Current views on the etiology, pathogenesis, pathomorphology and treatment methods of occupational chronic obstructive pulmonary disease comorbid with post-covid syndrome

The author considers modern concepts of the development of occupational chronic obstructive pulmonary disease (OCOPD) as a chronic disease affecting the respiratory tract as a result of exposure to pathogenic particles and gases in an industrial area, and post-covid syndrome (PСS), formed as a result of SARS-CoV-2 infection. He pays special attention to the inflammatory, vascular, and immunometabolic mechanisms that are similar for both pathologies. The basic principles of OCOPD therapy, taking into account post-covid complications, are presented. The author also analyzed the possibilities of drug correction of pulmonary anti-inflammatory fibrosis and endothelial dysfunction. Due to the presence of multiple application points in the treatment of both OCOPD and PСS, the issue of selecting therapy for these groups of patients remains relevant. In order to reduce the clinical manifestations of OCOPD and PCS, as well as improve the quality of life of patients whose professional activities are associated with the inhalation of pathogenic particles and gases, it is possible to use various combinations of drug therapy (the drug "Longidaza"), as well as non-drug treatment methods.

Scientific publications were searched and analyzed in the international and national bibliographic databases PubMed, Scopus, Web of Science and eLibrary.RU for the period from 2000 to 2025. Systematic reviews, meta-analyses, randomized controlled trials, cohort studies, and observational studies on occupational chronic obstructive pulmonary disease, and post-covid syndrome were included. The inclusion criteria were full-text peer-reviewed publications with clearly described methodology and clinical outcomes. Duplicate publications, uncensored sources, conference abstracts, and papers with insufficient evidence were excluded.

The study aims to present the results of an analysis of modern research on the etiology, pathogenesis, pathomorphology, diagnosis and therapeutic approaches in occupational chronic obstructive pulmonary disease in conditions of its comorbid course with post-covid syndrome.

Funding. The work was carried out within the Framework of exploratory scientific research (ESR) «Development of approaches to the treatment and medical rehabilitation of patients with comorbid post-covid syndrome and military personnel who suffered during the hostilities» (Reg. no. 123032000011-5).

Conflict of interest. The author declares no conflict of interest.

Received: 12.09.2025 / Accepted: 24.03.2026 / Published: 25.04.2026

1. Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing. On the state of sanitary and epidemiological well-being of the population in the Russian Federation in 2024: State report. Moscow; 2025. https://clck.ru/3SqYX4 (in Russian).

2. Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing. On the state of sanitary and epidemiological well-being of the population in Irkutsk Region in 2024: State report. Irkutsk; 2025. https://clck.ru/3SqYeR (in Russian).

3. Ghio A. A clinical guide to occupational and environmental lung diseases. New York: Springer; 2020.

4. Izmerov N.F., Chuchalin A.G., editors. Occupational respiratory diseases: National guidelines. Moscow: GEOTAR-Media; 2015. https://elibrary.ru/vezbej (in Russian).

5. Occupational Exposures and Chronic Obstructive Pulmonary Disease. Systematic Review. SBU; 2025. https://www.ncbi.nlm.nih.gov/books/NBK613831

6. Murgia N., Gambelunghe A. Occupational COPD — the most under-recognized occupational lung disease? Respirology. 2022; 27(6): 399–410. https://doi.org/10.1111/resp.14272

7. Agusti A., Vogelmeier C.F. GOLD 2024: a brief overview of key changes. J. Bras. Pneumol. 2023; 49(6): e20230369. https://doi.org/10.36416/1806-3756/e20230369

8. Xie C., Wang K., Yang K., Zhong Y., Gul A., Luo W., et al. Toward precision medicine in COPD: phenotypes, endotypes, biomarkers, and treatable traits. Respir. Res. 2025; 26(1): 274. https://doi.org/10.1186/s12931-025-03356-w

9. Tanabe N., Rhee C.K., Park H.Y., Suzuki M. Editorial: the heterogeneity in COPD phenotypes. Front. Med. (Lausanne). 2022; 9: 982121. https://doi.org/10.3389/fmed.2022.982121

10. Shapiro S.D. Animal models for COPD. Chest. 2000; 117(5(1)): 223–227. https://doi.org/10.1378/chest.117.5_suppl_1.223s

11. Velichkovsky B.T. Ecological pulmonology (the role of free radical processes). Yekaterinburg: EMNC POZRPP, Ministry of Health of Russia; 2003 (in Russian).

12. MacNee W. Guidelines for chronic obstructive pulmonary disease. BMJ. 2004; 329(7462): 361–363. https://doi.org/10.1136/bmj.329.7462.361

13. Hutchison G.R., Brown D.M., Hibbs L.R. et al. The effect of refurbishing a UK steel plant on PM10 metal composition and ability to induce inflammation. Respir Res. 2005; 6(1): 43. https://doi.org/10.1186/1465-9921-6-43

14. Vasilieva O.S., Gusakov A.A. Chronic obstructive pulmonary disease from exposure to industrial aerosols. Pulmonologiya. 2013; (3): 49–55. https://elibrary.ru/rbjujx (in Russian).

15. Almeida A.G., Duarte R., Mieiro L., Paiva A.C., Rodrigues A.M., Almeida M.H. et al. Pulmonary function in Portuguese firefighters. Rev. Port. Pneumol. 2007; 13(3): 349–364. https://pubmed.ncbi.nlm.nih.gov/17632674/

16. Kuzmina LP. Biochemical and molecular mechanisms of occupational bronchopulmonary pathology. Pulmonologiya. 2008; (4): 107–110. https://doi.org/10.18093/0869-0189-2008-0-4-107-110 (in Russian).

17. Lai P.S., Fresco J.M., Pinilla M.A., Macias A.A., Brown R.D., Englert J.A., et al. Chronic endotoxin exposure produces airflow obstruction and lung dendritic cell expansion. Am. J. Respir. Cell. Mol. Biol. 2012; 47(2): 209–217. https://doi.org/10.1165/rcmb.2011-0447OC

18. Shpagina L.A., Voevoda M.I., Kotova O.S., Maksimov V.N., Orlov P.S., Shpagin I.S. et al. Occupational chronic obstructive pulmonary disease from the standpoint of molecular genetic studies. Byulleten fiziologii i patologii dykhaniya. 2013; (49): 8–15. https://elibrary.ru/rbqoer (in Russian).

19. Barnes P.J. Inflammatory mechanisms in patients with chronic obstructive pulmonary disease. J. Allergy Clin. Immunol. 2016; 138(1): 16–27. https://doi.org/10.1016/j.jaci.2016.05.011

20. Chuchalin A.G., ed. Respiratory medicine: a guidebook. 2nd ed. Vol. 1. Moscow: Litterra; 2017 (in Russian).

21. Gredic M., Blanco I., Kovacs G., Helyes Z., Ferdinandy P., Olschewski H., et al. Pulmonary hypertension in chronic obstructive pulmonary disease. Br. J. Pharmacol. 2021; 178(1): 132–151. https://doi.org/10.1111/bph.14979

22. Zhang L., Liu Y., Zhao S., Wang Z., Zhang M., Zhang S., et al. Incidence and prevalence of pulmonary hypertension in COPD: a systematic review and meta-analysis. Int. J. Chron. Obstruct. Pulmon Dis. 2022; 17: 1365–1379. https://doi.org/10.2147/COPD.S359873

23. Stolz D., Mkorombindo T., Schumann D.M., Agusti A., Ash S.Y., Bafadhel M. et al. Towards the elimination of COPD: a Lancet Commission. Lancet. 2022; 400(10356): 921–972. https://doi.org/10.1016/S0140-6736(22)01273-9

24. Shpagina L.A., Kotova O.S., Gerasimenko O.N., Shpagin I.S., Surovenko T.N., Karmanovskaya S.A. et al. Phenotypes and endotypes of occupational COPD caused by toxic gas or inorganic dust. Vestnik sovremennoi klinicheskoi meditsiny. 2017; 10(5): 56–65. https://doi.org/10.20969/VSKM.2017.10(5).56-65

25. Cazzola M., Rogliani P., Blasi F. Can treatable traits address COPD heterogeneity? Int. J. Chron. Obstruct. Pulmon. Dis. 2023; 18: 1959–1964. https://doi.org/10.2147/COPD.S428391

26. Xie C., Wang K., Yang K., Zhong Y., Gul A., Luo W. et al. Toward precision medicine in COPD. Respir. Res. 2025; 26(1): 274. https://doi.org/10.1186/s12931-025-03356-w

27. Jin H., Lu L., Fan H. Global trends in Long COVID research: a bibliometric analysis. Int. J. Environ. Res. Public Health. 2022; 19(6): 3742. https://doi.org/10.3390/ijerph19063742

28. Callard F., Perego E. How and why patients made Long COVID. Soc. Sci. Med. 2021; 268: 113426. https://doi.org/10.1016/j.socscimed.2020.113426

29. Cares-Marambio K., Montenegro-Jiménez Y., Torres-Castro R., Vera-Uribe R., Torralba Y., Alsina-Restoy X., et al. Respiratory symptoms after COVID-19: systematic review and meta-analysis. Chron. Respir. Dis. 2021; 18: 14799731211002240. https://doi.org/10.1177/14799731211002240

30. Malevich R.M., Sumnaya D.B. Post-COVID-19 condition (Long-COVID). In: Innovations in science and practice: proceedings of the XII International scientific conference. Ufa; 2023. Pt. 3: 21–26 (in Russian).

31. Bernard I., Limonta D., Mahal L.K., Hobman T.C. Endothelium infection and dysregulation by SARS-CoV-2. Viruses. 2021; 13(1): 29. https://doi.org/10.3390/v13010029

32. Fogarty H., Townsend L., Morrin H., Ahmad A., Comerford C., Karampini E., et al. Persistent endotheliopathy in long COVID. J. Thromb. Haemost. 2021; 19(10): 2546–2553. https://doi.org/10.1111/jth.15490

33. Rodríguez C., Luque N., Blanco I., Sebastian L., Barberà J.A., Peinado V.I., et al. Pulmonary endothelial dysfunction in COVID-19. Am. J. Respir. Cell. Mol. Biol. 2021; 64(4): 407–415. https://doi.org/10.1165/rcmb.2020-0359PS

34. Wang C., Yu C., Jing H., Wu X., Novakovic V.A., Xie R. et al. Long COVID and thrombotic sequelae. Front Cell Infect Microbiol. 2022; 12: 861703. https://doi.org/10.3389/fcimb.2022.861703

35. Stefan N., Cusi K. NAFLD and diabetes interplay. Lancet Diabetes Endocrinol. 2022; 10(4): 284–296. https://doi.org/10.1016/S2213-8587(22)00003-1

36. Williamson E.J., Walker A.J., Bhaskaran K., Bacon S., Bates C., Morton C.E., et al. Factors associated with COVID-19 death. Nature. 2020; 584(7821): 430–436. https://doi.org/10.1038/s41586-020-2521-4

37. Gao Y.D., Ding M., Dong X., Zhang J.J., Azkur A.K., Azkur D., et al. Risk factors for severe COVID-19. Allergy. 2021; 76(2): 428–455. https://doi.org/10.1111/all.14657

38. Codo A.C., Davanzo G.G., Monteiro L.B., de Souza G.F., Muraro S.P., Virgilio-da-Silva J.V. et al. Elevated glucose and SARS-CoV-2 infection. Cell. Metab. 2020; 32(3): 437–446.e5. https://doi.org/10.1016/j.cmet.2020.07.007

39. Markova T.N., Mishchenko N.K., Petina D.V. Adipocytokines: definition and role. Probl. Endokrinol. 2022; 68(1): 73–80. https://doi.org/10.14341/probl12805 (in Russian).

40. Chuchalin A.G., Avdeev S.N., Aisanov Z.R., Belevskiy A.S., Leshchenko I.V., Ovcharenko S.I. et al. COPD clinical guidelines. Pulmonologiya. 2022; 32(3): 356–392. https://doi.org/10.18093/0869-0189-2022-32-3-356-392 (in Russian).

41. Ministry of Health of the Russian Federation. Chronic obstructive pulmonary disease in adults: clinical guidelines. Moscow; 2024 (in Russian).

42. Agusti A., Bel E., Thomas M., Vogelmeier C., Brusselle G., Holgate S. et al. Treatable traits in airway diseases. Eur. Respir. J. 2016; 47(2): 410–419. https://doi.org/10.1183/13993003.01359-2015

43. Chuchalin A.G., Yablonskiy P.K., Rubanik T.V., Chernyavskaya O.A, Naumov V.V., Korneva L.I., et al. Bovine hyaluronidase azoximer in patients with post-COVID syndrome (DISSOLVE). Pulmonologiya. 2023; 33(1): 52–63. https://doi.org/10.18093/0869-0189-2023-33-1-52-63 (in Russian).

44. Fedin A.I., Starykh E.P., Parfenov A.S., Mironova O.P., Abdrakhmanova E.K., Starykh E.V. Pharmacotherapy of endothelial dysfunction in cerebral ischemia. Zh. Nevrol. Psikhiatr. Im. S.S. Korsakova. 2013; 113(10): 45–48. https://elibrary.ru/rtekln (in Russian).

45. Belousoviene E., Pranskuniene Z., Vaitkaitiene E., Pilvinis V., Pranskunas A. Ascorbic acid and microcirculation in sepsis. BMC Anesthesiol. 2023; 23(1): 309. https://doi.org/10.1186/s12871-023-02265-z