CLINICAL, FUNCTIONAL AND IMMUNOLOGICAL CHARACTERISTICS OF SEVERE BRONCHIAL ASTHMA

Abstract

Bronchial asthma is the most common and socially significant disease in humans. Among patients who cannot achieve control, a special group is patients with severe asthma. Objective: comprehensive assessment of clinical, functional, immunological features and pharmacotherapy of severe bronchial asthma in real clinical practice to optimize basic pathogenetic therapy. Materials and methods: 83 patients diagnosed with severe asthma were examined. Patients with severe asthma are divided into 2 groups: patients with and without fixed airway obstruction. Plasma concentrations of cytokines IL-4, IL-5, IL-9, IL-13, periostin, cathepsin S, TGF- were determined by solid-phase enzyme immunoassay. Immune status was investigated on the NAVIOS Flow Cytometer. Results: In both groups of severe bronchial asthma, we found a decrease in T helper and immunoregulatory index levels with simultaneous increases in cytotoxic T lymphocytes, natural T killers, naive T lymphocytes, activated T and B lymphocytes, and phagocytic index compared to controls. There were no differences in immune status between the groups and the resulting changes were independent of the presence or absence of fixed obstruction. In both study groups, we found an increase in cathepsin S and TGF- in plasma compared to control. We identified the most significant risk factors for the formation of fixed obstruction: taking SABA more than 4 inhalations per day (OR = 4.2) and FeNO concentration more than 20 ppb (OR = 6.0). There was a significant improvement in the clinical condition of patients with severe asthma with fixed obstruction while taking genetically engineered biological therapy for a year. Conclusion: To date, there is no unambiguous idea of the mechanisms of implementation of pathobiochemical reactions in the bronchial wall in severe asthma, which lead to the development of fixed airway obstruction. Severe asthma is variable and depends on the correct choice of management tactics.