In the third part of the article, the bronchodilation tests methodology was considered: indications, contraindications, test procedure, interpretation. The methods of the bronchodilatory response assessing were considered, the differences between modern Russian recommendations and ERS/ATS interpretive strategies the bronchodilatory response assessing were shown. The specifics of the test procedure and evaluation of bronchodilation tests in children were described separately

The article discusses the use of methods for assessing lung respiratory function in patients with chronic obstructive pulmonary disease (COPD) and smokers. The aim of the study is a comparative evaluation of the informative value of capnometry, spirometry, multiple breath nitrogen washout method, and diffusion test in patients with COPD, as well as an early detection of respiratory function impairment in smokers. Results. Three groups of patients were examined: 1st — 30 patients with moderately severe COPD, average age 50.6 ± 4.3 years, 2nd — 30 smokers, average age 45.6 ± 2.4 years, 3rd (control group) — 30 practically healthy non-smokers, average age 45.6 ± 2.4 years. Capnometry showed a statistically significant increase in the slope of the alveolar phase in patients with COPD compared to the control group and smokers at rest, both before and after bronchodilator use. Significant differences between smokers and control groups were detected during forced exhalation. According to spirometry data, the FEV1/FVC ratio in patients with COPD was statistically significantly lower compared to the control group and smokers, both before and after bronchodilator use. Diffusion capacity was significantly lower in patients with COPD and smokers compared to the control group. The lung clearance index was significantly higher in the COPD group compared to the other two groups. Conclusions. All the mentioned methods were informative in patients with COPD, but capnometry and lung diffusion capacity assessment were sensitive methods in smokers, revealing uneven distribution of ventilation-perfusion ratios in the lungs and impaired gas exchange function.

The second part of the article discusses the spirometry interpretation using the latest international and national recommendations. Different systems of predicted values were considered, attention was paid to the GLI‑2012 reference equations advantages and the z-score assessment. The severity classification, obstructive disorders, extrathoracic and intrathoracic airway obstruction and possible spirometry indications of restrictive and mixed ventilation disorders were considered. The algorithm for spirometry evaluation was also presented, and the most common errors in the spirometry interpretation were discussed.

Improved approaches to quality assurance have led to the need to update the technical standards of spirometry taking into account modern technical capabilities. The aim of the study is to present updated recommendations on spirometry with explanations and additions that are important for everyday work in practical healthcare. Analysis of documents on technical standards of spirometry developed by an joint task force of specialists with expertise in conducting and analyzing lung function tests and ensuring laboratory quality, appointed by the Russian Respiratory Society, the Russian Association of Functional Diagnostics Specialists, the Russian Scientific Medical Society of Therapists, as well as a joint group of the American Thoracic Society and the European Respiratory Society. The 1st part presents sections on indications and contraindications to spirometry; technical conditions of the procedure, including infection control; methods of spirometry; describes the main indicators and criteria for the quality of the study. The implementation of the presented standards and consensus recommendations for clinicians, operators and researchers is necessary for improving the accuracy of spirometric measurements and the patient experience.

Russian Society of Cardiology (RSC) Developed with the special contribution of the Russian Functional Diagnostics Association, Russian Holter Monitoring and Non-invasive Electrophysiology Society, Russian Pediatric Cardiology Association.

Spirometry is the most common method to assess respiratory function. It is widely used to obtain objective information for the diagnosis of respiratory diseases and monitoring the functional state of the respiratory system. In 2014, the Russian Respiratory Society approved the technical standards for performing spirometry. Improvements in measuring devices have necessitated updating technical standards and standardizing the result interpretation algorithm. Methods. This document on spirometry was prepared by a joint group of experts from the Russian Respiratory Society and the Russian Association of Specialists in Functional Diagnostics, who have experience in performing spirometry in accordance with quality criteria, analyzing the results of the study, and developing national standards. Results. The 2014 Spirometry Technical Standards were revised, including the addition of quality criteria for measurements and test quality assessment. Where necessary, evidence was provided to support the change. The experience and knowledge of the expert group members were used to develop these recommendations. Conclusion. Standards for spirometry and bronchodilator test and the result interpretation algorithm are presented to improve the measurement quality and consistency of data interpretation.

The article discusses the possibilities of functional assessment of the state of the respiratory function of the lungs in patients with bronchial asthma.The purpose of the study: a comparative assessment of the information content of capnometry, spirometry, the method of multiple breath nitrogen washout and the diffusion test in patients with asthma.Results and conclusions: 2 groups of patients were examined: I — 30 patients with asthma of 3–4 degrees of severity, II — 30 healthy volunteers. Capnometry showed a statistically significant increase in the slope of the alveolar phase in patients with asthma compared to the control group with quiet breathing, both before and after the use of a bronchodilator. According to spirometry data, in patients, the FEV1 /FVC ratio was statistically significantly lower compared to the control group, both before and after bronchodilator use. In a comparative analysis of the diffusion capacity of the lungs, there was a trend towards lower DLCO values in patients with asthma. A statistically significant difference was obtained in relation to the lung clearance index between the group of patients with asthma and the control group, in which the index was significantly lower. There were no statistically significant differences between the FRC (%) estimates obtained using the diffusion test and the method of the multiple breath nitrogen washout in patients with asthma. Thus, the informative methods in patients with asthma were not only the method of spirometry, but also the method of capnometry and the method of multiple breath nitrogen washout, which revealed uneven ventilation and distribution of ventilation-perfusion ratios in the lungs.

Tuberculosis sequelae are very common after successful treatment of the disease. Airflow obstruction and restrictive impairment develop alongside with the changes. High prevalence of pulmonary impairment in patients with tuberculosis sequelae shows that lung function study and pulmonary rehabilitation should be performed. Malnutrition is very common among TB patients. The review deals with the methods of rehabilitation, which include physical training and nutritional status correction.

The exercise ECG test is traditionally the first choice in patients with suspected CHD, as the most accessible, despite the fact that its sensitivity and specificity are 68 % and 77 %, respectively. Description of a clinical case of multivessel coronary artery disease in a patient with a negative result of exercise ECG test is presented.

The analysis of the differences in the spirometry estimation using different predicted values systems (Clement R.F., ECSC-1993, Knudson R.J, and GLI2012) have been made. The predicted values for volume indicators (FVC and FEV1) calculated using the GLI-2012 system were higher than those of the first three systems, while the flow indicators (FEF25-75 and MEF75), on the contrary, were lower. This difference has led to a different assessment of deviation of normal when using different predicted values systems. This is especially true when the values are near the evaluated areas borders.

Allocation of three levels of an echocardiography with corresponding levels of algorithms for optimum integration into multilevel diagnostic process is offered. Express, clinical and expert division corresponds to preventive, standard medical-diagnostic and highly technological directions of public health services. Three-level gradation should not cause decrease in its quality at the expense of the differentiated direction of conditionally healthy faces — on screening, the diseased — on clinical, cardiological patients — on expert ultrasonic cardiac diagnostics.

The ECG stress test allows to determine possible presence of obstructive coronary atherosclerosis. The more severe the atherosclerotic lesion of coronary arteries the more likely a ST segment depression during the stress test. The article provides a description of a negative result of a stress test in a patient with multivessel coronary disease.

Spirometry is the basic method for pulmonary function evaluating but it is very dependent on the quality of performance. Currently, specialists in lung function diagnostics rely on the 2005 technical standards of spirometry, jointly developed by the American thoracic Society (ATS) and the European Respiratory Society (ERS), adapted for our country by the Russian Respiratory Society in 2013. New technical capabilities and research studies have shown the need to improve approaches to ensuring the measurements quality. A joint task force with experience in conducting and analyzing pulmonary functional tests assigned by the ATS and ERS has significantly updated international standards to ensure quality laboratory practice. The article discusses the standards update by the 2019 consensus, as well as the new added factors that were not previously mentioned. New standards are needed for manufacturers, clinicians, functional diagnostics specialists and researchers in order to increase the accuracy of spirometric measurements and reduce the negative impact on the patient.

The majority of errors committed during spirometry results in the lower values of test results. The objective: to compare spirometry results obtained when using standard criteria of American Thoracic Society / European Respiratory Society and visual quality control. Subjects and methods. Spirometry was performed twice in 62 patients using different quality control methods. Bland – Altman method was used for statistic analysis. Results. The values of forced volume vital capacity (FVL) and forced expiratory volume during the 1st second (FEV1) were higher when using standard criteria compared to visual quality control. The mean difference in FVL made 0.40 ± 0.28 L and in FEV1 – 0.07 ± 0.21 L.Conclusion. Using the standard criteria during spirometry can significantly improve the quality of the test and prevent errors.

The early signs of bronchial obstruction in smokers - obstruction of the small airways are discussed in the article. It is shown that the more informative spirometric signs of distal obstruction are flow measured at the end of the flow-volume curve and FEF25-75 versus FEV1, FVC and FEV1/ FVC. Diagnostic value of capnometry and nitrogen washout test are shown, which make the possibility to identify changes of the respiratory zone and small airways obstruction with normal spirometric values.

In most case, lung lesions of different character and extent remain after successful treatment of pulmonary tuberculosis. High tuberculosis morbidity contributes to increasing numbers of patients with post-tuberculosis abnormalities. Pulmonary tuberculosis or its consequences could cause consistent changes of the lung function. Lung function abnormalities in patients survived pulmonary tuberculosis have been reviewed In this article. A high prevalence of such cases provides the need in spirometric testing. Routine identification of patients with post-tuberculosis pulmonary impairment requires revision of recommendations for spirometry use in tuberculosis patients.

The article deals with the organization of work of nurses in the departments and cabinets of functional diagnostics. The issues of education of nurses are considered, essential documents regulating the work of nurses of departments (cabinets) of functional diagnostics are given.

In most case, lung lesions of different character and extent remain after successful treatment of pulmonary tuberculosis. High tuberculosis morbidity contributes to increasing numbers of patients with post-tuberculosis abnormalities. Pulmonary tuberculosis or its consequences could cause consistent changes of the lung function. Lung function abnormalities in patients survived pulmonary tuberculosis have been reviewed In this article. A high prevalence of such cases provides the need in spirometric testing. Routine identification of patients with post-tuberculosis pulmonary impairment requires revision of recommendations for spirometry use in tuberculosis patients.

Goal: to evaluate the life quality of patients cured of pulmonary tuberculosis. All patients had spirometry done. The life quality was assessed with the help of St. George's Respiratory Questionnaire (SGRQ) for respiratory function evaluation. Average values for all questions of St. George's Respiratory Questionnaire was lower compared to those healthy even in the patients with normal respiratory function. Data of St. George's Respiratory Questionnaire had statistically confident correlation with spirometry rates, high co-efficient of test-retest correlation and agreement. Therefore St. George's Respiratory Questionnaire is a true and reliable tool for life quality evaluation of patients cured of pulmonary tuberculosis. The main factors providing impact on life quality were respiratory function disorders and severity of dyspnea.