Background: mortality from chronic obstructive pulmonary disease (COPD) is increasing worldwide. The prognosis of a COPD patient's life largely depends on the presence of concomitant conditions, primarily diseases of the cardiovascular system. Aim: to analyze the fatal outcomes of COPD in 2022–2024 in St. Petersburg. Materials and Methods: statistical data on mortality from COPD in St. Petersburg for 2022–2024 were studied. Besides, 159 medical records and protocols of pathoanatomical autopsies of patients hospitalized with COPD who died in 2023 were analyzed. Results: in 2022 in St. Petersburg, COPD caused the fatal outcome of 165 people (0.27% of the total urban mortality structure), in 2023 — 252 (0.44%), in January and February 2024 — 78 (0.63%). During the same period, chronic coronary artery disease (CCAD) became more commonly mentioned as a concomitant disease in deceased patients with COPD: in 2022, 44.8% of patients, in 2023 — in 62.3%, in January and February 2024 — in 74.4%. Based on the analysis of medical records of 159 deceased patients, an expert group determined that in 53 cases, COPD either was not the cause of death, which occurred due to cardiovascular or oncological diseases, or was not confirmed upon expert evaluation. In 56 patients, the role of the respiratory disease was deemed primary, while in 50 cases, the severity of COPD and concurrent pathologies were comparable, preventing the experts from reaching a definitive conclusion regarding the cause of death. Overdiagnosis of COPD as the cause of death could be facilitated by the fact that the rate of payment for hospitalization under compulsory health insurance (CHI) for patients with COPD was higher than for patients with CCAD. Conclusions: in a significant part of the reviewed cases, COPD was not the main cause of death or its diagnosis was not justified. One of the conditions for improving the correctness of the disease diagnosis and the causes of fatal outcomes may be the pricing policy improvement of the CHI, which would make the estimation of the main diagnosis independent of economic factors. KEYWORDS: COPD, mortality from COPD, concomitant diseases in patients with COPD, mortality from chronic coronary heart disease, overdiagnosis of COPD, compulsory medical insurance. FOR CITATION: Titova O.N., Kuzubova N.A., Kozyrev A.G., Dvorakovskaya I.V., Chermenskii A.G. Analysis of the fatal outcomes due to chronic obstructive pulmonary disease in St. Petersburg. Russian Medical Inquiry. 2024;8(8):447–452 (in Russ.). DOI: 10.32364/2587- 6821-2024-8-8-1.

25 patients with CF and 20 with others of COPD were examinated. Ciliary beat was measured by a lifetime TV microscopy of bioptates of respiratory mucous. Material was obtained with the help of brush biopsy during fiberoptic bronchoscopy. The image of ciliary beat from a light microscope was recorded on the hard disk of the personal computer. The specially created program estimated ciliary beat frequency (CBF) and amplitude of ciliary beating. CBF into bronchi of the CF patients have made at impact phase – 6.3+0.33 Hz, raising phase – 5.7+0.36 Hz; in the patients with COPD: 6.5+0.32 Hz and 6.2+0.33 Hz accordingly. The precise tendency to a drop of CBF and amplitude of ciliary beating in the patients with CF on a comparison with the patients with COPD and literary datas was marked. Also, the drop of indexes of beating in the patients with Ps.aeruginosae mucoid were marked.

The article considers the incidence, mortality and in-hospital mortality rates from community-acquired pneumonia in St. Petersburg, 2009-2016. Epidemiological characteristics were studied in comparison with values in Russian Federation, as well as levels in Moscow and the Northwestern Federal District. The relationship between incidence and mortality rates from community-acquired pneumonia and epidemics of influenza was demonstrated. After the analysis of the medical records of patients who died of community-acquired pneumonia, defects in the organization of medical care, which had a negative prognostic impact, were indicated. A series of measures was proposed to improve the situation with community-acquired pneumonia in St. Petersburg.

This review discusses alpha - 1 - antitripsin (AAT) deficiency that is a wide - spread autosomal - recessive monogenic enzymopathy related to PI gene mutations. The most serious injury related to AAT deficiency is primary emphysema. A role of AAT for normal growth and functioning of the lungs as well as for occurrence of various structural and functional disorders is reviewed in the articles. The authors' own findings about AAT deficiency prevalence in Russian population are also shown. Clinical features of AAT deficiency and diagnostic methods are described. Finally, a clinical report of primary pulmonary emphysema due to congenital AAT deficiency is demonstrated.

An analysis of examination and treatment results was made in 123 patients with generalized emphysema of the lungs and respiratory failure of II-III degree. The patients were divided into two groups according to the age: younger than 40 years old (group A - 9 patients),40 years old and older (group B - 114). A surgical reduction of lung volume was performed to correct the respiratory failure in 69 patients. The rate of postoperative complications consisted of 14.7% in group A and it was 42.2% in group B.

In 13 cystic fibrosis (CF) patients of 5 to 23 years of age with a known mutation spectrum of gene CFTR, sweat chloride values and nasal-potential differences (NPD) were measured and localization characteristics of the protein product of gene CFTR in the cells of nasal epithelium were studied. Sweat Chloride values were normal or boundary (24 to 62 mM/l) in six CF patients. In seven CF patients, these values were significantly above the estimates for the control group. On average, the NPD values were -44.7 +/- 2.2 mV (from -32.5 to -68.9 mV) and -17.2 +/- 1.8 mV (from -6.8 to -30.2 mV) in CF patients and the control group, respectively. Histochemical studies clearly revealed the localization of the CFTR protein on the apical membrane of the nasal epithelium. Depending on the type of mutation, the protein product of gene CFTR was either absent or regularly distributed in the cytoplasm in CF patients; it was not detected in the apical membrane. Thus, NPD measurements and the analysis of the localization of the protein product of gene CFTR in scrapes of nasal epithelium were shown to be additional, highly informative methods of CF diagnostics.