Phenotypes of occupational bronchial asthma from the standpoint of immunopathogenesis

Abstract

IIntroduction. Currently, occupational bronchial asthma is considered as a phe notypically and genetically heterogeneous disease. The assessment of clinical data, func tional features, and immunopathogenesis opens up new opportunities in assessing the development, predicting the characteristics of the course, and working out a personalized approach to pharmacotherapy of occupational asthma, as well as in developing an individ ual strategy for its prevention. The purpose of the study was to determine clinical and immunological markers of the risk of developing occupational asthma under conditions of exposure to sensitizing substances in various phenotypes of this disease. Materials and methods. The study included 170 patients with various OA phenotypes and 50 participants in the control group. The pulmonary function test was carried out on the CareFusion MicroLab Desktop Spirometer (Great Britain). The levels of IL-17, TNF-α, vas cular endothelial growth factor (VEGF), MCP-1, IFN-γ, and total IgE in blood serum were determined by solid-phase enzyme immunoassay using kits and reagents (OOO «Protein contour», «Vector-Best», «Diatex-E», «DIA-plus», «Pharmacia diagnostika»). Results. For the first time, the features of clinical and immunological manifestations in allergic and non-allergic OA phenotypes, as well as phenotypes of OA combination with occupational chronic obstructive pulmonary disease and metabolic syndrome were es tablished; the features of formation, immunopathogenesis, and prognosis in various phe notypes of occupational bronchial asthma were revealed. This allows recommending the determination of these immunological parameters during in-depth periodic medical exam inations of workers under conditions of exposure to sensitizing and irritating substances for differential diagnosis of various phenotypes of occupational bronchial asthma in a specialized inpatient examination. Limitations of the study. The study has regional (Samara region) and professional (in terms of detailing the working conditions in the studied comparison groups) limitations. Conclusion. The identified clinical, immunological, and genotypic features in various OA phenotypes and the established profiles of OA genotypes can optimize the approach to early diagnosis, prognosis, prevention, and pharmacotherapy of this disease, as well as expand the list of immunological study indicators used during preliminary and periodic medical examinations, in-depth examination of patients with occupational bronchial asth ma in occupational disease clinics and occupational pathology centers, and the application of new reliable criteria for predicting the course of the disease.