The paper presents theoretical substantiation of findings with achievement of the solution of a scientific problem of the modern medical science, namely formulation of the concept of formation of early complications, their diagnosis and prevention in the comorbid course of asthma, diabetes mellitus type 2 and obesity. The solution of the above task was based on the study of endothelial dysfunctions, systemic inflammation, chemokines and indices of the cellular and humoral components of the immune system, thereby making it possible to reveal predictors of the formation of pulmonary-renal disorders. In order to solve the above tasks, 252 patients with asthma (As) were examined, of them there were 105 cases combined with diabetes mellitus type 2 (DM2) and 85 patients with obesity (Ob); 62 cases with an isolated course of As comprised the comparison group. The control group consisted of 21 apparently healthy volunteers, in whom As, DM2T and Ob were excluded on the basis of a complex of clinical and instrumental examinations. Mechanisms of realization of pulmonary-renal disorders in patients having moderate As combined with DM2 and Ob as regards clinical and immunological changes, endothelial dysfunction, systemic inflammation and disturbances in the functional state of the lungs and kidneys with the resultant development of fibroplastic changes in the lungs and tubulointerstitial changes in the kidneys were revealed. Patients with moderate As developed renal damages in 15.4% of cases, the rate of renal involvement increasing up to 36.8% when combined with Ob and up to 63.56% in combination with DM2. A relationship between progression of bronchial obstruction and reduction of glomerular filtration rate was proved. Endothelial dysfunction and its influence on the mechanisms of realization of pulmonary-renal changes in patients with the comorbidity were revealed. The necessity of determination of systemic inflammation markers - fractalkine, matrix methylproteinase-9, monocyte chemoattractant protein-1 - in the progression of a pathological process in patients with the comorbidity was substantiated. The study of the role of an imbalance of cytokines IL-8 and IL-12, associated with determination of the way of realization of hypersensitivity by the direct or indirect type, was continued. The combined course of As with comorbidity of DM2 and Ob was shown to be accompanied by changes in indices of specific and nonspecific immunity. This fact manifested itself by changes in immunoglobulins, circulating immune complexes, inhibition of CD3, CD4, CD16 and CD22, reduction of the immunoregulatory index and increase of the total count of antibodies against lymphocytes, thereby demonstrating formation of secondary immunodeficiency. Risk coefficients of As progression were developed according to regression equations for patients with As in combination with obesity (K risk 1) and for patients with BA in combination with DM2 (K risk 2). On the basis of the obtained results, a diagnostic and therapeutic strategy was developed, whose main objective consists in correction of causes of absence of control in patients having As combined with DM2. For the above purpose, arginine and tiotropium bromide against a background of the basic therapy were suggested and made it possible to control signs of the disease and clinical remission as well as to achieve reliably more marked positive dynamics in indices of systemic inflammation, endothelial function and pulmonary-renal disorders, thereby significantly improving prognosis in this category of patients.
