A unified care pathway and immune status: experts discussed new approaches to pneumonia management
More than 340 million cases of lower respiratory tract infections, predominantly pneumonia, are reported worldwide each year, claiming approximately 2 million lives[1]. On September 15, 2026, an expert advisory board meeting titled “Breathing Without Gaps: A Unified Patient Pathway for Pneumonia” brought together specialists from multiple disciplines. They discussed how to establish a coordinated care pathway for patients with community-acquired pneumonia, highlighting the importance of immunomodulatory therapy for selected patient groups and its place in the next update of the clinical guidelines.
Community-acquired pneumonia is a leading cause of hospitalization, severe complications, and death from infectious diseases[2]. In Russia, pneumonia incidence and mortality have remained stable in recent years, at approximately 600 cases and 8 deaths per 100,000 population, respectively[3]. The risk of hospitalization and disease severity depend on age, with children and older adults being particularly vulnerable[4]. Comorbidities, including chronic obstructive pulmonary disease (COPD), chronic heart failure, stroke, and diabetes, also play a role[4]. However, the risks associated with community-acquired pneumonia extend beyond the acute phase.
“Mortality continues to rise with each month after discharge, reaching 30% one year after pneumonia[5]. One reason is cardiovascular events, which occur in approximately one-quarter of patients[6]. This is why the patient care pathway must not end at hospital discharge: it must continue in the outpatient setting,”
After hospital discharge, patients with community-acquired pneumonia continue to experience asthenia, cognitive impairment, respiratory symptoms, a risk of recurrent infections, and destabilization of chronic conditions.
These patients require close monitoring and ongoing medical follow-up tailored to their risk profile. Developing clinical algorithms for primary care professionals, with step-by-step instructions readily available to every primary care physician, would help put this approach into practice, emphasized Oksana Drapkina, Director of the National Medical Research Center for Therapy and Preventive Medicine of the Russian Ministry of Health, Chief Specialist in Internal Medicine and General Practice of the Russian Ministry of Health, Doctor of Medical Sciences, Professor, and Academician of the Russian Academy of Sciences.
The algorithms should cover assessment of disease severity, decisions on hospitalization, regular follow-up, vaccination, and management of comorbidities. It is also important to consider patients’ immune status, which is often overlooked. Assessment is recommended in cases of severe pneumonia and in patients with a history of frequent or prolonged infections. At-risk groups include patients with immunosuppression, cancer, HIV infection, diabetes mellitus, kidney or liver disease, and those receiving immunosuppressive therapy. Where indicated, immunomodulatory medicines are prescribed for 10–14 days or in courses lasting up to 1–3 months.
“Immunomodulatory therapy is a critically important strategy in the treatment of viral pneumonia. However, classification as an immunomodulator alone is not sufficient grounds for prescribing a medicine. It must meet several criteria: be supported by evidence, be prescribed for a specific patient according to clear indications, and meet all the requirements of rational pharmacotherapy. Azoximer bromide meets these requirements, making it one of the first-line treatment options for patients with pneumonia,”
When discussing proposals for future clinical guidelines, the experts paid particular attention to azoximer bromide.
“This medicine has several effects: immunomodulatory, antioxidant, detoxifying, and moderate anti-inflammatory activity. It is more than an immune stimulant: it is an adjunct to standard therapy, used to normalize the immune response rather than simply boost immunity, support effective pathogen clearance, and reduce the risks of superinfection and prolonged recovery,”
In clinical trials, adding azoximer bromide to standard treatment for moderate to severe community-acquired pneumonia reduced the duration of hospitalization, intensive care unit (ICU) stays, and fever, as well as the incidence of acute respiratory distress syndrome and septic shock[7]. In patients with non-severe pneumonia, a lower incidence of recurrent lower respiratory tract infections was observed over two years[8].
The experts noted that the pharmaceutical market includes a vast number of immunomodulatory medicines, and not all of them have adequate efficacy. This makes it base decisions on the evidence and accumulated clinical experience with individual medicines, rather than on their classification as immunomodulators alone.
“My view of immunomodulators changed radically during the COVID-19 pandemic. At that time, severely ill patients receiving the most advanced treatment were dying from secondary infections in the setting of immune paralysis. Azoximer bromide helped turn the course of the illness around, in some cases enabling patients to be weaned off invasive mechanical ventilation. Today, it is clear that, when used appropriately, the medicine can address many clinical challenges,”
The current clinical guidelines for pneumonia treatment came into effect in 2024, but a new version is already being developed. The expert advisory board aims to formulate practical proposals in the near term, covering patient care pathways, regular follow-up, prevention, vaccination, and, in particular, the role of immunomodulatory therapy. This therapy is not indicated for every patient. In selected cases, however, it may provide substantial benefit, including through a course of azoximer bromide. It is therefore important to clearly define the clinical settings and indications for the use of immunomodulatory medicines.
1 GBD 2021 Lower Respiratory Infections and Antimicrobial Resistance Collaborators. Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990–2021: a systematic analysis from the Global Burden of Disease Study 2021. The Lancet Infectious Diseases. 2024;24(9):974–1002. doi:10.1016/S1473-3099(24)00176-2.
2 Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor). November 12, 2022 — World Pneumonia Day. (In Russian.)
3 Belotserkovskiy B.Z., Zyryanov S.K., Popov D.A., Rachina S.A., Sinopalnikov A.I., Shlyk I.V. Resolution of the Round Table “Pneumonia. From penicillin to the present day: what has changed over the last hundred years.” Clinical Microbiology and Antimicrobial Chemotherapy. 2026;28(1):64–70. doi:10.36488/cmac.2026.1.64-70. (In Russian.)
4 Cui C., Timbrook T.T., Polacek C., Heins Z., Rosenthal N.A. Disease burden and high-risk populations for complications in patients with acute respiratory infections: a scoping review. Frontiers in Medicine. 2024;11:1325236. doi:10.3389/fmed.2024.1325236.
5 Ramirez J.A. et al. Adults Hospitalized With Pneumonia in the United States: Incidence, Epidemiology, and Mortality. Clinical Infectious Diseases. 2017;65(11):1806–1812. doi:10.1093/cid/cix647.
6 Corrales-Medina V.F. et al. Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation. 2012;125(6):773–781. doi:10.1161/CIRCULATIONAHA.111.040766.
7 Zyryanov S.K. et al. Efficacy of azoximer bromide in the treatment of hospitalized patients with moderate to severe community-acquired pneumonia. Meditsinskiy Sovet = Medical Council. 2021;(18):106–117. doi:10.21518/2079-701X-2021-18-106-117. (In Russian.)
8 Kostinov M.P. et al. Use of immunomodulatory therapy as part of comprehensive treatment of non-severe community-acquired pneumonia and its long-term results. Drugs in Context. 2023;12:2022-10-5. doi:10.7573/dic.2022-10-5.
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