Vol 26, No 11 (2019)

The review presents modern ideas about severe eosinophilic bronchial asthma (SEBA); in this disease, a central role in the regulation and increased activation of eosinophils is played by the cytokines associated with this asthma phenotype, including interleukin-5. In this regard, in recent years, targeted therapy for SEBA using anti-interleukin-5 drugs, including mepolizumab, has been actively developing. A number of clinical studies carried out in accordance with the modern requirements of evidence-based medicine have demonstrated that a decrease in the level of eosinophilia that develops during treatment with mepolizumab in patients with SEBA is accompanied by a decrease in the frequency of exacerbations, improved control of the disease and lung function, and improved quality of life. The clinical effect of mepolizumab is independent of atopic status and eosinophilia level. Given the frequent combination of SEBA with polypous rhinosinusitis, data on the clinical efficacy of mepolizumab in this comorbid pathology, which significantly aggravate the condition of patients, deserve attention. The results of the studies analyzed and generalized in the review allow the authors to conclude that the wider introduction of mepolizumab for the treatment of SEBA patients is feasible.

The basis for the treatment of bronchial asthma (BA) includes inhaled glucocorticosteroids (IGCS), usually in combination with long-acting fc-adrenoagonists (LABA) - IGCS/LABA. As this group of drugs becomes more and more representative over time, the practitioner often faces a difficult question about choosing the “best possible". The main tool of evidence-based medicine is randomized clinical trials (RCTs), which do not always reflect real clinical practice. To this extent, the so-called pragmatic RCTs have no such disadvantage. One of them, the Salford Lung Study (SLS) is a 12-month phase III study to evaluate the efficacy and safety of the new combination drug containing modern IGCS fluticasone furoate (FF) and LABA vilanterol (VI) - 100 μg/25 μg or 200 μg/25 μg given once a day in the form of a multi-dose dry powder inhaler [23]. During the SLS, the therapeutic superiority of FF/VI over “conventional therapy" in achieving asthma control was demonstrated, and it was attributable to the clinical pharmacology features of the new combination of IGCS+LABA, including possibility of taking the drug once a day.

Background. To date, community-acquired pneumonia (CAP) remains the most important medical and social problem. This is primarily attributable to the high incidence rates (about 700 thousand cases per year) and mortality (standardized mortality rate was 23.2 cases per 100 thousand population) in the Russian Federation. Objective. The assessment of the level of basic knowledge on the prevention, diagnosis and basic treatment of CAP among medical practitioners (general practitioners, therapists) using the anonymous questionnaire survey. Methods. Within the framework of the multicentre KNOCAP (The assessment of physicians ’knowledge of community-acquired pneumonia basics) study, the article presents the results of a prospective anonymous questionnaire survey assessing the knowledge and preferences of physicians in the field of CAP pharmacotherapy. For the current period of the project (2017-2019), the results of a survey of 429 medical practitioners from 11 centers of Russia and Ukraine were obtained and analyzed. The anonymous questionnaire survey was used in this study, and an original questionnaire was developed based on current clinical guidelines. Results. The greatest difficulties were caused by such «fundamental» questions as the choice of the main diagnostic sign during examination of CAP patient, the terms for the repeated x-ray examination with positive dynamics of CAP treatment, the choice of starting antimicrobial therapy. In general, the study has showed a significant discrepancy between the doctors’ knowledge on the management of CAP patients and the current clinical guidelines 2010 and the draft new clinical guidelines 2018-2019. Conclusion. Currently, there is a huge reserve for optimizing the medical practitioners’ knowledge; a multicenter research of the knowledge and preferences of specialists has revealed their insufficient level of knowledge in a number of issues related to the correct management of CAP patients.

Background. Obstructive sleep apnea syndrome (OSAS) and snoring as one of its symptoms are a serious disease that causes not only social discomfort, but also leads to the development of serious complications up to death. A single tactic regarding the treatment of OSAS has not yet been developed. Objective. Evaluation of the effectiveness of surgical treatment of patients with snoring and OSAS depending on the severity of the disease and the level of obstruction of the upper respiratory tract. Methods. To assess the severity of the condition, 51 patients with complaints of snoring and sleep apnea underwent nocturnal advanced respiratory monitoring. To identify the cause of obstruction, a standard examination of ENT organs was carried out, supplemented by endoscopic examination and functional tests. Surgical treatment included elimination of all the diagnosed causes of OSAS. Results. Assessment of the effectiveness of surgical treatment of OSAS was performed 1 month after surgery. Elimination of snoring was achieved in 45 (86%) patients. As regard to sleep apnea, 41 (78%) patients did not have respiratory arrest; in 7 (16%) patients the apnea/hypopnea index decreased by 50% or more, from moderate and severe to mild OSAS; surgical treatment was not effective in 2 (4%) patients. Conclusion. Surgical treatment is an effective method for treating patients with uncomplicated snoring and mild to moderate OSAS, and surgery can be one of the treatment steps for patients with severe OSAS. Control objective examination after surgery is mandatory, because it allows to evaluate the results of treatment and correct further management of a patient.

Rheumatoid arthritis (RA) is a systemic autoimmune rheumatic disease with a wide range of extraarticular manifestations along with joint damage. Extraarticular manifestations of RA include pulmonary pathology (PP). The development of PP in patients with RA can by directly influenced by the course of the disease, infection, as well as therapy with disease-modifying antirheumatic drugs (DMARDs). The “gold" standard for RA therapy includes treatment with methotrexate. The article provides an overview of recent studies in the field of studying the role of methotrexate in the development of PP in patients with RA.

Background. Primary tumors of the trachea and major bronchi are rare and comprise from 1 to 2% of all tumors of the respiratory tract. In adults, the majority (60-90%) of these tumors are malignant, while in children, benign neoplasms are more common. About 1% of primary tracheal tumors are leiomyomas. This neoplasm can lead to obstruction of the upper respiratory tract and fatal asphyxiation. Description of the clinical case. A rare clinical case of tracheal leiomyoma in a 14-year-old adolescent admitted to the Department of Pulmonology of the Perm Regional Children’s Clinical Hospital with complaints of breathing difficulty is presented. Conclusion. The presented case demonstrates a rare cause of upper and lower respiratory tract obstruction - tracheal leiomyoma, which requires timely diagnosis and special treatment tactics.

Background. Coughing, being a clinical symptom of numerous diseases is the cause to visit doctors of various specialties, but most often general practitioners. Up to 30% of visits to a general practitioner are somehow related to the development of cough at night. In real clinical practice, serious diagnostic problems arise when examining patients with the so-called subacute cough, one of the causes of which is pertussis. Description of the clinical case. Patient K., 22 years old, visited a pulmonologist 04/17/2019, with complaints of a dry, prolonged paroxysmal cough. On February 22, 2019, she became acutely ill with a subfebrile temperature, a sharp weakness, lightheadedness and cough. The condition was diagnosed as ARVI, acute bronchitis, and bronchial asthma was assumed. She was treated with acetylcysteine, berodual, ambroxol, but without any improvement. Using ELISA, pertussis was detected in the patient. Against the background of the use of a complex preparation containing release-active antibodies, she noted a decrease in the severity and frequency of day and night cough. Daytime cough was completely stopped on the 4th day, and night cough - on the 7th day of treatment. Conclusion. This clinical case shows that in a routine practice, a physician, observing a patient with subacute cough, most often suggests common diagnoses, such as pharyngitis, laryngitis, prolonged course of acute bronchitis or the onset of bronchial asthma. Meanwhile, in the practice of any doctor, there may be cases of pertussis in adults, with a cough as main complaint, which does not fit into the framework of common diseases and does not respond to standard therapy.

Patients with severe bronchial asthma (SBA) are refractory to traditional therapy; they have a high frequency of asthma exacerbations, unplanned visits to the doctor and seeking emergency medical care, hospitalizations. Currently, genetically engineering biological preparations have appeared for these patients, the first of which was omalizumab, a recombinant monoclonal antibody to immunoglobulin E. In the world and in our country, quite a lot of experience has been gained with the use of omalizumab in allergic SBA, but local clinical experience of using the drug is still of interest. This article is devoted to the experience of using omalizumab in two young patients with allergic SBA, who managed to get a pronounced improvement in lung function, as well as a significant improvement in the quality of life.