Background: Asthma is a chronic inflammatory disease characterized by bronchoconstriction and breathing difficulties, which can be triggered by both allergic and non-allergic mechanisms. In allergic asthma, a hyperreactivity reaction occurs, leading to an increase in fractional exhaled nitric oxide (FeNO) levels. Therefore, FeNO is used to differentiate allergic and non-allergic types of asthma. In recent years, studies have been conducted to assess FeNO as an indicator of treatment effectiveness and symptom control. Our goal is to introduce FeNO measurement in Mongolia for the first time and utilize it for asthma diagnosis and treatment outcome evaluation. Aim: Study of FeNO levels in Asthma Diagnosis in Relation to Laboratory Findings and Lung Function Materials and Methods: This study included a total of 70 adult patients (18 years and older) with asthma who visited the Outpatient Clinic of Mongolia-Japan Hospital and Shargaljuut Spa Clinic from May to December 2024. Based on their allergic history, total IgE levels, and peripheral blood eosinophil count, participants were classified into allergic (>5%) and non-allergic (<5%) asthma. The study aimed to determine the diagnostic specificity and sensitivity of FeNO levels. Asthma control levels were assessed using the Asthma Control Test (ACT), lung function was evaluated using spirometry, and exercise capacity was measured with the 6-minute walk test. Results: In a single measurement, there were no differences between the allergic and non-allergic groups in parameters other than total IgE, peripheral blood eosinophil count, and FeNO levels. For diagnosing the allergic form of asthma, at a FeNO level of 25 ppb, sensitivity (Se) was 0.68, specificity (Sp) was 0.30 (p=0.008); at 40 ppb, Se was 0.77, Sp was 0.31 (p=0.001); and at 50 ppb, Se was 0.74, Sp was 0.33 (p=0.001). Lung function and exercise capacity were similar in both asthma groups. Conclusion The sensitivity of FeNO in distinguishing between allergic and non-allergic forms of asthma is 67-81%, and its sensitivity tends to increase as the FeNO level rises. By distinguishing the allergic type in which inhaled corticosteroids are more effective, the outcome of asthma treatment can be predicted in advance based on the FeNO level.

Background: Asthma management should be individualized, evidence-based, aimed at controlling clinical symptoms, preventing severe exacerbations, and improving quality of life. Studies have shown that inhalation therapy with iodine- bromide saltwater improves lung function in chronic obstructive pulmonary disease (COPD), while radon-containing mineral water inhalation reduces inflammation and oxidative stress in asthma. Several studies have analyzed the composition of the Shargaljuut hot spring, with Oyuntsesteg et al. identifying high levels of Na+-HCO3 - and Na+-SO4. Other studies on mineral water therapies have reported benefits such as thinning bronchial secretions, improving sputum clearance, reducing inflammation and acidity, mitigating oxidative stress, and enhancing quality of life. Aim: To study the effectiveness of combined asthma treatment with inhaled corticosteroids and hot spring inhalation. Materials and Methods: The study included 67 participants diagnosed with asthma who consented to participate and underwent 10 days of combined inhaled corticosteroid therapy and mineral water inhalation at Shargaljuut sanatorium. A total of 57 participants completed the pre- and post-treatment assessments. Treatment result was assessed using Asthma control questionnaire 7, asthma symptom control with Asthma Control Test (ACT), and exercise tolerance by a 6-minute walk test. Chest X-rays were taken for all participants to rule out pneumonia, cancer, or pulmonary fibrosis. Treatment outcomes were evaluated using ACT scores, peripheral blood eosinophil count, total IgE levels in serum, spirometry indices (FEV1, FVC, FEV1/FVC), and the 6-minute walk distance. Results: The average age of participants was 52±12 years, with a predominance of females. The mean asthma control score was 14.2±4.80, indicating poor asthma control. After 10 days of inhaling corticosteroids combined with hot spring inhalation post-treatment quality of life increased by 0.5 points, FEV1 improved by 7.5%, FVC by 4.2%, peripheral blood eosinophil count decreased by 0.3%, and total Ig E levels dropped from 73.3 (22.5; 216) to 73.2 (21.3; 223) u/ml (p=0.000). Conclusion In cases of uncontrolled asthma remission, combining of inhaled corticosteroid therapy with hot spring inhalation at Shargaljuut improved asthma symptoms, quality of life, enhanced lung function, and reduced inflammatory markers (p<0.001).

Background: Pneumonia caused by COVID-19 tends to be more severe in middle-aged and elderly individuals, often leading to decreased pulmonary ventilation function and negatively impacting quality of life post-recovery. However, studies on this topic are limited in Mongolia. Aim: To evaluate pulmonary ventilation function and exercise tolerance in middle-aged and elderly individuals after COVID-19 pneumonia. Materials and Methods: A hospital-based case-control study was conducted from June 2022 to December 2023 at Gurvan Gal United Hospital and the First Central Hospital of Mongolia. The study group included 65 individuals aged 50- 69 who had recovered from COVID-19 pneumonia, while the control group consisted of 65 age-matched individuals who had not contracted the infection. Participants underwent a questionnaire, spirometry, and a 6-minute walk test (6MWT) to assess lung function and exercise tolerance. Results: A total of 123 participants were included in the study. The study group showed a significant reduction in FEV1 (P=0.015). compared to the control group. However, no statistically significant differences were observed in FVC or the 6MWT results between the two groups (P=0.464). Symptoms such as chest pain, cough, fatigue, and insomnia were significantly more common in the study group than in the control group (P<0.0001). Conclusion Individuals aged 50-69 who had COVID-19 pneumonia exhibited prolonged symptoms such as persistent cough, chest pain, nasal congestion, sore throat, fatigue, and sleep disturbances at a significantly higher rate compared to the control group (P<0.0001). Pulmonary ventilation function showed a mild decline, with FEV1% being lower than in the control group (P=0.015). Additionally, pulmonary fibrosis was significantly more prevalent among the post-COVID-19 group compared to the control group (P=0.026).

Background: Asthma is a chronic airway disease, and its prevention involves avoiding risk factors and ensuring proper inhaler techniques to reduce the risk of exacerbation. Aim: To determine the results of refresher training in health education for the control of bronchial asthma. Materials and Methods: A total of 56 asthma patients’ asthma who visited the outpatient department of the Mongolian Japanese Hospital were enrolled in an educational program aimed at improving asthma knowledge. Three months later, 26 of them were re-evaluated, and a comparison was made of their asthma knowledge, quality of life, and pulmonary function. The occupational status was divided into two groups: those working in offices and those working in factories and construction sites. Education was divided into two groups: those with bachelor, less bachelor. The usage levels of relievers and corticosteroids were divided into two groups: reliever usage was 3 canisters up or down per year, while systemic corticosteroid usage was 10 ampules up or down per year. Ethical approval for the study was obtained in accordance with the approval of the Bioethics Committee of the School of Medicine, Mongolian National University of Medical Sciences (approval number: 2019.06.05), and written consent was obtained from the participants. The data analyses are processed using Excel and SPSS 26 software. Results: According to the asthma control test scores, the improvement in control after the training increased from 8% to 12%, and the percentage of those with poor control improved from 15% to 23%. After the training, 27% (7) of participants showed improvement from their baseline control level, 8% (2) showed a decline, and the rest showed no change. Among the participants, 30.8% (n=8) used bronchodilators with a frequency of more than 3 canisters per year, while 46.2% (n=12) used dexamethasone more than 10 ampules per year. Multivariable analysis showed that age had an odds ratio (OR) of 1.1 (95% CI 0.2-8.10), education had an OR of 1.7 (95% CI 0.2-15.8), occupation had an OR of 1.2 (95% CI 0.1-10.9), bronchodilator use had an OR of 3.6 (95% CI 0.3-45.8), and dexamethasone usage had an OR of 2.1 (95% CI 0.3-15.7), all of which were identified as risk factors. Conclusion As a result of the short-term asthma education program, quality of life and lung function improved, and the level of control increased. This suggests that continuous education should be implemented.

Background: In December 2019, SARS-CoV-2 spread rapidly worldwide, leading the World Health Organization (WHO) to declare it a pandemic in March 2020. COVID-19 is an infectious disease with symptoms similar to the flu, varying in severity from mild to critical. Post-COVID-19 syndrome refers to the persistence of certain symptoms after recovery from the acute infection. The most common symptoms, such as fatigue, shortness of breath, coughing, and headaches, negatively affect patients’ daily lives. Aim: To investigate the clinical manifestations of post-COVID-19 syndrome concerning the severity of the initial infection. Materials and Methods: A hospital-based cross-sectional study was conducted between 2022 and 2023 at the Pulmonology and Allergy Center of the National Center for Health. In this study, we included participants who came for follow-up one year after being diagnosed with COVID-19. The severity of COVID-19 was categorized according to Living guidance for clinical management of COVID-19 issued by WHO and the COVID-19 diagnostic and treatment guidelines approved by the Minister of Health (A/549). Post-COVID-19 conditions were assessed using the 6-minute walk test, Borg rating of perceived exertion, and Fatigue Severity Scale (FSS). The Chi-square and Mann-Whitney U tests used on SPSS 26.0, with a p-value of <0.05 considered statistically significant. This study was approved by the Research Ethics Committee of the Mongolian National University of Medical Science (2022/03-06). Results: A total of 185 participants were included, comprising 74 men (40%) and 111 women (60%), with a mean age of 57.15±11.29 years. Among them, 90 (48.6%) had severe COVID-19, while 95 (51.4%) had non-severe cases. Clinical symptoms, including cough, dyspnea, fatigue, headache, and myalgia, were statistically different between the non-severe and severe groups. The median FSS score was 45 in the severe group and 38 in the non-severe group, showing a statistically significant difference (p<0.05). The median of 6-minute walking distance was 265 meters in the severe group and 282 meters in the non-severe group (p<0.05). The median Borg score was 2 in the severe group compared to 1 in the non-severe group (p<0.05). Conclusion Individuals who experienced severe COVID-19 exhibited reduced exercise tolerance, increased breathlessness, and more pronounced fatigue than those with non-severe cases.

Background: Systemic sclerosis-related interstitial lung disease (ILD) is a major cause of mortality among patients with systemic sclerosis. During this disease, when the forced vital capacity (FVC) is <50% on spirometry, the prognosis is considered poor. Although early changes in systemic sclerosis-related ILD can be identified by chest computed tomography (CT), evaluating the spirometry test is essential for monitoring further follow-up and assessing treatment outcomes. This study aimed to highlight the importance of considering the role of the spirometry test among patients with systemic sclerosis. Materials and Methods: We conducted this study using a cross-sectional research design based at a single-center hospital. The study included 40 patients diagnosed with systemic sclerosis who were attending the rheumatology outpatient clinic at the Mongolia-Japan Hospital. The inclusion criteria were patients diagnosed with systemic sclerosis who had undergone chest imaging (chest x-ray, chest CT scan) and spirometry tests. Results: In our study, in 62.5% of patients diagnosed with systemic sclerosis, a chest CT scan revealed abnormalities indicative of SSc-ILD. There were statistically significant differences (p<0.05) in certain parameters of spirometry between the two groups (normal chest CT, abnormal chest CT). The group with abnormal chest CT had a higher usage of mycophenolate mofetil (p<0.05). A negative correlation was found between changes on chest CT scan and FVC (r= -.453, p<0.05). However, no statistically significant correlation was observed between FVC and disease duration or comorbidities. Conclusion Using spirometry to assess pulmonary function in patients with systemic sclerosis-related interstitial lung disease may be an appropriate method for evaluating the progression of the disease and detecting complications.

Background: Interleukin-33 (IL-33) cytokine plays a crucial role in asthma pathogenesis. Recent studies have established that IL-33 activity was increased in serum, airway smooth muscle and epithelial cells from patients with asthma and this increase positively correlates with asthma severity. We hypothesized that several genetic variations that contributing IL-33 expression and activity, which may risk factor for susceptibility to asthma. In this study, we examined the association between rs16924159 single nucleotide polymorphism (SNP) of IL-33 gene and asthma susceptibility. Methods: 51 asthma patients and 54 healthy volunteers were involved in this case-control study. Blood sample was collected for genomic DNA extraction. rs16924159 SNP genotyping was performed by the allele specific-polymerase chain reaction (AS-PCR) method. Statistical analysis was performed using STATA 13.0 software. Results: The groups were matched for age, gender and body mass index (p>0.05). The distribution of rs16924159 allele and genotypes among patients and controls was found in accordance with those expected by the Hardy-Weinberg equilibrium (p=0.088). Adenine (A) allele frequency of rs16924159 was significantly different between case and control groups (OR = 1.91, 95% CI = 1.04- 3.51, p = 0.037). Also, homozygote A/A (OR=6.53, 95% CI 0.68-62.38, p=0.104) and heterozygote (OR=2.08, 95% CI 0.93-4.62, p=0.073) genotypes were more frequent among asthma patients than in controls. Conclusions From these findings, we conclude the A allele of rs16924159 SNP in IL-33 gene may be contributing to asthma susceptibility, increasing the carrier`s risk to the development of asthma.

IntroductionMany factors can contribute to the occurrence of COPD. Recent studies have pointed to the notion thatpolymorphism of candidate genes may also play a signifi cant role in COPD pathogenesis.GoalTo investigate the association of polymorphisms in ADRB2 and TNF-α genes with COPD.Materials and MethodsWe genotyped three SNPs included rs1042713 and rs1042714 in ADRB2, rs1800629 in TNF-α gene,using PCR-RFLP method.ResultsThere is no statistically signifi cant difference was observed for TNF-α rs1800629 between case andcontrol groups. Genotype frequency of the homozygote Gly16 (rs1042713) was more frequent in COPDpatients than controls (OR=3.25; 95%CI, 1.58–6.66, p=0.0037). Also, haplotype frequency of Gly/Gly16+Gln/Glu27 was signifi cant difference among cases and controls (OR=5.03; 95%CI, 1.8–14.2,p<0.01).Conclusion:Overall, ADRB2 rs1042713 and rs1042714 polymorphisms are associated with increased susceptibilityto the development of COPD. Further studies in large groups of patients with COPD are needed toaddress other genetic risk factors.

Objective: To compare the efficacy of systemic and inhaled corticostcroid in patients with acute exacerbation of COPD.Methods: In this randomized, parallel-group study 80 patients (average age 59,7±7.7) were randomized to receive inhaled corticosteroid (fluticasone propionate 1000-1200 meg/daily, n -40) or systemic corticosteroid (intravenous dcxamethasone 4-8 mg every 24 hours, n-40). Outcome variables included the lung function tests (FEV1, FVC, FEV1/FVC), 6MWT, and 1 Symptoms. 2. Activity and 3. Impact components of St George's Respiratory Questionnaire for t OPD patients (SGRQ-C).Results: In group with systemic corticosteroid increased the FF.V1 from 63.5±9 to 68.118.1, FVC from 78.7±11.8 to 86.6±11, FEV1/FVC from 64.918.7 to 69.917.3; score of SGRQ-C improved I.from 58.5114.3 to 31 5ÈË 2. from 60.6116.7 to 37.7117.2, 3.1'rom 44.9+14.5 to 21.5113. In group wi«fi fluticasone propionate increased the FEV1 improved from 64.719 to 68.718.5, FVC from 79.7111.3 to 88.1110.7, and FEV1/FVC from 64.9+8.6 to 69.517.5; score of SGRQ-C I .from 58.5111.1 to 36.4113,0. 2.from 59.9117.2 to 39.1 + 16.8. 3.from 45.7114.7 to 23.5+13.8. The difference in efficacy of treatment in two groups was not significant.Conclusion:I fioth inhaled and systemic GSs improve airflow and lung function test in C'OPI) patients with ^cute exacerbation.2.1 ligh dose of ICSs may be an alternative to systemic corticosteroid in the treatment of non-severe acute exacerbation of COPD.3. Using of systemic and inhaled corticosteroids improve quality of life in COPD patients with acute exacerbation.

Abstract. This article refers to the management of adults with community acquired pneumonia (CAP) of all ages in the community or in hospital. Details of general investigations for patients managed in the community and for patients admitted to hospital, treatment in community, hospitals and in intensive care unit, follow up planning, empirical antibiotic choice, duration of antibiotic administration, failure to improve, the level of evidence of recommendations are given in the text and are summarized in figures and tables. Severity assessment is recommended as the key to planning appropriate management both in the community and in hospital. Certain adverse prognostic features have been associated with an increased risk of death and should be assessed in all patients. Patients who have two or more “core” adverse prognostic features are at high risk of death and should be managed as having severe pneumonia. Patients who display no adverse prognostic features can be managed as having non-severe pneumonia and may be suitable for outpatient treatment or early hospital discharge.