Vol 12, No 3 (2026)

A key innovation of the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) in 2026 became the concept of “COPD activity”. Increasing of disease activity leads to disease progression, and assessing this parameter requires searching for specific biomarkers.

The aim: to evaluate the value of 8-isoprostane and melatonin as biomarkers of COPD activity.

Material and methods. One hundred patients in the acute phase of COPD (69 males and 31 female, clinical group E, mean age 60.5 [52.5; 68.5] years) were examined. Changes in salivary melatonin and serum 8-isoprostane levels were assessed. A correlation analysis was made between these biomarkers and the clinical and functional parameters of patients, including the frequency of hospitalizations after one year.

Results. A direct correlation was established between salivary melatonin levels and forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), and peak expiratory flow rate (PEF), and an inverse correlation was found with the modified mMRC score. Serum 8-isoprostane levels were inversely correlated with the six-minute walk test results and spirometry parameters – FVC, FEV₁, and peak expiratory flow rate 25, 50, and 75% (MOC₂₅, MOC₅₀, and MOC₇₅). A direct correlation was found between 8-isoprostane concentrations and CAT and mMRC scores. By day 10, a decrease in 8-isoprostane levels and an increase in melatonin levels were observed. These results indicate the oxidant properties of 8-isoprostane and the antioxidant activity of melatonin. After one year of follow-up, statistically significant associations were found between the levels of these biomarkers and the frequency of hospitalizations.

Conclusion. The obtained data confirm that 8-isoprostane and melatonin may serve as promising biomarkers for monitoring COPD activity.

The relevance of this study is due to the lack of characteristic of elderly patients with bronchial asthma (BA) taking into account comorbidity in real-time medical practice.

The aim: to characterize patients over 65 years of age with BA in a real-time clinical settings.

Material and methods. A multicenter, cross-sectional, retrospective cohort study was performed. It involved 565 patients with BA, who were divided into two age groups: Group 1 (main group) – patients over 65 years of age (n = 423), Group 2 (comparison group) – patients aged 45–65 years (n = 142). The analysis included a review of outpatient records, medical history, assessment of the Charlson Comorbidity Index, determination of asthma control, and a study of pharmacotherapy.

Results. The study revealed significant differences in the clinical course of BA across different age groups. Patients over 65 years of age were found to have higher comorbidity (Charlson index 4.09 ± 1.40 vs. 1.75 ± 1.49 in the 45–65 age group), later disease onset (age at diagnosis 57.95 ± 14.2 vs. 44.78 ± 11.35 years), and higher doses of inhaled glucocorticosteroids (598.29 vs. 494.91 mcg/day). Cluster analysis of 565 patients revealed significant characteristic peculiarities of elderly patients with BA.

Conclusion. The study demonstrates the need for a differentiated approach to the management of patients with bronchial asthma in different age groups. The identified differences in BA clinical course require special attention to elderly patients, taking into account the higher comorbidity and later disease diagnosis in this group.

Six-minute walk test (SMWT) is a simple and informative method for assessing functional status of patients with cardiovascular diseases. However, SMWT has certain limitations in performance, necessitating the search for a simple and easily reproducible alternative. The one-minute sit-to-stand test (1STST) is proposed to be as such kind of the test.

The aim: to compare the results of SMWT and 1STST performed in patients with myocardial infarction in anamnesis (MI).

Material and methods. The cross-sectional, observational, prospective study included 61 patient with a history of MI and dyspnea on exertion. In addition to a general clinical examination, all participants underwent SMWT and 1STST.

Results. Average number of meters walked in the SMT was 485.69 ± 103.13 m, and the average number of repeats in 1STST was 20.50 (17.00–24.00). A direct correlation was found between the results of the exercise tests: fewer meters walked in SMWT were expected to be associated with fewer repeats in 1STST (r = 0.616, p < 0.001). A comparison of the TSS and 1STST results revealed direct correlations between heart rate, Borg scale scores, oxygen saturation (SpO₂) levels at the end of the tests, ΔSpO₂, and Δ Borg scale scores. An inverse correlation was found between SMWT and 1STST results and age, as well as direct correlations between test results and arm strength. The “Physical health” quality of life index was inversely associated with Δ Borg scale scores during the SMWT and 1STST and the scores on this scale at the end of the tests.

Conclusion. SMWT and 1STST methodics are comparable in their informativeness for assessing functional status in patients with previous myocardial infarction. 1STST can be proposed as a quick and easy alternative to the SMWT test.

Low treatment adherence is a pressing issue that significantly impacts the life quality (LQ) of multimorbid patients.

The aim: to assess LQ and treatment adherence in elderly outpatients with chronic heart failure (CHF).

Material and methods. The study included 90 outpatients – 32 male and 58 female individuals (median age 74 [67; 84] years). They were divided into two groups based on the presence of CHF: patients with this condition (n = 53) and those without it (n = 37). Additional analysis was made in the age subgroups 60–74 and ≥ 75 years. Various scales and questionnaires were used for clinical estimation of patients, and the Short Form-36 (SF-36) questionnaire was used to assess LQ. Treatment adherence was determined using the National Society for Evidence-Based Pharmacotherapy (NSEBP) scale.

Results. Participants with CHF showed a more pronounced decrease in LQ indexes comparatively to patients without CHF. The most significant differences were found in SF-36 questionnaire scales reflecting the physical component of health, the total index of which was lower in the CHF group across all age subgroups. That indicates the leading role of functional limitations in the decline of LQ in this patient category (p < 0.05). Logistic regression analysis revealed that deterioration in functional mobility, assessed by the time it takes to complete the “Get-up and Go” test, was associated with a reduced probability of full adherence to medication therapy (odds ratio 0.795; 95% confidence interval: 0.647–0.976; p = 0.029).

Conclusion. Elderly and senile patients with CHF have a more pronounced decline in LQ parameters comparatively to patients without CHF, primarily due to physical functioning deterioration. CHF is also associated with a higher prevalence of geriatric disorders and reduced functional mobility. The obtained data indicate a possible role of functional limitations in the formation of treatment adherence and highlight the need for a comprehensive assessment of geriatric factors in the management of older patients having CHF.

Impact of sarcoidosis on the course and outcome of pregnancy is often a difficult question for physicians, but it has been found that reproductive function is rarely impaired by this disease. Current article presents a review of recent literature, which presents compelling arguments in favor of the mutually beneficial effects of pregnancy and sarcoidosis, based on data on immune status and the balance of female sex hormones. Epidemiological data and clinical cases from various countries are analyzed. An analysis of relevant scientific sources allows us to conclude that the risk to the fetus in a pregnant female patient with sarcoidosis exists only in cases of severe organ failure and the use of teratogenic drugs.

Acute mitral valve insufficiency is a common condition encountered by physicians of various specialties, including cardiologists, therapists, rheumatologists, and cardiac surgeons. The underlying causes of the disease are varied, and the severity of the condition, caused by the development of acute left ventricular failure, requires early diagnosis and urgent care, including surgical intervention. Current article presents a clinical case of myxomatous degeneration of the mitral valve leaflets in a 41-year-old patient, complicated by chordal rupture with the development of acute mitral regurgitation, which resulted in death.

Dry (non-productive) cough is one of the most common reasons for seeking medical care. Undoubtedly, to eliminate cough syndrome, it is first and foremost necessary to directly address its etiology. However, in some cases, the cause remains unclear for a long time, or an excruciating dry cough causes significant discomfort to the patient. It is worth noting that in most cases, a dry cough resolves on its own, without the need for antitussive medications. The main indications for antitussive therapy include pneumothorax, postoperative period, pertussis, a nagging cough that significantly worsens the patient's condition, and preparation for bronchoscopy performing. The most effective and safe antitussive medications currently used in clinical practice are levodropropizine, prenoxdiazine, and butamirate.

Small airway involvement (SAI) is a clinically important yet often underestimated component of bronchial asthma and chronic obstructive pulmonary disease (COPD). In this review, SAI is considered both as small airways disease, associated with structural and morphological changes in the bronchioles, and as small airway dysfunction, manifested by peripheral airflow obstruction, ventilation heterogeneity, premature expiratory airway closure, air trapping, and dynamic hyperinflation. A mismatch between symptom burden and standard spirometric indices is frequently related to small airway dysfunction, which is only partly captured by FEV1. The review summarizes current concepts of small airway pathophysiology in asthma and COPD, outlines a diagnostic approach using functional tests and imaging modalities, and substantiates therapeutic strategies that take drug deposition in the peripheral bronchial tree into account. The role of comorbidities and practical aspects of patient management in primary care are addressed separately.

Exacerbations of chronic obstructive pulmonary disease (COPD) lead to a rapid decline in lung function, health deterioration, hospitalization, and increased disease-related mortality. Use of mucoactive agents as a part of combination therapy can reduce the frequency of COPD exacerbations. This article systematizes published data on the safety and clinical efficacy of erdosteine as an additional remedy to standard COPD therapy. Erdosteine is an orally administered mucoactive drug with antioxidant and anti-inflammatory properties. Its use reduces the adhesion of pathogenic bacteria and increases the efficacy of antibacterial drugs. An important peculiarity of erdosteine is its potential use both as a preventative therapy for COPD exacerbations and as a modifier of exacerbation symptoms. During COPD exacerbations, adjunctive use of this drug is accompanied by rapid relief of clinical manifestations and a shortened acute phase of the disease. Long-term use of erdosteine in patients with COPD has demonstrated its superior efficacy and safety comparatively to other mucolytics, with a reduction in exacerbation frequency and an increase in the time to first exacerbation. These aspects are highly actual for the combination therapy of COPD patients in terms of the prevention of exacerbations and their treatment.

The significance of upper respiratory tract infections, due to their high frequency and the risk of severe course and complications, determines high demands to the efficacy and safety of antibiotics prescribed for acute tonsillopharyngitis and acute sinusitis. For many years, aminopenicillins and macrolides were the main medications of their treatment. While the first ones are still remaining the drugs of choice, the fact of steadily increasing resistance of S. pneumoniae and S. pyogenes to macrolides and the near-total resistance to them of H. influenzae necessitate the search for additional options for empirical antibiotic therapy for these conditions. Third-generation cephalosporins, including cefixime, offer a viable alternative to the above mentioned drugs. Cefixime is characterized by high activity against the main pathogens that cause upper respiratory tract infections, including β-lactamase-resistant strains of H. influenzae. Administration of cefixime as dispersible tablets improves efficacy, tolerability, convenience, and adherence to therapy. An additional benefit of this drug is its suitability for use during pregnancy.