Bronchopulmonary Pathology Research Articles

Use of telemedicine technologies in organizing rehabilitation of patients with bronchopulmonary pathology. Myth or reality?

In 2013, telemedicine began to penetrate widely and actively into the activities of the medical community. Telerehabilitation acts as an alternative within the framework of considering and conducting traditional rehabilitation or as an additional therapeutic tool, which allows you to achieve the set goal of recovery faster and more effectively. During the period 2022-2023, 1,318 people participated in the telerehabilitation program: 712 patients who suffered pneumonia caused by the new coronavirus infection COVID-19, 606 patients with chronic obstructive pulmonary disease. During the course, not a single patient was hospitalized for an exacerbation of the disease or for a clinical deterioration of the condition. At the same time, there was a significant improvement in the calculated indicators, which confirmed the relevance of this area of medicine.

Long-term consequences of the functional state of the respiratory system after SARS-CoV-2-associated lung damage

Aim. To study the dynamics of respiratory system function in patients without a history of bronchopulmonary pathology after SARS-CoV-2 infection with virus-associated lung damage.Materials and methods. A retrospective study was conducted on 29 patients (median age 46 [43-51] years) at two stages: visit 1 (1-4 months) and visit 2 (8-13 months) from the onset of COVID-19. Data from spirometry, bodyplethysmography, diffusion capacity test, impulse oscillometry (IOS), and chest computed tomography (CT) obtained during the acute phase of the disease (CTmax), as well as dyspnea assessed by the mMRC scale, were analyzed.Results. The median CTmax was 75%, and 66% of patients received treatment in the intensive care unit. At visit 1, dyspnea was of mild or moderate severity. Medians of vital capacity (VC), total lung capacity (TLC), residual volume (RV), and diffusion capacity of the lungs (DLco) were reduced (<80% predicted). The median forced expiratory volume in the first second (FEV1) and IOS parameters were within normal ranges. However, increased reactance area (AX) and absolute frequency dependence of resistance (R5–R20) were found in 59% and 24% of cases, respectively. At visit 2, mild dyspnea persisted. Lung volumes were within normal limits, with statistically significant differences between visits. The median DLco was reduced at visit 1 but increased to normal at visit 2, with statistically significant differences between visits. The median IOS parameters remained within normal limits, with no statistically significant differences between visits. However, in visit 1 increased AX and (R5–R20) were observed in 59% and 24%, in visit 2 – 45% and 17% of cases, respectively, with no statistically significant differences between visits.Conclusions. Among the long-term functional consequences of SARS-CoV-2 infection with virus-associated lung damage, decreased lung diffusion capacity (reduced DLco) and small airway dysfunction (increased AX and/or R5-R20) were noted in some patients. Impulse oscillometry should be included in the comprehensive functional assessment plan for patients after SARS-CoV-2 infection to diagnose small airway dysfunction.

Inflammasome-Mediated Mechanisms Of Systemic Inflammation In COVID-19 And Asthma

The review examines the formation of inflammasome-mediated mechanisms of systemic inflammation in asthma after COVID-19. It provides insight into the clinical and pathophysiological relationship between asthma and COVID-19. The review summarizes information about the role of the NLRP3 inflammasome in the pathogenesis of asthma and describes in detail its manifestations in various asthma phenotypes. Emphasizing the significance of the inflammatory-mediated immune response during coronavirus infection in patients with bronchopulmonary pathology, the review outlines the consequences of hyperactivation of the NLRP3 pathway, leading to increased production of cytokines, the appearance of neutrophil and monocyte-derived traps, induction of pyroptosis and the development of complications.

Cough at the doctor’s office

Сough is a common symptom that requires medical attention. The range of diseases in which cough occurs is quite large. These are not only patients with bronchopulmonary pathology, cough can also occur in diseases of the gastrointestinal tract, cardiovascular system, diseases of the upper respiratory tract, taking medications and a number of other reasons. Cough has different developmental mechanisms and clinical characteristics. Treatment of cough should be primarily aimed at eliminating the cause of cough, the nosological form that triggered the development of this symptom. However, cough often requires a complex long-term diagnosis and personalized approach to therapy. Symptomatic treatment is often required before the cause of chronic cough is established and for patients with acute and subacute cough. When choosing symptomatic cough therapy, it is necessary to focus on a specific clinical situation and take a differentiated approach to the choice of medications. Combination medications are an effective symptomatic remedy in the treatment of cough, especially in situations where the patient has several symptoms at the same time (cough, viscous, difficult-to-separate sputum, bronchial obstruction). An example of such a combination are drugs that include bromhexine (mucolytic), guaifenesine (mucolytic/mucokinetic) and salbutamol (β2-adrenomimetic). The drugs have a synergistic effect, have an antitussive effect, improve mucociliary clearance, improve the rheological properties of bronchial secretions, reducing excessive bronchial tone, which leads to rapid cleansing of the bronchi from altered bronchial secretions and a decrease / cessation of coughing.

TREATMENT OF CHRONIC RHINOSINUSITIS IN PATIENTS WITH COMMUNITY ACQUISITED PNEUMONIA

As world statistics show, 60% of patients with chronic rhinosinusitis develop bronchopulmonary pathology. According to foreign authors, the number of patients with chronic rhinosinusitis increases annually by 1.5-2%, and today more than 2/3 of inpatients are affected by this pathology. Due to the anatomical, physiological and complementary characteristics of the upper and lower respiratory tracts, there is a tendency towards a protracted course of rhinosinusitis, which in turn leads to the spread of the infectious process to the lower respiratory tract. It should be noted that existing foci of infection in the upper respiratory tract spread to the lower respiratory tract through microaspiration after an acute respiratory illness, which is the cause of the development of chronic bronchitis, bronchial asthma, and in particular pneumonia. It should be noted that despite the efforts of a number of specialists in the treatment of penmonia, in recent years there has been a significant increase in the incidence rate, as well as, unfortunately, an increase in mortality among people of various age groups.

Assessing spatial distribution of sites with a risk of developing bronchopulmonary pathology based on mathematical modeling of air-dust flows in the human airways and lungs

The article continues the series of studies that describe a mathematical model of the respiratory system developed by the authors and dwell on its use in practice to assess and predict risks for human health caused by negative effects of airborne environmental factors. The mathematical model includes several submodels that describe how an air mixture flows in the air-conducting zone (it includes the nasal cavity, pharynx, larynx, trachea and five generations of bronchi) and the lungs approximated with a continuous two-phase elastically deformed porous medium. The mathematical model is described by using continuum mechanics relationships. It is realized numerically by using engineering software (to investigate processes in the airways) and a self-developed set of programs (to simulate processes in the lungs). Numeric modeling of a non-stationary flow of an air-dust mixture is performed for a personalized three-dimensional geometry of the human respiratory system based on CT-scans. The study provides calculated lines of velocity for a flow of particles in inhaled air in the airways. We have quantified shares of deposited articles with their diameters being 10 µm, 2.5 µm, and 1 µm (РМ10, РМ2,5, РМ1) in the airways; the study also provides trajectories of particulate matter. As particles become smaller and lighter, the share of deposited ones goes down in the airways and grows in the lungs. According to numeric modeling, most (more than 95 %) large particles (PM10) are deposited in the nasal cavity, pharynx and larynx; small particles are able to reach the lower airways and bronchi (most particles that reach the lungs penetrate lobar bronchi predominantly in the right lung). Sites with maximum health risks in the human lungs have been identified relying on assessing changes in an air phase mass within the respiration cycle; they are located in lower lobes of the lungs. When contacting airway walls, particles are able to be deposited and accumulate over time producing irritating, toxic and fibrogenic effects; they can thus cause and / or exacerbate pathological states.

Serotype diversity of <i>Streptococcus pneumoniae</i> in children with chronic bronchopulmonary pathology in the pre-vaccination and post-vaccination periods

.

An attempt at systematizing errors in bronchology practice

A systematization of errors in the practice of analyzing bronchopulmonary pathology was carried out. This study analyzes the records of 18,268 patients who underwent a total of 37,264 bronchoscopies (including both initial and subsequent procedures) from 2006 to 2023. The most common errors were identified at various stages: in the decision-making process for conducting bronchoscopy, in the preparation for the procedure, and during the bronchoscopy itself. These common errors are illustrated with clinical examples. The study concludes that eliminating errors in planning, preparation, and the actual performance of bronchoscopy is crucial for minimizing the risk of complications associated with this procedure.

Bronchial Lavage in the Treatment of Severe Bronchopulmonary Pathology in Adults. Approaches to Classification

Introduction Currently, bronchial lavage (BL) is widely used in clinical practice for the treatment of severe bronchopulmonary lesion in adults. However, indications and contraindications for this procedure are not fully defined. In addition, it was not possible to find in the literature a classification of either BL in general or used for therapeutic purposes in particular, which significantly complicates the standardization of procedures for its use in various diseases.Aim of study To determine possible classification characteristics, as well as indications, contraindications for therapeutic BL in adults and possible complications that may arise, based on the analysis of literature data.Results Therapeutic BL can be carried out both as planned and for health reasons. Indications for planned BL are purulent bronchitis, pneumonia, purulentdestructive infiltration, as well as chronic lung diseases: bronchiectasis, interstitial lesions. In turn, the indication for emergency therapeutic BL is progressive acute or chronic respiratory failure, developing due to bronchial obstruction. Such conditions may include massive pulmonary hemorrhage, acute obstruction of the bronchi with mucus and pus, postoperative atelectasis and hypoventilation of the lungs, aspiration of gastric contents, severe bronchial asthma, purulent destruction of the lungs, acute respiratory distress syndrome, thermochemical lesions of the respiratory tract. Contraindications to therapeutic BL can be both absolute and relative. Absolute contraindications are intolerance to drugs used for local anesthesia; decompensated heart and (or) pulmonary failure; acute cerebrovascular accident; various types of arrhythmias; stenosis of the larynx and (or) trachea II–III degree; neuropsychiatric diseases; pain syndrome in the abdominal cavity; extremely serious condition of the patient, when clarification of the diagnosis can no longer affect treatment tactics. Relative contraindications include acute respiratory disease of the upper respiratory tract; coronary artery disease; severe diabetes mellitus; pregnancy (second half); chronic alcoholism; grade III enlargement of the thyroid gland. It should be noted that most of the absolute contraindications are conditional and are not taken into account when performing BL according to vital indications with appropriate medical and technical support. Classification of BL used for medicinal purposes can be carried out according to the following criteria: method of sanitation; access used; level of sanitation; sanitized area; volume and composition of the lavage solution. It is noteworthy that the methods of carrying out procedures for various conditions and diseases still remain unregulated. An exception is the final stage of the therapeutic BL procedure in the case of the use of surfactant preparations, which standardization is regulated by approved standard operating procedures. It should also be noted that bronchial lavage for therapeutic purposes is justified from a pathoanatomical and pathophysiological point of view, but is accompanied by serious, albeit temporary, changes in the lungs, which can be partially avoided by improving the lavage technique.Conclusion All of the above indicates that in order to solve existing problems, it is necessary to conduct systematic research in this direction with the involvement of all interested specialists.

Obesity provokes the development of bronchopulmonary pathology and aggravates its course

The increase in the prevalence of obesity in recent decades is an urgent medical and social problem for all countries, increasing the cost of medical care and worsening the quality of life of patients. Obesity is an independent risk factor for the development of a number of chronic non-infectious diseases, including respiratory diseases. The presence of excess body weight not only provokes the development of bronchopulmonary pathology, but also aggravates its course. The article discusses the mechanisms of the impact of obesity on the pathogenesis of diseases such as bronchial asthma, chronic obstructive pulmonary disease and coronavirus infection.

Atmospheric ground layer pollution by suspended solid particles in areas with different technogenic loads

Introduction. According to the World Health Organization ambient air pollution causes enormous harm to public health around the world. Atmospheric solid suspended particles are a heterogeneous mixture of substances with various dimensional, qualitative and quantitative parameters. They are a key indicator of air pollution, contributing to the bronchopulmonary pathology formation. At the moment, there is no general recommended ranking of the solid suspended particles amount in the atmospheric air.Aim. Determination of the SSP fractional content in the air ground layer in high and relatively low technogenic load areas of Vladivostok.Materials and methods. Atmospheric air samples were taken «in the breathing zone» using an electric aspirator. In the granulometric analysis of SSP, the particle size distribution, expressed as a percentage, and the mass concentration of fractions (μg/m3 ) were determined. The ranges of dimensions have been identified, taking into account the solid suspended particles possible origin and the expected pathophysiological features of their effect on the organism.Results. An area with a high technogenic load is characterized by the prevalence of particles with a diameter of up to 10 microns, which have the most pathogenic effect on the organism. In an area with a relatively low technogenic load, particles of larger fractions (10-25, 1000-2000 microns) predominate.Conclusion. Studying the solid suspended particles parameters in specific areas and establishing their influence cellular mechanisms can help in the development of new strategies for the prevention of environmentally-related pathologies.

The role of nanoparticles of industrial aerosols in the formation of occupational bronchopulmonary pathology

The significant prevalence of industrial aerosols with unintentional nanoparticles and the increasing use of engineering nanoparticles in modern production determine the relevance of research on the patterns of interaction with the human bronchopulmonary system. Unintentional nanoparticles are formed during various production processes: melting and welding of metals, combustion, crushing, grinding of minerals, plasma processing of materials. Engineering nanoparticles are released into the air of the work area during their production or use in any technological processes.
 The respiratory system, as a barrier organ, is most vulnerable to the effects of adverse environmental factors. At the same time, nanoparticles are the least studied component of industrial aerosols. In order to systematize data on the role of nanoparticles in the development of occupational bronchopulmonary pathology, the authors conducted a literature review.
 The size determines the features of the physical, chemical and biological properties of nanoparticles. They have high values of the ratio of surface area to volume, total surface area, which leads to an increase in reactogenicity and penetrating power. The pathogenic properties of nanoparticles depend on the chemical composition, shape, curvature of the surface, structure, charge, mass concentration, total surface area of the particles, and exposure time.
 The multidimensionality of hygienic characteristics determines the complexity of hygienic rationing and monitoring of nanoparticles. To date, safe exposure levels have not been established. When interacting with cells of the respiratory tract, nanoparticles induce the following cellular and molecular mechanisms: oxidative stress, inflammation, violation of the epithelial barrier, autophagy and dysfunction of lysosomes, stress of the endoplasmic reticulum, apoptosis, senescence, fibrosis, endothelial dysfunction, DNA damage. This leads to the development of interstitial pneumonitis, pulmonary fibrosis and obstructive disorders, and an increase in the activity of allergic inflammation. All these mechanisms are present in the pathogenesis of occupational lung diseases. Under the influence of nanoparticles of various chemical compositions, separate phenotypes of occupational chronic obstructive pulmonary disease are formed. There is a lack of epidemiological studies of the possible etiological role of nanoparticles. Nanoparticles of industrial aerosols are a significant factor in the development of occupational diseases of the bronchopulmonary system and have a significant impact on the formation 
 of phenotypes.

Dynamics of Right Ventricle Pressure During Stress Echocardiography in Patients with Heart Failure with Preserved Ejection Fraction

Shortness of breath during physical exertion is a non-specific symptom that can hide such potentially dangerous diseases as structural or functional bronchopulmonary, coronary heart disease, structural cardiac disease, but the frequent cause is left ventricle diastolic dysfunction due to its significant hypertrophy. Pathogenetic mechanisms leading to this symptom require detailed study for the possibility of a comprehensive approach in the treatment of such patients with the aim of maximally improving their prognosis and quality of life. Objective — evaluate changes in right ventricle systolic pressure during stress echocardiography in patients with LV myocardial hypertrophy and clinical manifestations of heart failure, search for other mechanisms leading to clinical symptoms. Materials and methods. The study included 49 patients with shortness of breath during physical exertion, who underwent further diagnostic examination after exclusion of coronary stenotic lesions by invasive coronary and ventricular angiography. Patients were excluded from bronchopulmonary pathology using spirometry and chest radiography, structural heart pathology using echocardiography, microvascular angina using echocardiography with intravenous dipyridamole infusion, and the change in systolic pressure in the right ventricle was investigated using echocardiography during a physical exercise test. Results and discussion. There were no cases of infiltrative lung changes, signs of emphysema, or other manifestations of significant pathology according to X-ray data. Spirometry also showed the absence of significant functional abnormalities. Echocardiography revealed significant hypertrophy of LV myocar­dium (thickness of IVS — on average (14.1 ± 0.5) mm, posterior wall thickness — on average (13.5 ± 0.3) mm) with the presence of LV diastolic dysfunction and echocardiographic signs of increased end-diastolic pressure in the LV, which was confirmed invasively during coronary and ventricular angiography. In 9 (18.4 %) cases, heart wall thickening was due to hypertrophic cardiomyopathy according to cardiac MRI, these patients had LV outflow tract obstruction and mild pulmonary hypertension at rest. Conducting strain imaging showed the presence of signs of myocardial ischemia (segmental contractility disorder) with varying degrees of severity (from 1 to 5 segments), which spread to the IVS, the apex of the heart and, less often, to the anterior wall of the LV. All patients experienced an increase in pulmonary artery systolic pressure during exercise, on average, from (37.4 ± 2.1) to (47.1 ± 1.6) mm Hg. Conclusions. The pathogenic mechanism underlying shortness of breath in patients with LV myocardial hypertrophy involves transient pulmonary hypertension occurring during exercise due to left ventricular diastolic dysfunction. Another contributing factor is the development of myocardial ischemia during physical exertion, which, in the absence of coronary stenosis and microvascular angina, is attributed to inadequate supply of coronary blood flow volume velocity relative to the significant left ventricular hypertrophy.

Comorbidities of exudative otitis media in children: focus on cough

Introduction. Otitis media with effusion (OME) is the most common and asymptomatic form of otitis in preschool children, accompanied by the accumulation of exudate in the middle ear with the development of conductive and mixed hearing loss. The article discusses data on the nature of comorbid diseases in exudative otitis media and modern ideas about the effectiveness of a combination drug for concomitant bronchopulmonary pathology in children.Aim. To study the nature of comorbid diseases in OME and evaluate the effectiveness of a combined expectorant drug in the treatment of upper and lower respiratory tract infections.Materials and methods. 104 children diagnosed with acute and chronic otitis media with effusion were examined. All children were divided into 2 groups: Group I (50 people) with acute otitis media with effusion, Group II (54 people) with chronic otitis media with effusion. The average age of children in group I was 5.02 ± 0.48 years with the highest prevalence in the younger group (70%), the average age of children in group II was 5.87 ± 0.47 years with the highest prevalence in the preschool and primary school groups (88%). Group I children with tracheitis and bronchitis received a combined expectorant.Results and discussions. The recurrent course of otitis media with effusion is supported by allergies in 43%, and by pathology of the upper and lower respiratory tract in 34%. The development of hearing loss leads to dysarthria in 26% of cases, which can undoubtedly negatively affect the further social adaptation of the child. Complex therapy of cough with a combined expectorant gave a positive clinical effect in 95% of cases, reduced the need for systemic antibiotics by 2.5 times, shortened the duration of the disease by 1.7 times.Conclusions. Early diagnosis of comorbid diseases in AOME at a young age, timely complex treatment of bronchopulmonary pathology will prevent the development of COME with impaired speech development in older children.

Individual approach in the treatment of occupational chronic obstructive pulmonary disease

Introduction. Occupational COPD (PCODD) is characterized by partially irreversible airflow limitation, the phenomenon of "air traps" and the formation of emphysema, has a steadily progressive character. In the work of a practitioner, an individual approach to the patient with targeted pharmacotherapy using new combinations in the treatment of occupational COPD is important, taking into account the evaluation of the effectiveness of previous therapy.
 The study aims to evaluate the effectiveness of therapy with combined bronchodilators in PCOPD with an analysis of the dynamics of functional parameters, exercise tolerance, using additional criteria for differential diagnosis.
 Material and methods. The effectiveness of bronchodilator therapy was analyzed in 45 men, diagnosed with occupational COPD (PCODD). Additional differential diagnostics included the following informative indicators: instantaneous volumetric velocity after exhalation 75 FVC (MOS75); cough intensity according to the CAT questionnaire (1 point); ratio of forced vital capacity to forced expiratory volume in 1 minute (FVC/FEV1); 6MWT data, % predicted; 6MWT, m; overall score on the mMRС questionnaire; the severity of shortness of breath according to the CAT questionnaire (point 4); instantaneous volumetric velocity after exhalation 25 FVC (MOS25). The discriminant equation is represented by the formula: F=–9,76+0,75×a1–2,00×a2–0,19×a3+0,27×a4–0,11×a5+1,22×a6+3,62×a7+2,22×a8.
 Results. Two clinical trials were retrospectively analyzed using combined bronchodilator therapy with long-acting muscarinic receptor antagonists (LAA) and β2-agonists (LAA) in patients with PCOD. A group of patients was identified where a statistically significant improvement in clinical and functional parameters was not achieved against the background of the therapy. When to the group of occupational bronchial asthma (OBA). When conducting an individual analysis of indicators, it was found that for patients with PCOD during bronchodilator therapy, an improvement in spirometric parameters is characteristic, in particular, an increase in FEV1 and FVC; Significant reduction in symptoms of shortness of breath, cough, sputum. Whereas, the PBA group was characterized only by an improvement in the distance traveled in 6MWT.
 Conclusion. Our earlier clinical studies on the effectiveness of treatment of patients with PCOD with combined bronchodilator therapy showed the effectiveness of this therapy in 70–75% of the patients examined. An individual analysis of the clinical and functional parameters of the examined patients made it possible to identify the features of the course of occupational bronchopulmonary pathology, with the identification of individuals who need the use of a triple combination of LABA, LAAA with the addition of topical glucocorticosteroids. In this regard, all patients, as part of diagnostic measures, in addition to the standard examination, it is necessary to include 6MWT, BPG, questionnaires using mMRС and CAT questionnaires. Calculation of discriminant equations using data from spirometry, questionnaires, 6MWT and BPG will allow at the first stage of differential diagnosis to identify a group of patients for whom "triple" therapy is the means of choice.
 Ethics. The study was carried out in accordance with the ethical principles of the Declaration of Helsinki. The Clinical Study Protocol was reviewed at a meeting of the local Ethics Committee East-Siberian Institute of Medical and Ecological Research.

Quality of life and mental disorders in the post-COVID period (systematic review)

The 2019 novel coronavirus infection (COVID-19) pandemic has been a great burden for all of humanity. Soon after it began, researchers noticed that elimination of the virus from the body and recovery are not the end of the disease, since many patients did not return to their previous state of health, continued to complain of pathologies of various organs and systems, could not work, and some of them developed mental disorders.The aim of the review was to analyze and summarize published data on the quality of life and mental disorders in the post-COVID period. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, 7,374 scientific works were found, of which 176 English-language and 276 Russianlanguage relevant publications were selected for analysis. The review included 17 (including 2 Russian-language) articles relevant to the topic of this review. Complaints of decreased memory and attention, appearing no later than 6 months after recovery from COVID-19, were reported by 3.2–9.1% of patients. Asthenic symptoms during the first month after the elimination of the novel coronavirus infection occurred in 55–70% of patients, and six months later – in every fifth patient. At the same time, post-viral fatigue more often affected women discharged from respiratory hospitals and persons with chronic bronchopulmonary pathology. Quite often, those who recovered from COVID-19 experienced insomnia and emotional disturbances, the frequency of which also correlated with the female sex and the severe course of the disease, which required hospitalization in the intensive care unit (ICU). In the post-COVID period, the development of depressive symptoms is not excluded, but sufficient evidence for this has not been obtained. The quality of life in these patients decreased. After discharge from the hospital, some patients remained unable to work, and some began to experience difficulties with self-care. However, over time, there is a trend toward restoration of the quality of life, which is especially evident in young people. In patients who have been in the ICU for more than 7 days, the rehabilitation potential is much lower. Psychopathological symptoms contribute to a decrease in the quality of life along with physical factors (persistent dyspnea, decreased exercise tolerance).

Деякі особливості ендокринного статусу у реконвалесцентів після COVID-19 та його зміни під впливом відновлювального лікування

Abstract. The aim — to study the thyroid hormones and cortisol levels in convalescents after COVID-19, including patients with chronic obstructive pulmonary disease (COPD) and their possible changes under the influence of recovery treatment. Materials and methods. 83 convalescents after COVID-19 (with manifestations of COVID pneumonia in the acute period) aged 32–67 years, who had no history of thyroid or adrenal glands lesions’ manifestations were examined. 29 of them had COPD (GOLD II-III). Patients began the course of rehabilitation within 1–3 weeks after inpatient treatment. Тhe levels of thyroid-stimulating hormone (TSH), total fractions of thyroid hormones (thyroxine — T4 , triiodothyronine — T3 ), cortisol as well as the level of interleukin-8 (IL-8) were determined in blood serum. Assessment was carried out by immunoenzymatic method at the beginning of recovery treatment and after it (within 21–22 days). Recovery treatment included the necessary basic anti-inflammatory and broncholytic therapy (for patients with COPD) and a physiotherapeutic complex, which included the use of haloaerosoltherapy (HAT) — dry aerosol media with certain concentration and dispersion (18-20 sessions per course) and singlet oxygen therapy (12 procedures per course). Results. Before treatment significantly higher levels of all studied indices compared to control were found in both groups of patients (without history of COPD and patients with COPD). Certain change of the inverse relationship between the values of TSH and T4 , T3 was noted, which probably indicates the presence of maladaptive thyroid syndrome. The obtained results can be interpreted as a consequence of systemic immune activation caused by SARS-CoV 2 infection and as a result of intensive treatment in the acute period. These changes took place on the background of a significant IL-8 level increase. A correlation between the levels of IL-8 and TSH (r=0.43) was revealed, which indicates a certain dependence between stimulation of thyroid gland function and the severity of the inflammatory process. Thyroid hormone levels in convalescents after COVID-19 without COPD (1st group) and convalescents after COVID-19 with COPD history (2nd group) were compared. Direction of changes in the thyroid hormones levels in both groups was similar, but the increase of TSH and T4 levels in the 2nd group was significantly higher and took place on the background of a higher IL-8 level. Studies of cortisol secretion in the examined groups showed a moderate, but reliable increase in its levels compared to the control by 1.2 and 1.4 times respectively. This may be related to both activation of the adrenal cortex during the convalescence and the consequences of therapy in the acute period of COVID-19. Taking into account received data, as well as the analysis of individual deviations of the studied indices, these changes should be considered as a non-thyroidal illness syndrome (NTIS) and dysfunctional adrenal disorders. The applied recovery treatment had a corrective effect on the thyroid and adrenal functions. Thus, by the end of treatment, the levels of cortisol and T3 reached the control level on the background of a significant decrease of IL-8 level in both groups of patients. Positive changes in thyroid function in convalescents after COVID-19 without COPD history were more pronounced. Conclusions. In convalescents after COVID-19 thyroid and adrenal dysfunctional disorders were observed, they were more pronounced in patients with COPD and directly correlated with an increase of pro-inflammatory IL-8 level. Rehabilitation treatment based on haloaerosoltherapy, which is aimed at bronchopulmonary system sanation and reduction of inflammatory process, contributes to the recovery of thyroid and adrenal function. Positive effect is more pronounced in patients without a history of chronic bronchopulmonary pathology.

Modern approaches to studying the molecular mechanisms of lung functioning in normal and pathological conditions

Problems with breathing and lung function are caused by the development of various lung diseases associated with lifestyle, harmful environmental factors and genetic predisposition. Knowledge of the molecular mechanisms of the development of the pathological process will allow on time identification of the disease or the development of targeted therapy. The article provides an overview of modern methods that make it possible to most accurately reproduce the structural, functional and mechanical properties of the lung (organ-on-a-chip), to perform non-invasive molecular studies of biomarkers of bronchopulmonary pathology using saliva diagnostics, as well as using DNA and RNA aptamers, verify tumor markers in biological samples of human tissue. Analysis of alterations in the pattern of protein glycosylation using glycodiagnostic methods makes it possible to detect lung cancer in the early stages.

Селективный дефицит иммуноглобулина А в сочетании с селективным дефицитом иммуноглобулина G4 у взрослого пациента

Aim. To demonstrate the possibility of developing primary immunodeficiency with impaired antibody synthesis in an adult patient and discuss the algorithm for laboratory diagnostics and treatment tacticsto demonstrate the possibility of developing primar hypoimmunoglobulinemia after a course of imunosupressive therapy. Key points. Primary immunodeficiencies are a group of diseases associated with monogenic mutations. They do not have a typical clinical picture. A clinical observation is presented, when a selective deficiency of immunoglobulin A in combination with a selective deficiency of the subclass of immunoglobulin G was detected in a patient with chronic bronchopulmonary pathology. Clinical and laboratory criteria for diagnosis and treatment tactics are discussed. Сonclusion. Primary immunodeficiencies are often hidden by infectious masks. It is necessary to study serum immunoglobulins, with their normal levels or selective deficiency of immunoglobulin A, to additionally investigate the content of subclasses of immunoglobulin G. Keywords: primary immunodeficiency, selective immunoglobulin A deficiency, immunoglobulin G subclass deficiency.

Design of a prognostic model for assessing the risk of developing asbestosis based on the results of molecular genetic studies

Introduction. Preventive measures, including the development of a system for diagnosing early signs of changes in the health status of employees and predicting individual risks of developing the disease, aimed at preserving labor resources, reducing disability and extending working life expectancy, are an absolute priority in the field of occupational safety.
 The aim of the study to develop a prognostic model of the risk of developing asbestosis based on molecular genetic studies in employees of enterprises for the extraction and enrichment of chrysotile asbestos.
 Materials and methods. Based on studies previously conducted in the Laboratory of Biomedical Research at the Izmerov Research Institute of Occupational Health, scientists have identified a set of informative and significant single-nucleotide polymorphic gene variants for use as predictors in the construction of a prognostic model in the development of asbestos in workers of enterprises for the extraction and enrichment of chrysotile asbestos. We examined 136 people who worked at the enterprise for the extraction and enrichment of chrysotile asbestos. The researchers formed two groups comparable in terms of work experience, dustiness, age and gender: 68 former employees of the main production specialties with an established diagnosis of asbestos and 68 workers without bronchopulmonary pathology.
 The authors calculated the exposure dose of chrysotile-containing dust and calculated it taking into account the percentage of time spent at the workplace, and also performed a molecular genetic study of single-nucleotide polymorphic variants of the genes IL-1β rs16944, IL-4 rs2243250, TGF-β1 rs1800471, SOD-2 rs4880 and MMP-9 rs17576.
 Results. A predictive model has been developed to determine the probability of developing asbestosis in workers of an enterprise for the extraction and enrichment of chrysotile asbestos based on the determination of single nucleotide polymorphisms IL-1β rs16944, SOD-2 rs4880 and MMP-9 rs17576. The results of genetic tests are entered into the formula and if the resulting probability of developing asbestosis is equal to or higher than the threshold (0.582), the employee is included in the high-risk group. The sensitivity and specificity of the developed model were 70.1% and 70.6%, respectively.
 Conclusion. Molecular genetic indicators can act as predictors in the development of asbestosis in workers of the chrysotile extraction and enrichment industry and can be used to form high-risk groups during preventive measures.
 Ethics. The study was conducted in compliance with ethical standards that guarantee respect for all research subjects and the protection of their health and rights in accordance with the requirements of the Helsinki Declaration of the World Medical Association. All persons included in the study gave informed voluntary consent to the examination in accordance with Federal Law No. 323-FZ dated 11/21/2011 "On the Basics of Public Health Protection in the Russian Federation". The study was approved by the conclusion of the local Ethics committee of Izmerov Research Institute of Occupational Health (minutes of the meeting of the Ethics committee of Izmerov Research Institute of Occupational Health No. 9 dated 11/29/2016).