Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition characterized by persistent airflow limitation caused by chronic airway inflammation in response to harmful particles and gases. The diversity of clinical manifestations and pathophysiological mechanisms necessitates an individualized approach to treatment. The disease is driven by inflammatory processes, including the activation of macrophages, neutrophils, and T-cells, as well as the release of various inflammatory mediators that contribute to chronic airway damage. In recent years, attention has turned to eosinophilic inflammation, traditionally associated with asthma, which is also found in a significant portion of COPD patients. Eosinophilia is observed in a considerable number of COPD patients and is associated with more severe disease and an increased risk of exacerbations. However, data on the role of eosinophils in COPD are mixed: some studies find no difference in disease severity between high- and low-eosinophil groups, while others confirm an elevated risk of exacerbations in patients with high eosinophil levels. A promising therapeutic agent in this area is dupilumab — a monoclonal antibody that blocks interleukin-4 and -13 receptors, demonstrating the ability to reduce exacerbation frequency and improve lung function in COPD patients by targeting eosinophilic inflammation. Clinical trial results indicate that dupilumab provides significant clinical improvement and may become an important tool in treating eosinophilic COPD, offering a new approach based on the molecular understanding of the disease. This publication presents the latest data on the use of dupilumab in COPD treatment.

Bronchial asthma (BA) is one of the most common respiratory diseases. The primary purpose of BA treatment is to achieve disease control on a case-to-case basis. The disease control concept refers to not only the current control over symptoms, but also the risk of adverse outcomes in the future. Inhaled glucocorticosteroids (ICS) remain the mainstay of treatment for adult patients with AB. Long-acting e2-agonists (LABA) are recommended to all patients who continue to experience symptoms as add-on therapy to medium- or high-dose ICS as the preferred option for controlled treatment at stages 4 and 5. However, despite LABA / ICS therapy, some patients may still exhibit uncontrolled asthma, in which case long-acting anticholinergics (LAMA) should be included in the treatment regimen. Concurrent use of multiple and often different medications poses a significant burden for patients with BA. The presence of LABA / LAMA / ICS in a single inhaler can ensure the best medication adherence in patients with asthma. This therapy option is indicated for patients with persistent asthma uncontrolled with medium- or high-dose ICS + LABA and patients receiving medium- and high-dose ICS / LABA / tiotropium bromide in multiple inhalers. This will enhance BA control, which has been proven in a number of clinical studies. In the clinical case under discussion, a patient with severe BA had to be prescribed a disease-modifying drug in the form of a triple fixed-dose combination in a single inhaler to improve disease control, which led to increased tolerance of physical activities, absence of asthma attacks, shortness of breath, night symptoms, the need for short-acting e2-agonists (SABA), and calls for emergency medical service.

Current clinical guidelines for chronic obstructive pulmonary disease assign a significant role to the combination of a long-acting muscarinic antagonist / a long-acting β2-agonist (LAMA / LABA). The combined use of LAMA / LABA improves symptoms, quality of life, reduces the frequency of exacerbations, hospitalizations and mortality. Despite the existence of various guide-lines for the pharmacological treatment of COPD, there is a significant discrepancy between the recommendations and the actual practice of prescribing inhaled corticosteroids (ICS), especially in low-risk groups, where triple therapy is often overly prescribed. The purpose of this clinical observation is to demonstrate the de-escalation of triple therapy (ICS / LAMA / LABA) to a dual bronchodilation (LAMA / LABA) in a patient with COPD. Based on the dynamics of clinical, instrumental and laboratory parameters of the patient, the absence of indications for the appointment of ICS has been proven. The appointment of combined double therapy indacaterol / glycopyrronium bromide 110/50 mcg inhalation 1 time/day is justified. The positive effect dual bronchodilation therapy (indacatero / glycopyrronium bromide) has been demonstrated the symptoms and quality of life of the patient. The absence of adverse events against the background of taking indacaterol / glycopyrronium bromide and the convenience of using the Breezhaler® inhaler were established. Based on the above, conclusions are drawn: a thorough assessment of the indications for the appointment of ICS in stable patients with chronic obstructive pulmonary disease is necessary; the use of a combination of indacaterol / glycopyrronium bromide in one device 1 time per day provides better adherence to treatment; the inhaler Breezhaler® ensures optimal delivery of a dose of the drug to the lungs.

This article describes clinical cases of lung damage associated with e-cigarette smoking, EVALI (from E-cigarette and Vaping use-Associated Lung Injury) with a brief review of the literature. With the proliferation and popularization of electronic cigarettes, lung injury associated with their smoking is becoming more common. The term EVALI emerged in 2019 during the largest outbreak in the United States of America (USA), at which time criteria for verifying the diagnosis were developed. This review provides descriptions of a variety of vaping devices and smoking liquids, presents possible mechanisms of lung tissue damage resulting from smoking e-cigarettes, as well as traumatic effects from exploding lithium vape batteries. The most frequent clinical manifestations are respiratory (dyspnea, cough, chest pain, hemoptysis), constitutional (fever, general weakness) and gastroenterologic (nausea, vomiting, diarrhea, abdominal pain) symptoms. The radiologic and histologic pictures of the disease are nonspecific and varied. The diagnosis of “vape disease” includes a wide range of investigations and is a “diagnosis of exclusion”. There are no standardized approaches in the treatment of EVALI, but most patients require oxygen therapy, respiratory support, and the use of systemic glucocorticosteroids. In the current literature there is no information about chronic lung damage against the background of smoking electronic cigarettes. The presented article describes clinical cases of acute lung tissue damage and long-term consequences as a result of vaping. Thus, EVALI is an emerging disease requiring further surveillance and study.

Introduction. There is insufficient data on effectiveness and safety of targeted drugs aimed at T2 inflammation in real-life practice.

Aim. To evaluate benralizumab effectiveness in patients with T2-inflammatory airway diseases in real-life clinical practice and to identify predictors of a positive response to therapy.

Materials and methods. Patients' data from Sverdlovsk region registry with non-allergic eosinophilic (n = 32) and mixed (n = 6) severe asthma received benralizumab were analyzed. Reduction in proportion of patients requiring systemic GCS and proportion of patients with a good response to therapy according to BARS were the main endpoints. Dynamics in ACT score, basic therapy, asthma exacerbations frequency, emergency calls and hospitalizations, FEV1 and eosinophil blood count, scores in AQLQ, SNOT-22 and VAS were also evaluated. Control visits were conducted at baseline, after 4 and 12 months of benralizumab administration. Analysis of good response predictors to benralizumab was performed.

Results. Over 12 months of benralizumab therapy, the proportion of patients requiring systemic GCS decreased by 81.8%. According to BARS, a good response to therapy was demonstrated by 69.6% of patients (n = 16), satisfactory - 21.7% (n = 5), and insufficient - 8.7% (n = 2). Significant positive dynamics were observed in asthma control level, therapy volume (doses of inhaled GCS, intake of LABA, SABA), frequency of asthma exacerbations and hospitalizations, FEV1 and eosinophil blood count, AQLQ, SNOT-22 and VAS questionnaires. Patients with insufficient response to benralizumab had high initial blood eosinophilia.

Conclusions. In real clinical practice, benralizumab improves asthma control, reduces frequency of asthma exacerbations even in discontinuation of SGCS and reduction of basic therapy, improves lung function, quality of life, and reduces nasal symptoms in patients with concomitant inflammatory nasal diseases. A possible predictor of insufficient response to benralizumab was high initial eosinophilia (>2330 cells/μl).

Introduction. Severe asthma is a heterogeneous disease with several phenotypes and endotypes. However, little is known about frequency of severe asthma phenotypes and endotypes in Russia.

Aim. To assess frequency of severe asthma phenotypes and endotypes compared with mild/moderate asthma.

Materials and methods. Cross-sectional single center study included 643 adult outpatients with mild/moderate asthma and 314 patients with severe asthma (SA) aged 18-90 years. Spirometry and bronchodilator reversibility testing were carried out. Fractional exhaled nitric oxide (FeNO) was measured by a chemiluminescent analyzer (logan 4100, UK). Hypersensitivity to common inhalant allergen was assessed by skin prick and blood specific IgE level. Peripheral blood eosinophil counts were measured by automatic analyzer. Asthma control and asthma-related quality of life were assessed by using ACQ-5 and SGRQ.

Results. Allergic phenotype was more frequent in patients with mild/moderate asthma than in those with SA, but aspirin- induced asthma, steroid-dependent asthma, asthma with persistent airflow limitation and concomitant COPD, asthma with late onset and obesity were more frequent in SA. The majority of patients with SA had several phenotypes (mean 3 phenotypes) and at least one marker of T2-high endotype.

Conclusion. The most frequent phenotypes of SA were allergic, with persistent airflow limitation, with concomitant obesity and COPD. Occurrence of asthma phenotypes differed between patients with SA and mild/moderate asthma. The majority of SA patients have T2-endotype.

Introduction. Severe asthma (SA) is a heterogeneous disease with several phenotypes. There are lack of data about its stability.

Aim. To assess stability of SA phenotypes in adult patients during 5 years follow-up.

Materials and methods. Prospective study included 117 adult outpatients with allergic SA, 51 severe asthmatics with aspirin- induced disease, 59 patient with persistent airflow limitation (PAL) and 35 patients with SA and concomitant COPD, 65 steroid-dependent severe asthmatics and 89 patients with SA and frequent (>2 per year) exacerbations. Spirometry and bronchodilator reversibility testing were carried out; fractional exhaled nitric oxide (FeNO) was measured; hypersensitivity to common inhalant allergens (skin prick and blood specific IgE testing) and peripheral blood eosinophil counts were estimated. Asthma control and asthma-related quality of life were assessed by using ACQ-5 and SGRQ questionnaire.

Results. During 5-year prospective study stability of aspirin-induced SA and SA with COPD was 100%. Allergic phenotype was stable in 81% of SA cases and in patients with changed atopic status we revealed worsening of symptoms and accelerated lung function decline. Stability of SA phenotype with PAL without COPD was 86% and steroid-dependent SA was stable in 55% of cases. After 5 years of treatment frequent exacerbations remained in 28% of severe asthmatics.

Conclusion. The most stable phenotypes of SA were aspirin-induced and asthma with concomitant COPD. Less stable were allergic SA, steroid-dependent SA and phenotype with persistent airflow limitation. The least stable was SA phenotype with frequent exacerbations.

Introduction. Respiratory diseases are number one in the structure of general morbidity of the population of the Russian Federation. The main complication of respiratory diseases is respiratory failure, which may be treated with long-term oxygen therapy (LTOT) and respiratory support (RS): non-invasive mechanical lung ventilation (NIV) and invasive mechanical lung ventilation (IV). International medical experience indicates a widespread enough implementation of respiratory support and oxygen therapy at home (RS and OT at home) for patients including whose requiring palliative medical care.

Aim. The purpose of the study was to evaluate the clinical results of implementation of respiratory support and oxygen therapy at home.

Materials and methods. The study included 98 patients with chronic respiratory failure (CRF). All patients used RS and OT at home according to the Study Protocol. All patients were divided into 3 groups: LTOT - 47 patients, NIV in combination or with-out LTOT - 43 patients, IV in combination or without LTOT - 8 patients. The estimated parameters of the patients' condition were measured at the initiating visit and three subsequent control sessions. The planned duration of the Study was 9 months.

Results. During the Study, a statistically significant decrease in the severity of symptoms of respiratory failure was noted (CAT and mMRC scales) as well as an improvement in the quality of life and the general condition of the patient (SF-36 questionnaire and Karnovsky scale). During the study, 38 patients required hospitalization: in 8 cases hospitalization was associated with an exacerbation of CRF. The number of successful outcomes was 87 cases.

Conclusion. The Study showed that RS and OT at home is an effective and safe medical technology for patients with CFR, which reduces the manifestation of symptoms, improves the quality of life, reduces the number of hospitalizations associated with exacerbation of respiratory failure, reduces mortality, and demonstrates the effectiveness of using a modern respiratory equipment at home, as well as telemedicine technologies.

Introduction. The “spot” effect of immunobiological drugs necessitates patients' selection based on pathogenetic mechanisms of the disease to ensure therapy effectiveness.

Aim. To determine characteristics of T2-asthma main phenotypes and develop an algorithm for selecting a first- and second-line biologics.

Materials and methods. Being retrospective and prospective in nature the research was directed at adult patients with severe asthma who received target therapy and were included in the registry of Sverdlovsk region. Cluster analysis made it possible to identify the most distinctive features of allergic, nonallergic eosinophilic and mixed SA. Pathogenetic mechanisms of T2 inflammation determined the choice of first-and-second-line biologics.

Results. Allergic phenotype is characterized by existence of allergy and first appearance of asthma before the age of 18, satellite allergic rhinitis and the Phadiatop test result ≥ 1,53 PAU/L. The features of non-allergic eosinophilic asthma are as follows: asthma first appearance at the age of 32 and older, eosinophilia ≥ 150 cells/gl, absence of allergy, satellite chronic rhinosinusitis polyposa (CRSP) and NSAIDs intolerance. The features of the mixed asthma are as follows: first appearance at the age of ≥ 18 and < 32 years old, allergy in combination with eosinophilia ≥ 300 cells/gl, AR and a positive Phadiatop allergy test result, CRSP and NSAIDs intolerance. It is the allergic phenotype of SA when preference should be given to anti-IgE drug. Dealing with non-allergic phenotype of SA one should consider anti-IL5 biologics more preferable. Taking into consideration Th2 and ILC2 ways in action mechanism it is possible to affirm that anti-IL4R therapy is effective in mixed asthma.

Conclusions. In real clinical practice the initial phenotyping of SA facilitates the correct choice of a first- and second-line targeted drug.

Chronic respiratory failure (CRF) is the leading cause of mortality in patients with pulmonary diseases. One of the key treatments for CRF is long-term oxygen therapy (LTOT). The main purpose of LTOT is to improve the quality of life, increase physical performance, reduce the frequency of exacerbations and mortality of patients. It is recommended to use oxygen therapy for at least 15-16 hours a day, and if there is no effect, increase this time to 24 hours. Indications for LTOT have remained unchanged for a long time. The decision on the appointment of LTOT should be based on three-fold results of the gas composition of arterial blood, and the assessment of gas exchange parameters can be made only after stabilization of the condition (3-4 weeks after exacerbation). It is also worth considering the possibility of hypercapnia in patients and the likelihood of aggravation of the patient's condition due to oxygen-induced hypercapnia and respiratory acidosis. Despite the existence of numerous studies concerning the use of LTOT, most of them have been conducted on patients with COPD, which creates the need for a deeper study of the effectiveness of this method in patients with other diseases. The use of long-term oxygen therapy has a positive effect on the quality of life, physical performance, the frequency of exacerbations, hospitalizations and patient survival. There are various methods of oxygen delivery, which allows the use of LTOT not only at rest, but also when moving the patient over long distances. It is important to note that in addition to prescribing LTOT, patients need to change their lifestyle, stop smoking, and receive adequate drug therapy for the underlying disease.

Introduction. Chronic allergic respiratory inflammation triggered by contact with cause-significant allergens is the pathogenetic characteristic of atopic bronchial asthma. Identification of sensitization is essential for successful therapy of bronchial asthma.

Aim. To study age-related changes in the spectrum of sensitization to allergens in children with bronchial asthma followed up in healthcare facilities of Moscow and Moscow region.

Materials and methods. A total of 970 children aged 0 to 17 years 11 months residing in Moscow and Moscow region were include in the retrospective, cross-sectional, population-based study of the spectrum of allergic sensitization of bronchial asthma based on their medical records.

Results. Total IgE was only assessed in 37.11% (n = 360) of patients from the study cohort of children with bronchial asthma, of which an elevated IgE level was identified in 81% of cases (292 children), suggesting the prevalence of the atopic bronchial asthma phenotype over non-atopic asthma phenotype. The analysis showed the changing patterns of allergen sensitization by age group. Most of the patients, irrespective of their age, showed sensitization to household allergens. In addition to household allergen sensitization, food sensitization was also reported in 36% in children under 4 years of age, which was the highest rate as compared to other age periods. Sensitization to household and pollen allergens was found to increase significantly as children age (p < 0.05). Cross-sensitization (to pollens produced from wind-pollinated plants) to food allergens was low, but increased from an early age up to 15-18 years. Allergic rhinitis (AR) is a very common comorbidity of asthma and accounts for 18% with a gradual increase in indicators by the age of 18. Children with concurrent asthma have almost the same incidence of developing atopic dermatitis up to age 18.

Conclusions. The prevalence of sensitization to food allergens has been established in children with asthma residing in Moscow and Moscow region under 4 years old, and the prevalence of sensitization to household, pollen and epidermal allergens — over 5 years old, which should be taken into account when managing these patients.

Introduction. Covid-associated lung disease has become one of the leading problems of the COVID-19 pandemic, and early diagnosis of complications is complicated. Assessment of dyspnoea as a significant symptom is important, but its diagnostic ability in this lesion is poorly understood.

Aim. To study the features of dyspnoea in COVID-19-associated lung lesions and its diagnostic value.

Materials and methods. The study included 134 patients with COVID-19-confirmed pneumonia. Demographic and anthropometric data, subjective condition, dyspnoea severity according to Borg scale, concomitant pathologies, multispiral computed tomography (MSCT) data, arterial blood gas composition, capnometry and spirometry data, as well as disease outcomes (transfer to ICU, support ventilation, fatal outcome) were analysed.

Results. Dyspnoea was present in 43.3% of patients. Increased dyspnoea was associated with increased C-reactive protein (CRP), D-dimer, lung tissue damage (MSCT), decreased forced vital capacity (FVC), and increased alveolar-arterial gradient (P(A-a)O₂). Dyspnoea correlated with duration of hospitalisation and need for oxygen therapy (OR = 1.307, p = 0.008). 57.4% of patients with hypoxaemia did not complain of dyspnoea, but their outcomes did not differ between patients with dyspnoea and hypoxaemia. 32.2% of patients without hypoxaemia complained of dyspnoea. These patients did not have a significant increase in FGEF by the time of discharge, and it remained lower than in patients without dyspnoea and hypoxaemia.

Conclusion. Dyspnoea in COVID-19-associated lung disease is an important symptom correlating with clinical-functional, instrumental and laboratory characteristics of the disease. Comprehensive data analysis is necessary to identify patients requiring further observation.

The current understanding of the main functions of surfactant, data on its composition, and its role in dysfunction and pathogenesis of bronchopulmonary pathology are discussed. The paper presents new information about the results and prospects of surfactant therapy for bronchopulmonary pathology. The use of surfactant in acute respiratory distress syndrome (ARDS) in adults has been studied. An analysis of the composition of commercial drug products is conducted, and the current experience of replacement therapy with the exogenous surfactant preparation Surfactant-BL in infection caused by the SARS-CoV-2 virus (COVID-19) is provided. Personal experience in the use of the drug Surfactant-BL for treating patients with COVID-19 infection in real clinical practice is also presented using the example of 8 individuals. All patients (male and female) were over 18 years old, had a confirmed diagnosis of COVID-19, showed changes on chest CT scans (CT-2+), were undergoing oxygen therapy by any method, and had CRP > 30 mg/L. Surfactant-BL was administered to all patients as an inhaled emulsion at doses of 75-150 mg. An increase in oxygen saturation was observed in 1 (12.5%) patient 1 day after inhalation of the drug Surfactant-BL, in 4 (50%) patients on the 2^nd day, and in 3 (12.5%) patients on the 7^th day. The average duration of oxygen therapy was 4 days, and mechanical ventilation was 7 days. The average hospital stay of the patients was 25 days, which was reduced to 20 days after the use of Surfactant-B L. The drug Surfactant-BL demonstrated effectiveness; however, further research is needed as the authors have a limited number of cases studied.

Introduction. The effect of SARS-COV-2 on the lung function remains relevant at the present time.

Aim. Determination of the most important predictors of the restrictive ventilation disorder after COVID-19.

Materials and methods. The retrospective study included 341 patients without underlying lung diseases (median age 48 years) survivors after COVID-19 with bilateral pneumonia. The median of the greatest extent of parenchymal involvement in the acute phase of COVID-19 (CT_max) was 50%. Spirometry, body plethysmography, and diffusion test were performed. Descriptive statistics, correlation analysis, one-dimensional logistic regression analysis with an assessment of odds ratios (OR) and multivariate logistic regression analysis were applied. ROC analysis was used to assess the quality of the binary classifier model.

Results. The initial model for predicting reduced total lung capacity (TLC) (criterion 1: TLC < 80% predicted, criterion 2: TLC<predicted-1.645SD) included predictors: CT_max, time interval from the COVID-19 onset (TI), gender, age, body mass index. Backward stepwise regression was applied and a binary classifier model that includes CT_max and TI was obtained. Applying criterion 1 for reducing TLC, the sensitivity and specificity of the model were 70,5% and 89.3%, respectively, and criterion 2 - 96.6% and 67.3%, respectively. The analysis of OR for the obtained binary classifier models showed that OR>1 is observed at CT_max > 70%.

Conclusions. The restrictive ventilation disorder after COVID-19 is caused by CT_max and TI. The risk of reducing TLC after COVID-19 increases significantly with CT_max 70% or more. The criterion of the low level of normal of TLC affects the sensitivity and specificity of the obtained models.

Introduction. One of the insufficiently studied methods of Acute Respiratory Distress Syndrome (ARDS) therapy is therapy with a heated helium-oxygen mixture. Due to physico-chemical properties, helium demonstrates high efficiency in the treatment of various diseases of the pulmonological profile.

Aim. To study the effect of a heated helium-oxygen mixture on the course of a severe form of COVID-19 occurring with the development of ARDS.

Materials and methods. The study involved 58 patients with severe and extremely severe coronavirus infection and ARDS, divided into the NVL + t-He/O₂ group (n = 30) and the NVL+O₂ control group (n = 28). In addition to standard treatment, patients of the NVL + t-He/O₂ group received noninvasive ventilation (NVL) and therapy with a heated helium-oxygen mixture, according to clinical recommendations. In the main group, inhalations took place daily for 60 minutes per day for 5 days.

Results. Against the background of therapy with a heated helium-oxygen mixture, a more intense increase in the level of lymphocytes was observed: 1.39 (1.09-1.66) x 10⁹/l in the NVL + t-He/O₂ group versus 1.02 (0.78-1.40) x 10⁹/l (p = 0.02). Also, as a result of treatment, there was a significant decrease in RR, D-dimer and CRP in the study group: the level of RR (21 (20-22)/minute versus 22.5 (21-24)/minute, p = 0.003), D-dimer (0.44 (0.29-0.60) FEU ng/ml versus 0.79 (0.42-1.34) FEU ng/ml, p = 0.02) and CRP (1.1 (0.7-3.1)mg/l versus 16.6 (8.5-29.5) mg/l, p = 0.03), respectively. Similarly to the NVL + t-He/O₂ group, an increase in the level of PaO₂ and the oxygenation index was noted. In addition, there were significantly fewer patients with grade III and IV lung damage in the NVL + t-He/O₂ group compared with the control (p = 0.05).

Conclusion. The use of a heated helium-oxygen mixture in patients with severe COVID-19, occurring with the development of ARDS, against the background of standard therapy and NIV has shown its safety and effectiveness: there was a decrease in the intensity of inflammation, improved oxygenation and a reduction in the need for respiratory support.

The complexity of the differential diagnosis of tuberculosis is due to a combination of factors that lead to diagnostic difficulties and errors. At the forefront of this variability are: the similarity of the clinical and radiological picture of lung diseases with the absence of pathognomonic signs; the pathomorphosis and variability of clinical manifestations of lung diseases, where there is often a diversity of clinical variants of the same nosology. Some diseases with no established etiology (such as sarcoidosis and obliterative bronchiolitis) often mimic tuberculosis. At the current stage, the arsenal of tools that allows for the timely detection and diagnosis of the etiology of pathological changes in the lungs includes a recombinant tuberculosis allergen test (ATR) — the Diaskintest® preparation. Immunodiagnostics plays a leading role in establishing the presumed diagnosis of tuberculosis. This method allows for effective screening not only for active tuberculosis but also for latent tuberculosis infection in individuals with non-tuberculous lesions of the chest organs. Thus, Diaskintest® successfully addresses the issues of detection and differential diagnosis in real clinical practice within diagnostic algorithms for excluding tuberculosis. The article presents a clinical observation of newly diagnosed pulmonary tuberculosis in a 30-year-old man. A distinctive feature of this case is that, in the absence of detection of the tuberculosis pathogen in the early stages of the disease, it was the positive result of the Diaskintest that guided the diagnostic search. As further examination results showed, the probable diagnosis established based on the positive ATR test completely matched the verified diagnosis of tuberculosis. The use of the ATR test allowed for a reduction in the diagnostic pause interval and the timely initiation of appropriate therapy for the patient, even with a negative microscopy result during the differential diagnosis stage.

Introduction. A modern problem of phthisiology is the treatment of patients with a combination of drug-resistant tuberculosis and HIV infection. One of the most effective modern drugs in the treatment of MDR tuberculosis is bedaquiline. However, this drug has a number of adverse effects, among which the dominant one is the cardiotoxic effect, manifested in the form of prolongation of the QT interval. The risk of cardiac adverse events is increased in patients receiving other drugs with a cardiotoxic effect in combination therapy. These include fluoroquinolones and protease inhibitors used to treat HIV infection.

Aim. To analyze the dynamics of the QT interval in patients with a combination of tuberculosis and HIV infection who received complex anti-tuberculosis and antiretroviral therapy and determination of the risks of developing cardiac complications.

Materials and methods. The analysis of the dynamics of the QTc interval values was performed in 91 patients with a combination of drug-resistant tuberculosis and HIV infection who received bedaquiline in the tuberculosis chemotherapy regimen. The inclusion criteria for the study were the presence of HIV infection, newly diagnosed tuberculosis verified by a bacteriological method with the presence of multiple or extensive drug resistance of MBT, the use of bedaquiline in the tuberculosis treatment regimen, the use of antiretroviral therapy during anti-tuberculosis chemotherapy.

Results. During the complex therapy, which included bedaquiline and other potentially cardiotoxic drugs (fluoroquinolones, protease inhibitors), in no case was there a clinically significant event or change in the QTc interval that required treatment interruption. Factor analysis revealed a potentially significant effect on the change in the QTc interval of levofloxacin and moxifloxacin in tuberculosis chemotherapy regimens.

Conclusion. Bedaquiline is a safe anti-tuberculosis drug in terms of cardiotoxic reactions in the complex therapy of tuberculosis in patients with HIV infection and is well tolerated without the development of clinically significant cardiotoxic reactions.

Introduction. Cystic fibrosis is a severe chronic genetic disease, in which the microbiological status of the patient plays an important role, because it will determine the severity of the respiratory infection. In recent years, representatives of non-fermenting gram-negative bacteria (NFGNB) - P. aeruginosa, B. cenocepacia, Axylosoxidans; as well as representatives of the order Flavobacteriales - have become of great clinical importance in patients with cystic fibrosis. A feature of some representatives of NFGNB is the formation of resistance to antibacterial drugs, due to prolonged antimicrobial therapy. In addition to the acquired, there is a high level of natural resistance, and therefore the possibilities of using antibacterial drugs are significantly limited.

Aim. To estimate the distribution of the values of the minimum suppressive concentrations (MSC) of cefepim / sulbactam, piperacillin / tazobactam, biapenem in relation to 100 strains of Gram-negative bacteria isolated from respiratory samples from patients with cystic fibrosis.

Materials and methods. To date, new compounds have appeared with potential activity against the strains under consideration - cefepim / sulbactam, piperacillin / tazobactam, biapenem. We selected 100 bacterial strains isolated from respiratory samples from patients with cystic fibrosis from various regions of the Russian Federation. Among them, 69 strains are Pseudomonas aeruginosa, 6 - Achromobacter xylosoxidans, 14 - Burkholderia cenocepacia, 10 - Chryseobacterium spp., 1 - Elizabethkingia miricola. MSC values were determined for 3 antimicrobial drugs: cefepim / sulbactam, piperacillin / tazobactam, biapenem.

Results and discussions. According to the data obtained, it was found that most strains of Pseudomonas aeruginosa, Achromobacter xylosoxidans have a high level of sensitivity to cefepim/sulbactam, piperacillin/tazobactam. The criteria for evaluating the MSC indicators of the studied drugs in relation to Burkholderia cenocepacia and representatives of the order Flavobacteriales have not been determined, however, it is worth noting that most isolates have demonstrated an achievable value of MSC indicators. This suggests the possibility of practical application of antimicrobial drugs under test.

Conclusions. The data obtained indicate the microbiological efficacy of the drugs: cefepim/sulbactam, piperacillin/tazobactam, biapenem relative to NFGNB isolated from patients with cystic fibrosis.

Antibacterial therapy is an essential component of treatment for bacterial respiratory infections. The last decade has seen an increase in resistance of respiratory pathogens to different classes of antibiotics. The purpose of this review was to analyze publications on azithromycin, a macrolide with both antibacterial and non-antibacterial properties. Studies conducted worldwide indicate heterogeneity in both the frequency of azithromycin use and resistance to it, but in general, there is an increase in the values of its minimum inhibitory concentration against pathogens for which the use of macrolides is indicated. The COVID-19 pandemic has led to an expansion of clinical experience with the use of this azalide, demonstrating sufficient safety of the drug. However, recent large retrospective studies have shown the inappropriateness of its etiotropic use in this viral infection, limiting it only to proven cases of bacterial pneumonia caused by pathogens sensitive to macrolides. One of the ways to optimize the use of azithromycin is its combined use with other drugs that provide synergy in clinical effectiveness. An important property of azithromycin, ensuring its clinical effectiveness, is its ability to affect inflammatory processes in the respiratory tract, the state of the respiratory epithelium. The anti-inflammatory properties of azithromycin are used in various fields of medicine, including traumatology, gynecology and dentistry. The clinical effectiveness of antibiotics is determined by their rational use, patient compliance and convenience of the dosage form. In this regard, work is underway to create forms convenient for oral administration, to overcome the bitter taste. In this direction, certain successes have been achieved by domestic developers in the introduction of a dispersible form of azithromycin.

The presented article discusses the issue of overcoming antibiotic resistance in modern conditions. The main focus is on the formation of biofilms by microorganisms as one of the key mechanisms of antibacterial resistance. One of the key problems with the use of antibiotics for the treatment of biofilms is the necessity to achieve the required minimum inhibitory concentration (MIC) of the drug at the biofilm site, which may be 100-800 times greater than the MIC for planktonic cells. Considering the significant human and financial costs, there is an increasing need to develop new strategies for therapeutic intervention in biofilms. The effectiveness of treatment is linked to the ability of the antimicrobial agent to penetrate the heterogeneous structure of the bacterial colony's substrate. It has been shown that the ability of the drug to penetrate the biofilm depends on the structure of the matrix, the genus and strain of the bacteria, as well as the selected antibiotic. Strategies for the penetration of major antibacterial drugs into the biofilm matrix are provided, in particular the use of combination drugs such as thiamphenicol glycinate acetylcysteinate (TGA). The possibilities of using TGA in various conditions — chronic bronchitis, chronic obstructive pulmonary disease, cystic fibrosis, and rhinosinusitis — are discussed. In addition, data are presented on the positive impact of N-acetylcysteine (NAC) on biofilms in various other locations, including gastroenterology and catheter-associated infections. A review of the available medical literature shows that NAC in combination with thiamphenicol possesses, in addition to antibacterial properties, the ability to influence biofilm formation and disrupt biofilm function. The use of NAC may be a new strategy for the treatment of chronic respiratory infections associated with colony-forming microorganisms.

The major etiological factors that influence the development of acute respiratory diseases include various viral and bacterial agents that possess a high tropism for the respiratory epithelium. These diseases are known to be medical conditions that are associated with similar clinical signs and symptoms, as well as a pronounced range of degrees of severity and development of the disease complications. Cough is a prevalent clinical symptom in the clinical picture of ARD. For the treatment of cough, it is advisable to use drugs that have a complex effect: expectorant, secretolytic, bronchospasmolytic and anti-inflammatory. Herbal drugs have a reflex expectorant effect. When taken orally, they irritate the stomach receptors, bronchial gland secretion is enhanced reflexively, the ciliated epithelium activity is increased, and the bronchial tree smooth muscle contractions are intensified. The sputum becomes thinner and is cleared from the lungs more easily. Combinations of two or more medicinal herbs that complement or enhance each other's action are often used. It should be noted that such combination makes it possible to achieve a complex therapeutic effect i.e. anti-inflammatory, as well as mucolytic and secretolytic. It is preferable to prescribe mucoactive herbal drugs at the initial stage of the disease due to their multicomponent action, as well as good tolerability and high efficiency. Both Bronchipret (syrup) and Bronchipret TP (tablets) fully possess all these properties. The article presents the main mechanisms of action of the active substances of the drug, discusses the main points of “application” of pharmacological activity in the treatment of acute respiratory diseases with cough, and shows new targets for its use, taking into account new experimental and clinical evidence on antiviral activity against SARS-CoV-2.

Cough is a common and important respiratory symptom that can cause significant complications for patients and be a diagnostic challenge for physicians. An organized approach to the evaluation of cough begins with classifying it as acute, subacute, or chronic based on duration and time of onset. Acute cough (up to 3 weeks) is most often one of the main symptoms of acute respiratory viral infections and acute bronchitis. Subacute cough, lasting from 3 to 8 weeks, is usually postinfectious postviral in origin. Common causes of chronic cough lasting more than 8 weeks with a normal chest X-ray are cough variant of bronchial asthma, chronic obstructive pulmonary disease, upper airway cough syndrome / postnasal drip syndrome, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux, and medications (primarily angiotensin-converting enzyme inhibitors). The spectrum of possible causes of cough is diverse, however, respiratory pathology comes to the forefront in the differential diagnostic search. Successful treatment of cough is an important task in clinical practice. Given the possible multicomponent nature of cough, the presence of catarrhal-respiratory and broncho-obstructive syndromes in the clinical picture along with bronchitis syndrome, combination drugs become the drug of choice. In conclusion, the possibilities of a combined (bromhexine + guaifenesin + salbutamol) expectorant against cough, its effectiveness and safety are considered.

Introduction. The problem of lung diseases in patients with primary defects in antibody production has not been sufficiently studied, especially depending on the climatic, geographical and demographic conditions of real clinical practice.

Aim. To study the structure of lung disorders in adult patients with primary antibodies defects in the Middle Urals in real clinical practice.

Materials and methods. Register of adult patients with primary immunodeficiencies (PID) were created in 2013 in the Sverdlovsk region. Now it contains 209 people. The main group of the register is patients with primary antibodies defects (PAD, n = 143, 68.4%: agammaglobulinemia (AGG, n = 11, common variable immune deficiency (CVID, n = 37), PIK3-Kinase deficiency (n = 3), Selective IgA deficiency (SD IgA, n = 92). The diagnosis of PID was established on the criteria for the Russian Association of Allergists and Clinical Immunologists and European Societies of Immunodeficencies, in some cases it has a genetic confirmation. We used medical history of patients, radiological, functional studies to establish lung lesions. We occurred immunological examination for all PID patients.

Results. Repeated pneumonia were observed in all patients with AGG and CVID, especially in the onset of PID. Patients also had diseases such as bronchiectasis (up to 37.6% of patients), chronic obstructive lung disease (up to 70.3% of patients), bronchial asthma (only SD IgA), interstitial lung disease (only CVID).

Conclusion. According to our data, in the Middle Urals, lung diseases, especially pneumonia and bronchiectasis, are the most common clinical manifestations in patients with DA. Analysis of immunoglobulins' level is necessary in patients with repeated pneumonia, bronchiectasis and interstitial lung disease, bronchial asthma and early onset of chronic obstructive lung disease without smoking status.

Introduction. Studying the influence of chemical sensitivity on functional disorders by means of digital diagnostic technologies is a significant medical and social problem.

Aim. To study the possibility of the EcoMedic digital platform in the diagnosis of functional disorders with multiple chemical sensitivity (MCH).

Materials and methods. Questionnaires were administered using the QEESI questionnaire to 468 outpatients undergoing preventive medical examination (232 men, mean age 34.2 ± 9.3 years and 236 women mean age 42.9 ± 13.8 years). Data were collected using the developed digital platform EcoMedic. Statistical processing was performed using MedCalc statistical programme.

Results. The frequency of MCH was 211 patients (45.1%). The most frequent complaints in MCH were gastrointestinal (n = 174, 82.4%); second were cognitive symptoms (n = 158, 75.1%); dall neurological (n = 149, 71.1%); musculoskeletal (n = 144, 68.5%); neuromuscular (n = 139, 66.4%); respiratory and mucosal (n = 130, 62.1%); cutaneous (n = 124, 59.1%); affective (n = 118, 56.4%). In MCH, symptom frequency across all 10 symptom groups was significantly higher than in controls (p < 0.0001). In MCH, the frequency of symptoms in all 10 groups of symptoms was significantly higher than in patients without MCH (p < 0.0001). The frequency of overlapping of 3 regions of the MCH scales simultaneously in the group of patients with MCH was higher than without MCH (60.2% vs 3.1%, χ² = 186.065, p = 0.000). The proportion of people with thresholds for severity of symptoms or impact on daily life according to only one of the scales in the group of patients with HCV was significantly lower (9% vs 32.6%, χ² = 37.853, p = 0.001).

Conclusions. The EcoMedic digital platform has prospects for scaling technologies to diagnose patients with HCV and conduct scientific and practical studies of functional symptoms.

Introduction. Lymph node enlargement in the craniocervical region is a common occurrence in general medical, pediatric and otolaryngological practice. According to the topographic anatomy of the lymphatic drainage zones, there is a close relationship between inflammation of the ENT organs and localized lymphadenopathy. An increase in the size of the lymph nodes is one of the symptoms of many diseases and pathologies that differ in their cause, clinical manifestations, diagnostic methods, treatment and prognosis. When diagnosing lymphadenopathy due to non-specific inflammation of the ENT organs, it is necessary to differentiate from neoplasms and specific infections. Understanding the function of the lymph nodes, their location, description taking into account the etiopathogenesis of their enlargement is important for making clinical decisions about when a comprehensive examination and treatment are necessary, and in which cases only observation. The data of the literature review and further studies will help to identify age-related patterns in the formation of local lymphadenopathy of the craniocervical region according to the topographic zones of lymphatic drainage to determine the diagnostic algorithm in order to avoid possible surgical treatment and reduce the risk of serious complications.

Aim. Conduct an analysis of the prediction of localized lymphadenopathy in inflammation of the ENT organs according to the anatomical zones of lymphatic drainage based on materials from domestic and foreign literature.

Materials and methods. We searched for articles in public databases using the following queries: “lymphadenopathy”, “craniocervical region”, “anatomical zones of lymphatic drainage”, “inflammatory pathology of ENT organs”. A review of the literature carried out was over the past 10 years, including data from literary sources whose authors made a significant contribution to the development of otorhinolaryngology.

Results and discussion. The summary data of the literature review, including both original studies and descriptions of clinical cases, presented are in the relationship of localized lymphadenopathy of the craniocervical region in inflammatory nosology of ENT organs with anatomical and topographic zones of lymphatic drainage in norm and pathology. A checklist for early diagnostics of inflammation of the lymph nodes of the head and neck in ENT pathology and routing of patients with localized lymphadenopathy compiled has been to avoid possible surgical treatment and reduce the risk of serious complications.

Conclusion. Analysis of available literature sources showed that localized lymphadenopathy is one of the symptoms in acute and chronic ENT pathology. Craniocervical nodes are located in discrete anatomical areas, and their enlargement reflects lymphatic drainage from the inflammation zone of ENT organs when the barrier of immune protection of the lymphoepithelial pharyngeal is ring disrupted. The nature, distribution and number of lymph nodes can provide a lot of information to the clinician in diagnosing the recurrent course of inflammation of ENT organs, in connection with which an interdisciplinary approach is necessary in routing a patient with lymphadenopathy.