The article tells about the results of evaluating the effects of tiotropium on the level of bronchial hyperresponsiveness (BHR) and comparing its clinical efficacy in patients with chronic obstructive pulmonary disease (COPD) depending on the level of bronchial reactivity. Ttreatment with tiotropium was associated with a decrease in BHR (p <0.05) accompanied by a significant reduction in the severity of symptoms and frequency of COPD exacerbations, and improved quality of life compared to both baseline figures (p <0.05) and patients without BHR. COPD patients with BHR demonstrated higher efficacy of treatment with tiotropium compared with patients without BHR.

Chronic obstructive pulmonary disease (COPD) is a progressive disease with incompletely reversible airflow obstruction that occurs under the impact of various factors (among which smoking is the key factor). [1, 2] According to several recent studies, the incidence of COPD in people over 40 years is 10.1% globally (11.8% for men and 8.5% for women). [3] COPD is one of the most pressing health and social issues not only due to the prevalence of the disease. It also poses a high risk of serious complications resulting in disability and death including for the working population. [1, 2]

One of the main challenges in patients with respiratory failure (RF) is to ensure effective functioning of an important defense mechanism of the respiratory system - mucociliary clearance (MCC). MCC is characterized by the upward movement of mucus by ciliary motion. The target of the protective function of MCC is to remove dust particles and pathological microorganisms through the vibrational of the cilia.

Drug therapy in patients with obstructive lung diseases - bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) - is aimed at preventing and controlling symptoms, reducing the frequency and severity of exacerbations, improve health status and exercise tolerance. One of the main groups of drugs that can reduce and control symptoms in patients with asthma and COPD are glucocorticosteroids (GCS).

Studies carried out in different countries of the world revealed inadequate asthma control in clinical practice. [1--3] For example, in 56% of Russian patients who seek medical aid of specialists and GPs the disease is not controlled. [4] The data suggests that BA therapy needs to be improved. One of the most widely used treatments are inhaled corticosteroids (ICS) in combination with long-acting beta-adrenoceptor agonists (LABA). Global and national guidelines suggest using ICS/LABA at 3, 4 and 5th stages of asthma therapy. [5, 6] The article tells about a fixed combination containing formoterol and mometasone furoate (Zenheyl). The metered dose inhaler (MDIs, 50/5, 100/5 and 200/5 mcg) in aerosol form with dose counter is registered in Russia and other countries for the treatment of patients aged 12 years and older.

The increasing number of atopic people worldwide is a matter of ever growing concern among the healhcare community. Every fifth inhabitant of our planet suffers from some form of allergy. According to the World Health Organization (WHO), there are about 300 million patients with bronchial asthma (BA), 400 million patients with allergic rhinitis, while the incidencew of the nosologies is growing every year. [1] In September 2011, the UN General Assembly addressed non-communicable diseases, with a particular focus on the increasing impact of asthma on global health, economic development and social well-being.

According to the WHO, asthma is now one of the most common diseases in the world affecting more than 300 million people, and its incidence continues to grow, especially in developing countries. Asthma is a complex disease with a variety of course patterns. Currently, phenotyping of asthma is a matter of great interest and debate.

The article presents the results of the authors' trial involving 119 patients (aged 22 to 82 years) with severe bronchial asthma (BA) diagnosed according to the ERS/ATS guidelines (2014). Allergic asthma was diagnosed in 77% of patients. The study focused on house dust mites as the main allergens in the sensitization spectrum. A significant proportion of patients (82%) had uncontrolled course of the disease, and 76% suffered from airflow limitation that is not fully reversible. Markers of eosinophilic airway inflammation (nitric oxide in exhaled air and level of blood eosinophils above 150 cells per 1 µL) were found in 63% of patients. Good adherence to treatment (administration of more than 75% of the prescribed doses of drugs) was observed in 61% of patients. Among patients with severe asthma 27% were active smokers. Smokers demonstrated a decreased pulmonary function and a lower level of nitric oxide in exhaled air. Smokers were also less adherent to treatment with inhaled corticosteroids. Severe BA was combined with COPD in 37% of cases.

The main nosological forms of lower respiratory tract infections are infectious exacerbation of chronic bronchitis, chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP). The relevant antibacterial drugs in the above-mentioned diseases are b-lactam antibiotics (aminopenicillins including inhibitor-protected penicillins, II-III generation cephalosporins), macrolides, respiratory fluoroquinolones. Inhibitor-protected penicillins, macrolides, and respiratory fluoroquinolones are similar in their clinical and microbiological efficacy. When choosing the antibacterial drug, it is necessary to take into account the clinical case, in particular, the severity of acute exacerbations of chronic bronchitis, COPD and CAP, poor response factors, risk of antibiotic resistance, ease of dosing regimens, safety and tolerability of the antibacterial drug.

Differential diagnosis of community-acquired pneumonia is often a challenge for physician as it requires a deep knowledge not only in pulmonology but also in cardiology, surgery, neurology. The article uses real examples showing various disieases simulating CAP to examine the reasons for underdiagnosis of pneumonia.

Pneumococcal diseases are widespread all over the world. According to WHO, every year14.5 million (11,1--18 million) of children under the age of 5 years suffer from the diseases, while the number of deaths due to pneumococcal infection reaches 826 thousand (582--926 thousand), or 11% of all deaths among children in this age group. At the same time, pneumococci may be part of the normal flora of the upper respiratory tract contributing to the bacteria carrying capacity. The carrying may be asymptomatic but may result in contact or hematogenous penetration of microorganisms from nasopharynx to other organs. This is largely determined by the pneumococcal serotype.

The article analyzes the immunomodulatory therapy as part of pathogenetic treatment of community-acquired pneumonia. Immunological monitoring of patients with severe community-acquired pneumonia demonstrated a disbalance of natural resistance factors, cellular component of immune system and humoral stress factor, which required immunotherapy. Immunomodulatory therapy included azoximer bromide (Polyoxidonium) according to the prescribed regimen and demonstrated immunological efficacy.

Tuberculosis remains one of the most challenging infectious diseases in the Russian Federation. According to Rospotrebnadzor, in 2014, TB incidence was 56.9 per 100 thousand people. Despite overall tendency towards a decrease in TB incidence, some population groups demonstrate the opposite trend. The most vulnerable people are those living with HIV, and their number is steadily increasing. In Russia in 2014, the incidence of HIV infection amounted to 58.4 per 100 thousand people which exceeds the 2013 figure by 5.0%. In view of the high prevalence of latent TB infection, most adult HIV-infected patients are at risk of developing active tuberculosis. As a result, tuberculosis is the most frequently reported secondary infectious disease in patients with HIV infection. The incidence of TB associated with HIV has been steadily growing and reached 7.4 per 100 thousand people in 2014 which is above the 2013 figure (6.5 per 100 thousand people). Tuberculosis is the main cause of death in patients with HIV infection. In 2013, HIV infection was the cause of 26.5% of all deaths of TB patients, with an ever-increasing proportion of deaths from co-infection.

Currently, primary immunodeficiencies (PID) are becoming an increasingly relevant issue: it is now evident that this is not such a rare pathology as previously thought. According to the Immune Deficiency Foundation (USA), the total number of PID patients exceeds that of cystic fibrosis four-fold. Despite this, physician awareness of the disease is extremely low. The modern methods of diagnosis and treatment help the patients survive into adulthood. Patients with PID may get an appointment with any doctor: therapist, pulmonologist, hematologist, gastroenterologist, etc. since clinical manifestations of this disease are very diverse. Due to the fact that the prognosis for PID patients is determined by timeliness and adequacy of prescribed therapy, it is essential to study the various forms of PID to obtain new insights into the structure and principles of the human immune system.

Exhausting dry cough is the leading cause of seeking medical care because of the sharp decrease in the quality of life. There are psychological aspects of attitude to sick person suffering from bouts of non-productive cough. Pharmacotherapy of dry cough is complex and specific. Phytotherapy treatment should be pathogenetically validated and take into account potential side effects, as in the example with liquorice. The use of plantain and thyme extracts is feasible for relief of intrusive dry cough in acute inflammatory diseases of the upper respiratory tract.

Treatment of acute purulent pathology in otolaryngology remains a challenge due to ever high level of morbidity and number of patients' visits to general practitioners and otolaryngologists.

According to the World Health Organization (WHO), 3 to 5 million cases of influenza are registered every year worldwide, of which 250--500 thousand are fatal. Epidemics of influenza and acute respiratory viral infections occur most often in winter, however, outbreaks may also be recorded in the autumn-winter and winter-spring periods. Sporadic cases of ARVI occur at any time of the year. Factors contributing to the development of flu epidemics include: high density of population in metropolitan areas; adverse environmental factors; inadequate immunization coverage; poor hygiene during epidemics; unhealthy eating habits (unbalanced, excessive). Groups at risk of severe and complicated course of influenza and ARVI are young children, the elderly, and patients suffering from chronic disorders of the upper respiratory tract, bronchopulmonary and cardiovascular systems, as well as people with immunodeficiency. [1]

The article is a review of recent data on hormonal mechanisms of bronchial asthma. The role of sex hormones, hormones of the thyroid and adrenal glands on the formation and course of bronchial astma is highlighted.