Introduction. Acute respiratory viral and pneumococcal infections, the incidence of which is associated with high economic costs, are one of the most important problems in epidemiology and pulmonology. Preventive vaccination is a tool for managing the incidence of acute respiratory viral infection (ARVI) and pneumococcal infections. The issues of medical and economic efficiency of preventive vaccination are constantly in the field of epidemiological surveillance, and the estimates obtained in this case are a necessary condition for making decisions on the viability of investing in its organization.
Aim. Expert assessment and predictive modeling of the potential cost-effectiveness of vaccination with pneumococcal and influenza vaccines in immunocompetent adult patients with different levels of risk of acute and chronic respiratory diseases among the builders of the Amur Gas Processing Plant (GPP).
Materials and methods. A complex of studies was carried out using the methods of statistics, epidemiological analysis and monitoring, comparative and economic analysis. Determination of the economic profitability of vaccination was carried out on the basis of methods of comparing “costs” and “benefits”. The surveyed cohort is represented by adults working on the construction of the Amur GPP (Svobodny, Amur Region). The main risk factors and inclusion criteria were the conditions of adverse effects of occupational, social and biological factors on human respiratory health. A set of preventive measures was carried out using methods and means of specific prevention of acute and chronic respiratory diseases: anti-influenza (Ultrix Quadri) and pneumococcal (Prevenar-13) vaccines. Efficacy analysis was carried out for 20-, 40- and 60-year-old patients with 1, 2 and 3 risk factors in accordance with the methods of its medical, social and economic evaluation. A retrospective determination of the cases of diseases (deaths) and economic damage prevented as a result of vaccination was carried out on the basis of the difference in morbidity (mortality) rates for the period preceding vaccination and for the period following vaccination. When constructing a predictive model for evaluating the effectiveness of vaccine prevention of respiratory infections, expert assessments, legal documents and the methodology of individual researchers were used.
Results. The predicted incidence of pneumonia among the builders of the Amur GPP, taking into account all risk factors, can be 32.3‰. At the same time, the total volume of prevented predictive incidence of pneumonia in the post-vaccination period only with the use of pneumococcal vaccine can be 26.5‰, reducing the initial incidence rate by 5.5 times. As a result of the calculations and economic assessment, it was found that the total (direct and indirect) economic costs of the state and the plant (economic damage) with the incidence of community-acquired pneumonia in the working-age population (20-60 years) on the territory of this construction site is 112,811 rubles. per person per year. Consequently, the prevented economic damage among the employees and builders of the Amur GPP only as a result of the use of the pneumococcal vaccine “Prevenar-13” is 13,537,411 rubles. In addition, immunoprophylaxis with the use of influenza vaccines can reduce the incidence of influenza, ARVI, pneumonia and chronic forms of respiratory diseases, which corresponds to additional prevented economic damage to the plant in the amount of 103,786,764 rubles. Thus, the predicted total prevented economic damage for this plant as a result of vaccination may amount to 117,324,175 rubles.
Conclusion. The results of the studies indicate that the implementation of the Program for the Prevention of Acute Respiratory Diseases by means of influenza and pneumococcal vaccines among the builders of the Amur GPP has a high level of medical and socio-economic efficiency, identified on the basis of its predictive modeling and expert assessments.

Aim. To analyze clinical manifestations of novel coronavirus infection among vaccinated population of the Khabarovsk krai with breakthrough infection.
Materials and methods. Analysis was based on official data including information on COVID-19 breakthrough infections provided by Khabarovsk krai Rospotrebnadzor regional office. Statistical analysis included calculation of Spearman's rank correlation, odds ratio.
Results. A relatively small proportion (0.7%) of breakthrough COVID-cases that occurred among Khabarovsk residents vaccinated against SARS-CoV-2 was shown during analyzed period of time. The highest risk of contracting COVID-19 was revealed among people aged over 50 years. Course of breakthrough COVID-19 infection was mostly mild ‒ 61.0% (95% CI: 54.2‒67.6%). In most cases COVID-19 manifested itself as acute respiratory viral infection ‒ 66.7% (95% CI: 60.0‒73.0%). A significant negative correlation was noted between levels of blood saturation and duration of the disease (ρ=-0.82; p<0.05). Duration of COVID- 19 among vaccinated people was 16 days in for patients treated in an outpatient facility and 17 days for hospitalized patients in average. Most common clinical manifestations of COVID-19, noted by more than half of the respondents, were hyperthermia ‒ 55.7% (95% CI: 48.8–62.5%), weakness and cough ‒ 65.7% each (95% CI: 59.1–72,2%).
Conclusion. Obtained data testify in favor of significant protective potential of vaccines against COVID-19.

Aim. To analyze of the severity of respiratory symptoms in patients with chronic obstructive pulmonary disease (COPD), depending on the presence of an exacerbation or novel coronavirus infection (NCVI), taking into account the activity of acute phase blood parameters.
Materials and methods. The medical documentation of 162 patients with COPD was studied, which were divided into 3 groups: group 1 (n=61) ‒ COPD and NCVI, group 2 (n=53) – stable COPD, group 3 (n=48) ‒ COPD exacerbation. The severity of respiratory symptoms was assessed using points. To assess the activity of inflammation the following biochemical indicators were used ‒ C-reactive protein (CRP) and fibrinogen (g/L).
Results. According to the severity of cough and the intensity of dyspnea on the mMRC scale, the first, second and third groups did not differ statistically (p=0.07). Patients of the first group (82.5%) characterized by the absence of classical criteria for exacerbation of COPD. In terms of the severity of sputum production, the first, second and third groups are statistically different (p=0.0001). The first, second and third groups differ significantly in the level of serum CRP (p=0.0001) and fibrinogen (p=0.009). According to the results of the correlation analysis, some relationships found between respiratory symptoms and the level of CRP and fibrinogen.
Conclusion. The clinical feature of the associated course of stable COPD and NCVI is the presence of severe dyspnea and the absence of classic criteria for exacerbation of COPD. Systemic inflammation in NCVI and stable COPD are more pronounced than in isolated stable COPD or exacerbation and correlates with cough and dyspnea. Practitioners for the differential diagnosis of NCVI in stable COPD can use the data obtained.

Aim. To identify key diagnostic criteria for chronic obstructive pulmonary disease (COPD).
Materials and methods. We examined 112 patients with mild, moderate and severe COPD and 32 relatively healthy volunteers with no disturbances in the lung function. The level of IL-4, IL-6, IL-10, IL-17A, TNF-α, IFN-γ, TGF-β1 and CD4+CD126+ cells was determined by means of flow cytometry method. Prooxidant and antioxidant markers of oxidative stress 8-OHdeoxyguanosine, protein carbonyl, glutathione, glutathione reductase, glutathione peroxidase, thioredoxin-1, and thioredoxin reductase-1 were assessed by enzyme immunoassay.
Results. The presence of high-ranking correlations of the proinflammatory link of immunity and components of the prooxidant system was revealed, which indicates the presence of systemic alterative processes in patients with COPD. Based on ROC-analysis, key biomarkers were identified in patients with stable COPD: 8-OH-deoxyguanosine, CD4+CD126+ cells, IL-17, and thioredoxin, and their threshold levels were established.
Conclusion. The recommended diagnostic criteria will optimize the therapeutic strategies for COPD.

Introduction. Macrophages are one of the key cells in the pathogenesis of chronic obstructive pulmonary disease (COPD), mediating the primary immune response and coordinating the further reaction of the immune system upon contact with cigarette smoke and air pollutants. It is known that some TRP channels expressed on macrophages are receptors for dust particles and cigarette smoke components.
Aim. To study the features of TRPV1, TRPV4, TRPA1 and TRPM8 channels expression on monocyte-derived macrophages and alveolar macrophages of COPD patients and smokers without bronchial obstruction.
Materials and methods. Expression of TRP channels at the mRNA level was studied in monocyte-derived macrophages obtained from 8 COPD patients and 6 healthy smokers by quantitative reverse transcription PCR. Expression of TRP channels at the protein level was studied on alveolar macrophages of 39 COPD patients and 8 healthy smokers by indirect flow cytometry.
Results. It was found that under in vitro conditions, monocyte-derive macrophages of COPD patients were distinguished by a significant 4.8-fold increase in the number of TRPV1 transcripts (p=0.009). At the same time, the expression of the TRPV1 protein on the alveolar macrophages of COPD patients was also significantly higher when compared to the cells of smokers from the control group (14.1 [6.4‒21.2]% vs. 6.1 [2.1‒9.8]%, p=0.006). In addition, we found that TRPV4 expression was increased among active smokers with COPD, and the expression of TRPA1 and TRPM8 channels correlated with some lung function parameters.
Conclusion. The obtained results suggest that the increased expression of TRPV1 on macrophages may be a marker of the disease and contribute to its development, while the expression of TRPV4, TRPA1 and TRPM8 may influence the clinical course of COPD.

Introduction. The concept of the interaction of multidirectional cytokines that control the cellular and humoral immune response in the cold bronchospasm in asthma has been little studied.
Aim. To evaluate the role of Th1 and Th2 cytokines in the formation of the airway response to a cold stimulus in patients with asthma.
Materials and methods. The spectrum of cytokines (IFN-γ, IL-17А, TNFα, IL-1β, IL-2, IL-6, IL-4), protein IP-10 (chemokine CXCL10), MMP9 metalloproteinase and TIMP1 protein in exhaled breath condensate before and after 3-minute isocapnic hyperventilation with cold (-20ºС) air (IHCA) has been studied in 37 patients.
Results. Patients were divided into two groups: group 1 (n=11) consisted of individuals with cold airway hyperresponsiveness (CAHR), group 2 – 26 individuals with no response to IHCA (ΔFEV1 IHCA = -16.5±2.3 and -1.5±0.85%, respectively, p<0.0001). Pro-inflammatory cytokines TNFα, IL-2, IL-1β, and IL-6 had a predominant effect on the development of CAHR. IFN-γ was considered as a central regulator of the bronchial response to a cold stimulus, the increase in the level of which in cold bronchospasm relative to the group without CAHR (399,52 [237,1; 753,23] and 237,99 [57,63; 304,84] fg/mL, respectively, p<0.05) was accompanied by an increase in the concentration of IFN-γ-induced protein IP-10 (201.12 [199.4; 398.81] and 167.33 [132.94; 212.77] fg/mL, respectively (p<0.05). The absence of dynamics of IL-4 concentration in response to IHCA testified to the minimal involvement of IL-4 in the implementation of CAHR. The involvement of IL-17A could be associated with the activity of Th1 cytokines and the cold-activated proteolysis-antiproteolysis system involved in bronchial remodeling ‒ metalloproteinase MMP9 and a specific inhibitor of metalloproteinases TIMP1, the values of the latter two were higher in individuals with CAHR after the IHCA test.
Conclusion. In patients with asthma, in the implementation of cold bronchospasm, the dominance of the Th1 immune response and a decrease in the functional activity of Th2 cytokines are observed.

Introduction. Features of the clinical course of bronchial asthma in children with obesity made it possible to identify a special phenotype, when the presence and severity of obesity determine a more severe course of asthma and a worse response to asthma therapy. Asthma, like obesity, is recognized as a classic example of multifactorial diseases, which are based on a rather complex gene network. Studying the genetic basis of both of these complex traits and linking them to the asthma phenotype should contribute to our understanding of the overall genetic basis of these pathological disorders.
Aim. Evaluation of the clinical and genetic significance of the rs1801282 polymorphism of the PPARG2 gene (34C>G, p.Pro12Ala) in children with asthma and obesity.
Materials and methods. 161 children with asthma were examined, including 59 patients with obesity 1-3 degrees. The examination included general clinical, functional, instrumental methods. The level of asthma control was determined according to the GINA criteria (2018). The study of gene polymorphisms was carried out by the real-time polymerase chain reaction.
Results. An analysis of the frequencies of the PPARG2 gene polymorphism in children with bronchial asthma did not reveal any differences from the control group healthy people. In 61% of children with asthma and obesity, there was no control over the disease, which was associated with the G allele (OR 2.4 [95% CI: 1.09‒5.30], p=0.0281). An increase in the activity of lactate dehydrogenase and a decrease in the membrane potential of mitochondria in peripheral blood lymphocytes in children with the GG genotype were revealed, which may indirectly affect the level of disease control.
Conclusion. The comorbidity of asthma and obesity in children affects the control of the disease. This manifests itself through immune mechanisms that play a key role in energy homeostasis and mitochondrial dysfunction of immunocompetent blood cells. The G-allele of the PPARG2 gene can be a marker of the lack of control over the disease in obese children with asthma. The pathogenetic significance of this polymorphism requires further study.

Aim. To assess the diagnostic significance of the indicators obtained by the new method of quantitative evaluation of digital data of computed tomography (CT) images of the chest (CT densitovolumetry) in groups of patients with a diagnosis of sarcoidosis, stratified by radiological patterns, in comparison with groups formed according to the classification principle of J.G.Scadding , as well as in comparison with functional pulmonary tests.
Materials and methods. Healthy individuals (n=21) and patients with pulmonary sarcoidosis (n=101) were examined. Patients with sarcoidosis were divided into 5 groups according to the J.G.Scadding classification and into 5 groups according to combinations of radiological patterns. The lung function was assessed according to the data of forced expiratory spirometry, body plethysmography, and the study of diffusion capacity and lung volumes. All examined patients underwent a two-stage CT scan of the lungs in the inspiratory and expiratory phases with the measurement of parameters in 3 density ranges.
Results. The values of the obtained quantitative indicators, determined by the new method of CT-densitovolumetry, differed from the control values in healthy individuals both in the general group of patients with sarcoidosis, and in separate groups according to the J.G.Scadding classification and groups divided by radiological patterns. As a result, an intergroup statistically significant difference in indicators was determined. Correlations were found between radiometric measurements and lung function variables.
Conclusion. A new method of CT-densitovolumetry has identified a diagnostic difference between approaches to stratification of patients with pulmonary sarcoidosis. The results obtained can be treated as a useful tool for the development of a unified radiological classification based on qualitative CT characteristics of pathological changes in pulmonary sarcoidosis.

Introduction. The spread of the novel coronavirus infection COVID-19 required the restructuring of all links in the provision of specialized medical care, including the stages of medical rehabilitation. The organization of medical rehabilitation of patients with COVID-19 is in the process of active formation. For an objective assessment of а health-resort rehabilitation, it is necessary to use the criteria of the International Classification of Functioning, Disability and Health (ICF).
Aim. To develop a set of ICF domains for the period of health-resort medical rehabilitation of patients after COVID-19 to assess the initial state and rehabilitation results.
Materials and methods. Clinical, laboratory, functional examination was carried out for all patients upon admission and discharge. Medical rehabilitation was carried out in the conditions of a climatic health-resort institution.
Results. The set of ICF domains should meet the goals and objectives of each stage of rehabilitation. A set of ICF domains has been developed for patients entering health-resort rehabilitation after the COVID-19. Domains are filled with parameters of clinical, functional and laboratory examination.
Conclusion. The developed methodology can be used to assess the effectiveness of health-resort medical rehabilitation of patients after COVID-19.

Aim. To reveal the features of the psychophysiological status and the level of myocardial stress in wrestlers with masked hypertension.
Materials and methods. We examined 125 athletes, aged 18 to 30, male, Yakut nationality, high sportsmanship (candidate master of sports, master of sports). Depending on the level of blood pressure, athletes were divided into 2 groups: group 1 ‒ athletes with normal blood pressure (n=80, 64.0%); group 2 ‒ athletes with masked hypertension (n=45, 36.0%). A clinical examination, anthropometry, measurement of office and daily blood pressure levels, echocardiography of the left ventricle were performed.
Results. In athletes with masked hypertension, a high level of reactive anxiety prevails, which increases the relative chance of developing hypertension by 2.6 times (OR 2.601 [95% CI: 1.123‒6.023], p<0.05), a sympathicotonic type of regulation of the cardiovascular system was noted, an increase in systolic myocardial stress and high levels of left ventricular wall thickness compared with athletes with normal blood pressure.
Conclusion. High reactive anxiety can serve as a risk factor for the development of masked hypertension in athletes. A comprehensive assessment of the psychophysiological status and individual typological characteristics of athletes is necessary to prevent the development of prepathological and pathological changes in the cardiovascular system in athletes.

Aim. To evaluate changes in immunological parameters and umbilical blood flow in pregnant women with exacerbation of chronic bronchitis associated with cytomegalovirus infection (CMVI).
Materials and methods. The concentration of secretory immunoglobulin A (sIgA), immunoglobulin E (IgE), circulating immune complexes (CIC), interleukin- 6 (IL-6), interleukin-4 (IL-4) and systolic-diastolic ratio (SDR) in the umbilical artery was studied in 80 women with exacerbation of chronic bronchitis in the second trimester of pregnancy, uncomplicated and complicated by the acute phase of CMVI. The first group was represented by 30 women with cytomegalovirus seronegative physiological pregnancy; the second – 25 patients with exacerbation of chronic bronchitis caused by reactivation of CMVI, complicated by the development of chronic compensated placental insufficiency (CCPI); the third – 25 women with chronic simple bronchitis in the acute stage in the setting of the acute phase of CMVI, initiating the formation of chronic subcompensated placental insufficiency (CSPI) at 30-34 weeks of gestation.
Results. In the first group, the concentration of sIgA in blood serum was 4.3±0.26 mg/L, IgE – 3.64±0.23 IU/mL, CIC – 0.091±0.005 AU, IL-6 – 2.41±0.21 pg/mL, IL-4 – 30.1±2.19 pg/mL, cortisol – 527.2±20.95 nmol/L, and SDR in the artery umbilical cord – 3.41±0.06 relative units. In women of the second group, in comparison with the first one, there was an increase in the concentration of sIgA by 1.40 times (p<0.01), IgE – by 1.95 times (p<0.001), CIC – by 1.83 times (p<0.001) , IL-6 – 2.61 times (p<0.001), IL-4 – 1.29 times (p<0.05), cortisol – 1.35 times (p<0.001) in the absence of statistically significant differences the magnitude of vascular resistance in the umbilical artery. In the third group, in comparison with the first one, there was a decrease in sIgA values by 1.26 times (p<0.05) in the setting of an increase in the concentration of IgE by 2.56 times (p<0.001), CIC – by 2.09 times (p<0.001 ), IL-6 – by 3.65 times (p<0.001), IL-4 – by 1.64 times (p<0.001), cortisol – by 1.52 times (p<0.001) and SDR in the umbilical artery – 1.27 times (p<0.001). In women of the third group, in contrast to the second one, a decrease in the concentration of sIgA by 1.77 times (p<0.001), as well as an increase in IgE by 1.31 times (p<0.01), CIC ‒ by 1.14 times (p<0.001), IL-6 ‒ 1.39 times (p<0.001), IL-4 ‒ 1.27 times (p<0.05), cortisol ‒ 1.13 times (p<0.05) and SDR in the umbilical artery ‒ 1.21 times (p<0.001). A direct correlation was established between IL-6 and cord blood flow (r=0.53; p<0.01), as well as an inverse relationship between sIgA and cortisol (r=-0.44; p<0.05).
Conclusion. In the second trimester of gestation, exacerbation of chronic simple bronchitis caused by reactivation of CMVI, which initiates the development of CSPI, in contrast to chronic bronchitis in the acute stage, associated with the acute phase of chronic CMVI, which induces the formation of CCPI, is accompanied by an imbalance of nonspecific local and systemic immune responses, as well as stress-reaction, which leads to the growth of SDR in the umbilical artery.

Aim. To give pathomorphological characteristics of placental cotyledons with weakly contrasted bloodstream in women who had an exacerbation of cytomegalovirus infection (CMVI) in the second trimester of pregnancy.
Materials and methods. A study was made of involutive-destructive processes in 153 cotyledons of the placenta with well and weakly contrasted bloodstream in women with pregnancy, uncomplicated and complicated by exacerbation of CMVI at 21-24 weeks of gestation. The first group included 36 cotyledon placentas from women with CMV-seronegative uncomplicated pregnancy with well contrasted blood vessels; the second group – 67 cotyledon placentas from patients with chronic compensated placental insufficiency (CCPI) and poorly contrasted vascular network; the third group – 30 cotyledon placentas from women with chronic subcompensated placental insufficiency (CSPI) with indistinctly visualized blood vessels; the fourth group – 20 cotyledon placentas from patients with chronic decompensated placental insufficiency (CDPI). Dosed introduction of red lead on drying oil (1:3) into the blood vessels of the placenta was carried out through the umbilical cord vein. Obtaining X-ray images of cotyledons with well and weakly contrasted blood vessels in the marginal part of the organ was carried out on the apparatus RUM-20M with X-ray image intensifier Sapphire (Russia). Cotyledon biopsy specimens for histometry and histochemical analysis were taken before their contrasting, and for survey microscopy – after injection of the contrast mass.
Results. In the first group, the amount of fibrinoid in the stroma of the villi was 1.35±0.09%, perivillous fibrinoid − 1.02±0.08% in the absence of pseudonecrosis and calcifications. In the second group, unlike the first one, cotyledons prevailed, in which in 40-50% of cases weakly expressed contours of blood vessels were found, an increase in the specific volume of stromal fibrinoid by 1.82 times was observed (p<0.001), and fibrinoid around villi by 2.04 times (p<0.001); pseudonecrosis accounted for 2.29±0.13%, and calcificates − 1.50±0.12%. In the third group, in comparison with the second one, cotyledons were more common with 50-70% of indistinctly contoured vessels, villi with edematous changes and stromal collagenization; the concentration of stromal fibrinoid increased by 1.47 times (p<0.001), the proportion of perivillous fibrinoid – 1.46 times (p<0.001), pseudonecrosis – 1.41 times (p<0.001) and the accumulation of calcium salt – 1.57 times (p<0.001). In the fourth group, compared to the third one, cotyledons were more common, in which more than 70% of weakly contrasted blood vessels were determined, while the number of collagen fibers and acid glycosaminoglycans increased in the villi; there was an increase in the amount of fibrinoid around the villi by 1.24 times (p<0.01), pseudonecrosis – by 1.23 times (p<0.05) and calcificates – by 1.32 times (p<0.01).
Conclusion. In women with an exacerbation of CMVI in the second trimester of gestation and CSPI, in contrast to patients with a similar infectious disease and CCPI, a decrease in the flow of contrast into the bloodstream of cotyledons is due to more pronounced edema, the formation of collagen fibers, fibrinoid and calcium salts in the stroma of the villi, as well as perivillous fibrinoid. In CDPI of cytomegalovirus etiology, compared with CSPI, weak contrasting of the vascular bed of cotyledons is associated with increasing changes in the stroma involved in the regulation of the resistance of draining veins and intracotyledon blood vessels.

Aim. Demonstration of the clinical case of pneumomediastinum in a teenager with severe COVID-19- associated pneumonia.
Materials and methods. The clinical case of spontaneous pneumomediastinum was presented, which was a complication of the severe course of COVID-19 pneumonia in a teenager.
Results. Patient Ch., 15 years old, with obesity of the 1st degree, was admitted to the hospital of infectious diseases for patients with a COVID-19 on the 7th day of the illness in a severe condition and had complaints of an increase in body temperature to 40ºC, pronounced cough and weakness, dyspnea when walking and at rest. The PCR test for SARS-CoV-2 gave a positive result. Multispiral computed tomography showed polysegmental interstitial lesion of both lungs, which had multiple areas of “ground glass”, signs of pneumomediastinum, subcutaneous emphysema of the upper third of the chest, left-sided pleural effusion. The volume of lung tissue lesion was 50% on the right and 85% on the left. The positive effect of treatment was not observed after 2-3 days in the hospital. The condition of heavy severity continued due to intoxication syndrome, respiratory failure, inflammatory changes in lung tissue syndrome. In this regard, the patient was injected intravenously with tocilizumab (Actemra®) 400 mg. The child was released on the 20th day of hospitalization with a positive clinical effect.
Conclusion. The above clinical case demonstrates that in children a novel coronavirus infection can occur not only in severe form, but also with the possible development of complications in the form of pneumomediastinum and low effectiveness of antibacterial and antiviral therapy, which required the use of humanized monoclonal antibodies (tocilizumab).

Introduction. Diffusion capacity of lungs is the second most important respiratory test after spirometry. The importance of assessing lung diffusion capacity in chronic obstructive pulmonary disease (COPD) is not given due attention, although this parameter reflects changes in functional lung volume and gas transport through the alveolar-capillary membrane, thereby providing more information about respiratory physiology than spirometry results. Diffusing capacity of the lung for carbon monoxide (DLCO) measurement is the standard in pulmonology, however, in recent years, close attention has been given to the determination of lung diffusion capacity for nitric oxide (DLNO), which gives better explanation of gas transport through the alveolar-capillary membrane compared to DLCO. Recent literature is actively discussing the inclusion of age, race, and gender aspects in spirometric reference equations that are used to assess spirometric parameters and lung diffusion capacity.
Aim. To analyze the literature over the past five years, reflecting the views of modern researchers on methods for diagnosing lung diffusion capacity, as well as the contribution of age, race, and gender aspects to the assessment of this parameter in COPD.
Materials and methods. The PubMed database was searched for information for the period 2017-2022 according to the selected inclusion criteria. Information requests included the following set of keywords: “diffusion capacity”, “chronic obstructive pulmonary disease”, “gender”, “age”, “race”, “DLNO”, “DLCO”. 123 articles were analyzed.
Results. Recent evidence highlights the importance of including lung diffusivity in COPD prognostic programs. Determining the diffusion capacity of the lungs for nitric oxide may be a promising area of research soon. Gender and age considerations play an important role in the interpretation of spirometry data and lung diffusion capacity. The issue of including a racial trait in the assessment of the diffusing capacity of the lungs in COPD is in doubt.

Introduction. It is now recognized that small airway dysfunction is a component of the development of chronic obstructive diseases. The damage of the small airways is characteristic of certain phenotypes of bronchial asthma and chronic obstructive pulmonary disease, which determines the characteristics of the clinical manifestations of the disease and requires a personalized approach to treatment.
Aim. Summarizing the data of domestic and foreign researchers on the possibility of using non-drug methods of rehabilitation of chronic obstructive diseases in terms of their impact on the small airways.
Materials and methods. The review uses data from articles published in PubMed, Google Scholar, eLIBRARY.
Results. The article presents modern methods for assessing small airways. The choice of criteria and the complexity of diagnosing small airway dysfunction at the stage of rehabilitation treatment are discussed. The effectiveness of the use of natural and preformed physical factors in the rehabilitation treatment of chronic obstructive pulmonary diseases has been shown. The authors analyze the influence of physiotherapeutic factors on the dynamics of spirometry parameters, indirectly indicating the state of small airways. The preferred choice of inhalation preparations with extrasmall sizes of medicinal particles penetrating into the distal respiratory tract is shown. The influence of natural and preformed physical factors on the small airway dysfunction in chronic obstructive pulmonary diseases is highlighted.
Conclusion. Literature data suggest a positive effect of pulmonary rehabilitation methods on the small airway dysfunction. Further studies are required to study the mechanisms of action of physiotherapeutic factors on the peripheral parts of the respiratory tract and the development of targeted medical technologies.

Introduction. In the pathogenesis of the new coronavirus infection (COVID-19), innate cellular elements of the immune system are of great importance, among which special attention is paid to neutrophils and the mechanisms of their death – netosis, which leads to the formation of extracellular DNA traps. Neutrophil extracellular traps play an important role in the development of endothelial dysfunction and thrombotic disorders, which not only complicates the course of COVID-19 infection, but also causes severe obstetric complications that increase the risk of maternal and infant mortality. This review describes possible mechanisms for the formation of neutrophil extracellular traps, as well as their role in the pathogenesis of COVID-19.
Materials and methods. An analysis of Russian (eLibrary) and foreign (PubMed) literature was carried out with a search depth of 2010-2021.
Results. The pathogenesis of COVID-19 is directly related to the uncontrolled progression of systemic inflammation, which changes the innate immune response in the form of functional maladaptation and premature death of neutrophils with the formation of neutrophil extracellular traps. The neutrophils that were transformed by netosis play a key role in the development of thrombotic disorders of the microvasculature, which leads to the development of life-threatening complications such as acute respiratory distress syndrome and multiple organ failure, which increases the mortality of patients with COVID-19 infection. During pregnancy, increased formation of neutrophilic extracellular traps is the cause of hemodynamic disturbances of the fetoplacental complex, placental disorders and endothelial dysfunction, concomitant with the development of preterm labor and preeclampsia, which increases the risk of postpartum hemorrhage, maternal morbidity and mortality. Therefore, new data on neutrophil extracellular traps and mechanisms of formation may lead to a reconsideration of the pathogenesis of thrombotic disorders in pregnant women with COVID-19 infection, which is important for further management of pregnancy.