COMPARATIVE RISK-ORIENTED INTEGRATED ASSESSMENT OF LUNG HEALTH STATUS IN PREVENTIVE PLANNING OF REHABILITATION TREATMENT PROGRAMS IN A SANATORIUM
Authors: E.D. Mokin , N.A. Mokina 
Published: March 2022

Introduction. COPD is a heterogeneous disease, the variability and diversity of which depends on a combination of genetics and risk factors. At present, during the period of the deciphered human genome, an earlier assessment of the prognostic risk of the development of cochlea in young people is needed to understand the possibilities of establishing reversible lung lesions.
Aim as a part of preventive phenotyping in young people; substantiate the importance of a comparative risk-oriented complex epigenetic and genetic assessment of the lung health status for predictive assessment of the risk of developing COPD.
Materials and methods. In this cohort study, 293 young people (11-23 years old) took part, including 142 male and 151 female, who were divided into four groups. 1st group - 132 conditionally healthy non-smokers (51 male and 81 female), 2nd - 54 conditionally healthy smokers (39 male and 15 female), 3rd - 86 non-smokers, with chronic lung diseases (52 persons – chronical tracheobronchitis; 43 persons – bronchial asthma), 4th - 21 smokers with chronic lung diseases (HRTB - 12 persons, BA - 9 persons). To assess the differences in epigenetic and genetic criteria, methods such as spirometry, gas analysis, electronic auscultation, digital acoustic analysis of respiratory work, analysis of gene polymorphisms for the alpha1-antitrypsin-SERPINA-1 complex in venous blood serum were used. We have developed a computer program, taking into account the risk factors for the prognostic development of COPD in a cohort of smoking and non-smoking young people aged 11-23 years with or without a diagnosis of chronic lung disease.
Results. Among the most reliable, informative, sensitive and specific phenotyping indicators in assessing the prognostic degree of COPD risk in adolescents: cough, sputum production, ARI frequency per year, smoking index, electronic auscultation data, FEV1%, FVC%, FEV1 / FVC%, CO, O2, AAT, SERPINA. These criteria made up the characteristics of risk phenotypes, which allows the subjects to be graded according to groups (phenotypes) of the prognostic risk of COPD - low, moderate, high or extremely high, depending on the scale of criterion values. In young people in the context of predictive preventive personalized medicine. This made it possible to draw up an algorithm for assessing risk groups and a computer program based on this algorithm, which makes it possible to determine the phenotypes of COPD risk in young people.
Conclusion: Starting from adolescence, it is possible to record the initial functional disorders of the respiratory status in combination with genetic polymorphisms, which confirms the need for preventive screening for the primary identification of risk groups and the formation of preventive programs in young people. The developed algorithm and computer program make it possible to determine the prognostic risk of COPD in young people - from low to moderate, high and extremely high, in terms of the implementation of the concept of 3P (personalized, preventive, and predictive) medicine.