Introduction 
In  the  previous  study,  a  pharmacoeconomic  analysis  of codeine medicines was conducted using the ABC 
and VED methods [1]. Antitussive  drugs  play  an  important role in the treatment of respiratory diseases accompanied by cough. A special  niche  among  such  drugs  is  occupied  by  codeine medicines. Codeine is a semisynthetic opioid that has been used in medicine for more than a century. Codeine has a unique mechanism of action: it affects the cough center in the medulla oblongata, suppressing the cough reflex, which makes it indispensable in the treatment of dry, debilitating cough. However, along with proven effectiveness, codeine 
medicines  have  several  features  that  affect  their  use  in clinical practice [2-7]. Globally,  codeine  medicines  are  the  subject  of significant attention from regulatory authorities due to the risk  of  addiction,  abuse,  and  side  effects.  In  many countries, their circulation is strictly controlled, including restrictions  on  access  to  non-prescription  drugs  and  the establishment  of  quotas  for  production  and  sales.  In Ukraine,  this  problem  is  also  relevant,  as  codeine  abuse among  the  population  leads  to  social  and  medical complications, in particular the development of addiction and  side  effects.  At  the  same  time,  such  drugs  remain 
important  in  pharmacotherapy  due  to  their  high effectiveness [8-10]. Regulatory  aspects  of  the  use  of  codeine medicines in Ukraine deserve special attention. On the one hand,  there  is  a  need  to  ensure  the  availability  of  these drugs for patients who really need them. On the other hand, it is important to minimize the risks of uncontrolled use. As of today, Ukraine has introduced strict restrictions on the dispensing of codeine medicines - they are available only by prescription. In addition,  work is ongoing to improve the regulatory framework for their circulation, which meets international standards [11-13]. The epidemiological situation also affects the use of  codeine  medicines.  The  increase  in  the  number  of diseases  accompanied  by  cough,  such  as  influenza, COVID-19  and  other  acute  respiratory  infections, increases the demand for antitussives. At the same time, the pandemic has highlighted weaknesses in the supply chain of  medicines,  including  codeine  medicines,  in  particular problems  with  organization,  storage,  and  availability  for end users [14, 15]. 
Codeine abuse is a significant problem, especially among young people. Cases of using codeine medicines for 
non-medical purposes, such as achieving a euphoric effect, pose serious health risks and require active action by the state  and  the  medical  community.  In  this  context, preventive measures aimed at raising public awareness of the  dangers  of  abuse  and  strengthening  control  over  the circulation of such medicines are important [16, 17]. From  a  marketing  point  of  view,  codeine medicines  have  a  stable  demand  on  the  pharmaceutical 
market  of  Ukraine.  However,  competition  between manufacturers forces them to look for new ways to attract 
consumers,  through  the  introduction  of  new  forms  of release,  increasing  the  availability  of  information  about medicines and ensuring high product quality. At the same time, pharmaceutical companies face challenges related to regulatory restrictions and the need for transparency of the entire production and sales process [18, 19]. No less important are the forecasts for the further use  of  codeine  medicines  in  Ukraine.  It  is  expected  that 
regulatory policy will become stricter, especially regarding circulation  control  and  prescription  dispensing.  At  the same  time,  there  is  a  trend  in  the  world  to  search  for alternatives to codeine, synthetic or herbal remedies that provide similar efficacy, but have a lower risk of addiction [20]. The study utilized the following registries: European Convention  on  Drug  Control,  1986.  Council  of  Europe, International  Convention  on  Narcotic  Drugs  and Psychotropic Substances, 1988. UN, WHO Drug Control System, World Health Organization, 2019, and Convention on Narcotic Drugs, 1961. UN. Thus,  antitussive  codeine  medicines  remain  an 
important component of pharmacotherapy, but their use is accompanied by several challenges. The relevance of this issue is due not only to medical aspects, but also to social, economic,  and  regulatory  factors.  Further  study  of  these medicines  will  contribute  to  improving  their  use, increasing the safety and effectiveness of treatment. 
 Purpose of the study 
The  purpose  of  this  article  is  to  study  the  features  of codeine  medicines  and  analyze  their  role  in  modern medicine. The article aims to: 
1.  Describe the clinical and pharmacological properties of codeine – to reveal the mechanism of its action, antitussive, analgesic  effects,  and  explain  how  these  properties contribute to the treatment of various diseases. 
2.  Consider the features of the composition and forms of release of codeine medicines – to demonstrate the diversity of  medicines,  their  combinations  with  other  active substances,  as  well  as  the  advantages  of  each  form  in different clinical situations. 
3.  Analyze the codeine medicines market in Ukraine – to provide an idea of the main manufacturers, and to study the development trends of this segment of the pharmaceutical market. 
4.  Assess  the  regulatory  aspects  of  the  circulation  of codeine  medicines  –  to  study  the  rules  of  registration, release and control that operate on the Ukrainian market, and to compare them with international standards. 
5.  Warn about the risks of abuse – emphasize the danger of  developing  addiction  if  recommendations  are  not followed and consider measures that help minimize such risks. This article is aimed at comprehensively highlighting the role of codeine medicines in pharmacotherapy, as well as providing recommendations for their rational and safe use.  

Materials and methods 
The following materials and methods were used to conduct this study: 
Research materials 
1. Codeine medicines registration data Information  from  the  State  Register  of  Medicines  of Ukraine, containing information about codeine medicines, their  composition,  release  forms,  manufacturers,  and 
registration dates. 
Current pharmacopoeial and regulatory documents related to  the  production,  circulation,  and  control  of  codeine medicines. 
2. Scientific literature Publications  on  pharmacology,  toxicology  and  clinical medicine related to the use of codeine. Analytical reviews and studies devoted to the  medicines market in Ukraine and the world. 
The following databases were used in the study: 
State Register of Medicines State Formulary of Medicines ATC/DDD  Index  2024,  WHO  Collaborating  Centre  for Drug Statistics Methodology ATC/DDD  Index  2023,  WHO  Collaborating  Centre  for Drug Statistics Methodology ATC classification, Compendium Review of the pharmaceutical market of Ukraine Analytical reviews of the market – Weekly APTEKA Analysis of the pharmaceutical market in Ukraine, 2023 – Pro-Consulting Pharmaceutical market of Ukraine – analytical review Pharmacies of the world – 2023: digital initiatives and their impact on the pharmaceutical market Global pharmaceutical industry outlook, 2023 and beyond Global use of medicines: status and trends Pharmaceutical market – Pharmaceutical Encyclopedia World forecasts and trends – Weekly APTEKA 
Research methods 
1.  Analytical  method.  The  composition  of  codeine medicines,  their  release  forms  and  compliance  with 
modern pharmacopoeial requirements were analyzed. The features  of  combinations  of  codeine  with  other  active substances were studied. 
2.  Statistical method. Data processing was carried out on the number of registered codeine medicines in Ukraine, the dynamics of their sales and popularity among patients and doctors. 
3.  Comparative analysis. Regulatory requirements for the circulation  of  codeine  medicines  in  Ukraine  were 
compared  with  international  standards.  Differences  in release  forms  and  dosages  of  medicines  in  different markets were studied. 
4.  Documentary analysis of scientific sources. A critical analysis  of  scientific  works  was  conducted  that  consider the  effectiveness,  safety,  and  risks  of  the  use  of  codeine medicines. 
5.  Expert  assessment.  The  conclusions  of  practicing physicians,  pharmacologists  and  regulatory  specialists 
were involved to assess the safety of use and prospects for the development of the codeine medicines market. 
Research limitations The  study  is  based  on  available  public  sources  and statistical data. Limitations may include incomplete data on unofficial  consumption  of  codeine  medicines  or unavailability  of  information  on  clinical  trials  in  private companies. The  use  of  the  above  methods  allowed  to  provide  a comprehensive  approach  to  the  analysis  of  codeine medicines, their role in medicine and the pharmaceutical market of Ukraine. The research of the article is a fragment of research works of  Private  Scientific  Institution  "Scientific  and  Research University  of  Medical  and  Pharmaceutical  Law"  and Danylo Halytsky Lviv National Medical University on the topic  "Diagnosis,  treatment,  pharmacotherapy  of inflammatory,  traumatic  and  onco-thoracic  pathology using  instrumental  methods"  (state  registration  number 0125U000071,  implementation  period  2025-2031);  Lviv Medical Institute on the topic of "Improving the system of circulation of drugs during pharmacotherapy on the basis of  evidentiary  and  forensic  pharmacy,  organization, technology, biopharmacy and pharmaceutical law" (state registration number 0120U105348, implementation period 2021-2026);  Private  Scientific  Institution  "Scientific  and Research University of Medical and Pharmaceutical Law" on the topic “Multidisciplinary research of post-traumatic stress  disorders  during  war  among  patients  (primarily 
combatants)”  (state  registration  number  0124U002540, implementation period 2024-2028). 

Results and discussion 
1. Description of the pharmacological properties of codeine Codeine is an alkaloid of the opium poppy, which belongs to the group of semi-synthetic opioids. It is widely used in medicine as an analgesic, antitussive and  weak  sedative. The main pharmacological properties of codeine include: Anesthetic action Codeine  interacts  with  μ-opioid  receptors  in  the  central nervous  system,  which  reduces  the  transmission  of  pain impulses.  Its  analgesic  effect  is  weaker  than  that  of morphine, but sufficient to relieve moderate pain. Antitussive effect 
Codeine  suppresses  the  cough  reflex  by  acting  on  the cough centers in the medulla oblongata. Due to this, it is used in the treatment of unproductive cough, especially in cases where the symptom is debilitating for the patient. Weak sedative effect Codeine has a sedative effect, which is due to its effect on the central nervous system. In small doses, it rarely causes severe  drowsiness,  which  allows  its  use  in  outpatient practice. 

Abstract. The healthcare sector is faced with the need to find new innovative and multidisciplinary approaches  for  the  prevention  and  treatment  of Covid, post-Covid, long-Covid, chronic, comorbid disorders. The results of 30 years of experience in the  use  of  halotherapy  in  the  treatment  of pulmonary pathology indicate that the authors of the article have established the optimal level of use of  halotherapy  in  pathological  pulmonary 
processes.  At  the  same  time,  clinical  experience provides evidence for the optimal method of using 
the halotherapy method in pulmonary nosologies. The  method  of  using  salt  therapy  in  exudative 
pleurisy, in fibrinous pleurisy, in fibrotic processes in  the  lungs  has  been  theoretically  substantiated, 
developed, and implemented in clinical practice. It has  been  proven  that  halotherapy  is  an  effective 
treatment  method  for  bronchial  asthma,  chronic obstructive  pulmonary diseases,  acute  respiratory 
viral infections, fibrinous and exudative pleurisy. The therapeutic effect of this method is observed only when using halogenerators with the ability to grind salt in the range of 1-5 microns. Halotherapy sessions  in  patients  with  bronchial  asthma  with mild  and  moderate  severity  lead  to  the development  of  nonspecific hyposensitization, which  in  turn  provides  long-term  remission  of attacks  and  reduces  the  need  for 
glucocorticosteroid  drugs.  Halotherapy  has  a confirmed immunomodulatory effect and activates local and T-cell immunity. It requires further study of  the  experience  of  halotherapy,  conducting marketing, pharmacoeconomic  and  comparative analysis. 
Keywords:  halotherapy,  pulmonary  pathologies, thoracic  pathology,  bronchial  asthma,  fibrinous 
pleurisy, post-covid syndrome, patient.  

УДК 616.24-002-053.2:578.834](0.083.96)

Objective —    to    determine    the    features    of    pathogenesis    in    patients    with    the    pulmonary  form    of    SARS-CoV-2.    To     establish,     based     on     clinical     examination     data     and     electron     microscopy,     that     vasculitis     of     the     respiratory    
system    is    the    main    pathophysiological    and    pathomorphological    factor    in    lung    tissue    damage    in    COVID-19.
Materials and methods.    A    total    of    692    patients    aged    18    to    73    years    with    severe    SARS-CoV-2    were    examined.    The    control    group    consisted    of    50    patients    (25    women    and    25    men)    aged    25—70    years    with    a    moderately    severe    clinical     course     of     SARS-CoV-2.     58     patients     underwent     immunological     tests,     which     included     the     study    of    O-lymphocytes    and    D-lymphocytes,    circulating    small    and    large    immune    complexes.    A  group    of    30    people    who    died     of     COVID-19     pneumonia     underwent     a     pathohistological     examination     of     tissue     samples.     A     group     of    10    people    who    died    of    COVID-19    pneumonia    underwent    electron    microscopic    examination    of    tissue    samples.
Results and discussion. Immunological    examination    revealed    an    increase    in    the    number    of    O-lymphocytes    (53.3    ±    1.3),    an    increase    in    the    number    of    D-lymphocytes    (4.9    ±    0.7),   which    highlights    the    impairment    of   T-cells    of    immunity;    the    predominance    of    the  total   mass    of    an    increased    level    of    small    CICs    (71.3    ±    2.5),    which    indicates    a    particularly    «malignant»    autoimmune    component    with    damage    to    the    connective    tissue    structure,    primarily    the    vessels    of    the    lungs,    and    therefore    the    vessels    of    epithelial    organs,    and    an    increase    in    the    number    of    large    CICs,    which    explains    the    material    basis    of    allergic    complications    that    accompany    the    severe    course    of    
SARS.    Ultrastructural    electron    microscopic    examination    of    the    respiratory    tract    of    patients    who    died    from    respiratory     failure     in     COVID-19     revealed     the     development     of     degenerative     changes     in     the     capillaries     and    endothelium,     characterised     by     the     expansion     of     the     tubules     of     the     granular     endoplasmic     reticulum,     the    destruction     of     ribosomes,     the     appearance     of     vacuoles     in     the     cytoplasm     surrounded     by     a    double-contour    membrane    and    containing    small    virion-like    bodies,    the    basement    membrane  of    haemocapillaries    was    hetero-geneously    thickened.    The    development    of    venulitis    was  recorded,    which    is    characterised    by    the    accumulation    of    neutrophils    in    the    vessel    wall,  pronounced    degenerative    changes    in    the    endothelium,    accompanied    by    the    
destruction    of    cytoplasmic    organelles,    vacuolisation    of    the    cytoplasm    and    its   heterogeneous   osmophilia,    the    appearance     of     heterogeneous     microvilli     on     the     lumenal    surface     of     the     endothelium,     and     heterogeneous    thickening    of    the    cytoplasmic    membrane.    Ultrastructural    changes    in    the    vascular    endothelium    in    COVID-19    indicate    the   primary    occurrence    of    acute    vasculitis    as    a    pathogenetic    dominant    in    COVID-19    pneumonia. Conclusions.     Clinical     manifestations     and     ultrastructural     pathomorphological     studies    conducted     by     us    reliably    indicate    that    the    primary    pathogenetic    basis    of    atypical    pneumonia    in    COVID-19    syndrome    is    the    occurrence     of     acute     vasculitis     with     predominant     damage     to     the     vessels     of     the     pulmonary     system.     The    
«malignant»     course     of     COVID-19     syndrome     involves     the     transformation     of     acute     vasculitis     into     systemic    vasculitis     with     subsequent     unpredictable     damage     to     a     number     of     systems     (respiratory,     cardiovascular,    hepatobiliary,    genitourinary).

Keywords SARS-CoV-2, COVID-19, vasculitis, pneumonia, pulmonary system, coronavirus infection, pathomorphology, electron microscopic changes, fatalities, forensic medicine.