Efficiency of basic treatment of asthma phenotypes in children depending on the time of disease onset

Abstract

The study aimed at improving the effectiveness of asthma treatment by analyzing the level of control, the dynamics of inflammometric and spirometric indices in children with phenotypes of early and late onset of the disease. Materials and methods. On the base of pulmonological department of the Regional Pediatric Hospital (Chernivtsi) 97 school-age children with late onset asthma and 59 school-age children with early onset asthma were examined. All the children received an amount of anti-inflammatory treatment equivalent to severity and control, defined by current standards of care. Determination of the effectiveness of basic therapy was carried out by assessing the control parameters of the disease using the AST test. Bronchial inflammation intensity was determined by the content of metabolites of nitrogen monoxide in the expiratory condensate by Yemchenko N.L. Bronchial lability was assessed by evaluating exersice-induced bronchoconstriction and response to short-acting β2-agonist inhalation. Airway hyperresponsiveness was assessed according to the results of bronchoprovocation testing with histamine by determining bronchial hypersensitivity to stimuli while calculating the provocation concentration (PC20H) and dose (PD20H). Results. Achievement of asthma control after anti-inflammatory treatment was inherently slower in a group of children with late onset asthma. Clinical manifestations of asthma control were accompanied by reduce of bronchial inflammation activity in children with early-onset phenotype than in patients with a late-onset phenotype, which is reflected in the indices of asthma control. Basic control therapy did not significantly affect the expressiveness of the nonspecific bronchial hypersensitivity to direct and indirect provocative stimuli. Conclusion. The worst indices of control achieving in schoolchildren with late- onset asthma phenotypes are associated with pronounced bronchial inflammation and hyperresponsiveness. In school-age children with a late-onset asthma phenotype basic anti-inflammatory therapy is performed reasonably according to the de-escalation principle, taking into account the control achievement