The phenotype of asthma and obesity is an urgent problem of modern medicine. A number of studies have shown that obesity increases the risk of developing asthma by 1.4 – 2.6 times. It has been found that asthma in obese people is often associated with a larger number of symptoms, more pronounced impairment of pulmonary function, and a high need for inhaled drugs. Weight loss provides health benefits against many comorbidities such as obesity, but diet, exercise, and even pharmacologically induced weight loss are associated with poor long­term effectiveness. Bariatric surgery is a promising intervention for weight loss and long­term control of obesity­related comorbidities, including asthma. The purpose of this work is to summarize data on the effect of bariatric surgery on the course of asthma. Results. Available data support the effectiveness of bariatric methods in the treatment of asthma with morbid obesity: weight loss has a beneficial effect on asthma, its control and reduces the use of emergency medications, asthma exacerbations, hospitalizations, and also leads to improved quality of life and functional lung tests. The mechanisms that explain the improvement and sometimes remission of asthma after bariatric surgery are likely multifactorial. At the same time, it should be noted that the reported results of bariatric surgery in patients with asthma mostly come from observational studies, which have many limitations, including small numbers of patients, lack of clear endpoints, lack of standardization of diagnosis, classification and evaluation of asthma treatment results. Most studies do not specify the severity of asthma, and in those that do, most patients had mild or moderate asthma. It remains unclear whether the effect differs depending on the phenotype of the obese asthmatic patient. Also, at present, there is practically no data on differences in the effectiveness and safety of the method of surgical intervention used in patients with asthma. Conclusion. Bariatric techniques should be considered a treatment option in morbidly obese patients with severe asthma after the previous failure of medical, dietary, physical, and psychotherapeutic treatments.

Cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) are hereditary lung diseases. Cystic fibrosis is a monogenic disease, while PCD has a genetically heterogeneous nature and is 2 times less common than CF. More than 50 genes are responsible for PCD, one of them being the DNAAF11 gene (LRRC6 according to the previous nomenclature) – the assembly factor of the external and internal dynein arms. When the mutation is present, components of the dynein arms remain in the cytoplasm of cells. The aim is to present a clinical case of a newly diagnosed PCD in a 44-year-old woman with a homozygous pathogenic variant of the nucleotide sequence NM_012472.6:c.436G>C in the DNAAF11 gene. This clinical case demonstrates the complexity of verification and differential diagnosis of cystic fibrosis and primary ciliary dyskinesia, the features of the disease, and the modern diagnostic capabilities. The difficulties and some typical mistakes in the management of such patients are presented. Conclusion. The presented clinical case illustrates the difficulties of PCD diagnosis. It demonstrates that such patients need a comprehensive examination for a thorough differential diagnosis to exclude diseases with a similar clinical picture. The long-term follow-up is carried out by a multidisciplinary team of specialists and must include microbiological monitoring.

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unclear etiology that belongs to interstitial lung diseases and is characterized by a triad of symptoms: hemoptysis, iron deficiency anemia, and diffuse interstitial changes on computed tomography (CT) of the chest cavity. IPH can occur at any age, but the disease develops in childhood in 80% of cases, more often before 10 years of age. A significant proportion of pulmonary hemosiderosis cases in this age group remain undiagnosed. The purpose of the study is to demonstrate a clinical case illustrating the features of differential diagnosis and therapy of IPH during the COVID-19 pandemic. Conclusion. An 8-year-old girl was diagnosed with IPH based on fever, shortness of breath, weakness, and severe iron-deficient anemia. The chest CT scan revealed diffuse interstitial ground-glass opacity in lungs. The lung biopsy revealed hemosiderin deposits and hemosiderophages in the alveolar lumens. Treatment with systemic glucocorticoids (SGC) and azathioprine was effective. The patient was followed for 3 years.