Vol 98, No 3 (2026): Issues of pulmonology

Non-respiratory lung function (NFL) has been an area of intense scientific research for the past twenty years. Experts from the European Respiratory Society have developed a technical regulation that has made it possible to standardize the study of organic and inorganic volatile compounds both in the portion of exhaled air and in the collection of its condensate. The metabolic function of the pulmonary parenchyma is actively manifested in the regulation of water-electrolyte metabolism, as well as biologically active amines and peptides; unique properties of alveolocytes of the second type and alveolar macrophages in the synthesis and recycling of surfactant. A special role is played by the endotheliocytes of the pulmonary capillaries, which transform angiotensin-1 (deca peptide) into angiotensin-2 (octa peptide) with the help of an angiotensin-converting enzyme. The respiratory system is considered within the NFL as an active immunological organ. Bronchus-associated lymph nodes form mucosal immunity with the participation of secretory immunoglobulin class A, also participating in the formation of innate and acquired immunity. Clinical manifestations of immunopathological reactions of the respiratory system are diverse. Thus, in clinical practice, allergic reactions of both immediate and delayed types can be observed; granulomatous processes of the pulmonary parenchyma occupy a special place. In the mucous membrane of the respiratory tract, neuroepithelium can be identified, which plays an important role in the differentiation of cell structures and in the morphogenesis of lung tissue. However, the participation of the lungs in endocrinological reactions remains, at present, a poorly studied direction. The translation of scientific information on the metabolic, immunological and endocrinological functions of the lungs has made it possible to identify a number of biological markers in diseases such as bronchial asthma, COPD, lung cancer, and pneumonia. Studies of the proteome of exhaled air condensate have brought us closer to the discovery of new biological markers.

Background. Medical gases, inhaled nitric oxide (iNO) and molecular hydrogen (iH2), have been used in the therapy for various medical conditions. When combined, these gases have shown to be more effective and safer for patients, and may become a promising treatment option for various diseases рost-COVID-19 syndrome (PS).

Aim. To compare the efficacy and safety of combined therapy iNO/iH₂ with monotherapy iNO and a control group in patients with respiratory disorders during with PS.

Materials and methods. A prospective, open-label, controlled trial involving 60 patients with PS was conducted in parallel groups (the mean age of the participants was 58.1 ± 12.9 years, and the sample consisted of 18 men and 42 women). The participants were randomly assigned to 3 groups: 1 (n = 20) – iNO/iH₂ treatment; 2 (n = 20) – only iNO treatment; and 3 (n = 20) – control group. The duration of treatment was 10 days, and the treatment involved inhalation through a nasal cannula for 90 minutes (flow rate of 4 liters per minute, iH₂ concentrations < 4%, iNO – 60 pmm). Clinical outcomes were assessed using self-observation diaries, Modified Medical Research Council Dyspnea Scale questionnaires, the "Language of Dyspnea" Scale, Fatigue Assessment Scale, Hospital Anxiety and Depression Scale, and Short Form-36 Health Status Survey questionnaires. Additionally, a 6-Minute Walk Test was performed, and indicators of oxidative status in blood serum and microcirculation in the bulbar conjunctiva were measured.

Results. The course of iNO/iН₂ and iNO led to regression of the clinical manifestations of PS (dyspnea, cough, fatigue), improved the physical and psychological component of quality of life, and contributed to improvement in microcirculation (increased venule diameter and velocity) compared to the control group (p < 0.05). In combination therapy, there was an increase in distance traveled by 6-minute walk test and decrease in reactive oxygen species compared to iNO and control groups (p < 0.05). No serious adverse events were noted.

Conclusion. The study demonstrates the advantage of the iNO/iH₂ course in comparison with iNO and control in the rehabilitation program of patients with PS. The safety and effectiveness of the iNO/iH₂ course has been proven in the form of regression of clinical manifestations of PS, improvement of quality of life, exercise tolerance, microcirculation parameters, and restoration of the oxidative status of the body.

Background. The influence of nanoparticles of industrial aerosols on phenotypes of occupational chronic obstructive pulmonary disease (COPD) is not studied enough. In this connection the system signs and symptoms of the disease including sarcopenia is of a great interest for investigation, because there associations with quality of life and lifespan.

Aim. To establish the features of sarcopenia in patients with COPD due to aerosols containing nanoparticles.

Materials and methods. A prospective observational study was performed. Previously, chemical and hygienic investigation of nanoparticles in the workplaces air on the machine building enterprise was done. The groups under investigation were occupational COPD patients, who were employed at the workplaces that has been investigated and contacting with aerosols containing metal (n = 48) or silica (n = 55) nanoparticles. Groups were matched by sex, age, COPD duration. Study procedures were Sarcopenia Fast questionnaire, ultrasound measurement of quadriceps femoris, bioelectrical impedance analysis, hand grip strength by dynamometry, sit-to-stand test, short physical performance battery, pulmonary function tests, serum molecular markers measured by enzyme-linked immunosorbent assay or by kinetic method, serum fibrinogen by Klauss method. COPD was diagnosed when postbronchodilator forced expiratory volume in one second divided by forced vital capacity was less than 0.7. Sarcopenia was diagnosed by EWGSOP2 criteria (European Working Group on Sarcopenia in Older People). Statistical analysis included descriptive methods and liner regression.

Results. Sarcopenia rate was 26 (47.2%) in COPD due to aerosols containing silica nanoparticles, 17 (35.4%) in COPD due to aerosols containing metal nanoparticles and 15 (30.0%) in control group; p = 0.015. The differences of sarcopenia severity between COPD due to different environmental conditions were seen – Ме (Q₂–Q₃). COPD due to aerosols containing silica nanoparticles was characterized by minimal values of quadriceps cross-sectional area: 4.9 (4.0–5.5) sm² compared with 9.4 (8.4–9.9) sm² in COPD due to aerosols containing metal nanoparticles patients and with 9,0 (7.8; 9.2) sm² in control group respectivel; р = 0.010, quadriceps thickness, appendicular fat-free mass index: 7.1 (5.5–7.4), 7.5 (6.2–8.3) and 8.2 (6.8–9.1) kg/m²; р = 0.009, sit-to-stand test 15.8 (13.2–16.7), 12.1 (10.5–13.0) and 11.5 (9.4–13.8) s; р = 0.009, by elevated muscle echogenicity. COPD due to aerosols containing metal nanoparticles patients had the mid values. After 12 months these relationships were preserved. The associations of silica nanoparticles with quadriceps cross-sectional area (В = -0.95; р = 0.009), echogenicity (В = 1.02; р = 0.001), appendicular fat-free mass index (В = -1.05; р = 0.001) and sit-to-stand test (В = 0.91; р = 0.011) were explored.

Conclusion. Occuational COPD is characterized by sarcopenia rate, less values of muscle quantity and quality, especially pronounced in COPD due to aerosols containing silica nanoparticles.

Aim. To investigate the association between various sleep disorders and changes in clinical status in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and after surgical treatment.

Materials and methods. The study included 43 patients with a verified diagnosis of CTEPH hospitalized between December 2023 and February 2025. Assessment included general clinical status, echocardiography, and right heart catheterization data. Patients completed standardized questionnaires (STOP-Bang, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Index, International Restless Legs Syndrome Study Group Rating Scale) and underwent polyfunctional sleep monitoring before treatment and at least 3 months after completing a series of balloon pulmonary angioplasties or pulmonary thromboendarterectomy.

Results. After surgical treatment, patients with CTEPH maintained a high prevalence of sleep apnea/hypopnea (83.8%) and nocturnal hypoxemia (74.4%), despite a significant decrease in mean pulmonary artery pressure – mPAP (p < 0.0001) and pulmonary vascular resistance – PVR (p < 0.0001). The baseline percentage of total sleep time with saturation below 90% (T90) was significantly associated with postoperative mPAP (p = 0.0289), PVR (p = 0.0050), and the six-minute walk test distance – 6MWD (p = 0.0305). A preoperative T90 > 11.0% showed 85.7% sensitivity in predicting the achievement of the target 6MWD (p = 0.0130) after treatment.

Conclusion. A high prevalence of sleep-disordered breathing in patients with CTEPH persists despite effective pathogenetic treatment of the underlying disease. Nocturnal hypoxemia may be considered a predictor for prescribing timely respiratory support and pulmonary arterial hypertension-specific therapy.

In this review, we discuss the underexplored issue of the relationship between metabolic syndrome (MS) and respiratory diseases. The review discusses the main pathogenic mechanisms, including chronic low-grade inflammation, oxidative stress, endothelial dysfunction, and mechanical restriction of lung volumes. The concept of pulmonometabolic syndrome is introduced. Data of the results of studies of the functional parameters of the lungs in MS are presented. We describe the clinical and pathobiological characteristics of the mutually aggravating interaction between MS and respiratory disorders, such as chronic obstructive pulmonary disease, bronchial asthma, obstructive sleep apnea, lung cancer, and pulmonary hypertension.

The article provides a description and history of the creation of the room-museum of F.P. Haass in the village of Tishkovo near Moscow.