Bronchial asthma is one of the most common respiratory diseases, and follows a severe clinical course in 10% of patients. 70–80% of patients with severe asthma have signs of type 2 (T2) inflammation, which is clinically defined as an increase in blood and airways eosinophil counts. The emergence of genetically engineered biological drugs has made it possible to review the purpose of asthma therapy, that is, achieving remission instead of disease control, which includes managing the symptoms, absence of exacerbations, stabilization of functional parameters and normalization of biomarkers in the absence of therapy with systemic glucocorticoids. Clinical studies have shown that therapy with genetically engineered biological drugs can reduce the frequency of asthma exacerbations, decrease the need for maintenance therapy with systemic glucocorticoids, relieve symptoms, improve quality of life, which results in achieving a disease remission in 19.6–31.6% of patients. Predictors of suboptimal response to biological therapy were a high body mass index, admission to the intensive care unit and a history of severe asthma exacerbations, as well as initially more severe clinical manifestations of the disease. The most pronounced effect of omalizumab therapy was observed in patients with atopic severe asthma showing symptoms and exacerbations that are clinically associated with allergic sensitization confirmed by positive results of skin prick testing and (or) identification of serological allergen-specific IgE, elevated levels of T2 biomarkers. This publication presents the latest data on asthma remission: the concept, basic criteria, as well as the role of genetically engineered biological drugs in achieving a remission.

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive fibrotic interstitial lung disease of unknown cause. IPF is characterized by excessive production and deposition of extracellular matrix components, which lead to irreversible violations of the architectonics of lung tissue and loss of function. Without treatment, the average survival rate of patients after diagnosis does not exceed 3–5 years. However, published observations report improved survival over the past decade, due to the advent of antifibrotic drugs and earlier diagnosis. The benefits of antifibrotic therapy include a slower rate of reduction in forced lung capacity (FVC) and a reduction in mortality. Pirfenidone and nantedanib are the only currently approved antifibrotic drugs for the treatment of IPF. Several generic drugs with the INN pirfenidone are registered on the Russian market, including the drug PIRFASPEC® (267 mg capsules). Their efficacy and safety have been demonstrated both in randomized clinical trials and in real clinical practice studies. IPF patient registries, which have been maintained in many countries since 2010, provide additional information regarding the progression of the disease, the effectiveness of therapy, and the frequency of adverse events. Although they have a different mechanism of action and safety profile, their effectiveness in slowing the decline of FVC and reducing the risk of mortality over time is similar. However, IPF is still characterized by progressive shortness of breath and poor prognosis, as treatment can only delay the progression of IPF and cannot stop or reverse the damage. Although clinical trials of new drugs for the treatment of IPF are currently underway, no other drugs have yet been approved in the Russian Federation.

Combinations of inhaled glucocorticosteroids (IHGC) and long-acting bronchodilator inhalers (LABA inhalers) have been widely used to treat chronic obstructive pulmonary disease (COPD) over the past two decades. Prescription of these drugs was based on large studies showing that this therapeutic regimen was more effective compared to placebo and monotherapy. The article presents a clinical case report of a patient with severe course of COPD and coronary heart disease (CHD). Up-to-date concepts of using dual bronchodilator therapy when switching from combinations of inhaled glucocorticosteroids and long-acting bronchodilator inhalers (IHGC/LABA) is discussed. A patient with COPD and coronary artery disease, atrial fibrillation while using IHGC/LABA had progressive respiratory failure, frequent exacerbations, and acute symptomatology. As there is evidence that the use of IHGC/LABA has a number of limitations in the combined course of COPD and cardiovascular diseases, first of all in coronary artery disease and arrhythmias, it was recommended to replace therapy with a combination of dual bronchodilators – a long-acting muscarinic antagonist (LAMA) and a long-acting β agonist (LABA). The therapy resulted in stabilization of the condition, reduction of clinical symptoms, and absence of cardiovascular complications. It has been concluded that the dual bronchodilator therapy with a combination of glycopyrronium bromide and indacaterol is prioritized in COPD, including COPD combined with cardiovascular pathology; no increase in cardiovascular events in patients with COPD combined with coronary artery disease is observed; Breezhaler inhaler is user-friendly for the patients and has advantages over other delivery devices.

Severe asthma (SA) is a pressing problem in respiratory diseases and accounts for 3–10% of all asthma cases. It is increasingly recognized that SA consists of multiple heterogeneous phenotypes and their histopathology, especially in the distal airways and interstitium, remains poorly understood. Transbronchial biopsy with video imaging and histologic examination allow the detection of various changes, including cases associated with granulomatous inflammation in addition to eosinophilic infiltrates. In the presented clinical case of a patient with severe eosinophilic bronchial asthma in the absence of autoimmune diseases, transbronchial biopsy with further histologic examination of the biopsy specimen revealed eosinophilic granuloma in the form of polyp-like masses in the lung tissue and walls of small bronchi. The cellular composition of the granuloma was represented by macrophage elements, a cluster of lymphocytes with an admixture of eosinophils, individual plasma cells, fibroblasts and capillary vessels with clusters of eosinophils. The treatment (baseline and anti-IL5 therapy), in addition to achieving complete control of asthma symptoms, reduction of nasal congestion, reduction of blood eosinophils, FENO, led to the disappearance of polyposis eosinophilic formation in the bronchial mucosa. Such pathology is described in the literature as “asthmatic granulomatosis” and is of interest for further studies.

Introduction. The relevance of studying the possibility of using targeted therapy in the treatment of polypous rhinosinusitis in patients with comorbid bronchial asthma is due to the observed growth of the disease and the disclosure of new pathophysiological mechanisms of their development.

Aim. Based on the generalization of research results and the analysis of our own clinical observations, to improve the effectiveness of treatment and the quality of life of patients with polypous rhinosinusitis with a history of severe bronchial asthma, using genetically engineered biological therapy.

Materials and methods. The literature of the eLibrary databases is analyzed.RU RSCI, Medline, Scopus, Web of Science for the period 2011–2023. The inclusion of monoclonal antibodies in the treatment regimen for diseases that are difficult to treat with medication is based on the results of clinical studies and meta-analysis data. A study of the quality of life was conducted, according to the SF-36 Health Status Survey, 47 patients receiving targeted therapy with monoclonal antibodies in medical and preventive institutions of the megalopolis.

Results. The assessment of the quality of life of patients with polypous rhinosinusitis and comorbid bronchial asthma confirmed the effectiveness of targeted therapy with monoclonal antibodies. According to the SP-36 questionnaire, before treatment, the low-est scores were on the Role-Physical Functioning scales – 51.5 points and General Health – 49.1 points, respectively. At the 2^nd and 16^th weeks of treatment, gradually increasing positive dynamics was noted on all scales and by the end of the 52^nd week of monoclonal antibody use, values as close to normal as possible were recorded in the Social Functioning, Role Emotional, Mental Health scales and amounted to 97.7; 98,3 and 98.7 points. The effectiveness of the treatment was confirmed by two clinical cases.

Conclusions. Knowledge of the immunological and pathogenetic mechanisms of the disease allows us to open up significant prospects for diagnosis and treatment. Recommendations and drug selection should be consistently followed within the framework of the clinical recommendations of the relevant diseases. Strict consideration of the development of short-term and long-term risks of the use of genetically engineered biological therapy is necessary.

Introduction. Severe asthma targeted therapy effectiveness depends on precise targeting of the selected drug to the key link in pathogenesis. Therefore, severe asthma phenotyping in real clinical practice is relevant.

Aim. To determine main clinical and allergological characteristics of patients with severe asthma and to establish important phenotyping signs determined choice of a targeted drug for severe asthma treatment.

Materials and methods. The prospective and retrospective study involved patients (n = 198) of the Sverdlovsk region registry receiving targeted therapy of severe asthma. Considering clinical and allergological picture, allergic, non-allergic eosinophilic and mixed severe asthma phenotypes were identified. Clinical and laboratory characteristics of phenotypes were described. A phenotyping algorithm was developed.

Results. In the register of patients (n = 198) with severe asthma, non-allergic eosinophilic asthma was 46.5%, allergic – 34.8%, mixed – 18.7%. Significant signs for phenotyping were identified: age of asthma onset, proven allergy, Phadiatop ImmunoCAP level and blood eosinophils on baseline, concomitant allergic rhinitis, chronic rhinosinusitis with nasal polyps and hyper-sensitivity to NSAIDs. The main signs of allergic severe asthma determined: early onset, proven allergy and a positive result of Phadiatop ImmunoCAP (the probability of allergic phenotype increases with Phadiatop ≥ 1.53 PAU/l). Signs of non-allergic eosinophilic asthma were eosinophilia ≥ 150 cells/µl, absence of allergy, concomitant chronic rhinosinusitis with nasal polyps and hypersensitivity to NSAIDs, late onset (after 30 years). Signs were identified for mixed asthma: presence of proven allergy or latent sensitization in combination with high level of Phadiatop ImmunoCAP, late onset, eosinophilia ≥ 300 cells/µl, chronic rhinosinusitis with nasal polyps, hypersensitivity NSAIDs.

Conclusions. The algorithm for severe asthma phenotyping based on the isolation of eosinophilia of allergic and non-allergic origin is proposed. Severe asthma phenotyping, which can be carried out in real clinical practice, should facilitate the selection of an initial targeted drug.

Resolution of the Council of Experts

November 17, 2023

Respiratory diseases (acute and chronic bronchitis, chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis (CF), bronchial asthma, etc.) are often accompanied by impaired mucus clearance. In this regard, mucoactive drugs are most commonly used for the treatment. Hypertonic saline plus high-molecular-weight hyaluronic acid is one of the affordable and effective agents that can help with thinning and removal of bronchial secretions. The effect of 3%, 6%, 7% hypertonic saline on the respiratory system is multifaceted: it stimulates the osmotic fluid flow, breaks bonds linking polymers in the sputum, reduces swelling in the mucous membranes, stimulates ciliary beat frequency, and reduces the neutrophilic inflammation severity. The molecular size of HA plays an important role in the effectiveness of inhalation therapy with hypertonic saline combined with hyaluronic acid (HA). External administration of high-molecular-weight hyaluronic acid inhibits neutrophil elastase and metalloproteinase, potentiates hydration of bronchial secretions and has anti-inflammatory properties. In addition to clinical studies, real-life clinical practice in patients with cystic fibrosis, bronchiectasis and acute bronchitis also demonstrated the effectiveness of hypertonic saline combined with high-molecular-weight hyaluronic acid. The rationale for the use of hypertonic saline was reflected in the international GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines in 2023. Therefore, due to high interest in the hypertonic saline combined with high-molecular-weight hyaluronic acid, it is important to expand the evidence base: to initiate a Russian multicenter study evaluating the effectiveness and safety of this combination in patients with chronic bronchitis and COPD in the Russian Federation. It will allow us to recommend hypertonic saline combined with high-molecular-weight hyaluronic acid to be included in the Russian clinical guidelines on treatment of chronic bronchitis and COPD as a mucoactive drug.

Chronic obstructive pulmonary disease is one of the common respiratory diseases characterized by chronic inflammation, increased airway resistance and exacerbations. Treatment of chronic obstructive pulmonary disease is aimed at reducing the severity of symptoms, preventing exacerbations and progression of the disease, which significantly affects the well-being of patients. Irregular administration of prescribed drugs, as well as incorrect inhalation technique affects the well-being of patients, worsens the quality of life, increases the risk of adverse outcome. Over the past few years, the possibilities of therapy have certainly expanded, primarily due to the emergence of new combination drugs containing 2 or 3 components in one inhaler. The use of a medicament containing all three components in a single delivery device contributes to improved adherence to treatment and reduces the possibility of errors in inhalation technique. Drugs with the possibility of single use per day improve the patient’s adherence to therapy. In our clinical case, a patient with severe COPD and eosinophilia > 300 cells/µL with the administration of a double fixed combination of bronchodilators during the year showed an improvement in the condition, but a high level of blood eosinophils and frequent exacerbations remained. A personalized approach to COPD therapy will reduce the number of exacerbations, slow down the decline in lung function, and improve the quality of life of patients. The triple combination provides an effective and convenient option for supportive treatment of COPD, primarily for those whose disease is not controlled by dual ICS/LABA or LABA/LABA therapy.

Introduction. There is insufficiency of direct comparative studies of genetically engineered biological drugs (GEBD) for severe bronchial asthma (SA) treatment in scientific databases.

Aim. To compare omalizumab and dupilumab effectiveness in patients with allergic and mixed SA in real clinical practice.

Materials and methods. The direct comparative study included SA patients with an allergic component from regional registry of Sverdlovsk region. The data of patients with allergic (n = 68) and mixed (n = 27) SA treated with omalizumab (n = 62) and dupilumab (n = 33) were analyzed. Therapy effectiveness was determined for 12 months in general group No. 1, allergic asthma group No. 2 and mixed asthma group No. 3 according to the following indicators: asthma control level (ACT), proportion of patients with uncontrolled asthma, need for systemic glucocorticosteroids (SGCS) and short‐acting beta agonists (SABA), basic therapy volume, asthma exacerbations number, emergency calls and hospitalizations, forced expiratory volume in the first second (FEV ), assessment of life quality (AQLQ and SNOT-22). Control evaluation visits were conducted before therapy start, after 4 and 12 months of biologics taking.

Results. In general, during the 12 months of targeted therapy in patients receiving omalizumab statistically significant positive dynamics was observed in 12 of the 13 evaluated indicators; in patients receiving dupilumab – in 9 indicators. When analyzing such indicators as, ACT, taking SGCS, exacerbations of SA, FEV , statistically significant positive dynamics was revealed for all 4 indicators in patients receiving omalizumab in group No. 2 and in patients receiving dupilumab in group No. 3.

Conclusions. Patients with allergic component of SA respond equally well to therapy with omalizumab and dupilumab. At the same time, a tendency towards the advantage of omalizumab in patients with allergic asthma, and dupilumab in patients with a mixed phenotype of the disease was revealed.

Respiratory support for chronic respiratory failure in the last stages is widely used, most often in patients with end-stage COPD. It has been proven that the development of chronic hypercapnic respiratory failure is associated with an increasing in exacerbations, increased hospitalization rates, and an acceleration of the time before subsequent decompensation. Also hypercapnia is

a determining factor in mortality. Effective treatment method of hypercapnic insufficiency is non-invasive ventilation. Long-term non-invasive ventilation improves daytime hypercapnia, quality of life, increases the period until the next severe exacerbation and survival of patients with COPD. Patients with COPD have different phenotypes and various comorbid diseases, which which may be challenging while choosing method of respiratory support and assessing the effectiveness of this treatment method. There is lack of data on long-term non-invasive respiratory support for patients with COPD after pneumonectomy in chronic period. Most of publications dedicated for early post-operative period after pneumonectomy. The purpose of this publication is to present a case of successful long-term non-invasive ventilation combined with oxygen therapy in a patient with COPD and bronchiectasis of a single lung. Stages of management of hypoxemic and subsequently developed hypercapnic chronic respiratory failure are reflected. We demonstrate experience of successful long-term ambulatory non-invasive ventilation in a patient with chronic hypercapnic respiratory failure as a result of COPD and pneumonectomy was demonstrated. Observation study showed feasibility of combined respiratory support in outpatient settings for patient with COPD of a single lung and a history of pneumonectomy.

The inhalation way of drug delivery seems to be the most logical for respiratory diseases. However, the most important condition for the effectiveness of inhalation therapy in children and adolescents along with the correct choice of the active substance is the selection of the optimal device and adequate execution of the inspiratory maneuver. When prescribing therapy attention should be paid to the inhalation technique of a particular patient and also take into account the likelihood of side effects when using certain devices. The article provides data on factors affecting the pulmonary deposit of the drug, the internal resistance of various inhalers which have the greatest informativeness for choosing a device along with the assessment of the inspiratory flow rate developed by the patient. The most problematic aspects of drug delivery to the respiratory tract in children under 5 years of age and in patients with inadequate inhalation rate are analyzed. The principles of correct inhalation are discussed which are necessary to obtain an optimal respiratory fraction. It is known that the problem of synchronizing inhalation with the moment of receipt of the drug is the most important when using metered – dose aerosol inhalers. In children this problem can be solved by using a spacer or using nebulizers that convert the liquid form of the drug into an aerosol using compressor air. Individual selection of an inhaler depending on the abilities and preferences of the patient in some groups of patients can significantly increase the effectiveness of therapy without increasing the dose of medications. The article presents up-to-date data on digital inhaler systems and the possibilities of using electronic devices for monitoring and using the inhaler.

This article describes a case of lung cancer, the symptoms of which have long been regarded as manifestations of pneumonia; the stages of diagnostic search from the first symptoms of cancer to radical treatment are revealed. At the same time, the patient was diagnosed with monoclonal gammopathy of unknown significance, which at the stage of differential diagnosis suggested the development of synchronous cancer – lung cancer and the onset of multiple myeloma (MM). A number of literature sources were analyzed, according to the results of the analysis, it was found that at the moment six cases of the development of synchronous lung cancer and ММ have been described in the world, in most of which the age of patients was less than 70 years, which indicates a relatively early development of ММ. The issues of differential diagnosis of pneumonia and lung cancer are considered; the importance of early detection of malignant neoplasms (especially at the outpatient stage) is emphasized. It has been established that in some cases pneumonia can mask cancer, especially the detection of neoplasia after diagnosing pneumonia of the upper lobe localization. It has been suggested that the pathogenesis of lung cancer and ММ associated with intensive expression of CD38 may be common, and an example of a positive clinical effect on unresectable lung cancer with daratumumab is given (CD38-blocking monoclonal antibody used in MM therapy). At the same time, the revealed observation of the combined development of oncological diseases is very interesting, since in patients with different types of cancer, as a rule, each tumor tends to develop sequentially. However, our case was analyzed in comparison with literature data with cases of concomitant development of multiple myeloma and lung cancer simultaneously. At the same time, common genes and related pathogenesis of progression of two types of tumors were identified due to activation of the expression of the mitochondrial trans-2-enoyl-CoA reductase (MECR) concentrator gene.

Introduction. In pediatric otorhinolaryngological practice, chronic adenoiditis is one of the most common diseases and causes the search for additional and effective methods of treatment.

Aim. To evaluate the clinical effectiveness of the use of aqueous solutions treated with low-frequency ultrasound with high specific energy and monochromatic light radiation in the complex therapy of chronic adenoiditis in children.

Materials and methods. The number of participants in the study was 104 patients aged 4 to 15 years with a verified diagnosis of chronic adenoiditis and were divided into 3 groups depending on the treatment. A comparative analysis of the results obtained was carried out before the start of therapy (day 0) and on the 7th day after the 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. The use of a course of treatment of low-frequency ultrasonic cavitation in combination with photochromotherapy made it possible to relieve the signs of chronic adenoiditis in 62% of cases (p < 0.001), reduce the number of patients with grade III adenoid hypertrophy by 54% (p = 0.035), and reduce by 2 times (p = 0.05) number of relapses of chronic adenoiditis. In the group of children using low-frequency ultrasonic cavitation, the positive effect of treatment was 3.3 times [CI 0.75; 14.6] higher compared to the control group, and in combination with photochromotherapy it was 3.6 times [CI 0.85; 15.5]. The absence of adenotomy was assessed as a positive effect.

Conclusion. The data obtained showed that the inclusion of non-drug methods of physical influence (low-frequency ultrasonic cavitation both in monotherapy and in combination with photochromotherapy) in complex treatment can reduce the number of surgical interventions on the organs of the lymphopharyngeal ring – the pharyngeal tonsil.

Introduction. It is now well known that a proportion of patients with COVID-19 develop a pathological systemic inflammatory response with complications resulting in multiple organ failure. The severity and prognosis of the disease, as well as the effectiveness of the treatment provided should be assessed as early as possible. For this purpose, a number of laboratory markers are used, such as C-reactive protein (CRP), IL-6, fibrinogen, ferritin, and changes in these parameters serve as a basis for the disease prognosis.

Aim. To evaluate the effectiveness of levilimab in outpatients with COVID-19 based on the analysis of changes in laboratory markers of blood inflammatory activity.

Material and methods. A total of 120 patients with COVID-19 receiving standard therapy (ST) were included in the study. The patients were divided into 2 groups: the treatment group of patients who received 2 injections of levilimab, IL-6 receptor blocker, included 47 men and 29 women (average age 46.7 years); the control group, who only received CT, included 21 men and 23 women (average age 46.3 ± 2 years).

Results. The treatment group demonstrated a faster normalization of laboratory markers of inflammatory activity. After 14 days of follow-up, the CRP levels in the treatment group decreased significantly by 18.9 (67%) (p < 0.05), and in the control group by 14.3 (46.9%) (p < 0.05). The IL-6 level significantly decreased in patients of the control group, but did not change in the levilimab group. The changes in fibrinogen levels showed that the group of patients, who received levilimab, had a significant decrease in fibrinogen by 35% from baseline (p < 0.05), in contrast to the control group, in which fibrinogen levels virtually did not change (3.8% decrease) (p < 0.05).

Conclusion. Levilimab therapy carried out at onset of coronavirus infection results in a faster normalization of laboratory markers of inflammatory activity and helps prevent the severe course of COVID-19.

Introduction. The novel coronavirus disease (COVID-19) pandemic has presented challenges for health systems globally. However, as the number of COVID-19 survivors continue to increase, we get more and more evidence on the long-lasting symptoms after an acute infection. According to some studies, the total number of symptoms described can reach 200, but fatigue is considered the key presentation in such patients. The subjectivity of fatigue concept continues to be a significant obstacle to its study: the absence of validated assessment methods does not allow to adequately assess the prevalence and significance of fatigue in patients with lung injury induced by COVID-19.

Aim. To assess the prevalence of fatigue syndrome in patients with lung injury induced by COVID-19 using a validated tool, the Fatigue Assessment Scale, and risk factors for the development of this condition.

Materials and methods. Medical records of patients hospitalised for PCR-confirmed new coronavirus infection COVID-19 with lung lesions (n = 100), evaluated using the FAS scale, were retrospectively analysed. Statistical processing of the data was performed.

Results. Objectively assessed fatigue was detected in 66% of patients. Statistically significant association between fatigue syndrome and obesity, severity of acute phase of infection, presence of comorbidities, Charlson comorbidity index was revealed.

Conclusions. The use of objectification methods makes it possible to assess the prevalence and significance of fatigue syndrome in patients with COVID-19-induced lung lesions, to perform statistical analysis of possible risk factors for the development of this condition.

The new coronavirus infection caused by the SARS-CoV-2 virus has become a real challenge for the world’s population. Despite the fact that vaccines have been developed and the effectiveness of antiviral drugs has been demonstrated, COVID-19 continues to be an urgent problem. SARS-CoV-2 is genetically modified due to the accumulation of mutations, new strains with high virulence appear that distort the immune response. In addition, it has been shown that the virus can persist in the body for a long time, which ensures the maintenance of an inflammatory response and causes the persistence and recurrence of symptoms after acute infection, especially in certain groups of patients. The article presents a clinical case of a long-term course of new coronavirus infection with predominant lung damage in the form of interstitial changes and persistent inflammation for 7 months from the moment of diagnosis against the background of an immunodeficiency condition due to the patient’s lymphoma in remission after polychemotherapy, exclusion of pulmonary embolism and progression of lymphoproliferative disease. The article highlights the difficulties of determining the criteria for a post-COVID and the features of its treatment using long-term therapy with systemic glucocorticosteroids, inhalation administration of tauractant (Surfactant-BL) in comparison with the dynamic assessment of total ventilation disorders and dynamic control of MSCT of the chest organs. Thus, the importance of identifying risk factors for the progression of COVID-19-associated conditions in patients with different comorbid backgrounds and identifying criteria for the development of new long-COVID treatment strategies is emphasized.

Introduction. Pneumonia is a frequent manifestation of coronavirus infection. COVID-associated pneumonia is a disease characterized by a non-standard course and a number of clinical phenomena that complicate timely diagnosis and treatment.

Aim. To investigate the phenomenon of mute hypoxemia in COVID-associated pneumonia.

Materials and methods. The study included 214 patients who were divided into 2 groups. The study group included patients with confirmed COVID-associated pneumonia, and the control group included patients with interstitial lung diseases (idiopathic pulmonary fibrosis, nonspecific interstitial pneumonia, hypersensitivity pneumonitis). The subjective condition of the patient, presence of concomitant pathology, high-resolution computed tomography data, arterial blood gas composition, and spirometry data were evaluated.

Results. In patients with COVID-associated pneumonia, “silent hypoxemia” was encountered 1.3 times more frequently than in patients with non-COVID-associated pneumonia. When comparing patients with silent hypoxemia and hypoxemia with dyspnea in COVID-associated pneumonia, statistically significantly higher values of PaCO₂ and lower values of respiratory rate are observed. Such patterns are not detected in non-COVID-associated pneumonia. In patients with silent hypoxemia in non-COVID-associated pneumonia, the respiratory rate is statistically significantly higher compared to patients with COVID-associated pneumonia. Univariate logistic regression analysis demonstrates that in patients with non-COVID-associated pneumonia, silent hypoxemia is associated with BMI increase (OR = 1.380 (95% CI: 1.058–1.801); p = 0.017).

Conclusion. The phenomenon of “silent hypoxemia” may manifest not only in pulmonary impairments resulting from SARS-CoV-2 infection but notably in COVID-associated pneumonia, where the absence of patient-reported dyspnea is substantiated by the lack of tachypnea. Owing to the subtleties of “silent hypoxemia”, clinical presentations may exhibit delays, diverting attention from significant pulmonary compromise, which could subsequently precipitate the failure of compensatory mechanisms.

Introduction. The long-term consequences of COVID-19 (СOrona VIrus Disease 2019) for the respiratory system represent a socially significant problem. Long-lasting respiratory symptoms and functional changes in individuals who have suffered coronavirus infection justify the need to study pathogenetic mechanisms. There is little study of epithelial biomarkers and their potential role in the development of long-term respiratory complications.

Аim. Тo study the level of the circulating marker surfactant protein-D (SP-D) in patients who suffered severe COVID-19-associated lung damage at 3 and 12 months after the acute form and its relation with indicators of respiratory function.

Materials and methods. The study included 70 patients who were examined at 3 and 12 months after the acute phase of COVID-19, which occurred with severe and extremely severe lung damage. Patients underwent a comprehensive study of respiratory function (spirography, bodyplethysmography and diffusion test), a 6-minute step test with quantitative assessment of shortness of breath, both during exercise and in daily life; the study also determined the serum level of surfactant protein-D.

Results. The results of the study indicate that 57% of patients who have suffered severe COVID-19-associated lung damage remain persistently impaired in the diffusion capacity of the lungs throughout the year. It was found that the level of SP-D was increased in all patients 3 months after the acute phase of the disease, but in the group with reduced DLco this level was significantly higher after 3 and 12 months (469 ng/ml and 295 ng/ml, respectively).

Conclusion. Persistent impairments in the diffusion capacity of the lungs in some patients persist a year after suffering a severe form of COVID-19. Elevated SP-D levels have been found to be associated with decreased lung diffusion capacity. Thus, SP-D can be considered as a potential biomarker of lung injury severity in the long-term period of COVID-19.

Introduction. The 6 Minute Walk Test (6MWT) plays a key role in assessing functional exercise tolerance and prognosis for a wide range of chronic respiratory and cardiovascular diseases. In acute bronchopulmonary diseases, in particular COVID-19, there is practically no data on the possibilities of using 6MWT.

Aim. To compare the results of a 6-minute walk test with clinical and laboratory parameters of patients hospitalized with new coronovirus infection.

Materials and methods. The prospective, non-randomized comparative study sequentially enrolled 117 patients hospitalized with a confirmed diagnosis of COVID-19. Upon admission to the hospital, all patients performed 6MWT in accordance with international recommendations.

Results. During the 6-minute trial, patients walked an average of 390 m (340.0; 420.0). In 96.6% of patients, there was a marked limitation of physical activity. Desaturation during the 6-minute test was registered in 25 (21.4%) patients. When conducting a correlation analysis, it was found that the result of the test with physical activity (the number of meters traveled) is associated with both initial and final SpO₂, the presence of desaturation and the severity of dyspnea according to Borg, with the age of patients, the severity of the course of new coronovirus infection, laboratory signs of the activity of the inflammatory process upon admission. Relationships between the results of 6MWT (the number of meters covered and the % decrease in SpO₂) and the duration of hospitalization, the maximum volume of lung damage according to CT data, the maximum severity of laboratory signs of inflammation (CRP, ferritin) during hospitalization, the need for oxygen therapy, the volume of anti-inflammatory therapy (doses of systemic glucocorticoids, pulse therapy with methylprednisolone). Patients with desaturation during exercise had a more severe course of the disease with a large amount of lung tissue damage, as well as higher laboratory indicators of the activity of the inflammatory process. It was also found that patients who desaturate during the exercise test more often required oxygen therapy during hospitalization, more often pulse therapy with methylprednisolone was performed.

Conclusion. Patients with COVID-19 develop a decrease in physical performance, which is multifactorial. These include respiratory failure due to lung tissue damage, muscle weakness, nervous system damage (anxiety, depression), and systemic inflammation, which characterizes the severity of the infection and the associated immune response. The results of 6MWT may have a certain prognostic value in terms of the severity of the course of the disease, the severity of systemic inflammation, the need for oxygen therapy, and pulse therapy with glucocorticoids.

Introduction. Chronic rhinosinusitis with nasal polyps (CRSwNP) pathogenesis is based on inadequate local immune response, additional SARS-CoV-2 infection can alter CRSwNP pathological process.

Aim. To effect of COVID-19 on CRSwNP course in patients with different drug control degree.

Materials and methods. 99 patients with bilateral CRSwNP (48 men, 51 women, 58.37 ± 14.43 years), were divided into 3 groups based on CRSwNP medical control degree for 5 years [17]. Group 1 (n = 34) – patients with mild CRSwNP received treatment according to treatment algorithm stages I and II. Group 2 (n = 32) – moderate severity CRSwNP, therapy corresponded to algorithm stage II or III. Group 3 (n = 33) – patients with severe CRSwNP received stage IV treatment 1 or more times. All data about vaccination against coronavirus infection and confirmed COVID-19 episodes with an analysis of its severity were recorded,

Results. 63 people had COVID-19 (63.64%, 62.5 ± 13.1 years), of which 62.5% people were vaccinated before infection. COVID-19 was mild in 84.1% (54.70 ± 13.83 years), moderate COVID-19 – in 12.7% (63.1 ± 15.38 years), and severe – in 3.2% (age – 40 years). 36% people (62.5 ± 13.1 years) did not infected with coronavirus. In group 1 mild COVID-19 was observed in 35.29%, moderate severity – in 5.88%. In group 2 all patients who had COVID-19 (87.5%) had mild course. In group 3 39.39% patients had mild COVID-19, 18.18% had moderate COVID-19. Severe COVID-19 was observed in 2 people from this group.

Conclusions. COVID-19 was mild in most cases in CRSwNP patients. In 84.1% patients were treated as outpatients. CRSwNP patients had frequent swabs to detect SARS-CoV-2 RNA due to complaints of hyposmia and raised coronavirus infection suspicion.

Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality worldwide. Successful treatment of patients with CAP is mainly determined by the correct choice of the place of treatment (outpatient or inpatient) and the correct initial empirical therapy, considering the predictable spectrum of potential pathogens of CAP. The article provides up-to-date data on the etiological structure of non-severe CAP. Most patients with CAP receive outpatient medical care, which is determined by their clinical status and a limited number of laboratory data for minimizing the risk of adverse outcomes in CAP. The absence of a microbiological diagnosis in a mild course of CAP does not lead to a decrease in the effectiveness of empirical antibacterial therapy in outpatient settings. The article highlights current clinical recommendations on the choice of empirical antibiotic therapy for CAP in outpatients. Amoxicillin is a semi-synthetic penicillin, which, including in combination with the beta-lactamase inhibitor clavulanic acid, is the most affordable and widely used penicillin in various countries. According to clinical recommendations, amoxicillin, including in combination with a β-lactamase inhibitor, is the drug of choice for the initial empirical therapy of most outpatients with CAP. The oral route is the most common and preferred for antibiotic delivery in mild CAP. Dispersible forms of tablets have certain advantages, including easier intake in patients with difficulty swallowing, such as the elderly, stroke patients, and children. The assessment of biological equivalence showed similar pharmacokinetic parameters of Amoxicillin and Amoxicillin in combination with clavulanic acid in the form of dispersible tablets and in the original form of film-coated tablets.

Introduction. The most common extragenital pathology during pregnancy includes upper and lower respiratory tract infections (URTI and LRTI), which, if left untreated, leading to obstetric and perinatal pathology. It is relevant to conduct pharmacoepidemiological studies assessing the preferences of specialists regarding the treatment of pregnant women and attitudes towards vaccination in real clinical practice.

Aim. To analyze approaches to pharmacotherapy of URTI and LRTI in pregnant women, evaluate the compliance of prescribed drugs with current clinical recommendations and treatment standards.

Materials and methods. The study was conducted from 2018 to 2022 using an anonymous questionnaire method in seven regions of Russia.

Results and discussion. A total of 227 physicians from seven regions of Russia were surveyed, with 66.8% being internal medicine doctors and 33.2% obstetrician-gynecologists. This study revealed that physicians’ knowledge regarding the rational use of antimicrobial drugs (AMD) in pregnant women is insufficient. Respondents showed better results in the use of AMD in the treatment of pneumonia, with 78.7% of surveys indicating correct tactics. The worst results were observed in answering the question about the appropriateness of prescribing AMD for URTI, tracheitis, and bronchitis (40.3% to 67.7% of respondents made incorrect choices). Overall, 57.7% of respondents understand the importance of vaccination among pregnant women.

Conclusion. The results of the conducted study indicate that the choice of drugs for the therapy of URTI and LRTI, especially AMD, for outpatient treatment of pregnant women in some situations does not fully correspond to the current clinical recommendations in our country. Moreover, it is particularly concerning that some physicians prescribe drugs that are unsafe for pregnant women or lack the necessary evidence base or indications for use.

Сough is a common symptom that requires medical attention. The range of diseases in which cough occurs is quite large. These are not only patients with bronchopulmonary pathology, cough can also occur in diseases of the gastrointestinal tract, cardiovascular system, diseases of the upper respiratory tract, taking medications and a number of other reasons. Cough has different developmental mechanisms and clinical characteristics. Treatment of cough should be primarily aimed at eliminating the cause of cough, the nosological form that triggered the development of this symptom. However, cough often requires a complex long-term diagnosis and personalized approach to therapy. Symptomatic treatment is often required before the cause of chronic cough is established and for patients with acute and subacute cough. When choosing symptomatic cough therapy, it is necessary to focus on a specific clinical situation and take a differentiated approach to the choice of medications. Combination medications are an effective symptomatic remedy in the treatment of cough, especially in situations where the patient has several symptoms at the same time (cough, viscous, difficult-to-separate sputum, bronchial obstruction). An example of such a combination are drugs that include bromhexine (mucolytic), guaifenesine (mucolytic/mucokinetic) and salbutamol (β2-adrenomimetic). The drugs have a synergistic effect, have an antitussive effect, improve mucociliary clearance, improve the rheological properties of bronchial secretions, reducing excessive bronchial tone, which leads to rapid cleansing of the bronchi from altered bronchial secretions and a decrease / cessation of coughing.