In Russia, approximately 150–200 people are born every day with cystic fibrosis1, a severe, life-threatening disease that causes damage to almost every human organ. But the field of medicine is constantly evolving, which as a result allows patients to raise their quality of life and life expectancy. The advent of targeted therapy presented an opportunity for the greatest advances, which have made a significant contribution to improving clinical outcomes. Its role and the emergence of new, effective, safe, and more affordable drugs for the treatment of this group of patients were discussed by the leading Russian doctors who participated in the symposium “Targeted Therapy for Cystic Fibrosis”, which was held as part of the XXXV National Congress on Respiratory Diseases.

The modern strategy for as-needed therapy in asthma has undergone a fundamental revision due to accumulating evidence of the risks associated with the overuse of short-acting β2-agonists (SABA). The paradigm has shifted from SABA monotherapy to the use of anti-inflammatory agents for symptom relief, such as fixed-dose combinations of inhaled corticosteroids (ICS) and bronchodilators. This review summarises the evidence for the effectiveness and safety of two key approaches: the single-inhaler Maintenance and Reliever Therapy (MART) regimen with ICS-formoterol and the use of an ICS-SABA combination (budesonide-salbutamol) exclusively for symptom relief. Analysis of the results of clinical trials demonstrates that both approaches significantly improve asthma control, reducing the risk of exacerbations and the need for systemic glucocorticoids, compared with SABA monotherapy. This strategy improves the effectiveness of anti-inflammatory therapy during periods of worsening symptoms, making it particularly useful for preventing exacerbations. The use of combination drugs containing ICS for asthma symptom relief is now considered a preferred strategy by international experts. According to the latest Global Initiative for Asthma (GINA) guidelines, as-needed ICS-formoterol therapy is preferred at Steps 1–2, while the MART regimen is applied at Steps 3–5. The ICS-SABA combination represents an alternative option for symptom relief starting from Step 1. Thus, modern as-needed therapy provides new possibilities for the effective and safe management of asthma, reducing the risks associated with SABA use and enhancing long-term disease outcomes.

Introduction. Chronic obstructive pulmonary disease has a high prevalence, morbidity and mortality, which makes the problem of early diagnosis of precursor conditions, including PRISm, relevant. Despite the growing interest in PRISm, the pathogenesis and clinical consequences of this condition remain poorly understood.

Aim. To conduct а search and analysis of scientific data on PRISm, including epidemiology, pathogenesis, diagnostics, and the relationship of this condition with other diseases.

Materials and methods. The material was searched in the electronic databases eLIBRARY.ru, CyberLeninka, PubMed, Cochrane Library for 2009–2025 by keywords. Publications of the results of original studies were selected for analysis.

Results. Analysis of modern research results indicates that PRISm is a heterogeneous condition characterized by a decrease in FEV₁ (<80%) with a preserved FEV₁/FVC ratio (>70%). The prevalence of PRISm varies from 3 to 20% and is associated with risk factors such as smoking, obesity, air pollution, metabolic disorders (eg, type 2 diabetes mellitus), and genetic predisposition. Pathogenetic mechanisms include restrictive changes (fibrosis, decreased lung tissue compliance), systemic inflammation (increased IL-6, TNF-α levels), and oxidative stress. PRISm is associated with an increased risk of progression to COPD, cardiovascular disease, and all-cause mortality, which emphasizes its clinical significance.

Conclusion. PRISm is a heterogeneous and clinically significant condition that requires a multidisciplinary approach to diagnosis and treatment. Further research is needed to clarify its pathophysiology, develop standardized diagnostic criteria, and personalized therapeutic strategies. The results of current scientific research emphasize the importance of early detection of PRISm to improve patient prognosis.

Introduction. Tezepelumab is the first biologic targeting TSLP approved for uncontrolled severe asthma (SA) regardless of phenotype/endotype. Data on its effectiveness in real-world clinical practice In Russia are limited.

Aim. To evaluate the clinical effectiveness and safety of tezepelumab in patients with SA over 3 and 6 months of therapy.

Materials and methods. A prospective, multicenter study included 21 patients with SA (16 with T2-endotype, 5 with non-T2endotype). Effectiveness was assessed at baseline, 3, and 6 months based on dynamics in asthma control (ACT questionnaire), exacerbation rate, systemic glucocorticosteroids (SGCS), short-acting bronchodilators (SABD) use, lung function (FEV ), blood eosinophil count, and nasal symptoms (SNOT-22).

Results. At 3 months, significant improvement in asthma control was achieved: the ACT score increased from 15.00 [10.00–18.00] to 22.00 [20.00–24.00] (p < 0.001). The proportion of patients with uncontrolled asthma decreased from 94.4% to 22.2%. SABD use decreased from 28.00 to 14.00 doses/week (p < 0.001), and regular SGCS use was discontinued in all patients. Response heterogeneity was observed: the T2-subgroup showed a significant reduction in annualized exacerbation rate from 4.33 ± 2.67 to 2.00 ± 2.70 (p = 0.032), whereas a trend towards increase was noted in the non-T2-subgroup. Nasal symptoms (SNOT-22) significantly decreased from 35.00 to 28.50 points (p = 0.007). In 5 patients followed for 6 months, the positive dynamics persisted. No adverse events were reported.

Conclusions. Tezepelumab demonstrated high effectiveness and safety in real-world clinical practice in patients with SA, particularly those with a T2-endotype. The findings underscore the need for further data accumulation on tezepelumab use in real-world practice across different patient groups.

Introduction. Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality worldwide. The global prevalence of COPD is estimated at 10.3%. In Russia, there are more than 4 million patients with COPD, with 40% requiring hospitalization and 14% needing rehospitalization. Such statistics highlight the significance of COPD.

Aim. To assess the level of knowledge among physicians and senior medical students regarding COPD pharmacotherapy.

Materials and methods. This article presents an analysis of data on the knowledge assessment and preferences of specialists and senior medical students regarding COPD pharmacotherapy, obtained during the multicenter ASCO III study conducted between 2019 and 2023.

Results. A total of 420 physician questionnaires from 11 regions and 372 student questionnaires from 7 medical universities were analyzed. The average level of correct answers (LCA) was 56.1% among physicians and 41.6% among students (p < 0.001). Respondents demonstrated the best results in questions related to the combination of drugs in a single delivery device. The poorest results were observed in questions regarding the choice of baseline therapy for severe COPD symptoms and the optimal selection of antibacterial agents during disease exacerbations. Correlation analysis of the relationship between “LCA” and “Years of Experience” among physicians revealed a weak inverse correlation between specialists’ knowledge level and their work experience.

Conclusions. A relatively low level of knowledge in COPD pharmacotherapy was identified among both physicians and students. Physicians demonstrated significantly better knowledge than students in most areas. According to the authors, there is a need for continued assessment of knowledge in real-world practice and the optimization of both core and supplementary educational activities in this field.

Bronchial asthma (BA) is one of the most common chronic respiratory diseases worldwide. In Russia, the prevalence of asthma among the adult population is 6.9%.Its pathogenesis is associated with a complex interaction of genetic, environmental, and immune factors, among which acute respiratory viral infections play a significant role. These pathogens can damage the airway epithelium, triggering chronic inflammation and inducing a Th2immune response with hyperproduction of interleukin (IL) 4, IL-5, and IL-13. The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has highlighted the long-term consequences of the infection, including the risk of developing new cases of asthma and worsening existing asthma. Virus-induced airway inflammation mediated by type 2 immune mechanisms (T2 inflammation) may play a key role in the pathogenesis of asthma in the post-COVID-19 period. In support of this hypothesis, recent retrospective studies have shown that in adult patients, the risk of asthma exacerbations requiring enhanced maintenance therapy may persist for an average of 6–14 months after COVID-19. These findings suggest that a significant proportion of asthma patients may experience loss of asthma control after COVID-19, which may lead to an increased long-term risk of severe exacerbations (requiring hospitalization) and mortality. Currently, data on the long-term effects of SARS-CoV-2 on immune pathways regulating T2 inflammation, the role of IL-13 in the persistence of post-COVID-19 respiratory symptoms, the effectiveness of biological therapies (e.g., anti-IL-13/IL-4) for preventing asthma after COVID-19, and the impact of COVID-19 on the long-term risk of severe exacerbations and mortality are insufficient. This review integrates the results of molecular, immunological, and clinical studies, offering a comprehensive perspective.

Introduction. The multifactorial nature of the formation of chronic fatigue syndrome after patients have suffered coronavirus infection COVID-19 or the so-called covid syndrome actualizes the need for further study of the etiopathogenetic mechanisms of the disease and improvement of rehabilitation methods.

Aim. Based on a descriptive analysis of literature sources on the formation of chronic fatigue syndrome in people who have suffered from coronavirus infection, prescriptive analytics should be performed to improve patient rehabilitation methods.

Materials and methods. The sources of descriptive analysis were the literary data of scientific databases.: Web of Science, eLIBRARY, MEDLINE, PubMed Central, Scopus. Based on the results of a chronological review of the literature, a comparison of clinical manifestations and pathogenetic hypotheses of the development of postcovoid syndrome and postinfectious phenomena with prescriptive analytics was carried out.

Results and discussion. When comparing the clinical picture of patients, more diverse symptoms of post-ovoid condition were revealed compared with chronic fatigue syndrome. Modern studies of pathogenesis have revealed similar immune mechanisms characteristic of both chronic fatigue syndrome and post-ovarian syndrome, namely, multidirectional immune dysfunction in the form of prolonged stimulation with the development of an inadequate response and autoimmune inflammation, which eventually transforms into an “immune depletion syndrome”. The similarity of the clinic of post-cystic syndrome and chronic fatigue syndrome with the initial manifestations of autoimmune diseases, the widespread occurrence of these post-infectious conditions in the population are of concern to scientists and doctors and dictate the need for further study of this problem. In addition, the possible launch of an autoimmune process with the formation of autoimmune diseases is extremely important from the point of view of assessing the long-term impact of COVID-19 on human health.

Conclusion. The obtained results of a descriptive analysis of literary sources confirm the relevance of further research into the problems of postcovoid syndrome and the need for prescriptive analytics to reduce the long-term impact of the disease on human health and prevent the development of chronic diseases.

Introduction. Sarcoidosis is considered a disease that can lead to pulmonary fibrosis, but the incidence of progressive fibrosis and the need for antifibrotic therapy have not been fully determined.

Аim. To evaluate the condition of patients with sarcoidosis at the time of development of pulmonary fibrosis and during the following two years.

Materials and methods. Retrospective analysis of data of 65 patients with verified diagnosis of sarcoidosis from medical centers of Kazan, Moscow, St. Petersburg and Irkutsk. Data were recorded at four points: upon detection of sarcoidosis, upon detection of fibrosis and one and two years later. The analysis was performed using SPSS-18 software (IBM, USA). Differences were considered significant at p < 0.05.

Results. Upon detection, stage I was diagnosed in 7 (10.8%), stage II – in 41 (63.1%), stage III – in 15 (23.1%) and stage IV – in 2 (3.0%). Löfgren’s syndrome was present in 2 (3.1%) patients. According to the international Delphi consensus, the most common fibrosis was type A – 25 (38.5%), type C and type D – 14 each (21.5%), and type B – 12 (18.5%). The decrease in FVC was significant upon detection of fibrosis from 80.0 ± 3.7% to 69.9 ± 3.3% (p = 0.0001), after a year 72.3 ± 3.7% (p = 0.015) and after 2 –

68.3 ± 3.5% (p = 0.0001), after the formation of fibrosis there was no decrease. HRCT signs did not change in 58.5%, increased in 30.2%, and decreased in 11.3%. DLco, like FVC, significantly decreased relative to the initial value, but did not decrease after the formation of fibrosis. Only in 50% of cases of sarcoidosis, the treatment tactics corresponded to federal clinical recommendations. Systemic GCS were received by 66.2% before the formation of fibrosis, and then by 43.1% and 34.1%. Among the drugs that affected fibrosis, nintedanib (13.6%), pirfenidone (4.6%), N-acetylcysteine (6.8%) and longidaza (3.1%) were used, none of them significantly affected all the indicators of progressive fibrosis. In a small sample, no advantages were found for their use in either stable or progressive fibrosis in patients with sarcoidosis.

Introduction. Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) that occurs in susceptible individuals in response to various inhaled antigens. Pulmonary hypertension (PH) is a common and unfavourable prognostic complication of HP, particularly in patients with the progressive fibrotic phenotype. Early detection of PH is significantly more difficult due to the non-specific nature of clinical symptoms and the complexity of diagnosis.

Аim. To estimate the prevalence of PH and to identify predictors of PH in patients with chronic HP.

Materials and methods. We conducted an observational longitudinal study that included 85 patients with an established diagnosis of HP. Clinical examination, high-resolution computed tomography (HRCT) of the chest, arterial blood gases analyses, six-minute walking test (6MWT), pulmonary function tests, and echocardiography were performed.

Results. Patients were divided into groups with fibrotic (71.8%) and nonfibrotic phenotype (28.2%) of HP (fHP and nfHP). PH was diagnosed in 42 patients (49.4%): 35 (57.4%) in the fHP subgroup and 7 (29.2%) in the nfHP subgroup. The most significant predictors of PH development in patients with HP were the presence of pulmonary fibrosis on HRCT (OR 6.35 (95% CI 1.63–24.70), p = 0.008) and a history of cardiovascular diseases (OR 3.72 (95% CI 1.0–13.6), p = 0.050). Furthermore, the likelihood of developing PH rises with age over 60 years, SpO₂ levels at the end of the 6MWT below 85%, the distance covered in the 6MWT less than 390 metres, and a FVC/DLco ratio greater than 1.5.

Conclusions. PH is a common condition in patients with chronic HP, especially with the fibrotic phenotype. Early detection of the PH predictors is necessary for the timely diagnosis of this complication of HP.

Introduction. In the context of a decrease in the intensity of the epidemic situation of tuberculosis In Russia, the search for new ways to increase the effectiveness of preventive measures to combat tuberculosis among the adult population remains relevant. Aim. To study the prevalence of latent tuberculosis infection in adult tuberculosis risk groups, and to conduct a comparative assessment of the effectiveness of detecting active tuberculosis by immunodiagnostics and fluorography among adults at risk of tuberculosis.

Materials and methods. In a retrospective study, the results of a survey of people at risk of developing tuberculosis over the age of 18 with a positive test result from ATR-test were analyzed. At the first stage, the prevalence of latent tuberculosis infection was studied. At the second stage, a comparative analysis of the detectability of active tuberculosis during immunodiagnostics and during preventive fluorographic studies was carried out.

Results. It was found that among adults at risk of tuberculosis, the prevalence of latent tuberculosis infection in the medical risk group was 2.7 times higher, and in the social risk group it was 8.7 times higher than the average in the population. The detection rate of active tuberculosis according to the results of immunodiagnostics was the highest in the social risk group – 3.8 cases per 1,000 examined.

In terms of the effectiveness of tuberculosis detection in adults at risk of tuberculosis, immunodiagnostics is comparable to fluorographic studies (0.19 and 0.17 per 1,000 at-risk subjects, respectively).

Conclusions. Conducting annual immunodiagnostics among adults at risk of tuberculosis allows timely detection of latent tuberculosis infection, and also increases the effectiveness of early detection of active tuberculosis, which helps reduce the reservoir of tuberculosis infection.

Chronic spontaneous urticaria (CSU) is one of the most common skin diseases. Patients who fail to achieve control, including with escalated doses of antihistamines (AH), require gene-engineered biological therapy (GIBT) with omalizumab. This article presents a clinical experience of personalized dosing and duration of biological therapy for the treatment and prevention of disease recurrences in a patient with severe recurrent CSU, which may be of interest to practicing allergists. A 49-year-old man first sought medical help in 2019 with complaints of daily, generalized urticarial eruptions. The Urticaria Activity Score 7 (UAS7) was 42 points, and the Urticaria Control Test (UCT) was 0 points. Switching from previous antihistamine therapy to bilastine 20 mg daily, including escalated doses of 4 tablets/day, did not produce a significant effect. Routine tests showed no deviations from reference values. Due to the lack of response to the above treatment, GIBT with omalizumab was initiated at 300 mg once every 4 weeks—6 injections with a positive effect. After 1.5–2 months, a relapse occurred, and the course of omalizumab 300 mg once every 4 weeks was resumed, totaling 12 injections. Subsequently, due to persistent recurrences, three more courses of omalizumab therapy were administered. In subsequent management, to prevent another predictable exacerbation, the medical team decided to use GIBT with omalizumab at a dose of 150 mg once every 4 weeks. This clinical case demonstrates that a low dose of omalizumab (150 mg) was comparable to the standard dose (300 mg) and also allowed for disease control. Based on the authors' own experience and analysis of international and domestic medical research data, conclusions were made regarding the prospects and justification for prescribing GIBT with omalizumab at a dose of 150 mg once every 4 weeks.

Introduction. Cow’s milk proteins (CMP) often cause severe anaphylactic reactions in IgE-mediated food allergies. To establish the atopic nature of symptoms, it is necessary to collect clinical and anamnestic data and conduct an allergological study. Determining spectrum and levels of IgE sensitization can provide information in predicting timing of desensitization and risks of repeated systemic reactions.

Aim. Еstablish molecular spectrum and level of IgE sensitization to milk proteins and their peptides on Milk Allergen MicroArray (MAMA) ImmunoCAP ISAC microchip in children suffering from allergy to CMP; to monitor indicators after a long-term elimination diet.

Materials and methods. Prospective cohort open study included children (n = 41, 31 boys and 10 girls): group 1 – with persistent CMP allergy, who had a history of anaphylaxis to CMP (n = 20); group 2 – children with CMP allergy (n = 21) without systemic reactions. Average age – 4.17 ± 2.14 years. Anamnesis collection, clinical examination and on MAMA panel examination were performed. Repeated measurement of sIgE in twelve people was carried out after 18 months of a dairy-free elimination diet.

Results. Spectrum and level of sIgE to CMP were determined on MAMA panel (n = 41): sIgE values in children with anaphylaxis were significantly higher (from 2.0 to 346.0 ISU-E) than in children without systemic reactions (from 0.3 to 11.4 ISU-E) (p = 0.000). High sensitization to at least one major protein was recorded in children with anaphylaxis. A repeat study identified patients with desensitization who can be administered milk proteins.

Conclusions. Milk Allergen Micro-Array (MAMA) ImmunoCAP ISAC multiplex panel can be useful in diagnosing and monitoring of spectrum and level of sensitization in IgE-dependent forms of CMP allergy from moment of diagnosis until formation of desensitization and signs of clinical tolerance.

Chronic urticaria is divided into chronic spontaneous urticaria (CSU) and induced forms, which may be combined in one third of patients. This comorbid association may be accompanied by longer and more severe disease course. The literature describes cases of patients having several subtypes of chronic induced urticaria (CIndU), but large-scale studies of such combinations have not been conducted. We present two severe CSU/CIndU cases: 39-year-old female patient with a severe course of CSU and CIndU (symptomatic dermographism, solar, cold, delayed pressure) and 51-year-old female patient with a severe course of CSU and CIndU (delayed pressure). The presented cases of combined CSU and CIndU demonstrate the difficulties of such patients’ management. It is shown that standard and high doses of antihistamines do not lead to disease control in cases with CSU/CIndU combinations. Prescription of anti-IgE therapy with omalizumab was effective in comorbid course of CSU and one subtype of CIndU (delayed pressure), but did not lead to decrease in urticaria symptoms in case of combination of CSU and several subtypes of CIndU (symptomatic dermographism, solar, cold, delayed pressure). Further study of CSU/CIndU combinations is necessary to optimize such patients’ management.

Pneumococcal infection caused by Streptococcus pneumoniae poses a serious health threat worldwide, leading to high morbidity and mortality, especially among children and the elderly. Its danger lies in the variety of clinical manifestations (from non-invasive to generalized), significant economic costs of treatment, and growing resistance of the bacteria to antibiotics. There are more than 100 serotypes of pneumococcus, but most infections are caused by about 20 of them. Vaccination is the most effective way to fight this infection. Polysaccharide (PPV) and conjugate (PCV) vaccines are used for prevention. PCVs, such as Prevenar 13, are more effective and elicit a strong immune response through T-cell activation and memory cell formation, unlike PPVs, which elicit a T-independent response. In 2025, a new 20-valent conjugate vaccine, Prevenar 20, was registered In Russia. It includes all 13 serotypes of Prevenar 13 and 7 additional ones, thus expanding protection. The vaccine is approved for children older than 6 weeks and adults 18 years of age and older. Clinical studies have shown that Prevenar 20 elicits an immune response comparable to existing vaccines Prevenar 13 and Pneumovax 23 and has a high safety profile. This new vaccine represents a significant step forward in the fight against pneumococcal infection, offering broader protection and potentially reducing morbidity, especially among high-risk groups. Long-term efficacy and safety will be further evaluated in post-marketing studies.

One of the urgent issues for otorhinolaryngologists and doctors of related specialties is the early diagnosis of atypical manifestations of upper respiratory tract inflammation, the study of etiopathogenetic mechanisms of the disease, the provision of highly qualified medical care and the adoption of effective preventive measures. In this context, chronic idiopathic urticaria in people suffering from allergic rhinitis with and without nasal polyposis is the most in-demand for study. The main task of writing the article by the team of authors was to evaluate the effectiveness and substantiate the prospects of using a humanized monoclonal antibody in the treatment of allergic rhinitis with comorbid chronic idiopathic urticaria. The analysis of literary sources (articles and relevant abstracts) covering topical issues of etiopathogenetic mechanisms of development of chronic idiopathic urticaria in people suffering from allergic rhinitis, clinical features and experience in the use of humanized monoclonal antibodies has been carried out. Scientific bases have been used Elibrary.ru, Google, Yandex, Scopus, Pubmed, etc. The main pathogenetic links of allergic rhinitis and chronic urticaria are highlighted, modern data on the possibilities of conservative therapy of IgE-mediated inflammation are summarized. The results of the analysis showed that the use of a humanized monoclonal antibody in the treatment of allergic rhinitis with comorbid chronic idiopathic urticaria makes it possible to establish control over the symptoms of the disease in a short time. Clinical cases are presented illustrating the positive dynamics of manifestations of allergic rhinitis and chronic idiopathic urticaria in the form of a reduction in skin rashes and nasal rhinological symptoms as early as day 14 of therapy, complete relief of symptoms during 3 months of treatment with Omalizumab in the form of a ready-made solution, confirmed by a persistent tendency to normalize the level of total IgE from the initial 389 to 136 IU/ml for 1.5 months, followed by a decrease to 98.4 IU/ml by 3 months of biological therapy.

Introduction. Severe pneumonia complicated by acute respiratory distress syndrome (ARDS) is associated with high mortality, necessitating the search for additional pathogenetic treatment methods. One of the key pathogenesis factors is secondary pulmonary surfactant deficiency. Despite compelling theoretical support, the clinical efficacy of inhaled exogenous surfactants in adult patients remains controversial.

Aim. To retrospectively analyze the efficacy and safety of inhaled surfactant in combination therapy for patients with severe pneumonia complicated by ARDS.

Materials and methods. This retrospective cohort study included 48 patients with severe pneumonia (community-acquired – 56.3%, influenza-associated – 27.1%, COVID-19 – 16.6%) who received inhaled surfactant-BL at a dose of 75 mg twice daily for 7 [5; 9] days in addition to standard therapy, including respiratory support and antimicrobial therapy. Efficacy was assessed based on changes in oxygen saturation (SpO₂).

Results. All patients initially experienced severe hypoxemia (median SpO₂ before therapy 86 [80; 92] %). Positive changes were observed during therapy: after 72 hours, the median SpO₂ increased to 92 [89; 96] %, and by the time of discharge, it reached 96 [89; 99] %. Overall survival in the cohort was 66.7% (32 patients). Mortality (33.3%, 16 patients) was recorded in the most severe subgroup with a fulminant course and severe comorbidity.

Conclusion. The addition of inhaled surfactant-BL to combination therapy for severe pneumonia with ARDS is associated with a significant improvement in oxygenation and acceptable survival rates in critically ill patients.

Acute cough is most often a benign self-resolving condition. The main causes of acute productive cough include acute bronchitis, community-acquired pneumonia, exacerbation of chronic obstructive pulmonary disease (COPD), and exacerbation of bronchial asthma. Acute bronchitis is most often caused by a viral and viral-bacterial infection, and is an exceptional diagnosis that requires laboratory examination, radiography, and spirometry. For the assessment of both chronic and acute cough, the following tools can be used: Visual Analog Scale for cough severity (VAS), Cough Symptoms Score (CSS), Cough Severity Diary (CSD), Leicester Cough Questionnaire (LCQ), Cough Specific Quality of Life Questionnaire (CQLQ), Cough Severity Diary (CSD), Cough and Sputum Assessment Questionnaire (CASA-Q), and the Breathlessness, Cough, and Sputum Scale (BCSS). Using the example of a clinical case, the article discusses an algorithm for diagnosing acute bronchitis and its treatment in accordance with modern recommendations. Coughing causes a number of complications, including a negative impact on the quality of life. Mucoactive drugs are used to treat productive cough, which are classified according to the mechanism of their action and the integration of mucus. They are grouped into four different classes: expectorants, mucokinetics, mucoregulators, and mucolytics. Additionally, bronchodilators are used for airway obstruction. In most cases, combined mucoactive drugs are effective. Antitussive drugs based on medicinal plants are low-toxic and effective cough treatments. Using the example of a clinical case, the effectiveness of the herbal medicinal product Bronchipret® has been demonstrated. The results of clinical studies confirming the efficacy and safety of the use of two dosage forms of Bronchipret® (syrup, tablets) in adults and children are presented.

Chronic mucus hypersecretion plays an important role in the pathogenesis and progression of chronic obstructive pulmonary disease (COPD). Based on the currently available data, mucolytic drugs are included in current clinical guidelines. N-acetylcysteine (NAC) is an effective mucolytic drug that reduces the viscosity and elasticity of sputum, improves mucociliary clearance, and has antioxidant and anti-inflammatory activity, including in patients with COPD. NAC improves the symptoms and quality of life of patients with COPD, the risk and duration of COPD exacerbations, and the risk of mortality in certain groups of patients with COPD. Taking NAC is associated with a favorable safety profile at both high and standard doses. The purpose of this clinical observation is to evaluate the effectiveness of NAC in the complex treatment of a patient with extremely severe COPD. Based on the dynamics of the patient’s clinical, instrumental and laboratory parameters, the appointment of mucolytic (NAC) at a dose of 600 mg/day is justified. The presented clinical case demonstrated the high efficacy of N-acetylcysteine at a dose of 600 mg/day, prescribed in addition to basic therapy to a patient with extremely severe COPD who has a productive cough with difficult-to-separate sputum. Conclusions: when adding a dose of NAC 600 mg/day to a fixed triple combination LABA/LAMA/ICS in a patient with extremely severe COPD showed a decrease in cough, an improvement in sputum discharge, and a decrease in CAT scores; no adverse reactions were reported while taking NAC at a dose of 600 mg/day.

Sarcoid-like reactions associated with the immunotherapy are rare adverse events. The first case of a sarcoid-like reaction related to the use of checkpoint inhibitors was described in 2008 in a patient with melanoma receiving ipilimumab therapy. The gastrointestinal tract is most frequently affected, with less frequent involvement of mediastinal lymph nodes and the lungs, and very rarely the thyroid gland. These changes present significant diagnostic challenges, as it is impossible to differentiate a sarcoid reaction from the progression of the underlying oncological disease without morphological verification. Moreover, a sarcoid reaction can develop in parallel with the progression of the primary disease, further complicating the diagnosis. In the presented case, a patient with progressive melanoma developed mediastinal lymphadenopathy and lung involvement with severe respiratory symptoms 10 months after initiating immunotherapy. To confirm the diagnosis, transbronchial lymph node biopsy and cryobiopsy of lung tissue were performed. Histological examination revealed epithelioid cell granulomas, confirming the diagnosis of a sarcoid-like reaction and enabling the initiation of pathogenetic therapy with methylprednisolone. However, in our case, there were two relapses of sarcoidosis 6 months and a year after discontinuation of immune therapy against the background of discontinuation of steroid treatment, which may indicate the initial induction of sarcoidosis by immune therapy with further chronization of the process. Thus, given the increasing role of immunotherapy in oncology, knowledge about the potential development of various immunopathological reactions is important for determining treatment strategies. This clinical case highlights the importance of raising awareness among clinicians about the possibility of such complications during immunotherapy.

Myasthenia gravis (MG) is an autoimmune disease characterized by the formation of antibodies to the postsynaptic membrane of the neuromuscular junction in voluntary muscles. Among all manifestations of MG, the most severe is respiratory dysfunction, which results from the weakness of the diaphragm, intercostal and accessory muscles, as well as pharyngeal and laryngeal muscles. An analysis of respiratory disorders was conducted in a 29-year-old female patient suffering from highly active, refractory, generalized MG with juvenile onset and anti-acetylcholine receptor antibodies. Parameters of spirometry, impulse oscillometry, lung diffusion capacity (DLCO), and respiratory muscle strength were studied. Significant impairment of respiratory muscle strength was revealed, along with signs of bronchial asthma with predominant small airway involvement, which is likely an autoimmune comorbid condition and represents a non-eosinophilic endotype of airway inflammation. The patient began receiving targeted immunological therapy for myasthenia with monoclonal antibodies against the C5 complement component. After the initiation of therapy, a dynamic functional assessment of the respiratory system was conducted, revealing an improvement in respiratory function based on parameters such as vital capacity, forced vital capacity and forced expiratory volume in one second, and DLCO, which highlights the role of complement inhibitors in treating neuromuscular dysfunction. However, parameters of inspiratory and expiratory muscle strength (maximal inspiratory and expiratory pressures, MIP and MEP) did not change. Pulmonary function testing is essential for clarifying the state of the respiratory system and muscle strength, ruling out concomitant lung and bronchial pathology, while dynamic assessment of respiratory parameters allows for objective evaluation of the efficacy of targeted therapy.