ON THE OPTIMIZATION OF VERIFICATION OF BRONCHIAL ASTHMA IN CHILDREN WITH MANIFESTATIONS OF BRONCHOOBSTRUCTIVE SYNDROME

Abstract

Bronchial asthma in children has different causes of development, and examination of markers to verify the disease in case of the first signs of bronchial obstruction is an important issue to find transitory or persisting asthma phenotypes. There were examined 156 children with signs of bronchial obstruction syndrome.They were divided into three clinical groups: the first (І) group included 36 children with acute obstructive bronchitis (average age 6,1 ± 0,6 years, 36 % of girls), the second (ІІ) group – 74 children with relapsing obstructive bronchitis (average age 5,60 ± 0,34 years, 38 % of girls), the third (ІІІ) group included 46 children suffering from bronchial asthma for two years (average age 11,6 ± 0,5 years, 33 % of girls).The family history of one of the parents and of both parents, aggravated by allergic diseases, was most often found in patients with bronchial asthma: in 34,8 % of children on maternal side (Р ˂ 0,05 with І, ІІ : ІІІ), in 17,4 % of cases on paternal side (Р ˃ 0,05) and in 4,3 % – on both sides (Р ˃ 0,05). Patients suffering from bronchial asthma in 78,3 % of cases demonstrated domestic, food or medical allergy, that was reliably higher than that of an appropriate number of children in І (33,3 %) and ІІ groups (37,2 %), Р ˂ 0,05. In case of complicated family anamnesis with allergic diseases and the level of nitrogen monoxide metabolites more than 40 µmol/l the diagnostic value of this test in detection of bronchial asthma is the following: sensitivity 87,5 %, specificity 89,5 %, predicted value of a negative result 97,1 % with realization odds ratio 59,5, relative risk 22,3. Relative blood eosinophilia (Р ˂ 0,05 with ІІІ : І, ІІ) and sputum eosinophilia (Р ˂ 0,05 with ІІІ : І, ІІ) in children suffering from bronchial asthma as compared to the patients with obstructive bronchitis were found. In patients with verified asthma compared with children with acute and recurrent obstructive bronchitis, a significantly higher number of eosinophils, alveolar macrophages and epithelial cells in sputum is observed, which is accompanied by a lower content of neutrophil granulocytes and lymphocytes.Thus, in children with bronchial obstruction, even at its first episode, to identify the risk of bronchial asthma, a family history should be carefully collected on the burden of allergic diseases, the history of the child on allergic manifestations, in the dynamics to determine the number of eosinophils in the peripheral blood and induced sputum, the level serum immunoglobulin E and the content of metabolites of nitric oxide in the condensate of exhaled air.