The paper presents algorithms for adult outpatient care of coronavirus disease 2019 (COVID-19) and its assumption.

The Interdisciplinary Council of Experts in Therapeutics, Pulmonology and Clinical Pharmacology was held on February 11, 2023 in Moscow.

Aim. Effectiveness and safety of levosalbutamol metered dose inhaler (MDI) in comparison with placebo and salbutamol. Materials and methods. In this multicenter, randomized, placebo-controlled, 3-period crossover study, all asthma patients (n=91) received levosalbutamol (90 mcg), salbutamol (180 mcg), and placebo using standard MDI. Pulmonary function testing – forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) – was performed 45 and 15 minutes before and 5, 10, 15, 30, 60, 90, 120, 180, 240, 300 and 360 minutes after dosing. The primary efficacy endpoint was the baseline-corrected area under FEV1 curve from 0 to 6 hours (AUC(0–6h)). Secondary endpoints were the baseline adjusted FEV1 and FVC peak values, as well as the onset of drug action. Results. The FEV1 AUC0–6 hours analysis confirmed similar bronchodilatory levosalbutamol and salbutamol effect (p=0.595), significantly improved compared with placebo (p0.001). The peak values of FEV1 and FVC after levosalbutamol or salbutamol dosing were similar (p=0.643) and significantly higher compared with placebo group (p0.001). The active therapy effect was observed 5 minutes after dosing and throughout the entire observation period up to 6 hours, however, there was some tendency towards a longer duration of action of levosalbutamol compared to salbutamol. Levosalbutamol was well tolerated by patients; after levosalbutamol dosing twiсе fewer adverse reactions were observed compared to salbutamol. Conclusion. Levosalbutamol at a 90-mcg dose showed efficacy similar to that of salbutamol at a dose of 180 mcg, assosiated with a good safety profile.

The success of antibacterial therapy has overshadowed non-drug pathogenetic methods of tuberculosis treatment. However, the growth of drug resistance requires not only the search for new reserve drugs for the treatment of the disease but also the active study and conscious use of longknown non-drug methods.The aim of the work was to familiarize doctors with the main directions of non-drug pathogenic treatment and to create motivation for a more detailed study of individual directions and their implementation in clinical practice.Conclusion. The use of most non-drug treatment methods is justified from the point of view of modern understanding of the pathogenesis of the disease. Evidence criteria have to be developed for a more complete study of their effectiveness and subsequent inclusion in clinical guidelines.

Despite the steady decline in the main epidemiologically significant indicators of tuberculosis in Russia, the problem remains of choosing an affordable and informative diagnostic test for the timely detection of latent tuberculosis infection (LTI).The aim of this study was to evaluate the compatibility of various methods of immunological diagnosis in adult patients with LTI with a high (LTI-HR) and low (LTI-LR) risk of developing tuberculosis, as well as in patients with established tuberculosis of the respiratory system.Methods. A cross-sectional open single-center study was conducted, which included 100 adult patients. The first group included 50 conditionally healthy individuals with LTI-LR. The second group of patients consisted of 25 people with LTI-HR. The third group of patients included 25 patients with tuberculosis of the respiratory system (TRS). All participants were examined once using six immunological diagnostic tests: Mantoux test with 2 units PPD-L, Diaskintest, T-SPOT®.TB, QuantiFERON®-TB Gold Plus, Standard E TB-Feron IGRA and IGRA-TB. The end point of the study was the overall percentage consistency of the results, that is, the ability of the tests to correctly predict the condition assumed by the combination of clinical signs.Results. The proportion of “correct results” (positive in the TRS and LTI-HR group and negative in the LTI-LR group) was 83% for the IGRA-TB test, 80% for the Diaskintest, 80% for the QuantiFERON®-TB Gold Plus test, 78% for the Standard E TB-Feron IGRA test, 67% for the T-SPOT®.TB test (p > 0.05). Only the Mantoux test with 2 units PPD-L showed significantly lower “accuracy” in our study (53%; p < 0.05).Conclusion. The new Russian test IGRA-TB is not inferior to its foreign counterparts and can be recommended in practical healthcare as a diagnosis of latent tuberculosis infection in adults. It seems fundamentally important to continue studying the informative value of tests in adult patients in real clinical practice without applying strict selection criteria. The immunological features of the patients, which determine the different sensitivity of the tests, need to be further studied.

The problem of multidrug resistant pathogens has significantly limited the capabilities of tuberculosis chemotherapy, reinstating the need for pathogenetic treatment methods in phthisiology. The practitioner is faced with a difficult choice between the expediency and even necessity of prescribing drugs for pathogenetic therapy and the risk of prescribing drugs whose effectiveness and safety have not been proven. The aim of the work was to familiarize doctors with the principles of prescribing pathogenetic therapy included in the current version of the clinical recommendations “Tuberculosis in adults”. Conclusion. Today, the phthisiological service has drugs of various pharmacological groups in its toolkit that can influence the pathogenesis of tuberculosis and have a high level of evidence from pre-clinical and clinical studies. The new data should be reflected in future versions of the clinical guidelines.