[Nutrition status and obesity paradox in chronic obstructive pulmonary disease].

Chronic obstructive pulmonary disease (COPD) is one of the main causes of increasing morbidity and mortality worldwide, and therefore is becoming a major public health problem. The aim of this research was to summarize the data of observational and clinical studies concerning the influence of nutritional status (both malnutrition and obesity) on the COPD course and outcomes. Material and methods. The databases PubMed, RSCI, MEDLINE, EMBASE were used for the period from January 2008 to February 2021, with a total of 582 works viewed. Searches included the keywords: nutritional status, obesity paradox, chronic obstructive pulmonary disease. Results. In the pathogenesis of malnutrition in COPD, such phenomena as excessively enhanced metabolism, loss of appetite and dietary imbalance are most often described. It is proposed to pay great attention to preventing muscle loss in the correction of these phenomena. More than a third of COPD patients has obesity, which is associated according to some reports with a low quality of life, an increased frequency of hospitalizations for exacerbations, but also with better survival. The issue of the obesity paradox in COPD is increasingly discussed in scientific literature. Many authors emphasize that basic scientific research will help to understand the mechanisms of obesity and COPD relationship, as well as timely adjust the rehabilitation program, improving the quality of patients' life. Conclusion. Nutritional status is the important factor in COPD outcomes. Maintaining muscle mass is a priority in COPD patients, including those with obesity. The proposed dietary therapy should take into account the food intake according to the needs of patients, the correct proportion of macronutrients and the level of the body mass index.

[BRONCHIAL ASTHMA AND METABOLIC SYNDROME].

UNLABELLED: Bronchial asthma (BA) and metabolic syndrome (MS) are important socio-medical problems with complicated pathogenetic relations between them that account for the development of mutually aggravating conditions making it dificult to control BA and deteriorating quality of life. AIM: To study the clinical picture of BA in patients with MS and analyse the influence of MS components on BA control. MATERIALS AND METHODS: The study included 95 patients with partly controlled BA divided into 2 groups. Group 1 comprised 35 patients with BA without MS, group 2 consisted of 60 patients with BA and MS. Their comprehensive clinical and instrumental examination included evaluation of clinical symptoms and BA control, quality of life, anthropometric and spirometric data, arterial pressure, carbohydrate metabolism, blood lipid spectrum. RESULTS AND DISCUSSION: Patients with BA and MS suffered more pronounced changes of bronchial patency (forced expiratory volume during the first second) and the spread of daily peak exhalation rates than patients without MC. Also, they showed a tendency toward a decrease of vital lung capacity and Tiffeneau index. The assessment of the quality of life based on the Short Form-36 questionnaire revealed marked negative effect of BA +MS combination. Results of the first stage of the study were confirmed by correlation analysis of MS components, BA picture and control, spirometric data and quality of life characteristics. Among MS components, abdominal obesity and BMI showed the best correlation with the parameters characterizing the clinical picture of BA, such as apnea, BA control, results of spirometry (forced expiratory volume during the first second), and the spread of daily peak exhalation rates. CONCLUSION: The presence of MS components (obesity, arterial hypertension, disordered lipid and carbohydrate metabolism) increases severity of BA and accounts for the deterioration of the patients' quality of life.

[Subclinical hypothyroidism as a cause of dyslipidemia].

Subclinical hypothyroidism (SHT) is a clinical-laboratory syndrome characterized by an elevated thyrotropin level and normal levels of T3 and T4. Lipid metabolism disorders in patients with SHT and the influence of substitution therapy with L-thyroxin on the lipid profile are considered in many publications, but the results of these studies are contradictory. This paper was aimed to discuss the relevant literature and search for the most effective treatment strategy.

[POSSIBLE CAUSES OF INEFFICIENT MONOTHERAPY OF SUBCLINICAL HYPOTHYROIDISM WITH L-THYROXIN].

Substitution therapy with L-thyroxin was recognized in 2012 to be the method of choice for the treatment of subclinical hypothyroidism. However it does not always allow to achieve normalization of all metabolic parameters. The aim of our work was to search for and analyze data on the possible mechanisms responsible for the failure of replacement hormonal therapy with L-thyroxin with a view to changing the therapeutic strategy for patients with subclinical hypothyroidism.

[Asthma and metabolic syndrome: Clinical and pathogenetic relationships]. / Bronkhial'naia astma i metabolicheskii sindrom: kliniko-patogeneticheskie vzaimosviazi.

Asthma and metabolic syndrome (MS) are common and social diseases. External and internal factors influencing the development and manifestations of asthma are identified; among which there is obesity that is a major risk factor for MS. Accordingly, the concurrence of asthma and MS and to study their clinical and pathogenetic relationships are a topical problem. There is a tendency to identify a particular asthma phenotype that is characterized by later-onset disease in the presence of obesity; the low prevalence of atopy, low serum level of IgE, and a poorly-controlled course with a trend of standard therapy resistance. It is necessary to understand the essence of asthma cause-effect relationships in the presence of obesity for defining management tactics for this group of patients.

[The diagnostic value of systemic inflammation biomarkers in chronic obstructive pulmonary disease].

Chronic obstructive pulmonary disease (COPD) is a cause of appreciable social and economic losses. Airway inflammation is the main factor at the early stages of COPD pathogenesis and persists for many years after cessation of the action of provoking factors. In the last years, researchers have shown much interest in biomarkers associated with various diseases including COPD. Biomarkers of COPD are related to pathophysiology ofthe disease and inflammatory processes in the lungs. This review is designed to summarize the currently available data on systemic COPD biomarkers, their use for the assessment of activity of the disease and the possible role in the formation of COPD phenotype. Most systemic biomarkers are not specific for COPD. Moreove, evaluation of their significance encounters difficulties due to the presence of concomitant pathologies, in the first place cardiovascular diseases. Nevertheless, studies involving a large number of patients with COPD provided information about the role of biomarkers in the activity of COPD and formation of its phenotype with systemic inflammation. The introduction ofbiomarkers in protocols ofexamination ofCOPD patients needs further substantiation.