The article was submitted 30.10.2025; approved after reviewing 18.01.2026; accepted for publication 02.02.2026
Modern medicine is faced with an increasing number of patients suffering from multiple chronic diseases simultaneously. The presence of two or more conditions increases the complexity of diagnosis, appropriate treatment selection, and patient care. People with a combination of several chronic non-communicable diseases are more likely to face disability, restrictions in daily activities, and a reduced quality of life. The prevalence of cardiovascular diseases and diseases of the bronchopulmonary system remains high. In addition, they often have common risk factors and pathogenetic interactions. This article examines the problem of the combination of bronchial asthma and hypertension from the perspective of common risk factors and pathophysiological relationships.

Review is focused on modern approaches to diagnosis and treatment of asthma exacerbations as events of high socio-economic importance. Principles of management of patients with asthma exacerbations of different severity based on actual international and national recommendations are discussed.

Bronchial asthma is a heterogeneous disease with multiple phenotypes that differ in functional characteristics and pathophysiological mechanisms. This paper presents a critical analysis of the relationships between pulmonary function parameters and various clinical phenotypes of asthma. Functional patterns of allergic and non-allergic variants, early-onset and late-onset asthma, eosinophilic and neutrophilic phenotypes are reviewed. It is shown that allergic asthma is characterized by intermittent disturbances with good reversibility, while late-onset asthma demonstrates accelerated decline in lung function and tendency toward remodeling. Particular attention is paid to the role of small airways in disease pathogenesis and the need for specialized methods to assess their function. The significance of inflammatory biomarkers for accurate phenotyping and selection of personalized therapy is discussed. It is emphasized that integration of functional parameters with clinical and molecular data allows optimization of diagnosis, monitoring and treatment of bronchial asthma.

Since the mid-1970s, Gleb Borisovich Fedoseev has played a key role in the development of allergy and immunology services in Leningrad–Saint Petersburg, with a particular focus on the diagnosis and treatment of inborn errors of immunity (IEI), as well as on the training of physicians of various specialties. Inborn errors of immunity represent a heterogeneous group of genetic diseases associated with increased susceptibility to infections, as well as autoimmune, autoinflammatory, and lymphoproliferative manifestations. Despite their rarity as individual nosological entities, the overall prevalence of IEI is comparable to that of other orphan diseases, while the real frequency is likely higher due to underdiagnosis and clinical polymorphism.
The modern understanding of IEI has shifted from predominantly humoral defects to disorders of immune regulation associated with dysfunction of signaling pathways, regulatory T cells, apoptosis, and tolerance mechanisms. This results in a wide spectrum of clinical phenotypes and complicates early diagnosis. Comprehensive diagnostic algorithms using molecular genetic and functional immunological methods, including high-throughput sequencing and immune repertoire analysis, are therefore of paramount importance.
Treatment of IEI includes immunoglobulin replacement therapy, hematopoietic stem cell transplantation, and the use of targeted drugs aimed at correcting specific pathogenetic mechanisms.
In Saint Petersburg, a specialized center has been established at the Saint-Petersburg Pasteur Institute, providing diagnostics, treatment, long-term follow-up, maintenance of patient registry, and educational activities. The development of registries, technologies, and interdisciplinary cooperation forms the basis for further improvement of care for patients with IEI..

The aim of the study was to evaluate the possibility of reducing doses of systemic glucocorticosteroids in patients with severe bronchial asthma receiving standard stage V therapy in combination with genetically engineered biological therapy.
Methods and materials. An open observational, single-center prospective study was conducted in the conditions of the pulmonary allergy center of the KKB Krasnoyarsk, which included 66 patients with severe bronchial asthma. Among the studied patients, women were found in 75% (46 people), men in 25% (17 people) of cases; the average age was 55 [48; 62] years, the duration of the disease was 21 [14.5; 34] years, and the age of onset corresponded to 34 [30.5; 50] years. The duration of treatment with the immunobiological drug Dupilumab was 4 years in 6 (9%) patients, 3 years in 13 (20%) patients, 28 (42%) patients received genetically engineered biological therapy for 2 years, and 19 (29%) patients had an allergic phenotype of asthma for 12 months. 49 (74%) patients, non-allergic phenotype was determined in 17 (26%) patients.
Results. At the time of the appointment of genetically engineered therapy, all patients had daily ASTHMA symptoms, which ensured a regular need for CDBA. Clinical symptoms were objectified by the AST and ACQ-5 tests, the results of which also confirmed the absence of AD control (Median ACQ-5 – 3 points, AST-test – 15 points). After 12 months of additional therapy, the number of seizures and the need for short-term medications decreased (p<0.005). When studying the functional parameters, a significant increase in the FEV1 index and the FEV1/FVC ratio was noted against the background of 12 months of Dupilumab therapy, it is worth noting that the increase in FEV1 was 390 ml. When assessing the volume of basic therapy, it was determined that all respondents received high-dose ICS/DDBA therapy. Additional therapy with Tiotropium bromide was detected in 34% of patients, and antileukotriene drugs were used in 21% of patients. 12 people registered regular intake of SGCS. Against the background of immunobiological therapy with Dupilumab, it was possible to reduce the volume of basic therapy: DDAX to 14% and antileukotriene drugs to 14%. Complete withdrawal from the use of OCS was achieved in 9 patients. After 12 months of therapy, 3 patients took 2.5 mg of prednisone daily.

Sarcoidosis (S) is a systemic inflammatory disease of unknown etiology characterized by the formation of noncaseating granulomas, multisystemic organ involvement, and T-cell activation at the site of granulomatous inflammation with the release of various chemokines and cytokines. In Russia, a large team of specialists in various fields has developed clinical guidelines. Primary diagnosis of S. requires comprehensive laboratory and instrumental studies, including imaging diagnostics, and treatment is recommended only in cases of disease progression and a life-threatening course. Symptoms of S. vary widely, from acute to asymptomatic. Spontaneous remissions occur in up to 70% of cases, but fibrosis may develop in 10-15%. Dangerous variants of S. include cardiac sarcoidosis, sarcoidosis of the nervous system, and sarcoidosis of the eyes. In stable cases, long-term use of alpha-tocopherol and pentoxifylline is possible. Systemic glucocorticosteroids are considered first-line treatment for progressive sarcoidosis, with a starting dose of at least 20 mg per day and a duration of at least 10- 12 months. However, this therapy is more often associated with relapses, and low doses and short courses more often lead to subsequent fibrosis. Second-line treatments include methotrexate, but also leflunomide, azathioprine, mycophenolate, and cyclophosphamide. Third-line treatments include adalimumab and infliximab, but they themselves can cause sarcoid reactions. In refractory and recurrent cases, efferent therapies are used. The authors invite readers to discuss the updated version of clinical guidelines, available on the website of the Russian Respiratory Society to continue working on them.

Bronchiolitis obliterans syndrome (BOS) is a rare non-infectious bronchopulmonary complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with an unfavorable prognosis. This article presents a case of effective BOS treatment after allo-HSCT with therapeutic response achievement in a short time.

Introduction. Adequate pain management in cancer patients remains a serious challenge. Long-term and uncontrolled use of NSAIDs is associated with a high risk of complications, while the use of opioids is often limited by their adverse effects, particularly constipation, and the potential risk of diversion. Combination drugs such as Bupraxon (buprenorphine + naloxone) represent a promising alternative.
Objective. To present to the medical community the initial clinical experience with the domestic combined drug Bupraxon for sublingual administration in cancer patients with chronic pain syndrome (CPS).
Methods and materials. This paper presents the results of a post-marketing observational study involving 22 cancer patients with CPS, as well as two detailed clinical case reports. The analgesic efficacy, time to onset and duration of action, tolerability, and safety of the drug were assessed in a real-world clinical setting.
Results. Bupraxon was shown to provide effective control of moderate to severe intensity pain. The onset of action was observed within 30–45 minutes, and the duration of analgesia was 4–8 hours. For 12 out of 22 patients, an effective dose was titrated within 2–3 days. The drug was well-tolerated, with no significant gastrointestinal adverse events (specifically, no constipation) and no withdrawal syndrome following short-term use. The combination with naloxone enhances narcological safety by reducing the risk of abuse.
Conclusions. Bupraxon is an effective and safe option for the management of CPS in cancer patients, particularly in those at risk of bowel obstruction. Its non-invasive form, controllable analgesia, and favorable safety profile make it a promising alternative to other opioid analgesics. Further comparative studies are required for a comprehensive assessment of the drug's potential.

On September 4, 2025, Gleb Borisovich Fedoseev – a distinguished Soviet and Russian pulmonologist, allergologist, founder of the scientific school for the study of bronchial asthma, Corresponding Member of the Russian Academy of Sciences, and Honored Scientist of the Russian Federation, would have turned 95 years old. His life was inextricably linked with the First Pavlov Leningrad  Institute (St. Petersburg State Medical University), where he rose from student to head of department, leaving behind a cohort of disciples and fundamental research in the field of respiratory medicine. His bright memory will forever remain in the hearts of his students, colleagues, and patients.