Introduction. The study of omalizumab efficacy in patients with severe bronchial asthma (SA) in randomized clinical trials is limited to 52 weeks. In real clinical practice, patients can receive the drug for much longer.

Aim. Evaluate the one-year and two-year efficacy of omalizumab in patients with SA in Sverdlovsk region.

Material and methods. The study included patients (n = 54) with allergic and mixed SA from the registry of Sverdlovsk region. Omalizumab efficacy was assessed over 12 and 24 months of therapy by dynamics of asthma exacerbations frequency, the use of health care resources, the need for short-acting beta-agonists (SABA) and systemic glucocorticosteroids (SGCS), the level of asthma control according to ACT, and the quality of life according to AQLQ, FEV1 levels and peripheral blood eosinophils.

Results. During 12 months of omalizumab therapy, the reduction in asthma exacerbation rate was 63.7% (from 2.01 ± 1.51 per patient per year to 0.73 ± 1.03) (p < 0.001), which was accompanied by a decrease in emergency calls and hospitalizations rates by 92.4 and 84.1%, respectively (p < 0.001). Improved asthma control (by ACT) from 9 (Q1-Q3: 7–13) to 20 points (Q1-Q3: 16–23); the proportion of patients with uncontrolled SA decreased from 97.4 to 48.7% (p < 0.001). The need for SABA decreased to 92.9% (p < 0.001). The proportion of patients on SGCS decreased from 60.5% to 15.8% (p < 0.001). The quality of life (AQLQ) significantly improved, FEV1 increased (p < 0.001), the number of eosinophils in peripheral blood decreased (p = 0.015). By the end of the second year of therapy, the trend of improvement in indicators of efficacy continued.

Conclusions. During 1 year of therapy with omalizumab, patients with allergic SA experienced a significant decrease in the number of exacerbations and use of health care resources, improved quality of life and asthma control, reduced need for SABA and SGCS, and improved respiratory function. In patients treated with omalizumab for 2 years, there was a further improvement or stabilization of efficacy indicators.

Introduction. The accumulation of clinical experience in the use of biological therapy in patients with severe bronchial asthma (SBA) in real-world clinical practice with the possible identification of additional, previously undescribed clinical results is of practical interest.

Aim. The goal of the study is to present results of observational study that reflects experience of using benralizumab in SBA in real-world clinical practice in city of Saint Petersburg.

Materials and methods. We presents results of more than 1 year observation of 18 patients with eosinophilic SBA (12 females, 6 males, age from 28 to 74, average age 55 ± 11.9 years). Patients received benralizumab in addition to standard medical management. Conducted clinical, laboratory, functional examination of patients, assessment of the frequency of exacerbations and additional clinical effects.

Results. It was shown that the inclusion of benralizumab in complex therapy led to a significant improvement in disease control, improved bronchial conduction, a significant decrease in blood eosinophilia and a reduction in the number of exacerbations. Clinical examples are given that evidence to the stabilizing effect of this therapy on the course of recurrent nasal polyposis and the positive effects on the course of eosinophilic granulomatous polyangiitis, manifested by SBA.

Conclusions. In real clinical practice, the possibility of a significant improvement in control in patients with SBA with the use of biological therapy has been confirmed. At the same time, data have been obtained that will allow expanding the indications for the use of benralizumab in the future.

The review analyzes the role of microRNAs in the pathogenesis of bronchopulmonary diseases. The universality of the mechanisms underlying epigenetics causes a continuously growing interest in research in this field in various fields of medicine. Research in the field of epigenetics not only allows us to expand knowledge in the field of etiology and pathogenesis, but also helps to explain the heterogeneity of the disease. Currently, biomarkers used in determining the phenotype of bronchial asthma or COPD are not able to display the variety of pathological processes involved in the pathogenesis of the disease at the molecular level. It is noteworthy that microRNAs retain their stability in various body environments, are resistant to high temperatures, pH fluctuations, and freeze-thaw cycles, which greatly simplifies the process of detecting these molecules in biological fluids. The amount of detected microRNA is highly specific for a particular pathological process occurring intracellularly. Currently, biomarkers used in determining the phenotype of bronchial asthma or chronic obstructive pulmonary disease are not able to reflect the variety of pathological processes involved in the pathogenesis of the disease at the molecular level. For both diseases, the key links are known to be inflammation, airway remodeling, and an abnormal response of epithelial cells to external stimuli. Thus, there is a great potential for using microRNAs in clinical practice: as noninvasive biomarkers reflecting key points of pathogenesis, as a prognostic biomarker predicting response to therapy, and possibly in the future as new therapeutic targets.

Obesity is a rapidly growing social problem that affects more than 650 million people worldwide. It has been proven that obesity is associated with diabetes mellitus, dyslipidemia, hypertension, cardiovascular diseases, obstructive sleep apnea (OSA) syndrome. However, one of the most serious and least reported complications is obesity-hypoventilation syndrome, characterized by obesity (body mass index ≥ 30 kg/m²), hypercapnia (PaCO₂ > 45 mmHg), as well as respiratory disorders during sleep (AHI > 5h). The prevalence of OHS is estimated at 10–20% in obese patients. The basis of the pathogenesis of OHS is low compliance of the chest and lungs due to excessive weight load. An effective method of treatment is to change the life-style in order to reduce body weight, however, there are frequent cases of acute respiratory failure (ARF), for the correction of which respiratory support is necessary, in particular with the help of non-invasive ventilation (NVL). For this purpose, an artificial ventilation device is used with various modes of operation: continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), average volume-assured pressure support (AVAPS). At the same time, obstructive phenomena are not attributed to the main causes of OHS, which is why CPAP is not conceptually a method of treating OHS, however, it was found that more than 90% of patients with OHS have concomitant OSA. In such patients, most of the pathophysiological links can be safely corrected using CPAP therapy, since with this method the stability of the upper respiratory tract lumen is achieved. BiPAP and AVAPS regimens affect the pathogenetic mechanisms of OHS, which is why they demonstrate high effectiveness both in the short term (ARF) and in the long term (long-term treatment with respiratory support).

The COVID-19 pandemic was accompanied at different times by the prescription of various drugs. The prescription of antibacterial drugs was regarded differently, and even the term “pneumonia” was the subject of discussion. The frequency of antibiotic use during the pandemic varied widely across countries, with a general trend towards overprescribing. According to most studies, in the early period of this viral infection, there were no indications for antibiotic therapy, while later, when a bacterial process is attached, a rational choice of the drug is important, taking into account the potential resistance of the pathogen, including the production of beta-lactamase. In the current version of the guidelines on COVID-19, the topic of bacterial infections has been carefully worked out. It is clearly stated that antibiotic therapy is prescribed only if there are convincing signs of a bacterial infection. On the one hand, it was noted that most patients with COVID-19 do not need antibiotic therapy, and on the other hand, for patients who do not need hospitalization with signs of a bacterial infection, amoxicillin and amoxicillin/clavulanate are the drugs of choice. The latter combination is also approved for hospitalized patients. Literature analysis has shown that amoxicillin/clavulanate remains a highly effective antibiotic for the initial treatment of community-acquired respiratory tract infections. In the conditions of import substitution, the creation of effective and safe, affordable domestic generics that have therapeutic equivalence with original drugs is a significant achievement of the Russian pharmaceutical science and industry. This review assesses the efficacy and safety of antibiotic use during a pandemic, as well as the place of amoxicillin/clavulanate in modern clinical practice.

The subacute period of coronavirus infection is a 4- to-12-week period after acute illness associated with the SARS-CoV-2 infection. A range of bronchopulmonary symptoms in the subacute period of COVID-19 includes cough, shortness of breath, reduced exercise tolerance, which, in turn, worsens the patient’s quality of life. Despite all the achievements of modern medicine, there is still no exact understanding of the mechanisms of this condition. There are also limitations of current patients’ treatments. The successful use of exogenous surfactant in the acute period of SARS-CoV-2 infection has become the starting point in the search for new therapeutic tools for this category of patients. The paper describes a clinical observation with the use of inhaled therapy with surfactant 150 mg/day for 7 days in a patient who underwent COVID-associated pneumonia with persistent ventilation disorders, decreased exercise tolerance, and characteristic changes identified due to the multispiral computed tomography examination. The treatment included the use of the Russian-manufactured surfactant (tauractant), a lyophilisate for suspension for endotracheal, endobronchial and inhalation administration, 75 mg vials. The drug is sourced from bovine lungs, refers to ATC R07AA30 (therapeutic combinations comprising pulmonary surfactants); pharmacotherapeutic group: surfactant. The studied treatment demonstrated the efficacy and safety of administration in this category of patients, and also ensured the disease control and improved quality of life.

Introduction. The study of the manifestations of symptoms of COVID-19 and hemorrhagic fever with renal syndrome (HFRS) is an important aspect of the diagnosis, especially for regions endemic for HFRS.

Aim. To conduct сomparative study of the clinical symptoms and parametres of a complete blood test at the onset of the disease with lung involvement in patients with HFRS and COVID-19 with moderate severity.

Materials and methods. A retrospective comparative analysis and identification of laboratory data of patients with moderate form of HFRS with respiratory syndrome (n = 52) and patients with moderate severity form of COVID-19 (n = 52) upon admission to the hospital was carried out.

Results. Fever is one of the main symptoms for both diseases, characterizing the degree of severity. At the same time, the temperature in patients with HFRS on admission was higher than in patients with COVID-19 (p < 0.05). Shortness of breath is much more often recorded in the group of patients with viral pneumonia COVID-19 (p = 0.0001). The oxygen saturation index (SpO2) in patients with HFRS was below 95%, but the average value of 96.4% was normal, while in patients with COVID-19 the average value was 92.8% (p < 0.05). When comparing the indicators of the general blood test, there was a statistically significant excess of the level of red blood cells and hematocrit in the group of patients with COVID-19, with a comparable level of hemoglobin in both groups. The average value of the absolute content of platelets was significantly lower, and the number of patients with thrombocytopenia is much higher in the group of patients with HFRS.

Conclusion. Kidney damage in HFRS is the main clinical and laboratory syndrome, but it is important to remember that lung damage by the type of viral pneumonia in HFRS is also possible. In all suspicious cases, an examination for SARS-CoV-2 and serological diagnosis of hantavirus infection are indicated.

The article presents a literature review on the pathogenesis, clinical and radiological manifestations and therapy options for post-COVID syndrome. The pathophysiological mechanisms underlying lung injury in severe COVID-19 and ARDS of any other aetiology include acute injury to the alveolar epithelium and pulmonary vascular endothelium with increased alveolar-capillary permeability, interstitial and alveolar oedema, formation of hyaline membranes, and accumulation of neutrophils in the lung tissue. The completion of the acute phase is followed by hyperplasia of type II alveolocytes, proliferation of fibroblasts and myofibroblasts as manifestations of the reparative processes. Post-COVID syndrome combines pathological conditions that are accompanied by the clinically meaningful decline in quality of life and risk of death and persist for a long time after the disappearance of the infectious symptoms of the disease. Post-COVID lung parenchymal consolidations are accompanied by impaired pulmonary ventilation, frequent development of chronic respiratory failure with exercise-induced hypoxemia, reduce the patients’ quality of life and require treatment. Currently, attempts are being made to use various drugs for the treatment of post-COVID interstitial changes in lungs, but the evidence base for providing guidelines is currently insufficient. Bovhyaluronidase azoximer is one of the promising drugs. A multicenter, randomized, double-blind, placebo-controlled, parallel-group clinical trial to evaluate the efficacy of bovhyaluronidase azoximer in patients with post-covid interstitial changes in lungs is currently being conducted in the Russian Federation. The study results can provide reliable information about the place and role of this drug in the treatment of post-COVID interstitial changes in lungs.

Introduction. Part of the reconvalescents after new coronavirus infection (NCI), have residual respiratory structural and functional abnormalities.

Aim. To evaluate the efficacy and safety of low-dose systemic glucocorticoids (SSG) in patients with respiratory symptoms and residual “fibrosis-like” changes in lung tissue after a moderately severe NCI with up to 50% lesion volume.

Materials and methods. Reconvalescents with moderate NKI who had respiratory symptoms and residual fibrosis-like changes in lung tissue at the time of discharge were randomly divided into two groups: those receiving systemic glucocorticoids (n = 15) and those not (n = 27). Complaint assessment, 6-minute walk test (6-MHT), spirometry, and high-resolution computed tomography (HRT) were performed at baseline, 2, and 9 months later. The primary endpoint of the study was complete disappearance of pathological changes in the lungs according to CTVR. Secondary endpoints of the study were: disappearance of respiratory complaints, increase in the distance traveled in 6-MCG test, regression of functional ventilatory disturbances according to spirometry data.

Results and discussion. In both groups by the 9th month of the study there was a significant positive dynamics: respiratory symptoms regressed, tolerance to physical activity improved, residual changes of lung tissue according to CTBPR decreased and in most cases completely disappeared. However, respiratory symptoms and residual changes in lung tissue remained in 9% of cases. Significant improvement of ventilatory lung function and exercise tolerance by the 9th month of follow-up was established in the systemic glucocorticoids group, with no adverse events detected.

Conclusions. In the acute phase of moderate NKI, both spontaneous resolution of respiratory symptoms and residual lung tissue changes and their effective and safe resolution due to the use of systemic glucocorticoids can be assumed.

Introduction. The issues of rational treatment of a new coronavirus infection (NCI), compliance of medical prescriptions with current clinical recommendations have been extremely relevant since the beginning of the pandemic. Of particular importance is the problem of overprescribing antimicrobials.

Aim. To analyze the prescriptions of medicines and evaluate the results of the implementation of the medical decision support system (MDSS) among general practitioners and general practitioners of the Belgorod outpatient department in the treatment of NCI

Materials and methods. Treatment regimens for outpatient patients with confirmed or probable COVID-19 infection were studied. The study was carried out in two stages: before and after the implementation of the MDSS: in the main group (MG, departments of the Belgorod polyclinic with the implemented MDSS), 95 episodes of treatment were analyzed before the implementation of the MDSS and 94 after. In the control group (CG, without the introduction of MDSS) – 48 episodes at the 1st and 2nd stages. The prescriptions of the main groups of drugs, their compliance with the recommendations were assessed, the impact of the introduction of MDSS on the applied therapy regimens was assessed. Statistical analysis was performed using four-field and multi-field contingency tables using Pearson’s χ² test, Fisher’s exact test.

Results. The 285 NCI therapy regimens were analyzed. In the course of the study, the structure of drug prescriptions was determined. It was found that against the background of the implementation of the MDSS, the specialists of the MG statistically significantly reduced the unreasonable prescription of antibacterial drugs (from 24.2 to 6.4%, p < 0.001; in the CG, p > 0.05; p_(MG-CG) < 0.001), less frequently prescribed anticoagulants (p_(MG-CG) > 0.05); significantly less often – systemic glucocorticosteroids (p_(MG-CG) < 0.001), the group of mucolitic, bronchodilator and antitussive drugs (p_(MG-CG) < 0.01), vitamins (p_(MG-CG) < 0.001); significantly more often (p_(MG-CG) < 0.05) – local antiseptics and the group of the other drugs . There were no significant differences (p_(MG-CG) > 0.05) at the second stage of the study in the use of antiviral, immunomodulatory, non-steroidal anti-inflammatory drugs.

Conclusion. Insufficient adherence of medical specialists to recommendations for the treatment of NCI has been established, a number of irrational therapeutic preferences have been identified. We believe that the follow-up medical educational activities, improvement and rational use of MDSS will help improve the quality of management of patients with NCI.

A high proportion of patients with various interstitial lung diseases (ILD) develop progressive pulmonary fibrosis (PLF) associated with a deterioration in the quality of life, a decrease in functional status and early mortality. PLF is diagnosed in patients with ILD of known or unknown etiology other than idiopathic pulmonary fibrosis (ILF), who have radiological signs of pulmonary fibrosis, and at least two of the three criteria for progression, including clinical, functional and radiological indicators that have arisen over the past year in the absence of alternative causes of deterioration. Subtypes of ILD that are at risk of developing a progressive fibrosing phenotype include ILD associated with connective tissue diseases, such as rheumatoid arthritis and systemic scleroderma; sarcoidosis; hypersensitive pneumonitis, occupational lung diseases. In 2022, new criteria for the diagnosis of PLF appeared. The existing evidence of common pathogenesis mechanisms leading to progressive pulmonary fibrosis suggests the presence of uniform biomarkers of disease activity for a wide range of diseases. Pulmonary fibrosis is initiated by microinjuries of the alveolar epithelium of various etiologies, in the future its progression includes similar pathophysiological mechanisms, which suggests the presence of uniform biomarkers of disease activity for a wide range of diseases. Biomarkers can help not only identify patients at risk of progression, but also allow monitoring the early response to treatment. Biomarker research to date has identified a number of molecular markers that predict the presence of the disease, prognosis and/or response to treatment. The creation of national and international registries allows for long-term monitoring of patients with PLF, to answer questions about the long-term effectiveness of treatment. To date, a number of molecular factors that claim to be predictors are being discussed, allowing to verify the diagnosis, determine the prognosis and response to therapy.

Introduction. The priority of anti-tuberculosis work in the Saratov Region is the early detection of the disease and the prevention of new cases of pathology. The presence of medical and social risk factors for developing tuberculosis significantly increases the risk of developing local forms of tuberculosis, especially if patients have latent tuberculosis infection (LTBI).

Aim. To assess the prevalence of LTBI in the adult population with an increased risk of developing tuberculosis in the adult population.

Materials and methods. The design of the study is a retrospective non-comparative. The data of patients from high-risk groups for the development of the disease for the period of 2015–2019, examined using a skin test with a recombinant tuberculosis allergen (Diaskintest, Generium JSC, Russia) in the Saratov Region, were analyzed.

Results. 153,120 people from medical outpatient risk groups and 3,099 people from social risk groups were examined. Among adults with medical risk factors for developing tuberculosis, the largest number of positive and doubtful results of Diaskintest were recorded in patients with chronic bronchopulmonary pathology – 15.88%; among the group of those surveyed with social risk factors for developing tuberculosis – in persons released from penitentiary institutions (25.88%).

Conclusions. The decrease in incidence rates in the Saratov Region confirms the correctness of the chosen tactics regarding the use of the Diaskintest test to identify individuals with LTBI among the adult population and the implementation of measures to reduce the reservoir of tuberculosis infection. Given the effectiveness of the measures taken, it is advisable to work with risk groups for Diaskintest and further examination in a general medical network. To do this, it is necessary to make additions to the current Order of the Ministry of Health of the Russian Federation dated March 21, 2017 No. 124n “On approval of the procedure and terms for conducting preventive medical examinations of citizens in order to detect tuberculosis” regarding the use of recombinant tuberculosis allergen samples in the adult population.

Introduction. Cystic fibrosis is a severe systemic multiorgan exocrinopathy, the severity of the condition in 95% cases is caused by the depth of respiratory organ damage. Symptom management drugs that were developed over more than 50 years allowed to improve survival, but average life expectancy in cystic fibrosis (CF) remains well below the general population average. Targeted therapy is the most promising treatment, which restores the chloride channel function. Lumacaftor/ivacaftor is the first targeted therapy drug authorized in Russia.

Aim. To evaluate the effect of lumacaftor/ivacaftor therapy on the respiratory function, microbiological profile, nutritional and oxygen status, as well as the rescue antibiotic therapy coverage in adult patients with CF.

Materials and methods. 39 adult patients with CF received lumacaftor/ivacaftor for one year. The therapy effectiveness endpoints included the changes in indices of the pulmonary function tests: FEV₁, FVC, FEV₁/FVC, sweat test results, nutritional and oxygen status, antibiotic therapy coverage. The tolerability of the drug was assessed. The median age of patients was 28.9 (11.3) years. 6 patients (15.4%) discontinued therapy due to different adverse reactions.

Results. The median increase in FVC was 2.9 (4.1)%, in FEV₁ – 3.1 (4.1)%, sweat chloride decreased by 21 (27) mmol/l during 1–1.5-month lumacaftor/ivacaftor therapy. After 12-month therapy, the median increase in FVC was 2.3 (3.6)%, in FEV₁ – 2.4 (3.8)%, BMI increased by 0.6 (0.6) kg/m² and the frequency of rescue antibiotic therapy decreased by half. The patients showed a significant increase in FVC and FEV¹ indices and a decrease in sweat chloride after 1-month therapy and an increase in FEV₁ indices, BMI vales as well as a reduced need for rescue antibiotic therapy after 12-month therapy.

Conclusion. The first experience with a long-term pathogenetic therapy with lumacaftor/ivacaftor in adult patients with CF in Russia demonstrated the expected positive effect on the respiratory function and changes in nutritional status, a reduced need for rescue antibiotic therapy, and low rates of adverse reactions.

Viral upper respiratory infection  (VURI)-associated acute cough is the most common symptom worldwide among children and adults. It causes  serious  economic  and  social  problems  both  for individual  patients, patients’  families, and  the  health  care system as a whole. There is still no effective pharmacological agent  capable  of interfering  with all the main pathophysiological mechanisms involved in VURI-associated acute  cough. This circumstance partly explains  the increased prevalence of the prolonged course of acute  respiratory  infections, when the cough takes on the features  of subacute or post-infectious course. The pathophysiology of this symptom is being actively investigated to optimize  the treatment of cough. A viral infection  provokes an acute  cough  induced  by various irritative  stimuli, the  main one  being  secretions from the  respiratory  tract, which directly acts on reflexogenic areas  of the mucosa. Inflammatory mediators also play an important role, acting  on the peripheral sensory terminations of airways. Inflammatory mediators also induce post-infectious bronchial hyperreactivity, which is an important component of the pathogenesis of post-infectious cough. Recently, researchers are becoming increasingly interested in the  role of the  voluntary  or conscious  cough  component, which is implemented due  to the  cortical  response to afferent information  from the receptors of the upper respiratory tract.This hypothesis  explains the ineffectiveness of central antitussive agents  in patients with viral infection-associated dry cough  and  expands  the  possibilities  of peripheral antitussive agents represented by levodropropizine. In addition  to the  action  on nerve endings, the  agent  also affects  inflammatory  mediators, which enhances its ability to break the “vicious circle” of this symptom, prevents the development of post-infectious cough and promotes rehabilitation of the  bronchial  tree. The efficacy and safety of levodropropizine has been  demonstrated in clinical trials in both children and adults.

Acute Respiratory Viral Infections (ARI) are the most common respiratory diseases. The main purposes of ARI and influenza therapy are to improve the quality of life of the patient and prevent complications, which can be achieved by combining antiviral and symptomatic therapy. It is important for general practitioners to know the principles of respiratory tract infectious disease treatment. The principles of the therapy include reduction of viral load, broncho- and mucolitic effects and improvement of the patient’s quality of life (reductions in symptoms), prevention of complications. It is recommended to start treatment with antiviral drugs for the first 48 hours after the clinical manifestation of the disease. To improve the quality of life, the prescription of combination medicines is a priority. The use of combined drugs is more convenient than mono-component drugs and safe for patients. It is important to bear in mind that, that immunomodulating agents after a manifestation of the disease are not effective. Local and international clinical recommendations prescribe the use of symptomatic agents for ARI and influenza, but their preventive use is not permitted. Symptomatic treatment is a priority and makes it possible to relieve the general condition, accelerate recovery and improve the quality of life of patients, and gives the doctor time to make an accurate diagnosis and prescribe ethiotropic therapy. The combined drugs, including the analgesic/antipyretic component paracetamol, antihistamine phenylamine and decongestant phenylephrine, relive the main clinical symptoms of ARI. The purpose of this combination is optimal from the point of view of efficiency and safety.

Introduction. Although acute cough in acute inflammatory diseases of the upper respiratory tract seems to be a minor problem and can be stopped on its own, it holds the leading position among all reasons for population receiving health care due to significant decrease in life quality.

Purpose. To  analyze the cough severity in patients with acute nasopharyngitis with intoxication syndrome in the treatment  of systemic non-steroidal anti-inflammatory drugs (NSAIDs) and local interferon therapy.

Materials and methods. The study included 62 patients with acute nasopharyngitis with intoxication syndrome, in the period from the onset of the first symptoms to the visit to the doctor was no more than 24 hours. They were divided into 2 groups: group 1 − 32 people (14 men, 18 women, age 34.4 ± 10.3 years) received traditional systemic therapy with NSAIDs, group 2 − 30 people (13 men, 17 women, age 41.1 ± 13.7 years) received interferon-α2b intranasally. Cough severity was assessed using a 3-point visual analog scale (VAS) on the day of admission and for the next 7 days.

Results. On the 1st day dry cough was observed in 62.5–63.3% of cases. Starting from the 3rd day of observation, there were statistically significant differences in the intensity of this symptom between the groups. In the traditional therapy of NSAIDs, an increase in the number of patients with a complaint of cough, and an increase in its severity compared with the first day  of observation was revealed. They lasted until the 6th day of illness, which was explained by the spread of the inflammatory process to the trachea and bronchi. In the treatment of local interferon therapy, cough regression was noted on day 4 in 83.3% of cases, with its complete disappearance in this group on day 6. The total duration of cough in group 1 was 6.0 (5.0; 8.0) days, in group 2 – 2.0 (1.0; 3.0) days.

Conclusion. In acute inflammatory diseases of the upper respiratory tract, cough in the absence of prescribing drugs that affect this symptom persists on the eighth day of observation in 56.2% of patients with traditional therapy with systemic NSAIDs.

Erdosteine is a drug based on thiol and used at the beginning only as a mucolytic. The main indication for it is the treatment of acute and chronic lung diseases, accompanied by difficult sputum discharge. The therapeutic effect of erdosteine is due to the action of thiol metabolites, which, in addition to mucoactive, have antioxidant, anti-inflammatory and antibacterial activities. Experimental studies have shown that this drug reduces the degree of damage to lung tissue caused by oxidative stress, primarily by reducing the production of reactive oxygen species. It increases the concentration of IgA in the respiratory mucosa, thereby reducing the damaging effect of tobacco smoke on endothelial and macrophage cells. In the RESTORE clinical study, which studied the effect of erdosteine on the frequency of exacerbations of chronic obstructive pulmonary disease, it was demonstrated that it significantly reduces the risk, frequency and severity of COPD exacerbations, regardless of patients taking inhaled corticosteroids and eosinophil levels. Recent experimental studies have shown that erdosteine also has the ability to slow the progression rate of fibrosis in pulmonary tissue. It has been shown to inhibit the development of bleomycin-induced fibrosis. The authors of the study suggested that this effect may be related to the suppression of neutrophil migration metabolite erastheine, the inhibition of lipid peroxidation and, in general, the regulation of antioxidant protection mechanisms Data obtained in recent studies also open up new possibilities for the use of erdosteine in patients with bronchial asthma and idiopathic pulmonary fibrosis, significantly expanding the indications for its use.

Pneumonia is the most common and deadly nosology among all respiratory diseases associated with microorganisms. Despite advances in antibacterial and antiviral therapy, mortality due to pneumonia is not decreasing. It should be noted that the problem of infectious pathology has always been discussed only in narrow circles of specialists, which led to its underestimation, including during the pandemic of a new coronavirus infection. At present, scientific possibilities have not reached their perfection in the etiological diagnosis of pneumonia. Of no small concern is the lack of sections on immunology in the training program for general practitioners and pulmonologists and, as a result, the lack of knowledge by most medical specialists of the basics of the immune response in various infectious diseases, in particular, the differences in the immune response of a macroorganism in viral and bacterial infections, the stages of the immune response, differences between innate and adaptive immune responses, possibilities of immunocorrective therapy. Being followers  of the scientific school of pulmonology of academician N.S. Molchanov,  in this review, we evaluated the features of etiological factors and immune characteristics of the body on the course and out-comes of pneumonia, taking into account modern scientific knowledge. The current definition of pneumonia is formulated, the issues of the etiology of pneumonia from the perspective of the lung microbiome, the features of the immune response of the macroorganism in viral and bacterial pneumonia, the inconsistency of immune protection and the impact of comorbidity on this are covered in detail. Understanding the processes that lead to the disruption of the respiratory microbiome, the multiplication of pathobionts, the attachment of multiresistant microorganisms and the reactivity of the macroorganism will contribute to the development of new therapeutic approaches in the treatment of pneumonia.

A classification of monocyte subpopulations developed in 2010 with coverage of the immunobiological properties of cells, their functional activity and participation in various pathological processes (inflammatory, cardiovascular diseases, strokes, myocardial infarctions, aortic aneurysms, surgical modification of heart valves, diabetes, burns, etc.). The diagnostic and prognostic aspects of the analysis of monocytic subpopulations are considered. The unique data obtained by the staff of the Gamaleya Institute of epidemiology and microbiology. They consist in the fact that various physical forms of unmodified native type 1 collagen are powder, i.e. crushed bundles of collagen fibers, a hydrogel or a solution of extracellular matrix peptides, as well as a suspension of collagen fibers obtained from a powder, when applied to the surface of acute and chronic and diabetic wounds, bedsores, trophic ulcers, etc., can provide a pronounced anti-inflammatory, reparative, remodulating and regenerative effect on condition of wounds, providing their accelerated healing due to the local accumulation of “regenerative” subpopulations of Mon3 monocytes, which can be most directly used in burn tissue lesions. In this case, the analysis of monocytic subpopulations is of paramount importance. Moreover, possible potentiating effects of additional use in burns under the control of the analysis of monocyte subpopulations of powerful modern pluripotent immunomodulators – polyoxidonium, galavit and their possible combination with local use of collagen preparations are discussed. Finally, we obtained preliminary data indicating the development in burned patients of a deficiency in the absolute and relative content of the most important “patrolling” non-classical subpopulation of CD14+CD16++ monocytes compared with healthy primary (non-professional) donors, which can be a very important finding in the diagnosis and prognosis and substantiation of new methods of treatment of burns.

Introduction. Medical conferences are a key source of new and relevant knowledge for practicing physicians. Physicians use social media to share this knowledge with their colleagues. As a result, there is a lot of discussion on social media about the topics covered in the scientific presentations. This initiative has some educational value, which is being actively explored. The discussions around such posts make ideas, insights, opinions and experiences of peer-colleagues easily available. They also immediately raise awareness of new clinical research and scientific data.

Objective. We studied how often Russian physicians use available social networks (vrachirf.ru, doktornarabote.ru. vk.com) to share information from scientific conferences with their colleagues.

Materials and мethods. We searched for posts using keywords related to medical conferences and selected among the search results the entries whose authors, as physicians, disclosed selected elements of the content of scientific presentations.

Results. We identified 65 entries over the past 4–12 months where physicians shared facts and ideas presented at scientific conferences. Entries posted on professional physicians’ social networks with access restricted to lay public generated vigorous meaningful discussions, unlike posts on the mainstream social network vk.com.

Conclusions. Doctors very rarely share on social media the facts and ideas presented at Russian scientific medical conferences. Physicians demonstrate significant interest in these posts and actively discuss them. Further study should reveal the educational potential of the described phenomenon and suggest the pathways to its effective utilization.

Introduction. Chronic edematous-polypous laryngitis, Reinke – Gayek’s edema accounts for 5.5% of all benign diseases of the vocal folds. Surgical treatment of Reinke – Gayek disease consists in removing excess mucosa, or “stripping” – tearing off a strip of mucosa with forceps from the vocal fold. The principle of laryngeal surgery is to preserve the structures of the vocal fold, to obtain flexible vibration of the muscular-membranous part and the mucous membrane of the vocal fold.

Purpose. Improving the effectiveness of the treatment of patients with Reinke – Hayek edema by developing sparing methods of surgical treatment using a carbon dioxide laser. To develop criteria for choosing a method of sparing surgical treatment of Reinke – Hayek edema using a carbon dioxide laser, depending on the type of edema according to the Yonekawa classification.

Materials and methods. 80 patients with Reinke – Gayek’s disease, 59 women and 21 men, from 29 to 77 years old, divided into two subgroups, and a control group were treated. Preoperative examination included endoscopic examination, laryngostroboscopy. The type was determined according to the H. Yonekawa classification. In type II, subgroup 1 – aspiration technique, n = 30. In type III, subgroup 2 – M-shaped technique, n = 30. Control group, it includes patients with type II and III edema, resection technique, n = 20.

Results. Patients in the preoperative period were surveyed with the SF-36 Health Status Survey questionnaire, the dysphonia severity index (DSI), as well as the time of maximum phonation. In the postoperative period, they were examined, 1 month after the operation and 6 months after the operation. There is an increase in indicators, an increase in the time of maximum phonation, an increase in SF-36 scores.

Conclusion. The use of this technique made it possible to significantly accelerate the recovery of the voice, reduce the time spent in the hospital, minimally damaging the structure of the mucous membrane of the vocal folds.