Optimization of personalized approaches to the basic treatment of persistent bronchial asthma in children regarding the phenotypic and genotypic characteristics of patients

Abstract

Objective. To evaluate the effectiveness of inhaled glucocorticosteroids in children with atopic and non-atopic asthma phenotypes depending on the acetylation status.Material and methods. A complex clinico-immunological examination involved 119 children with bronchial asthma. The genetic marker, namely the type of acetylation, has been identified by the method of V. M. Prebsting — V. I. Gavrilova in the modification of Timofeeva. They were divided into four clinical groups: group I — 36 children with atopic bronchial asthma (ABA) and slow acetylation type (patients’ average age — 13,4±0,6 years, the proportion of boys — 69,2±2,2%), group II — 30 patients with fast acetylating status and ABA (average age of patients — 12,±0,5 years, the quota of boys — 70,0±2,0%). The third (III) clinical group included 26 patients with nonatopic variant of the disease and slow acetylation phenotype (patients’ average age — 12,6±0,6 years, the proportion of boys — 59,1±1,6%), and in the forth (ІV) group there were 26 patients with nonatopic bronchial asthma (NBA) with a fast typeof acetylation (average age of patients — 12,5±0,6 years; (P> 0,05); the share of boys - 65,2±2,0% (P> 0,05). The main clinical characteristics of the comparison groups were comparable.Results. The use of IGS in patients with a fast acetylation status and atopic bronchial asthma were found to be more effective than that in patients with slow acetylation type, and such treatment improved clinical and paraclinical parameters of asthma control significantly as evidenced by an increase in the relative risk of a relatively satisfactory level of control by 68.1%, an increase in the absolute risk of bronchial asthma control by 58.0%, with a minimum number of patients who need to be treated by such method in order to achieve at least one positive result is 2.2. At the same time, in patients with a non-atopic bronchial asthma phenotype in the presence of a slow acetylation status, the use of IGS resulted in an increase by 59.7% of relative risk by 47.0% of absolute risk of control of the disease. Conclusions. Basic anti-inflammatory therapy of bronchial asthma using ICS is more effective for treatment of children with atopic asthma as well as for patients with nonatopic asthma phenotype associated with a slow type of acetylation.