Airway mucus hypersecretion is a pathophysiologic manifestation of acute and chronic airway inflammatory disease. Mucolytics can reduce mucus viscosity and promote mucus discharge and therefore can be considered pathogenetically based therapy.The purpose of this publication with the resolution of the scientific forum of experts was to discuss pharmacological features, efficacy, and safety of erdosteine.Results. Experts of thescientific forum not only reviewed the results of clinical trials, but also voted on the use of mucoactive drugs according to the principle of Delphi consensus. Comparison of the efficacy and safety of mucoactive drugs (erdosteine, acetylcysteine, carbocysteine, ambroxol) in patients with respiratory diseases by the experts during voting showed that the highest level of agreement among the experts was achieved for the drug Elmucin® (erdosteine) in terms of its mucolytic activity and other pharmacological features, as well as when discussing the safety of the compared drugs in the officially recommended doses. The highest level of agreement was also noted on the erdosteine efficacy in COPD patients in reducing the frequency and duration of disease exacerbations, as well as reducing the risk of hospitalization of COPD patients when used long-term as part of combination therapy. The demonstrated safety profile was the most beneficial among the reviewed mucoactive drugs.Conclusion. Elmucin® is a mucolytic with pleiotropic effects such as complex mucoactive action, potent antioxidant, anti-inflammatory and antibacterial activity with anti-adhesive effect for pathogens that determine its clinical efficacy in the treatment of acute and chronic airway diseases.

Objective. To study the etiology of community-acquired pneumonia (CAP) in adult hospitalized patients after the COVID-19 pandemic. Materials and Methods. The prospective multicenter study included patients 18 years and older with confirmed diagnosis of CAP admitted to 6 hospitals in different regions of Russia from July to November 2023. Etiology was confirmed by respiratory samples (sputum, tracheal aspirate) culture, blood culture (severe cases), and urinary antigen tests (Legionella pneumophila serogroup 1, Streptococcus pneumoniae). Mycoplasma pneumoniae, Chlamydia pneumoniae, and common respiratory viruses were identified using the real-time polymerase chain reaction (PCR) in respiratory samples. Qualitative PCR for S. pneumoniae and Haemophilus influenzae DNA tests were also applied. Results. Altogether 152 patients were enrolled, and significant CAP pathogens were identified in 96 (63%) cases; the median age of patients with verified etiology of CAP was 45 [34.8; 66] years, comorbidity index was 0.5 (0; 3.0) points. The most frequently detected pathogens were M. pneumoniae – 42 (44%), rhinovirus – 23 (24%), S. pneumoniae – 17 (18%) and SARS-CoV-2 – 13 (14%). Coinfection was registered in 22% of cases, the most common associations were M. pneumoniae + rhinovirus – 5 (3.3%), S. pneumoniae + rhinovirus – 3 (2%). Pneumococcal bacteremia was detected in 1 patient. In most patients CAP was non-severe; 17 (18%) patients required admission to the ICU. Hospital mortality was 7%. Conclusions. M. pneumoniae, respiratory viruses (mainly rhinovirus and SARS-CoV-2), and S. pneumoniae were the predominant CAP pathogens in hospitalized adults with CAP in the first months after the COVID-19 pandemiс. The use of an integrated approach to etiological diagnosis can significantly increase the proportion of patients with an established etiology of CAP.

Resolution of the Council of Experts November 17, 2023 Respiratory diseases (acute and chronic bronchitis, chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis (CF), bronchial asthma, etc.) are often accompanied by impaired mucus clearance. In this regard, mucoactive drugs are most commonly used for the treatment. Hypertonic saline plus high-molecular-weight hyaluronic acid is one of the affordable and effective agents that can help with thinning and removal of bronchial secretions. The effect of 3%, 6%, 7% hypertonic saline on the respiratory system is multifaceted: it stimulates the osmotic fluid flow, breaks bonds linking polymers in the sputum, reduces swelling in the mucous membranes, stimulates ciliary beat frequency, and reduces the neutrophilic inflammation severity. The molecular size of HA plays an important role in the effectiveness of inhalation therapy with hypertonic saline combined with hyaluronic acid (HA). External administration of high-molecular-weight hyaluronic acid inhibits neutrophil elastase and metalloproteinase, potentiates hydration of bronchial secretions and has anti-inflammatory properties. In addition to clinical studies, real-life clinical practice in patients with cystic fibrosis, bronchiectasis and acute bronchitis also demonstrated the effectiveness of hypertonic saline combined with high-molecular-weight hyaluronic acid. The rationale for the use of hypertonic saline was reflected in the international GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines in 2023. Therefore, due to high interest in the hypertonic saline combined with high-molecular-weight hyaluronic acid, it is important to expand the evidence base: to initiate a Russian multicenter study evaluating the effectiveness and safety of this combination in patients with chronic bronchitis and COPD in the Russian Federation. It will allow us to recommend hypertonic saline combined with high-molecular-weight hyaluronic acid to be included in the Russian clinical guidelines on treatment of chronic bronchitis and COPD as a mucoactive drug.

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.

Obliterative (constrictive) bronchiolitis (OB) is a rare disease characterized by destruction of the bronchiolar epithelium and subsequent progressive airway obstruction. OB is most common in rheumatoid arthritis (RA) compared to other systemic rheumatic diseases. Clinical manifestations of OB are found mainly with a long duration of RA and the absence of adequate therapy for articular manifestations. We present a clinical observation, demonstrating the distal respiratory tract involvement in a patient with RA during the first year of the disease, which is observed in no more than 10–20% of cases. The nonspecificity of respiratory symptoms on the background of immunosuppressive therapy led to a diverse differential diagnostic spectrum of pulmonary pathology. For timely diagnosis and optimization of therapeutic approaches, clinical suspicion for respiratory lesions in patients with RA and interdisciplinary cooperation are necessary.

The Interstitial lung diseases (ILD) are a wide heterogeneous group of disorders, different in many parameters, however having similar pathophysiological mechanisms. Idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), chronic hypersensitivity pneumonitis (CHP), ILD associated with autoimmune disorders (predominantly systemic sclerosis (SSc ILD) and rheumatoid arthritis (RA ILD), and other diseases may be accompanied by the formation of pulmonary fibrosis. Currently there are no generally accepted criteria for the fibrosing and progressive fibrosing ILD, and the information on the frequency of these conditions is limited. The study aims to research the structure of fibrosing ILD and the frequency of the progressive fibrosing phenotype (PFP) according to the register of patients with ILD in Irkutsk, Russia. Methods. At the first stage information letters were sent to all medical institutions of Irkutsk with recommendations on all referral patients with ILD for further examination. At the second stage, each ILD case was verified collegially ( n = 270). All patients’ data were analysed in terms of clinical, functional, radiological and histological aspects. A register of ILD patients was formed based on this analysis. The follow-up period was 1 to 5 years. Results. According to the results of a comprehensive assessment, HRCT signs of pulmonary fibrosis were detected by 104 patients (38.5%). fibrosing course was observed in 100% IPF and SSc ILD, in 90.9% of CHP, 71.4% of NSIP and 60% of RA ILD. 61 patients (22.6% of all ILD cases, 58.6% of fibrosing ILD) was diagnosed with PFP. The 5-year mortality for PFP ILD was 55.5%. Conclusion. In the case of a PFP development, the evolution of ILD loses its nosological specificity, acquiring similarity with IPF. Due to the high mortality rate, it is necessary to actively identify the progressive fibrosing course of a wide range of ILD and to prescribe an antifibrotic therapy in a timely manner.

Introduction. The natural course of some interstitial lung diseases (ILD) is characterized by progressive fibrosing phenotype resembling idiopathic pulmonary fibrosis (IPF). Until recently, the antifibrotic drug nintedanib was approved for treatment of the only fibrosing ILD which was IPF. A new indication for this drug which has been registered in Russian Federation in 2021 includes other fibrosing ILDs with progressive phenotype (PF-ILDs) and ILD associated with systemic scleroderma (SS-ILD).The aim of this publication is to describe general considerations of the decision of Multidisciplinary Expert Board on diagnosis and treatment of PF-ILDs including SS-ILD.Results. According to the extension in nintedanib use mentioned above, the Expert Board created an algorithm for diagnosis and treatment of patients with PF-ILDs and criteria for nuntedanib administration in PF-ILDs.Conclusion. Antifibrotic therapy is needed for patients with PF-ILDs with the failure of the stanrard therapy. In those patients antifibrotic treatment should be initiated as early as possible to better preserve the lung function.

The study was designed to evaluate influence of 6-month therapy with salmeterol on clinical and functional parameters and quality of life in 20 patients with moderate to severe COPD. The disease symptoms were analyzed before and in 3 and 6 months of the treatment using the Piggario scale, the lung function parameters (FEV 1 , FVC, TLC, RV, Raw) were measures with spirography and body plethysmography, physical tolerance was assessed in 6-minute walking test, quality of life was evaluated with the Saint George's Respiratory Questionnaire. Results showed that Salmeterol reduced dyspnoea, cough, sputum production and improved tolerance to the cold air in the COPD patients. The 6-minute walking distance and FEV 1 significantly increased to the end of the study period. The quality of life improved greatly in all scales of the questionnaire. We concluded that salmeterol was reliably effective in COPD patients living at the strong continental climate of the Eastern Siberia.

Interstitial lesion is one of the most common lung pathologies in patients with systemic scleroderma (SS) In most cases, interstitial lung disease (ILD) is formed during the detailed clinical picture of SS, but it can manifest from interstitial lung disease, which significantly complicates early nosological diagnosis. Patterns of non-specific and common interstitial pneumonia are most often found among the variants of interstitial lung lesion at SS Clinical manifestations of ILD-SS are non-specific and vary significantly between patients from asymptomatic to rapidly progressing respiratory failure. Early diagnosis of subclinical interstitial pulmonary lesion at SS is carried out using high-resolution computed tomography. Active immunosuppressive therapy is required for timely diagnosis of progressive forms of ILD-SS The presented clinical study demonstrates a case of late diagnosis of ILD-SS

Chronic obstructive pulmonary disease (COPD) is a global problem in modern medicine. In recent years, the medical community’s understanding of COPD has changed significantly, which is primarily due to the emergence of a new classification and the identification of various phenotypes of the disease. These changes could not affect the tactics of COPD treatment. The article discusses not only the debatable issues of treating COPD; it provides an overview of changes in international (Global Initiative for Chronic Obstructive Lung Disease, 2018) and national (2019) recommendations, but also the significance and benefits of triple therapy in terms of evidence-based medicine as well as the benefits of extra-fine drugs in the treatment of bronchial obstructive syndrome.

Interstitial lesion is one of the most common lung pathologies in patients with systemic scleroderma (SS) In most cases, interstitial lung disease (ILD) is formed during the detailed clinical picture of SS, but it can manifest from interstitial lung disease, which significantly complicates early nosological diagnosis. Patterns of non-specific and common interstitial pneumonia are most often found among the variants of interstitial lung lesion at SS Clinical manifestations of ILD-SS are non-specific and vary significantly between patients from asymptomatic to rapidly progressing respiratory failure. Early diagnosis of subclinical interstitial pulmonary lesion at SS is carried out using high-resolution computed tomography. Active immunosuppressive therapy is required for timely diagnosis of progressive forms of ILD-SS The presented clinical study demonstrates a case of late diagnosis of ILD-SS

Bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) are chronic inflammatory diseases of the airways. Inhaled bronchodilators and corticosteroids are the cornerstone of pharmacological long-term treatment for asthma and COPD. The efficacy of any topical inhaled medication is dependent upon successful distribution of the drug to the site of disease. Targeting small airways inflammation in severe asthma and COPD are critically important as the combined surface area of small airways far exceeds the surface area that large central airways provide. Small airway dysfunction in BA is associated with increased asthma symptoms, worse asthma control and an increased number of exacerbations. Chronic inflammation in COPD causes structural alterations and narrowing of particularly the small airways. The extrafine combination of beclomethasone dipropionate/formoterol (BDP/F) enables drug delivery to both the large and small airways, and allows the clinical benefits to be achieved with a lower corticosteroid dose. The use of extrafine BDP/F is more effective in achievement asthma control and reduce COPD exacerbations. If it is necessary to continue ICS as part of a double or triple COPD therapy extrafine fixed combination of BDP/F can be considered as the drug of choice and optimal replacement of the ICS molecule.

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.

Frequency and clinical manifestations of respiratory disease in systemic connective tissue diseases (CTD) differ significantly including clinical course and outcomes. Pulmonary  abnormalities  are seen in 20% to 95% of patients with CTD ranging from subtle to life-threatening disease and could be fatal. Commonly, CTD-related interstitial lung disease (ILD)  is crucial for prognosis. Interstitial  pneumonias  are the most frequent variant of respiratory disease in patients with CTD.  CTD-related ILDs comprise 15% to 25% of all ILDs. Usually, respiratory disease develops in symptomatic CTD,  but in some cases, ILD can be the first appearance  of CTD which precedes systemic symptoms that could significantly impede early diagnosis. Therefore,  diagnostic workup in ILD should consider extrapulmonary  manifestations  of CTD.  Moreover,  an intrinsic part of diagnostic algorithm should be specific laboratory assessment including measurement  of autoantibodies.  Combination of specific antibodies and clinical features provides higher probability of CTD diagnosis.

Frequency and clinical manifestations of respiratory disease in systemic connective tissue diseases (CTD) differ significantly including clinical course and outcomes. Pulmonary abnormalities are seen in 20% to 95% of patients with CTD ranging from subtle to life-threatening disease and could be fatal. Commonly, CTD-related interstitial lung disease (ILD) is crucial for prognosis. Interstitial pneumonias are the most frequent variant of respiratory disease in patients with CTD. CTD-related ILDs comprise 15% to 25% of all ILDs. Usually, respiratory disease develops in symptomatic CTD, but in some cases, ILD can be the first appearance of CTD which precedes systemic symptoms that could significantly impede early diagnosis. Therefore, diagnostic workup in ILD should consider extrapulmonary manifestations of CTD. Moreover, an intrinsic part of diagnostic algorithm should be specific laboratory assessment including measurement of autoantibodies. Combination of specific antibodies and clinical features provides higher probability of CTD diagnosis.

The aim of the study was to investigate clinical features of interstitial lung diseases (ILD) using data from the register of Irkutsk residents with ILD. Methods. Medical history, clinical and functional data and data of high-resolution computed tomography (HRCT) of the lungs of 110 patients (67 women, 43 men, mean age, 56.2 ± 15.9 years) were analyzed. Lung biopsy was performed in 49 patients (45%). Results. Bilateral slowly resolving and/or recurrent pneumonia, unexplained pulmonary dissemination and idiopathic pulmonary fibrosis were the most frequent referral diagnoses. After thorough examination, three groups of ILDs were diagnosed most often: ILD with a known cause (32%), idiopathic interstitial pneumonias (30%), and pulmonary sarcoidosis (29%). Cough and dyspnea were the leading symptoms at ILD onset (in 48% and 39% of patients, respectively). The average duration of respiratory symptoms was 29.5 ± 33.0 months. Asymptomatic radiological abnormalities were the only reason for diagnostic work-up in 13% of the patients. Conclusion. Diagnosis of ILD is quite challenging for primary care physicians and pulmonologists. Accuracy and timeliness of diagnosis of ILD requires multidisciplinary approach as far as depends on quality of diagnostic procedures including medical history, lung auscultation, lung function testing, HRCT, and morphological examination, but also on the physician’s awareness and clinical experience.

Bronchial hyperreactivity (BHR) is one of the functional characteristics of chronic obstructive pulmonary disease (COPD) and is present in most patients with this disease. BHR has a negative modifying effect on the development of COPD, contributing to adverse prognosis and increased mortality compared to patients without bronchial hyperresponsiveness. The results of the evaluation of the impact of glycopyrronium bromide (GB) on BHR show a pronounced effect of the bronchoprotective broncholytic. The therapy by GB results in decrease in the level of BHR (p < 0.05), accompanied by a significant reduction of symptoms of COPD, improves tolerance to exercise and quality of life of patients in comparison with initial parameters (p < 0.05). Thus, BHR in patients with COPD appears to be an important criterion of therapeutic efficacy and decrease of the level of bronchial hyperresponsiveness has a significant clinical impact on the course of the disease.

This is a review of published data on pulmonary manifestations of ankylosing spondylitis (AS) and a case report of 49-year old male suffering from AS with pulmonary involvement. Lung lesions are frequent extra-articular manifestations of AS. There are a variety of pulmonary manifestations in AS, including lesions of the lung parenchyma, the pleura, the airways and ventilation disorders due to sclerosis of the costovertebral joints and ankylosis of the thoracic spine. An incidence of the lung injury in AS patients has increased significantly after implementation of high-resolution computed tomography (CT). Pulmonary apical fibro-bullous changes were found in CT scans. These lesions are common targets for Aspergillus infection. In the present case, bilateral upper lobe cavitating pneumonia was diagnosed in the patient after exclusion of pulmonary tuberculosis. The patient repeatedly received prolonged antibiotic therapy. His condition deteriorated with development of chronic bilateral pulmonary cavitary aspergillosis. This clinical case demonstrates insufficient knowledge of physicians and radiologists on pulmonary involvement in AS. This leads to therapeutic mistakes and the late diagnosis of pulmonary disease.