Introduction. Poor medication adherence significantly increases the likelihood of complications, which leads to a decrease in quality of life (QoL) in patients and an increase in treatment costs.

Goal. To study the adherence and effectiveness of treatment in COPD patients (group D) using a fixed triple combination of vilanterol/umeclidinium bromide/fluticasone furoate (FF/UMEC/VI).

Material and methods. The study included 26 male patients with severe COPD with frequent exacerbations (group D). All patients were recommended therapy with a fixed triple combination of vilanterol/umeclidinium bromide/fluticasone furoate (FF/UMEC/VI). Patients were monitored for 12 months, and the following endpoints were recorded: hospitalization due to exacerbation of COPD, progression of COPD (decrease in FEV1), and death of the patient. In addition, the dynamics of treatment adherence, the number of SAT test scores, and the level of depression on the Beck scale were evaluated.

Results. After 6 months of taking a fixed triple combination of FF/UMEC/VI, there was an improvement in treatment adherence in the form of a 15.3% decrease in the proportion of non-committed patients with COPD and an increase in the proportion of patients committed to therapy by 7.7%; the average frequency of exacerbations significantly decreased, this dynamics remained by the 12th month of follow-up. After 12 months, patients with COPD showed a statistically significant decrease in the proportion of patients who were not committed to treatment and a statistically significant increase in the proportion of patients who were committed to treatment for COPD; there was a statistically significant decrease in the frequency of severe depression in COPD patients; there was a statistically significant decrease in the proportion of patients with severe and moderate COPD influence on the quality of life.

Conclusion. The results of our study confirmed the view that adherence plays a significant role in the effectiveness of treatment of COPD patients, and the use of a fixed triple combination of FF/UMEC/VI helps to increase it.

Clinical and molecular heterogeneity of bronchial asthma has been documented in recent years. The search for novel solutions to enhance efficient patient support related first of all to understanding of asthma heterogenic nature and allows to personalize each patient treatment. Biological therapy application can influence to achieve better control at greater extent for patients with severe uncontrolled asthma. Nowadays 5 biological drugs are registered on Russian Federation territory and implemented according to severe asthma phenotypes: anti-IgE, anti-IL-4,13 and anti-IL-5 class therapies. Omalizumab become the first target drug for uncontrolled allergic asthma patients (monoclonal antibody against IgE). This medication is prescribed for uncontrolled moderate and severe allergic (atopic) asthma in patients on basic asthma therapy according GINA step 4 and 5 (Level of evidence A). Clinical trials confidently reported that anti- IgE-therapy reduces the rate of asthma exacerbations, severity of disease in patients with chronic severe asthma on high doses of inhaled steroids or systemic steroids and allows to reduce or withdraw systemic steroids doses in case of steroid-dependent asthma. For the last years special attention led to and demonstrated omalizumab positive effect on airways remodeling and modification of bronchial asthma natural course in adults and children. Antiinflammatory effect of omalizumab is documented. Omalizumab significantly reduces eosinophilic infiltration of submucosal bronchi layer among patients with atopic asthma, sputum eosinophilia, which correlates with reduction of FeNO during biologic treatment, reduces mast cells infiltration of smooth muscle cells in bronchi. Omalizumab significantly reduces the thickness of the bronchial wall, increases the lumen of the bronchi (positive dynamics of CT-scan parameters), which is clinically manifested by increased of FEV1.

Chronic obstructive pulmonary disease (COPD) today remains one of the most important problems of modern medicine. The social significance of this disease is determined by the annual health care costs for treating patients with exacerbated COPD, as well as the still high mortality and disability rates worldwide. The main goals of COPD treatment are to slow the rate of disease progression, control the symptoms, reduce the frequency of exacerbations and hospitalizations, and reduce the risk of future exacerbations. Currently, the main groups of drugs for basic therapy of COPD are inhaled prolonged bronchodilators from the groups of β2-adrenergic agonists and M-anticholinergics, as well as their combinations. Patients with COPD and bronchial asthma, as well as patients with COPD with elevated levels of eosinophils and frequent exacerbations, inhaled glucocorticosteroids (ICS) are used. It has been proven that the addition of corticosteroids to LABA in patients with moderate to severe COPD and frequent exacerbations has a more effective influence on pulmonary function and the number of exacerbations. Clinical studies have shown the relationship between the level of blood eosinophilia and the clinical effects of preventing future exacerbations when using iCS in combination with LABA. In our clinical observation, in patient with moderate COPD and blood eosinophilia > 300 cells/μL, when prescribing monotherapy with long-acting agonists, frequent exacerbations of the disease were noted. The addition of corticosteroids to monotherapy with a long-acting agonist made it possible to influence the frequency of exacerbations and reduce the level of eosinophils in the blood.

The effectiveness of inhalation therapy can be significantly reduced by a number of problems. For example, inhalation technique errors can reduce the dose delivered by 22-95% compared to the optimal value in patients with technical errors in the use of the inhaler. Sub-optimal inspiratory flow rates in a number of patients with chronic obstructive pulmonary disease and asthma are often the cause of technical errors during inhalation. Patient education does not produce the expected results, as the underlying cause of reduced flow is high hyperinflation and weakening of the respiratory musculature. The use of technologically outdated inhalers is another significant cause of reduced therapy effectiveness. Patient education and even conversion to a different inhaler do not always increase the effectiveness of therapy. Respimat, a brand new delivery agent introduced in 2004, allows 39% to 67% of the nominal dose to be delivered to the airways, while the degree of pulmonary deposit is independent of inspiratory flow and pulmonary drug deposit does not decrease with increasing obstruction. Compared to powder inhalers, Respimat creates less resistance to airflow on inhalation. In addition, Respimat is an active device that requires no effort on the part of the patient to move the aerosol particles. These features make Respimat the new standard for inhalation therapy. This review aims to familiarise readers with the main features of the Respimat and the latest research findings

For two decades, the GOLD Initiative has consistently identified the use of bronchodilators as a priority in the pharmacotherapeutic strategy for COPD. The authors of international and national clinical guidelines consider fixed combinations of long-acting beta2-agonists (LABAs) and long-acting muscarinic receptor antagonists (LAMAs) as “first-line” drugs in most patients with COPD. Numerous clinical studies have shown that fixed LABAs/LAMAs combinations provide optimal bronchodilation and play a paramount role in preventing exacerbations of COPD. Outperforming placebo and active controls, LABAs, LAMAs, inhaled glucocorticosteroids (ICS)/LABAs combination bronchodilators may differ in their therapeutic potential. The available evidence base currently does not allow to make an unambiguous choice in favor of one or another fixed LABAs/ LAMAs combination. With the appearance of “triple” combinations (ICS/LABAs/LAMAs) on the pharmaceutical market, the issue of their comparison with “dual” bronchodilators has become particularly acute. Currently available data suggest that the use of “triple” therapy is not considered as a starting treatment option for COPD and is appropriate only in a subgroup of patients with a higher baseline risk of exacerbations: in the presence of a history of exacerbations ≥ 1, which required prescription of systemic antibiotics and/or glucocorticosteroids, or necessitated hospitalization during the previous year. Thus, ICS-containing therapy is justified only in cases of recurrent exacerbations of moderate COPD or single episodes of severe exacerbations, despite the continued administration of LABAs/LAMAs, as well as in certain categories of patients whose inflammatory profile suggests a “response” to ICS.

Introduction. One of their main aspects in the treatment of patients with bronchial asthma is maintaining adequate control over the course of the disease.

The aim: to assess the level of control, the causes of the uncontrolled course of the disease and the quality of life in patients with severe bronchial asthma.

Materials and methods. The study involved 160 patients with severe bronchial asthma taking basic anti-inflammatory therapy. The assessment of adherence to baseline therapy was assessed by questionnaires of patients with a modified Morisky-Green questionnaire and a test to assess adherence to inhalers (TAI). A quality of life questionnaire for patients with bronchial asthma (AQLQ) was used to assess quality of life.

Results. It was revealed that all patients had reported daily symptoms and a daily need for short acting beta-agonists; 96.6% of the patients enrolled in the study had night awakenings and physical activity restriction. The survey of patients with the help of the Morisky-Green questionnaire showed that deliberate low adherence to therapy was noted in 45.6% of cases, which was formed due to inattention to the hours of medication – 67.1% and missing the drug in good health in 47.9% of patients. Low motivation and low awareness of their disease is recorded in 24.4% of patients.

Conclusions. All patients did not achieve control of the disease. In half of patients with severe asthma, there is low deliberate adherence to basic anti-inflammatory therapy, which is formed mainly by missing the drug in good health and inattention to the hours of medication. Asthma symptoms have the greatest impact on the patient’s emotional state, physical activity, and overall quality of life.

Bronchial asthma remains one of the most common chronic respiratory diseases. The apparent heterogeneity of BA underlies the concept of phenotype-specific or patient-centered therapy. However, in real clinical practice, BA continues to be regarded as a rather homogeneous pathological condition and its treatment in the vast majority of cases retains an empirical approach, the basis of which are inhaled glucocorticosteroids, usually in combination with long-acting beta2-agonists. Since this group of drugs is very representative, the physician is faced with the question of choosing the optimal drug. The basis of evidence-based medicine is a hierarchical classification, where systematic reviews, meta-analyses, and randomized clinical trials are considered the highest level of evidence. Because randomized clinical trials are conducted in carefully selected highly selected patient populations, they have little relevance to patients encountered in everyday clinical practice. In contrast, pragmatic randomized clinical trials assess the clinical efficacy of the investigational agent in a large, unselected population in which patients with comorbidities are included. In this context, the Salford Lung Study (SLS) is of particular interest. It was conducted before the registration of a new combination drug containing the modern ICS fluticasone furoate and the long-acting beta2-agonist vilanterol. The SLS results indicated not only that the use of fluticasone furoate with vilanterol provides better control of BA compared to continued "conventional therapy" (ICS ± LABAs) in symptomatic patients, but also leads to a consistent improvement in the surrogate parameters of quality of life.

The relevance of pneumonia remains at the forefront and has recently attracted the attention of not only the entire medical community, but also all political and economic institutions of most countries of the planet. This nosology continues to be in the center of attention, identifying one of the key causes in the frequency of mortality of the population. The presented article accumulates the most up-to-date theses regarding viral pneumonia on the basis of a review of a large number of scientific literature, domestic and foreign studies. Although the term “viral pneumonia” has been used in medical practice for more than a century, nevertheless, there is no final diagnostic algorithm and an established final concept. The article reflects special historical medical and philosophical aspects in the study of pneumonia from the time of Hippocrates to the present. The epidemiological features, etiology, and also the terminological base of viral pneumonia are updated, thereby the concept of viral pneumonia in medical categories is fixed. A promising classification of viral pneumonia according to ICD-XI is presented. Attention is drawn to the autopsy morphological characteristics of the bronchopulmonary organ complex in viral pneumonia, post-mortem descriptions are given with links to authoritative research sources. The main modern diagnostic capabilities of the scientific medical community in the detection of pneumonia are described, the issues of the formation of new diagnostic algorithms are reflected. The clinical picture of viral pneumonia is described in detail, the clinical concept of the phase course of the disease based on pathomorphological data is presented for the first time. The main modern groups of drugs for etiotropic and pathogenetic treatment of the disease are considered. The conclusion reflects the main problematic postulates and prospects for further study of the disease.

The development of an effective and safe drug for the treatment of patients with COVID-19 is currently an urgent task for the global medical community. Given that lung damage remains the predominant syndrome in COVID-19, and the development of acute respiratory distress syndrome (ARDS) is the most common reason for transfer to intensive care unit and connection to artificial lung ventilation, it seems promising to study the effectiveness and safety of surfactant therapy, successfully proven in practice in the treatment of adult and preterm infants ARDS. Despite the fact that most studies are devoted to the use of this method in patients in the acute stage, we present a case from our own practice of Surfactant-BL inhalation in a patient with COVID-19-associated pneumonia at the 2nd stage of rehabilitation treatment. Clinical signs of respiratory failure (RR 22 per minute, Sa O2 86% on atmospheric air, 95% on insufflation of humidified oxygen 7 L/min), high percentage of lung tissue damage according to thoracic CT (55% – CT3) on admission to the Medical Rehabilitation Unit, as well as a score of 6 on the NEWS2 scale served as a basis for the patient to receive Surfactant-BL inhalation for the indication «prevention of the development of acute respiratory distress syndrome» in a dosage of 75 mg twice a day for 5 days. Positive dynamics of clinical data at the end of the course of inhalations (decrease of RR to 16 per minute, increase of Sa O2 to 90% on atmospheric air and to 95% on insufflation of humidified oxygen 5 l/min, improvement of auscultatory picture), as well as the control thoracic CT scan, which showed a decrease of lung parenchyma damage to 45.2% (CT-2), indicated the effectiveness and safety of this method in the complex rehabilitation of COVID-19 patient, being a basis for further investigation of this issue

Introduction. New coronavirus infection (COVID-19) contributes to the aggravation of respiratory symptoms in patients with COPD, including affecting the intensity and nature of cough. Hypertonic solution (HS) has a positive effect on the rheological properties of sputum and mucociliary clearance. However, there are no studies in the available literature on the use of HS in patients who have undergone COVID-19.

Goal. To evaluate the effect of the combination of 7% hypertonic saline and 0.1% natrii hyaluronas on the intensity and productive nature of cough in patients with COPD who have undergone a new coronavirus infection and the safety of its use in this cohort of patients.

Materials and methods. 50 patients with severe COPD in remission who suffered a new coronavirus infection were examined. The rehabilitation stage of treatment was carried out in the conditions of the pulmonology department. From the moment of receiving the last negative PCR result for SARS-CoV-2 to admission to the hospital for rehabilitation, it took from 2 to 3 weeks. The duration of follow-up of patients was 10 days. The patients were divided into two groups: group 1 (n = 25) – patients who received combination of 7% hypertonic saline and 0.1% natrii hyaluronas 7% by inhalation through a nebulizer; group 2 (n = 25) – patients who did not receive combination of 7% hypertonic saline and 0.1% natrii hyaluronas. The severity of cough was assessed (cough severity scale; shortness of breath, cough and sputum scale), clinical and biochemical blood tests, ECG, spirometry.

Results. In patients treated with combination of 7% hypertonic saline and 0.1% natrii hyaluronas, a significant decrease in the severity of cough, the amount of sputum was revealed. The tendency to reduce shortness of breath and improve the quality of life is determined. No serious adverse events were detected when using the drug.

Conclusions. The use of the combination of 7% hypertonic saline and 0.1% natrii hyaluronas in patients with COPD who have suffered a new coronavirus infection at the rehabilitation stage leads to a decrease in the intensity of cough and improved sputum discharge, which helps to reduce the severity of shortness of breath and improve the quality of life. The use of the drug is safe and does not lead to clinically significant adverse events.

There is suffering with bronchial asthma (BA) all over the world. This pathology is one of the most common diseases of respiratory system. In 2019, the coronavirus infection (COVID-19) pandemic spread all over the world. COVID-19 has made a big difference in the lives of the entire population. Patients with BA appeared to be especially the «weakest» cohort. At the beginning of the pandemic, it was considered that patients with asthma were most susceptible to COVID-19 infection and severe infection. Currently, it is known that BA does not affect on the COVID-19 severity. It is considering opinion that the predominance of cytokines of Th-2 immune response type and the eosinophils overproduction can somehow counteract to accumulation of pro-inflammatory cytokines, preventing development of a «cytokine storm» in COVID-19 disease, which explains the low percentage of infection in patients with BA. During the pandemic, there were 35 patients with BA under observation. As a baseline therapy, patients took a fixed combination of formoterol/budesonide (Formisonide-native) in the metered-dose powder inhaler; delivery method was carried out using “Inhaler CDM” in a single dose of 4.5/160 μg. Daily inhaled glucocorticosteroids (ICS) doses choice was corresponded to asthma severity. Medium ICS doses were taken by 17 patients (48.6%), high doses were taken by 18 patients (51.4%). Special properties of budesonide and formoterol make it possible to use their combination in the treatment of asthma both as baseline therapy and for attacks relief («therapy on demand»). Formisonide-native has advantages: the dose is strictly fixed, the patient has visual control and confidence in the delivered dose, which increases the patient’s compliance with therapy, especially in a pandemic. Also, during the period of COVID-19, patients with BA need to have followed-up regular medical care in the form of on-line consultations through modern messengers, to be trained to control the disease and implement the basic therapy dosage regimen.

Influenza is one of the most common infectious diseases and a significant public health problem. Every year, the influenza virus causes 3–5 million severe cases, millions hospitalizations and approximately 650,000 deaths. According to WHO four new influenza strains are projected to circulate in the 2020–2021 epidemic season. Influenza A and B strains are: A/Guangdong-Maonan/ SWL1536/2019 (H1N1) pdm09, A/Hong Kong/2671/2019 (H3N2), B/Washington/02/2019 (Victoria lineage), B/ Phuket/3073/2013 (Yamagata lineage). In this context, the problem of prescribing rational antiviral therapy is particularly importance. COVID-19, along with influenza, is a group of respiratory viral infections, but important differences exist in terms of viral agents and the spread of infection. Important differences include the rate of transmission. The average incubation period and generation time (the time between infecting one person and infecting another) for influenza are shorter. COVID-19 may be more severe, causing complications and deaths in 3–4% of cases. The estimated generation time for COVID 19 is 5-6 days, while for influenza it is 3 days. According to the latest data, the reproductive number, i.e., the number of people who can be infected by one patient, is in the range of 2 to 2.5 in COVID 19, which is higher than in influenza. Only a laboratory test can accurately identify the type of pathogen and distinguish it from influenza and other respiratory viruses. Neuraminidase inhibitors are currently first-line drugs recommended by WHO for the treatment and prevention of influenza.

Introduction. Exposure to SARS-CoV-2 leads to damage and dysfunction of the microvasculature of the lungs. The development of vasculitis, an increase in the permeability of the vessel wall, changes in the vascular-platelet and coagulation hemostasis, lead to the development of thrombosis / thromboembolism and hemorrhages. Single-photon emission tomography of the lungs is optimal for assessing changes in microcirculation in the lungs of patients with COVID-19 infection, since CT angiography can detect these formidable complications only in the large vessels of the lungs.

Оbjective оf the work. To assess changes in the microvasculature of the lungs in patients with the development of postcovid syndrome and to assess the possibilities of single photon emission computed tomography in the diagnosis of thromboembolism, thrombosis and hemorrhages.

Material and methods. The data of radiological studies performed in 138 patients in the postcovid period were analyzed, directed for examination to assess changes in blood circulation in the lungs and identify complications of the disease (thromboembolism, thrombosis, hemorrhages).

Results. In patients who underwent an infection caused by the SARS-CoV-2 virus in a mild form, we identified changes in microcirculation most characteristic of manifestations of vasculitis and small local blood flow defects close to a triangular shape (microthrombosis), which correlated with an increase in fibrinogen (4.32 ± 0.21 g/L) (rs = 0.97; p = 0.001). Signs of microthrombosis, pulmonary embolism were detected in 35.9% of moderately severe patients who did not receive anticoagulant therapy or was prescribed it on day 10–12 of illness, and in 67.2% of severe and extremely severe patients who received anticoagulant therapy during the illness. Signs of postthromboembolic changes were detected in 16 patients (59.2%) in the late postcovid period, which correlated to a high degree (rs = 0.81; p = 0.03) with an increase in the level of fibrinogen (4.5 ± 1.9 mg/l).

Conclusions. The severity of microcirculation disorders in the lungs depends on the severity of the disease and the timing of the postcovid period. Signs of small branch thromboembolism / thrombosis are detected in the early postcovid period. In patients who have undergone COVID-19 with the development of thrombosis, signs of postponed pulmonary embolism are revealed and zones of local pneumosclerosis are formed.

Introduction. According to available data, the frequency of prescribing antibacterial drugs to patients hospitalized with COVID-19 is many times higher than the level of bacterial infection recorded in them. This trend may make an extremely negative contribution to the problem of antibiotic resistance in the future, which makes it important to monitor and study the consumption of antibiotics in this category of patients.

Aim of the study. To estimate the change in the consumption of antibacterial drugs in patients hospitalized with COVID-19 in a multidisciplinary hospital compared with the consumption in the pre-pandemic period, and to conduct a subsequent analysis of the detected changes.

Materials and methods. This retrospective study, reviewed the medical records of patients hospitalized with COVID-19 in the Moscow city hospital No. 4 in the period from April 27 to December 31, 2020, as well as medical records of patients hospitalized in the same medical institution for the same period of 2019. Results of the use of antibacterial drugs were obtained. They were evaluated using the ATC/DDD methodology and then subjected to further analysis.

Results. Total consumption increased from 31,576 DDD/100 bed-days to 220,609 DDD/100 bed-days among the patients hospitalized with COVID-19. The level of consumption of macrolides increased most significantly – from 0.024 DDD/100 bed-days to 147.898 DDD/100 bed-days. The level of consumption of penicillins increased from 2,346 DDD/100 bed-days to 15,892 DDD/100 beddays, cephalosporins – from 11.78 DDD/100 bed-days to 19,107 DDD/100 bed-days, fluoroquinolones – from 10,276 DDD/100 beddays to 25,535 DDD/100 bed-days.

Conclusion. The consumption of antibiotics has increased dramatically on the backdrop of the COVID-19 pandemic. Based on the data of the frequency of bacterial complications in patients with COVID-19 (no more than 8%), a more rational approach to antibacterial therapy in this group of patients is needed to reduce the potential deterioration of the problem of antibiotic resistance.

The course and management of coronavirus infection (CI) in patients with severe comorbidity are extremely important scientific and practical issues in the era of COVID-19. Kidney transplant recipients make up one of the most vulnerable groups for CI-associated adverse outcomes. Considering the presence of comorbidities, the optimal pharmacotherapy regimens for CI and its complications have not yet been worked out for these patients. In this article, we present two clinical observations demonstrating typical manifestations of coronavirus pneumonia (CP) in kidney transplant recipients, the COVID-19 diagnostic and verification algorithm, and the therapeutic options used to achieve a favorable outcome of CP and to prevent fatal complications. Our findings confirm that in kidney transplant recipients CP is linked to increased disease severity with rapid progression of lung damage and a high risk of developing systemic complications, including thrombotic microangiopathy. It is shown that compliance with the current recommendations for a rational combination of antiviral, anti-inflammatory, anticoagulant and basic immunosuppressive agents in this group of patients provides good treatment outcomes and prevents kidney transplant failure. Two adverse outcomes in the observed group were due to associated opportunistic infection. Based on our findings and clinical data, we conclude that preemptive therapy with IL-6 inhibitors or colchicine is an effective therapeutic option in kidney transplant recipients.

Introduction. The treatment of children with multidrug-resistant and extensively drug-resistant tuberculosis (MDR / XDR-TB) is a difficult task due to many factors: the duration of treatment, the lack of drugs with children’s dosages, age restrictions (according to the drug instructions).

Purpose of the study. To assess the efficacy and safety of regimen with the inclusion of bedaquiline in children and adolescent with respiratory tuberculosis with drug-resistant tuberculosis.

Materials and methods. The study is prospective, cohort, non-comparative from the period 2017–2019. We included 24 patients aged 5 to 17 years with MDR-TB (established or suspected) began regimen containing bedaquiline for 24 weeks. The duration of observation of patients included in the study was 24 months.

Results. We can state a sufficient level of safety of using the latter for 24 weeks: adverse events presumably associated directly with the intake of bedaquiline were noted in only 1 patient out of 24 (4.2%; 95% CI 0.7-20.3). The efficacy of a regimen containing bedaquiline in combination with other anti-tuberculosis reserve drugs is beyond doubt: positive clinical and radiological dynamics and cessation of bacterial excretion by the end of the 24-week course of treatment were noted in all patients included in the study. In the course of 2-year follow-up, no exacerbation of the tuberculous process was observed in any case. All patients achieved clinical cure of tuberculosis.

Conclusion. Regimen containing bedaquiline for children aged 5–17 years with multidrug-resistant tuberculosis is effective and safe.

Introduction. In the context of a decrease in the tension of the epidemic situation on tuberculosis in Russia, it remains relevant to search for new ways to increase the effectiveness of preventive anti-tuberculosis measures among children and teenagers, taking into account an integrated approach to assessing all risk factors for tuberculosis in various age groups of the child population.

Objective. Tо study the complex characteristics of groups at increased risk of tuberculosis among children of different ages who have positive results of a skin test with a recombinant tuberculous allergen (АТR).

Materials and methods. The study retrospectively included 392 patients aged 2–17 years with a positive ATR test result. The рatients were randomized by age into 3 groups: in the 1st group there were 87 children 2–7 years old, in the 2nd group 182 children aged 8–14 years were included, in the 3rd group included 121 patients 15–17 years. The children did not have clinical and radiological signs of active tuberculosis and were HIV-negativ.

Result. Among children and adolescents with a positive result of the test with ATR, social risk factors for developing tuberculosis (unfavorable living conditions, lack of permanent employment in 86.3% of parents) were determined. It was found that children living in families with low social status were dominated by contact with patients with multidrug resistance of the pathogen (MDR-TB), more than half of children (53.1%) had comorbidities. In 13.3% of children, small calcifications were detected in the lungs, in the intrathoracic lymph nodes.

Conclusion. Among children 2–7 years old with positive results of the test with ATR, a complex of risk factors for the development of tuberculosis prevails: low material security in every second family, alcohol and drug dependence of parents in every third family, contact with MDR-TB patients in 56.5% of children, high incidence of concomitant pathology (in 67.4% of children).

Introduction. Mucolytic therapy is basic in the treatment of patients with cystic fibrosis (CF). Currently, inhalation of hypertonic saline (HS) of NaCl is recommended for the treatment of CF patients.

The aim of the study was to investigate the experience of the use of HS NaCl for inhalations CF patients in the Russian Federation.

Material and methods. To estimate the use of HS NaCl, data of national registers for 2011–2019 were used. Pharmacoeconomic analysis of “HS 7% NaCl + 0.1% sodium hyaluronate”, presented in the Russian market, carried out according to the cost estimate for the course of therapy based on the cost from the site of the unified information system in the sphere of procurement.

Results. From 2011 to 2019, an increase in the number of patients receiving the inhalation of a HS is observed. 2011 –8.7% of patients with CF, by 2019 – in 71.5% of CF patients. In 25 regions of the Russian Federation more than 80% of CF patients used HS NaCl. The cost analysis of Russian-made medicinal products for human use containing 7% HS and 0.1% sodium hyaluronate solution, and foreign-made products of similar composition showed that the annual cost of therapy with Russian-made products was 2.15 times lower than that with the foreign-made products. As for the medicinal product mannitol, the annual cost of therapy with a foreign-made product is 8.1 times higher than the cost of a Russian-made product.

Conclusions. The clinical practice of treating patients with CF has accumulated positive use of HS in inhalations, the use of which has increased significantly since 2011. Medical products 3 and 7% HS with a 0.1% solution of sodium hyaluronate are prescribed from the moment of diagnosis and have advantages over the HS pharmacy production over portability and ease of use. The use of the “7% HS with a 0.1% solution of sodium hyaluronate” is mainly determined by the financial accessibility.

Chronic lung infection caused by Pseudomonas aeruginosa reduces respiratory function and life expectancy in people with cystic fibrosis. Up to 2/3 of hospitalized patients, have antibiotic-resistant strains of Pseudomonas aeruginosa, which presents significant difficulties in prescribing eradication antibiotic therapy, which in some cases is aggravated by undesirable side effects of antimicrobial chemotherapy. The nutritional status of patients with cystic fibrosis is directly related to the activity of chronic pulmonary infection and the frequency of pulmonary exacerbations. A clinical example discusses the tactics of prescribing an alternative inhaled antibiotic aztreonam lysine (Cayston (Aztreonam lysine), Gilead Sciences Inc.) active against carbapenemases, including metallobetalactamases, in a patient with multidrug-resistant Pseudomonas aeruginosa. The clinical case demonstrates the successful eradication of the multidrug-resistant biotypes of Pseudomonas aeruginosa, and, as a consequence, the improvement of respiratory function and nutritional status, including the normalization of the 25(OH)D level in the patient.

Algorithms for de-escalation of basic therapy, including the abolition of inhaled corticosteroids (ICS), in patients with chronic obstructive pulmonary disease (COPD), as well as the development of clear criteria for prescribing triple therapy in clinical practice remain the subject of numerous studies and discussions. The given case report of managing a patient with a long experience of smoking and severe COPD demonstrated an unsuccessful experience of de-escalation of therapy with the abolition of ICS due to concerns about the fact of pneumonia. The dual bronchodilator therapy prescribed in accordance with modern recommendations was insufficiently effective in preventing exacerbations, and the stabilization of the patient’s condition was observed after the appointment of a fixed triple combination of drugs in a single inhaler (VI/UMEC/FF), which contains vilanterol (VI), umeclidinium bromide (UMEC) and ICS fluticasone furoate (FF). An additional contribution to ensuring clinical success was made by such factors as strict compliance with medical prescriptions by the patient, smoking cessation and compliance with recommendations for maintaining physical activity, compliance with a strict self-isolation regime during the pandemic, which reduced the risks of respiratory viral infections. Additional clinical predictors of the effectiveness of ICS in COPD were the bronchitis type, the persistence of symptoms and the recurrence of exacerbations of the disease after discontinuation of the drug, the level of blood eosinophilia. When deciding whether to prescribe or cancel triple therapy, it is recommended to take into account the data on the effect of ICS on improving the functional parameters and clinical course of the disease with a decrease in symptoms, on reducing the risk of exacerbations, on increasing patient survival and a positive prognosis during COPD.

The asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), atopic dermatitis (AD), eosinophilic esophagitis and other diseases based on T2-inflammation are a widespread in the world. It has led to the development of genetically engineered drugs aimed at individual and specific components of inflammation. One of the leading positions in the pathogenesis of T2-mediated diseases is occupied by interleukin (IL)-4 and IL-13, which explains the prospects of studying these cytokines for the creation of anti-IL-4/IL-13 monoclonal antibodies. The first immunobiological drug was registered to directe against the α subunit of the IL-4 receptor (IL-4Ra), common to both IL-4 and IL-4/IL-13 receptor complexes is dupilumab which is a fully human monoclonal antibody. Dupilumab targets the IL-4 receptor alpha chain (IL-4Rα), common to both IL-4R complexes: type 1 (IL-4Rα/γc; IL-4 specific) and type 2 (IL-4Rα/IL-13Rα1; IL-4 and IL-13 specific). Because the IL-4/IL-13/STAT6 signaling pathway plays a significant role in T2 inflammation. IL-4 and IL-13 are secreted by several cells and, along with other T2 cytokines, as well as with the participation of IL-33, IL-25 and TSLP can stimulate cells to further secrete pro-inflammatory cytokines, contributing to the maintenance of the inflammatory process. Currently, dupilumab has been studied in at least 3,000 patients with asthma, AD, CRSwNP and eosinophilic esophagitis. The results of investigation show an acceptable safety profile in placebo-controlled studies worldwide. In this article, we have highlighted the results of numerous clinical studies and observations that have proven the effectiveness and safety of the use of dupilumab in asthma, AD, CRSwNP, prurigo, eosinophilic esophagitis and eosinophilic pneumonia.

Despite the evidence and logical fact that smoking and asthma are incompatible, many patients are smoke. The proportion of smokers among asthmatics is comparable to the proportion of smokers in the population. The proportion of smokers among asthmatics is comparable to the proportion of smokers in the population. Currently, the prevalence of tobacco use in the Russian Federation remains high at over 20%. In addition to active smoking, patients may be exposed to the negative effects of tobacco smoke through secondhand smoke. Smokers with asthma are more likely to have signs of poor disease control, and are more likely to seek exacerbation. However, a therapy strategy for them has not been worked out. For many randomized trials, patient smoking is the exclusion criterion, and therefore the effectiveness of a particular anti-asthma therapy in smokers is poorly understood. In addition, it is a known fact that smoking develops resistance to the main anti-asthma therapy, inhalation glucocorticosteroids. The article discusses the mechanism of exposure to tobacco smoke on lung tissue, the development of pathological processes under the influence of components of tobacco smoke and possible solutions to the problem. The mechanism of inflammatory and anti-inflammatory effects of various components of tobacco smoke. Particular attention is paid to the role of cysteinyl leukotrienes in the formation of inflammation in the lower respiratory tract in smoking patients with asthma and the possibility of treating these patients with leukotriene receptor antagonists. A review of studies conducted in patients with bronchial asthma and exposure to tobacco smoke in whom montelukast was used as therapy is presented. Provides information on the safety and side effects of the drug.

Cough is one of the auxiliary mechanisms for cleaning the airways from mucus, foreign particles, microorganisms. The physiological cough reflex allows the mechanism of airway cleansing, provided that mucociliary clearance works sufficiently. However, sometimes the cough loses its protective function, becomes persistent, and impairs the quality of life of the patient. In this regard, in the treatment of cough, attention is paid to both secretomotor and secretolytic therapy. Medicinal plants are among the drugs with such properties. Numerous group of drugs containing herbal components has a reflex action, which allows coping most effectively with cough in the initial stages of diseases accompanied by respiratory symptoms. The most common among them and widely used are plantain leaf, coltsfoot leaf, thermopsis herb, ipecacuanha root, marshmallow root, licorice root, anise fruit, thyme (thyme) herb extract, ivy leaf extract. A well-known drug, the active ingredient of which is ivy leaf extract. Its mechanism of action consists in increasing the production of surfactant and increasing the number of β2-adrenoreceptors on the surface of alveolar cells of the bronchial tree, to which ivy active substance α-hederin is attached, which has a bronchospasmodic and expectorant action. Numerous clinical studies have proven a high efficacy and safety of the product based on ivy leaf extract, which allows us to recommend it as the drug of choice for symptomatic cough therapy in both children and adults during acute respiratory infections.

Chronic respiratory diseases are among the most common non- infection diseases. In particular, it is bronchial asthma (BA), characterized by bronchial hyperreactivity and varying degrees of airway obstruction that is the cause of morbidity and mortality. The methods available for the information about the presence of inflammation in the airways, such as bronchoscopy and bronchial biopsy to be obtained have currently been invasive and difficult in everyday clinical practice, especially for children and seriously ill patients. In this regard, recently there has been an increase in the development of non-invasive methods for diagnosing the respiratory system, being comfortable and painless for trial subjects, especially children, also providing the inflammatory process control in the lungs, the severity assessment and monitoring the treatment process. The exhaled breath condensate (EBC) is of great attention, which is a source of various biomolecules, including nitric oxide (NO), leukotrienes, 8-isoprostane, prostaglandins, etc., being locally or systemically associated with disease processes in the body. Of particular interest is the presence of cytokines in EBC, namely the specific proteins produced by various cells of the body that play a key role in inflammatory processes in AD and provide cell communication (cytokine network). Thereby, it becomes possible for the severity and control level of childhood bronchial asthma using only the EBC analysis to be assessed. In addition, the non-invasiveness of this method allows it to be reused for monitoring lung diseases of even the smallest patients, including infants. Thus, the field of metabolite analysis in EBC has been developing and, in the near future, the given method is likely to be the most common for diagnosing the respiratory system diseases in both children and adults.