Chronic obstructive pulmonary disease (COPD) is a progressing disease. Each exacerbation impairs the patient’s prognosis and increases burden for the healthcare system. The most common maintenance treatment options for COPD include long-acting bronchodilators – β2-agonists (LABA) and long-acting antimuscarinic agents (LAMA), and inhaled glucocorticosteroids (ICS), in fixed/opened double and triple combinations. Triple therapy in subjects with exacerbation history is the most effective way to prevent negative outcomes of the disease. It can reduce the frequency of exacerbations, slow down the disease progression, improve quality of life, and reduce mortality in the long run. On the other hand, the response to triple therapy may change over the time depending on airways inflammation level, infection activity, and exacerbation frequency. Current COPD guidelines propose different indications for therapy escalation and de-escalation (ICS addition/withdrawal) for more personalized and safe treatment. At the same time, many practical issues of this process are still unclear, e.g. how often treatment regimens should be reviewed and what escalation/de-escalation criteria should be prioritized. The authors strongly believe that COPD therapy should adapt a holistic treatment approach (continuum) with quick responses to any changes in the patient’s condition.The aim of our work was to create an algorithm for ICS administration/ withdrawal for COPD patients on long-acting dual bronchodilators maintenance therapy and to establish a therapeutic continuum that takes into account exacerbation history, symptoms severity, blood eosinophilia level, and concomitant asthma.Conclusion. This instrument can be a useful and convenient tool for long-term patient management when access to specialized medical care might be restricted. It takes into account the main current recommendations for COPD management and is easy to apply in real clinical practice.

In this work, we investigate the preconditioning action of various modes of pulsed magnetic field (PMF) on the blood biochemical parameters of rats exposed to adrenal toxemia. PMF was shown to trigger adaptive response; however, its rate can differ depending on the selected PMF mode. The possibility of using low-frequency PMF as a protector of stress-induced conditions caused by adrenal toxemia is demonstrated.

The development of new methods for diagnosing infectious diseases, such as polymerase chain reaction, sequencing, and mass spectrometry, has made it possible to expand our understanding of the microflora of the human body in general and of the respiratory tract in particular. The most common microorganisms in lungs include Proteobacteria (Pseudomonas spp., Haemophilus spp.), Bacteriodetes (Prevotella spp., Porphyromonas spp.) and Firmicutes (Veillonella spp., Streptococcus spp.). Pathological processes in the lower respiratory tract change the microbiome. Consequently, Moraxella, Haemophilus, and Acinetobacter microorganisms are found in patients with chronic obstructive pulmonary disease. The main causative agents of community-acquired pneumonia include Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Klebsiella pneumoniae and other enterobacteria. Atypical causative agents of pneumonia include Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila. The wide prevalence of S. pneumoniae in the population confirms the need for vaccines to prevent the development of invasive and noninvasive forms of infection. The aim of the study was to analyze literature data on the structure of the normal microflora of the lung and to investigate its role in the development of pathological conditions. Conclusion . A growing body of research confirms the important role of the normal microflora of the respiratory tract. Vaccination against diseases of the bronchopulmonary system may reduce the incidence and mortality of pneumonia. However, the problem of community-acquired pneumonia is still relevant. In particular, the changes in the structure of the pathogens of this disease is of great interest. Vaccination against respiratory pathogens in combination with uncontrolled use of antibiotics during the pandemic of the new coronavirus infection could contribute to a change in the structure of both the lower respiratory microflora in general and the pathogens of bacterial community-acquired pneumonia in particular. The detection of a change in the predominant pathogen calls for revising etiotropic treatment and organizing planned prophylaxis if the appropriate vaccines are available.

Chronic obstructive pulmonary disease (COPD) is a serious problem for global health. Infectious agents play a main role in the development of COPD exacerbations. Bacterial colonization of the lower respiratory tract is common in patients with stable COPD. The role of microbiota and host immune response to potential pathogens is not well studied. Microbiota composition disorders in respiratory tract are found in patients with COPD and associated with maladaptive changes in the immune system of the lungs and increased level of inflammation. This review investigates role of microbiota in the pathogenesis of COPD and its impact on the course of the disease. Some important issues such as pneumococcal vaccination and antimicrobial resistance of respiratory pathogens are also discussed.

The frequency of exacerbations of chronic obstructive pulmonary disease (COPD) is one of the main factors determining the outcome. The search for biomarkers which reflect the risk of exacerbations is one of the urgent scientific and practical objectives. Aim. The study aimed to analyze the relationship between the serum concentration of hyaluronic acid (HA) and the frequency of exacerbations of occupational COPD caused by exposure to silica dust and to substantiate the use of HA as a predictor of exacerbations of COPD. Methods. 78 individuals with a diagnosis of occupational COPD were examined. Respiratory function was assessed based on forced vital capacity of the lungs (FVC, %), the forced expiratory volume in 1 second (FEV1, %) and the calculated ratio of these parameters (FEV1/FVC, %), i.e., modified Tiffno index. The serum concentration of hyaluronic acid (ng/ml) was determined in all individuals using solid-phase enzyme-linked immunosorbent assay (ELISA). The absolute blood level of eosinophils (cell/μl) was determined by a unified method of morphological study of hemocytes with white blood cell differential count. Results. Serum HA concentration in patients with occupational COPD with frequent exacerbations was 25% higher than in the patients with rare exacerbations (the difference was statistically significant; р = 0,004). The analysis of the obtained data showed that the most significant moderate correlation was found between the level of HA and the frequency of COPD exacerbations (direct relationship, r = 0.32; p < 0.05), and FEV1 and the frequency of COPD exacerbations (feedback, r = -0.32;p < 0.05). A weak relationship was found between the relative number of eosinophils and the frequency of COPD exacerbations (direct relationship, r = 0.2; p < 0.05). Weak correlations were also found between the level of HA and FEV1 (feedback, r = -0.23; p < 0.05), between the level of HA and the relative number of eosinophils (direct relationship, r = 0.18; p < 0.05). Conclusion. Quantitative analysis of serum HA in patients with occupational COPD can be used in clinical practice as a biochemical marker for assessing the risk of exacerbations and progression of bronchopulmonary pathology.

The role of low-density oxidized lipoproteins (OxLDL) in the pathogenesis of occupational chronic obstructive pulmonary disease (COPD) is not understood well enough.The study aims to determine the serum levels of oxidized low-density lipoproteins and their relationship with lipid profile, the level of oxidative stress and level C-reactive protein in patients with occupational chronic obstructive pulmonary disease.Methods. 116 patients diagnosed with occupational COPD and 25 patients with no respiratory diseases (comparison group) were examined. Serum levels of OxLDL was determined by solid phase enzyme-linked immunosorbent assay (ELISA) using the commercial reagent kit MDA-oxLDL from Biomedica Gruppe, Austria.Results. Circulating OxLDL was detected in serum in a significant proportion of patients with stable occupational COPD. In most of the patients, the concentration of OxLDL was within the values observed in the comparison group or exceeded them by no more than two times. In the minority of patients with occupational COPD (16.5%), the concentration of OxLDL was high and 4 – 10 times higher than its average value in the comparison group. It can be assumed that the revealed differences in the concentration of OxLDL are due to the different degree and intensity of oxidation of low-density lipoproteins. The relationships between OxLDL and lipid metabolism, oxidative stress (OS), the antioxidant capacity of serum (AOS), and serum levels of C-reactive protein were described.Conclusion. Serum OxLDL levels in patients with occupational COPD, the relationship between OxLDL and lipid metabolism, oxidative stress, and inflammation will provide an expanded view of the pathogenetic aspects of occupational COPD.

The specific features of the course of chronic occupational bronchitis (OCB) and its relationships with occupational chronic obstructive pulmonary disease (OCOPD) have not been adequately investigated in the clinic of occupational pathology. The aim of the study was to study risk factors, clinical features and prognosis of chronic non-obstructive bronchitis. 222 patients (metal workers) with OCB and OCOPD were randomly selected for the study. The medical histories of diseases were studied from the initial diagnosis to the present status (in average the period of 10 years).Patients were divided into three groups: with the initial diagnosis of OCOPD (1), with the initial diagnosis of OCB, but transformed to OCOPD (2) and the patients with the initial diagnosis of OCB (3). Patients were divided into three groups: those initially diagnosed with COPD PE made up group No. 1, those initially diagnosed with CKD PE who did not show signs of COPD PE during the annual examination made up group No. 2, and those initially diagnosed with CKD PE who showed signs of COPD PE during the dynamic examination made up group No. 3. All groups showed a decrease in spirometry parameters. FEV1 was statistically significantly decreased by 12% in group 1, by 13% in the second group and by 27% in the third group. When analyzing modified Typhno index (MTI) values in group 3, there was a statistically significant decrease in MTI from baseline by 21% (p=0.002, Z = 2.9, Wilcoxon test). In 52 people out of 156 (or 34.6%) with the initial diagnosis of OCB, a manifestation of OCOPD occurred during the observation period. Two phenotypes of chronic bronchitis were distinguished: with favorable and unfavorable prognoses. Patients with OCB, after establishing a professional diagnosis, should be recommended to rational employment out of exposure to industrial aerosols, due to the high risk of disease progression.Funding. The study had no funding.Conflict of interests. The authors declare no conflict of interests.

Currently there is no convincing evidence concerning pathogenetic mechanisms of fibrous and sclerotic processes in pulmonary tissue as well as processes of bronchopulmonary system remodeling in patients with chronic obstructive pulmonary disease (COPD) of occupation etiology (OE).The purpose of the study was to identify relationship between the serum hyaluronic acid (HA) level and severity of obstructive pulmonary ventilation impairment according to spirometry data in subjects with COPD associated with the impact of silica-containing dust and chronic occupational non-obstructive (common) bronchitis (CONB) of occupational etiology.Materials and Methods. Patients (n = 153) with the diagnosis OE COPD (n = 92), OE CONB (n = 36) and healthy subjects participated in the study.Results. The study data demonstrated that serum HA level in patients with OE COPD and CONB was 3–5 times higher than that in healthy subjects (p = 0.0001). In patients with OE COPD HA concentration was significantly higher, than that in subjects with OE CONB (p = 0.039). Negative correlation between HA concentration and forced expiratory volume in 1 second value was observed (p = 0.006; R = –0.31). There was statistically significant positive correlation between HA level and disease duration (р = 0.021; R = 0.21).Conclusion. Serum HA level in patients with OE-related COPD and CONB may be used as a biomarker of fibrous and sclerotic process in pulmonary tissue, reflecting progression of obstruction and remodeling of small bronchi.

The aim of the study was to analyze the trends of spirometry changes in occupational chronic bronchitis patients during the period of 10 years. It was found out that in 34,1% of 158 patients had transformed into chronic obstructive pulmonary disease, regardless of the history of smoking.

On basis of approbation of volume sphygmography method in group of 89 workers underwent periodical medical examinations, analysis of modern scientific literature, and experience of clinical department of FBSI «Nizhny Novgorod research institute for hygiene and occupational pathology» to conduct medical examinations of workers exposed to hazardous and dangerous working conditions; the authors demonstrated informativeness and non-high laboriousness of volume sphygmography method for revealing of an increased vascular wall hardness as a risk factor for of cardio-vascular pathology.

The aim of the investigation is to study the efficacy of low frequency pulse magnetotherapy as part of complex treatment of patients with arterial hypertension in hospital period.Materials and methods. There were examined 70 patients of both sexes, aged 25-50 years with verified diagnosis of essential arterial hypertension, I and II degrees, with no complications and associated diseases. The duration of arterial hypertension was from 2 to 5 years. The main group (n=40) had antihypertensive therapy: beta-blockers, ACE (angiotensin converting enzyme) inhibitors, and low-frequency pulse magnetotherapy, while the control group (n=30) -similar antihypertensive therapy only.Results. There was stated positive effect of low-frequency pulsed magnet field with individually adjusted parameters when used as a part of complex therapy on heart rate variability in patients with arterial hypertension. These patients showed the regression of clinical manifestations of vegetative dysregualtion.

The aim of the investigation is to study the efficacy of low frequency pulse magnetotherapy as part of complex treatment of patients with arterial hypertension in hospital period. Materials and methods. There were examined 70 patients of both sexes, aged 25-50 years with verified diagnosis of essential arterial hypertension, I and II degrees, with no complications and associated diseases. The duration of arterial hypertension was from 2 to 5 years. The main group (n=40) had antihypertensive therapy: beta-blockers, ACE (angiotensin converting enzyme) inhibitors, and low-frequency pulse magnetotherapy, while the control group (n=30) similar antihypertensive therapy only. Results. There was stated positive effect of low-frequency pulsed magnet field with individually adjusted parameters when used as a part of complex therapy on heart rate variability in patients with arterial hypertension. These patients showed the regression of clinical manifestations of vegetative dysregualtion.

A new approach is proposed for the choice of low-frequency magnetic therapy on an individual basis using the results of analysis of heart rhythm variability. The clinical efficiency of low-frequency magnetic therapy incorporated in the combined treatment of 65 patients aged between 25 and 45 years with essential arterial hypertension was estimated. The statistically significant positive effects of the treatment included normalization of blood pressure and characteristics of heart rhythm variability as well as resolution of clinical symptoms of vegetative dysregulation.