Morphological examination reveals microcirculation disorders in combination with small areas of lung damage in the long term after COVID-19. Therefore, the function of the respiratory system should be assessed after COVID-19. Aim of this study was to evaluate the dynamics of respiratory dysfunction in patients with COVID-19-associated lung injury using a complex examination of lung function (spirometry, body plethysmography, and lung diffusion testing) one year after hospital discharge. Methods. 60 patients (38 men/22 women, aged 39 to 80 years) with a diagnosis of “COVID-19-associated interstitial process in the lungs” were examined. Lung function (spirometry, body plethysmography, and lung diffusion capacity testing) was examined in all patients twice, at 1 – 6 months (visit 1) and at 12 – 24 months (visit 2) after hospital discharge. Results. At visit 1, 60% of patients had restrictive pulmonary ventilation disorders. Obstructive ventilation disorders were detected in only 1 patient. Decreased lung diffusion capacity (D CO corr. ) was found in 78% of patients. At visit 2, obstructive disorders were detected in 1 patient, and the frequency of restrictive ventilation disorders was 29%. Decreased DL CO corr. was noted in 57% of cases. The parameters of pulmonary ventilation and pulmonary gas exchange function differed significantly between visits. Significant correlations were found between changes in the functional parameters of the respiratory system and disorders identified at visit 1 after hospital discharge. Conclusion. Thus, there is a decrease in the lung diffusion capacity and the rate of restrictive ventilation disorders even one year after severe COVID-19-associated lung injury. However, our results suggest a marked improvement in respiratory system function over time.

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.

Since the beginning of the pandemic, COVID-19 (COronaVIrus Disease-2019) has been viewed as a respiratory disease with characteristic symptoms including cough, shortness of breath, and difficulty breathing. However, some patients still have respiratory complaints and post-inflammatory changes in the lung tissue according to high-resolution computed tomography of the chest organs (CT scan) even after discharge from the hospital.The aim. To assess the functional changes in the respiratory system in patients who had COVID-19-associated lung injury using a comprehensive testing of the respiratory function (spirometry, body plethysmography and diffusion test) in the first 6 months after discharge from the hospital.Methods. The study included 434 patients (252 men and 182 women, aged 20 to 79 years), who were divided into 3 groups depending on the time interval between discharge from the hospital and the respiratory function test: Group 1 – 15 – 45 days; Group 2 – 46 – 93 days; Group 3 – 94 – 183 days. All patients underwent a comprehensive testing of respiratory function.Results. The average pulmonary ventilation indicators remained within the normal range both in the general group and in separate groups. A decrease in DLCO was found in most patients: in 53% of people in the general group, in 54, 54 and 51% of cases in Groups 1, 2 and 3, respectively. Restrictive ventilation disorders (reduction of TLC below the lower limit of normal (LLN)) were detected in 29 % of people in the general group, 33, 27 and 26% in Groups 1, 2 and 3, respectively. Obstructive ventilation disorders (decrease in FEV1/FVC below LLN) were detected in 2 % in the general group, and in 3, 1 and 1% in groups 1, 2 and 3, respectively. Statistically significant correlations were found between the maximum volume of lung tissue damage in the acute period of COVID-19, the age of the patients, and the respiratory function indicators.Conclusion. The pulmonary ventilation indicators normalized within 6 months after COVID-19, while a decrease in lung diffusion capacity persisted in most patients and required further active follow-up.

Introduction. COVID-19 is a highly contagious infectious disease caused by the novel coronavirus SARS-CoV-2. After the acute phase and discharge from the hospital, convalescent people continue to have respiratory symptoms, changes in pulmonary function (PF) and indicators of chest computed tomography (CT).Aim. To evaluate changes in PF and quantitative CT data in patients after severe coronavirus pneumonia.Materials and methods. A cross-sectional observational study was conducted: 55 patients (including 28 men, aged 32–78 years) with a diagnosis of “lung interstitial process due to a coronavirus infection” were examined. All patients underwent a study of PF (spirometry, body plethysmography, measurement of the diffusion lung capacity: DLCO) in the interval of 24–305 days after discharge from the hospital. CT scan of the chest was performed simultaneously with the functional examination (±30 days), the parameters were calculated: ground glass areas, functional lung tissue volume (FV), affected tissue volume (AV), CovidQ (AV/FV ratio).Results. A decrease in DLCO was found in 28 patients. Restrictive disorders – in 13 patients, obstructive disorders – in 2 patients. At the time of the CT examination, all patients had residual changes in both lungs of varying severity. Functional parameters (FVC, TLC and DLCO) were statistically significantly correlated with the CT data.Conclusion. During the recovery period in patients after COVID-19, lung structural changes, according to CT scans, persist for at least 3 months. Pulmonary ventilation indicators in most patients normalize during this time, half of the patients retained a decrease in diffusion lung capacity. Acknowledgment. The study was carried out as part of the state task on the topic: “The impact of the new coronavirus infection SARS-CoV-2 on the functional parameters of the respiratory system during the convalescence period” (code: “PostCOVID-functional diagnostics”).

Aim: To assess the state of cardiac and respiratory function in adult cystic fibrosis patients. 36 patients participated in the study. Lung function tests and Doppler echocardiography were performed to each patient. The majority of adult CF patients develop generalized obstructive pattern of lung function and hyperinflation. Significant decrease of VC and its part in TLC was noted. Assessment of exercise tolerance revealed significant decrease of hemoglobin oxygen saturation and heart rate increase. Right atrium and ventricle dilatation and an increase of systolic pressure in pulmonary artery were reported in 20% of patients, all of them had severe bronchial obstruction (FEV 1 <35% pred), in 28% of patients left ventricle dysfunction of both systolic and diastolic nature was registered. Our finding suggest that generalized obstructive disorders, hyperinflation and reduction in diffusion capacity are characteristic for adult cystic fibrosis patients. Pulmonary hypertension and cor pulmonale develop in patients with severe obstructive disorders.

Active hydrogen inhalation (H(H2O)m) has powerful antioxidant and antiapoptotic effects. In recent years, it has been used in a number of experimental and clinical studies.Aim. To study the safety and effectiveness of inhalation of the “active form of hydrogen” (AFV;(H(H2O)m)) in the rehabilitation program of coronavirus disease 2019 (COVID-19) survivors during the recovery period.Material and methods. This randomized controlled parallel prospective study included 60 COVID-19 survivors with post-COVID-19 syndrome (ICD-10: U09.9) during the recovery period, with clinical manifestations of chronic fatigue syndrome (CFS), who received standard therapy in accordance with the management protocol of patients with CFS (ICD-10: G93.3): physiotherapy and medication therapy with drugs containing magnesium, B vitamins and L-carnitine. The patients were divided into 2 groups. The experimental group (n=30) included patients who received hydrogen inhalation for 90 minutes every day during 10 days (SUISONIA hydrogen inhalation device, Japan). The control group (n=30) consisted of patients who received standard therapy. In both groups, patients were comparable in sex and mean age: in the experimental group — 53 (22; 70) years, in the control group — 51 (25; 70) years. Biological markers of systemic inflammation, oxygen transport, lactate metabolism, intrapulmonary shunting, 6-minute walk test, and vascular endothelial function were determined in all patients on the 1st and 10th days of follow-up.Results. In the experimental group, a decrease in following parameters was revealed: stiffness index (SI), from 8,8±1,8 to 6,8±1,5 (p<0,0001); ALT, from 24,0±12,7 to 20,22±10,61 U/L (p<0,001); venous blood lactate, from 2,5±0,8 to 1,5±1,0 mmol/L (p<0,001); capillary blood lactate, from 2,9±0,8 to 2,0±0,8 mmol/L (p<0,0001); estimated pulmonary shunt fraction (Qs/Qt, Berggren equation, 1942) from 8,98±5,7 to 5,34±3,2 (p<0,01); white blood cells, from 6,64±1,57 to 5,92±1,32 109/L. In addition, we revealed an increase in the refractive index (RI) from 46,67±13,26% to 63,32±13,44% (p<0,0001), minimum blood oxygen saturation (SpO2) from 92,25±2,9 to 94,25±1, 56% (p<0,05), direct bilirubin from 2,99±1,41 to 3,39±1,34 pmol/L (p<0,01), partial oxygen tension (PvO2) from 26,9±5,0 to 34,8±5,6 mm Hg (p<0,0001), venous oxygen saturation (SvO2) from 51,8±020,6 to 61,1±018,1% (p<0,05), partial capillary oxygen tension (PcO2) from 48,7±15,4 to 63,8±21,2 mm Hg (p<0,01), capillary oxygen saturation (ScO2) from 82,2±4,2 to 86,2±4,8% (p<0,01), distance in 6 minute walk test from 429±45,0 to 569±60 m.Conclusion. Inhalation therapy with H(H2O)m in the rehabilitation program of COVID-19 survivors during the recovery period is a safe and highly effective method. Manifestations of silent hypoxemia and endothelial dysfunction decreased, while exercise tolerance increased. As for laboratory tests, a decrease in the white blood cell count, estimated pulmonary shunt fraction and lactate content parameters was revealed.

Pulmonary function after COVID-19 in early convalescence phase. The aim of the study is to investigate the influence of Coronavirus disease 2019 (COVID-19) on pulmonary function in early convalescence phase.Materials and methods. The study included 44 patients (35 male) after COVID-19 without concomitant bronchopulmonary pathology, with a median age of 47.5 years. All patients underwent standard pulmonary function tests (PFTs): spirometry, body plethysmography, diffusion test. Besides, dyspnea on the mMRC scale was assessed, oxygen saturation level (SpO2 ) was measured. Depending on degree of lung damage determined using high-resolution computed tomography (CT), the patients were divided into 2 groups: group 1 (22 patients) — CT 1 and CT 2, group 2 (22 patients) — CT 3 and CT 4.Results. The medians of standard PFTs parameters were in normal values. However, there were statistically significant differences between groups: VC, FVC, FEV1 and TLC were lower in second group. Diffusing capacity was reduced in 52% of patients. Statistical significant correlations were established between lung damage by CT and the parameters of VC, FVC, FEV1 , TLC, IC and DLCO.Conclusion. The degree of functional disorders of lungs depended on the extent of abnormal CT. Impaired diffusing capacity were detected in more than half of the COVID-19 patients in early convalescence phase.

In recent years, a greater understanding of the heterogeneity and complexity of chronic obstructive pulmonary disease (COPD) has come from the point of view of an integrated clinical assessment of severity, pathophysiology, and the relationship with other pathologies. A typical COPD patient suffers on average 4 or more concomitant diseases and every day about a third of patients take from 5 to 10 different drugs. The mechanisms of the interaction of COPD and cardiovascular disease (CVD) include the effects of systemic inflammation, hyperinflation (hyperinflation) of the lungs and bronchial obstruction. The risk of developing CVD in patients with COPD is on average 2-3 times higher than in people of a comparable age in the general population, even taking into account the risk of smoking. The prevalence of coronary heart disease, heart failure, and rhythm disturbances among COPD patients is significantly higher than in the general population. The article discusses in detail the safety of prescribing various groups of drugs for the treatment of CVD in patients with COPD. Achieving success in understanding and managing patients with COPD and CVD is possible using an integrated multidisciplinary approach.

COPDPatients with chronic obstructive pulmonary disease (COPD) are unable to do physical exercises included into standard pulmonary rehabilitation programs.Neuromuscular electrical stimulation (NMES) is a good alternative for such patients as it does not aggravate shortness of breath.The aim of this work was to assess the effect of short-term NMES of the quadriceps femoris muscle on the physical activity of patients with COPD.Our prospective open randomized study was carried out in 36 patients distributed into two groups.The main group was administered NMES for 10 days.On day 10 clinical and functional parameters, as well as adverse events, were evaluated.On admission to hospital, the groups did not differ in terms of the studied parameters.Following the treatment course, the main group significantly improved their step count and electromyography results (418.5 (86.0; 815.0) vs. 226.7 (48.0; 660.0), p = 0.02, and 463.0 (122; 804) vs. 210.5 (64; 481), p = 0.0001, respectively).The patients scored much less on the Mmrc and Borg scales and the 34.0) vs. 28.4(26.0; 34.0), p = 0.00007; 2.7 (2.0; 4.0) vs. 3.1 (3.0; 4.0), p = 0.03; and 6.3 (5.0; 7.0) vs. 7.2 (6.0; 9.0), p = 0.0002, respectively.No adverse events were registered in the main group.Based on the obtained results, we conclude that shortterm NMES of the quadriceps femoris muscle improves physical activity, the quality of life and ability to do physical exercise in patients with COPD providing them with a good alternative to standard rehabilitation programs.Пациенты с обострением хронической обструктивной болезни легких (ХОБЛ) не способны выполнять тренировочные упражнения в рамках программы легочной реабилитации.Альтернативой служит метод электромиостимуляции (ЭМС), поскольку его применение не вызывает усиления одышки у пациента.Целью работы была оценка эффективности краткосрочной ЭМС четырехглавой мышцы бедра на двигательную активность у пациентов с ХОБЛ.В проспективное открытое рандомизированное исследование вошли 36 пациентов, разделенные на две сопоставимые группы.Пациентам в основной группе проводили ЭМС в течение 10 дней.На 10-е сутки регистрировали и сравнивали клинико-функциональные параметры и потенциальные побочные эффекты.Между двумя группами не было отмечено существенных различий в отношении исходных характеристик.По результатам межгруппового анализа, основная группа имела статистически значимые улучшения показателей измерений, выполненных шагомерм и при миографии, равных соответственно 418,5 (86,0; 815,0) против 226,7 (48,0; 660,0) (p = 0,02), 463,0 (122; 804) против 210,5 (64; 481) (p = 0,0001).Отмечалось значительное снижение баллов при оценке ХОБЛ по CAT-тесту и оценке одышки по mMRCшкале и по шкале Borg: 22,8 (18,0; 34,0) против 28,4 (26,0; 34,0) (p = 0,00007), 2,7 (2,0; 4,0) против 3,1 (3,0; 4,0) (p = 0,03) и 6,3 (5,0; 7,0) против 7,2 (6,0; 9,0) (p = 0,0002) соответственно.Побочных эффектов в основной группе отмечено не было.На основании полученных результатов можно сделать вывод, что краткосрочная ЭМС четырехглавой мышцы бедра улучшает двигательную активность пациентов, повышая качество жизни и способность выполнять программы легочной реабилитации в последующем, и является альтернативой физическим тренировкам у пациентов с ХОБЛ.

Patients with chronic obstructive pulmonary disease (COPD) are unable to do physical exercises included into standard pulmonary rehabilitation programs. Neuromuscular electrical stimulation (NMES) is a good alternative for such patients as it does not aggravate shortness of breath. The aim of this work was to assess the effect of short-term NMES of the quadriceps femoris muscle on the physical activity of patients with COPD. Our prospective open randomized study was carried out in 36 patients distributed into two groups. The main group was administered NMES for 10 days. On day 10 clinical and functional parameters, as well as adverse events, were evaluated. On admission to hospital, the groups did not differ in terms of the studied parameters. Following the treatment course, the main group significantly improved their step count and electromyography results (418.5 (86.0; 815.0) vs. 226.7 (48.0; 660.0), p = 0.02, and 463.0 (122; 804) vs. 210.5 (64; 481), p = 0.0001, respectively). The patients scored much less on the Mmrc and Borg scales and the CAT-test: 22.8 (18.0; 34.0) vs. 28.4 (26.0; 34.0), p = 0.00007; 2.7 (2.0; 4.0) vs. 3.1 (3.0; 4.0), p = 0.03; and 6.3 (5.0; 7.0) vs. 7.2 (6.0; 9.0), p = 0.0002, respectively. No adverse events were registered in the main group. Based on the obtained results, we conclude that shortterm NMES of the quadriceps femoris muscle improves physical activity, the quality of life and ability to do physical exercise in patients with COPD providing them with a good alternative to standard rehabilitation programs.

The article is devoted to the concept of early treatment of patients with intermittent and slight course of bronchial asthma with the use of fixed combinations of inhaled corticosteroids and long-acting beta2-agonists. It describes the basic pathophysiological and molecular mechanisms of this therapy, and the synergy of its components and the local anti-inflammatory effects. Considerable attention is paid to the justification of different strategies for the prescription of steroid-containing combinations as initial therapy: regular prescription of fixed doses, use of a single inhaler for maintenance and symptomatic therapy, including ICS for patients with intermittent and mild BA, abandonment of regular therapy and use of combinations only for therapy on demand. It is emphasized that the basis for the application of such a strategy is low adherence to regular ICS therapy in patients with rare symptoms and undesirability of complete withdrawal of low dose ICS in patients with the light course of the disease because of the high risk of exacerbations. Current evidence suggests that the concept of early prescription of combinations on demand allows combining symptomatic and anti-inflammatory therapy as part of the start of treatment of patients with mild bronchial asthma.

Spirometry is the principal method of diagnosis and evaluation of severity and therapeutic efficacy in patients with chronic obstructive pulmonary disease (COPD). According to the current definition of this disease the main pathophysiological sign of COPD is persistent and generally progres sive airflow limitation. This article will reviews common spirometric parameters used for COPD diagnosis and a diagnostic value of FEV1 / FVC ratio used in absolute values or as the lower limit of its normal range. Spirometry allows detecting pulmonary hyperinflation, particularly using the inspiratory capacity; this possibility is very important but is not widely applied. This is a probable reason of COPD underestimation and late diagnosis. Underestimation of COPD is thought to be due to low spirometry implementation in primary care practice as majority of COPD patients seek medical care in the advanced disease when pulmonary function has already been lost significantly. A great problem for wide implementation of spirometry in general practice is difficulty to learn adequate spirometric testing and interpretation of test results. Notwithstanding a new integral assessment of COPD underlying the current COPD classification spirometric parameters (FEV1 < 50 %pred.) often are the leading criteria to predict a high risk of future exacerbations. Recent data have been demonstrated that early spirometric diagnosis of COPD in primary care is the most effective strategy providing more sufficient therapy results.

This guidelines are focused on the principal method of lung function examination which is spirometry. Spirometry is a non - invasive method for measuring airflow and air volumes as a function of time using forced maneuvers. This guidelines are based on international documents on spirometry standardization and interpretation and considered opinions of primary care physicians and general practitioners about comprehension and importance of these guidelines as an everyday practical tool. Spirometry is widely used for diagnosis, monitoring, expertise of invalidity, in epidemiological surveys and clinical trials. Spirometry could be performed under tidal breathing or forced maneuvers. All spirometers should fit minimal technical requirements and should be calibrated daily. Main spirometric parameters and their changes in patients with obstructive, restrictive or mixed ventilation disorders have been reviewed in the guidelines. Bronchodilator test has also been described.

сегодня является одной из основных причин заболе$ ваемости и смертности во всем мире (около 210 млн больных, 3 млн смертей (5 % всех смертей) ежегод$ но). По некоторым прогнозам, к 2030 г. ХОБЛ займет 3$е место среди ведущих причин смертности [1–3]. В течении ХОБЛ часто отмечаются эпизоды кли$ нической нестабильности, которые определяются как обострения. Прогрессирование заболевания в значи$ тельной степени связано с обострениями, которые в соответствии с GOLD (Global Initiative for Chronic Obstructive Lung Disease) определяются как "события при естественном течении заболевания, которые ха$ рактеризуются изменением базального уровня одышки, кашля и / или выделения мокроты, выходят за рамки межсуточных колебаний, возникают остро и могут потребовать изменения плановых назначе$ ний" [1]. Основными симптомами обострения являются появление или усиление одышки, кашля и / или от$ деления мокроты, а также изменение цвета и / или вязкости мокроты [4]. Тяжесть обострения может быть классифицирована на основании изменения симптомов или применения препарата, обычно используемого для лечения обострений [5]. Обостре$ ния обычно связаны с бактериальными и / или вирусными инфекциями дыхательных путей и повы$ шением уровня загрязненности воздуха [1] и сопро$ вождаются увеличением уровня маркеров воспале$ ния в дыхательных путях и системном кровотоке, а так же повышением скорости падения легочной функции, которая наиболее выражена у пациентов с частыми обострениями. Процесс восстановления больного после тяжелого обострения может растя$ нуться на период до нескольких недель [6–9]. Фенотип ХОБЛ с частыми обострениями

The study involved 59 patients with mild, moderate or severe COPD and 29 smokers without pulmonary or cardiac disease as controls. All patients underwent lung function tests and echocardiographic examination. Planimetric, haemodynamic and tissue Doppler parameters were compared between the groups. In the COPD patients, the right ventricular diastolic dysfunction was found using the tissue Doppler imaging; the right ventricular myocardial performance index increased significantly when compared with the control group. The left heart remodeling emerged as the left ventricular diastolic dysfunction in 57.6% of patients and also as increased left ventricular myocardial performance index and increased left atrial volume index.

Целью настоящего исследования была оценка функционально-структурных изменений сердца у пациентов с изолированным течением хронической обструктивной болезни легких (ХОБЛ) в сочетании с ишемической болезнью сердца (ИБС). Использовались методы стандартной и тканевой допплерэхокардиографии. В исследовании участвовали 144 пациента, которые были разделены на 3 группы: 1-я - 59 больных ХОБЛ (I-III стадии), 2-я - 56 пациентов с сочетанием ХОБЛ и ИБС, 3-я (контрольная) - 29 курящих пациентов без клинических и функциональных проявлений сердечнолегочной патологии. Проводились исследование функции внешнего дыхания, эхокардиография у больных всех групп. Сравнивались планиметрические, гемодинамические, параметры тканевой допплерографии. Индекс объема левого предсердия достоверно различался во всех группах: в 1-й - 29,2 ± 3,5; во 2-й - 33,7 ± 2,95; в 3-й - 24,1 ± 2,3. Наиболее выраженными различия между группами были при сравнении параметра Е / Еm левого желудочка. В 1-й группе данный показатель возрастал на 49,1 % по отношению к контрольной группе, а во 2-й - на 132,7 %. Диастолическая дисфункция левого желудочка (ДДЛЖ) развивалась у 57,6 % пациентов 1-й группы и у 98,2 % - 2-й группы. Систолическое давление в легочной артерии в 1-й группе было на 15 % выше, а во 2-й - на 55 % выше, чем в группе контроля. Выраженная легочная гипертензия у пациентов 2-й группы приводила к ухудшению работы правого желудочка: индекс миокардиальной производительности правого желудочка почти в 2 раза увеличивался у больных ХОБЛ и еще более - у пациентов с сочетанной патологией. Уменьшение соотношения показателей ранней и поздней диастолической волн при использовании тканевого допплера c латерального кольца трикуспидального клапана регистрировалось у пациентов 1-й группы и было более выраженным во 2-й группе, что подтверждает усиление степени ДДЛЖ у пациентов с сочетанием ХОБЛ и ИБС, по сравнению с больными ХОБЛ. Таким образом, метод тканевой допплерографии помогает обнаружить ДД обоих желудочков на более ранней стадии, когда посредством импульсно-волновой допплерографии изменения не выявляются.