Chronic Obstructive Pulmonary Disease (COPD) is a chronic condition characterized by persistent airflow limitation, caused by chronic inflammation in response to exposure to inhaled damaging particles or gases. Exacerbations of COPD lead to the progression of symptoms, worsening lung function, reduced physical tolerance, and, as a result, contribute to an increase mortality. Therefore, the prevention of exacerbations is a primary objective in the management of COPD. The foundation of COPD therapy involves prescribing long-acting bronchodilators, and for some patients, the use of anti-inflammatory agents, such as inhaled corticosteroids (ICS). ICS are used in combination with long-acting beta2-agonists (LABA) or as part of triple therapy (ICS/LABA/ LAMA). The choice of triple therapy depends on the patient’s exacerbation history, severity of symptom, level of peripheral blood eosinophilia, risk of infectious complications, and the presence of a concomitant diagnosis of bronchial asthma. Triple therapy offers advantages in terms of improving lung function, disease symptoms, reducing exacerbation frequency, and significantly decreasing mortality compared to other inhaled therapy options for COPD. A significant advantage of this therapy has been shown in patients with eosinophilic COPD. Currently, three combined inhalation medications containing ICS/LABA/LAMA are available for COPD treatment in our country. This review provides basic information on the clinical efficacy and safety profile of one of them, budesonide/glycopyrronium bromide/formoterol, in patients with various COPD phenotypes.

Introduction. Biologics for severe asthma (SA) treatment are widely used in real clinical practice. But there are very few direct comparative studies at the moment.

Aim. To compare mepolizumab and dupilumab effectiveness in patients with non-allergic eosinophilic SA in real clinical practice using regional register of Sverdlovsk region.

Materials and methods. The data of patients with non-allergic eosinophilic SA treated with dupilumab (n = 23) and mepolizumab (n = 19) were analyzed. Therapy effectiveness was determined according to BARS and patients’ proportion who achieved asthma remission, dynamics of ACT, AQLQ, FEV₁, blood eosinophils, frequency of short-acting bronchodilators use and systemic glucocorticosteroids (SGCS) demand, frequency of asthma exacerbations and hospitalizations.

Results. Within 12 months of targeted therapy a good response to biologics according to BARS in 77.8% of patients on dupilumab and in 82.4% of patients on mepolizumab (p = 1.000) was revealed. Remission of SA (without FEV₁) was achieved in 62.5% of patients in dupilumab group and in 68.8% of patients in mepolizumab group (p = 1.000). Remission of SA (with FEV₁) was achieved in 43.8% of patients on dupilumab and in 56.2% of patients on mepolizumab (p = 0.724). There were statistically significant improvements for all separately analyzed indicators in each observation group. Statistically significant differences after a year of therapy between groups were recorded in terms of eosinophil levels (p < 0.001) and nasal symptoms assessed using the SNOT-22 questionnaire (p = 0.048) in favour of mepolizumab.

Conclusions. Patients with non-allergic eosinophilic SA have good response to both dupilumab and mepolizumab. The drugs equally improve disease control, life quality, reduce the need for relievers and SGCS, show a similar safety level.

Chronic broncho-obstructive pulmonary diseases – bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) – are a serious clinical problem and an economic burden for practical healthcare. The purpose of the scientific review is to track the evolution of views on the use of bronchodilators and inhaled corticosteroids (ICS) in these diseases and to analyze modern approaches to treatment based on domestic and international guidelines. COPD treatment is aimed at two pathogenetic components – inflammation of the bronchi and the formation of emphysema. The basis of basic therapy remains the use of long-acting bronchodilators of two classes. Treatment of asthma is directed primarily at chronic inflammation of the airways using long-acting bronchodilators. The basis of basic therapy for asthma is the use of inhaled glucocorticosteroids. Currently, the same combinations of bronchodilators and ICS are recommended for both asthma and COPD. One direction is based on the use of ICS with formoterol, a 12-hour drug with a fast onset, in which the drug can be used on demand. The second direction is based on the constant use of ICS/LABA only on a regular basis, but with the ability to use bronchodilators on demand. In this case, ICS with high affinity are more often used. An important component of treatment is adherence to medical prescriptions and the availability of different types of drugs for patients in real clinical practice. At present, conditions have been created in Russia for the implementation of both the treatment of patients with asthma and the treatment of patients with COPD with frequent exacerbations and eosinophilia based on import substitution with modern drugs.

Introduction. Repeated exacerbations play a leading role in the progression of chronic obstructive pulmonary disease (COPD), contributing to an increase in the number of hospitalizations, a decrease in ventilation function of the lungs, and an increase in deaths.

Aim. To analyze the clinical efficacy of pneumococcal disease vaccine prophylaxis in patients with COPD in combination with type 2 diabetes mellitus (DM) during 5 years of follow-up.

Materials and methods. The study included patients (n = 113) with COPD and type 2 DM. The main parameters for evaluating the effectiveness of vaccination were the number of COPD exacerbations, including severe, requiring hospitalization of patients, the incidence of pneumonia, the dynamics of the severity of shortness of breath using the Modified Medical Research Council questionnaire – mMRC, the volume of forced exhalation in 1 second (FEV1), the dynamics of changes in laboratory indicators and prognostic indices BODEX, e-BODE, DOSE, ADO, CODEX. Pneumococcal conjugate 13-valent vaccine was used for vaccinoprophylaxis.

Results. It has been established that vaccination against pneumococcal disease in patients with COPD and type 2 DM allows not only to significantly reduce the number of COPD exacerbations (by 2.7 times), reduce the frequency of episodes of community-acquired pneumonia (by 8 times) and significantly reduce the number of hospitalizations, but also stabilize the main functional indicators of the respiratory system while maintaining clinical effectiveness during the 5-year follow-up period. The dynamics of prognostic indices in the group of vaccinated patients reliably confirms the effectiveness of pneumococcal disease vaccine prophylaxis programs and the survival rate of patients with a combination of COPD and type 2 DM.

Conclusion. The results of the study confirm that the vaccine prophylaxis of pneumococcal infection significantly reduces the risk of such undesirable events as exacerbations of COPD, pneumonia, hospitalization, and allows to stabilize the course of not only COPD, but also concomitant type 2 diabetes mellitus and thereby improve the prognosis for patients.

Introduction. New insights into the complex pathophysiology of severe asthma (SA) have led to the development of personalized treatment strategies using genetically engineered drugs, which is based not only on disease severity, but also on specific patient characteristics and asthma endotypes.

Aim. Evaluation of the effectiveness of omalizumab in patients with severe bronchial asthma (SBA).

Materials and methods. A prospective observational study (12 months) with the participation of 39 patients with TB (20 women and 19 men, average age 47.7 ± 14.2 years) who were treated at the Ochapovsky Regional Clinic Hospital of Krasnodar Region. All patients included in the study were prescribed the drug omalizumab.

Results. After 6 months of follow-up, there was an improvement in asthma control in the form of an increase in the average number of points according to the ACT questionnaire: 15.9 (1.19) vs 10.7 (3.19); a decrease in the proportion of patients with an ACT score of ≤ 19 points by 15.6% (from 32 patients to 27), a decrease in the proportion of patients with the result of the ACT is less than 15 points by 16%. Within 12 months from the start of treatment with omalizumab, there was a decrease in asthma exacerbations regardless of the initial level of IgE and eosinophils, a decrease in the number of days of disability by 68.9%, the number of emergency calls by 50%, outpatient visits to a pulmonologist by 65.2%, the number of hospitalizations by 63.6%, the number of days spent in hospital – by 49.2, there was a significant decrease in daily doses of IGCS, oral GCS, the total number of exacerbations, the average score on the ACT test in all patients (p = 0.01).

Conclusions. Use of the drug omalizumab in patients with SBA, in combination with a different spectrum of sensitization, it was possible to bring the treatment of such patients to a qualitatively new level, providing a pronounced clinical effect by minimizing symptoms, stopping exacerbations, and improving the quality of life. It is important to have a good safety and portability profile, as well as a convenient application mode.

Pulmonary surfactant is an important structure of the lungs, providing basic vital functions: reducing alveolar surface tension and facilitating breathing, preventing collapse of the airways and ensuring their patency, protection against infections and pathological environmental factors. Although disturbances of surfactant homeostasis are usually considered in the context of respiratory distress syndrome in preterm infants, it has been established that many lung diseases in adults are accompanied by significant disturbances of surfactant homeostasis. However, preclinical and clinical studies of bronchopulmonary pathology too often overlook the potential role of changes in the qualitative or quantitative composition of pulmonary surfactant in the pathogenesis and development of disease symptoms. In many lung diseases, whether these disturbances in homeostasis are cause or effect remains contravertial field. This review will examine current data on the composition, main functions of pulmonary surfactant and the role of its dysfunction in the pathogenesis of the most frequently encountered bronchopulmonary diseases in the practice of pulmonologists, therapists and rehabilitation specialists, in particular, such as acute respiratory distress syndrome in adults, including associated with a new coronavirus infection, pneumonia of various etiologies and their consequences, bronchial asthma, chronic obstructive pulmonary disease. The review presents the current best practices of replacement therapy with exogenous surfactant preparations and the prospects for pharmacological modulation of surfactant homeostasis disorders in the above nosological forms.

T2 inflammation underlies diseases such as bronchial asthma, allergic rhinitis and chronic rhinosinusitis with nasal polyps. These diseases often have a severe course and often accompany each other, which leads to a significant decrease in the quality of life of patients. Studying the mechanisms of inflammation at the molecular level has made it possible to develop immunobiological drugs aimed at different stages of pathogenesis. One of the targets of immunobiological therapy for T2 inflammation, which can be affected by monoclonal antibodies, is immunoglobulin E. The purpose of the scientific review is to summarize the data accumulated over the past 25 years from randomized clinical trials and studies of real clinical practice on the effectiveness and safety of the original anti-IgE drug – “omalizumab”, including in comorbid patients. Clinical trials have shown that the use of omalizumab in patients with severe bronchial asthma reduces the frequency of exacerbations and severe exacerbations of asthma, reduces the number of hospitalizations and emergency room visits due to asthma exacerbations, reduces oral and inhaled glucocorticosteroids doses, improves respiratory function and improves quality of life. Omalizumab reduces the severity of nasal and ocular symptoms and reduces the need for antihistamines in patients with severe allergic rhinitis. Omalizumab effectiveness in patients with chronic rhinosinusitis with nasal polyps is manifested by decrease in nasal symptoms (nasal congestion, rhinorrhea), improvement in the sense of smell, decrease in polyps size, and the need for systemic glucocorticosteroids and surgical interventions. Omalizumab showed good tolerability and safety profile comparable to placebo in both clinical trials and routine practice.

Pharmacotherapy for chronic obstructive pulmonary disease (COPD) primarily relies on inhalation therapy. The choice of an appropriate inhalation device is of particular importance as it impacts the frequency of device use errors, patient adherence to treatment, and overall treatment effectiveness. Peak inspiratory flow (PIF) represents the maximum air flow rate generated by a patient during inhalation and is measured in liters per minute. Dry powder inhalers (DPIs) possess internal device resistance that patients must overcome to activate the device. Measuring PIF is an integral component of optimizing COPD therapy when utilizing dry powder inhalers (DPIs). For most DPIs, an optimal PIF value is considered to be no less than 60 L/min, while with a PIF of less than 30 L/min, the medication can’t reach the lower airways. At the same time, the clinical effectiveness of the use of DPI at values of PIF from 30 L/min to 60 L/min may be insufficient, therefore, it is necessary to take into account the value of PIF for the selection of basic COPD therapy. Given the lack of portable fluometers among doctors in real clinical practice, it is important to identify risk factors for suboptimal PIF in patients with COPD. Patients with emphysema, pulmonary hyperinflation, elderly, female, short height, obesity and comorbidity are at risk for insufficient PIF value for further effective use of DPI.This review provides essential information about the role of inspiratory flow for the effective use of DPIs, presents methods for its measurement, discusses predictors of suboptimal PIF, and offers recommendations for selecting inhalation devices for COPD patients based on PIF values.

Introduction. The experience of domestic phthisiatry, which has been using bedaquiline for more than 10 years, testifies to the efficacy and safety of the drug for the treatment of drug-resistant forms of tuberculosis. At the present stage, the evaluation of the effect and safety of bedaquiline in the postoperative stage of chemotherapy, including patients with HIV/tuberculosis co-infection, becomes the most relevant.

Aim. To evaluate the results of bedaquiline application in the postoperative stage of complex tuberculosis therapy.

Materials and methods. Results of a retrospective study of medical records of 57 patients. The inclusion criterion was the surgery performed for tuberculosis and the presence of bedaquiline in the postoperative chemotherapy regimen. Frequency of tuberculosis progression 1 month after surgery was evaluated as an efficacy criterion. The frequency of QTc interval prolongation with clinical manifestations, frequency and nature of hepatotoxic reactions were evaluated as the drug safety criterion.

Results. In the absolute majority of patients – 54 (94.7%) postoperative period, during which bedaquiline was used, proceeded without complications. Cases of tuberculosis progression were observed only in patients with severe concomitant diseases. Undesirable side effects on bedaquiline were observed in 9 (15.8%) patients, the absolute majority of patients resumed taking the drug in full after drug correction. The average duration of bedaquiline prescription was 282 ± 5 doses.

Conclusions. The use of bedaquiline in the postoperative period increases the effectiveness of complex therapy and prevents progression of tuberculosis and according to our data should be regarded as safe. Administration of bedaquiline in patients with HIV/tuberculosis co-infection also contributes to the positive result of the therapy. Repeated courses of bedaquiline after surgical intervention, including in patients with HIV/tuberculosis co-infection, prevent progression of tuberculosis in the postoperative period. The tolerability of the bedaquiline-containing regimen in this category of patients, including long courses of more than 24 weeks, was assessed as quite satisfactory.

Introduction. Chemotherapy is the main component used in the treatment of tuberculosis. In addition to chemotherapy, pathogenetic treatment holds a special place in the complex treatment. The inhaled tauractant therapy restores phospholipid content on the surface of the alveolar epithelium, stimulates the involvement of additional lung parenchyma areas in breathing, facilitates elimination of toxic substances together with sputum from the alveolar space and protects the alveolar epithelium against injury caused by chemical and physical agents. Thereby it promotes acceleration of the lung parenchyma recovery processes.

Aim. To study the experience of using Surfactant-BL in patients with destructive pulmonary tuberculosis receiving a standard chemotherapy regimen, taking into account the drug susceptibility for Mycobacterium tuberculosis.

Materials and methods. A study was conducted involving 10 patients with destructive pulmonary tuberculosis who were diagnosed with it for the first time in their lives. They received treatment in Respiratory Tuberculosis Patients Department No. 4 of the Budgetary Healthcare Institution of Omsk Region – Clinical TB Dispensary in 2022–2023.

Results. Tauractant showed a pronounced positive effect on the destructive tuberculosis process in patients who already received a standard chemotherapy regimen. Inhaled therapy promoted acceleration of the cavity closure.

Conclusion. The addition of inhaled tauractant therapy to the standard chemotherapy regimen in patients with multidrug resistance (MDR) and pre-extensively drug-resistant (pre-XDR) respiratory TB significantly accelerated the TB cavity closure. The severity of intoxication and respiratory syndrome decreased in terms of clinical symptoms (relief of shortness of breath and cough). Spirography showed an increase in major indices of the pulmonary function test monitored at 2and 4-month follow-up.

Introduction. The article is devoted to the effectiveness of the treatment of pulmonary tuberculosis with multiple (MDR) and broad drug resistance (XDR) M. tuberculosis (MBT) in patients after the end of the main course of treatment (intensive and continuation phase), which were observed with clinical cure in 3rd dispensary registration group.

Aim. To study the long-term results of treatment of newly diagnosed patients with pulmonary tuberculosis with MDR and XDR MBT with the determination of significant risk factors for relapse in a megalopolis.

Materials and methods. The main course of treatment was completed by 119 newly diagnosed patients with pulmonary tuberculosis with MDR or XDR TB for the period from 2013 to 2019, who were treated in anti-tuberculosis hospitals in St. Petersburg and outpatient in St. Petersburg Interdistrict Petrograd-Primorsky TB Dispensary No. 3. The patients were divided into two groups: the main group (MG) consisted of 40 people who received treatment regimens that included drugs (thioureidoiminomethylpyridinium perchlorate (perchlosone, bedaquiline, linezolid ), the control group (CG) – 79 people who received who received standard therapy, without the above drugs. The groups are comparable in clinical, radiological and bacteriological characteristics. The course of treatment was found effective in 86 (72.3%): in MG – in 34 (85.0%) people, in CG – in 52 (65.8%) people, p < 0.01. These 86 patients were transferred to the 3rd group of dispensary registration with a diagnosis of “clinical cure”.

Results. Adverse treatment outcomes were analyzed, including the causes of tuberculosis recurrence. The use of drugs (perchlosone, bedaquiline, linezolid) in the complex chemotherapy of tuberculosis with MDR and XDR MBT increases the effectiveness of treatment of patients and significantly less often they have a recurrence of pulmonary tuberculosis (12.5%), compared with the group without the use of these drugs (27.8%). The most significant risk factors for relapses of drug-resistant tuberculosis: the preservation of residual cavities in the absence of bacterial excretion at the end of the main c male gender, concomitant pathology (HIV infection), past incarceration, late detection of the disease and destructive forms of tuberculosis.

Conclusions. The main course of therapy was found to be effective in 86 (72.3%) in patients with MG – in 34 (85.0%) people, in CG – in 52 (65.8%) people, p < 0.01. All the patients who completed the course of therapy were transferred to the 3rd group of dispensary registration with a diagnosis of “clinical cure”. Relapses of the disease occurred much less frequently in patients receiving perchlozon, bedaquiline, linezolid in complex therapy compared with the control group.

Introduction. Violation of sputum evacuation in patients with cystic fibrosis leads to the persistence of microorganisms. Most often, the microorganisms are isolated from sputum in patients with cystic fibrosis: Staphylococcus aureus, Pseudomonas aeruginosa, Burkholderia cepacia complex, etc. For the treatment of infections caused by P. aeruginosa, the following groups of antibiotics are used: aminoglycosides, carbapenems, polymyxins, cephalosporins, fluoroquinolones, inhibitor-protected penicillins and fosfomycin.

Aim. To the study is to determine antimicrobial resistance in P. aeruginosa isolated from patients with cystic fibrosis.

Materials and methods. An analysis of 87 results of sputum, biomaterial from the posterior wall of the pharynx and nose was made.

Results and discussion. Biomaterial was taken from the nasal in 4.6% cases, from the posterior pharyngeal wall in 35.6% and sputum in 59.8%. The lowest level of resistance was registered in strains isolated from the nasal cavity. Microorganisms isolated from the posterior pharyngeal wall showed a higher level of antibiotic resistance. The sensitivity data of sputum isolates were similar to the results from the posterior pharyngeal wall. The highest level of resistance was obtained to aminoglycosides (19.3%) and carbapenems (14.8%). In addition, 12.5% of P. aeruginosa isolates were resistant to sodium colistimethate, 10.2% to fluoroquinolones. The lowest level of insensitivity was found to cephalosporins (5.7%) and protected beta-lactams (4.5%). The revealed trend of decreasing sensitivity, in our opinion, is associated with a greater frequency of antibiotic use.

Conclusion. Chronic P. aeruginosa infection in patients with CF contributes to a more severe course of the disease and increases the risk of complications.

Introduction. Cystic fibrosis is a hereditary disease characterized by the defeat of all exocrine glands, vital organs and systems. Currently, the life expectancy of patients with cystic fibrosis is increasing due to the development of new therapies.

Goal. Analysis of the results of a comprehensive examination of patients with cystic fibrosis under the supervision of a pulmonologist of Republican Clinical Hospital (RCH) of the Ministry of Health of the Republic of Tatarstan.

Materials and methods. The analysis of the database of patients with cystic fibrosis, older than 18 years, registered in the Regional Center of cystic fibrosis of the Republic of Tatarstan (RT).

Results. As of April 2023, 47 patients over the age of 18 with a diagnosis of cystic fibrosis were registered in the RCH of the Ministry of Health of the Republic of Tatarstan. The diagnosis was made on the basis of a positive sweat sample and/or a genetic study. The age of patients is from 18 to 39 years (26.1 ± 1.1 years). Women – 49%, men – 51%. Median body weight – 51.5 kg, height – 165 cm, BMI – 18.05 kg/m2. 25 patients (53.2%) had a BMI of less than 18.5 kg/m2. Among patients in RT, the most common mutation is F508del. When assessing the microbiological profile of the respiratory tract, chronic infection was detected in 37 patients (78.7%). Ps. aeruginosa (66.0%) and S.aureus (35.6%) were the most frequently sown. The average FVC indicators were 72.6 ± 4.3% predicted values, the average FEV1 indicators were 61.6 ± 28.1% predicted values.

Conclusion. On the territory of the Republic of Tatarstan in patients with cystic fibrosis, the F508del mutation was detected in 30 (66.7%) adult patients, 9 of whom receive targeted therapy elecsacaftor / tezacaftor / ivacaftor+ ivacaftor with a pronounced positive effect. The high incidence of P. aeruginosa infection (66.0%) and a decrease in respiratory function among adult patients indicate a more severe course of cystic fibrosis.

The use of nitric oxide is widespread in medical practice. Inhaled form of NO in patients with respiratory disease is especially interesting. As an inhalation therapy, nitric oxide reaches well-ventilated areas of the lungs, having a negligible systemic effect due to its rapid inactivation in the bloodstream. It has long been known that inhaled NO improves oxygenation in various pathological conditions. Low doses of inhaled nitric oxide are known as a vasodilator in patients with pulmonary hypertension, its use is possible even in newborns with hypoxemic respiratory failure and persistent pulmonary hypertension. In turn, high doses are used in the treatment of infectious lung diseases, besides, another surge of scientific interest in nitric oxide arose during the coronavirus pandemic. Although the antimicrobial potential of nitric oxide is widely known, it is little used in clinical practice. Endogenous antimicrobial activity is largely mediated by high local concentrations of NO. Numerous preclinical studies have demonstrated that NO has general static and bactericidal activity against viruses, bacteria, protozoa and fungi/yeast in vitro. Due to the dose-dependent positive and negative effects of NO, safety and efficacy tests of NO and its donors are needed to assess their role in the prevention and treatment of infections. This review provides information on the chemical structure, features of metabolism and delivery of inhaled NO, and also pays special attention to the antimicrobial effect in various diseases of the pulmonological profile.

Introduction. An urgent issue of modern medicine is still early diagnosis and treatment of virus-associated respiratory infections. In this context, infectious lesions of the tracheobronchial tree, associated with a high incidence and limited use of drug therapy, are of particular relevance. Analysis of individual mechanisms for the development of acute bronchitis will allow you to choose the addition of course treatment with herbal remedies with high efficiency and safety.

Aim. Based on the clinical and epidemiological analysis of the incidence of acute bronchitis and the study of the pathogenetic mechanisms of the development of the disease, to determine the effectiveness of the use of herbal preparations in the course of preventive treatment.

Materials and methods. An open, controlled, comparative clinical study was conducted on 63 patients with a diagnosis of acute bronchitis of viral etiology of preventive use in the complex therapy of a phytopreparation containing an extract of common ivy leaves and to evaluate its clinical efficacy and safety.

Results. Analysis of the literature showed a high incidence of acute bronchitis during the outbreak of acute respiratory viral infections, the variability of the clinical course and the need to use additional methods of treatment. An early positive trend was noted in people who, in addition to standard therapy, used a phytopreparation containing an extract of ordinary ivy leaves in comparison with preparations of the amino acid derivative of cysteine relief of all symptoms already on the 5th day. The drug was easily tolerated by patients; no side effects were observed.

Conclusions. Preventive use in the complex therapy of acute bronchitis, herbal preparations with mucolytic action, which facilitate sputum discharge, allows for a faster recovery.

Antibacterial drugs are the basis of pathogenetic therapy of most infectious diseases, including lower respiratory tract infections, which continue to occupy a leading place in the structure of morbidity and mortality from infectious diseases worldwide. At the same time, the continuing steady growth of antibiotic resistance of microorganisms, the problem of creating and developing new antibacterial drugs for use in outpatient practice determines the degree of importance of optimizing the dosage regimen of this group of drugs. According to domestic and foreign clinical recommendations, the drugs of choice for the treatment of lower respiratory tract infections in outpatient practice are aminopenicillins and inhibitor-protected penicillins. In the literature review of domestic and foreign studies, the advantages of instant forms of antibacterial drugs in the pharmacotherapy of lower respiratory tract infections are considered in detail and systematized. These include higher bioavailability of the drug, which provides an appropriate level of pharmacodynamic and clinical efficacy, a more favorable safety profile, ease of use in children and elderly patients, as well as in patients with impaired swallowing function, pharmacoeconomical advantages. Thus, the use of dispersible forms of antibacterial drugs in outpatient practice in the treatment of lower respiratory tract infections makes it possible to increase the effectiveness of pharmacotherapy, improve patient tolerance and adherence to treatment, which is especially important when taking medications independently, reduce treatment costs, which in combination helps to curb the development of antibiotic resistance.

Patients with a new-onset cough and poorly expectorated sputum are quite often in the practice of both a general (family) practitioner and a pulmonologist. In this case, doctors often have difficulty diagnosing a disease and determining the correct approach to the management of the patient. Acute bronchitis (AB) is one of the reasons for this kind of cough that develops in a patient who underwent an acute respiratory infection (ARVI). AB is an inflammatory bronchi disease predominantly of infectious origin, which is manifested by a cough (dry or productive) and lasts up to 3 weeks. The prevalence of AB in the population is extremely high: 5% of the adult population falls ill annually. Acute cough is one of the most common reasons to see a therapist. However, other diseases, both respiratory and extrapulmonary, can mask under an occurrence of AB. The success of antitussive therapy primarily depends on the timely diagnosis of the disease and on the correct assessment of the characteristics of the cough: the nature, quantity and viscosity of the bronchial secretion (mucous or purulent), and the degree of expectoration. The article pays great attention to the mucoactive therapy. Mucolytics are the most effective antitussive drugs with efferent peripheral action. Erdosteine is one of them. It has not only mucolytic, but also anti-inflammatory and antioxidant effects. The main mechanisms of action of erdosteine, indications and experience in the treatment of AB in clinical practice are described. The presented article discusses the issues of etiology, diagnosis, differential diagnosis and therapy of AB, and offers a clinical case report of a patient with suspected AB.

Introduction. During the COVID-19 pandemic, the first experience was gained in managing patients with sarcoidosis in the face of a dangerous viral infection, a combination of two diseases and vaccination against COVID-19. Publications on this issue remain ambiguous, which made it relevant to assess the management of patients with sarcoidosis during a pandemic and the features of vaccination of these patients.

Aim. To assess the condition of patients with sarcoidosis who turned to a pulmonologist during the pandemic, to compare the parameters of patients with sarcoidosis who had and did not have COVID-19, with mild and severe course, as well as to evaluate the effectiveness and safety of vaccination.

Materials and methods. The study was a retrospective, observational, non-interventional study. We included 299 patients who visited a pulmonologist in 176 (58.9%) of whom developed COVID-19 and 123 (41.1%) did not have a viral disease. Information on survivors of COVID-19 was collected using the COVIZ application. Data summarization and statistical processing were carried out using the SPPS-18 program (IBM) p < 0.05 values were considered statistically significant.

Research results. Comparison of data of patients with sarcoidosis who fell ill and did not become ill with COVID-19 during the pandemic period showed that those who fell ill with this viral infection were significantly younger, more often had extrapulmonary manifestations of sarcoidosis. Patients did not differ in the radiation stage of sarcoidosis, the frequency of Löfgren’s syndrome, and the frequency of familial cases of granulomatosis. The use of methotrexate was accompanied by a higher incidence of COVID-19, the probability of getting sick was more than 3 times higher (OR = 3.39; 95% CI 1.12–10.28). Among those who received GCS (n = 49), those who received a dose of 10 mg prednisolone equivalent and above (OR = 12.056; CI95% 2.12–68.5) were more likely to develop COVID-19. The risk of developing COVID-19 in those who were not vaccinated was significantly higher than in those who received the vaccine after a viral illness (OR = 2.50; CI95% 1.75–3.58). One case of death is presented.

Conclusion. A retrospective analysis of cases of sarcoidosis during the COVID-19 pandemic indicated a favorable course of both diseases when combined. Negative prognostic factors were the use of immunosuppressive therapy for sarcoidosis and severe comorbidities of the cardiovascular system. Vaccination against COVID-19 was effective and safe in patients with pulmonary sarcoidosis.

Dyspnea may not be a major symptom of the disease. There are many reports that some patients with COVID-19 did not complain of dyspnea. There is no consensus on the clinical significance of hypoxemia without dyspnea. Several studies suggest that patients with hypoxemia without dyspnea are not protected against the development of adverse COVID-19 outcomes. It is unclear whether hypoxemia with and without dyspnea are two distinct COVID-19 phenotypes or two phases of the disease. There is currently no consensus on the terminology of this condition, its definition, and its mechanisms of formation. It has not been established whether hypoxemia without dyspnea is associated with a favorable outcome of the disease or not. The question of the absence of respiratory response to hypoxia improves the prognosis in such patients remains unresolved. Analysis of currently available data on the mechanisms of hypoxemia development and related manifestations of dyspnea in SARS-CoV-2 virus infection. “Silent hypoxemia” can be observed both in the initial manifestations of respiratory failure and in progression of the disease. Clinical significance of “silent hypoxemia” is that the decrease in physiologic responses and the absence of dyspnea allow patients to feel normal, thus denying the severity of their condition and masking the true severity of the disease. In addition, in elderly patients and patients with diabetes mellitus, suppression of respiratory function in response to hypoxia and the development of “silent hypoxemia” with rapid decompensation should be expected. The attitude to patients with “asymptomatic carriage” of the virus should be reconsidered and comprehensive monitoring of such patients with mandatory pulse oximetry or arterial blood gas test composition should be carried out.

It is well known that COVID-19, caused by the SARS-CoV-2 virus and characterized by an acute respiratory syndrome with a high morbidity and mortality had rapidly spread around the world, taking on the character of a pandemic. The virus affects not only the respiratory tract, but also other organs due to mechanisms of the cytokine storm mechanism, in addition, hypoxic damage, immune mechanism and the mechanism involving angiotensin-converting enzyme. The frequency of CVT associated with COVID-19 is less than 0.02%, on the one hand, is low, but on the other hand, this rate is 30–60 times higher than the frequency of CVT in persons without COVID-19 (0.0003–0.0004% in adults and 0.0007% in children). For an individual patient, it is extremely important that the combination of CVT and COVID-19 is associated with a higher mortality rate (45.5%) in contrast to CVT (15%) and COVID-19 (5.6%) separately. In the presented literature review, the authors focus on the pathophysiological mechanisms of the development of COVID-19 associated cerebral thrombosis for a deeper and more holistic view of the pathological process occurring in the body in order to form and improve the clinical thinking of specialist doctors, and cite their own clinical observation as an illustration of the difficulties of diagnosing COVID-19 associated cerebral thrombosis. The authors believe that this review of the literature describing a clinical case is valuable from the point of view of practical applicability, both for clinicians of various fields and for researchers.

Currently the new coronavirus infection caused by SARS-CoV-2 continues to be a serious public health problem. The fight against this virus includes a continuous search not only for the optimal treatment of the disease itself, but also for the full rehabilitation of patients in the postcovid period. Given the clinical variability and the need for one-stage correcting functions of many systems and organs after this disease, it seems appropriate to use in the recovery of these patients plant adaptogens, which have multiple effects on the body. Our review demonstrates the phytoadaptogen uniqueness in their mild multidirectional impact on neuroendocrine-immune regulation, which leads to the correcton of physiological functions disturbed during the disease. Plantl adaptogens were shown to help reduce pathological changes in the lungs, have antihypoxic and antioxidant effects, exhibit psychotropic and neuroprotective properties, influence on carbohydrate metabolism and cardiovascular system activity, support immune homeostasis and have a general adaptogenic effect. In addition, these biologics enhance the effectiveness of the entire complex therapy and allow neutralizing the side effects of the jointly taken synthetic drugs. To achieve the optimal effect of phytoadaptogens in post-COVID-19 patients it is preferable to use adaptogenic plant combinations, taking into account the mutually reinforcing pharmacological plant properties and leading pathognomonic syndromes. The phytoadaptogen use in the post-COVID-19 patient treatment will contribute to their psychoemotional stabilization, immunoresistance increase, pathological change regression in organs and tissues, mental and physical performance improvement, which will eventually improve the life quality of recovered from COVID-19 patients and preserve public health.

Introduction. In pediatric otorhinolaryngology, chronic adenoiditis is one of the most common diseases and leads to the search for effective methods of treatment. In this regard, it is of interest to study the use of additional physiotherapeutic methods of influence in complex therapy.

Objective. To increase the effectiveness of the treatment of chronic adenoiditis in children using low-frequency ultrasonic cavitation in combination with photochromotherapy in complex therapy.

Materials and methods. 104 patients with chronic adenoiditis aged 3 to 15 years were examined. By randomization by the envelope method, patients were divided into 3 groups depending on the treatment: the control group, the group with the use of only low-frequency ultrasonic cavitation as conventional therapy, and the group in combination with photochromotherapy, daily for seven days with a duration of one session of five minutes. Comparative evaluation of indicators was carried out before the start of therapy (day 0) and on the 7th day of treatment. The state of the nasopharynx was assessed using a flexible nasopharyngoscope, as well as the structure of the middle ear and auditory tube during acoustic impedancemetry.

Results. There was a decrease in the size of the pharyngeal tonsil in patients with grade III adenoid hypertrophy by 46%, compared with the control group using only low-frequency ultrasonic cavitation, and by 54% in the group where photochromotherapy was added. Mucopurulent discharge from the surface of the pharyngeal tonsil decreased by 18% and 21%, purulent by 40% and 41%, respectively, compared with the control group. The positive effect in the second group was 3.3 times higher [CI 0.75; 14.6] compared with the control group, and in combination with photochromotherapy it was 3.6 times higher [CI 0.85; 15.5].

Conclusions. The inclusion of low-frequency ultrasonic cavitation and photochromotherapy in the complex treatment of chronic adenoiditis makes it possible to achieve positive results earlier and reduce the number of adenotomies.