[Clinic and functional features of chronic obstructive pulmonary disease after virus-induced acute exacerbations.]

AIM: To establish symptoms, lung function and to evaluate subsequent exacerbations of chronic obstructive pulmonary disease (COPD) during a year after virus-induced COPD exacerbations. MATERIALS AND METHODS: Patients hospitalized with viral (n=60), bacterial (n=60) and viral-bacterial (n=60) COPD exacerbations were enrolled to single-center prospective observational study. COPD was diagnosed according spirography criteria. Viral infection was established in bronchoalveolar lavage fluid or sputum by real-time reverse transcription-polymerase chain reaction for RNA of influenza A and B virus, rhinovirus, respiratory syncytial virus and SARS-CoV-2. Symptoms, lung function, COPD exacerbations were assessed. Patients were investigated at the hospitalization onset and then 4 and 52 weeks following the discharge from the hospital. RESULTS: After 52 weeks in viral and viral-bacterial COPD exacerbations groups the rate of forced expiratory volume in one second (FEV1) decline were maximal - 71 (68; 73) ml/year and 69 (67; 72) ml/year versus 59 (55; 62) ml/year after bacterial exacerbations. Low levels of diffusion lung capacity for carbon monoxide (DLco/Va) - 52.5% (45.1%; 55.8%), 50.2% (44.9%; 56.0%) and 75.3% (72.2%; 80.1%) respectively, of 6-minute walk distance; p<0.001 in relation to bacterial exacerbations. In Cox proportional hazards regression analyses viral and viral-bacterial exacerbations were associated with increased risk of subsequent COPD exacerbations by 2.4 times independent of exacerbations rate before index event and FEV1. In linear regression models the relationships between airflow limitation and respiratory syncytial virus, rhinovirus and influenza virus infection, between low DLco/Va and rhinovirus, influenza virus and SARS-CoV-2 infection. CONCLUSION: COPD after virus-induced exacerbations were characterized by progression of airflow limitation, low DLco/Va, low 6-minute walking test distance, subsequent COPD exacerbations risk.

[Diagnostic and Prognostic Markers of Chronic Heart Failure in Patients with Occupational Chronic Obstructive Pulmonary Disease].

Aim      Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are a common comorbidity. Professional chronic obstructive pulmonary disease (PCOPD) is a specific phenotype, which suggests peculiarities in the development of HF. Difficulties of HF diagnosis in such patients determine the relevance of searching for additional markers. The aim of the study was identifying HF markers in patients with PCOPD.Material and methods  This single-site, cohort, prospective, observational study included 345 patients. The main group consisted of PCOPD patients; the comparison group consisted of patients with COPD induced by tobacco smoking; and the control group included conventionally healthy individuals. The groups were matched by the index of coincidence; pairs were matched at 1:1 by the "nearest neighbor index"; covariates for matching included COPD duration, sex, and age. Each group included 115 patients. The major professional adverse factors were silica-containing dust and organic solvents. COPD was diagnosed according to GOLD criteria; HF was diagnosed in accordance with Russian clinical guidelines. The markers were determined by multifactorial logistic regression. Likelihood of events with allowance for the time to the event was analyzed by the Kaplan-Meier method.Results HF in PCOPD patients was characterized by biventricular damage, preserved left ventricular ejection fraction, and frequent hospitalizations for decompensation (17.5 % vs. 9.5 % for COPD in smokers). HF markers in patients with PCOPD included the length of work of more than 20 years, pulmonary artery systolic pressure (PASP) higher than 35 mm Hg according to data of Doppler echocardiography, diffusing capacity of lungs for carbon monoxide (DLCO) less than 50 %, increased serum concentrations of CC-chemokine ligand 18 (CCL18), S-100­beta protein, and N-terminal pro-brain natriuretic peptide (NT-pro-BNP). Diagnostic sensitivity of the multifactorial model was 84 % and specificity was 81 %. Two models were proposed for purposes of screening, which included the following parameters: length of work, exposure to aromatic hydrocarbons, decreased distance in 6-min walk test by more than 60 m per year and length of work, exposure to inorganic dust, and decreased forced expiratory volume during the first second by more than 55 ml per year.Conclusion      The markers for development of HF in PCOPD patients are length of work >20 years, PASP >35 mm Hg, DLCO <50 %, and increased serum concentrations of CCL18, S-100­beta protein, and NT-pro-BNP.

Efficacy of 13-valent pneumococcal conjugate vaccine in healthcare workers.

AIM: To establish the efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) for healthcare workers protection from occupational acquired infection and impact of healthcare staff vaccination on the risk of transmission to patients. MATERIALS AND METHODS: Healthcare personnel (n=157 of whom 105 critical care department staff) and 1770 patients of that critical care department observed. Healthcare workers received PCV13. Infections caused by Str. pneumoniae, respiratory infections regardless of etiology, work absenteeism in healthcare workers during 12 month before and after vaccination assessed. In the same time monitoring of hospital-acquired infections in patients of critical care department performed. Statistical analysis was done using SPSS 24, relationships were assessed by rate ratio, Cox regression, logistic regression and Kaplan-Meier estimator. RESULTS: Healthcare workers' vaccine coverage in critical care department was 97.2%. In healthcare personnel the rate of all pneumococcal infections, asymptomatic carriage of Str. pneumoniae and respiratory pneumococcal infections were decreased after vaccination by 2.1, 2.2 and 2.1 times accordingly. The rate of respiratory infections regardless of etiology was decreased by 30%, р<0.05. Cumulative percent of subjects without pneumococcal respiratory infections during 12 month was 87.9 before and 94.3 after vaccination, р=0.015. Work absenteeism due to respiratory infections was reduced. In patients of critical care department decreasing of all respiratory infections by 58%, pneumococcal respiratory infections by 66%, hospital acquired pneumonias by 46% were seen, р<0.05. CONCLUSION: Healthcare personnel vaccination with PCV 13 is effective in protection from occupational acquired pneumococcal respiratory infections and asymptomatic carriage and promotes decreasing of hospital acquired infections among patients.

[Occupational chronic obstructive lung disease: phenotypic characteristics.]

Prospective cohort observational study covered phenotypic features of COLD formed under influence of various occupational etiologic factors vs. COLD caused by tobacco smoking. The study included totally 170 COLD patients (2011 criteria of COLD). In accordance with exogenous etiologic factor, the authors selected examinees in 3 strata simultaneously: COLD due to toxico-chemical aerosols (n = 42), COLD due to inorganic dust (n = 55), COLD due to tobacco smoking (n = 73). Evaluation covered influence of ecologic and industrial conditions on main mainfestations of the disease. Statistic analysis: comparison of quantitative variables - Kruskal-WaRIisANOVA, quantitative variables - criteria c(2), influence of independent variable on the dependent one - single-factor and multi-factor regression, p = 0,05. For COLD due to toxico-chemical aerosol, characteristics are rare but severe exacerbations .(total amount is 366/427 person-years, severe ones - 312/427 person-years), severe dyspnea (mMRC 2,5 ± 0,12 points), minimal decrease of FEVI (65,7% ? 3,21%) and minimal speed of bronchial obstruction progress (decrease of FEV1 by 0,08 ml ± 0,006 ml per year), emphysema, pulmonary hypertension, low serum level of VEGFA. For COLD due to dust, characteristics were bronchial hyperreactivity (in 45% of patients), cough, rare severe exacerbations (total exacerbations 825/537 person- years, severe ones - 227/537 person-years), lower dyspnea intensity (mMRC 1,9 ± 0,13 points), concomitant interstitial fibrosis, "average" level of VEGFA.

[Experience With Serelaksin for Acute Right Ventricular Failure due to Pulmonary Embolism in Acute Ischemic Stroke].

OBJECTIVE: to demonstrate effects of serelaxin in treatment of acute right ventricular failure (ARVF) caused by pulmonary embolism (PE).

[Topical problems of pulmonology in contemporary occupational medicine].

Respiratory tract diseases are very common in occupational medicine. The present literature review is aimed to specify topical directions of research in this sphere. The review is based on search in databases (e. library.ru, pubmed. com and Cocran library). Molecular genetic and proteome studies make a fundamental basis for better prophylaxis, diagnosis and treatment of occupational respiratory diseases. Other problems of maximal scientific and practical importance are: phenotyping of chronic obstructive lung disease (COLD) for differential approach to patients management, new methods for early diagnosis of COLD, improved classification of pneumoconiosis according to contemporary view of occupational interstitial lung diseases pathogenesis, studies of immune suppression efficiency in rapidly progressing pneumoconiosis, understanding etiology of infectious complications of lung diseases with subsequent specifying the recommendations on rational antibacterial therapy.

[Genetic aspects of occupational chronic obstructive lung disease under exposure to various risk factors].

The article deals with data on association of SNP rs1828591 of HHIP gene with COLD development under exposure to dust and chemical factors. SNP rs1800470 of TGFbeta1 gene is associated with occupational COLD under exposure to dust and did not show connection with COLD under exposure to chemical aerosols. No association was seen between SNP rs4129267 of IL-6R gene and SNP rs1051730 of CHRNA3 gene with occupational COLD under exposure to the studied factors. SNP rs1828591 of HHIP gene is associated with occupational COLD development under exposure to dust and chemical factors. Study of association of genotype and phenotypic features of COLD revealed the following trends: "dust" COLD patients with genotype AA SNP rs1800470 of TGFbeta1 gene show lower level of C-reactive protein and TNF-alpha, if compared with other genotypes.