Determination of markers of systemic inflammation is one of the important directions in the study of pathogenesis and improvement of diagnosis of chronic obstructive pulmonary disease (COPD), asthma-COPD overlap (ACO), and bronchial asthma (BA). The aim of our work was a comparative study of the features of changes in serum levels of IL-17, IL-18, and TNF-α in patients with COPD, ACO, and BA with various severity of the disease, as well as evaluation of the relationship between the level of these cytokines and lung ventilation function. A total of 147 patients with COPD (n=58), ACO (n=57), and BA (n=32) during a stable period have been examined in this study. The control group included 21 healthy nonsmokers with similar sex-age indicators. Serum levels of IL-17, IL-18, and TNF-α were determined by ELISA. The concentrations of these cytokines in the circulation in the studied patients with COPD, ACO, and BA were higher than those in healthy nonsmokers (p≤0.001). IL-17 and IL-18 levels in the blood serum were comparable in all examined patients. The mean TNF-α concentrations in the circulation in COPD and ACO were significantly higher than those in BA (p<0.001). In patients with COPD, the levels of IL-17 and TNF-α increased progressively against the background of a decrease in numerous spirometric indicators, which allows us to consider these cytokines as systemic biomarkers of disease severity. In BA, the inverse correlations between the level of IL-17 and FEV1/FVC (%) and FEV1 have been found. In patients with ACO, the increase in IL-18 levels was associated with a decrease in FEV1 and TNF-α with FEV1/FVC (%). These findings indicate that IL-17, IL-18, and TNF-α can participate in the mechanisms of systemic inflammation and the genesis of disorders of airway obstruction in COPD, AСO, and BA. An increase in the levels of IL-17 and TNF-α may be associated with impaired bronchial patency in COPD and BA. The established associations of the IL-18 concentration in the blood serum and FEV1 only in patients with ACO allow using the level of IL-18 as a potential marker of the degree of impaired airway obstruction in this disease.

Bronchial asthma (BA) is often associated with chronic inflammatory processes in the nasal mucosa; these processes give rise to allergic rhinitis, chronic rhinosinusitis, adenoiditis, and polypous rhinosinusitis. Due to their multiple symptoms, these diseases of the upper respiratory tract, especially allergic rhinitis, are often difficult to verify in patients with asthma. The aim of the study was to evaluate the diagnostic potential of endonasal IR thermometry in BA patients suspected of allergic rhinitis. Materials and Methods. Fifty children diagnosed with both BA and allergic rhinitis and 15 healthy children, matched by gender and age, participated in the study. The endonasal temperature determined with contactless IR thermometry was confronted with the symptoms of allergic rhinitis and sinusitis assessed with the TNSS and SNOT-20 questionnaires. The results were compared with the severity of nasal obstruction as determined through the anterior active rhinomanometry. Results. The nasal temperature in patients with asthma and allergic rhinitis was 33.77 [33.37; 34.17]°С, which was significantly lower than that in the group of healthy children (34.98 [34.57; 35.39]°С; p=0.0006); the body temperature did not differ between the groups (36.55 [36.45; 36.65] and 36.58 [36.40; 36.76]°С, respectively; p=0.5). We found a negative correlation between the values of nasal temperature and the sinusitis symptom scores in patients with BA and allergic rhinitis (R=-0.32; p=0.02). Conclusion. Patients with both BA and allergic rhinitis showed a decreased endonasal temperature in comparison with healthy children; the endonasal temperature can serve an indicator of allergic inflammation of the nasal mucosa.

The aim of the study was to define cardiac biomarkers in patients with isolated and combined chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF), to assess their level and diagnostic value in order to optimize the tactics of managing these patients. Materials and Methods. The study included 184 patients aged 38-85 years who were divided into 3 comparison groups: group 1 (n=68) was composed of patients with I-III stage COPD (GOLD, 2017); group 2 (n=64) patients with I-III functional class CHF; group 3 (n=52) patients with a combined course of COPD and CHF. Specific cardiac biomarkers were evaluated in 80 patients (in group 1 in 26, in group 2 in 27, and in group 3 in 27 patients). Patients' blood serum obtained by centrifuging was used for cardiac biomarker investigations. Results. NT-proBNP (F=0.59; p=0.0490) was found to be the most sensitive biomarker for determining the severity degree of the heart damage in the combined course of COPD and CHF. ST2 biomarker reliably reflects the severity of the isolated CHF (F=0.76; p=0.0285), while in the combined course of COPD and CHF, the value of this marker decreases (F=0.76; p=0.4718). A direct correlation has been established between the level of cardiac biomarker NT-proBNP and CHF functional class both in the isolated and combined course of COPD and CHF. In patients highly adherent to therapy, statistically significant reduction in the values of ST2 (F=3.22; p=0.0453) and NT-proBNP (F=12.20; p=0.0000) is observed which enables the physicians to control patient adherence to the administered therapy. The levels of biomarkers have been established at which a high risk of COPD progressing to one step or higher and/or CHF to one functional class and higher is noted in comorbid COPD and CHF course. Conclusion. The obtained data about the diagnostic value of cardiac biomarkers in comorbid course of COPD and CHF is reasonable to use for therapy optimization in order to improve the quality of patient's life and decrease the risk of unfavorable outcomes.

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