Федеральные клинические рекомендации Российского респираторного общества по использованию метода спирометрии

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.

Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic fibrotic interstitial pneumonia with a progressive course and poor prognosis. The prevalence of IPF in the Russian Federation is about 8 – 12 cases per 100,000 population. The basic treatment of IPF is antifibrotic agents.Methodology. The target audience of these clinical recommendations are therapists, general practitioners, pulmonologists, pathologists, radiologists, and medical rehabilitation doctors. Each thesis-recommendation about diagnostic and therapeutic procedures has been scored according to the scale of classes of recommendations from 1 to 5 and A, B, C scale of the levels of evidence. Clinical recommendations also contain comments and explanations to the theses, algorithms for the diagnosis and treatment of idiopathic pulmonary fibrosis, and reference materials.Conclusion. The presented clinical guidelines cover current information about the etiology and pathogenesis, clinical manifestations, diagnosis, treatment, and prevention of idiopathic pulmonary fibrosis. These guidelines were approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation in 2021.

Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) resulting from an immune-mediated response in susceptible and sensitized individuals to a large variety of inhaled antigens. Chronic HP with a fibrotic phenotype is characterized by disease progression and a dismal prognosis. The aim of this study was to identify predictors of progression and mortality in patients with chronic HP in real clinical practice. Materials and methods: This retrospective, multicenter, observational study used data from a registry of 1355 patients with fibrosing ILDs. The study included 292 patients diagnosed with chronic HP based on the conclusion of a multidisciplinary discussion (MDD). Results: The patients were divided into groups with progressive (92 (30.3%) patients) and nonprogressive pulmonary fibrosis (200 (69.7%) patients). The most significant predictors of adverse outcomes were a DLco < 50% predicted, an SpO2 at the end of a six-minute walk test (6-MWT) < 85%, and a GAP score ≥ 4 points. Conclusion: Pulmonary fibrosis and a progressive fibrotic phenotype are common in patients with chronic HP. Early detection of the predictors of an adverse prognosis of chronic HP is necessary for the timely initiation of antifibrotic therapy.

Introduction. The natural course of some interstitial lung diseases (ILD) is characterized by progressive fibrosing phenotype resembling idiopathic pulmonary fibrosis (IPF). Until recently, the antifibrotic drug nintedanib was approved for treatment of the only fibrosing ILD which was IPF. A new indication for this drug which has been registered in Russian Federation in 2021 includes other fibrosing ILDs with progressive phenotype (PF-ILDs) and ILD associated with systemic scleroderma (SS-ILD).The aim of this publication is to describe general considerations of the decision of Multidisciplinary Expert Board on diagnosis and treatment of PF-ILDs including SS-ILD.Results. According to the extension in nintedanib use mentioned above, the Expert Board created an algorithm for diagnosis and treatment of patients with PF-ILDs and criteria for nuntedanib administration in PF-ILDs.Conclusion. Antifibrotic therapy is needed for patients with PF-ILDs with the failure of the stanrard therapy. In those patients antifibrotic treatment should be initiated as early as possible to better preserve the lung function.

Hypersensitivity pneumonitis (HP) is an inflammatory and/or fibrotic lung disease that occurs in response to repeated inhalation of broad-spectrum aerosol antigens. The prevalence of HP ranges from 0.3 to 0.9 cases per 100,000 population. The basis treatment of HP therapy includes glucocorticoids, immunosuppressants, and antifibrotic drugs. The target audience of these clinical recommendations are general practitioners, pulmonologists, pathologists, radiologists, and medical rehabilitation specialists. Methods. Each thesis-recommendation for diagnostic and therapeutic measures is evaluated on a scale of evidence reliability from 1 to 5 and a scale of the recommendation persuasiveness with the categories A, B, C. The guidelines also contain comments and explanations to these thesis-recommendations, algorithms for the diagnosis and treatment of idiopathic pulmonary fibrosis, and reference materials. Conclusion. The presented clinical guidelines cover current information about the etiology and pathogenesis, clinical manifestations, diagnosis, and treatment of hypersensitivity pneumonitis. These guidelines were approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation in 2023.