Data of the most recent achievements in diagnostics and therapy of chronic obstructive pulmonary disease (COPD) from positions of division by phenotypes and global initiative GOLD-2015.

The therapy by fixed combinations, LABA/LAACD on the basis of indacaterol and glycopyrronium bromide is characterized by a high clinical efficacy compared to monocomponents of the product, tiotropium, and a fixed combination of LABA/iCGS. The results of the clinical studies confirm the pharmacological concept of synergistic potentiation of the bronchodilator effect by using medications with different mechanisms of action, which LABA and LAACD are. It is important that the achievement of additional therapeutic effect is possible without increasing the risk of adverse effects. All this is the basis for the conclusion that the joint indication of indacaterol and glycopyrrolate can lead to optimization and maximization of bronchodilatation of many COPD patients who didn’t achieve adequate improvement of bronchial patency with the use of only one bronchodilator. Combination therapy with indacaterol and glycopyrronium (drug Ultipro® Brizhaler®, Novartis Pharma) results in significant improvement of clinical symptoms, pulmonary function, quality of life and decrease of exacerbations in patients with COPD.

Chronic obstructive pulmonary disease (COPD) is one of the leading reasons of mortality in the whole world. The insufficiency of alpha-1-antitrypsin (А1АТ) protein is an important factor of genetic predisposition to COPD development. А1АТ deficit can be diagnosed with the help of phenotyping. Detection of PiZZ phenotype of А1АТ preconditions 95% of А1АТ deficit cases whereas PiMM phenotype testifies about the conservation function of the protein. Detection of A1AT in case of COPD might be accompanied by a graver course of the diseases, it is characterized by peculiarities of complex study parameters of the external respiratory function and densitometric values of the pulmonary tissue determined by computer tomography.
The objective of this study is comparison of external respiratory function in COPD patients with PiZZ and PiMM phenotype of А1АТ.
Materials and methods: COPD patients with PiZZ phenotype of А1АТ (N = 6) and PiMM phenotype of A1AT (N = 75) were studies. The following spirometric values were evaluate: forced expiratory volume per 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, maximum expiratory flow rate (MEFR), peak flow rates (PFR50 and PFR75), mean flow rate (MFR), as well as the total lung capacity (TLC) etc. Spiral computer tomography was performed with application of the densitometric analysis software.
Evaluation of the intensity of dyspnoe and effect of symptoms on the quality of life was done.
Results. Comparison of spirometric values showed that for patients at PiZZ phenotype of А1АТ showed lower values of FEV1/ FVC, PFR50, PFR75, MFR, DLco, va and higher parameters of MEFR, FVC and TLC than in PiMM phenotype of А1АТ (p < 0,05*).
Conclusions: in COPD patients with PiZZ phenotype of А1АТ more intense deviations of bronchial obstruction, reduction of elastic properties of the pulmonary tissues, hyperinflation, reduction of the capillary bed due to emphysematous pulmonary involvement are observed.

Despite considerable progress in development of effective therapeutic means, numerous studies are indicative of the insufficient BA control level resulting in reduction of patient life quality as well as to the high risk of disease exacerbations.
The major therapeutic approach aimed at achievement of control and reduction of damage from disease is anti-inflammatory therapy based on modern inhalation glucocorticosteroids (IGCC) complemented if required by long-acting beta-2-adrenergic agonists (LABA).

Severe bronchial asthma is a serious healthcare and social challenge. Severe asthma in both in children and adults may have an unfavorable course, has heterogeneous clinical phenotypes and is very difficult to treat. Treatment of patients with inadequately controlled severe asthma requires significant resources from the healthcare system.
At the same time, severe asthma in children, adolescents and adults has a number of specific features making it a separate phenotype. These groups of patients are at high risk of hospitalization and mortality.

In the bronchial asthma structure the mild form of the disease takes the leading place: from 50 to 75% of patients suffer from mild asthma. Modern diagnostics of disease in these patients and adequate therapy allow preventing the disease progress. This article discusses issues of determination of the bronchial asthma gravity, incidence rate, disease burden and standard approaches to therapy of the mild bronchial asthma. Particular attention is given to a new possibility of therapy of mild asthma in adult patients with the help of the combined drug Salbutamol/Beclomethazone represented in the form of an aerosol inhaler and intended for arrest of symptoms and permanent therapy of bronchial asthma and chronic obstructive pulmonary disease in adults from the age of 18. Use of fixed combination Salbutamol/Beclomethazone in the regime “on demand” in adult patients with mild bronchial asthma leads to increase of the time to the first exacerbation and reduction of the disease exacerbations, at the same time it is accompanied by the minimum cumulative dosage of the inhalation corticosteroid and allows overcoming the low commitment of patients to therapy by inhalation corticosteroids.

Adequate management of patients with chronic obstructive pulmonary disease (COPD) is not getting less relevant year by year. Sustainable management of the patient requires additional tools and methods as well as approaches to evaluating the effectiveness of treatment schemes. It is known that the ability of drugs to improve functional parameters does not always lead to an improvement in patients’ well-being or enhance their daily living. In this regard, it is especially important to evaluate the quality of life as a marker of treatment efficacy. The aim of the study was to evaluate the effect of vaccination on the quality of life in patients with COPD during a 3-year follow up. Material and Methods: 362 male patients diagnosed with COPD were included in the study. 13-valent conjugate pneumococcal vaccine Prevenar-13 (PCV13) and polyvalent Pnevmo23 pneumococcal vaccine (PPV23) were used in vaccination. The quality of life (QoL) evaluation was done using two questionnaires, the Russian version of the St. George Hospital Respiratory Questionnaire (SGRQ) and the universal COPD assessment test (CAT). Results and conclusions: vaccination with PCV13 and PPV23 had a positive impact on the quality of life in the first year after vaccination, but the effect of PPV23 decreased in the third year of follow-up. Quality of life questionnaires allow to focus on the right treatment strategy both in early and long-term follow up of patients with COPD.

The fan-associated pneumonia currently is a leading reason of mortality of patients in resuscitation and intensive care unit. Development of the disease is accompanied by serious clinical and economic consequences. The adequate antibacterial therapy plays the determining role in the favorable outcome in pneumonia. Doripemen is a new parenteral 1-beta-methyl-carbapenem that was launched into the pharmaceutical market of Russia in 2008.
The purpose of this review is to generalize the results accumulated to this moment on effectiveness of doripenem in therapy of fan-associated pneumonia.

The beginning of 2016 was marked by an epidemic circulation of influenza viruses and a rise in the incidence of influenza and acute respiratory viral infections from the 2nd till the 16th week of the year. The epidemic peaked in week 4-5 (25-31.01.2016 and 01.02-07.02.2016) when the epidemic thresholds were exceeded in 74 and 68 subjects, respectively, in all federal districts of the Russian Federation, and all age groups were involved into the epidemic process. Among the circulating viruses, influenza A(H1N1)pdm09 was predominating (82,0–85,0%), and by the end of the epidemic the number of patients with influenza virus type B increased. Seasonal influenza vaccination has proved to be effective. Based on the characteristics of the isolated influenza viruses, the composition of influenza vaccines for 2016-2017 was changed as recommended by the WHO.

Respiratory viral infections of non-flu etiology – adenoviral infection, paraflu, RS-vioral infection etc. – account for the major share of SARS, up to 90%. The frequency of flu viruses infection makes up about 15% (type A – 12%, type B – 3%), paraflu viruses – up to 50%, adenoviruses – from 5 to 10%, RS-viruses – 4%, mycoplasma – 2.7%, enteroviruses – 1.2%. Combined infections make up about 23% of cases [1].

The article tells about the evolution in the development of endoscopic diagnostic methods for early central lung cancer, from rigid bronchoscopes to modern high-resolution video endoscopes. The current multimodal diagnostic methods are described, including the recent data on the use of confocal laser endomicroscopy and endocytoscopy which allow to detect lesions caused by intramucosal cancer in the tracheobronchial tree as well as to study the cellular-level morphology in vivo. Long-term clinical experience of the P.A. Herzen Moscow Oncology Research Institute in the diagnosis of central lung cancer is presented.

The article presents the results of our studies and literature data in order to evaluate the efficacy and safety of antitussive drug of a new class (Rengalin®) containing release active antibodies to mediators of inflammation to morphine, bradykinin and histamine. Clinical studies in this promising area are not numerous but confirm the results of experimental studies and testify to the efficacy and safety of Rengalin in the cough treatment. The first in Russia clinical study (2012) of the drug Rengalin for the treatment of dry cough in children aged 3 - 10 y.o. (n = 61) with acute respiratory infections (acute rinopharingitis, laryngotracheitis, tracheitis) in a conditions of a clinic showed its clinical efficacy and safety similar to the effect of butamirate citrate (Sinecod®). Data few works of other researchers confirm the data obtained by the authors.

Obviously, the key role in the treatment of infectious diseases often belongs to adequate and timely antibacterial therapy (ABT) which determines favorable clinical outcome, minimizes the risk of selection and spread of drug resistant pathogens, ultimately resulting in a lower cost of treatment. It is also practically assured that opting for a generic drug could reduce financial costs due to the price difference between generic and original (innovative) antibacterial drugs.

The prevalence of influenza and acute respiratory viral infections, high frequency of complications with a high mortality rate in certain groups of the population, short duration of specific immunity and the lack of efficiency of use of antiviral drugs for the treatment of patients make the problem of rational pathogenetic therapy of respiratory infections extremely urgent. The excessive local inflammatory reaction in response to the penetration of the pathogen of SARS in the body can lead to massive death of the tissue and rapid systemic spread of the infectious agent. Treatment of patients with influenza should be based on the likely dynamics of the onset of symptoms, development of complications and severe disturbances of the vital organs.
According to the principle of step by step treatment, any «influenza infection» must be regarded as a potentially serious illness that threatens the patient serious complications. Even with normal flu symptoms from the first hours from the onset of the disease, it is advisable to prescribe combination of the antiviral and pathogenetic therapy. A combination of antiviral, antipyretic, anti-inflammatory and antioxidant therapy at an early stage in most cases allows limitation of the development of severe forms of the disease and death prevention.

Chronic lower respiratory tract infection in patients with cystic fibrosis (CF) is the major factor determining the severity of the clinical course and prognosis of the disease. The purpose of the study was to investigate the prevailing respiratory microflora in patients with CF and changes in the activity of antibacterial medicines (ABM) during the period 2000–2015 in order to optimize guidelines for antibiotic therapy. Bronchial secretion was evaluated in CF patients from 2000 till 2015. 9774 samples were studied, 16.703 microbial strains were obtained. In 2000–2015, P. aeruginosa (smooth and mucoid morphological types) was the most widespread gram-negative strain. Typical strains of P. aeruginosa were isolated more often than mucoid morphotypes. In 2000–2015, isolation rates for P. aeruginosa decreased from 41.2 to 20.0% (p <0.001). The proportion of B. cepacia complex increased from 1.1 to 7.3%, up to 11.3% in 2008–2011, and a rise in the proportion A. xylosoxidans was registered from 2.9 to 4.9% (p <0.001). During the follow-up period, the diversity of isolated species has grown.
ABM such as colistin (active against 100% of strains), carbapenems (imipenem is active against 70.3–72.2% of strains, and meropenem against 75.8 and 78.9%) remain active against P. aeruginosa. The effect of piperacillin/tazobactam is similar to that of carbapenems. Cefepime is less effective than ceftazidime. Fluoroquinolones and tobramycin also remian active.

The purpose of the study was to study of effects of sulodexide on clinical and functional parameters in patients with chronic obstructive pulmonary disease (COPD) in combination with hypertension. 40 COPD patients were examined. Patients were divided into two groups of 20 people. One group received only basic COPD therapy and antihypertensive treatment, the other group - basic and antihypertensive therapy in combination with sulodexide. After a year of observation the assessment of the clinical course of the disease, and ventilatory lung function, cardiopulmonary hemodynamics, endothelium-dependent vasomotor function was done.
In patients, additionally treated with sulodexide, the following parameters were marked: stabilization of blood pressure parameters, reduction of dizziness and headaches, increase of tolerance to physical load, reducing the number of exacerbations, improvement in spirometry, lung diffusion capacity, improvement of pulmonary hemodynamics parameters and improvement of endothelium-dependent
vasodilation. Thus, the positive effect of sulodexide on clinical and functional parameters indicates the feasibility of further study of the use of angioprotectors in complex pathogenetic therapy of COPD.