Eosinophilic T2 inflammation plays a central role in the pathophysiology of most cases of severe, difficult-to-control asthma. Several monoclonal antibodies are now available that block the signaling pathways of eosinophilic T2 inflammation by binding to specific interleukins or their receptors. In order to select the optimal treatment strategy that ensures effective disease control and adequate quality of life, in addition to accurate asthma pheno-/endotyping, it is necessary to determine biomarkers that predict the effectiveness of biological therapy and disease outcome. New biomarkers are needed to identify those patients who are most likely to respond to biological drugs. The review presents an analysis of scientific publications of recent years devoted to the search for prognostic molecular biomarkers that allow assessing the activation status of eosinophils and determining the choice of a specific biological drug based on the prognosis of the possible outcome of the disease. A systematic search was performed in the electronic databases PubMed, Medline, Web of Science. The possible prognostic role of granular cytotoxic molecules (eosinophil-derived neurotoxin, eosinophil peroxidase, eosinophilic cationic protein) released during degranulation of activated eosinophils as indicators of activation status and predictors of the effectiveness of biological therapy is considered. Analysis of scientific studies shows that the serum level of eosinophil-derived neurotoxin has a quite high prognostic value, the accessible measurement of which in peripheral blood allows identifying a subpopulation of patients with a high activation status of eosinophils and a more severe form of bronchial asthma, and can be considered as a biomarker for determining optimal personalized biological therapy. However, in the absence of evidence-based studies on the usefulness of any given molecular predictor of clinical response to biological therapy, the initial choice of biological agents is determined by the experience and opinions of treating physicians and experts.

Bronchial asthma is one of the most common chronic diseases in children. Severe asthma is defined by the European Respiratory Society and American Thoracic Society as asthma that requires treatment with high-dose combination therapy of inhaled corticosteroids in combination with long-acting bronchodilators and/or with the use of systemic corticosteroids, or remains uncontrolled despite treatment. In the structure of severity, severe asthma occupies about 5%, but it leads to a maximum decrease in quality of life, causes disability, and also requires significant expenditure of health care resources. Therefore, selection of therapy for severe bronchial asthma remains an important task. The introduction of monoclonal antibody drugs into practice makes it possible to improve the control of severe bronchial asthma in children at the 5th stage of therapy. The first biological drug to treat severe asthma was Omalizumab, and over twenty years of its use has been shown to be effective in controlling symptoms, reducing the frequency of exacerbations, and improving lung function. Our study assessed the effectiveness of biological therapy. Treatment with omalizumab led to in a reduction in the frequency of symptoms, number of exacerbations, total IgE, and improvement of lung function as assessed by spirography. No severe reactions to the drug were observed. The article presents a clinical example of long-term use of omalizumab in a patient with severe bronchial asthma, which made it possible to achieve control over the disease, improve quality of life and reduce the volume of basic therapy, while no adverse reactions to the drug were recorded.

Asthma is a heterogeneous disease that affects approximately 339 million people worldwide. In most patients, asthma can be controlled with standard treatments, including inhaled corticosteroids (ICS), long-acting beta-agonists (LABs), long-acting anticholinergics (LACs), and oral leukotriene receptor antagonists. For more severe cases that remain uncontrolled with standard treatment, gene-engineered therapies (GEBTs) are now available. Existing gene-engineered therapies only inhibit specific molecular targets, such as IgE and T-2 inflammatory cytokines, are suitable for a small subset of patients with severe asthma, and are ineffective in non-allergic or non-eosinophilic (non-T2) asthma phenotypes. However, these biological drugs are only suitable for a group of patients with severe T-2 bronchial asthma and are ineffective in non-allergic or non-eosinophilic asthma phenotypes. Heterogeneous response to asthma treatment is directly related to differences in the nature of airway inflammation, immune cell activation, and glucocorticoid sensitivity. Tezepelumab is a first-in-class monoclonal antibody to thymic stromal lymphopoietin (TSLP) that is prescribed for sever asthma, regardless of the endotype of inflammation. In the presented clinical observation, the inclusion of tezepelumab in the treatment of severe non-atopic non-eosinophilic (non-T-2) uncontrolled asthma led to complete control of asthma symptoms, significant improvement in respiratory function, and did not cause adverse events. The data obtained coincided with the results of the studies.

Obstructive sleep apnea is a condition characterized by snoring, periodic collapse of the upper respiratory tract at the level of the pharynx and cessation of pulmonary ventilation with continued respiratory efforts, decreased blood oxygen levels, gross fragmentation of sleep and excessive daytime sleepiness. Bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) remain a global problem for humanity due to persistent high levels of morbidity and mortality from these diseases. OSA is a common comorbid condition in many diseases, including chronic bronchopulmonary diseases such as BA, COPD and others, and always affects the course of these diseases. The presence of OSA in such patients is associated with disease progression, lack of disease control, frequent exacerbations, and an unfavorable outcome. This category of patients is difficult to treat with standard treatment and achieve disease control. This should be the key aspect in considering the appropriateness of diagnostics for obstructive sleep apnea syndrome. Despite the available data on the combination of OSA with chronic lung diseases, practitioners in most cases do not recognize this disease, and patients are left without full treatment. Timely detection and correction of OSA can reduce the frequency of hospitalizations, improve the course of BA and COPD, and reduce mortality. It is still relevant to conduct large population studies to identify the comorbidity of OSA in COPD and asthma, which will allow the development of algorithms for the early diagnosis of OSA with appropriate correction.

Introduction. Bronchial asthma (BA) is the most common chronic pathology in children. The basis of medical rehabilitation is currently a “multidisciplinary approach”, which includes, among other things, a personalized approach.

Aim. Тo develop a comprehensive targeted program for medical rehabilitation of children with bronchial asthma, and to study the effectiveness of a comprehensive targeted program selected taking into account the individual characteristics of the child.

Materials and methods. For each patient participating in the study, an individual targeted program of medical rehabilitation was developed in accordance with the procedures and standards of medical care, taking into account indications and contraindications, taking into account a multidisciplinary approach and rehabilitation methods, namely: climatotherapy, physiotherapy, speleotherapy, aromatherapy, inhalation therapy, oxygen therapy, hypoxic therapy, mechanotherapy, psychocorrection, massage, therapeutic exercise, phytotherapy. Patients were randomized into three groups, without reference to the treatment method or other factor. All three groups of patients received a basic program of medical rehabilitation, which included magnetotherapy, dry carbon dioxide baths, speleotherapy and therapeutic exercise.

Results. Positiveindicators of clinical and laboratory results and subjective data as a result of rehabilitation were obtained in all patients from all 3 groups. In children with bronchial asthma of mixed genesis, as a result of complex treatment, a significant improvement was noted. These results allow us to speak about the significant effectiveness of individually selected targeted medical rehabilitation programs in patients with bronchial asthma.

Conclusion. The use of an individual rehabilitation complex of procedures and treatment methods in pediatric patients with bronchial asthma is effective, it allows improving the condition and well-being of patients according to subjective sensations, as well as clinical and diagnostic indicators. It is possible to recommend the introduction of the use of these programs in medical rehabilitation of this group of patients.

Introduction. The natural course of chronic obstructive pulmonary disease (COPD) is characterized by an exacerbation of symptoms and a decrease in quality of life (QOL). QOL is a complex indicator for assessing people’s health and well-being, which is influenced by many factors. Health-related QOL assessment tools are widely used to determine physical, functional, social, and psychosocial well-being from a patient’s perspective. Low QOL levels are common among patients with COPD, especially in the late stages. In 2023, the results of a 10-year evaluation of the effectiveness of vaccine prophylaxis against pneumococcal infection were published, but they did not include a QOL analysis.

Aim. To conduct a posteriori analysis of the assessment of QOL over 10 years of follow-up in patients with COPD vaccinated with conjugated pneumococcal vaccine Prevenar 13 (PCV13).

Materials and methods. The study included a total of 362 male patients who were treated or monitored at the Chelyabinsk Regional Pulmonological Center in 2012–2022. The 13-valent conjugated pneumococcal vaccine Preventar-13 was used for vaccine prophylaxis. The QOL assessment was conducted using two questionnaires: the Russian-language version of the St. George Hospital Questionnaire (SGRQ), and the universal CAT questionnaire.

Results. The indicators of the SGRQ questionnaire scales in the studied groups did not significantly differ (p > 0.05). A year after the start of the observation, changes in QOL were detected on all scales of the questionnaire, while maintaining statistically significant changes over the 10 years of observation. In the observation group of unvaccinated patients, there was no clinically or statistically significant change in QOL parameters according to all criteria. A similar dynamic was demonstrated by the indicator of the СAT questionnaire.

Conclusions. Vaccine prophylaxis with pneumococcal vaccines has a significant positive effect on the QOL of patients with COPD, at least in the 10-year follow-up period. The use of QOL questionnaires makes it possible to focus on the correctness of the chosen treatment tactics both in the early and long-term periods of follow-up of patients with COPD. The use of PCV13 for the vaccination of COPD patients reliably minimizes the number of exacerbations requiring outpatient and hospital treatment, reduces the number of episodes of pneumonia as much as possible, and reduces the cost of the healthcare system to combat this nosology.

Results of modern research show that despite new approaches to the treatment of bronchial asthma (BA) (including new strategies for using combinations of inhaled and biological drugs), about 5-10% of patients belong to the phenotype with persistent resistance to standard therapy, more pronounced bronchial reactivity and, as a result, a tendency to frequent exacerbations. In this regard, it is necessary to study and implement additional methods of BA therapy. Recent research suggests that antidiabetic drugs such as metformin and glucagon-like peptide-1 (GLP-1) agonists may have a positive effect on asthma. A new UK study led by Chloe Bloom of Imperial College London has shown that metformin reduces the risk of asthma attacks by 30%, while adding a GLP-1 agonist to the treatment reduces the risk by a further 40%. In experimental studies, the diabetes drugs metformin and GLP-1 agonists reduced airway inflammation, hyperreactivity and bronchial remodelling. These results highlight the need for further study of the potential of antidiabetic drugs in the treatment of asthma in combination with obesity or type 2 diabetes, and suggest the possibility of repurposing antidiabetic drugs into much-needed alternative treatments for asthma.

Digitalization of healthcare is becoming an integral part of providing medical care to the population. The introduction of artificial intelligence (AI) in medicine leads to the formation of “digital thinking” and public trust in digital healthcare. The purpose of this literature review was to summarize the data related to AI in general and to the study of sarcoidosis – a multiorgan granulomatosis of unknown origin. The most widely represented works are on image recognition, which use different approaches. In pulmonology, this is work with fluorograms, radiographs and computed tomograms. At the same time, comprehensive work is underway on radiomics – comparing image diagnostic data with laboratory and functional data. Programs have been created that recognize speech, analyze the texts of conclusions, the results of tissue diagnostics and even patient auscultation data. In sarcoidosis, the creation of systems to support medical decision-making has been underway since the 1990s, with priority given to Russian phthisiologists, pulmonologists, and mathematicians. In international practice, deep learning has been most fully studied for the diagnosis of pulmonary sarcoidosis. Radiomics was mainly used to differentiate sarcoidosis from malignant tumors. Work is underway to differentiate sarcoidosis and normal data in pulmonary and cardiac sarcoidosis, and for remote self-monitoring of patients. Literature analysis has shown that in clinical medicine, the success of AI is possible only in close cooperation with an expert physician or a multidisciplinary committee of physicians.

Introduction. Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of death in the world, being a global problem. In Russia, the prevalence of COPD is 15.3% in the general population and 21.8% among people with respiratory symptoms. Nevertheless, this disease is quite successfully treatable and controllable.

Aim. To determine the level of basic knowledge among therapeutic profile physicians and senior medical students regarding the issues of etiopathogenesis and diagnosis of COPD.

Materials and methods. The ASCO-III study was conducted in 2019–2023 using an anonymous questionnaire, 478 therapeutic doctors from 11 centers and 401 students from 7 centers participated in it. An original questionnaire based on current clinical recommendations was used to conduct the ASCO-III study.

Results. The study revealed an insufficient level of knowledge among doctors and students regarding the etiology, pathogenesis, and diagnosis of COPD. In the section on “Etiopathogenesis and Diagnostics,” the level of correct answers (LCA) among doctors was 73.5%, increasing to 82% when including questions about vaccination. For students, the LCA was 68% and 73.6%, respectively. Significant differences were observed between the overall populations of doctors and students concerning the final LCA (p < 0.001). The best results were noted in questions about risk factors for COPD, with 88.0% of doctors and 88.8% of students providing correct answers. Additionally, in questions regarding the signs that may suggest this disease, the correct answer rates were 89.9% for doctors and 84.9% for students. Conversely, the lowest scores were recorded for questions about the CAT and mMRC scales, with incorrect responses from 69.3% of doctors and 72.8% of students. Furthermore, in the question assessing the importance of vaccination as a means of controlling COPD, 45.5% of doctors and 61.6% of students provided incorrect answers.

Conclusions. During the analysis of the results of the study, an insufficient level of basic knowledge of respondents on COPD was revealed, which, according to the authors, indicates the need for additional educational activities among practicing doctors and students.

Dyspnea in elderly patients is one of the most common symptoms in clinical practice; its interpretation requires a deep diagnostic search and exclusion of different pathological conditions and diseases. Many patients who had suffered a new coronavirus infection, for a long time after being discharged from the hospital or completing an outpatient course of therapy, continued to notice a number of clinical manifestations, which later became known as Post-COVID-19 syndrome. Patients who had a severe course of COVID-19 with lung tissue damage deserve a special attention. As clinical observations demonstrate that even several years after new coronavirus infection, pathological changes in lungs can persist and sometimes progress, which is accompanied by respiratory symptoms, the most common of which is dyspnea. Taking into account the diversity of pathogenic mechanisms of SARS-CoV-2, pathological changes in the lung tissue may have a different mechanism and nature (conditionally fibrotic and non-fibrotic), the development of which is influenced by a combination of exogenous and endogenous factors of the patient. The article presents clinical observations of patients with dyspnea in the late post-COVID-19 period with different mechanisms of lung tissue damage, who suffered from severe COVID-19. The article analyzes a set of potential risk factors for the persistence and further progression of post-COVID-19 pulmonary changes in the presented patients, and compares data with the most relevant scientific and clinical information of the world scientific sources. Further accumulation of information on the current problem may help to develop diagnostic and therapeutic algorithms for the management the post-COVID-19 pulmonary injuries, which will improve the quality and duration of life in such patients.

Introduction. Pulmonary surfactant is a key component of the respiratory system that ensures the stability of the alveoli by reducing surface tension, preventing collapse of the respiratory tract and protecting against infections. Its dysfunction is observed in severe respiratory diseases, including COVID-19, ARDS, pneumonia, COPD and bronchial asthma. Of particular interest is the inhalation use of exogenous forms of surfactant not only in acute COVID-19, but also in the post-covid period.

Aim. The aim of the study is to evaluate the effectiveness of a course of inhalation of tauractant emulsion (Surfactant-BL) through a nebulizer in patients with COVID-associated pneumonia with persistent ventilation disorders after 3 months of therapy in the post-covid period.

Materials and methods: The study included 60 patients with COVID-associated pneumonia with confirmed violations of lung ventilation and pronounced residual changes in lung tissue, who were randomly divided into 2 groups – the main group (n = 30) and the comparison group (n = 30). The main group, in addition to the standard therapy for post-covid syndrome, received a course of inhalation with Surfactant-BL twice a day for 7 days. All patients underwent a comprehensive study of respiratory function (spirography, bodyplethysmography and diffusion test) at the stage of inclusion in the study and after 3 months.

Results. In the main group, significant positive dynamics in FEV1, FEV1/FVC, FRC, and TLC were revealed, while the diffusion capacity DLCO of the lungs did not significantly change.

Conclusion. In this study, the effectiveness of the use of an exogenous surfactant in the post-pregnancy period was demonstrated. It is advisable to continue conducting studies using more numerous groups of patients to determine clear criteria for the use of inhaled surfactant therapy in the post-covid period.

Introduction. The coronavirus epidemic, which began in 2019 and quickly spread throughout the world, was characterized by viral pneumonia and acute hypoxemic respiratory failure.

Aim. To evaluate the effectiveness of non-invasive ventilation in patients with acute respiratory failure due to coronavirus infection at the pre-intensive care unit stage.

Materials and methods. A retrospective cohort study included patients with confirmed coronavirus infection and acute respiratory failure. Demographic, clinical, and laboratory data were collected at admission, while respiratory parameters were recorded both before the initiation of noninvasive ventilation and during the first 24 hours of its application.

Results. For most patients, noninvasive ventilation was successful, but some required transfer to the intensive care unit due to its ineffectiveness. Overall mortality in the study group was significant. Patients for whom non-invasive ventilation was ineffective were older and had higher respiratory rates and levels of certain biochemical markers upon admission. А few hours after the initiation of noninvasive ventilation, these patients demonstrated higher minute ventilation and ventilatory ratio values. Factors identified as potential predictors of noninvasive ventilation failure included low oxygen saturation before ventilation, elevated ventilatory ratio, increased minute ventilation, and tidal volume several hours after the intervention began.

Conclusion. Thus, noninvasive ventilation can be an effective treatment for patients with acute hypoxemic respiratory failure caused by coronavirus infection at the pre-intensive care unit stage.

Both idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) are characterized by steady progression, dismal prognosis and high mortality. Antifibrotic therapies such as pirfenidone and nintedanib slow the decline in lung function and improve patient survival, serving as the cornerstone of treatment for IPF. The use of antifibrotics in PPF has been actively explored in recent years. Pirfenidone, with its antifibrotic, anti-inflammatory, and antioxidant properties, inhibits key pathways of fibrogenesis, including TGF-β-mediated mechanisms. This review presents current data on the use of pirfenidone in IPF and PPF, including hypersensitivity pneumonitis, silicosis, and interstitial lung disease associated with connective tissue diseases. The paper reviews the mechanisms of action of pirfenidone, its evidence base (including the results of the pivotal CAPACITY, ASCEND and RELIEF clinical trials) as well as data from real-world clinical practice confirming that pirfenidone slows disease progression and decline in pulmonary function parameters in both IPF and PPF. In a comparative evaluation of pirfenidone and nintedanib, both drugs demonstrate comparable efficacy, but pirfenidone has a more predictable safety profile, with dose-related gastrointestinal disturbances and photosensitization as the most common adverse events. Serious side effects are rarely observed, making pirfenidone a relatively safe treatment option. New therapeutic strategies such as combination with nintedanib, low dose and inhaled forms of the drug are emphasized. Special attention is given to treatment optimization, considering pirfenidone’s safety profile and individual patient characteristics. The prospects for further applications of pirfenidone across different PPF subtypes are discussed.

Introduction. Progressive pulmonary fibrosis (PPF) represents а poor prognosis in patients with interstitial lung diseases, including hypersensitivity pneumonitis (HP). Currently, along with common functional and radiological diagnostic criteria for PPF, an active search for laboratory biomarkers of PPF is underway.

Aim. To study of the dynamic of metalloproteinase levels (MMP-1, MMP-7, MMP-9), monocyte chemoattractant protein-1 (MCP-1) and vascular endothelial growth factor (VEGF) in bronchoalveolar lavage fluid (BAL) and their relationship with IPF criteria in patients with IPF and GP.

Materials and methods. The study included 62 patients with ILD over 18 years old, the diagnosis of ILD was established based on the diagnostic criteria of the American Thoracic Society (2022). The levels of markers in bronchoalveolar lavage fluid were determined using Vector-Best kits (Russia) for quantitative determination of MCP-1 and VEGF levels and RayBiotech kits (USA) for determining the level of MMP-1, MMP-7, MMP-9. The study was conducted on a Hydro Flex enzyme immunoassay analyzer (TECAN, Austria). Statistical data processing was performed using the Statistica 10.0 program.

Results. Baseline levels of MCP-1, VEGF, MMP-1, MMP-7, MMP-9 in BAL fluid were higher in patients with IPF and PLF in GP compared to patients with GP without signs of PLF. When studying the levels of MMP-7 and VEGF, a reliable association was found between an increase in these biomarkers and a decrease in FVC ≥ 5% and DLCO ≥ 10% of the predicted value within 1 year.

Conclusion. Increased levels of MMP-7 and MCP-1 in BAL fluid have an inverse correlation with the dynamics of FVC and DLCO indicators during the year, which corresponds to the FVC criterion.

Introduction. TB incidence rate among children is a dynamic indicator used to describe the epidemic situation of tuberculosis. Monitoring and analysis of the epidemic situation helps improve the performance of the primary health care in the early detection of tuberculosis in children and adolescents, the formation of groups at high risk of exposure to tuberculosis and the implementation of preventive measures in these groups.

Aim. To provide a detailed analysis of the current epidemiological situation of tuberculosis among children and adolescents in the Saratov region, assess the implementation of early detection of tuberculosis in the pediatric population over a five-year observation period (2019–2023) and in high-risk groups.

Materials and methods. The statistical data on TB patients collected using Federal Statistical Observation Form No. 33 and the information presented in the annual reports from different areas of the region and Saratov city for the period from 2019 to 2023 were studied.

Results. The incidence rates in population were 3.5 times lower in 2023 compared to 2001, the incidence rates among children and adolescents decreased as follows: 8.5 times in children and 2.6 times in adolescents. The comparative analysis of the effectiveness of skin tests in the early detection of active tuberculosis in children under 14 years showed the prevailing value of Diaskintest. The analysis of TB detection methods in adolescents proves the appropriateness of TB testing done twice over the course of a year, alternating between using Diaskintest and check-up X-ray at the age of 15, 16, 17 years. The results of Diaskintest in children with medical and biological (n = 14.840) factors, as well as social risk factors (n = 3.767) were assessed. The level of latent tuberculosis infection (LTBI) in each group was 1.4% and 3.3%, respectively, which is higher than that (0.6%) in the general population of the region.

Conclusions. Monitoring TB incidence rates among children and adolescents in the Saratov region indicates sufficient performance of anti-tuberculosis program in the region. The data obtained confirm the rationale for using immunodiagnostics in adolescents as the key screening test for tuberculosis.

Cystic fibrosis is the most common hereditary clinically and genetically heterogeneous disease with an autosomal recessive type of inheritance, the main cause of which is mutations in the cystic fibrosis transmembrane conduction regulator CFTR gene. An important contribution to the correction of the main cellular defect was the emergence of a new group of drugs, CFTR modulators, small molecules that either correct improper protein folding and processing, or improve the functioning of channels to enhance the apical transport of chlorides and bicarbonates. By partially restoring channel function, CFTR modulators improve a number of clinical parameters, but the effect varies depending on CFTR mutations, modulator combinations used, and individual clinical characteristics. The triple fixed combination of elexacaftor + tezacaftor + ivacaftor has the potential to treat at least 85% of cystic fibrosis patients, highlighting its impact on treatment and prognosis in cystic fibrosis. The presented clinical case describes the experience of including the generic drug ivacaftor + tezacaftor + elexacaftor and ivacaftor in the treatment of an adult patient with late diagnosis of cystic fibrosis. The 6-month therapy resulted in an increase in nutritional status, a decrease in shortness of breath, and an improvement in general condition, laboratory examination, sweat test, gas exchange, and lung function, and did not cause any adverse events. The data obtained coincided with the results of the conducted studies. Further studies are being conducted to better understand the effect of CFTR modulators on other manifestations of cystic fibrosis or the possibility of treating cystic fibrosis patients with rare CFTR mutations using the triple combination ivacaftor + tezacaftor + elexacaftor.

Hereditary angioedema (NAO) is a rare, potentially life-threatening genetically determined disease that belongs to primary immunodeficiency without infectious manifestations. The main manifestations of NAO are localized, acute, transient, recurrent edema of the skin or mucous membranes, which persist from several hours to several days. The cause of edema is a genetic defect that causes dysfunction or deficiency of the C1 esterase inhibitor of the complement component, which leads to an increase in the formation of bradykinin, which increases the permeability of the vascular wall, and therefore therapy with systemic corticosteroids and antihistamines is not effective. The clinical feature of edema is the absence of itching and hyperemia of the skin, as well as concomitant urticaria. The relevance of the problem is associated with the low awareness of doctors about this disease, which is the reason for its rare detection and late diagnosis. A clinical case of NAO with normal C1 inhibitor levels, but with significantly reduced function and mutation in the SERPING 1 gene in three patients is presented. The peculiarity of this case was the late diagnosis (10–29 years after the onset of the disease), burdened heredity (the presence of a similar mutation in 3 blood relatives), a combination of peripheral edema, swelling of the face, tongue, larynx and abdominal attacks in the clinical picture of the mother and children. The symptoms significantly disrupted daily activities, reduced the quality of life of patients, and they used drugs for a long time that did not affect the course of the disease. Due to the severity of the disease, the mother was recommended long-term prophylaxis with lanadelumab, which is a human monoclonal antibody that binds plasma kallikrein, preventing the release of bradykinin, the main mediator of edema in NAO.

Introduction. Polypous rhinosinusitis is one of the most common diseases in otorhinolaryngology. The registration of key risk groups, taking into account the anthropogenic load that aggravates the course of the polyposis process, contributes to the development of preventive measures to improve the quality of life of megalopolis residents.

Aim. To assess the quantitative prevalence of polypous rhinosinusitis by comparative dynamic analysis of incidence data by year in selected areas of the metropolis.

Materials and methods. The work was performed at the Department of Otorhinolaryngology of the South Ural State Medical University. A retrospective analysis of the prevalence of polypous rhinosinusitis (J33) in a megalopolis was conducted in individual service areas of medical organizations, based on information from the number of registrations of the disease in 26,970 patients, including 10,963 men and 16,007 women, according to form No. 12 of the annual report for 2020–2024.

Results. An increase in the incidence of polypous rhinosinusitis has been noted in all areas of the metropolis. The disease is more often recorded in people of working age from 18 to 44 years, with increasing age, the frequency of nosology registration decreases regardless of the area of the metropolis. Among all referrals, nasal polyposis was registered in patients living in areas with nearby heavy industry complexes from 19.1% to 23.5%, compared with people living in more favorable areas of the city, where the detection rates were equated to 14.1–16.5% in the structure of the total number of cases in the district in 2024. In 2024, the ratio of men to women was 1:1, in previous years, from 2020–2023, women were in the lead. Taking into account seasonality, the maximum turnover rates were recorded in the spring months, in areas located in close proximity to heavy industry complexes – mainly in the summer season.

Conclusion. The study of epidemiology indicators will make it easier to create medical examination groups, monitor the course of the disease, reduce the frequency of relapses, and improve the quality of life of megalopolis residents.

Introduction. Increasing antibiotic resistance is an important global problem. One of the most common classes of antibacterial drugs used in therapeutic practice are fluoroquinolones. Such drugs as levofloxacin, moxifloxacin, and pazufloxacin are the most promising for the treatment of a wide range of infections. Pazufloxacin has a good clinical effect in the treatment of infections resistant to other antibiotics. With respect to levofloxacin and moxifloxacin, there are criteria for determining sensitivity and significant experience in clinical and microbiological studies indicating their effectiveness, but with respect to pazufloxacin, there are few such studies and currently there are no criteria for interpreting the diameters of growth retardation zones and/or indicators of the values of the minimum suppressive concentration (MSC).

Aim. To evaluate the distribution of the values of the minimum suppressive concentrations of drugs of the fluoroquinolone group: pazufloxacin, levofloxacin, moxifloxacin in relation to 200 clinical isolates of microorganisms.

Materials and methods. We selected 200 bacterial strains isolated from patients from various regions of the Russian Federation. Among them are 20 strains of Pseudomonas aeruginosa, excluding MBL producers, 20 – Klebsiella pneumoniae, excluding MBL producers, 20 – Streptococcus pneumoniae, 20 – Enterococcus faecalis, 20 – Enterococcus faecium, 20 – Escherichia coli, excluding MBL producers, 20 – Proteus spp., excluding MBL producers, 20 – Staphylococcus aureus, including MRSA, 20 – Haemophilus influenzae, 20 – Moraxella catarrhalis.

Results and discussion. According to the data obtained, it was found that some of the studied strains have a high level of sensitivity to the drugs levofloxacin and moxifloxacin, and some, on the contrary, retain a high level of resistance. The criteria for evaluating the MSC of pazufloxacin in relation to the studied isolates have not been determined, but it is worth noting that most cultures have demonstrated an achievable value of MSC indicators. This suggests a high level of efficacy of the drug in clinical use.

Conclusions. According to the results of the study, sensitivity to low values of pazufloxacin was revealed in relation to a number of cultures, in the absence of sensitivity to other drugs of the fluoroquinolone group, this also indicates the absence of crossresistance with drugs of this group.

Pulmonary surfactant is a complex substance with high surface activity that prevents alveoli collapse at the end of expiration and, therefore, stabilizes the lung volume and the gas exchange. These properties of surfactant opened the way for its investigation in the respiratory distress syndrome of newborn and the acute respiratory distress syndrome (ARDS) in adults including patients with severe virus-associated and bacterial pneumonias. This paper is a review of published laboratory data and clinical findings on the efficacy of surfactant in adults. Several authors demonstrated that exogenous surfactant could improve mortality in patients with ARDS, reduce the need in mechanical ventilation and a length of hospitalization in general. Most clinical trials of surfactant were related to the novel coronavirus infection COVID-19, but several papers included patient with severe pneumonia associated with influenza or respiratory syncytial virus. Moreover, surfactant could be useful for better delivery of pharmacological agents, including antibiotics, in the distal airways and the lung tissue in patients with bacterial pneumonia. Unfortunately, current findings are scarce to certainly detecting a role of exogenous surfactant in the management of such patients. Further studies of clinical efficacy of exogenous surfactant in severe lung injury are required.

Despite significant advances in the diagnosis and treatment of acute and chronic respiratory pathology accompanied by cough, the development of algorithms for choosing the optimal therapeutic strategy is one of the pressing problems of clinical pediatrics. In recent years, there has been a growing interest in herbal medicine as a supplement to traditional methods of treating respiratory diseases. This is due not only to the safety of herbal preparations, but also to their ability to have a complex effect on the body, which is especially important in pediatric practice. In this context, phytotherapy is a promising direction. Particular attention is paid to herbal preparations based on ivy extract (Hedera helix), which contain various biologically active components that provide a complex and multidirectional effect. Modern data confirm the advisability of including ivy extract-based drugs in the complex therapy of respiratory infections in children, due to their high efficiency and favorable safety profile. Ivybased preparations are used as an expectorant in the treatment of infectious and inflammatory diseases of the upper and lower respiratory tract, possessing proven effects such as secretolytic, mucolytic, bronchospasmolytic and anti-inflammatory action. Herbal preparations based on ivy extract can be used in various forms – syrup, drops, which allows you to choose the most convenient and acceptable option for children of different ages. Thus, promising results and detailed study of the effects of herbal medicines based on ivy extracts serve as a basis for their recommendation as part of the complex therapy of cough in children.

Mycoplasma pneumoniae (M. pneumoniae) is one of the key pathogens causing the community-acquired pneumonia in all countries, especially in children and adolescents. Globally, M. pneumoniae infections occur in different regions of the world every 3–7 years and last 1–2 years. M. pneumoniae has infective factors characterized by high affinity to the epithelial cells of the respiratory tract, direct damaging effect, as well as ability to interact with immune system cells. The pathogenesis of mycoplasma infection, i.e. pneumonia, includes both direct damage and immune response mediated by vasculitis and thrombosis. Macrolides are used as the main class of antibiotics for the treatment of mycoplasma infection. They inhibit bacterial growth by binding to 23S rRNA and inhibiting protein synthesis. However, macrolide-resistant strains of M. pneumoniae (MRMP) have become widespread in Asia since 2000, accounting for about 80–90% infections in China and Japan today, at the same time, the detection rate of MRMP is very low in European countries and the US. Azithromycin and clarithromycin have high bioavailability, are stable at acidic pH, oral forms do not require intestinal coating. Instant soluble drug forms (azithromycin) and suspension can be used by patients regardless of food intake, which ensures convenience. While the slow released drug forms of azithromycin should be taken only on an empty stomach, the slow released extended forms of clarithromycin should be taken with food.

Cough is a common symptom of respiratory diseases. The formation of mucus in the respiratory tract and the cough reflex are associated with a physiological protective function. Productive cough in inflammatory diseases is caused by hypersecretion of mucus; which can lead to impaired mucociliary clearance; increased risk of infection; airway occlusion; decreased therapy effectiveness; severe impairment of quality of life; and other complications. The article presents clinical cases of acute bronchitis and exacerbation of chronic obstructive pulmonary disease; demonstrating management tactics; including approaches to antibacterial therapy; as well as the effectiveness of combined mucoactive drugs for productive cough. A clinical case of acute bronchitis demonstrates a cure without the use of antibacterial therapy and the effectiveness of the combined mucolytic drug salbutamol + bromhexine hydrochloride + guaifenesin to relieve productive cough. Using the example of a clinical case of COPD exacerbation; the criteria for prescribing antibacterial therapy; as well as the effectiveness of prescribing a combined mucoactive drug to relieve cough and improve sputum expectoration; are analyzed. The validity and effectiveness of the use of combined mucoactive drugs; given in clinical cases; are compared with domestic and foreign clinical recommendations. The results of clinical studies that have proven the effectiveness of using a fixed combination of salbutamol + bromhexine hydrochloride + guaifenesin for productive cough; as well as improved sputum characteristics compared with other groups of mucolytic drug combinations; are presented.