Gastroesophageal reflux disease (GERD) is a common chronic disease leading to a spontaneous and regular retrograde flow of gastric and/or duodenal contents into the esophagus. Reflux of the gastric contents into the oral cavity refers to the extraesophageal presentation of the disease, which, in the absence of timely treatment, can result in erosion of dental hard tissue (EDHT) through repeated exposure of the dental tissue to acidic contents. EDHT are non-carious lesions of the dental hard tissues (mainly enamel, and in some cases dentin), induced by a chemical reaction involving acids, which results in demineralization processes. The incidence rates of EDHT in adult patients with GERD are 32.5–51.5%. The EDHT in GERD develops in stages. Initially, the gradual degradation of tooth pelicula happens when it gradually becomes decayed by repeated acidic attacks. The loss of the pelicula results in direct contact of hydrochloric acid refluxate with the enamel surface and initiation of its demineralization at pH < 5.5 with dissolution of hydroxyapatite crystals. Given the high prevalence of GERD in the population, it seems important to update an integrated approach to the treatment of such patients, which involves pharmacotherapy provided by the gastroenterologist, as well as prevention and minimally invasive treatment of presentations in the oral cavity by the dentist. Patients with EDHT due to GERD need to maintain individual oral hygiene (use mouth washes with a neutral pH level, avoid abrasive toothpastes), use remineralization therapy at home applying remogels (Tooth Mousse), and also be observed by a dentist as part of the follow-up care. Minimally invasive treatment by the dentist involves restorations using composite tooth filling materials and ceramic veneers. It is reasonable to empirically use proton pump inhibitors twice a day for 3 months for the direct treatment of GERD in patients with EDHT.

Introdiction . The article highlights the importance of optimizing the treatment of chronic heart failure (CHF) in patients with comorbid cardiopulmonary pathology, namely ischemic heart disease (CHD) in combination with chronic obstructive pulmonary disease (COPD). The results of our own research on the evaluation of the clinical efficacy of trimetazidine inclusion in the complex therapy of comorbid pathology are presented. Objective . To study the clinical efficacy of trimetazidine as part of the complex therapy of patients with ischemic heart failure in combination with COPD. Materials and methods . 60 patients with CHF II-III FC, left ventricular ejection fraction (LVEF) <45% were studied against the background of postinfarction cardiosclerosis and COPD of 2–3 degrees of airflow restriction. The patients were divided into 2 groups: 1st (30 patients) took trimetazidine; 2nd (30 patients) received therapy without the addition of trimetazidine. The dynamics of: clinical condition with the use of SHOCK, FC CHF, test with 6-min. walking, quality of life (MLHFQ, SGRQ), indicators of 24-bifunctional monitoring, TTE, spirometry, platelet aggregation and blood viscosity. Results and conclusion . The use of trimetazidine as part of therapy led to an improvement in the clinical course of the disease, significantly increased exercise tolerance. The number and duration of ischemia episodes decreased by 34 and 39% (p < 0.05). The number of angina attacks per week and the need for nitroglycerin decreased by 65% and 42% (p < 0.05), respectively. There was an improvement in intracardiac and peripheral hemodynamics. Thus, LV LV increased by 21%, pulmonary artery pressure decreased by 18%, the indicators of LVD, platelet aggregation and blood rheology improved. There was a more positive dynamics of lipid peroxidation and antioxidant system indicators compared to the control group.

Acotiamide is a prokinetic with a novel mechanism of action an antagonist of muscarinic M1 and M2 receptors and an acetylcholinesterase inhibitor. Acetylcholine is the central mediator of the tone of the muscular components of the gastrointestinal tract, increasing its motor activity. Blockade of presynaptic M1 and M2 receptors neutralizes the inhibitory effect of the feedback mechanism on the acetylcholine synthesis, while inhibition of acetylcholinesterase in the synaptic cleft reduces the acetylcholine degradation. Currently, the clinical efficacy of acotiamide in the population of patients with functional dyspepsia is demonstrated in more than 10 clinical studies in different regions of the world, demonstrating a reduction of the symptoms of the disease during treatment with this agent and an improvement in the quality of life of patients. In addition, the combination of acotiamide with proton pump inhibitors optimizes the management of patients with gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is one of the most widespread gastrointestinal pathologies and the most common reason for seeking medical care at the level of a primary link of public health services in many countries around the world. The classic clinical presentations of GERD are heartburn, belching, and regurgitation (spitting up), but the overall spectrum of GERD symptoms is broader and more heterogeneous in scope, including extraesophageal symptoms. Clinical and/or endoscopic refractoriness of some patients to the standard proton pump inhibitors (PPIs) therapy remains a global challenge in the management of patients with GERD at the current stage of clinical medicine development. A medicinal product of a fundamentally new class was developed to optimize the treatment of patients with GERD – an esophageal mucosal protectant, which consists of a fixed combination of hyaluronic acid and chondroitin sulfate dissolved in a bioadhesive carrier (polymerase 407). This review is primarily aimed at systematizing data on the efficacy of the esophageal mucosal protectant in the treatment of patients with GERD. The systematic review that summarized the results of 10 studies involving 1090 patients with GERD showed that adding this esophageal mucosal protectant to the PPI therapy increased the efficacy of GERD therapy, as well as improved the frequency of symptomatic, endoscopic and morphological response to the treatment. Such combination therapy contributes to the optimization of the treatment of patients with various disease phenotypes, regress of both esophageal and extraesophageal symptoms, and potentiation of repair of the esophageal mucosa. To increase the efficacy of treatment and improve the prognosis of the disease, this approach should be implemented at the early stages of therapy in real clinical practice.

Currently, functional dyspepsia (FD) and irritable bowel syndrome (IBS) are among the most common nosological units in the structure of functional gastrointestinal diseases in adults. An important problem of treatment of these diseases at the current stage of medicine is low efficiency of monotarget drugs, which is determined by multicomponent pathogenesis. Indeed, the currently available methods of drug treatment of FD and IBS have suboptimal efficacy, as illustrated by recent meta-analyses demonstrating high rates of NNT (the average number of patients who need to be treated to achieve a certain favorable outcome). In addition, the frequent “overlap” of these diseases forces clinicians to prescribe several drugs with different pharmacological actions to the patient, which inevitably leads to a decrease in compliance. The optimal strategy for managing patients with FD and IBS is the tactics of multitarget drugs that act on several links in the pathogenesis of these pathologies and have a significant evidence base in the effectiveness and safety of use. STW 5 (Iberogast®), included in the clinical guidelines of the Russian Gastroenterological Association on the diagnosis and treatment of patients with FD, published in 2017, has the above-mentioned characteristics, as well as the clinical guidelines of the Russian Gastroenterological Association in collaboration with the Russian Association of Coloproctologists on the diagnosis and treatment of IBS, published in 2021. The clinical effectiveness of Iberogast in the treatment of FD and IBS has been demonstrated in a number of randomized trials, the results of which showed high efficacy of the drug and its good tolerability.

Proton pump inhibitors (PPIs) are baseline drugs for induction and maintenance of remission in gastroesophageal reflux disease (GERD). PPIs have proven to be highly effective in healing esophageal mucosal lesions and relieving the symptoms of the disease in most cases. However, according to the literature data, the incidence rate of clinical ineffectiveness of PPIs in the form of partial or complete persistence of current symptoms during administration of standard doses of PPIs ranges from 10 to 40%. Optimization of GERD therapy in PPI refractory patients is a significant challenge. In most cases, experts advise to increase a dose / dosage frequency of PPIs, switch to CYP2C19-independent PPIs (rabeprazole, esomeprazole, dexlansoprazole), add an esophagoprotective or promotility agents to therapy. At the same time, these recommendations have a limited effect in some patients, which opens up opportunities for looking for new solutions related to the optimization of GERD therapy. Today there is growing evidence of the relevance of the role of disruption of the cytoprotective and barrier properties of the esophageal mucosa in the genesis of GERD and the formation of refractoriness. Intercellular contacts ensure the integrity of the barrier function of the esophageal mucosa to protect it from various exogenous intraluminal substances with detergent properties. Acid-peptic attack in patients with GERD leads to alteration of the expression of some tight junction proteins in epithelial cells of the esophageal mucosa. The latter leads to increased mucosal permeability, which facilitates the penetration of hydrogen ions and other substances into the submucosal layer, where they stimulate the terminals of nerve fibers playing a role in the induction and persistence of the symptoms of the disease. The above evidence brought up to date the effectiveness study of the cytoprotective drugs with tropism to the gastrointestinal tract, as part of the combination therapy of GERD.

Aim. The goal is to evaluate the effectiveness of pancreatic enzyme replacement therapy (PERT) using microencapsulated pancreatin preparations for the correction of nutritional status in patients with chronic pancreatitis (CP) and associated exocrine pancreatic insufficiency (EPI). Materials and methods. The study included 58 patients with CP who were divided into two groups depending on the results of a laboratory assessment of indicators of nutritional status: group I (n=30) consisted of patients with CP and signs of EPI (according to low elastase test values) without deviations in nutritional status; Group II (n=28) consisted of patients with CP with a EPI and an abnormal nutritional status. In both groups, patients during the entire observation period (8-12 months) received PERT using microencapsulated pancreatin preparations at a dose adjusted for the severity of permanent residence permit. Before and after the PERT course, the dynamics of anthropometric [body weight, body mass index (BMI)] and laboratory indicators of nutritional status (total protein, albumin, vitamins D and B12, transferrin, iron and magnesium) were evaluated. Results. After the completion of PERT, a significant tendency towards an increase in BMI in patients was noted in both groups. In group I, this indicator increased from 21.45 [95% confidence interval (CI) 19.80-23.92] kg/m2 to 22.15 (95% CI 20.31-23.86) kg/m2, and in II group - from 19.22 (95% CI 18.33-21.99) kg/m2 to 22.0 (95% CI 19.97-24.08) kg/m2. At the same time, the duration of PERT (months) significantly correlated with the dynamics of the patient’s body weight (r=0.4679; 95% CI 0.2384-0.6479, p=0.0002). When assessing laboratory markers of nutritional status after PERT, a general tendency was found to increase the levels of total protein, albumin, vitamin D, magnesium, transferrin, and iron in both groups, however, statistically significant differences in the dynamics were observed mainly in group II patients. So, the level of total protein in group II increased from 69.05 (95% CI 65.6717-70.9000) g/l to 72.8 (95% CI 71.1358-74.9000) g/l, vitamin D - from 10.6 (95% CI 32.8397-38.9603) ng/ml to 17.1 (95% CI 12.0166-23.6232) ng/ml, magnesium - from 0.72 ( 95% CI 0.6892-0.7825) mmol/L to 0.795 (95% CI 0.7692-0.8800) mmol/L, and transferrin from 2.91 (95% CI 2.1800-3.3656 ) g/l to 2.92 (95% CI 2.4000-3.5200) g/l. Conclusion. A prospective observational study demonstrated the effectiveness of PERT using microencapsulated pancreatin preparations in the correction of nutritional status in patients with CP.

AIMDetermine the primary antibiotic resistance of Helicobacter pylori (H. pylori) strains isolated from patients living in the European part of the Russian Federation.MATERIALS AND METHODSAs part of a clinical laboratory study, from 2015 to 2018, 27 gastrobiopsy samples obtained from H. pylori-infected patients were analyzed. H. pylori infection was verified using a rapid urease test or a 13C-urea breath test. The values of the minimum inhibitory concentration (MIC) of antibiotics were determined by the diffusion method using E-test strips (BioMerieux, France) according to the recommendations of the manufacturer. The sensitivity of the isolates was determined for 6 antibacterial drugs (amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, rifampicin).RESULTSAccording to the data obtained, resistance to amoxicillin was 0%, clarithromycin 11.1%, metronidazole 59.3%, levofloxacin 3.7%, tetracycline 0%, and rifampicin 14.8%. Dual resistance to clarithromycin and metronidazole was recorded in two isolates (7.4%).CONCLUSIONThus, the first results of the evaluation of H. pylori antibiotic resistance in the European part of the Russian Federation indicate a low resistance of the microorganism to clarithromycin and quite high to metronidazole.

AIM:Evaluation of the efficacy and safety of quadrupletherapy without bismuth (concomitant therapy) in patients with Helicobacter pylori - associated gastric ulcer and duodenal ulcer in the framework of a comparative research in the population of patients in Russia.MATERIALS AND METHODS:A prospective randomized trial was conducted, which included 210 patients with H. pylori - associated gastric/duodenal ulcer without complications. During the process of randomization, the patients were divided into three equal groups (n=70) depending on the prescribed 10-day scheme of eradication therapy (ET): the first group received the classic triple scheme (Omeprazole 20 mg 2 times a day, Amoxicillin 1000 mg 2 times a day and Clarithromycin 500 mg 2 times a day); the second group received quadruple therapy with bismuth drugs (Omeprazole 20 mg 2 times a day, Tetracycline 500 mg 4 times a day, Metronidazole 500 mg 3 times a day, Bismuth subcitrate potassium 120 mg 4 times a day); the third group received quadruple therapy without bismuth - concomitant therapy (Omeprazole 20 mg 2 times a day, Amoxicillin 1000 mg 2 times a day, Clarithromycin 500 mg 2 times a day and Metronidazole 500 mg 2 times a day). Diagnostics of H. pylori infection during screening and control of eradication was carried out via the fast urease biopsy sample test and urea breath test system. Control of the effectiveness of ET of the microorganism was carried out not earlier than 4 weeks after the end of the treatment. During the course of therapy, the frequency of development of side effects was assessed using a special questionnaire.RESULTS AND DISCUSSION:The effectiveness of triple therapy was 72.8% (ITT; 95% CI of 62.17-83.54) and 78,4% (PP; 95% CI 68.19-88.72); quadruple therapy with the preparation of bismuth - 80.0% (ITT; 95% CI 70.39-89.6) and 84,8% (PP; 95% CI, 75.96-93.73); quadruple therapy without bismuth - concomitant therapy - 84.2% (ITT; 95% CI 75.54-93.02) and 92.1% (PP; 95% CI 85.43-98.94). Quadruple therapy without bismuth was reliably more effective than the classical triple therapy in the PP selection (p=0.044883). Statistical analysis showed a tendency to poorer effectiveness of ET in patients who had previously used antibiotic therapy (OR 0.4317; 95% CI 0.1776-1.049), and in individuals with a rapid metabolism genotype - CYP2C19*1/*1 (OR 0.12; 95% CI 0.005848-2.4624). The frequency of development of side effects during the use of triple therapy was 18.5% (95% CI of 9.23-27.91), when using quadruple therapy with bismuth - 20.0% (95% CI 10.39-29.6), and with the use of quadruple therapy without bismuth - concomitant therapy - 24.2% (95% CI 13.98-34.58).CONCLUSION:This prospective randomized study demonstrated the high efficiency of quadruple therapy without bismuth (concomitant therapy) in the framework of eradication of H. pylori infection in Russia.

Despite a significant amount of works specifying immune mechanisms of bronchial asthma (BA), different phenotypes observed in this pathology need to be studied. The aim of present study was to analyze functional activity of Th1, Th2 и Th17 lymphocytes, and to determine features of inflammation in controlled and partly controlled asthma.We examined eighty-four BA patients that were divided into 2 groups, depending on the control of symptoms and the clinical course of BA. Group I included 45 patients with controlled BA, whereas group II included 39 patients with partially controlled asthma. The subsets of Th1, Th2, and Th17 lymphocytes were assessed by serum cytokine levels (TNFα, IFNγ, IL-2, IL-4, IL-6, IL-10, IL-17A) using flow cytometry technique.The results of this study were as follows: we have shown a combined T-helper (Th) immune response in asthma patients, with its origin depending on the degree of the disease control. Th2 (62%), Th1/Th2 (20%) and Th1 (18%) types of immune response have been detected in the patients with controlled BA. Th2/Th17 (49%), Th1/Th17 (13%) and Th17 (37%) types of immune response have been identified in the patients with partially controlled BA. It has been shown, that Th1 immune response in patients with controlled asthma is induced by intracellular infection. The formation of the Th1/Th2 phenotype is associated with a site of chronic bacterial infection revealed, and with persistence of viral infection in the body. This phenotype can be used as an indicator of asthma worsening. Further studies in the role of prevalent immune response type in the development of partially controlled BA have shown that activation of Th17 lymphocytes is associated with prolonged course of the disease. Irrespectively of initial phenotype, the development of Th17-dependent immune response seems to result from a durable systemic persistent inflammation.The views on the key role of Th1/Th2 balance in the development of asthma are accomplished by evidence of Th17 lymphocyte involvement into the process, and Th1/Th17, Th2/Th17 phenotypes seem to be the polar features of the disease. Estimation of intensity and phenotype of inflammation in BA will permit a more objective evaluation of the therapy applied, and to choose further management strategies.

The study was carried out using sampling of 74 patients (20 males and 54 females) aged from 48 to 75 years (average age 61.5±7.4 years) with diabetes mellitus type II. The analysis was applied to anthropometric parameters, lipid metabolism condition, level of highly sensitive C-reactive protein, tumor necrosis factor-α depending on degree of compensation of carbohydrate metabolism-level of glycosylated hemoglobin (HbA1c). In patients with diabetes mellitus type II with worse compensation of carbohydrate metabolism (HbA1c>7,5%) their body mass, waist circumference, body mass index occurred higher than in patients with HbA1c≤7,5%. The level of highly sensitive C-reactive protein corresponding to risk of development of cardio-vascular diseases was established in 97% of patients and increased level of tumor necrosis factor-α was established in 66% of patients independently of indices of glycemia. The patients were divided in 2 groups. The group I included 50 patients whose treatment was supplemented with mimetic of glucagon-like peptide Exenatid in the mode of double subcutaneous injections in dosage of 5 mkg 2 t per day during a month and then 10 mkg 2t per day during 5 months. The control group included 20 patients receiving a standard sugar-decreasing therapy. The initially analyzed indices had no statistically reliable differences in both groups. In patients of both groups a reliable decreasing of HbA1c was established in 6 months. Only in patients of group I statistically reliable amelioration of lipid specter, decreasing of body mass, waist circumference and level of markers of non-specific inflammation: highly sensitive C-reactive protein and tumor necrosis factor-α.

Aim. To investigate the composition of plasma fatty acids (FA) and red blood cells and the level of eicosanoids in patients with metabolic syndrome (MS) and to assess whether metabolic disturbances may be corrected during a cycle use of an ω-3 polyunsaturated fatty acid (PUFA). Subjects and methods. Examinations were made in 46 patients, including Group 1 (a control group) of 15 persons without MS components; Group 2 of 31 patients with MS, Group 3 of 16 MS patients who had taken an ω-3 PUFA for 6 months, and Group 4 of 15 MS patients who had received the drug for 12 months. The composition of plasma FA and red blood cells was analyzed on a gas-liquid chromatograph. An enzyme immunoassay was used to measure the serum levels of tumor necrosis factor-α (TNF-α) and eicosanoids (thromboxane B2, 6-keto-prostaglandin F1α, leukotriene B4). A biologically active additive from the king crab (Paralithodes camtschatica) hepatopancreas was used as a source of ω-3 PUFA. Results. Having a higher proportion of linoleic and α-linolenic acids in the plasma, the patients were found to have decreased levels of ω-3 and ω-6 PUFAs (linoleic and α-linolenic, arachidonic, and eicosapentaenoic acids) and a larger proportion of Mead acid and saturated FAs (myristic and stearic acids) in the red blood cells, suggesting that that cellular blood FA transfer was impaired and FAs were absorbed by cells. Their serum samples showed the high levels of leukotriene B4, 6-keto-prostaglandin F1α, and thromboxane A2. The long-term (6- and 12-month) use of ω-3 PUFA from the king crab hepatopancreas had a positive impact in modifying the lipid FA composition of red blood cells and in eliminating deficiencies of physiologically important ω-3 and ω-6 PUFAs in the blood cells. Conclusion. The findings suggest that FAs and their metabolites play an important role in the pathogenesis of MS and that dietary ω-3 PUFA should be incorporated into a package of preventive and therapeutic measures for MS.

We studied cytokine profiles relevant to the Th1 and Th17 modes of immune response in 116 patients with mild, moderate and severe chronic obstructive pulmonary disease (COPD). Relative contents of Th1- and Th17-type lymphocytes were evaluated by serum levels of specific cytokines: TNFα, IL-6, IL-10,IL-17A, IL-21, IFNγ, TGF-β1. We found that the shift in balance of pro- and anti-inflammatory cytokines is typical to both Th1 and Th17 immune response types in COPD of different severity. The variety of immune response types was achieved due to activation of different effector cells. I.e., the Th1 response was associated with macrophage activation and IFNγ induction, whereas domination of Th17 response was accompanied by activation of neutrophils, and increased synthesis of IL-17, IL-21. The Th17 type of immune response was shown to prevail in severe COPD. Thus, the certain types of immune disorders in COPD presume application of combined therapy including immunocorrective drugs which are able to suppress inflammation and correct the cytokine imbalances.

We examined composition of plasma non-esterified fatty acids (NFAs), erythrocyte fatty acids, levels of eicosanoids in patients with asthma and chronic obstructive pulmonary disease (COPD) with different type of the inflammatory response. The results of our study show that asthma and COPD in remission are associated with changes in the composition NFAs of plasma, FA of erythrocytes, level eicosanoid despite the difference in the regulation of immunological mechanisms of systemic inflammation. These changes are characterized by excessive production of arachidonic acid (20:4n-6) and cyclooxygenase and lipoxygenase metabolites (thromboxane B2, leukotriene B4) and deficiency of their functional antagonist, eicosapentaenoic acid (20:5n-3). The recognized association between altered fatty acid composition and disorders of the immune mechanisms of regulation of systemic inflammation in COPD and asthma demonstrated the important role of fatty acids and their metabolites in persistence of inflammatory processes in diseases of the respiratory system in the condition of remission.

Abstract. We studied cytokine profile in blood and exhaled breath condensate (EBC) in patients with chronic obstructive pulmonary disease (COPD) being in remission state. It is shown that pro- and anti-inflammatory cytokine contents depended on the disease severity, both in whole blood and EBC of the COPD patients. We have revealed an increase in TNFα, s-TNFα RI, TGF-β1 and bFGF in EBC of patients with COPD manifestations, thus being indicative for progression of metabolic changes in lung tissue, and advanced stage of respiratory functional disturbances. Cytokine profile abnormalities in COPD patients resulting, in part, from systemic and local disorders of cellular immunity, represent a major pathogenetic mechanism determining the disease progression.

Abstract. Expression of endocannabinoid receptors (СВ1, СВ2) in immunocompetent cells was studied under the conditions of in vivo stimulation of immune system. Intracorporeal blood irradiation and enrichment of peripheral blood by ozone/oxygen mixture were used to stimulate immune system. It was revealed that normal amounts of mononuclear leukocytes (MLs) expressing a differentiating surface antigen for СВ2 receptor exceeded 90%. We have not detected MLs with a differentiating antigen to СВ1 receptor. In vivo stimulation of immune system caused a suppressed endocannabinoid СВ2 receptor expression on ML surface. The data provide a direct proof for involvement of endocannabinoid system in immune response regulation.

Abstract. It was found that development of lipid disorders in rats is accompanied by increased levels of tumor necrosis factor alpha (TNFα) in blood and liver, decreased cytokine regulation index, thus suggesting arising inflammatory reaction at the organ and systemic levels, exhaustion of functional reserve and diminished response of immunocompetent cells. Intensity of TNFα secretion depends on the duration of emerging alimentary dyslipidemia in rats, i.e., maximal amounts of TNFα in blood and liver were detected at day 30 of evolving dyslipidemia. At 90th and 180th day after starting the alimentary load, a gradual inhibition of cytokineproducing ability by immune cells is observed. In the course of evolving alimentary dyslipidemia, the patterns of intra-and intersystemic interactions are altered towards increased correlations between lipid transport and immune markers, as well as higher intercorrelations between the parameters of blood lipid metabolism and proinflammatory cytokine levels in the liver. (Med. Immunol., 2011, vol. 13, N 1, pp 61-66)

The article presents results of study of membrane potential of mitochondria of thrombocytes in patients with chronic obstructive disease of lungs. The index of membrane potential of mitochondria reflects both disorders of oxygen consumption by blood cells and development of hypoxia. At the same time, index denotes formation and progression of bronchopulmonary pathology. The direct relationship is established between the degree of bronchial patency and condition of mitochondrial apparatus of cell. The lower bronchial patency is the lesser index of membrane potential of mitochondria is. This dependence testifies lesion of mitochondrion and development of mitochondrial dysfunction. Therefore, the established pattern can be taken into account in the process of development of medical technologies of prognostic of disorders of bronchial patency under diseases of respiratory organs.

The aim of this study was investigation of cellular and humoral immunity and of systemic inflammation in patients with COPD + asthma phenotype. Methods . The study involved 115 patients (60 males) including 44 patients with stable COPD stage I–II, 39 patients with mild controlled or partially controlled asthma and 12 patients with COPD + asthma phenotype. Twenty healthy nonsmokers were included as controls. Results. Immune disorders in patients with COPD + asthma phenotype included increased numbers of T - helpers, cytotoxic T - lymphocytes and B - lymphocytes and increased IgE level. Increased serum concentrations of TNF - α and IL - 4 and decreased IFN - γ concentration were also found in these patients. Conclusion. Th2 - type of the immune response was observed in patients with COPD + asthma phenotype; these findings could underlie persistent inflammation.