1 -Федеральное государственное бюджетное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И.Пирогова» Министерства здравоохранения Российской Федерации: 117997, Москва, ул. Островитянова, 1; 2 -Федеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М.Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет): 119991, Москва, ул. Трубецкая, 8, стр. 2; 3 -Некоммерческое партнерство «Национальная ассоциация специалистов по контролю инфекций, связанных с оказанием медицинской помощи»: 603022, Нижний Новгород, ул. Пушкина, 20, стр. 4; 4 -Федеральное государственное бюджетное учреждение «Научно-исследовательский институт пульмонологии» Федерального медико-биологического агентства: 115682, Москва, Ореховый бульвар, 28; 5 -Федеральное государственное бюджетное образовательное учреждение высшего образования «Красноярский государственный медицинский университет имени профессора В.Ф.Войно-Ясенецкого» Министерства здравоохранения Российской Федерации: 660022, Красноярск, ул. Партизана Железняка, 1; 6 -Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр профилактической медицины» Министерства здравоохранения Российской Федерации: 101000, Москва, Петроверигский переулок, 10, стр. 3; 7 -Федеральное государственное бюджетное образовательное учреждение высшего образования «Самарский государственный медицинский университет» Министерства здравоохранения Российской Федерации: 443099, Самара, ул. Чапаевская, 89; 8 -Федеральное государственное бюджетное учреждение «Главный военный клинический госпиталь имени академика Н.Н.Бурденко» Министерства обороны Российской Федерации: 105094, Москва, Госпитальная пл., 3; 9 -Федеральное государственное бюджетное образовательное учреждение высшего образования «Южно-Уральский государственный медицинский университет» Министерства здравоохранения Российской Федерации: 454092, Челябинск, Воровского, 64; 10 -Федеральное государственное бюджетное образовательное учреждение высшего образования «Приволжский исследовательский медицинский университет» Министерства здравоохранения Российской Федерации: 603005, Нижний Новгород, пл. Минина и Пожарского, 10 / 1; 11 -Федеральное государственное бюджетное научное учреждение «Научно-исследовательский институт вакцин и сывороток им. И.И.Мечникова»: 105064, Москва, Малый Казенный переулок, 5а; 12 -Федеральное государственное бюджетное образовательное учреждение высшего образования «Пермский государственный медицинский университет имени академика Е.А.Вагнера» Министерства здравоохранения Российской Федерации: 614990, Пермский край, Пермь, ул. Петропавловская, 26; 13 -Федеральное государственное бюджетное учреждение «Детский научно-клинический центр инфекционных болезней» Федерального медико-биологического агентства: 197022, Санкт-Петербург, ул. Профессора Попова, 9; 14 -Федеральное государственное бюджетное учреждение здравоох...

РезюмеНаиболее важными симптомами при хронической обструктивной болезни легких (ХОБЛ) являются одышка, кашель и продукция мок роты. По данным различных исследований, у пациентов с ХОБЛ на текущей терапии клинически значимая одышка сохраняется в 50-70 % случаев. Одышка имеет важное прогностическое значение, коррелируя с частотой обострений и выживаемостью больных. Важные кри терии эффективности проводимой терапии -снижение выраженности симптомов (в первую очередь -одышки). Инструменты измере ния одышки несовершенны, понятие -субъективно, однако существующие количественные инструменты ее оценки позволяют опре делить степень выраженности симптомов у пациентов с ХОБЛ. Применяемые инструменты (модифицированная шкала Британского Медицинского cовета -Modified Medical Research Council; COPD Assessment Test -САТ) должны быть адаптированы к уровню оказания медицинской помощи (первичное звено, специалист и т. д.). Длительно действующие бронходилататоры являются обязательным ком понентом терапии больного ХОБЛ независимо от его фенотипа. Пациенты, получающие комбинированные лекарственные средства, включающие ингаляционные глюкокортикостероиды (иГКС), должны быть фенотипированы для определения показаний для назначе ния ГКС. Длительная терапия иГКС показана пациентам следующих групп: с сочетанием бронхиальной астмы и ХОБЛ; с высоким рис ком обострений (объем форсированного выдоха за 1 ю секунду (ОФВ1) < 50 %долж. при ≥ 2 неинфекционных обострениях в год или с ≥ 1 госпитализацией по поводу неинфекционного обострения); с эозинофилией мокроты > 3 % и / или > 300 клеток в 1 мл крови с учетом тяжести течения заболевания. При назначении иГКС необходимо учитывать риск побочных эффектов. Не следует добавлять иГКС при ОФВ1 ≥ 50 %, у пациентов с < 2 обострениями или отсутствием указаний на госпитализацию по поводу обострения ХОБЛ в течение 1 года; иГКС могут быть отменены, если они были назначены не по показаниям. У пациентов с сохраняющейся симптоматикой на фо не монотерапии длительно действующими бронходилататорами, иГКС / длительно действующими β2 агонистами или без четких пока заний к назначению иГКС оптимальным выбором может послужить комбинация индакатерол / гликопирроний. Ключевые слова: хроническая обструктивная болезнь легких, длительно действующие бронходилататоры, ингаляционные глюкокорти костероиды, комбинированная терапия, одышка.

Vaccination against Streptococcus pneumoniae is among the most effective measures for preventing pneumonia and reducing the rate of chronic obstructive pulmonary disease (COPD) exacerbations. The objective of this work was to evaluate the long-term effectiveness of PCV13 and PPV23 for preventing pneumonia and COPD exacerbations. The open-label, prospective, observational cohort study involved 302 male patients aged ≥ 45 years: PCV13 group (n = 123); PPV23 group (n = 32); and vaccine-naïve group (n = 147). The primary endpoint included the frequency of pneumonia episodes and COPD exacerbations per year over a 5-year follow-up period. The secondary endpoints included the dynamics of dyspnea severity (MMRC), the BODE index, FEV1, the CAT index, the SGRQ score, and the results of 6-min walk test. Vaccination with PCV13 and PPV23 significantly reduces the total rate of pneumonia during the first year after vaccination. Starting with the second year, clinical effectiveness in PPV23 group decreases compared with both PCV13 group and vaccine-naïve patients. Pneumonia by year 5 after vaccination was registered in 47% of patients in the PPV23 group, versus 3.3% of patients in the PCV13 group (p < 0.001); COPD exacerbations—in 81.3% versus 23.6%, respectively (p < 0.001). Vaccination with PCV13 significantly reduced and maintained the BODE index over the 5-year follow-up period. Although both vaccines have comparable clinical effects during the first year after vaccination, only PCV13 is characterized by persistent clinical effectiveness during the 5-year follow-up period. Patients older than 55 years who received PPV23 have significantly higher risks of having pneumonia episodes more frequently during the long-term follow-up.

The article uses the analysis of clinical and pharmacoeconomic effectiveness of 13-valent conjugated pneumococcal vaccine in patients with combined course of chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD) and chronic heart failure (CHF). Materials and methods. 429 male patients with diagnoses of COPD, IHD, CHF were included in the study. The main endpoints of observation, for 5 years, for evaluation of effectiveness were dynamic assessment for class CHF, the number of exacerbations, hospitalizations, the number of pneumonias. The 13-valent conjugated pneumococcal vaccine (PCV13) Prevenar-13 was used for vaccine prophylaxis. Results and discussion. The increase in age with the combined course of COPD and cardiovascular pathology leads to a deterioration in the basic clinical and functional indicators. With the increase in the clinical symptoms of the defeat of the respiratory system. There is an increase in the functional class of heart failure. Inclusion of vaccine prophylaxis PCV13 in the management plan of patients with combined pathology. Reduce the degree of dyspnea and stabilize the main functional indicators. Conclusions. Vaccination of patients with COPD using PCV13 combined with CHF and IHD made it possible to manage the health system expenses by 74-84%.

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.

Data on asthma remission in adults are scarce worldwide and have not been searched in Russian Federation.The aim of the study was to describe clinical course and remission rate in adult patients with atopic asthma in Chelyabinsk.Methods. A retrospective analysis of 313 outpatient records of patients with atopic asthma aged 18 to 70 years was carried out. The patients were followed from 1992 to 2018. The median duration of the follow-up was 8 (5; 15) years. Then, the patients were surveyed by phone. Asthma Control Test (AСT) was used in 181 (58%) of 313 respondents. Clinical remission of asthma was determined as being symptom-free with no need in inhaled corticosteroids (ICSs) and short-acting β2-agonists (SABAs) during ≥ 1 year.Results. The median age of asthma onset was 14.5 (8; 2) years in males and 28 (24; 36) years in females (p < 0.001). The diagnosis was made 5 years after the onset of symptoms. Asthma severity was related to gender: mild asthma was seen more often in males compared to females (p = 0.008). Allergic rhinitis and asthma comorbidity was found in 78% of patients. The proportion of patients sensitized to pollen was 72%; tree pollen allergens were the main cause of seasonal allergy (in 51% of patients). Different combinations of sensitization to indoor, animal, and pollen allergens (polysensitization) were detected in 80% of patients. Clinical remission of atopic bronchial asthma was determined in 22.7% of cases. Asthma remission was not related to the patient’s gender or age of symptom onset. The median age of the remission group patients was 33 (28; 39.5) years vs 40 (29; 51) years in patients without remission (p = 0.015). Asthma remission was associated with normal body mass index (23 (21; 24) kg / m2 vs 25 (22; 29) kg / m2 (p = 0.007); allergen elimination (p < 0.001) and allergen-specific immunotherapy (p < 0.001).Conclusion. Predicting the probability of asthma remission and identifying conditions required to achieve the remission could improve our knowledge about asthma natural course and could increase treatment efficacy and adherence of patients to the treatment.

Most subjects with the COVID-19 experience mild to moderate symptoms, but approximately 10% of cases suffer from severe course of disease. IL-6 inhibitors are actively used to neutralize and prevent the cytokine storm. Olokizumab is a humanized monoclonal antibody belonging to the G4/Kappa immunoglobulin isotype that selectively binds to human IL-6 and effectively neutralizes it. Aim.To evaluate the efficacy and safety of Artlegia (olokizumab) for the treatment of subjects with a disease caused by the SARS-COV-2 virus in a real-world clinical setting. Materials and methods.The analysis included data of 610 subjects aged 55.0812.68 years who received olokizumab at a single dose of 160 mg/mL 0.4 mL subcutaneously as a preemptive anti-inflammatory therapy. The comparison group included 511 subjects aged 55.2311.23 years who received standard therapy without IL-6 inhibitors. Control Endpoints: 1. Positive clinical changes on Day 7. 2. Changes in the CRP levels on Days 1, 2, and 7. 3. Duration of oxygen therapy. 4. Number of days in hospital. 5. Number of adverse events. 6. Disease outcome. Results.If a cytokine storm occurs, immune regulatory events will trigger the development of either a protective immune response or an exacerbated inflammatory response. The use of preemptive anti-inflammatory therapy has both a short-term and, most importantly, a long-term effect on the T and B parts of the immune process. These aspects definitely require further research and observation. Conclusion.The use of olokizumab to treat the new COVID-19 coronavirus disease has demonstrated a positive effect on clinical and laboratory parameters. Primarily, it affects the severity of clinical parameters by improving the general condition already on the first day of observation, and decreasing body temperature to normal values. The changes in the C-reactive protein levels show a significant effect of the IL-6 inhibitor on the systemic inflammatory response.

BackgroundVaccination against Streptococcus pneumoniae is among the most effective measures for preventing pneumonia and reducing the rate of chronic obstructive pulmonary disease (COPD) exacerbations. The objective of this work was to evaluate the long-term effectiveness of PCV13 and PPV23 for preventing pneumonia and COPD exacerbations.MethodsThe open-label, prospective, observational cohort study involved 302 male patients aged ≥45 years: PCV13 group (n=123); PPV23 group (n=32); and vaccine-naïve group (n=147). The primary endpoint included the frequency of pneumonia episodes and COPD exacerbations per year over a 5-year follow-up period. The secondary endpoints included the dynamics of dyspnea severity (MMRC), the BODE index, FEV1, the CAT index, the SGRQ score, and the results of 6-min walk test.ResultsVaccination with PCV13 and PPV23 significantly reduces the total rate of pneumonia during the first year after vaccination. Starting with the second year, clinical effectiveness in PPV23 group decreases compared with both PCV13 group and vaccine-naïve patients. Pneumonia by year 5 after vaccination were registered in versus 47% of patients in the PPV23 group 3.3% of patients in the PCV13 group (p<0.001); COPD exacerbations – in 81.3% versus 23.6%, respectively (p<0.001). Vaccination with PCV13 significantly reduced and maintained the BODE index over the 5-year follow-up period.ConclusionAlthough both vaccines have comparable clinical effects during the first year after vaccination, only PCV13 is characterized by persistent clinical effectiveness during the 5-year follow-up period. Patients older than 55 years on PPV23 have significantly higher risks of having pneumonia episodes more frequently during the long-term follow-up.