Pulmonologiya最新文献

{"title":"The effectiveness of early administration of antifibrotic therapy as a reflection of properly organized medical care for patients with progressive pulmonary fibrosis","authors":"G. Ignatova, V. Antonov, E. V. Blinova, M. Belsner","doi":"10.18093/0869-0189-2024-34-1-115-120","DOIUrl":"https://doi.org/10.18093/0869-0189-2024-34-1-115-120","url":null,"abstract":"The issues of organization of medical care and early administration of antifibrotic therapy in patients with progressive fibrotic phenotype require in-depth study and implementation in real clinical practice.The aim of this paper is to provide a rationale for the early administration of antifibrotic drugs in patients with various forms of interstitial lung disease.Results. The article addresses organizational issues in the medical care for interstitial lung disease with a progressive fibrotic phenotype. Topical epidemiological problems are also addressed, in particular the high mortality rate in this disease. The main risk factors of the disease are considered. Diagnostic markers for the fibrosis progression are analyzed. Data from large-scale studies on the early initiation of antifibrotic therapy and its effect on disease outcomes are presented.Conclusion. The main reasons for early initiation of therapy in a progressive fibrotic phenotype are presented: an unfavorable prognosis, an unpredictable course, a progressive decrease in forced vital capacity, and the association of changes in FVC with an increase in mortality. Using the Chelyabinsk region as an example, a model of care for patients with interstitial lung diseases is considered, with a brief analysis of the effectiveness of antifibrotic therapy, its early initiation and the impact on mortality in patients with this disease.","PeriodicalId":37383,"journal":{"name":"Pulmonologiya","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140493895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combination therapy with medical gases (nitric oxide and molecular hydrogen): safety assessment","authors":"D. D. Pozdnyakova, I. A. Baranova, V. D. Selemir, A. G. Chuchalin","doi":"10.18093/0869-0189-2024-34-1-42-49","DOIUrl":"https://doi.org/10.18093/0869-0189-2024-34-1-42-49","url":null,"abstract":"Inhaled nitric oxide (NO) and molecular hydrogen (iH2) are actively studied nowadays. The therapeutic algorithms for their use in the various conditions are being developed, but the combined use of these medical gases (MG) has not been studied well enough.The aim of the study was to assess the safety of iNO and iH2 combination in healthy volunteers.Methods. 10 healthy volunteers (4 males and 6 females), mean age 24.0 ± 1.3 years, were included in the open non-comparative prospective study. All volunteers received a single combined inhalation of NO and H2 for 90 minutes. The NO concentration was 60 ppm and the H2 concentration did not exceed 4% in the gas mixture. Changes in the vital signs, arterial blood gases, and hemodynamic parameters were evaluated. The hemodynamic parameters were investigated before and after inhalation using echocardiography (Vivid E9 General Electric, USA). We also assessed the microcirculation of the bulbar conjunctiva (“OKO” capillaroscope), the main functional lung parameters, and the diffusion lung capacity (GANSHORN PowerCube Body apparatus). The clinical side effects were recorded. After inhalation, the serum concentration of methemoglobin was evaluated.Results. When comparing the results before and after MG inhalation, there was no negative impact on the vital signs, arterial blood gases (РaO2, РaСO2, SаO2), the functional lung volumes (FEV1, FVC, FEV1 / FVC), the diffusion test parameters, main EchoCG hemodynamic data (ejection fraction, tricuspid annular plane systolic excursion (TAPSE), mean pulmonary artery pressure, left and right ventricular sizes) (p > 0,05). After inhalation, the microcirculatory parameters (the volume velocity in arterioles and venules and the arteriolar diameter) increased significantly (p < 0.05). We did not observe the increase in serum methemoglobin concentration (0.59 ± 0.11%). No clinical side effects were reported during the study.Conclusions. Combined use of inhaled NO / H2 is clinically safe, does not have any negative impact on hemodynamic parameters, functional lung volumes, and arterial blood gases. The improvement of the microcirculation was noted after a single inhalation. This new method can be recommended for further studies of the therapeutic effect in various conditions.","PeriodicalId":37383,"journal":{"name":"Pulmonologiya","volume":"20 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140509230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitochondria as a key target of molecular hydrogen","authors":"S. V. Nesterov, A. G. Rogov, R. G. Vasilov","doi":"10.18093/0869-0189-2024-34-1-59-64","DOIUrl":"https://doi.org/10.18093/0869-0189-2024-34-1-59-64","url":null,"abstract":"The aim of the work was to systematize the data on the biologically significant effects of molecular hydrogen to uncover the mechanisms of its effect on the human body. The paper analyzes the literature on the effect of molecular hydrogen administered in the form of inhalation and hydrogenenriched water on the human body, on laboratory mammals (rats, mice), and on model cell systems in vitro. As a result, a mechanism has been proposed according to which, in addition to the already known effect of hydrogen in neutralizing highly reactive oxygen species, there is at least one other group of molecules that are the target of molecular hydrogen in the body. These are the porphyrins, which are part of the hemoproteins, in particularly the cytochromes of the mitochondrial respiratory chain. In the presence of high concentrations of carbon dioxide, which is formed in the tricarboxylic acid cycle in the mitochondrial matrix, hydrogen damages some of the hemes as a result of covalent binding of the CO group to them. At low doses of hydrogen, this causes a moderate decrease in mitochondrial potential and stimulates the adaptive response of the body, including activation of the transcription factor Nrf2, expression of the heme oxygenase and antioxidant defense enzymes, mitophagy, and renewal of the mitochondrial population in the cell.Conclusion. Molecular hydrogen is an adaptogen that causes mitochondrial hormesis – the renewal and strengthening of the body’s bioenergetic and antioxidant systems.","PeriodicalId":37383,"journal":{"name":"Pulmonologiya","volume":"14 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140509183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary hemorrhage in cystic fibrosis: a review of current data","authors":"M. M. Fedotova, A. A. Doronina","doi":"10.18093/0869-0189-2023-33-6-820-831","DOIUrl":"https://doi.org/10.18093/0869-0189-2023-33-6-820-831","url":null,"abstract":"Pulmonary hemorrhage is a serious complication of cystic fibrosis (CF) with a prevalence up to 9.1%. According to the Registry of Patients with Cystic Fibrosis of the Russian Federation for 2020, the prevalence of pulmonary hemorrhage was 1.5% in the general population, and 6.5% in patients over 18 years of age. Despite the importance of this problem, there is no systematic information on pulmonary hemorrhage in CF.Aim. The purpose of this study was to review current data on the pathogenesis, risk factors, and approaches to the treatment of pulmonary hemorrhage in patients with CF. Information was searched in еLibrary and PubMed databases.Results. During the literature review, we summarized and systematized the collected scientific data on pulmonary hemorrhage in CF. The pathogenesis of pulmonary hemorrhage is chronic inflammation in the bronchial wall accompanied by increased angiogenesis factors that promote neovascularization with development of many tortuous, thin-walled vessels. Exacerbation of bronchial inflammation and mechanical strain contribute to erosion and damage of fragile vessels and cause the bleeding. The main risk factors for pulmonary hemorrhage were colonization with Pseudomonas aeruginosa, Staphylococcus aureus, diabetes mellitus, and FEV1 < 70%. Complex therapy for pulmonary hemorrhage includes the use of antibiotics and antifibrinolytic agents. Some of the published regimens use β-blockers and blood coagulation factor VII. Data on the efficacy of vitamin K are unclear, but it is also used in the treatment of pulmonary hemorrhage. In cases of massive bleeding, temporarily discontinuation of inhalations of hypertonic solution and kinesiotherapy is recommended. In case of recurrent massive bleedings, bronchial artery embolization is performed and lung resection can be done in extreme cases.Conclusion. Hemoptysis in CF is a complex clinical problem that requires a multidisciplinary approach. Currently, important aspects of the pathogenesis of pulmonary hemorrhage remain unclear. Given the increasing life expectancy of CF patients and the age-related risk of pulmonary hemorrhage, it is important to investigate the pathogenetic aspects of this complication for the subsequent development of effective and justified treatment algorithms.","PeriodicalId":37383,"journal":{"name":"Pulmonologiya","volume":"34 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138976457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tiotropium bromide in the treatment of chronic obstructive pulmonary disease","authors":"O. N. Titova, N. Kuzubova, A. Kozyrev","doi":"10.18093/0869-0189-2023-33-6-810-818","DOIUrl":"https://doi.org/10.18093/0869-0189-2023-33-6-810-818","url":null,"abstract":"The aim of this review was to analyze current information on tiotropium bromide as one of the LAMAs. Tiotropium was chronologically the first LAMA in clinical practice. It is administered using a dry powder inhaler or an aerosol inhaler (Respimat soft mist inhaler). Due to the long bronchodilator effect, tiotropium can be inhaled once a day. The drug has a significant effect on functional respiratory parameters, reduces lung hyperinflation, improves exercise tolerance and quality of life. Tiotropium is superior to short-acting bronchodilators and long-acting β2-agonists (LABAs) and is comparable to other LAMAs, as well as combinations of LABAs and inhaled corticosteroids in the prevention of COPD exacerbations. Tiotropium bromide has a favorable safety profile. Generic tiotropium drug products, including Respium®, are currently available in the Russian Federation. A clinical trial confirmed the non-inferiority and safety of generic tiotropium drug compared to the original branded product.Conclusion. Tiotropium is an effective and safe medication for the maintenance treatment of COPD and for reducing COPD exacerbations. The generic tiotropium drug products widen the range of effective inhaled medications available to physicians.","PeriodicalId":37383,"journal":{"name":"Pulmonologiya","volume":"113 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139003595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis, combined treatment, and long-term follow-up of a thymoma patient","authors":"N. Chichkova, E. A. Kogan, V. V. Fomin, V. D. Parshin, E. Fominykh, Yu. M. Bychkov, N. V. Morozova, A. B. Ponomarev","doi":"10.18093/0869-0189-2023-33-6-832-840","DOIUrl":"https://doi.org/10.18093/0869-0189-2023-33-6-832-840","url":null,"abstract":"Thymic neoplasms account for 20 – 25% of primary mediastinal tumors. Nonspecific clinical symptoms are often associated with delayed diagnosis of thymoma, leading to a distinctive problem of late diagnosis. Nowadays, surgical removal of the tumor is the method of choice for thymoma treatment. Combination treatment is indicated in the case of an unresectable tumor. Modern therapy (various combinations of anticancer drugs) helps reduce neoplasm size, stop metastasis, and maintain good quality of life in patients with thymoma.Aim. The presented clinical case of type B3 thymoma (with invasion into surrounding organs and metastatic pleura) is characterized by a long asymptomatic period of the disease, the onset of symptoms after suffering COVID-19 (COronaVIrus Disease 2019) and successful long-term polychemotherapy. The causes of late diagnosis, as well as insufficient oncologic vigilance in evaluating the results of laboratory and instrumental tests, are discussed based on this clinical case.Conclusion. A correct diagnosis, as well as successful treatment, requires a multidisciplinary approach involving physicians from different specialties – general practitioners, oncologists, surgeons, radiologists, and morphologists.","PeriodicalId":37383,"journal":{"name":"Pulmonologiya","volume":"41 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138976395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberous sclerosis with lung involvement","authors":"N. Ovsyannikov, O. Bilevich, I. A. Ratynskaya, N. Cherkashchenko, I. V. Sazhina","doi":"10.18093/0869-0189-2023-33-6-849-855","DOIUrl":"https://doi.org/10.18093/0869-0189-2023-33-6-849-855","url":null,"abstract":"","PeriodicalId":37383,"journal":{"name":"Pulmonologiya","volume":"38 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139003272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid disfunction and chronic obstructive pulmonary disease: case report","authors":"T. Kalenchic, S. Kabak, E. V. Zaharenko","doi":"10.18093/0869-0189-2023-33-6-856-860","DOIUrl":"https://doi.org/10.18093/0869-0189-2023-33-6-856-860","url":null,"abstract":"Common concomitant endocrine diseases in chronic obstructive pulmonary disease (COPD) patients include both structural and functional lesions of the thyroid gland.The purpose of the study was to determine specific indicators for the differential diagnosis of thyroid storm and exacerbation of COPD. A clinical observation of a 60-year-old patient who received inpatient treatment in the therapeutic department of a city clinical hospital is presented. The diagnosis upon admission was COPD, mixed form, severe, exacerbation, and respiratory failure of the first degree.Results. In the hospital, the patient experienced an episode of difficulty breathing lasting 45 minutes. Increased shortness of breath alternated with normal breathing and was accompanied by tremor of the hands. The patient was agitated, refused to breathe oxygen through the mask, and was in orthopnea. The patient’s condition during the attack was assessed at 40 points according to the Burch – Wartofsky scale, which corresponds to a high probability of thyroid storm (TS). Pronounced ventilation disturbances of a mixed type were recorded based on the spirography results (forced expiratory volume in 1 second – 19%). Echocardiography revealed no signs of cor pulmonale or pulmonary hypertension. A low concentration of thyroid-stimulating hormone was recorded, the level of free thyroxine (T4) remained within the reference range. Serum levels of thyroid peroxidase antibodies did not increase, and no changes in the thyroid gland were detected during ultrasound examination.Conclusion. When thyroid abnormality manifests in a patient with COPD, certain difficulties may arise with the differential diagnosis of exacerbation of COPD and TS due to the similarity of their clinical manifestations.","PeriodicalId":37383,"journal":{"name":"Pulmonologiya","volume":"30 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139006736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interstitial lung diseases in persons infected with human immunodeficiency virus","authors":"Elena V. Korzh","doi":"10.18093/0869-0189-2023-33-6-841-848","DOIUrl":"https://doi.org/10.18093/0869-0189-2023-33-6-841-848","url":null,"abstract":"Diagnosis of interstitial lung diseases (ILD) in individuals infected with the human immunodeficiency virus (HIV) remains poorly understood.The purpose of the work was to demonstrate approaches to the diagnosis of ILD in HIV-infected patients with different levels of CD4 lymphocytes. An analysis of literature data and clinical observations of ILD in HIV-infected individuals (n = 2) whose CD4 lymphocyte count was 677 (37.5%) and 1 (0.21%) cells/μl are presented. The patients were observed and treated for a long time by pulmonology specialists, including anti-tuberculosis chemotherapy. The patient with CD4 lymphocyte count of 677 cells/μl in the absence of Mycobacterium tuberculosis in the sputum had an established diagnosis of idiopathic pulmonary fibrosis with the progressive development of respiratory failure and progression of the computed tomographic pattern from large areas of “ground glass” to the formation of reticular changes and “honeycomb” lung within 2 years. The patient with CD4 count of 1 cell/μl was diagnosed with nonspecific interstitial pneumonia based on characteristic clinical manifestations of increasing respiratory failure against the background of diffuse interstitial pneumofibrosis in the absence of bacterial excretion, the effects of antimycobacterial, antibacterial and antifungal treatment for 7 months, and excluding other causes of lung damage.Conclusion. The development of interstitial fibrosing pulmonary process of non-infectious etiology in HIV-infected patients with different states of T-helper immunity has been demonstrated. After excluding opportunistic infections, the influence of other factors, and concomitant diseases, these patients were diagnosed with various forms of idiopathic interstitial pneumonia. However, existing reports of the direct damaging effects of the virus on the pulmonary parenchyma also suggest the possibility of HIV-associated interstitial pulmonary fibrosis.","PeriodicalId":37383,"journal":{"name":"Pulmonologiya","volume":"134 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139004271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oscillometry: clinical significance and applications","authors":"L. D. Kiryukhina, A. V. Chernyak","doi":"10.18093/0869-0189-2023-33-6-798-808","DOIUrl":"https://doi.org/10.18093/0869-0189-2023-33-6-798-808","url":null,"abstract":"Oscillometry (the forced oscillation technique) is widely used in the Russian Federation. It is a simple, noninvasive functional diagnostic test that offers unique advantages in cases where spirometry and other pulmonary function tests are not appropriate, such as in young children, debilitated patients, or patients with physical and cognitive barriers to performing tests that require effort and coordination.The aim of this study was to analyze scientific literature data and our own results and to evaluate the significance and applications of oscillometry in clinical practice. The review examined the physiological principles of oscillometry and the basis for interpreting the results. Oscillometry is now recognized as a sensitive diagnostic tool for assessing airway resistance. This article describes sensitivity of the method for bronchodilation and bronchoprovocation tests, as well as its response to drug treatment, especially in asthma and chronic obstructive pulmonary disease. Oscillometry is a useful tool for diagnosing obstructive ventilation disorders. It should be used as an addition to spirometry to clarify phenotypes of small airways diseases. However, despite its great promise as a useful diagnostic tool, further evidence of its clinical utility in restrictive conditions is needed.Conclusion. Thus, oscillometry can be considered an addition and sometimes an alternative to spirometry and bronchodilation test, since it is well standardized. The test results are highly reproducible, the study does not require maximum effort, and the test is carried out during spontaneous tidal breathing.","PeriodicalId":37383,"journal":{"name":"Pulmonologiya","volume":"35 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139005241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}