Search

Sarcoidosis is a multi-organ granulomatosis of unknown origin. Modern diagnostic methods allow detecting this disease at an early stage. The absence of specific markers requires a comprehensive approach to diagnosis based on comparison of radiation, clinical, morphological and functional data. The course of sarcoidosis without damage to the respiratory system presents significant difficulties. It is extremely important to understand the time and means of starting Sarcoidosis’s treatment to avoid the early initiation of hormones and cytostatics and, on the other hand, to timely respond to progression and threatening conditions. Methods. Clinical recommendations are based on the analysis of Russian and English publications of the latest sarcoidosis research. The target audience of these clinical guidelines are therapists, general practitioners, pulmonologists, TB doctors, rheumatologists, dermatologists, radiation diagnosticians, immunologists, and clinical pharmacologists. Each thesis-recommendation for diagnosis and treatment is evaluated on an 1 to 5 scale of levels of evidence and an A, B, C scale of the grades of recommendations. The clinical guidelines also contain comments and explanations for the theses-recommendations, diagnostic algorithms, treatment strategies, reference materials on the use of recommended drugs. Conclusion. Current information on epidemiology, clinical manifestations, diagnosis and management strategies for patients with sarcoidosis are covered in the presented clinical guidelines. Approved by the decision of the Scientific and Practical Council of the Ministry of Health of the Russian Federation (2022).

Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic fibrotic interstitial pneumonia with a progressive course and poor prognosis. The prevalence of IPF in the Russian Federation is about 8 – 12 cases per 100,000 population. The basic treatment of IPF is antifibrotic agents.Methodology. The target audience of these clinical recommendations are therapists, general practitioners, pulmonologists, pathologists, radiologists, and medical rehabilitation doctors. Each thesis-recommendation about diagnostic and therapeutic procedures has been scored according to the scale of classes of recommendations from 1 to 5 and A, B, C scale of the levels of evidence. Clinical recommendations also contain comments and explanations to the theses, algorithms for the diagnosis and treatment of idiopathic pulmonary fibrosis, and reference materials.Conclusion. The presented clinical guidelines cover current information about the etiology and pathogenesis, clinical manifestations, diagnosis, treatment, and prevention of idiopathic pulmonary fibrosis. These guidelines were approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation in 2021.

The aim of the study was to explore the clinical, radiological, functional indicators of hypersensitivity pneumonitis (HP) in combination with arterial hypertension, to assess the effect of these diseases on each other.Methods. The study included 50 patients with hypersensitivity pneumonitis (HP) and 49 patients with arterial hypertension (AH). The patients were divided into three groups. The main group included 24 patients with hypersensitivity pneumonitis combined with AH. The comparison group was 26 patients with HP without AH; the control group was 25 patients with arterial hypertension alone. Clinical symptoms, radiological findings, and results of instrumental tests were analyzed.Results. The intensity of clinical symptoms (shortness of breath, cough) was significantly higher in the main group than in the control and comparison groups. Exercise tolerance estimated from the six-minute walk test was significantly lower in the main group. The clinical status correlated with the functional testResults. Volumetric and velocity spirometry values tended to decrease more in the main group compared to the other two groups. The lung diffusion capacity was significantly lower in the group of patients with HP in combination with AH compared to the group of patients with hypertension only. A similar trend was observed when assessing the chest CT: significantly more pronounced changes were found in the main group. EchoCG showed a significant increase in pulmonary hypertension and volumes of the right heart in the main group compared to the group of patients with AH alone.Conclusion. The present study provides evidence of the greater intensity of respiratory symptoms, decreased functional status, ventilation disorders, dilated heart cavities, greater risk of fatal vascular complications in patients with HP associated with hypertension.

Incidence and prevalence of non-tuberculous mycobacteriosis (NTM) are recorded in many countries, but the rates vary. There are no official statistics on the prevalence and incidence of NTMs in the Russian Federation at the moment. The regulatory and expert clinical database for NTMs has not yet been developed. The aim of thе article is to share the experience of the Federal State Scientific Institution “Central Research Institute of Tuberculosis” (FSSI “CRIT”) in working with patients with NTMB over the past 7 years. Methods. The study included 190 patients with a confirmed diagnosis of NTMB who were treated at the FSSI “CRIT” in 2011 – 2018. Before the diagnosis of NTMB, all patients were followed for a long time by various specialists (pulmonologists, general practitioners) for various chronic respiratory diseases. NTMs were isolated from the diagnostic material by the culture method. The material was inoculated into a liquid medium in an automated BACTEC MGIT 960 system and into Levenshtein – Jensen dense medium until the culture growth was obtained. The HTM species was determined using DNA strips GenoType® Mycobacterium CM by Hain Lifescience (Germany). Results. More than half of the examined patients were registered with a phthisiatrician for various clinical forms of pulmonary tuberculosis (disseminated, fibro-cavernous, focal). In 85.6% of cases, no MBT DNA was found in the sputum and skin tests with recombinant tuberculosis antigen (Diaskintest®) were negative. Nevertheless, the changes in the lungs detected on the chest CT and even a single detection of acid-fast microorganisms (AFB) without typing led to an erroneous diagnosis of tuberculosis. In some patients (6.8%), a combination of pulmonary tuberculosis and NTMB was diagnosed. Bronchiectasis and COPD were the most common chronic nonspecific lung diseases. 66.7% of the patients had centrilobular foci characterized by the involvement of not only the bronchial wall but also the pulmonary vessels. NTMB resistance to a wide range of antibacterial drugs was determined in 118 patients (out of 190). The prolonged use of chemotherapy drugs revealed a wide range of drug intolerance. Side effects were handled in various ways: drug replacement (with consideration to the sensitivity), temporary withdrawal, and drug discontinuation. Conclusion. This work reflects the long-term experience of the FSSI “CRIT” staff with patients with NTMs, which can be used in creating national recommendations on NTMs.

Aim. Analysis of quantitative and qualitative parameters of dyspnea in patients with the fibrotic phenotype of interstitial lung disease associated with coronary artery disease. Material and methods. We examined 49 patients. Among those were 9 patients with idiopathic pulmonary fibrosis, 25 patients with chronic variant of hypersensitive pneumonitis, and 14 patients with nonspecific interstitial pneumonia. The main group consisted of 25 patients with interstitial lung diseases and coronary heart disease; comparison group consisted of 24 patients without ischemic heart disease. Clinical symptoms, questionnaire results, and instrumental study data were analyzed. Results and discussion. Patients with coronary heart disease experienced increased dyspnea earlier (after 3,21 days) than patients without it (after 7,18 days; p

Pharmacotherapy for patients with chronic obstructive pulmonary disease is administered through various inhalation devices. The inhalers have different designs, principles of operation and activation methods, the number of steps necessary to prepare the device for use, the resistance that the patient has to overcome with inhalation, and many other characteristics. The suboptimal choice of an inhalation device may affect the clinical outcomes of the disease. Therefore, the guidelines consider replacement of the inhaler to be an alternative to escalation of therapy with treatment failure. When choosing an inhalation device, a number of the patient’s clinical features should be considered, including the patient's ability to induce an inspiration effort. Since devices that estimate the force of inspiratory effort at different resistances are not available in Russian Federation for routine clinical practice, the expert group described some clinical features that may be observed in patients with suboptimal inspiratory flow based on the existing data. Their final choice was made by voting according to the Delphi panel method that accounts for the opinion of each expert.

The main objectives of chronic obstructive pulmonary disease (COPD) therapy are to reduce the severity of symptoms and the risk of exacerbations. The article discusses the role of local and systemic inflammation in the pathogenesis of COPD as well as various mechanisms of pharmacological influence on it. Approaches to prescribing basic therapy for patients with COPD, recommended by various national and global guidelines (clinical recommendations of the Russian respiratory society, criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), guidelines of the National Institute for Health and Clinical Excellence (NICE)), as well as recommendations on the therapy frequency review are considered. Currently, so-called triple combinations – fixed combinations of double bronchodilators with inhaled glucocorticosteroids – are being developed and registered in the world, and their place and significance in the treatment of COPD raise many discussions. The paper discusses the role of fixed triple combinations in reducing the incidence of COPD exacerbations, the impact on functional and patient-reported outcomes, and provides recommendations for the use of triple combinations in patients with COPD, taking into account the benefit/risk ratio.

The review is devoted to the urgent problem of modern pulmonology: the differential diagnosis of idiopathic pulmonary fibrosis (ILF). ILF occupies a special place among many interstitial lung diseases for a number of reasons: 1) it is a deadly disease; 2) early diagnosis and adequate antifibrotic therapy significantly extend the life expectancy of patients; 3) anti-inflammatory drugs (corticosteroids) and cytostatics with ILF that are widely used in other forms of interstitial lung diseases are ineffective and accelerate the progression of the process; 4) the commonality of the main clinical signs (increasing respiratory failure) of various interstitial lung diseases. The list of respiratory diseases with which ILF should be differentiated is huge, and if with diffuse lung lesions of a known nature (disseminated pulmonary tuberculosis, pneumoconiosis, etc.) with a certain experience/qualification, the diagnosis is relatively simple, then the isolation of ILF from the group of idiopathic interstitial pneumonias always represents certain difficulties. The main methods used in the diagnosis of ILF are summarized taking into account current international and national recommendations.Обзор посвящен актуальной проблеме современной пульмонологии: дифференциальной диагностике идиопатического легочного фиброза (ИЛФ). ИЛФ занимает особое место среди множества интерстициальных болезней легких по ряду причин: 1) это смертельная болезнь; 2) ранняя диагностика и адекватная антифибротическая терапия существенно удлиняют продолжительность жизни больных; 3) широко применяемые при других формах интерстициальных болезней легких противовоспалительные препараты (кортикостероиды) и цитостатики при ИЛФ неэффективны и ускоряют прогрессирование процесса; 4) общность основных клинических признаков (нарастающая дыхательная недостаточность) различных интерстициальных болезней легких. Перечень заболеваний органов дыхания, с которыми следует дифференцировать ИЛФ, огромен, и если с диффузными поражениями легких известной природы (диссеминированный туберкулез легких, пневмокониозы и др.) при определенном опыте/квалификации диагностика относительно проста, то выделение ИЛФ из группы идиопатических интерстициальных пневмоний всегда представляет определенные трудности. Суммируются основные методы, используемые в диагностике ИЛФ, с учетом современных международных и национальных рекомендаций.

The purposeof this study was to determine detection rate and clinical and morphological characteristics of mediastinal lymphadenopathy (ML) in patients with respiratory system sarcoidosis (RSS), disseminated pulmonary tuberculosis (DPT) and exogenic allergic alveolitis (EAA).Materials and Methods.Patients (n= 278) with established diagnosis RSS, DPT, EAA were investigated. The cumulative index parameters were determined, hematology test, assessments of pulmonary function, diffuse lung capacity, diffusion coefficient were performed in all patients. Computed tomography of chest organs and morphologic examination of mediastinal lymph node (LN) biopsy were performed.Results.Subjects with newly diagnosed (n= 72) and recurrent (n= 104) disease were observed among patients with RSS (n= 176). ML was observed in 95% of cases, involved bronchopulmonary, bifurcation, paratracheal and paraaortal groups; dimensions of intrathoracic LN (ITLN) were 20.0 ± 1.9 mm. Epitheliocellular granulomas (EG) without necrosis, not fusing with each other, were established morphologically; they were determined in recurrent disease course in association with background fibrosis. In patients with DPT (n= 41), subacute (n= 28) and chronic (n= 13) disease course was noted. With subacute course of DPT in 28.6% of cases, ML of paratracheal and bifurcation groups (dimensions of ITLN – 13.1 ± 0.3 mm) was observed, with chronic course – the enlargement of paratracheal and bronchopulmonary LN (7.7% of cases). EG with necrosis and tendency to fusion was verified histologically; inflammatory process involved LN capsule and could be spread to fatty tissue. In patients with EAA (n= 76), acute (n= 10), subacute (n= 38) and chronic (n= 28) disease courses were observed. With acute EAA course, hyperplasia of ITLN of bifurcation and tracheo-bronchial groups up to 13.5 ± 0.6 mm was observed in 20% of cases. Follicular hyperplasia with widening and edema of hermintative centers was observed at morphological investigation. With subacute EAA course, increased ITLN in bifurcation and broncho-pulmonary groups up to 13.6 ± 0.6 mm were observed in 46% of cases. Formation of histiocytic-macrophagal granulomas without epithelioid cells and deposit precipitation in the plasma cell aggregation areas was found at morphological evaluation. With chronic EAA, ML in broncho-pulmonary and paratracheal groups was detected in 17.8% of cases (enlargement of LN up to 11 ± 0.9 mm). The formation of diffuse and focal fibrosis and hyalinosis was noted morphologically.Conclusion.ML is observed in all granulomatous pulmonary diseases studied, however its rate and severity, composition of involved ITLN groups and character of morphological changes is different which is possible to use in diagnostics.

The main goals of COPD therapy are to achieve clinical stability with minimal clinical manifestations and low risk of relapse. The proposed COPD control concept by analogy with asthma has not been quite well characterized yet. COPD control is defined as "the long - term maintenance of a clinical situation with a low impact of symptoms on the patient's life and absence of exacerbations." The situation of clinical control in COPD is considered desirable and potentially achievable for most patients with COPD. Pharmacotherapeutic options for COPD are constantly expanding. The control concept may be useful when the decision on treatment of COPD is made for dynamic adjustment of the therapy volume.Основными целями терапии хронической обструктивной болезни легких (ХОБЛ) является достижение клинической стабильности с наименьшим количеством симптомов и низким риском обострений. Предложенная концепция контроля ХОБЛ по аналогии с бронхиальной астмой пока недостаточно хорошо охарактеризована. Контроль ХОБЛ определяется как «долгосрочное поддержание клинической ситуации с низким воздействием симптомов на жизнь пациента и отсутствием обострений». Ситуация клинического контроля при ХОБЛ рассматривается как желательная и потенциально достижимая для большинства пациентов с ХОБЛ. Возможности фармакологической терапии ХОБЛ постоянно расширяются. Концепция контроля может быть полезна для принятия решения о лечении ХОБЛ для динамической корректировки объема терапии.

The aim of this study was to investigate arterial wall stiffness and its relationship with right ventricle systolic function (RVSF) in patients with interstitial lung disease. Methods . Fifty patients with chronic hypersensitivity pneumonitis (HP) and 26 patients with idiopathic pulmonary fibrosis (IPF) were included. Spirometry, body plethysmography were performed, lung diffusion capacity for carbon monoxide (DLCO), blood gases and arterial wall stiffness were measured. High resolution computed tomography (HRCT) of the chest was assessed using Kazerooni scale. Results . The aortic pulse wave velocity (PWV, m/s) was increased in 26 (52%) patients with HP and in 14 patients with IPF. Correlation analysis showed statistically significant association between PWV А o and DLCO (p < 0.05), partial oxygen pressure in the arterial blood (PaO2) (p < 0.05), pulmonary fibrosis (p = 0.001), and the extension of ground glass opacities (p < 0.05). Tricuspid annual plane systolic excursion (TAPSE), right ventricular myocardial performance index (MPI) and tricuspid annular systolic velocity (S’) were significantly related to PWV А o, ambulatory arterial stiffness index (AASI) and augmentation index (AIx) (p < 0.05). Conclusion . Increased arterial stiffness was often found in patients with HP and IPF. The increased arterial stiffness is associated with hypoxemia, pulmonary fibrosis and decreased lung diffusion capacity. The arterial stiffness is also related to the right ventricular systolic dysfunction.

Observational studies indicate that overutilization of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD). Overprescription and the high risk of serious ICS-related adverse events make withdrawal of this treatment necessary in patients for whom the treatment-related risks outweigh the expected benefits. Elaboration of an optimal, universal, user-friendly algorithm for withdrawal of ICS therapy has been identified as an important clinical need. This article reviews the available evidence on the efficacy, risks, and indications of ICS in COPD, as well as the benefits of ICS treatment withdrawal in patients for whom its use is not recommended by current guidelines. After discussing proposed approaches to ICS withdrawal published by professional associations and individual authors, we present a new algorithm developed by consensus of an international group of experts in the field of COPD. This relatively simple algorithm is based on consideration and integrated assessment of the most relevant factors (markers) influencing decision-making, such a history of exacerbations, peripheral blood eosinophil count, presence of infection, and risk of community-acquired pneumonia.

Background: It is known that right heart failure contributes significantly to morbidity and mortality among patients with chronic lung diseases. However, there is very little literature describing factors associated with right ventricle (RV) dysfunction among patients with chronic hypersensitivity pneumonitis (HP). Our aim was to investigate factors associated with the RV systolic dysfunction among patients with chronic HP. Material and Methods: We identified 86 patients with chronic HP, who underwent echocardiography, spirometry, plethysmography, diffusing capacity of carbon monoxide (DLCO), bronchoscopy and lung biopsy. Pulmonary high resolution computed tomography (HRCT) was assessed by Kazerooni scale (ground glass and lung fibrosis). Pulse wave velocity (PWV), and BMI were evaluated. RV systolic function was assessed using different methods (tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (MPI) and RV systolic excursion velocity by tissue Doppler (S′)). Results: RV systolic dysfunction was found in 40.6% of subjects by TAPSE and 38.4% by RV MPI and S′. All parameters of RV systolic function correlated with total lung capacity (p Conclusions: RV systolic dysfunction is associated with lungs fibrosis, diffusion disturbance and arterial stiffness among patients with chronic HP.

Show the possibilities of diagnosing non - tuberculous mycobacteriosis of the lungs (NTML) in the practice of the pulmonologist.A survey of 90 patients with a confirmed diagnosis of non - tuberculous mycobacteriosis of the lungs (NTML) was presented. The diagnosis of pulmonary mycobacteriosis was established in accordance with the criteria proposed in 2007 by the American Thoracic Society and the American Society of Infectious Diseases (ATS/IDRS). Among the patients, 55 (61.1%) women prevailed, the average age was 51.2±15.3 years. Patients were evaluated complaints, the presence of concomitant diseases of the lungs, was carried out computed tomography of the chest high - resolution (HRCT), a culture study of sputum, in the absence of sputum or a single determination of the NTM culture in it, a study was conducted on materials of bronchoalveolar washout (ALS/BAL), or lung biopsies. Statistical processing of the research results was performed using descriptive statistics using Microsoft® Excel for Windows xp® on a personal computer.As a result of the study, it was revealed that before the diagnosis of NTML was established, 66.7% of patients were long observed for chronic lung diseases (chronic obstructive pulmonary disease, chronic bronchitis), and in 55.6% of cases (50 people) were registered with a phthisiologist about pulmonary tuberculosis. According to the CT scan of OGK, dissemination was determined in 66.7% of cases, in 48.9% - bronchiectasis, single or multiple destruction cavities - 46.7% of cases. In 72.2% of cases, non - tuberculous mycobacteria (NTM) were found in sputum, in 33.3% - in ALS and in 22.2% of NTMs were found in the surgical material. In 14.4% of cases, only surgery allowed to establish the diagnosis of mycobacteriosis.Цель исследования. Показать возможности диагностики нетуберкулезных микобактериозов легких (НТМЛ) в практике пульмонолога. Материалы и методы. Представлены материалы обследования 90 пациентов с подтвержденным диагнозом НТМЛ. Диагноз микобактериоза легких установлен в соответствии с предложенными в 2007 г. критериями Американского торакального общества и Американского общества инфекционных болезней (ATS/IDRS). Среди пациентов преобладали женщины - 55 (61,1%) человек, средний возраст составил 51,2±15,3 года. У пациентов оценивали жалобы, наличие сопутствующих заболеваний легких, проводили компьютерную томографию высокого разрешения органов грудной клетки (КТ ОГК), культуральное исследование мокроты, в случае отсутствия мокроты или однократного определения в ней культуры нетуберкулезных микобактерий (НТМБ) проводилось исследование материалов бронхоальвеолярного смыва (БАС/БАЛ) или биоптатов легких. Статистическая обработка результатов исследования выполнена методом описательной статистики с использованием Microsoft® Excel для Windows хр® на персональном компьютере. Результаты и заключение. В результате проведенного исследования выявлено, что до установления диагноза НТМЛ 66,7% пациентов длительно наблюдались по поводу хронических заболеваний легких (хроническая обструктивная болезнь легких, хронический бронхит), а в 55,6% случаев (50 человек) находились на учете у врача - фтизиатра по поводу туберкулеза легких. По данным КТ ОГК в 66,7% случаев определялась диссеминация, в 48,9% - бронхоэктазии, в 46,7% - одиночные или множественные полости деструкции. В 72,2% случаев НТМБ были найдены в мокроте, в 33,3% - в БАС и в 22,2% обнаружены в операционном материале. В 14,4% случаев только оперативное вмешательство позволило установить диагноз микобактериоза.

Introduction. Investigation of relationships between interstitial lung diseases (ILD) and development of heart failure would be useful for determining target therapy of heart failure (HF) among such patients. Aims.To study intracardiac hemodynamic and factors associated with its dysfunction among patients with ILD. 40 patients including: 34 with Chronic Hypersensitivity Pneumonitis (HP) and 6 with idiopathic pulmonary fibrosis (IPF). Methods. Pulmonary high-resolution computed tomography, echocardiography, spirometry, diffusing lung capacity for carbon monoxide (DLCO), bodypletysmography, blood oxygen (PaO ) were estimated. Results. 55.9% of patients with HP and all patients with IPF had a «cor pulmonale» with diastolic disfunction (DD), and 40% of them also had systolic dysfunction of right ventricle (RV). DD of left ventricle (LV) of I type was found among 10% of patients. 20% of patients were diagnosed with high pulmonary pressure (PP). The basal diameter of right ventricle (BDRV) correlated with DLCO (r=-0,718, p=0,004), PaO (r=-0,690, p=0,006), lung fibrosis (LF) (r=0,602, p=0,002). Tricuspid Annular Plane Systolic Excursion (TAPSE) correlated with mitral E/E’ ratio, tricuspid E/E’ ratio, total lung capacity (TLC) and LF (r=-0,753, p=0,002). Parameters of DD of RV significantly correlated with BDRV, TLC, DLCO, LF. Mitral E/E’ ratio correlated with DLCO and LF. PP corresponded with DLCO, DD of LV, LF (r=0,536, p=0,03) Conclusions. Correlation of LF with parameters of heart failure makes it one of the targets for ILD therapy as well as HF associated with ILD.

Zaurbek Aisanov,1 Sergey Avdeev,2 Vladimir Arkhipov,3 Andrey Belevskiy,1 Alexander Chuchalin,1 Igor Leshchenko,4 Svetlana Ovcharenko,5 Evgeny Shmelev,6 Marc Miravitlles7 1Department of Pulmonology, N.I. Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia, 2Clinical Department, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia, 3Clinical Pharmacology Department, RUDN University, 4Department of Phthisiology, Pulmonology and Thoracic Surgery, Ural State Medical University, Healthcare Ministry of Russia, Ekaterinburg, 5Internal Medicine Department No.1, I.M. Sechenov First Moscow State Medical University, Healthcare Ministry of Russia, 6Department of Differential Diagnostics, Federal Central Research Institute of Tuberculosis, Moscow, Russia; 7Pneumology Department, University Hospital Vall d’Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain Abstract: The high prevalence of COPD together with its high level of misdiagnosis and late diagnosis dictate the necessity for the development and implementation of clinical practice guidelines (CPGs) in order to improve the management of this disease. High-quality, evidence-based international CPGs need to be adapted to the particular situation of each country or region. A new version of the Russian Respiratory Society guidelines released at the end of 2016 was based on the proposal by Global Initiative for Obstructive Lung Disease but adapted to the characteristics of the Russian health system and included an algorithm of pharmacologic treatment of COPD. The proposed algorithm had to comply with the requirements of the Russian Ministry of Health to be included into the unified electronic rubricator, which required a balance between the level of information and the simplicity of the graphic design. This was achieved by: exclusion of the initial diagnostic process, grouping together the common pharmacologic and nonpharmacologic measures for all patients, and the decision not to use the letters A–D for simplicity and clarity. At all stages of the treatment algorithm, efficacy and safety have to be carefully assessed. Escalation and de-escalation is possible in the case of lack of or insufficient efficacy or safety issues. Bronchodilators should not be discontinued except in the case of significant side effects. At the same time, inhaled corticosteroid (ICS) withdrawal is not represented in the algorithm, because it was agreed that there is insufficient evidence to establish clear criteria for ICSs discontinuation. Finally, based on the Global Initiative for Obstructive Lung Disease statement, the proposed algorithm reflects and summarizes different approaches to the pharmacological treatment of COPD taking into account the reality of health care in the Russian Federation. Keywords: COPD, clinical guidelines, Russia, treatment algorithm

Background: Cardiovascular diseases are the most common comorbidities among patients with chronic lung diseases. Arterial stiffness (AS) is one of the most potent prognostic factors of cardiovascular morbidity and mortality. However, there is very little literature describing the factors associated with the increase of AS among patients with chronic hypersensitivity pneumonitis (HP). Aims and Objectives: were to investigate arterial stiffness and determine factors associated with its increase among patients with HP. Methods: We identified 106 patients with chronic HP, who underwent spirometry, plethysmography, diffusing capacity of carbon monoxide (DLCO), pulmonary high resolution computed tomography (HRCT), bronchoscopy and lung biopsy. AS was measured by pulse wave velocity (PWV). BMI, the duration of HP and the exacerbations frequency were evaluated. Results: The increase of arterial stiffness was found in 71 (67%) of patients. Correlation analysis adjusted for age showed a significant correlation between PWV and DLCO, the extent of lung fibrosis (LF) on HRCT (p Conclusions: The increase of arterial stiffness is associated with the extent of lung fibrosis on HRCT, diffusion disturbance, and frequency of exacerbations among patients with chronic hypersensitivity pneumonitis.

The paper deals with interstitial lung diseases in children. It gives an update and the results of the authors’ observations of different forms of interstitial lung diseases. Particular emphasis is placed on hypersensitive pneumonitis as the most common nosological entity among childhood interstitial lung diseases. The authors followed up 186 children with hypersensitive pneumonitis. They present the most important clinical, functional, radiological, and immunological diagnostic signs of this disease and consider its prognosis. In addition, there is evidence for other rare forms of interstitial lung diseases (idiopathic interstitial pneumonia, idiopathic pulmonary hemosiderosis, etc.) in children.

UDC 621.391.822 In this work, we study the spectrum SiD of natural (thermal and shot) current noise of the p-n junction and the Schottky barrier in the case where their current-voltage characteristic has a nonideality coefficient η exceeding unity. The results obtained with the help of a special experimental setup are presented and explained using an equivalent scheme, which takes into account the presence of the series resistance of the diode base and contacts, as well as the possibility of existence of the leakage current. It is theoretically proven and experimentally confirmed that the van der Ziel relation SiD =2 q (ID +2 Is), which is used for calculating the current-noise spectrum of an “ideal” junction with η =1 , cannot be used for η> 1 (here, q is the elementary charge, ID is the current across the junction, and Is is the junction saturation current). The previously obtained results are generalized using the Gupta theorem for the thermal-noise spectrum in the nonlinear resistive systems and are confirmed experimentally. It is found that the noise-current spectrum is given by the formula SiD =( 2 q/η )( ID +2 Is), which is a modification of the van der Ziel relation for the case of an arbitrary value of the nonideality coefficient. The obtained formula for SiD is experimentally tested by measuring the noise spectrum of the δ-doped Schottky diode, which is in thermodynamic equilibrium with the surrounding medium.

Idiopathic pulmonary fibrosis (IPF) is a severe lung disease, with death occurring within 2-5 years after its onset. IPF affects people in the second half of life. Its causes are unknown. Before 1999, IPF was out from the group of idiopathic interstitial lung diseases as a separate nosological entity. Practitioners very often (80%) make diagnostic errors in IPF and prescribe antibiotics, anti-inflammatory drugs, which worsen the course of this disease. The distinctive feature of the pathogenesis of IPF is the absence of inflammation, which is clinically manifested by the inefficacy of glucocorticosteroids and other anti-inflammatory drugs. Pharmacological agents for the treatment of IPF have been designed since 2000. One of them has been registered and permitted for use in the Russian Federation. This paper is a review of an update on the problem of IPF, which should facilitate the appropriate orientation of physicians in diagnosing and treating this severe disease.Идиопатический фиброз легких (ИФЛ) - тяжелое заболевание легких со смертельным исходом в течение 2-5 лет от начала болезни. ИФЛ поражает людей во второй половине жизни. Причины ИФЛ неизвестны. До 1999 г. ИЛФ выделен из группы идиопатических интерстициальных болезней легких в отдельную нозологическую форму. Практикующие врачи очень часто (до 80%) допускают диагностические ошибки при ИФЛ и назначают антибиотики, противовоспалительные средства, усугубляющие течение заболевания. Отличительная черта патогенеза ИФЛ - отсутствие воспаления, что клинически проявляется неэффективностью глюкокортикостероидов и других противовоспалительных средств. Начиная с 2000 г. разрабатываются фармакологические средства для лечения ИФЛ. Один из них зарегистрирован и разрешен к применению в Российской Федерации. Настоящая статья представляет обзор современных данных по проблеме ИФЛ, что должно способствовать правильной ориентации врачей в проблемах диагностики и лечения этого тяжелого заболевания.

AIM: To evaluate the efficiency of stepwise treatment in patients with isolated thermal inhalation injury (TIJ)/MATERIAL AND METHODS: The study enrolled 101 patients with isolated TIJ. A study group (n=56) was treated at the Pulmonology Department after managing at the Burn Center (BC); a control group (n=45) received no systematic treatment after discharging from BC. The magnitude of respiratory symptoms (according to the rating system) and external respiratory function (ERF) was evaluated and fibrobronchoscopy was made in all the included patients at their discharge from BC. On admission to the Pulmonology Department, the study group patients underwent evaluation of the magnitude of respiratory symptoms, EFR, and lung diffusing capacity, determination of blood gas composition and exercise tolerance, and chest computed tomography. Respiratory symptoms, ERF, and exercise tolerance were evaluated in all the included patients one month after hospital discharge/RESULTS: Examination at the Pulmonology Department established preserved respiratory manifestations in patients who had to continue therapy. The use of Β2-agonists or inhaled steroids used in combination or alone need, mucoregulators or antibiotics revealed the efficiency of a stepwise approach to managing patients with TIJ/CONCLUSION: There is evidence that it is expedient to perform two-stage treatment in patients with TIJ, by transferring them from BC to a specialized pulmonology hospital, which substantially enhances the efficiency of medical care for this contingent of patients.

The lecture analyses current tools of anti-inflammatory treatment of patients with chronic obstructive pulmonary disease (COPD). Anti-inflammatory treatment is aimed at a key element of COPD pathogenesis. The results of treatment with main anti-inflammatory drugs and methods in COPD management are reviewed as well as efficacy of a new anti-inflammatory drug roflumilast in COPD patients.

The article characterizes current strategy of treatment of chronic obstructive pulmonary disease (COPD), contains epidemiological data, draws attention to various phenotypes of COPD which determine individual approach to therapy. Individual treatment programs must consider stage of the disease, its progression, comorbid pathology. Pharmacological and non-pharmacological treatment methods are outlined. It is important to give therapists advanced training in COPD diagnosis and treatment.

Aim. To obtain objective information on the quality of pulmonological outpatient care for patients living in the North Administrative District (NAD) of Moscow; to propose methods of this care improvement. Material and methods. An epidemiological study of Moscow NAD population was made to detect respiratory diseases, to assess qualification of district physicians in management of most prevalent chronic diseases of the respiratory system: bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD). Results. The epidemiological study has revealed standard errors of district physicians in management of BA and COPD patients. Effective measures on reduction of the typical mistakes are proposed. Conclusion. More active detection of respiratory diseases in Moscow population is recommended.

Recent guidelines define chronic obstructive pulmonary disease (COPD) as a preventable and treatable disease characterized by airflow limitation and systemic consequences. Airflow limitation in COPD worsens over years as assessed by FEV1 . Parametric and nonparametric statistic techniques were used to analyze prognostic influence of acute exacerbations of COPD, smoking, compliance, and type of treatment on forced spirometric parameters in a cohort of 191 consecutive patients with COPD and chronic bronchitis followed up during 1, 2, 3, 4, 5, and 6-7 years. This study showed that acute exacerbations of COPD, smoking, and low compliance have negative impact on the patient's prognosis. We conclude that deterioration of health status in patients with COPD and chronic bronchitis could be reduced by the treatment adherence to the GOLD guidelines, smoking cessation and improvement in the patient's compliance.

Comparison of the state of 83 patients with histologically confirmed sarcoidosis observed with a 10 year interval revealed remission in 47% of the cases. The main factors having negative effect on prognosis of the disease included extrapulmonary symptoms, the use ofcorticosteroids (at all stages, especially at stage I and in Lofgren syndrome) and antituberculosis drugs, positive TB test. Risk factors of relapses were stage II sarcoidosis, the use of systemic corticosteroids in patients with Lofgren syndrome and antituberculosis drugs, initially low FEV1/FVLC ratio and the number of lymphocytes in peripheral blood.

The aim of this study was to assess efficacy of the antiinflammatory drug fenspirid (Erespal) in patients with stable COPD. The study was opened, comparative, randomized, multicentre and involved 84 patients with 2 stage stable COPD from 7 Russian medical centres. The patients were randomly divided in 2 groups: the study group (42 patients) received Erespal during 6 months additionally to the standard therapy, the comparative group (42 patients) received the standard therapy only which included ipratropium bromide (Atrovent) 2 doses twice daily and salbutamol as needed. Significant improvement in cough severity (p = 0.004), need in salbutamol (p = 0.023). and FEV1 (p = 0.012) was noted in the Erespal group by the end of the study period. These parameters also improved in the comparative group but with no statistical significance. The exacerbation rate was lower in the Erespal group but the difference was not significant. Quality of life improved in all the parameters in the Erespal group and only in psychical health in the comparative group. Therefore, Erespal allows improving cough severity, need in salbutamol, and quality of life, slowing FEV1 decline. The rate of side effects while using Erespal is similar to the standard therapy. The results show reasonability of basic administration of Erespal in stable 2 stage COPD patients.

This study was designed to investigate long term treatment effects of short acting bronchodilators on respiratory symptoms, lung function, and the mean pulmonary artery pressure (mPAP) in patients with chronic obstructive pulmonary disease (COPD) and COPD combined with asthma (COPD + BA). The study involved 14 COPD patients and 16 COPD+BA patients, males and females (the average age, 60 yrs) with moderate to severe disease and the mPAP higher than 20 mm Hg. Clinical examination with scoring of cough, sputum, dyspnea, and lung auscultation signs; spirometry, ECG, echocardiography, chest X ray, and blood analysis were used. Clinical status and lung function were evaluated primarily and in 4, 12, and 24 wks; the mPAP was measured initially and in 12 and 24 wks. Before the study no one patient received persistent supporting therapy with bronchodilators, 15 COPD + BA patients and 7 COPD patients were given inhaled steroids. Persistent therapy of all the patients with Berodual 2 doses 4 times daily for 24 wks resulted in improvement in the clinical symptoms and lung function parameters, reduction in mPAP in both the groups but the results were better and they were reached faster in the patients with combined pathology. Thus, the regularly combined therapy with short acting β2 agonists and anticholinergics (Berodual) can be included in the algorithm of therapy of pulmonary hypertension in patients with COPD and COPD + BA.

The efficacy and safety of almitrine bismesylate treatment was assessed in COPD patients in 6 month open prospective multicentre trial. 77 COPD patients with moderate hypoxemia were included (males / females — 57 / 20, mean age 63.2 ± 9.7 years; mean FEV1 0.95 ± 0.38 L, mean PaO2 63.3 ± 5.4 mmHg, mean PaСO2 44.1 ± 7.3 mmHg). We used an intermittent regime of almitrine administration: 1 mg / kg / day, for 3 months, then a "window" of 1 month, and again active therapy for 2 months. Almitrine therapy resulted in improvement of РаО2: rise after 1 month to 71.5 ± 10.6 mmHg, after 3 month — to 70.3 ± 8.3 mmHg, and after 6 month — to 72.5 ± 14.2 mmHg (р < 0.001). There was a significant fall in dyspnea during daily life activities (MRC score): from 3.5 ± 0.9 to 3.0 ± 0.9 (1 month), 2.8 ± 0.9 (3 month), 2.6 ± 0.7 (6 month) (р < 0.001). The distance during 6 minute walk test (6 MWT) increased from 334 ± 108 m to 371 ± 101 m (1 month), 377 ± 88 m (3 month), 398 ± 104 m (6 month) (р < 0.001). The levels of desaturation and Borg dyspnea score during 6 MWT significantly decreased (both р < 0.001). During almitrine treatment an improvement in almost all domains of SF 36 quality of life questionnaire was noted. 58 COPD patients completed the study. The most common adverse effects were parasthesia (6.4 %) and worsening of dyspnea (5 %), pulmonary artery pressure did not change during study. Conclusions: almitrine treatment in COPD patients with moderate hypoxemia resulted in improvement of arterial oxygenation, reduction of dyspnea during daily life activities and exercise, increase of physical capacity and improvement of health related quality of life.