The pioglitazone belongs to the class of antidiabetic medications and has various pleiotropic effects. The evidence base for this medication, based on the results of randomized clinical trials, demonstrates convincing cardio- and cerebroprotective efficacy of pioglitazone, comparable to innovative glucose-lowering drugs from the classes of GLP-1 agonists and SGLT-2 inhibitors. Currently, in Russia, a fixed combination of pioglitazone and alogliptin is available. However, it should be noted that there has been a recent lack of GLP-1 agonists on the domestic pharmaceutical market, which raises questions about the choice of further tactics for patients who have been taking them until recently.This clinical case presents an example of the transformation of glucose-lowering therapy from a combined treatment regimen with semaglutide and metformin to the combined use of a fixed combination of alogliptin and pioglitazone with empagliflozin. Against the background of therapy change, a stable and pronounced glucose-lowering effect was obtained and confirmed after six months, comparable to GLP-1 receptor agonists without the effect of escape and hypoglycemia. No edema or weight gain was observed, and no other adverse events were detected, which allowed continuing the chosen glucose-lowering therapy. Strategic perspectives of the prescribed therapy were determined — reducing cardio- and cerebrovascular risk and improving the patient’s prognosis.

The effects of short- and long-term administrations of dexamethasone on survival, severity of pulmonary edema, and hemostasis on experimental lipopolysaccharide-induced acute lung injury in rats were analyzed. Acute lung injury in rats was modeled by the intratracheal injection of lipopolysaccharide from the Salmonella enterica cell wall. White male rats were randomly divided into nine groups: the intact group consisted of 10 animals; two control groups of 20 animals each, in which acute lung injury was simulated without further treatment and removed from the experiment on day 3 or 7; six comparison groups of 20 animals each, in which, 3 h after modeling of acute lung injury and then once a day for 3 days (short mode of administration) or 7 days (long mode of administration), dexamethasone solution was administered intraperitoneally in the following doses: 0. 52 (equivalent to 6 mg/day for humans), 1. 71 (20 mg/day for humans), and 8 mg/kg/day (94 mg/day, pulse therapy for humans). On days 3 and 7, the survival rate, coagulogram values (active partial thromboplastin time, prothrombin time, activity of antithrombin, and soluble fibrin monomer complexes), and low-frequency piezotromboelastography data were assessed in the surviving animals. The results revealed that dexamethasone reduces mortality in acute lung injury and has a dose-dependent effect on the hemostasis system: with an increase in the dose administered, blood clotting processes increase and fibrinolysis is inhibited. Low-frequency piezothromboelastography with a conventional coagulogram allows for a comprehensive assessment of the hemostasis system, identifying violations, and timely drug correction.

Introduction. Given the increasing frequency of the association of gout and type 2 diabetes, it is necessary to study the impact of modern therapy on their course.Aim. To evaluate the influence of isolated and combined use of febuxostat and empagliflozin on metabolic parameters and inflammatory markers in patients with gout and type 2 diabetes.Materials and methods. The “OPORA” study included 120 men aged 40–65 years with the simultaneous presence of gout and type 2 diabetes. The subjects were randomized into 3 groups (n = 40): group 1 (F), receiving febuxostat 80 mg/day; group 2 (E) – empagliflozin 25 mg/day; group 3 (FE) – combination of drugs febuxostat 80 mg/day + empagliflozin 25 mg/day. The studied parameters were analyzed before the appointment of therapy and after 12 weeks of treatment.Results. The decrease in uric acid levels was most significant in group 1 (F) (Δ = 22.3%, p < 0.01). The most pronounced decrease in glucose levels was achieved in group 2 (E) (Δ = 32.2%, p < 0.01) and group 3 (FE) (Δ = 21.6%, p < 0.01). In group 3 (FE) a more significant decrease in insulin levels was revealed (Δ = 26.2%, p < 0.01) and HOMA-IR (Δ = 23.0%, p < 0.01) after 3 months. The most significant increase in the level of adiponectin and decrease in the level of leptin was noted in group 3 (FE), p < 0.01. The greatest effect in reducing indicators characterizing inflammation was observed in group 3 (PE) in the form of a significant decrease in the levels of ESR, CRP, TNF-a. After 12 weeks, a decrease in body weight of ~3 kg was noted in groups 2 (E) and 3 (FE).Conclusions. The combination of febuxostat and empagliflozin has an additive effect in positively influencing inflammatory markers and adiponectin levels, without mutual attenuation of urateand glucose-lowering effects.

Introduction. Systemic glucocorticoids have been successfully used in the treatment of patients with moderate to severe COVID-19. However, the best clinical efficacy dosage regimen and duration of glucocorticoid usage is remained unclear.Aim. To evaluate the results of using different regimens of systemic glucocorticoid therapy in the treatment of patients with moderate and severe COVID-19.Materials and methods. The results of a retrospective study of medical papers of 200 patients who had moderate to severe COVID-19 in the period from May 2020 to December 2021 are presented. The inclusion criterion was the use different regimens of doses and durations systemic glucocorticoid therapy in these patients without the use blockers of Janus kinases. and genetically engineered biological drugs. Clinical effectiveness was assessed by the severity and sufficiency of the anti-inflammatory effect, the frequency and nature of side effects of this therapy.Results. The regimen of glucocorticoids at a dose equivalent to 6 mg/day of dexamethasone for 7 days demonstrated the greatest clinical effectiveness: it significantly reduced C-reactive protein, hematological inflammatory indices,% lung tissue damage, minimally affecting carbohydrate metabolism and hemostasis. Glucocorticoid therapy equivalent to 20 mg/day of dexamethasone for more than 7 days and pulse-therapy for 3 days demonstrated significantly lower clinical effectiveness.Conclusions. In patients with moderate to severe COVID-19, it is reasonable to use a dose of glucocorticoid equivalent to 6 mg/day of dexamethasone for 7 to 10 days, or equivalent to 20 mg/day for no more than 7 days. The use of pulse therapy and the use of glucocorticoids at a dose equivalent to ≥ 20 mg/day of dexamethasone for a duration of 7 days are not recommended. To assess the dynamics of inflammation and monitor the effectiveness of glucorticoid therapy, in addition to routine markers of inflammation, it is recommended to use hematological inflammatory indices.

Aim. To evaluate the efficacy and safety of dexamethasone at various doses in an experimental model of direct acute lung injury (ALI). Materials and methods. The study was performed on 80 white outbred male rats, in which ALI was modeled by intratracheal administration of lipopolysaccharide. The animals were divided into 4 groups: the control group and three experimental groups (groups 1–3), where the animals were intraperitoneally administered dexamethasone at doses of 0.52, 1.71, and 8.00 mg / kg / day, respectively, for 3 days. A complete blood count, blood biochemistry test, and hemostatic tests were performed to assess the efficacy and safety of dexamethasone on day 3 of the experiment The severity of pulmonary edema was assessed by changes in the lung weight coefficient and the wet / dry weight ratio. Results. The use of dexamethasone in the ALI model increased the survival of rats in groups 1 and 2 by 35% ( p < 0.05), and in group 3 only by 20% compared with control animals. The rat lung weight coefficient and the wet / dry weight ratio when using dexamethasone at all doses studied were equally reduced by an average of 28% ( p < 0.05) and 17% ( p < 0.05), respectively ( p < 0.05). The severity of side effects of dexamethasone (hyperglycemia, hyperproteinemia, hyperkalemia, hypercoagulability, increased activity of creatine phosphokinase in the blood) was dose-dependent and was maximum in group 3 (dexamethasone dose 8.00 mg / kg / day). Conclusion. The effectiveness of both low (0.52 mg / kg / day) and high (8.00 mg / kg / day) doses of dexamethasone in an experimental model of ALI in rats is characterized by the same anti-edematous effect. Based on the results of the blood tests and the analysis of rat survival, the use of dexamethasone at the lowest dose (0.52 mg / kg / day) should be considered the safest.

Pneumonia is the most common and deadly nosology among all respiratory diseases associated with microorganisms. Despite advances in antibacterial and antiviral therapy, mortality due to pneumonia is not decreasing. It should be noted that the problem of infectious pathology has always been discussed only in narrow circles of specialists, which led to its underestimation, including during the pandemic of a new coronavirus infection. At present, scientific possibilities have not reached their perfection in the etiological diagnosis of pneumonia. Of no small concern is the lack of sections on immunology in the training program for general practitioners and pulmonologists and, as a result, the lack of knowledge by most medical specialists of the basics of the immune response in various infectious diseases, in particular, the differences in the immune response of a macroorganism in viral and bacterial infections, the stages of the immune response, differences between innate and adaptive immune responses, possibilities of immunocorrective therapy. Being followers of the scientific school of pulmonology of academician N.S. Molchanov, in this review, we evaluated the features of etiological factors and immune characteristics of the body on the course and out-comes of pneumonia, taking into account modern scientific knowledge. The current definition of pneumonia is formulated, the issues of the etiology of pneumonia from the perspective of the lung microbiome, the features of the immune response of the macroorganism in viral and bacterial pneumonia, the inconsistency of immune protection and the impact of comorbidity on this are covered in detail. Understanding the processes that lead to the disruption of the respiratory microbiome, the multiplication of pathobionts, the attachment of multiresistant microorganisms and the reactivity of the macroorganism will contribute to the development of new therapeutic approaches in the treatment of pneumonia.

ЦЕЛЬ: исследование влияния различных по дозе и длительности (3 и 7 сут) режимов глюкокортикосте- роидной (ГКС) терапии на концентрацию глюкозы венозной крови при экспериментальном липополиса- харид-индуцированном остром повреждении легких (ОПЛ) у крыс. МАТЕРИАЛЫ И МЕТОДЫ: ОПЛ, как экспериментальную модель острого респираторного дистресс- синдрома взрослых, у крыс моделировали посредством интратрахеального ведения липополисахарида клеточной стенки бактерии Salmonella enterica в дозе 20 мг/кг. Крысы-самцы случайным образом были разделены на группы: группу интактных животных (n=10); две контрольную группу (n=20), в которой жи- вотным моделировали острое повреждение легких без дальнейшего лечения и выводили из эксперимента на 3 сут и на 7 сут; группы сравнения (n=20), в которых, через 3 часа после моделирования ОПЛ, а затем ежедневно один раз в сутки в течение 3 сут и 7 сут, для лечения ОПЛ применяли внутрибрюшинно раствор дексаметазона в следующих дозах: 0,52 мг/кг/сут (эквивалентно 6,00 мг/сут для человека) в группе № 1 в течение 3 сут, в группе № 2 в течение 7 сут; 1,71 мг/кг/сут (20 мг/сут для человека) в группе № 3 в тече- ние 3 сут, в группе № 4 в течение 7 сут; 8,00 мг/сут (94 мг/сут, пульс-терапия) в группе № 5 и № 6 в течение 3 сут, только выживших животных группы № 6 выводили на 7 сут. На 3 сут и 7 сут измеряли концентрацию глюкозы венозной крови (Анализатор газов и электролитов крови «Abbot I-STAT» (США)). Для оценки па- раметров Me [Q1;Q3] были применены методы описательной статистики и непараметрического анализа с использованием программы Graph Pad Prism 8.0. РЕЗУЛЬТАТЫ: во всех группах, где животным вводили ГКС, регистрировали значимо большие концен- трации глюкозы, чем в группе интактных животных: группа № 1 – 9,3 ммоль/л [8,2;11,8] vs группа интакт- ных – 6,1 ммоль/л [5,6;6,4] (p=0,0004); группа № 2 – 10,1 ммоль/л [8,3;11,1] vs группа интактных (p=0,0003); группа № 3 – 9,2 ммоль/л [7,8;11,5] vs группа интактных (p=0,001); группа № 4 – 11,0 ммоль/л [9,7;11,4] vs группа интактных (p=0,0001); группа № 5 – 11,4 ммоль/л [10,4;14,4] vs группа интактных (p=0,0001). Следует отметить, что только в группе № 6 (пульс-терапия в течение 3 сут, с выведением животных на 7 сут) – 8,0 ммоль/л [6,5;8,7] концентрация глюкозы значимо не отличалась от таковой у интактных животных. Вероятнее всего, это связано с выведением ГКС из организма к 7 сут исследования и подтверждает тран- зиторный характер гипергликемии. Важным являлось то, что концентрация глюкозы у животных групп № 5 (пульс-терапия 3 сут) и № 4 (20 мг/сут в течение 7 сут) была значимо выше, чем у животных контрольной группы – 6,3 ммоль/л [8,2;8,7] (p=0,002 и p=0,04 соответственно). ВЫВОДЫ: применение дексаметазона, в диапазоне доз 6 – 94 мг/сут, для лечения ОПЛ сопровождалось развитием дозозависимой стероид-индуцированной гипергликемии. Максимально выраженная гипергли- кемия регистрировалась на фоне пульс-терапии на 3 сут. Известным фактом является то, что ГКС повышают концентрацию глюкозы в крови, посредством стимуляции глюконеогенеза и гликогенолиза, а длительная гипергликемия опасна, особенно у коморбидных пациентов. Необходимо мониторировать концентрацию глюкозы во время длительного использования ГКС, а также применения высоких доз, близких к пульс- терапии и своевременно прибегать к ее коррекции.

AIM: Assessment of the effect of various doses of dexamethasone as an inflammation modulator in experimental lipopolysaccharide-induced acute lung injury in rats. MATERIALS AND METHODS: Acute lung injury in rats was modeled by intratracheal administration of cell wall lipopolysaccharide from the Salmonella enterica. White male rats were divided into groups: a group of intact animals (n = 10); the control group (n = 40), in which the animals were simulated acute lung injury without further treatment and removed from the experiment on day 3; three experimental groups (n = 40), in which, 3 hours after modeling acute lung injury, and then daily once a day for 3 days, dexamethasone solution was administered intraperitoneally in the following doses: in group 1 0.52 mg/kg (equivalent to 6.0 mg/day for a person), in group 2 1.71 mg/kg (20.0 mg/day for a person), in group 3 8.0 mg/kg (94.0 mg/day, pulse therapy for humans). On the 3rd day, blood samples were taken from the caudal vena cava in surviving animals for clinical analysis and evaluation of the function of mitochondria of peripheral blood leukocytes. To determine the severity of local inflammatory reactions and pulmonary edema, bronchoalveolar lavage was performed with the study of an endopulmonary cytogram and an assessment of pathomorphological changes in the lung tissue. RESULTS: indicate that dexamethasone reduces the amount of lung tissue damage and animal mortality, dose-dependently reduces the functions of mitochondria and the number of lymphocytes and monocytes in peripheral blood, as well as neutrophils, lymphocytes and macrophages in bronchoalveolar lavage samples. CONCLUSION: The use of dexamethasone at a dose of 0.52 mg/kg (equivalent to 6.0 mg/day for humans) is accompanied by better survival, minimal effect on the viability and functional activity of inflammatory cells. Pulse therapy leads to a significant decrease in the number of immunocompetent cells in bronchoalveolar lavage, mitochondrial dysfunction in the form of a decrease in the ability of these cells to use the reserve power of mitochondrial respiration in response to the action of a stress factor. Excessive inhibition of immunocompetent cells can contribute to the activation of latent and opportunistic infections, which must be taken into account when choosing a dosing regimen for glucocorticosteroids.

BACKGROUND: Diabetes mellitus (DM) is a predisposing factor for the development of many infectious complications. Numerous studies have demonstrated the association of hyperglycemia in patients having DM with a high risk of a more unfavorable course of COVID-19. However, hyperglycemia is often detected in patients with a COVID-19 not having anamnesis of DM. The following remains unclear: the etiological factors causing such disorders of carbohydrate metabolism, the persistence of these disorders and the characteristics of the course, as well as their comparative effect on the outcomes of COVID-19 and the further prognosis of patients.AIM: To study the prevalence and nature of carbohydrate metabolism disorders in patients with moderate to severe course of COVID-19, as well as 6 months after it.MATERIALS AND METHODS: Hospitalized patients with a confirmed diagnosis of COVID-19 of moderate and severe course of the disease were examined. There were no medical interventions outside recommendations of patient management. The observation was carried out during two time periods: inpatient treatment of a COVID-19 and 6 months after discharge. The following were evaluated: anamnesis data, the level of fasting plasma glucose; HbA1c, the results of computed tomography of the lungs, the drug therapy taken in all patients. Descriptive statistics methods were used to evaluate the parameters.RESULTS: The study included 280 patients with a median age of 61.5±14,2 years. During the disease, a violation of carbohydrate metabolism was detected in 188 people (67%), the remaining patients (33%) made up the normoglycemia group. Patients with hyperglycemia were stratified in a following way: a group with an established diagnosis of DM before COVID -19 included — 56 people (20%), a group with steroid-induced hyperglycemia (SIH) — 95 people (34%), a group of stress- induced hyperglycaemia — 20 people (7%), with undiagnosed diabetes — 17 people (6%). In the postcovid period (after 6 months), the normal level of glycemia in the same sample group was observed in 199 people (71.4%); 8 people (3%) were diagnosed with new cases of DM. The mortality rate was 10 people (3.6%) in the group of SIH (8 people) and undiagnosed DM (2 people).CONCLUSION: The use of glucocorticoids in hospitalized patients with COVID-19 leads to high incidence of SIH, which has reversible character. About 6% among hospitalized patients with a COVID-19 had undiagnosed DM and were not receiving antihyperglycemic therapy. The highest mortality was noted in the group of SIH, which allows us to conclude that SIH worsens the prognosis of patients to the greatest extent. Patients with newly diagnosed hyperglycemia, regardless of the level of hyperglycemia, are characterized by a more unfavorable course.

Intriduction. In the last decade, conflicting data has appeared that the presence of obesity in patients with several diseases not only does not worsen, but even improves their prognosis, which is called the “obesity paradox”. The role of elevated body mass index in patients with coronavirus pneumonia (COVID-19) remains unclear.Aim. To study the features of the course of pneumonia in young and middle-aged men depending on the body mass index.Materials and methods. A retrospective analysis has investigated and it included 451 young and middle-aged men who underwent inpatient treatment for COVID-19 pneumonia. Patients were randomized according to body mass index into groups: normal nutrition (N), overnutrition (On), obesity (Ob). Clinical and laboratory parameters were assessed using statistical analysis.Results and discussion. In patients with obesity, the causative agent of pneumonia was detected in 91.9% of cases, in contrast to group N (65.75%). At the onset of pneumonia, group Ob differed significantly from group N in terms of erythrocyte sedimentation rate (17 versus 9 mm/h), C-reactive protein (18.3 versus 7.2 mg/l), D-dimer (304 versus 230 ng/ml), glycemia (6.2 versus 5.2 mmol/l), lymphocytes 9 (1.3 versus 1.5 × 109/l). In the dynamics in the group Ob, in comparison with the group N, there is a higher level of platelets (307 versus 1 × 109/l), neutrophils (6.3 versus 3.7 × 109/l), monocytes (0.8 versus 0.6 × 109/l) and a smaller number of lymphocytes (1.4 versus 2.0 × 109/l). It was revealed that the lymphocytic index and the index of the ratio of lymphocytes to monocytes in dynamics significantly increase in group N (from 0.5 to 0.7 and from 3.5 to 4.5, respectively), in group On only the lymphocyte index significantly increases (from 0.4 to 0.5), in the obesity group they do not change (from 0.4 to 0.5 and 3 from.0 to 2.7, respectively). The greatest need for respiratory support had group Ob (21.1%) in comparison with GNP (6.0%).Conclusions. The level of adipose tissue in the body has a direct impact on the course of pneumonia.

АНАЛИТИЧЕСКИЕ ОБЗОРЫОжирение -один из основных факторов риска сахарного диабета (СД) 2-го типа (СД2), представляющий собой серьезный вызов для системы здравоохранения.Умеренное снижение массы тела (5%, но <10%) позволяет минимизировать и уменьшить осложнения, связанные с СД2, а значительная потеря массы тела может предопределить даже ремиссию заболевания.Двунаправленная связь между ожирением и СД2 проявляется и в том, что гиперинсулинемия, инсулинорезистентность, в свою очередь, могут определять набор массы тела у больных СД.Увеличение объема висцерального и эктопированного жира определяет не только рост инсулинорезистентности и, как следствие, эскалацию сахароснижающей терапии, но и нарастание кардиоваскулярного риска.Современная сахароснижающая терапия оказывает значительное влияние на массу тела пациента, побуждая к тщательному выбору инструментов управления СД2.Метформин в меньшей степени снижает массу тела больных, а ингибиторы натрий-глюкозного котранспортера 2-го типа и агонисты рецепторов глюкагоноподобного пептида-1 (аГПП-1) -в большей.Ингибиторы дипептидилпептидазы-4 и комбинированная терапия инсулин/аГПП-1 с фиксированным соотношением, по-видимому, обладают нейтральным влиянием на массу тела.Секретагоги инсулина -производные сульфонилмочевины, меглитиниды и собственно инсулины приводят к увеличению массы тела и связаны с более высоким риском тяжелых гипогликемий из-за гиперинсулинемии, что делает их менее подходящими для

Adipsin is one of the first discovered adipokines hormones produced by adipose tissue. Adipsin performs the function of a regulator of carbohydrate and lipid metabolism and participates in the adaptation of metabolism to the real needs of the body, being a powerful stimulant of anabolic processes. A characteristic feature of adipsin is that it is also a complement factor D, which is necessary for the normal functioning of an alternative pathway of activation of the complement system. Due to this, adipsin is represented in the body as a link between the energy block of the endocrine system and the humoral block of the immune system. Adipsin is known as a regulator of the function of pancreatic beta cells, a stimulator of lipogenesis, a modulator of inflammation processes. Recently, there have been works indicating the effect of adipsin on the microbiota, as well as its role in non-alcoholic fatty liver disease. To date, there are a large number of publications describing the biochemical structure, functions of adipsin, mechanisms of regulation of its synthesis, as well as changes in the level of adipsin in various pathological conditions. Attempts are also described to pharmacologically influence adipsin in order to modulate its functions or use it as a biomarker for the diagnosis of diseases. However, there is currently no structured review that summarizes and systematizes all available information about this adipokine. This is exactly the task we set ourselves in this study. The paper contains the results of all available studies on adipsin. In some cases, they are contradictory in nature, which indicates the need for further research in detecting connections between the body's systems.

ВЛИЯНИЕ ОЖИРЕНИЯ НА ВЕРОЯТНОСТЬ ОБНАРУЖЕНИЯ SARS-COV-2 У ПАЦИЕНТОВ С ВИРУСНОЙ ПНЕВМОНИЕЙСалухов В .В ., Минаков А .А

Algorithms for de-escalation of basic therapy, including the abolition of inhaled corticosteroids (ICS), in patients with chronic obstructive pulmonary disease (COPD), as well as the development of clear criteria for prescribing triple therapy in clinical practice remain the subject of numerous studies and discussions. The given case report of managing a patient with a long experience of smoking and severe COPD demonstrated an unsuccessful experience of de-escalation of therapy with the abolition of ICS due to concerns about the fact of pneumonia. The dual bronchodilator therapy prescribed in accordance with modern recommendations was insufficiently effective in preventing exacerbations, and the stabilization of the patient’s condition was observed after the appointment of a fixed triple combination of drugs in a single inhaler (VI/UMEC/FF), which contains vilanterol (VI), umeclidinium bromide (UMEC) and ICS fluticasone furoate (FF). An additional contribution to ensuring clinical success was made by such factors as strict compliance with medical prescriptions by the patient, smoking cessation and compliance with recommendations for maintaining physical activity, compliance with a strict self-isolation regime during the pandemic, which reduced the risks of respiratory viral infections. Additional clinical predictors of the effectiveness of ICS in COPD were the bronchitis type, the persistence of symptoms and the recurrence of exacerbations of the disease after discontinuation of the drug, the level of blood eosinophilia. When deciding whether to prescribe or cancel triple therapy, it is recommended to take into account the data on the effect of ICS on improving the functional parameters and clinical course of the disease with a decrease in symptoms, on reducing the risk of exacerbations, on increasing patient survival and a positive prognosis during COPD.

The relevance of pneumonia remains at the forefront and has recently attracted the attention of not only the entire medical community, but also all political and economic institutions of most countries of the planet. This nosology continues to be in the center of attention, identifying one of the key causes in the frequency of mortality of the population. The presented article accumulates the most up-to-date theses regarding viral pneumonia on the basis of a review of a large number of scientific literature, domestic and foreign studies. Although the term “viral pneumonia” has been used in medical practice for more than a century, nevertheless, there is no final diagnostic algorithm and an established final concept. The article reflects special historical medical and philosophical aspects in the study of pneumonia from the time of Hippocrates to the present. The epidemiological features, etiology, and also the terminological base of viral pneumonia are updated, thereby the concept of viral pneumonia in medical categories is fixed. A promising classification of viral pneumonia according to ICD-XI is presented. Attention is drawn to the autopsy morphological characteristics of the bronchopulmonary organ complex in viral pneumonia, post-mortem descriptions are given with links to authoritative research sources. The main modern diagnostic capabilities of the scientific medical community in the detection of pneumonia are described, the issues of the formation of new diagnostic algorithms are reflected. The clinical picture of viral pneumonia is described in detail, the clinical concept of the phase course of the disease based on pathomorphological data is presented for the first time. The main modern groups of drugs for etiotropic and pathogenetic treatment of the disease are considered. The conclusion reflects the main problematic postulates and prospects for further study of the disease.

Algorithms for de-escalation of basic therapy, including the abolition of inhaled corticosteroids (ICS), in patients with chronic obstructive pulmonary disease (COPD), as well as the development of clear criteria for prescribing triple therapy in clinical practice remain the subject of numerous studies and discussions. The given case report of managing a patient with a long experience of smoking and severe COPD demonstrated an unsuccessful experience of de-escalation of therapy with the abolition of ICS due to concerns about the fact of pneumonia. The dual bronchodilator therapy prescribed in accordance with modern recommendations was insufficiently effective in preventing exacerbations, and the stabilization of the patient’s condition was observed after the appointment of a fixed triple combination of drugs in a single inhaler (VI/UMEC/FF), which contains vilanterol (VI), umeclidinium bromide (UMEC) and ICS fluticasone furoate (FF). An additional contribution to ensuring clinical success was made by such factors as strict compliance with medical prescriptions by the patient, smoking cessation and compliance with recommendations for maintaining physical activity, compliance with a strict self-isolation regime during the pandemic, which reduced the risks of respiratory viral infections. Additional clinical predictors of the effectiveness of ICS in COPD were the bronchitis type, the persistence of symptoms and the recurrence of exacerbations of the disease after discontinuation of the drug, the level of blood eosinophilia. When deciding whether to prescribe or cancel triple therapy, it is recommended to take into account the data on the effect of ICS on improving the functional parameters and clinical course of the disease with a decrease in symptoms, on reducing the risk of exacerbations, on increasing patient survival and a positive prognosis during COPD.

The relevance of pneumonia remains at the forefront and has recently attracted the attention of not only the entire medical community, but also all political and economic institutions of most countries of the planet. This nosology continues to be in the center of attention, identifying one of the key causes in the frequency of mortality of the population. The presented article accumulates the most up-to-date theses regarding viral pneumonia on the basis of a review of a large number of scientific literature, domestic and foreign studies. Although the term “viral pneumonia” has been used in medical practice for more than a century, nevertheless, there is no final diagnostic algorithm and an established final concept. The article reflects special historical medical and philosophical aspects in the study of pneumonia from the time of Hippocrates to the present. The epidemiological features, etiology, and also the terminological base of viral pneumonia are updated, thereby the concept of viral pneumonia in medical categories is fixed. A promising classification of viral pneumonia according to ICD-XI is presented. Attention is drawn to the autopsy morphological characteristics of the bronchopulmonary organ complex in viral pneumonia, post-mortem descriptions are given with links to authoritative research sources. The main modern diagnostic capabilities of the scientific medical community in the detection of pneumonia are described, the issues of the formation of new diagnostic algorithms are reflected. The clinical picture of viral pneumonia is described in detail, the clinical concept of the phase course of the disease based on pathomorphological data is presented for the first time. The main modern groups of drugs for etiotropic and pathogenetic treatment of the disease are considered. The conclusion reflects the main problematic postulates and prospects for further study of the disease.