]. The main “tool” in achieving therapeutic goals in accordance with current guidelines GOLD [1], GesEPOC [3], NICE [4], PPO [5], etc. - are bronchodilators. Fixed-dose combinations of long acting beta-2 agonists/long acting anticholinergic agents provide optimal bronchodilation and play a primary role in preventing exacerbations of COPD.

The studies of the serotype composition of pneumococci in various countries indicate that over 80% of the most severe invasive diseases are caused by 20 serotypes, and 13 serotypes cause 70–75% of diseases globally [3]. The vaccination of the population is the main way to reduce the incidence of both invasive and non-invasive pneumococcal infections. With evidence of the safety and efficacy of pneumococcal conjugate vaccines, WHO and UNCF consider it necessary to include these vaccines for children in the national immunization programs around the world.

Herbal therapy occupies a special niche in the treatment of acute respiratory infections. The article discusses the causes and mechanisms of cough, as well as the possibility of its therapy with herbal drugs. It presents the multipurpose effect of phytopreparations on all components of the cough pathogenesis: they facilitate expectoration, improve the bronchial drainage, as well as the antimicrobial effect, which is an integral part of the treatment. The authors highlighted the compatibility of phytopreparations with other drugs for the treatment of respiratory pathology.

The article presents an analytical review of the use of aclidinium, formoterol, and combination of aclidinium and formoterol to treat chronic obstructive pulmonary disease (COPD) using a metered-dose dry powder inhaler Genuair® to administer a fixeddose combination. It is noted that twelve hours’ double bronchodilating effect has some advantages including the rapid elimination of drugs having minimal systemic effects, significant effect on dyspnoea and exhalation rates, profitability of using this drug. It is proven that Genuair® is a new, patient-friendly, easy to administer at any age powder inhaler with an informative feedback mechanism. All this makes it possible to consider a new fixed-dose combination of bronchodilators in the innovative device to be a promising basic therapy for COPD.

Despite considerable progress that has been made in the diagnosis, treatment and prevention of respiratory tract infections, community-acquired pneumonia (CAP) remains a fairly common disease [1-3] that continues to have the status of the leading infectious cause of death in modern humans and claims more lives each year than tuberculosis, meningitis, AIDS and infective endocarditis taken all together [4]. In this case, it is evident that clinical guidelines stating, among other things, approaches to the rational empirical antibacterial therapy (ABT) of the disease are the most effective measures in achieving better outcomes of CAP [5–8]. However, the issue of determining the optimal duration of ABT remains a subject of lively discussions (Table. 1). It is important to note here that the clinical stability of patients with EP can be achieved in most cases during the first 3–5 days of empirical ABT, and it is a rare occasion when the need for long-term prescription of antibiotics arises [12].

Idiopathic pulmonary fibrosis (IPF) is the most common form of idiopathic interstitial pneumonia that is characterized by a steadily progressive course and poor prognosis. The worsening pulmonary fibrosis resulting in honeycomb lungs accounts for the deterioration of clinical symptoms and functional status in patients with IPF. Today, the drugs with anti-fibrotic properties are recommend as a drug therapy for IPF. The article provides information on the efficacy and safety of this therapy as well as practical guidelines on the management of patients with IPF receiving such therapy.

The study discusses the relationship between the content of NF-KB and cytokine signaling suppressor 7 (SOCS7) in mononuclear peripheral blood cells (MNC) phosphorylated form of nuclear transcription factor inhibitor (NF-KB) and the production of MNC cytokines (TNF, IFN, IL-1β, IL-4, IL-10, IL-12) determining the state of congenital and adaptive immune response.

The content and level of phosphorylation of the nuclear transcription factor NF-KB (Ikba) inhibitor and the SOCS7 protein concentration were determined by enzyme immunoassay in MNC. In addition, the concentration of TNF, IFN, IL-1β, IL-4, IL-10, IL-12 was determined in cellular supernatants. The interrelations between the studied factors were evaluated by the method of linear regression analysis.

The results of the study indicate that the stage of recovery of community-acquired pneumonia is accompanied by a decrease in the level of IL-1, TNF and IL-4 and an increase in the production of Information. Also in the stage of convalescence there is a decrease in phosphorylation of Ikba and an increase in the concentration of SOCS7 in the OLS. The analysis revealed a significant effect on the level of phosphorylation of Ikba content in the cell SOCS7. Thus, a strong negative relationship between SOCS7 and phosphorylation of Ikba can be mediated by inhibition under its influence of STAT3/5 and MARK / SAPK-dependent cytokine production mechanisms, which allows to consider this factor as a therapeutic target for limiting excessive immunosuppression in pneumonia.