Особенности иммунного ответа на инфекцию Helicobacter pylori у детей с бронхиальной астмой

Актуальность. На сегодняшний день вопрос влияния избыточной массы тела и ожирения на клиническое течение бронхиальной астмы у детей остается малоизученным и требует дальнейших исследований. Цель: изучить клинические особенности течения бронхиальной астмы у детей с избыточной массой тела и ожирением. Материалы и методы. Проведено исследование 94 больных бронхиальной астмой детей в возрасте от 6 до 18 лет. В зависимости от индекса массы тела пациенты были разделены на следующие клинические группы: 30 детей с нормальной массой тела, 45 детей с избыточной массой тела и 19 детей с ожирением. Методы исследования: общеклинические, антропометрия, лабораторные, анкетно-опросный (опросник контроля бронхиальной астмы ACТ). Статистическую обработку полученных данных проводили с помощью статистического пакета IBM SPSS Statistics Base (версия 22) и программного обеспечения EZR, версия 1.32 (графический интерфейс среды R (версия 2.13.0)). Результаты. Установлено, что для детей групп с избыточной массой тела и ожирением характерен ранний дебют астмы (3 [3; 4]) года) с длительным персистирующим характером. Для всех трех групп наиболее существенными по частоте были жалобы на кашель, причем в группе нормального веса — на сухой (83,3 ± 7,4 %), а в группах с избыточной массой тела и ожирением — на влажный (соответственно 66,7 ± 7,0 % и 73,7 ± 10,1 %), и одышку при физической нагрузке: группа нормальной массы тела — 46,7 ± 9,1 %, избыточной массы тела — 82,2 ± 5,7 % и ожирения — 100 %. Для групп избыточной массы тела и ожирения также существенными по частоте были жалобы на ночные приступы удушья — 68,9 ± 6,9 % и 73,3 ± 10,1 % соответственно. χ2-тест показал статистически значимые различия между тремя группами по этому показателю: χ2(2) = 15,947; p < 0,001. У больных из группы ожирения чаще встречалось (70,0 ± 10,5 %) тяжелое течение бронхиальной астмы, выявлены статистически значимые различия между тремя группами по тесту: χ2(2) = 5,2463, p < 0,001. Неконтролируемая астма статистически значимо преобладала в группе детей с ожирением. Выявлена статистически значимая разница между различными весовыми группами в потребности в бронхолитиках: H(2) = 40,756; p < 0,001, и в количестве ночных приступов астмы: H(2) = 17,803, p < 0,001. Выводы. Проведенное нами исследование свидетельствует о значительном влиянии избыточной массы тела и ожирения на клиническое течение бронхиальной астмы у детей, может быть основанием для коррекции терапии астмы у таких пациентов.

According to various epidemiological studies, the prevalence of bronchial asthma (BA) in children in Ukraine ranges from 5 to 12%. Despite numerous studies of etiological factors, mechanisms of pathogenesis, the creation of international and national programs, until now it is not possible to take control of the morbidity and course of asthma. Therefore, the purpose of our study is to determine the clinical features of the course of bronchial asthma in children, depending on the age and level of disease control. We examined 227 children with asthma aged 6 to 17 years. In the objective examination, respiratory failure, shortness of breath, dry cough, nasal breathing difficulties, wheezy breathing, emphysema, bloating of the chest, were taken into account. The statistical processing of the results was carried out using the IBM SPSS Statistics, version 20 (2013), using parametric and non-parametric methods for evaluating the results. Under supervision were 181 boys (79.73±0.5%), from the total number of examined patients with asthma and 46 girls (20.27±1.98%). The control group included 40 practically healthy children aged 6 to 17 years. It was established that the persistent course of light and medium severity was noted 2.5 times more often than the severe course of asthma, and also 2.4 and 2 times more often (p≤0.01) in the age group of 6–11 years, unlike children 12–17 years old. Severe exacerbations were twice as likely to occur in patients with asthma-mediated etiology, and lungs — in patients with atopic asthma. Uncontrolled levels of the disease were noted 1.6–2 times more often in non-atopic form of asthma, than in its other variants. Thus, among children with asthma, mixed asthma and non-atopic asthma with an uncontrolled course, there is a clear need to find factors that are trigger in the development of exacerbations of the disease, determine their duration and severity, which helps to prevent the progression of asthma and avoid complications.

The study of the polymorphism of individual genes is the basis of both preventive medicine and is used in the selection of adequate therapy. Polymorphism of individual candidate genes in bronchial asthma (BA) is studied taking into account many personal characteristics and the influence of environmental factors. Aim - to analyze the status of the study of the role of polymorphism of β2-adrenoceptors (ADRβ2) in the pathogenesis of bronchial asthma in children and to compare them with our own findings. Materials and methods. The results of research on polymorphism of individual genes in children with BA, which includes the PubMed database, were analyzed. An in-depth study of the anamnesis data (disease, life, hereditary), a complex clinical and laboratory examination of children (n=101) of school age with BA was carried out (the average age was: for boys 11.15±0.48 years; for girls - 10.63±0.7 years). Patients were diagnosed with BA in accordance with the GINA recommendations of the current revision. Determination of the Arg16Gly polymorphism of the ADRβ2 gene (rs 1042713) was performed by the polymerase chain reaction method followed by restriction enzyme analysis. The obtained data were processed in the Statsoft STATISTICA software package. Mean values were given as (M±m), Student's test was used for comparison. Results. The assessment of the frequency of polymorphism of the Arg16Gly gene in BA established that two variants prevailed in boys: Arg16Gly and Gly16Gly; at that time, the Gly16Gly genotype prevailed among girls, which, according to individual studies, is associated with good effectiveness of the applied therapy (nebulization of salbutamol). Mutations in the ADRβ2 gene in patients with BA were twice as frequent in the Arg16Gly genotype and three times as frequent in the Gln27Glu genotype, in contrast to healthy children. Such a polymorphism affects the functional activity of ADRβ2, the occurrence and course of BA. Conclusions. The Arg16Gly polymorphism of the ADRβ2 gene in children with BA largely determines the sensitivity of ADRβ2 to the applied exacerbation therapy and the effectiveness of basic treatment. In patients with the Gly16Gly genotype, most researchers note the good clinical effectiveness of both fast broncholytic drugs (β2 short-acting agonists) and basic anti-inflammatory drugs. The diagnosed homozygous Arg16Arg genotype of the ADRβ2 gene mostly accompanies the uncontrolled (or partially controlled) course of asthma in children. The revealed features of the Arg16Gly polymorphism of the ADRβ2 gene will help the doctor to draw up an adequate treatment plan, which is based on the genetically determined sensitivity of ADRβ2 receptors to medical preparations. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Objective. To assess the dynamics of bronchial asthma (BA) and allergic rhinitis (AR) caused by house dust mites (HDM) in children during 3 years of allergen specific immunotherapy (ASIT) with HDM allergens and 1 year after treatment cessation.Research methods. 50 patients completed an open, prospective, controlled 5-year study. 25 patients of the main group with BA and sensitization to HDM underwent a year of preliminary observation, 3 years of ASIT with HDM allergens, and 1 year of follow-up: 16 boys (64%), 9 girls (36%), 5 years to 13 years (8.3 [6.7; 11.5]) at inclusion. The control group of 25 patients, who did not receive ASIT, was selected as pairs copies. At inclusion, the concentration of periostin and thymic stromal lymphopoietin (TSLP) in blood serum and nasal material was determined in all patients. The dynamics BA and AR was assessed based on the total index of symptoms and medications for each year of observation.Results. During 3 years of treatment, a significant clinical effect of ASIT was formed, which persisted for 1 year of follow-up after the end of ASIT. At the end of the follow-up year, the overall index of symptoms and medications was 8.77 ± 1.06 points in the ASIT group and 22.01 ± 2.18 points in the control group (p=0.00001). The concentration of periostin before the start of treatment did not affect the effectiveness and features of the ASIT treatment course. A high serum TSLP concentration (>750 pg/ml) is characteristic of the subgroup with a higher incidence of adverse events associated with ASIT; the final effectiveness of ASIT does not depend on the concentration of this marker.Conclusion. ASIT with HDM sublingual drops is the method of first choice in the treatment of children with BA and AR, in cases where the role of HDM allergens in the genesis of the disease has been proven. A successful ASIT has a prolonged effect (at least 1 year of follow-up), which indicates the possibility of changing the natural course of asthma in children. The study of biomarkers does not allow us to predict the effectiveness of ASIT.

Introduction. Studies have shown that bronchial asthma (BA) associated with obesity has a more severe course, lower control, more frequent cases of low efficacy of basic treatment, and exacerbations. Two phenotypes have been distinguished in BA-obesity comorbidity based on age of onset: early atopic and late non-atopic. It is known that genetic factors associated with β2-adrenoceptor (AR) genes are important in the development of both asthma and obesity. The purpose of the study aimed to analyze the association of the Gln27Glu polymorphism of the β2-adrenoceptor gene with the severity of the course of bronchial asthma with obesity, taking into account the age of its onset. Research material and methods. 195 asthma patients with obesity consented for the study participation were examined. The control group consisted of 95 practically healthy people. Patients were divided into two clinical groups depending on the age of onset of BA: the first group included 100 patients with an early onset, the second group - 95 patients with a late onset. The diagnosis and treatment of asthma followed the guidelines of the Global Initiative for Asthma (2016) and its updated versions. The study was approved by the Bioethics Commission of the Educational and Scientific Medical Institute of Sumy State University. Determination of the Gln27Glu polymorphism of the β2-AR gene (rs1042714) was performed using the polymerase chain reaction with the subsequent analysis of restriction fragments. Statistical analysis of the obtained results was carried out using the SPSS-17 program. Pearson's chi-squared test was used to compare genotype distributions between experimental groups. To determine the risk of BA and obesity, odds ratios and 95% confidence intervals were calculated for dominant, recessive, superdominant, and additive models of inheritance. Their relevance was assessed using the Akaike information criterion. All tests were two-sided, and values p < 0.05 were considered statistically significant. Research results. The frequency of Gln/Gln, Gln/Glu and Glu/Glu genotypes according to the Gln27Glu polymorphism of the β2-AR gene in patients with early-onset obesity-associated asthma was 70.0; 25.0; 5.0% with a mild course and 55.0; 36.2; 8.8% with severe (χ2 = 1.49; p = 0.473); and with a late debut - 50.0; 43.8; 6.2% with mild and 54.0%; 31.7; 14.3%, respectively, with severe (χ2 = 2.10; p = 0.350). Despite the absence of a probable difference in the distribution of genotypes depending on the severity of the course, it was found that the frequency of homozygotes for the minor allele was 1.8 times higher in patients with a severe course of early BA and 2.3 times higher in late BA compared to that in patients with mild BA course. The risk of early-onset BA with obesity and a severe course showed no association in all models of inheritance, and in patients with late-onset BA, there was a 1.66-fold increase (95% CI (1.03 – 2.72), p = 0.04) in the additive inheritance model (p = 0.04). Conclusions. There are no statistically significant differences in the distribution of genotypes according to the Gln27Glu polymorphism of the β2-AR gene depending on the severity of the course of early and late BA with obesity. The risk of developing a severe course of early BA did not depend on the Gln27Glu polymorphism of the β2-AR gene, and late BA increased by 1.66 times in the additive model of inheritance.

Objective: To assess the level of adherence to medical prescriptions and recommendations by patients with bronchial asthma (BA), in order to achieve control over the symptoms of the disease; to identify the most common factors of low adherence to BA therapy; to suggest strategies for optimizing treatment compliance. Methods: 92 children with a verified diagnosis of BA were examined. All patients underwent a general clinical, laboratory and instrumental examination, as well as an additional screening test with a mixture of respiratory allergens – the ImmunoCapPhadia® 250 method. The control of BA symptoms was assessed using ACT and ACQ tests. Adherence to BA therapy was assessed using a questionnaire. Results: Analysis of gender differences revealed that the proportion of male patients was 58%; female – 42%. The median age was 11 years. The average age of diagnosis of BA in children was 9 years. All patients were hospitalized during the period of exacerbation of the disease, the proportion of children with an attack of moderate BA – 87%; severe – 13%. An intermittent course of BA was observed in 28%; a persistent course in 72%. Analysis of ImmunoCap Phadia®250 data revealed that in 17.2% of cases class V sensitization prevailed, and the average values of allergen-specific IgE antibodies were 69.82 kU/L. Assessment of the level of control over asthma symptoms and the use of AST and ACQ tests revealed that partially controlled the course of BA was noted by 56% and uncontrolled over 46% of children. Analysis of the «Questionnaire of adherence to treatment of bronchial asthma (BA) in children», differences were found in the response to questions: «Do you experience difficulties in using the inhaler?» (χ2=8.952; p=0.003), «Was there any reluctance to take medications?» (χ2=4.715; p=0.03); «Does it happen that you forget to take drugs one/several days?» (χ2=5.093; p=0.025), «Are you satisfied with the prescribed therapy for BA?» (χ2=5.093; p=0.025). Conclusions: In order to achieve success in long-term control of the symptoms of BA in a patient, a comprehensive approach to the treatment and prevention of exacerbation of BA is required with an individual approach to each child, both from the doctor and from an adult who participates in the conduct and adherence to doctors appointments. Keywords: Asthma, children, adherence, compliance, symptom control.

The role of viral infection in bronchial asthma (BA) is well-known being reflected particularly in GINA. An effect of pneumotropic intracellular persistent herpesviruses on the course of BA is of particular interest. The most common viruses of this group are cytomegalovirus (CMV), EpsteinBarr virus (EBV), and human herpesvirus 6 (HHV-6). The CMV role has been discussed in our previous publications allowing us to focus here on EBV and HHV-6. We examined 167 children with BA that was diagnosed and clinically assessed in accordance with the current national clinical guidelines. Patients with controlled asthma (70 patients), partially controlled and uncontrolled asthma (97 patients) were stratified into several groups. The detection of EBV and HHV-6 DNA was carried out in throat swabs by PCR; the level of total and virus-specific IgA, IgM, IgG, IgE as well as serum level of IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-8 and TNF was assessed by enzyme linked immunosorbent assay; lymphocyte subpopulations were analyzed by flow cytometry. The dose of topic GCS was taken into account with reference to the fluticosone equivalent; the function of external respiration was studied by spirometry. It was revealed that EBV DNA was found in 14.2% of cases, whereas HHV-6 in 19.0% of cases, but 14.4% and 52.4% of patients, respectively, shed no pathogen-linked DNA. At the same time, patients with uncontrolled BA are significantly more likely to shed the pathogen DNA, so that EBV is released in 17.1% vs 4.5% of patients with controlled BA, HHV-6 in 19.5% vs 13.6%. On the contrary, children with controlled BA were significantly more often (63.6% vs 51.2%) negative for viral DNA shedding. Moreover, virus shedding was paralleled with higher levels of IL-5: it was as high as 0.91 pg/ml and 0.29 pg/ml for EBV and HHV-6, respectively; those shedding DNA of both pathogens vs no shedding had IL-5 at level of 0.25 pg/ml vs 0.11 pg/ml. Similar pattern was observed for higher total IgE: 184.5 IU for EBV, 113.1 IU for HHV-6, and 371.7 IU shedding both viruses vs 95.2 IU in without DNA pathogen shedding; lower level of FEV1: EBV 96.6%, HHV-6 98.8%, and 106.2% in patients shedding both viruses vs 109.8% in patients not shedding the pathogen DNA. Patients shedding EBV DNA require higher doses of topic GCS to achieve disease control: EBV 325.0 mg, HHV-6 186.4 mg; shedding both viruses 328.1 mg of topic GCS vs 198.6 mg in patients without pathogen DNA shedding. Thus, activation of both EBV and HHV-6 worsens BA control and aggravates its course, but EBV persistence has a more pronounced effect on the course and control of the disease.

Psychopathology in the family seems to have a role in the course of a child's asthma. The purpose of this study was to examine the possible impact of parental anxiety and depression on the course of asthma, as well as to examine the relationship between left-handedness and asthma in children. The International Study of Asthma and Allergy in Childhood (ISAAC), the Foulds and Bedford Inventory for Anxiety and Depression (DSSI/sAD), and the Edinburgh Left-handedness Inventory were administered to 70 families with asthmatic children 4-8 years old. One year later, the children's asthma was reevaluated using a brief questionnaire based on ISAAC. A sample of 70 families with nonasthmatic healthy children were used as controls. The majority of children in the study group had mild asthma. Allergic rhinitis was found in 31.4% and allergic dermatitis in 20% of the sample. The parents of the asthmatic children scored significantly higher in DSSI/sAD compared to parents of the controls. Maternal anxiety reached the le...

Numerous observations of patients with bronchial asthma (BA) vaccinated against pneumococcal infection have revealed a significantly reduced frequency of exacerbations and hospitalisations after immunisation. Several studies have considered pneumococcal vaccines potential immunoregulators that may improve the clinical course of BA via modulation of the immune response. However, interpretation of these results has serious limitations due to heterogeneity of primary disease and differences in vaccine preparations. The aim of the present study was to perform a comparative analysis of the key cytokines levels which characterize development of distinct BA endotypes in patients following administration of conjugated pneumococcal vaccine. We have analyzed serum samples (n = 31) from patients with BA immunized by PCV13 (Prevenar 13), using ELISA technique, for Th1/Th2/Treg cytokines (IFNγ, IL-4, IL-6, IL-8, IL-10, IL-18, TNFα, and MCP-1), and total IgE level. The time points of sampling were as follows: initial terms, 6 weeks, 6 and 12 months after vaccination.The results of the study indicate that vaccination against pneumococcal infection using a PCV13 in patients with BA was accompanied by high clinical efficacy, regardless of the disease endotype. This finding was evidenced by a decreased number of BA exacerbations in the patients, and an increased number of non-hospitalized BA patients during 1 year of observation. The clustering of patients according to their inflammatory profile enabled us to detect specific patterns of the cytokine profile. These changes included a statistically significant increase in the concentration of IFNγ in blood serum at 6 weeks after immunisation in the patients with the T2-“high” asthma endotype. Statistically significant changes were observed in patients with atopy and elevated total IgE levels in serum, who exhibited a peak increase in IFNγ concentration, also 6 weeks after vaccination. Conversely, no significant changes in cytokine levels were observed in patients with T2-“low” asthma endotype within a year after vaccination. The results of the study demonstrate that IFNγ plays a significant role in the potential adjustment of immunity in the patients with T2-«high» asthma endotype following immunisation with a pneumococcal conjugate vaccine.

Food allergy is a common type of allergy reactions in children. At the same time, there is little explored the impact of food allergy on the development and course of bronchial asthma in children.Objective: to study the characteristics and clinical manifestations of bronchial asthma in children.Material. 100 children with bronchial asthma associated with food sensitization (experimental group) have been examined. The control group consisted of 60 children with bronchial asthma, who had no manifestations of food allergy. The age of patients was from 1 year to 16 years.The results of the study.It is noted more previous (p <0,01) beginning bronchial asthma in children who had food allergens as the cause significant factors in its exacerbation in comparison to the control group. Bronchial asthma attacks in children with food sensitization were recorded in the experimental group was 1.8 times more than in control group. Severe bronchial asthma was noted in 2 times more often in children with food sensitization than in the control group. The higher level of total IgE (p<0,05) in children with bronchial asthma exacerbation to food antigens from 6 to 9 years of age was noted in comparison to control group. Gastroduodenit(38.2% and 41.3%) was dominated inthe experimental and the control group, respectivelyand eyunit, esophagitis in children with acute asthma were found in 2 times more likely than children in the control group.

Microbial colonization of the airway plays a role in the pathogenesis of asthma; however, the effect of the upper airway microbiome on childhood asthma is not fully understood. We analyzed the metagenome of airway microbiome to understand the associated role of upper airway microbiome with the natural course of childhood asthma. Nasopharyngeal swabs were collected from children with asthma, those in asthma remission, and control groups. High-throughput sequencing was used to examine the structure and functional dynamics of the airway microbiome with respect to asthma phenotypes. The composition of microbiota differed among healthy control, asthma, and remission groups. The relative abundance of Streptococcus was negatively associated with FEV1% predicted (P=.023) and that of Staphylococcus was negatively associated with methacholine PC20 (P=.013). Genes related to arachidonic acid metabolites, lysine residues, and glycosaminoglycans in the microbiome could be associated with airway inflammation. In particular, genes related to synthesis of anti-inflammatory prostaglandin E2 (PGE2 ) were not detected from the airway microbiome in the asthma group. These data suggest that alterations in the composition and function of the upper airway microbiome could be related with the natural course of asthma in children.

Psychological characteristics associated with the onset and course of asthma in children and adolescents: A systematic review of longitudinal effects

Introduction. The development of chronic allergic inflammation of the respiratory tract is determined by various genes. It is assumed that the clinical features of the course of bronchial asthma may be associated with singlet polymorphism of the vitamin D receptor.Аim. To analyze the frequency of occurrence of polymorphic variants of the VDR-63980G>A gene and evaluate their association with the features of the development and course of bronchial asthma in children.Materials and methods. To study the association of the VDR-63980G>A gene polymorphism with bronchial asthma in children, 154 patients with bronchial asthma aged 1 to 18 years and 116 healthy subjects were selected. The objective status of the patients was assessed with the clarification of the anamnesis, standard laboratory and instrumental examination. Single nucleotide substitutions were typed by polymerase chain reaction with real-time detection of the results. The genotype distribution was evaluated using the “Gen-Expert” program.Results. As a result of the association analysis, the relationship of VDR-63980G>A with bronchial asthma in children was established. The presence of genotype -63980AA of the VDR gene increases the risk of developing bronchial asthma in a child by 1.85 times (OR=1.85, [CI 1.02-3.38]; χ 2=4.22, p=0.04). The homozygous genotype -63980GG was more common in the control group – in 49.5% versus 45.4% against the sick children. The genotype of the minor homozygote -63980AA is associated with the early onset of the disease, pronounced obstructive pulmonary ventilation disorders.Conclusion. The association of genotype -63980AA of the VDR gene with the risk of asthma development in preschool children was revealed.

Objective. To study the association of polymorphic variants HHIP, ADRB2 and IL-33 genes with phenotypes of clinical course of bronchial asthma in children and effective treatment. Materials and methods. 90 patients aged from 5 to 17 with the diagnosis of bronchial asthma were included in the investigation. Diagnostic procedures were carried out in all the patients. They included the study of genetic polymorphism of HHIP, ADRB2 and IL-33 genes to establish the association with the clinical phenotypes, findings of laboratory and instrumental study determining the course of bronchial asthma and the degree of its control. Results. The study of polymorphism of HHIP, ADRB2 and IL-33 genes in children with bronchial asthma with different phenotypes of the disease revealed the association of genetic polymorphism with the severity of course of the disease as well as concomitant diseases. It was determined that allele T of genetic variant rs12504628 (TC) of HHIP gene reduces the risk of a severe course of BA. Its protective role in the development of drug allergy was also proved. Genotype AA of ADRB2 gene is associated with reduced risks of the development of congenital defects of the tracheobronchial tree in BA. Polymorphic variants in the 4th and 6th exon of IL-33 gene are more frequently associated with moderate and severe course of asthma and base substitution in the 4th and 6th exon are associated with the severe course. Conclusions. Associations of polymorphic variants of HHIP, ADRB2 and IL-33 genes with clinical manifestations of BA in children are determined in this study. They can be considered in a personalized monitoring of the patients and can help to control the disease totally.

Background Asthma is a common disease with increasing prevalence in children and adults. The WHO estimates that annually 15 million disability-adjusted life-years are lost, and 250,000 asthma deaths are reported worldwide. Approximately, 500,000 annual hospitalizations are due to asthma (1). Aim In our study, we aimed to evaluate the endothelial function in children with asthma in remission and the prognosis of severe asthma. Materials and methods The study involved examination of 91 children, aged 6–17 years, with persistent asthma in the remission period. Indices of endothelial function (soluble vascular molecule of intercellular adhesion-1 [sVCAM-1], concentration of stable metabolites of nitric oxide in blood serum [NO2 +NO3 ], thickness of the intima-media complex [IMC] of the common carotid artery (CCA), and endothelium-dependent dilatation of the brachial artery [FMD%]). Statistical analyses were performed with StatSoft STATISTICA Version 8 (Tulsa, OK). To determine the relation between qualitative characteristics, the criterion χ2 was used, and the procedure of multiple logistic regression analysis was performed. Results The endothelium parameter levels (FMD% [H = 46.02], IMC [H = 60.75], NO2 + NO3 [H = 40.82], and sVCAM-1 [H = 76.57, p = 0.0000]) depend on the severity of the disease. The study showed that the factors that should be taken into account in prognosis of the formation of the severe course of asthma include positive family allergic history, serum sVCAM-1 and NO2 + NO3 levels, and the thickness of IMC CCA. Conclusions All the children with asthma in the remission period were found to have endothelial dysfunction. The degree of disruption of the function of the endothelium depends on the severity of the course of asthma. An algorithm for predicting the severe course of asthma in children has been developed.