Eosinophilic segment of airway inflammation is one of the basic links of the pathogenesis of asthma. The aim of this work was a complex characteristic of eosinophilic inflammation in relation to clinical and functional parameters of the disease in patients with asthma during cold-induced bronchospasm. The study involved 94 patients with uncontrolled asthma (17.5±0.6 ACT points). In the patients there was assessed the lung function before and after the test of isocapnic hyperventilation with cold air (IHCA); there was done sampling and cytology of induced sputum (IS) and spontaneously produced sputum before and after IHCA, as well as analysis of peripheral blood. The forced expiratory volume in the first second (FEV₁) amounted to an average of 95.6±1.8% of predicted. In the cellular composition of IS, on average, in the general group, an increased percentage of eosinophils and neutrophils was found, which significantly increased under the effect of the cold trigger (eosinophils from 9.8±1.07 till 13.3±1.0%, p=0.011; neutrophils from 48.9±1.53 till 52.8±1.36%, p=0.022). By the results of the airways response to IHCA there were formed two groups: group 1 (n=33) with cold airway hyperresponsiveness (CAHR) and group 2 (n=61) with no signs of CAHR. According to anamnesis, 48% of patients in group 1 and 66% of patients in group 2 (χ²=1.95; p>0.05) had irregular anti-inflammatory treatment or did not have any. Patients of group 1 compared with group 2 had a lower level of ACT (15.6±1.0 and 18.6±0.8 points, p=0.021) and МОС_25-75 (66.1±4.0 and 76.9±3.5%; p=0.035). A high baseline level of IS eosinophils (≥2% eosinophils in IS) was in 81% of patients of group 1 and in 85% of patients of group 2 (p>0.05). Exposure to cold air led to an increase in the granulocyte cell elements of IS in both groups. In the analysis of peripheral blood, the absolute number of eosinophils in patients of group 1 was higher than in group 2 (186.0 [156.0; 224.0] and 129.0 [112.0; 192.0] in 1 µl; p=0.007). A close correlation was found between ACT (points), baseline values of small airways patency (МОС₇₅) and the absolute number of eosinophils in the peripheral blood (r=-0.33; p=0.031 and r=-0.31; p=0.025, respectively). Thus, patients with a lack of asthma control are characterized by induction of granulocytic cell inflammation in the bronchi under the influence of a cold trigger. A decrease in the level of asthma control and lung function in patients with CAHR is associated with an increase in the absolute number of eosinophils in peripheral blood.

The aim of the research was to study the characteristics of apoptosis, membrane-released microparticles (MRM) formation and cytokines production in case of lymphocyte damage in young patients with bronchial asthma, depending on body mass index. 224 people were examined. In all the patients there was done an assessment of the excessive weight and determination of obesity degree as well as clinical and functional examination; there was performed a determination of cytokines and adipokines; the lymphocytes were separated from the peripheral blood. The number of apoptotic cells was estimated in accordance with the standard protocol; the number of MRM was counted. It was found out that in case of bronchial asthma and obesity syntropy, even at a young age, more often there are patients with moderate and severe clinical course; besides, the severity of bronchial-obstructive syndrome in patients of this group is more significant with the tendency to decrease in FEV₁ and FEV₁/FVC. In the group of young patients with obesity combined with bronchial asthma in the peripheral blood there was imbalance of both adipokines and cytokines, characterized by evident increase in the levels of pro-inflammatory leptin, IL-4, IL-6, TNF-α, and the decrease in potential body weight regulator IL-15, and at the same time low levels of anti-inflammatory adiponectin. In patients with obesity, the percentage of cells in apoptosis was significantly lower compared to both those in control with obesity and patients with normal body weight. The number of MRM, as cell damage indicator, significantly increased in the group with obesity. It can be assumed that the imbalance of cytokines, adipokines and mechanisms of programmed cell death is a possible pathogenetic factor in asthma and obesity syntropy.

Obstructive sleep apnea syndrome (OSAS) is a pathogenetically heterogeneous condition that aggravates the course of asthma. For this reason, timely diagnosis and treatment of OSAS may improve asthma control, reduce the number of exacerbations and the frequency of short-acting bronchodilators use. The aim of the study was to describe the clinical and functional features of patients with asthma and OSAS, and to identify risk factors that allow suspecting the comorbidity. A total of 194 patients with asthma were examined. The research methods included assessment of symptoms using the ACT questionnaire, spirometry with bronchoprovocational tests, body plethysmography and determination of lung diffusion capacity, analysis of the cellular composition of induced sputum, echocardiography, overnight cardiorespiratory monitoring. According to the results of cardio-respiratory monitoring OSAS of varying severity was detected in 33% of patients (n=65). Epworth sleepiness scale did not allow specific discrimination of OSAS among the examined patients. In general, patients with the comorbid pathologies were more often men of older age groups, they had a long history of disease and smoking. In patients with OSAS diabetes and cardiovascular diseases were more common in the structure of concomitant pathology. The presence of OSAS did not significantly affect spirometry but was associated with a pronounced airway hyperresponsiveness regardless of the provocative stimulus. In addition, a higher airway resistance and an increase in lung diffusion capacity were noted in OSAS patients. Neutrophilic phenotype of inflammation was three times more common in case of concomitant OSAS, and signs of cardiac remodeling and an increase in pulmonary artery pressure were also observed in these patients. Thus, knowledge of the above features of asthma-OSAS phenotype will facilitate timely diagnosis and optimal therapeutic care for patients with a combination of pathologies.

Along with chronic obstructive pulmonary disease, asthma may also be accompanied by an irreversible decrease in lung function. It is known that among other causes of this phenomenon genetic predisposition may play a certain role. The aim of the study was to investigate the effect of rs11562975 polymorphism of TRPM8 gene on lung function in patients with asthma. The study enrolled 285 patients with uncontrolled persistent mild and moderate asthma. All patients underwent standard spirometry before and 15 minutes after inhalation of fenoterol bronchodilator. rs11562975 polymorphism was genotyped using LATE-PCR. It has been established that polymorphism is significantly interrelated with a number of lung function parameters, including FEV₁/FVC. Carriage of GC and CC genotypes was accompanied by reduced values of both pre- and postbronchodilator ratio FEV₁/FVC. At the same time, the frequency of GС+СC genotypes was significantly higher among patients with baseline FEV₁/FVC<70%, and among patients with postbronchodilator FEV₁/FVC<80%. All associations of the polymorphism with FEV₁/FVC were significant regardless of gender, age, body mass index, duration of the disease, age of asthma onset, pack-year index and cold airway hyperresponsiveness. The obtained results indicate the potential presence of TRPM8-dependent component of asthma pathogenesis

The results of recent studies indicate the potential role of gamma-aminobutyric acid (GABA), as an inhibitory mediator of the central nervous system, in the pathogenesis of obstructive sleep apnea syndrome (OSAS) - a common disorder that often accompanies asthma. The aim of the study was to investigate the possible role of some GABAergic system genetic polymorphisms in the formation of OSAS in asthma patients. Overnight cardiorespiratory monitoring was performed to diagnose OSAS and spirometry was conducted to evaluate the airway reactivity to the bronchodilator fenoterol in 184 asthma patients. Polymorphisms of GAD1 , GAD2 , GABBR1 and GABBR2 genes (15 polymorphisms in total) were genotyped by LATE-PCR method. Significant results were obtained for rs3749034 polymorphism of GAD1 gene and rs35400353 of GABBR2 in association analysis with the presence of OSAS. rs3749034 significantly influenced the presence of OSAS in males, which was accompanied by the predominance of the CC genotype among patients with OSAS, while CT+TT genotypes were more common in patients without OSAS (OR 3.9 95%CI [1.36-11.67], p=0.01). In total sample GAD1 rs3749034 polymorphism was an independent factor increasing the likelihood of having OSAS after adjustment for significant confounders (OR 1.9 95%CI [1.23-3.15], p=0.005). rs35400353 polymorphism was also associated with OSAS after adjustment for confounders, although its relationship was less significant (OR 1.5 95%CI [1.1-2.3], p=0.04). There was a tendency for interrelation with airway hyperresponsiveness to bronchodilator for both polymorphisms: rs3749034 - in case of CT+TT genotypes, rs35400353 - in case of DD genotype. rs3749034 polymorphism also significantly influenced lung function parameters. After additional verification of the results, the identified genetic polymorphisms may be used to individually predict the risk of OSAS as well as for the development of personalized approaches in asthma treatment using GABA.

Community-acquired pneumonia (CAP) is a leading cause of mortality from lower respiratory tract infections and is associated with high incidence and unfavorable prognosis. In this regard, the timely assessment of the severity of CAP at the stage of hospitalization of the patient comes to the first place. The existing scales have a number of limitations, therefore they can’t always be better than the clinical solution. The aim of the research is to search for predictors of severe CAP and combine the most significant ones into a predictive model. There were examined 418 patients with CAP. The severity was determined according to IDSA/ATS criteria. Static analysis was performed in IBM SPSS Statistics. Logistic regression was used to identify and combine in a model the most significant criteria. The criteria were included in the predictive model with odds ratio (OR) >2. Demographic, laboratory, radiological and clinical indicators were analyzed in the course of the retrospective analysis. Significant differences between groups of the severity of pneumonia groups were revealed in 16 predictors. All predictors were included in the predictive model with odds ratios >2. As a result there were selected 7 criteria: age >40 years old, heart rate >93 bpm, the presence of HIV infection, liver disease, lesion >1 lung lobes, C-reactive protein >156 mg/L, creatinine >123 mmol/L. All predictors were combined using logistic regression. The resulting model was examined by ROC analysis. The area under the curve (AUC) was 0.88. Sensitivity and specificity were 87.5 and 73.5%, respectively. Thus, the article proposes a model for determining the severity of pneumonia (AUC=0.88), which includes the criteria used in the routine practice of pulmonologists in the Russian Federation. Further research is needed to create a scale based on the presented model.

There were studied the possibilities of predicting the effectiveness of treatment with roflumilast in the complex therapy of patients with chronic obstructive pulmonary disease (COPD) with low and high risk by assessing the clinical and functional parameters (lung function, severity of respiratory complaints, frequency of exacerbations in the previous year) and serum indicators of systemic inflammation (C-reactive protein, TNF-α, IL-6, IL-8, fibrinogen). One-year study included 60 patients with COPD, among whom there were 22 patients with low risk (group 1) and 38 patients with high risk (group 2), according to the multi-faceted classification of disease. Each group was divided into 2 subgroups depending on the response to treatment: subgroup A included the patients whose therapy was effective and subgroup B consisted of the patients whose therapy was not effective. The criteria for the effectiveness of the treatment were: group 1 - the absence of exacerbations during a year or 1 episode that did not require hospitalization, the initial test CAT (COPD Assessment Test) - 10 points and lower, dyspnea on the mMRC scale no more than 2 points, an increase in FEV₁ by 11% or more; in patients of group 2 the number of exacerbations was 0 or no more than 2 and they did not require hospitalization, dyspnea on the mMRC scale was no more than 2 points, there was no decrease in FEV₁. The effectiveness of treatment was evaluated in points (4 points meant effective treatment, below 4 points - not effective treatment). It was found out that in group 1 in subgroup A after treatment the results of CAT (p<0.001), IL-8 (p<0.001), TNF-α (p<0.001) were significantly lower than in group B (p<0.001). In group 2 after treatment in subgroup A test CAT (p<0.001), CRP (p<0.001) and IL-6 (p<0.01) were significantly lower than in subgroup B. The revealed regularities formed the basis for the creation of mathematical model for predicting the effective application of roflumilast by discriminant analysis for different phenotypes of the disease which allow clinicians to solve the problem of a personalized approach to the selection of patients with COPD with low and high risk.

A new method of diagnosis of cerebral circulation insufficiency in patients with chronic obstructive pulmonary disease (COPD) is presented. The essence of the method consists in determining the patient's age, smoking index, oxygen partial pressure in arterialized blood (pO₂), forced expiratory volume per 1^st second (FEV₁), the level of hemoglobin in the clinical analysis of blood, and solution of the regression equation. The numerical value of the equation of 70 or more points allows to diagnose the presence of signs of cerebral circulation insufficiency, less than 70 points - their absence. Preliminary correlation analysis was carried out in 67 patients with COPD using statistical package STATISTICA 6.1 between the following variables: age, smoking index, pO₂, FEV₁, hemoglobin level. The coefficient of multiple determination (R₂) was 0.79 (79.0%), which confirms the reliability of the model prediction. The invention relates to medicine, namely, internal diseases, in particular to pulmonology and can be used for the diagnosis of early signs of cerebral circulation insufficiency in patients with COPD for the purpose of a differentiated approach to the choice of therapeutic and preventive measures. The problem solved by the invention is to create a method that allows to detect disorders in the state of cerebral circulation in patients with COPD to improve the effectiveness of therapeutic and preventive measures and improve the prognosis of the disease.

The article presents the results of long-term observations of the authors to assess the health of pregnant women, children and adolescents of the Far-Eastern Federal District. In the dynamics of the observation there is an improvement in indicators characterizing the health status of women and children: the reduction of morbidity, infant and child mortality. However, these data are much higher than in European countries. Thus, the infant mortality rate on average in the Far Eastern Federal District decreased from 11.0‰ in 2013 to 5.7‰ in 2017 (on average in Russia it was 5.5‰). At the same time, in the “new” countries of the European Union (EU) that are the closest in socio-economic condition to Russia (Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, Slovenia), this figure in 2016 amounted to 3.9‰, and in the “old” countries of the EU it was 3.3‰. The child mortality rate (1-17 years old) in some regions of the Far Eastern Federal District ranges from 73.0 in the Khabarovsk territory (per 100 thousand of the corresponding age) to 101.1 in the Jewish Autonomous Region and on average in Russia in 2016 it was 70.9. And in the EU countries, this figure was significantly lower and amounted to 37.6 in the “new” countries and 31.4 in the “old” countries. In the analysis of risk factors affecting health, infant and child mortality, the following biological factors were noted: maternal health, complicated pregnancy, genetic factors, living conditions and, above all, economic and biogeochemical environmental factors. In areas with a tense and critical assessment of the environmental situation, the proportion of spontaneous abortions, stillbirths, premature, congenital malformations is much higher. In the formation of pathology in children, the deficiency or imbalance of essential, i.e. vital trace elements, the nature of nutrition, nutrient deficiency, and the formation of energy deficiency of immunocompetent blood cells can influence a lot. All these environmental factors, in fact, are etiological and determine different variants of pathology, the formation of metabolic imprinting, the manifestation of fetal programming and the birth of immature offspring. Disturbance of embryogenesis under the influence of these factors leads to the development of various pathologies of newborns, long-term consequences in the form of reproductive dysfunction, pathology of immune reactions, mental dysfunction, and reduced adaptability. As a result, we have an increased morbidity, sick offspring, and a decrease in life expectancy. In order to develop specific measures to reduce morbidity, infant and child mortality, it is necessary to solve a number of medical and organizational measures, strengthen the preventive orientation of medical care for pregnant women, and timely correct the deficit conditions. It is necessary to organize the system of active health follow-up (examination based on automated control systems) of pregnant women, a system of data banks for the examination, treatment and rehabilitation of women with a burdened obstetric history and from the risk group for the development of perinatal pathology at the stage of planning pregnancy (the best option) or in the early stages of pregnancy.

The first two decades of the XXI century in the Far Eastern Federal District continue to be characterized by a constantly decreasing level of the population living on its territory with an annual increase in the number of patients with cancer pathology, which makes a negative contribution to the already negative demographic situation in the region. The purpose of this study was to make a scientific assessment of the main morbidity and mortality rates of the population from malignant tumors of the trachea, bronchi and lung in the Far Eastern Federal District over the past ten years (2008- 2017). In the course of the work, morbidity and mortality indicators, reporting forms of statistical records of cancer patients and regulatory documents of higher organizations, information on ten-year observations of the dynamics of changes in the numerical values of indicators of the studied pathology were used. The main indicators of medical care for oncology patients in the Far Eastern Federal District are shown, and it was found out that 3180 new cases of tracheal, bronchial and lung malignant neoplasms were registered in 2017, which is 30.9% more than ten years ago (in 2008 there were 2429 cases). The maximum number of cases was in the age group of 50-69 years. The number of patientswith stages I-II (29.4%) of the cancer process increased slightly whereas the number of patients with advanced forms of the disease increased significantly (41.5%). The percentage of patients identified during routine check-ups was 28.0% (in 2008 it was 15.8%). Mortality in the first year from the time of diagnosis was reduced to 49.2% (in 2008 - 55.0%) remaining, at the same time, at very high numbers, which makes it impossible to characterize medical care for oncology patients as adequate for the time required. In the structure of total mortality, trachea, bronchus and lung tumors (20.7%) take the first place significantly exceeding the Russian level (17.3%). There was designated the quality of the service’s activity according to the confidence index of accounting for this category of patients, which in 2017 did not fall below 0.6 in any of the territories forming the Far Eastern Federal District. A great deal of work of primary health care institutions responsible for identifying malignant neoplasms in the initial stages of the process, unfortunately, has not led to the desired reduction in morbidity and mortality in the Far Eastern Federal District in the last decade. On the contrary, the level of intensive indicators of medical care for cancer patients in the region remains high, with an annual increase in mortality and the number of cases, especially among the female population.

The state of health of 100 full-term newborns from mothers with uncomplicated course of pregnancy and with chronic simple bronchitis in remission was studied. The first group consisted of 30 newborns from mothers with physiological pregnancy. The second group consisted of 38 children of a similar age from mothers who were diagnosed with simple chronic bronchitis without exacerbation in the period of gestation. The third group was represented by 32 newborns with antenatal history, burdened with chronic simple bronchitis in remission and the threat of miscarriage in their mothers in the second trimester of pregnancy. It was shown that in children of the third group, in comparison with the second group, there was a lower score on the Apgar scale at 5^th minute (7.7±0.14 and 8.1±0.12 points, respectively, p<0.05); cerebral ischemia of moderate severity (n=7 and n=1, respectively, p<0.05) and vesiculosis (n=8 and n=1, respectively, p<0.05) were registered oftener. Only the third group of newborns showed signs of respiratory distress syndrome of moderate (n=2) and severe (n=2) degree, as well as aspiration of amniotic fluid (n=2). This indicates the role of chronic simple bronchitis in remission, associated with the threat of miscarriage in the second trimester of gestation, and in disturbance of delivery of oxygen and metabolites to the intrauterine patient, as well as in changing the conditions of antenatal development of its central nervous and respiratory systems.

The aim of the work is to study the content of 11-deoxycorticosterone in the placenta during pregnancy complicated by exacerbation of cytomegalovirus infection. Histochemical method was used to determine the content of 11-deoxycorticosterone in 72 placentas, including 37 cases from women with acute cytomegalovirus infection and simultaneously diagnosed moderate preeclampsia, and 35 placentas from women with exacerbation of chronic cytomegalovirus infection without concomitant diseases. The control group consisted of 30 placentas from mothers with chronic cytomegalovirus infection in the latent stage. It was found out that an increase in the content of 11-deoxycorticosterone in placenta by 25% in comparison with the control group occurred during gestation with an exacerbation of cytomegalovirus infection. A significant increase (by 40%) in the content of this hormone in the placenta was noted during the reactivation of the viral process accompanied by preeclampsia. We believe that an increase in the production of 11-deoxycorticosterone with mineralocorticotropic effect in the placenta could contribute to the development of hypertensive disorders in pregnancy complicated by cytomegalovirus infection.

In order to identify the molecular effects of erythropoietin on the lipid composition and properties of the membrane of red blood cells of the umbilical cord, 35 newborn children born from cytomegalovirus seropositive women with exacerbation of infection in the third trimester of pregnancy (main group) were examined. The control group consisted of 30 newborns born from cytomegalovirus seronegative women. Plasma and red blood cells of the umbilical cord became the material for the study. In the membrane of red blood cells of the umbilical cord by spectrophotometry there were studied the products that react with thiobarbituric acid; membrane microviscosity was studied by lateral diffusion of hydrophobic fluorescent probe of pyrenes; lysophosphatidylcholine content by a thin-layer chromatography; the content of arachidonic, oleic and α-linolenic fatty acids by gas chromatography; ionized calcium content by analyzer of blood gases and electrolytes; erythropoietin in umbilical cord blood plasma by enzyme immunoassay. The number of erythrocytes was determined by an automatic hematological analyzer. The assessment of erythrocytes morphology and echinocytes counting was performed by light microscopy with further cytophotometrical data processing. In the umbilical cord blood of newborns born from cytomegalovirus seropositive women with exacerbation of infection in the third trimester of pregnancy, there was found out an increase in the level of erythropoietin by 20% (p<0.05), the number of erythrocytes by 21% (p<0.01), of products reacting with thiobarbituric acid by 60% (p<0.001), of lysophosphatidylcholine by 42% (p<0.001), of arachidonic acid by 31% (p<0.001)<0.001), of ionized calcium by 14% (p<0.05), of the amount of echinocytes by 91% (p<0.001); with a decrease in the content of oleic and α-linolenic fatty acids by 40% (p<0.001), there was an increase in the ratio of fluorescence of excimers and monomers (Fe/Fm) by 30% (p<0.001), the number of red blood cells by 21% (p<0.01). The results obtained suggested in the newborns from seropositive women to cytomegalovirus with exacerbation of the infection in the third trimester of pregnancy the development of ineffective erythropoiesis, enhancing oxidative damage of red blood cells, leading to echinocytosis and eryptosis.

In 36 full-term newborns who died at an early neonatal age under various conditions of intrauterine development, ultrasound examination and morphological study of the brain liquor space was conducted at the 1^st-2^nd days of life. The first group included 20 newborns aged 38-40 weeks, whose cause of death on the 4^th -5^th day of life was intranatal and postnatal hypoxia. The second group included 16 dead children of the same age with congenital cytomegalovirus infection. It was found out that immaturity (n=7, p<0.05), pseudocysts of the vascular plexus of the lateral ventricles (n=9, p<0.5), as well as intraventricular hemorrhages of I degree (n=8, p<0.05) were more often diagnosed in the second group compared with the first one in neurosonographic study. Only in the second group there was a pronounced ventriculomegaly. A morphological study in the brain often detected a pronounced pericellular and perivascular edema, alterative changes of neurons, vasculitis (n=7), subependyma (n=3), choriocephalitis (n=3) and encephalitis (n=1) with small calcifications, ependymocyte desquamation and lymphocytic infiltration, with a pronounced hyperemia and hemorrhages. In all cases, specific cells of the "owl's eye" were not detected. The detected ultrasound and pathomorphological changes in the liquor space in intrauterine cytomegalovirus infection indicate the possibility of direct cytodestructive effect of the pathogen in the absence of markers of viral metamorphosis, as well as the indirect effect of antenatal hypoxia, endotoxemia and cytokineemia on the brain in newborns.

Radiofrequency ablation of the suprascapular nerve is a modern and promising method of treatment of chronic pain in the shoulder joint. The paper presents the results of this analgesic procedure in 18 patients: 11 women (61.2%) and 7 men (38.8%) aged 53 to 82 years (the mean age is 67). To assess the intensity of pain, a visual analog scale was used; to assess the volume of active movements there was used Dauborn's abduction test. Within 3 months the positive result was maintained in 16 patients (89%). The conclusion was made about efficiency in the short term and safety of radiofrequency ablation of the suprascapular nerve. It can be considered as a method of choice in chronic pain syndrome in the shoulder joint, resistant to complex conservative therapy and local injections of glucocorticoids.

Fractional exhaled nitric oxide (FeNO) is one of the inflammatory biomarkers that have recently attracted the attention of researchers. During the last decade there have been published many articles on FeNO for monitoring, identifying and treatment of airway inflammation, especially in asthma. However, the role of FeNO in patients with сhronic obstructive pulmonary disease (COPD) is still unclear and needs to be defined. Moreover, literature defining the role of FeNO in patients with COPD is minimal. Improved monitoring and prevention of exacerbations in patients with COPD may improve quality of life and potential survival. The present article is dedicated to studying the role of nitric oxide in pathophysiology and treatment of COPD and also to summarize findings from different studies. The need for additional large-scale studies to expand the clinical application of measurements of the level of FeNO in the diagnosis and treatment of this disease has been shown. The ability of medical ozone to modulate the release of nitric oxide by endotheliocytes is described. Moreover, the necessity of studying the dosing regimens and the duration of the course of ozone therapy in COPD has been substantiated.

Currently, in parallel with the increase in the prevalence of asthma, there is an increase in the number of obese patients. The results of numerous studies indicate that the asthma phenotype in combination with obesity has well-defined clinical features - a more severe course with frequent exacerbations and reduced control of the disease. The article considers the main pathogenetic mechanisms that determine the development of the asthma phenotype in combination with obesity. The influence of excess adipose tissue in the chest on respiratory mechanics, the correlation of gastroesophageal reflux disease and respiratory depression in sleep are described. It is shown that the phenotype of asthma with obesity is characterized by inflammation of adipose tissue, adipokine imbalance, insulin resistance, and disturbance of vitamin D metabolism. Gender peculiarities and genetic condition of asthma associated with obesity are considered. Understanding general mechanisms underlying the formation of asthma and obesity will undoubtedly contribute to the development of new therapeutic strategies.

Thanks to a large number of studies on community-acquired pneumonia (CAP) by scientists around the world, new data are emerging on various aspects of the problem. Therefore, it is necessary to regularly update knowledge on this issue. Despite the tendency to decrease in recent years, the incidence of CAP is 5-10 cases per 1 thousand of the population. In the structure of the general morbidity of respiratory diseases, CAP ranks 2nd in the adult population and 1st in children. Mortality from CAP ranges from 5% to 25-50% depending on the severity, mechanisms of development and personality of the patient (age, nutritional status, concomitant diseases, immune system, etc.), increasing with the growth of diseases of the upper respiratory tract caused by pneumotropic viruses. The clinical lecture presents current data on the features of etiology, previously little known mechanisms of the pathogenesis of CAP, the clinic of typical bacterial, viral, fungal, mycoplasmic and parasitic CAP, as well as the features of the disease in patients with severe immune disorders (AIDS, other diseases/pathological conditions) and aspiration pneumonia. In short form there are discussed the main recommendations for the treatment of CAP in various clinical groups: outpatients, persons with mild CAP, patients with severe CAP with suspected infection with Pseudomonas aeruginosa and aspiration.