Aim: Investigation of the peculiarities of different haloaerosoltherapy regimes influence (treatment with different intensity of haloaerosol load) upon non-specific defense and cellular immunity at convalescents after community acquired pneumonia.Objectives: patients with community acquired pneumonia in the early convalescence period (after completing antibiotic therapy), who received treatment in conditions of artificial rock salt aerosol medium (haloaerosoltherapy).Material and Methods. 42 patients with non-severe community acquired pneumonia were examined in the early convalescence period before and after the course of haloaerosoltherapy, which was prescribed after antibacterial therapy. Immunological studies included: evaluation of phagocytic activity of neutrophils (PhAN -the percentage of phagocytic neutrophils), phagocytic number (PhN -average number of latex particles absorbed by a neutrophil); metabolism of neutrophils in the test with nitroblue tetrasolium (NBT-test) spontaneous and induced, which allowed to assess the functional reserve of neutrophils (FR); calculation of cytochemical coefficient (CCC) for lysosomal cationic proteins (LCP) and for myeloperoxidase (MPO) of neutrophils; number of T-and B-lymphocytes and their subpopulations (CD3 + -, CD4 + -, CD8 + -, CD22 + -lymphocytes), calculation the number of 0-lymphocytes and the ratio of CD4 + /CD8 + lymphocytes. Laboratory examinations were also conducted in 21 practically healthy individuals (control group).Two regimes of haloaerosoltherapy were used in recovery treatment of patients with community acquired pneumonia: treating complex №1 (TC-1) with standard haloaerosol load and with increased haloaerosol load (TC-2).Results. After completion the antibiotic therapy at patients with community acquired pneumonia the moderate inhibition of phagocytic activity of neutrophils (47,6±0,58% to 55,5±1,14% in control group) remained and was accompanied with a decrease in neutrophil bactericidal capacity, mainly oxygen-dependent. However, the disturbances of cellular immunity was observed which manifested by reduced number of T-lymphocytes, mainly on account of Thelper cells and decrease of the CD4 + /CD8 + ratio and was accompanied by the elevation of 0-lymphocytes percentage.Under the influence of recovery treatment on the base of haloerosoltherapy usage the positive dynamics of studied parameters was observed and it was more expressed when using treatment procedures with increased haloaerosol load. Conclusions.1. The patients with non-severe community acquired pneumonia have moderate disturbances of neutrophils phagocytosis, associated with secondary T-cell dysfunction, which are accompanied with the increasing in the number of undifferentiated 0-lymphocytes and B lymphocytes, which remained after of completing of antibiotic therapy. These changes determine the necessity of recovery treatment in this stage of the disease.2. Haloaerosoltherapy usage in the recovery treatment of convalescents after community acquired pneumonia improves the func...

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Today, chronic obstructive pulmonary disease is considered as a multifactorial disease with systemic extrapulmonary manifestations and a high level of comorbidity. Differentiation of the polymorbidity and comorbidity concepts for patients with this pathology is very important. The common trigger factors and/or pathogenetic mechanisms lay in the basis of comorbid conditions, and their progression is comparable in time with the underlying disease. This determines the necessity for appropriate integrated management of such patients. The presence of other diseases that are not related to the main pathological process through common causative factors and/or pathogenetic mechanisms should be regarded as concomitant and lying in the basis for polymorbidity. The domestic and foreign scientific literature data on the mechanisms of potential comorbid pathology in this group of patients have been summarized. Information concerning the leading role of oxidative stress and systemic inflammatory process of low intensity in the development of comorbidity in chronic obstructive pulmonary disease is presented. The mechanisms of their influence, relationship, discussion questions and actual data on genetic and molecular mechanisms of development of these pathological processes are highlighted. Special attention is paid to the metabolic processes that develop as a result of oxidative stress and systemic inflammation. In particular, it has been shown that systemic inflammation leads to the development of insulin resistance, diabetes and other metabolic disorders. Data is outlined, supporting rationale for stratification of the metabolic profiles or phenotypes, as well as the pathogenetic significance of endotoxemia. Endothelial dysfunction and associated diseases of the cardiovascular system are also the consequences of oxidative stress and systemic inflammation. The analysis has been performed for the peculiarities of the manifestations of some of them in this group of patients.

The second part of the review examines in detail the questions of diagnostics and peculiarities of the metabolic syndrome manifestations, which presents the link between most comorbid conditions at patients with chronic obstructive pulmonary disease. The metabolic syndrome is based on the insulin resistance and compensatory hyperinsulinemia, caused by both chronic low‑intensity inflammation and increased adipose tissue, often against the background of aggravated heredity at diabetes mellitus. The authors elucidate aspects of the effects of obesity, cachexia and some endocrine disorders on the disease course. The deficiency of researches on endocrine status, especially thyroid function and related metabolic disorders was emphasized. Possible pathogenetic mechanisms of osteoporosis development in this contingent of patients are considered. The need for further research of the pathogenetic role of vitamin D is discussed. Data on the role of the functional state of kidneys in the development of metabolic disorders in an organism have been presented, though kidney pathology in patients with chronic obstructive pulmonary disease is not currently considered as a comorbid condition. The contradictory literature data on the development of anemia in these patients were analysed. The authors presented data on the development of oncological processes as a systemic manifestation at COPD and performed analysis of common and mutually aggravating mechanisms of the development of these pathological conditions. Attention has been paid to the relationship between gastroesophageal reflux disease, bronchiectasis and obstructive sleep apnea with chronic obstructive pulmonary disease. The prospects of modern genetic research in chronic obstructive pulmonary disease and comorbid conditions have been determined.

Rehabilitation programs for patients with COPD are based on physical exercises usage, but accounting low tolerance to physical activity, this is not always a real task. The aim is to study the effect of haloaerosoltherapy (HAT) and complex rehabilitation treatment based on it on functional recovery of COPD patients. Materials and methods: 133 patients with COPD (GOLD II-III) beyond acute period were examined. Bronchial obstruction, intensity of clinical manifestations, disturbances of cardiovascular system were investigated. The 6-minute walk test was conducted. Results: Before treatment, it has been shown that exercise tolerance significantly depended on severity of bronchial obstruction, intensity of clinical manifestations and degree of cardiovascular risk. Treatment was carried out according to three treatment complexes (TC). TC-1 was based on HAT usage with certain concentration and dispersion of aerosol, 18-20 seances per course. In TC-2, singlet oxygen therapy was included, in TC-3 mineral water was administered as drinking use and inhalation. After course of treatment, walking distance covered in 6 minutes has been increased in patients of all groups. When using complex treatment, these changes were more pronounced. Con-clusions: HAT with appropriate dispersion and concentration of haloaerosol promotes in-creasing tolerance to physical activity and may be used as a stage of physical rehabilitation with possible subsequent therapeutic physical exercises. Notably pronounced positive dy-namics of studied data was noted in COPD patients convalescents after COVID-19. Key words: COPD, physical rehabilitation, haloaerosoltherapy, COVID-19 convalescents.