Severe bronchial asthma (SBA) remains a challenging clinical problem associated with a significant disease burden, frequent exacerbations, and a worsened quality of life. Despite modern inhaled therapy options, including high doses of inhaled glucocorticosteroids (ICS) in combination with long-acting beta-2 agonists (LABAs), a large number of patients remain inadequately controlled. In recent years, one therapeutic advance in severe asthma has been the introduction of triple-inhaler therapy combining ICS, long-acting beta-agonists (LABAs), and long-acting muscarinic antagonists (LAMAs). An important question in the management of severe asthma is whether triple therapy can delay or eliminate the need for biological agents. A systematic search was performed in the electronic databases PubMed, Web of Science, and Medline. The findings revealed that extrafine beclomethasone – formoterol – glycopyrronium significantly improved lung function, reduced the risk of asthma worsening and the occurrence of exacerbations, and allowed patients to achieve sustained disease control without biological therapy. This was accompanied by significant improvements in symptoms, small airway function, and peripheral inflammation. Consequently, the inhaled triple combination ICS/LABA/LAMA may be considered a first-line treatment strategy for severe asthma, with the potential to enhance disease management and postpone the need for initiating biologic agents.

Introduction. One of the most common phenotypes in Russia is eosinophilic bronchial asthma (BA) with late onset. The term “asthma with late onset” refers to a condition where symptoms similar to BA first appear in a person over 40 years of age. The high prevalence of comorbid conditions significantly complicates the diagnosis and treatment of late-onset asthma.

Aim. To study the features of the clinical course and laboratory-functional indicators in patients with bronchial asthma of late and very late onset.

Materials and methods. A prospective observational study included 130 hospitalized patients with late-onset bronchial asthma. All patients had a documented diagnosis of “bronchial asthma” based on GINA clinical criteria. The late-onset bronchial asthma phenotype was defined as the onset of BA symptoms at an age older than 40 years. The very late-onset bronchial asthma phenotype was defined as the onset of BA symptoms at an elderly age (older than 60 years, according to WHO).

Results. The mean age of the patients was 63.5 ± 11.3 years, and the age of BA onset was 51.5 (42–62) years. Women predominated among the patients (71.5%). The majority (88.5%) had a T2 endotype of BA, which included allergic and/or eosinophilic phenotypes, was characterized by reversible obstruction (53.9% vs. 0% in the non-T2 group, p < 0.001) and higher lung diffusing capacity (p = 0.035). The non-T2 endotype was characterized by a non-allergic phenotype, a higher frequency of combination with COPD (46.7 vs 20.0%, p = 0.044) and bronchiectasis (46.7 vs 19.1%, p = 0.041). The course of asthma was predominantly uncontrolled (86.2%) with frequent exacerbations. Patients with very late onset (≥60 years) had more pronounced impairments in external respiratory function, a decrease in air flow rate in the small airways (decrease in MEF₅₀, MEF₇₅, PEF; p < 0.05), and statistically significantly more often suffered from coronary artery disease (66.7 vs 42.9%, p = 0.013).

Conclusion. Late-onset BA is characterized by a predominance of the T2 endotype, a severe uncontrolled course, and high comorbidity. Bronchial asthma with a very late onset (≥60 years) has more pronounced impairments in external respiratory function, signs of systemic inflammation, a lower frequency of exacerbations during the year, and a more frequent combination with cardiovascular diseases.

Inhaled bronchodilator therapy remains an integral part of treatment for patients with COPD and bronchial asthma. This article presents an analytical review of Russian and international literature from the past three years devoted to the first-ever selective, long-acting anticholinergic inhaled bronchodilator, tiotropium bromide (TB). A search of PubMed and eLIBRARY.RU using the keyword “tiotropium bromide” was conducted, and 213 articles were reviewed. Forty articles containing the results of clinical trials of TB – randomized, comparative, and observational – were selected for analysis. A significant number of articles were excluded due to duplicate descriptions of the same studies. This article presents studies that continue to study TB and have demonstrated the reliability of its bronchodilator effect and a high degree of safety. The extrapulmonary effects of TB are described. Particular attention is paid to liquid dosage forms, inhalation technique issues, and treatment adherence. Despite the drug’s use for over 20 years, its properties continue to be studied in Russia and abroad, with combinations being developed and delivery methods being improved. The availability of a reliable, long-acting anticholinergic agent as mono-therapy, as well as a dual inhaled bronchodilator component or a second bronchodilator in a triple inhalation formulation, increases the likelihood of achieving obstruction control in both COPD and asthma, allowing for a reduction in steroid use or an early transition to biological therapy. The introduction of a metered-dose aerosol inhaler with TB marks a new step toward its use in Russia. The feasibility of using TB for chronic broncho-obstructive diseases as a new metered-dose aerosol inhaler is driven by issues of treatment adherence, patient preferences in choosing a delivery method, and the ability to use inhalers correctly. The introduction of this new dosage form into clinical practice in Russia was recommended at a meeting of federal pulmonology experts in 2025.

Introduction. Biologics have shifted the treatment paradigm for severe asthma (SA), making clinico-functional remission a priority. However, the stability of this state and its predictors in real-world practice remain insufficiently studied.

Aim. To evaluate the frequency of sustained clinico-functional remission in SA patients and identify factors associated with long-term success.

Materials and methods. This 30-month retrospective study analyzed data from a regional registry (Sverdlovsk Region) of SA patients treated with dupilumab, mepolizumab, benralizumab, or omalizumab. 4-component (no exacerbations, OCS withdrawal, ACT control, FEV1 stability) and 3-component (excluding FEV1) remissions were evaluated in rolling intervals (4–18, 12–24, and 18–30 months). Sustained remission required continuous fulfillment of criteria at all points (months 4, 12, 18, 24, and 30).

Results. Remission frequency in rolling intervals ranged from 1.7% to 45.1%. Sustained remission was achieved by 26.3% of patients. This group was significantly younger (46.5 vs 54.3 years; p = 0.014) and non-obese (BMI 23.1 vs 29.6 kg/m²; p = 0.001). Logistic regression identified elevated BMI as an independent predictor of remission failure (AUC 0.782; 95% CI: 0.652–0.912). A trend toward higher efficacy was noted with a disease duration < 12 years (p = 0.053). The highest proportion of sustained responses occurred with dupilumab (47.6%).

Conclusions. Sustained remission is achievable in 25% of SA patients. Excess body weight and long disease duration are key barriers, highlighting the need for early biologic initiation and metabolic correction.

Introduction. Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality worldwide. The persistent clinical stereotype “COPD – smoker’s disease” leads to systematic diagnostic errors, especially among neversmokers, women, and elderly patients with comorbidities.

Aim. To systematize the main causes of misdiagnosis of COPD based on the analysis of clinical cases from forensic medical practice and to propose practical algorithms for its early detection.

Materials and methods. An analysis of international studies (PubMed, Scopus, Web of Science, 2000–2025) and GOLD 2025 clinical guidelines was performed. Additionally, materials from four forensic medical examinations (2021–2024) with fatal outcomes, where the diagnosis of COPD was established only at autopsy or its severity was underestimated, were analyzed.

Results. Four clinical cases are presented: a 65-year-old patient with severe COPD (GOLD IV) and central lung cancer; a 48-yearold patient with a misdiagnosis of bronchial asthma (at autopsy – bullous emphysema); an 86-year-old patient (never-smoker, biomass fuel exposure) with a clinical diagnosis of pneumonia and chronic heart failure; a 54-year-old patient with dermatomyositis-like rash treated for a systemic connective tissue disease (at autopsy – COPD). The key defect in all cases was the absence or incorrect interpretation of spirometry.

Conclusion. Post-bronchodilator spirometry remains the gold standard for COPD verification. Lack of response to standard therapy, asymmetry of respiratory excursion, skin manifestations, and yellow nail syndrome are red flags requiring extended differential diagnostic investigation. Assessment of alternative risk factors (biomass fuel, occupational hazards) is mandatory regardless of smoking status.

Introduction. The combined long-term oxygen therapy (COT) is the most optimal home-based COT regimen for patients with chronic respiratory failure (CRF). It is characterized by the use of stationary oxygen delivery systems during seated rest and sleep and portable oxygen therapy devices during active activities.

Aim. To evaluate the efficacy and safety of portable oxygen concentrators in patients with chronic respiratory failure.

Materials and methods. The study included 15 patients with chronic respiratory failure. The study assessed the patients' clinical condition, blood gas parameters, respiratory system function, pulmonary hemodynamics, and exercise tolerance at entrollment, and 3, 6, 9 and 12 months using the portable oxygen concentrator. Physical activity was assessed by measuring the number of steps walked without oxygen support and with a portable oxygen concentrator. Data were collected from patients' fitness trackers for 24 hours a day.

Results. After 12 months of long-term oxygen therapy, the patients showed the following improvements in clinical symptoms: a decrease in the BORG dyspnea scores from 6 to 3 (p = 0.001), MRC scores from 3 to 2 (p = 0.035), and VAS scores from 7 to 5 (p < 0.001); an improvement in SpO2 gas exchange parameters from 92 to 94% (p = 0.002); stabilization of functional parameters: diffusing capacity of the lungs from 37 to 35% (p = 1.000) and a decrease in the pulmonary artery systolic pressure from 55 to 50 mmHg. The patients showed significant improvements in physical activity: the number of steps walked increased from 82.5 to 360 (p < 0.001).

Conclusions. These findings support the clinical efficacy and safety of portable oxygen concentrators as part of long-term oxygen therapy in patients with chronic respiratory failure.

Introduction. Sarcoidosis is a multiorgan granulomatosis recognized since the second half of the 19th century. For over 70 years, systemic glucocorticosteroids have remained the primary method of influencing the immune response in this disease. Accumulated experience has led to the need for further modification of treatment, and methotrexate holds great promise among second-line agents.

Aim. To analyze the efficacy and safety of methotrexate as a second-line treatment in patients with sarcoidosis.

Material and methods. A longitudinal and cross-sectional observational study of 146 patients with pulmonary sarcoidosis receiving methotrexate for 3, 6, 10–12, and more than 12 months. Patients’ general condition, spirometry, and computed tomography data were assessed. Analysis was performed using SPSS-18 (IBM, USA). Differences were considered significant at p < 0.05.

Results. The study primarily confirmed the efficacy and safety of MTT in sarcoidosis at a dose of 15 mg weekly, as recommended in the 2013 WASOG publication. Significant changes in both frequency and quantitative parameters were achieved beginning at month 6 of treatment. At this point, 60.7% reported improvement in their condition, and another 32.5% rated it as stable. Significant improvement in HRCT changes began as early as month 3. A significant indicator at all time points was a decrease in the size of the largest intrathoracic lymph node. After 10–12 months of treatment, only 2 patients (3.4%) showed negative dynamics, 51.7% showed improvement, and 44.8% had stable radiographic imaging. Spirometry parameters remained stable at month 6 in 79.8% of patients. The MTT discontinuation rate decreased from 16.1% at month 3 to 4.2% after one year.

Conclusion. The study confirmed the efficacy and safety of methotrexate as a second-line drug for sarcoidosis.

The long-term consequences of COVID-19 remain poorly understood. All authors agree on one thing: single nucleotide polymorphisms (SNPs) have the potential to become a valuable tool for predicting long-term clinical outcome in patients infected with SARS-CoV-2. Thus, the ACE2 rs2106809 SNP has been shown to be a functional marker of brain changes, and its potential involvement in long-term COVID-19 requires further study. Recent studies have linked the FOXP4 gene to the severity of COVID-19 and the risk of long-term COVID-19. SNP rs9367106 is likely associated with the development of long-term symptomatic abnormalities in the lungs and brain observed after recovery from COVID-19. Olfactory and gustatory impairment has been identified as a pathognomonic feature not only of acute COVID-19 but also of post-COVID chronic fatigue syndrome, and is determined by the leading single nucleotide polymorphism rs10893121. Also, CC genotypes of the methylenetetrahydrofolate reductase (MTHFR) gene were statistically more common in chronic COVID-19. It can be assumed that some variants of nucleotide sequences involved in the genesis of diabetes and its complications, in the formation of patient comorbidity, and in the development of COVID, may potentially participate in the formation of PCS in patients with diabetes. We have demonstrated an association with post-COVID syndrome of single nucleotide polymorphisms in the following genes: FABP2, NOS3, COMT, and PAI-1. Subsequently, phenotypes of post-COVID syndrome will be developed in patients with type 2 diabetes, taking into account genetic determinants. A prognosis for the post-COVID period in this category of patients will be determined. Consequently, personalized treatment for patients will be developed, taking into account the combination of pathological alleles of pleiotropic genes.

Introduction. Concomitant chronic obstructive pulmonary disease (COPD) is one of the most important risk factors for the development of COVID-associated lung damage.

Aim. To study risk factors for the development of severe COVID-associated lung damage in patients with COPD.

Materials and methods. A retrospective single-center comparative study was conducted. The study included 154 patients hospitalized for COVID-19, of which 103 patients had COPD. The comparison group consisted of patients (n = 51) without COPD and smoking history on the case-control principle. The presence of COVID-19 was confirmed by laboratory tests and/or clinically and radiologically. The dynamics of clinical and laboratory-instrumental indicators were evaluated from the first to the seventh day of observation.

Results. In the COVID-19 group without COPD, the proportion of patients with lung damage CT 1–2 and CT 3–4 was 47% (18/38), in the COVID-19 and COPD group – 38% (39/103); no statistically significant differences were found (p = 0.41). Lung damage CT 3–4 regardless of the presence/absence of COPD was statistically significantly associated with older age, higher body mass index, coronary artery disease, increased levels of blood pressure, respiratory rate, neutrophils, CRP, AST, LDH, and decreased SpO₂ level. In the group of patients with COVID-19 and COPD, lung damage CT 3–4 was associated with higher values of these indicators than in the group of patients with COVID-19 without COPD: the threshold value of leukocytes in the COVID-19 group without COPD was 5.6 × 10⁹/L versus 10.9 × 10⁹/L in patients with COVID-19 and COPD, the threshold value of neutrophils – 4.2 × 10⁹/L and 9.3×10⁹/L, the threshold value of the neutrophil/lymphocyte ratio – 5.8 and 11.3. Lung damage CT 3–4 in patients with COVID-19 and COPD was associated with higher mMRC scores (odds ratio [OR] = 2.75 [95% CI: 1.09–6.92] for 3 points versus 2, OR = 4.24 [95% CI: 1.26–14.3] for 4 points versus 2), higher CAT scores (OR = 4.87; 95% CI: 1.88–13.53 for CAT above 18 points) and mixed COPD phenotype (OR = 2.94; 95% CI: 1.10–8.07) versus bronchitic (p = 0.045).

Conclusion. Severe COVID-associated lung damage (CT 3–4) develops under the influence of general factors (age, obesity, inflammation, hypoxemia), but in patients with COPD it occurs against the background of more pronounced systemic inflammation and is aggravated by symptoms of the underlying disease.

Introduction. The combination of esophageal pathology and bronchial asthma is frequently encountered in clinical practice, but in some cases it may remain unrecognized due to diagnostic difficulties and a lack of clinical suspicion.

Aim. To evaluate the structural, functional, and laboratory abnormalities detected in patients with bronchial asthma combined with esophageal pathology.

Materials and methods. The study was conducted at the Allergology Department of the Krasnoyarsk Regional Clinical Hospital. Sixty-nine patients admitted for inpatient treatment with a diagnosis of bronchial asthma were examined. Based on clinical and anamnestic data, the patients were divided into two groups: those with bronchial asthma without esophageal pathology (Group 1: 38 patients (55.07%)) and those with bronchial asthma combined with esophageal pathology (Group 2: 31 patients (44.93%)). The examination methods included: anamnestic analysis, physical examination, completion of the ACQ-5, ACT, GERDQ, and dysphagia questionnaires, instrumental tests (spirography with a bronchodilator, fibrogastroduodenoscopy), laboratory tests, and esophageal morphological examination.

Results. Patients with asthma combined with esophageal pathology had a significantly higher number of daytime and nighttime attacks and, consequently, a higher need for SABA. According to spirometry data, fixed airway obstruction was significantly more common among patients in Group 2. Immune status showed a significant decrease in NKT cells in Group 2 patients. A decrease in NKT cells in patients with bronchial asthma combined with esophageal pathology, as well as a negative association with fungal esophagitis, may indirectly indicate a decrease in epithelial barrier function and, consequently, a greater vulnerability to environmental factors, as also confirmed by the AQLQ questionnaire scores in the “environment” domain.

Conclusions. The obtained data confirm the aggravating effect of esophageal pathology on the course of bronchial asthma and also indirectly indicate changes in the mucosal immune system, which may lead to combined damage to the mucous membranes of the esophagus and respiratory tract.

Introduction. Diabetes mellitus (DM) remains one of the most prevalent chronic diseases: as of October 2024, more than 5 million patients are registered in the country, predominantly with type 2 DM, while a substantial proportion of cases are identified only through active screening. In addition to traditional target organs, the lungs are considered a potentially vulnerable structure; however, pulmonary involvement in diabetes remains insufficiently studied. Current evidence indicates a higher prevalence of DM among patients with interstitial lung diseases (ILDs), including idiopathic pulmonary fibrosis, yet the impact of diabetes as an independent condition on the course of ILD remains unclear.

Aim. To determine the clinical and functional characteristics of patients with chronic interstitial lung diseases of various etiologies complicated by diabetes mellitus.

Materials and мethods. A cross-sectional retrospective–prospective cohort study including 126 patients was conducted. The main group (group 1) consisted of 70 patients with ILD and concomitant DM, while the comparison group (group 2) included 56 patients with ILD without diabetes. Inclusion criteria required the presence of DM as an independent disease entity. All patients underwent medical history assessment, radiographic archive analysis, a 6-minute walk test, body plethysmography, and evaluation of diffusing capacity of the lungs.

Results. The groups were comparable in terms of sex, age, and nosological structure. Patients with combined pathology demonstrated longer disease duration, a higher prevalence of dyspnea and weakness, reduced exercise tolerance, more pronounced impairment in FEV₁ and diffusing capacity, and a greater need for intensive therapy.

Conclusions. Diabetes mellitus has an adverse impact on clinical and functional parameters in patients with chronic ILDs.

Introduction. Idiopathic pulmonary fibrosis (IPF) is frequently complicated by pulmonary hypertension (PH), the prevalence of which reaches 50–80% among patients awaiting lung transplantation. At the same time, the accuracy of transthoracic echocardiography as the main screening method for PH in patients with IPF is limited, which determines the need for simple non-invasive functional tests to select patients for further in-depth evaluation.

Aim. To determine the clinical and functional predictors of pulmonary hypertension in patients with idiopathic pulmonary fibrosis. Materials and methods. The study included 121 patients with IPF. Based on echocardiography findings, the patients were divided into two groups: without PH (PASP <35 mmHg, n = 35) and with PH (PASP ≥35 mmHg, n = 86). Comparative analysis, ROC analysis, univariate and multivariate logistic regression were performed.

Results. The groups did not differ significantly in age, sex, BMI, or smoking status. In patients with PH, cardiovascular events were significantly more frequent (59 vs. 26%, p < 0.001), as was chronic heart failure (55 vs. 23%, p = 0.001). The Charlson Comorbidity Index (p = 0.027) and dyspnea severity according to the mMRC scale (p = 0.022) were higher in the PH group. Absolute DLCO was lower in the PH group (8.5 vs. 10.1 mL/min/mmHg, p = 0.041). The level of desaturation during the 6MWT was higher, and post-6MWT SpO₂ was lower in the PH group (p = 0.002 and p = 0.001, respectively). ROC analysis identified the following cut-off values: post-6MWT SpO₂ <84% (specificity 87.1%, AUC = 0.703) and DLCO ≤11 mL/min/mmHg (sensitivity 78.6%, AUC = 0.628). Univariate logistic regression revealed significant predictors of PH: cardiovascular events (OR = 4.202), CHF (OR = 4.065), desaturation level during 6MWT (OR = 1.192 per 1%), post-6MWT SpO₂ (OR = 0.890), mMRC score (OR = 2.103), and Charlson Comorbidity Index (OR = 1.289). In the multivariate regression model, the level of desaturation during the 6MWT remained an independent predictor (OR = 1.190 per 1%; p = 0.009).

Conclusion. In patients with IPF, pulmonary hypertension is associated with comorbidity burden, reduced exercise tolerance (desaturation), and decreased DLCO. The degree of desaturation during the 6MWT is the strongest independent predictor of PH. The identified threshold values (desaturation >9%, post-6MWT SpO₂ <84%) may be utilized for screening purposes.

Introduction. Progressive pulmonary fibrosis (PPF) is characterized by relentless decline in lung function, poor prognosis, and limited therapeutic options. Exogenous surfactant is considered a potential pathogenetic agent.

Aim. To evaluate the efficacy and safety of inhaled Surfactant-BL (INN: tauractant, a natural surfactant from bovine lungs) as an add-on to standard therapy in patients with PPF.

Materials and methods. A single-center prospective randomized open-label controlled trial was conducted. 71 patients with PPF were assigned to three groups: surfactant 75 mg (n = 21), 150 mg (n = 19) or control (n = 31). Inhalations were administered twice daily for 10 days.

Results. In the pooled surfactant group, by day 10 respiratory rate decreased from 22 (19–22) to 20 (18–21) breaths/min (p = 0.03) and SpO₂ increased from 93 (85–94)% to 94 (92–96)% (p = 0.028); by day 30, forced vital capacity (FVC) increased from 65 (45–77)% to 73 (64–83)% of predicted (p = 0.05). No dose-dependent differences were observed. In the 150 mg group, transient cough worsening occurred by day 10 (p = 0.013) followed by improvement by day 30 (p = 0.021). In patients with PaO₂/FiO₂ < 300 mmHg, PaO₂ increased by day 30 (p = 0.042), while those with PaO2/FiO2 > 300 mmHg showed increased SpO₂ by day 10 (p = 0.0006). A baseline FVC predicted response (SpO₂ increase ≥ 4%; OR 1.08, 95% CI 1.03–1.14; p = 0.003) with an optimal threshold of 70% predicted (AUC 0.787). In patients with FVC > 70% predicted, surfactant demonstrated advantages over control at day 30 for SpO₂ (95% vs. 93%, p = 0.052) and DLco (52.5% vs. 40.0%, p = 0.046).

Conclusions. Inhaled surfactant represents a pathogenetically justified and effective add-on to standard therapy for PPF. The greatest benefit is achieved in patients with FVC > 70% predicted, hypoxemic respiratory failure, and refractory cough.

Introduction. Pulmonary hypertension (PH) frequently complicates the course of idiopathic pulmonary fibrosis (IPF) and worsens its prognosis; however, echocardiographic signs of right heart chamber remodeling and clinical and functional factors associated with systolic pulmonary artery pressure (PASP) level in IPF remain insufficiently studied.

Aim. To characterize echocardiographic changes in the right heart chambers in patients with idiopathic pulmonary fibrosis depending on the presence of pulmonary hypertension and to identify clinical and functional factors associated with the value of systolic pulmonary artery pressure.

Materials and methods. The study included 121 patients with IPF. Based on echocardiography, patients were divided into groups without PH (PASP < 35 mmHg, n = 35) and with PH (PASP ≥ 35 mmHg, n = 86). Right atrial area (RA area), mean right ventricular diameter (RV diameter), TAPSE, TAPSE/PASP ratio, and left ventricular ejection fraction (LVEF) were assessed. Spearman correlation analysis, univariate and multivariate linear regression analysis with PASP as a continuous variable were performed.

Results. The PH group showed larger RA area (17.0 vs 13.5 cm², p < 0.001), larger RV diameter (4.00 vs 3.75 cm, p < 0.001), and a lower TAPSE/PASP ratio (0.438 vs 0.697, p < 0.001) with no difference in absolute TAPSE (p = 0.941). LVEF was slightly lower in the PH group (61% vs 62%, p = 0.016) but remained within normal limits. PASP correlated positively with RA area (r = 0.491, p = 0.019) and desaturation level during 6MWT (r = 0.355, p < 0.001), and negatively with post-exercise SpO₂ (r = -0.336, p = 0.001). DLCO correlated positively with post-exercise SpO₂ (r = 0.347, p = 0.001) and negatively with mMRC (r = -0.338, p = 0.001) and desaturation (r = -0.270, p = 0.014). Univariate linear regression showed associations of PASP with cardiovascular events (β = 10.8), CHF (β = 10.9), desaturation (β = 1.02 per 1%), post-exercise SpO₂ (β = -0.603), mMRC (β = 4.52), LTOT duration (β = 3.74 per year), and LVEF (β = -0.562). In multivariate linear regression, independent determinants of PASP were the Charlson comorbidity index (β = 2.205 per 1 point; p = 0.006), desaturation level (β = 1.153 per 1%; p < 0.001), and LTOT duration (β = 4.281 per year; p = 0.020).

Conclusion. In patients with IPF, pulmonary hypertension is associated with right heart remodeling (enlarged RA area, RV diameter) and reduced right ventricular-pulmonary arterial coupling (decreased TAPSE/PASP ratio) despite preserved TAPSE. Independent determinants of PASP value are comorbidity burden (Charlson index), desaturation during exercise, and long-term oxygen therapy duration.

Introduction. Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease characterized by inflammation and/or pulmonary fibrosis. Fibrotic HP (fHP) is associated with an unfavorable prognosis, however, the impact of comorbidities on disease progression and outcomes remains insufficiently studied.

Aim. To assess the prevalence and clinical significance of comorbidities and to identify predictors of disease progression and mortality in patients with fibrotic and non-fibrotic HP (non-fHP).

Materials and methods. This prospective observational study included 392 patients with multidisciplinary-confirmed HP. The follow-up period was 12 months. Clinical, functional, and radiological characteristics, Charlson comorbidity index, 6-minute walk test (6-MWT), echocardiographic parameters were evaluated. Disease progression was assessed according to the ATS/ ERS/JRS/ALAT 2022 criteria. Logistic regression and ROC analyses were used to identify predictors of progression and mortality.

Results. A total of 339 patients were included in the analysis: 89.9% with fHP and 11.1% with non-fHP. Patients with fHP were older and demonstrated higher GAP scores, more severe dyspnea and cough, poorer 6-MWT performance, and higher mortality compared with non-fHP. Patients with fHP also had higher Charlson comorbidity index values (4 (2-5) vs 2 (1-4), p = 0.003) and a higher prevalence of cardiovascular diseases. A usual interstitial pneumonia (UIP) pattern on high-resolution computed tomography was an independent predictor of progression (OR 3.16, 95% CI 1.06–9.46). Predictors of mortality included unidentified causative antigen exposure, oxygen desaturation at the end of the 6-MWT, Charlson comorbidity index ≥ 4, and left ventricular ejection fraction ≤ 55%. Diabetes mellitus was also associated with an increased risk of progression and mortality (OR 2.58, 95% CI 1.19–5.56, p = 0.016).

Conclusion. Patients with fHP are characterized by a high burden of comorbidities, particularly cardiovascular diseases and diabetes mellitus. UIP pattern, unidentified causative antigen exposure, significant oxygen desaturation during the 6-MWT, and a high Charlson comorbidity index have a substantial impact on disease prognosis.

Introduction. Interstitial lung diseases (ILDs) constitute a heterogeneous group of conditions, a significant proportion of which consists of idiopathic pulmonary fibrosis (IPF) and ILDs associated with systemic connective tissue diseases (SCTD-ILDs). Despite sharing common features of a progressive fibrotic phenotype, these forms differ in pathogenesis, clinical manifestations, radiological characteristics, laboratory features, and treatment approaches.

Aim. To conduct a comparative clinical and functional analysis in patients with IPF and CTD-ILD, as well as to identify differences in risk factors between the two groups.

Materials and methods. A single-center cross-sectional study in 82 patients (28% men) with a mean age of 58.3 ± 11.9 years. A comparative analysis of demographic, clinical, radiological, functional, and laboratory parameters was performed.

Results. It was established that patients with IPF were statistically significantly older, predominantly male, and more likely to have a history of smoking. IPF was characterized by a significant predominance of the typical interstitial pneumonia pattern, higher lactate dehydrogenase levels, and more pronounced respiratory symptoms as measured by the CAT index. In the CTD-ILD group, a pattern of nonspecific interstitial pneumonia, positive antinuclear antibodies, and higher levels of rheumatoid factor were more frequently detected, reflecting the autoimmune nature of the disease.

Conclusions. The data confirm that IPF and CTD-ILD represent distinct clinical and pathogenetic phenotypes of interstitial lung diseases. A comprehensive assessment of demographic, radiological, functional, and laboratory characteristics is essential for refining the diagnosis, phenotypic stratification of patients, prognosis assessment, and selection of a personalized therapeutic strategy.

Introduction. Hypersensitivity pneumonitis (HP) is the most common interstitial lung disease (ILD), which is characterized by the development of progressive pulmonary fibrosis (PPF).

Aim. To study the relationship between monocyte chemoattractant protein-1 (MCP-1), vascular endothelial growth factor (VEGF-A) and interleukin-10 (IL-10) in serum and PPF criteria in patients with HP.

Materials and methods. The study included 51 patients with GP, the diagnosis of PPF was established based on the diagnostic criteria of the American Thoracic Society (2022), and 12 patients with idiopathic pulmonary fibrosis (IPF). Quantitative determination of the level of MCP-1, VEGF-A and IL-10 in the blood serum was performed using Vector-Best kits (Russia) on the enzyme immunoassay analyzer “Hydro Flex” (TECAN, Austria). Statistical data processing was performed using Statistica 10.0 software.

Results. Baseline levels of MCP-1 and IL-10 (7.11 ± 2.26 vs. 6.53 ± 2.62 pg/ml) in the blood serum were comparable in IPF and GP with PPF (p = 0.36 and p = 0.18, respectively). MCP-1 levels were significantly higher in IPF and GP with PPF (291.3 ± 68.4 vs. 270.9 ± 54.2 pg/ml) compared to GP without PFF (220,9 ± 42,8 pg/ml; p = 0.005 and p = 0.008). A negative correlation was found between MCP-1 and IL-10 levels and dynamics FVC and DLCO over 12 months.

Conclusion. Increased serum MCP-1 and IL-10 levels in patients with PPF in GP are statistically significantly associated with a decrease in FVC ≥ 5% and DLCO ≥ 10% over a 12-month period.

Introduction. Forecasting the development of the tuberculosis (TB) epidemic is a complex task, as the epidemic process as a phenomenon is multifactorial.

Aim. To create a dynamic model for long-term forecasting of TB incidence in the Russian Federation using machine learning methods for planning and implementing evidence-based preventive measures, taking into account regional characteristics of the epidemic situation.

Materials and methods. The development of the dynamic forecast model included the selection of epidemiological, social, demographic, and economic factors with the greatest influence on the development of the TB epidemic using the Delphi expert assessment method; determination of the weight of each factor; ranking of the constituent entities of the Russian Federation by level of economic development, TB incidence, and mortality; and the creation of a mathematical model using machine learning methods. A Gaussian process was chosen as the machine learning model. The model was trained on data from 2010–2016 and validated on data from 2017–2021. The models were implemented in Python 3 using the open-source scikit-learn library and CatBoost.

Results. The model matrix consisted of indicators that have the greatest impact on the development of the TB epidemic: gross regional product, unemployment rate, life expectancy; TB incidence; the proportion of newly diagnosed pulmonary TB patients with bacterial isolation detected by sputum smear microscopy and culture, the proportion of primary multidrug-resistant TB cases, and the number of TB-related deaths during the first year of observation. The resulting dynamic model of TB incidence using machine learning methods has high predictive ability (R2 = 0.78).

Conclusions. The dynamic model for predicting TB incidence has high predictive capabilities regardless of the level of economic development of a constituent entity of the Russian Federation and can serve as the basis for developing individualized algorithms for selecting measures to optimize the detection, treatment, and prevention of TB.

Cystic fibrosis (CF) is an autosomal recessive monogenic hereditary disease characterized by dysfunction of the exocrine glands with damage to vital organs and systems, primarily the respiratory and digestive systems. Cystic fibrosis is associated with a reduction in life expectancy, the most common cause of death is progressive lung damage with the development of respiratory failure (RF). It is RF that most often determines the prognosis of CF, so timely diagnosis and correction of this complication is necessary. According to changes in the gas composition of arterial blood, there are 2 types of respiratory failure: hypoxemic and hypercapnic. Taking into account the types of RF, the type of respiratory support is determined: oxygen therapy and / or non-invasive ventilation (NIV). NIV has a positive effect on lung function, arterial blood gas parameters, body weight, duration and quality of life of patients with severe CF. Positive effects of NIV also include the effect of improving sputum drainage due to significant improvement of collateral ventilation. In recent years, due to the introduction of targeted therapy, the clinical picture of patients with CF has changed due to a decrease in the frequency of exacerbations of chronic bronchitis, improvement of functional indicators, and slowing down of the degradation of pulmonary function. However, the use of NIV in patients with CF remains relevant in cases where there is chronic hypercapnic respiratory failure, pronounced bronchopulmonary changes have formed in the form of widespread bronchiectasis, chronic, frequently recurring infectious process and pronounced impairment of sputum drainage. NIV is also indicated when targeted therapy cannot be prescribed due to the absence of corresponding mutations in the CFTR gene or if patients with CF do not have access to targeted therapy. In this regard, the accumulation of experience in NIV in patients with CF is an urgent task.

Introduction. Cystic fibrosis (CF) remains one of the most significant inherited multisystem diseases of childhood, characterized by progressive damage to the bronchopulmonary system, exocrine pancreatic insufficiency, and marked clinical phenotype variability governed by both underlying genotype and the timing of pathogenetic therapy initiation. Recently, the advent of CFTR-modulators dramatically changed the paradigm of CF management, as it has become possible for the first time to address the molecular defect underlying the disease, rather than just its clinical manifestations.

Aim. To analyze the regional structure of the CF patient population in the Southern Federal District (SFD) and assess the coverage of the pediatric cohort with targeted therapy.

Materials and methods. A descriptive analysis was conducted using the regional data on CF patients in the SFD. The following parameters were assessed: the number of patients, patient distribution across the SFD entities, the number of newly diagnosed cases in 2025, the volume of patient referrals to the therapeutic facilities, availability of CFTR-modulators, and prescription profiles.

Results. The SFD CF population was estimated at 521 patients, with 366 children and 155 adults. The Krasnodar Territory, Rostov Region, Republic of Crimea, and Volgograd Region had the largest cohorts of CF patients. In 2025, 20 new cases of the disease were diagnosed in the district, as compared with the expected number of 25–30, calculated from population-based data on the average incidence of CF in the Russian Federation. 246 children received targeted therapy, while 120 patients remained without pathogen-oriented treatment. Among targeted drugs dominated the triple combination composed of elexacaftor, tezacaftor, and ivacaftor introduced to the Russian market under the trade name Trilexa® (Tuteur S.A.C.I.F.I.A., Argentina) (78%) and Trikafta® (Vertex Pharmaceuticals) (15.9%).

Conclusions. The available data show a signficant progress in the availability of pathogen-oriented therapy in the SFD, but there remain genetic, age-related, and institutional barriers limiting full patient coverage with highly effective CFTR-modulators. The regional analysis highlights the need for further improvements in the neonatal screening system, expansion of genotypeoriented therapy, and continuity of medical care for adolescents and young adults.

Introduction. Cystic fibrosis is a hereditary disease associated with progressive damage to the bronchopulmonary system and the risk of disability. The introduction of triple CFTR modulators (ivacaftor/tezacaftor/elexaftor and ivacaftor) has significantly improved the prognosis. However, the high cost of the original drug Trikafta® and limited healthcare resources have driven interest in the bioequivalent generic drug Trilexa®.

Aim. To evaluate the efficacy and safety of the pathogenetic therapy drugs Trikafta and Trilexa in children with cystic fibrosis in the Chechen Republic, as well as the transition from the original to the generic version within the same INN (ivacaftor + tezacaftor + elexacaftor and ivacaftor), in routine clinical practice.

Materials and methods. A retrospective, single-center observational study was conducted in the Chechen Republic. The analysis included 22 patients under 18 years of age with a genotype corresponding to the indications for triple CFTR modulator therapy. Three groups were formed: Group 1 (n = 5) – treatment with Trikafta only; Group 2 (n = 2) – treatment with Trilexa only; Group 3 (n = 15) – patients switched from Trikafta to Trilexa. Changes in sweat chloride concentrations, body mass index (BMI), pulmonary function parameters (FEV₁, FVC), the frequency of pulmonary exacerbations, and the safety profile were assessed.

Results. A decrease in sweat chloride concentrations was noted in all groups, indicating restoration of CFTR function. In Group 3, sweat chloride levels decreased from 91.0 to 41.0 mmol/L while on Trikafta and remained stable after switching to Trilexa. BMI significantly increased from 14.9 to 15.7 kg/m² during the Trikafta phase (p = 0.002) and continued to increase after switching to Trilexa. FEV₁ and FVC remained consistently high after switching (p > 0.05). The incidence of pulmonary exacerbations decreased and remained minimal while on Trilexa.

Conclusion. The use of both the original drug and generic Trilexa in children with CF is associated with clinical improvements in key efficacy indicators and a favorable safety profile.

The article discusses the issues of rational choice of H1-antihistamines (H1-AHs) in the treatment of allergic diseases, mainly allergic rhinitis (AR) and urticaria. Modern ideas about the pathogenetic mechanisms of allergy are described, including the role of histamine and immunoglobulin E, as well as key pathophysiological processes that determine the formation of allergic reactions. Particular attention is paid to the differentiation of H1-AHs by pharmacological properties, their effect on the central nervous system, which is of particular importance for people of certain professions and the elderly, indicating studies and data on specific aspects of this effect. The authors emphasize the need to abandon the use of first-generation sedatives in favor of modern non-sedative H1-AHs with a more favorable safety profile. As an example of a highly effective and safe H1-Ahs of the second generation, ebastine is considered: its pharmacokinetic parameters, the results of randomized clinical trials in AR and various forms of urticaria, as well as a tolerability profile characterized by a minimal risk of cognitive impairment, including long-term use and when used in doses higher than therapeutic, are presented. Arguments in favor of the validity of the use of ebastin as a first-line drug in patients over 12 years of age are presented, as well as data on the bioequivalence of the domestic drug Allergostin to the original drug. The conclusion notes that second-generation non-sedative H1-AHs, such as ebastine, have an optimal balance between efficacy and safety and are recommended for the treatment of allergic diseases in accordance with current federal and international clinical guidelines.

The comorbidity of bronchial asthma and allergic rhinitis remains one of the most significant problems of respiratory medicine, since these diseases often coexist and mutually aggravate each other’s course. For example, nasal obstruction, postnasal congestion, breathing through the mouth, seasonal increase in symptoms of allergic rhinitis and stress-induced cough often create the impression of unstable asthma even when inhalation therapy is correctly selected. In this context, leukotriene receptor antagonists are of particular interest, primarily Ektalust (the active ingredient is montelukast), which remain in practical demand in some patients with the asthma + allergic rhinitis phenotype, not only as drugs that reduce bronchospasm, but also as agents for nasal obstruction, rhinorrhea, itching and sneezing. The Russian Clinical Guidelines for Allergic Rhinitis of 2024 suggest that such patients should be prescribed them for antiallergic, anti–inflammatory and anti-asthmatic effects, noting the high levels of persuasiveness of recommendation (A) and reliability of evidence (1). The commentary to the recommendation explicitly states that their use allows you to control the symptoms of both diseases and avoid polypragmasia. At the same time, the practical use of leukotriene receptor blockers requires proper positioning, since they are not a means of relieving an acute asthma attack, should not replace inhaled glucocorticosteroids, and are not considered as a universal starting therapy for allergic rhinitis. The key aspect of the article is the analysis of treatment in three different clinical cases using Ektalust and the answer to the question due to which pathogenetic and organizational mechanisms a positive clinical effect was achieved. Special emphasis is placed on the greatest value of the drug not as a universal control tool, but as a tool for personalized therapy in patients with asthma and comorbid conditions.

Respiratory syncytial virus (RSV) infection represents a global public health challenge, causing millions of hospitalizations and thousands of deaths annually among children and adults. Until recently, effective specific preventive measures were unavailable. For a long time, RSV infection was regarded primarily as a pediatric issue; however, in recent years, attention has grown regarding its impact on older adults and individuals with chronic conditions. A breakthrough in immunoprevention occurred in 2023–2024 with the approval of the first effective vaccines, including Abrysvo, authorized by the U.S. Food and Drug Administration (FDA) for three target populations: individuals aged 60 years and older, pregnant women for the protection of infants during their first six months of life, and adults aged 18–59 years with underlying risk factors. The vaccine is administered as a single dose, preferably prior to the onset of the RSV season. Clinical trials demonstrated high efficacy: in adults ≥ 60 years, 66.7% against lower respiratory tract RSV disease and 85.7% against severe forms; with maternal immunization, efficacy reached 81.8% within the infant’s first 90 days of life and 69.4% through day 180. Concomitant administration with seasonal influenza vaccine in individuals ≥ 65 years was shown to be feasible without compromising immune response or increasing the frequency of adverse events. The vaccine’s safety profile is favorable: the most common reactions were local (injection site pain) and systemic (headache, myalgia, fatigue), predominantly mild and transient. In pregnant women, an increased risk of preterm birth was observed, leading to a restriction limiting vaccination to gestational weeks 32–36. Thus, Abrysvo represents an important tool within a comprehensive RSV prevention strategy, enabling simultaneous protection of vulnerable adult populations and newborns through maternal immunization. Incorporating the vaccine into national immunization programs has the potential to substantially reduce the burden of RSV infection, alleviate pressure on healthcare systems, and improve the quality of life for millions of people.

The use of electronic cigarettes has become an integral part of modern youth culture, initially adopted as a safer alternative to traditional tobacco smoking. This shift was driven by active marketing, increased accessibility, and the perception that electronic nicotine delivery systems are permitted for use in any public place. However, electronic cigarette use has been associated with a growing number of severe lung complications, such as lung damage caused by E-cigarette or Vaping product use-Associated Lung Injury (EVALI). This article presents a review primarily based on American literature sources from the PubMed database on EVALI for the period 2019–2023. It includes the history of the lung injury outbreak related to electronic nicotine delivery systems in The United States of America (USA), the definition of EVALI as a diagnosis, its epidemiology, pathophysiological mechanisms, typical clinical symptoms of main variants, lung damage confirmed by imaging methods, diagnostic criteria, and potential outcomes. Clinical manifestations of EVALI can be divided into three groups: systemic, respiratory, and gastrointestinal symptoms. Several forms of EVALI are identified among patients, including organizing pneumonia, diffuse alveolar damage, hypersensitive pneumonitis, acute eosinophilic pneumonia, acute respiratory distress syndrome, respiratory bronchiolitis, interstitial lung disease-associated, acute fibrinous organizing pneumonia, and granulomatous pneumonitis. Histological patterns most commonly observed in lung biopsies of EVALI patients are organizing pneumonia and diffuse alveolar damage. The current understanding suggests that EVALI develops due to oxidative stress caused by ingredients in e-cigarette liquids. These findings can aid clinicians of various specialties in rapid diagnosis and treatment initiation.

Introduction. Modern methods of treating polypous rhinosinusitis improve the patient’s quality of life, but they do not always allow predicting the outcome of the disease. In this context, the issues of predicting relapses remain open and require in-depth study and the formation of an evidence base.

Aim. To analyze the clinical, anamnestic and laboratory data of patients to form the basis of the criteria for the prognosis of polypous rhinosinusitis.

Materials and methods. The study included 240 subjects who, based on the biomarker, were divided into 2 groups: group 1: patients with Th2-mediated polypous rhinosinusitis; group 2: patients with non-Th2-mediated polypous rhinosinusitis. Anamnesis assessment was recorded through a questionnaire, clinical complaints and the level of quality of life were recorded using the SNOT-22 questionnaire.

Results and discussion. Analysis of clinical and anamnestic data showed the highest incidence of polypous rhinosinusitis in the range from 46 to 60 years, the prevalence in men (60%) is more common than in women (40%). In 35.9% of cases of polypous rhinosinusitis, Th2-mediated type occurs with the presence of bronchial asthma, most often (18.2%) Bronchial asthma with a predominance of the allergic component J45.0. Rhinological symptoms have a significant impact on the subjective sphere of life of the examined individuals and, as a result, a pronounced effect of polypous rhinosinusitis (71.7 ± 6.06 points) on the quality of life of patients. Polypous rhinosinusitis, non-H2-mediated type, occurs in 24.7% of cases with a history of bronchial asthma, most often 14.4% non-allergic asthma J45.1. The experience of bronchial asthma is lower, due to the later onset. The severity of complaints leads to a moderate effect (65.1 ± 4.07 points) of polypous rhinosinusitis on the quality of life of patients.

Conclusion. The analysis of clinical, anamnestic and laboratory data of patients with polypous rhinosinusitis revealed the features of the clinical picture and their impact on the quality of life of patients, which can be the basis for an in-depth instrumental examination to assess the prognosis of polypous rhinosinusitis.

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are common diseases, and their combination is called overlap syndrome (OS) and is distinguished as a separate phenotype. Physiological disturbances observed during sleep in patients with COPD and OSA include increased upper airway resistance, ineffective gas exchange, and effects on central sleep regulation. Patients with OSA are at higher risk of atrial fibrillation, cardiovascular events, including fatal ones (sudden cardiovascular death), and the risk of developing pulmonary hypertension more often than patients with COPD alone or isolated OSA. The article presents the pathophysiology of respiratory disturbances in patients with OSA during sleep, epidemiological studies, clinical implications, and factors influencing the association of COPD with OSA. It is necessary to use screening questionnaires to identify patients for in-depth diagnostics of OSA, and the clinician should also pay attention to clinical signs defined as indications for the assessment of possible sleep-disordered breathing in COPD. Treatment of OSA in patients with COPD can reduce cardiovascular mortality and improve survival in these patients. Therapy for patients with OS, along with lifestyle changes, includes respiratory support methods: supplemental oxygen therapy, treatment with continuous positive airway pressure (CPAP), non-invasive ventilation (NIV). Bronchodilators and corticosteroids may be appropriate as drugs for drug therapy of SP.

Lymphangioleiomyomatosis (LAM) is a rare disease that affects many organs, including the lungs, as well as the abdominal and pelvic organs. Currently, there are no national clinical guidelines for the diagnosis and treatment of LAM, which increases the risk of late diagnosis. The tactic basis for a practical approach to patients in LAM is the guideline by the European Respiratory Society. According to it, we can establish the diagnosis of “definite LAM” without histological verification by a typical picture on high-resolution computed tomography of the chest organs (HRCT CHO) and the one of a several criteria. At the same time there is not a straightly regulation for histological criteria to verify the diagnosis and moreover they include not only the linear immunological markers but many others, some of which are presented in this demonstration. The aim of this presentation is the increasing of medical specialists’ attention to LAM during an examination of their patients. There is a clinical case of definite LAM in a 40-year-old woman with an angiomyolipoma of the left kidney, uterine fibroid and a typical HRCT CHO picture of LAM, with an intravital histological verification and death before the start of specific therapy. This clinical case demonstrates late diagnosis of the disease, that is caused probably by the low awareness of the medical community about rare diseases, as well as a significantly delayed start of specific therapy, despite the fact it was prescribed in a relatively short time after diagnosis. The solution to both issues could be the creating of national clinical guidelines for the diagnosis and treatment of LAM, including clear algorithms of action of doctors, including outpatient physicians.