Abstract
The aim of research was to improve the management of bronchial asthma in children by examining the peculiarities and diagnostic value of reaction markers of eosinophil granulocytes in the sputum and peripheral blood of patients with signs of eosinophil and non-eosinophil phenotypes of this disease. A cohort of 118 school-age children suffering from BA was examined during a period free from attacks. Group I (the main group ) included 61 schoolchildren with signs of eosinophil phenotype (EP) of asthma detected by the character of bronchial inflammation with eosinophil granulocytes present in the sputum at a level of >3%, group II (the comparison group) included 57 patients with a lower number of eosinophils in the sputum (non-eosinophil phenotype (NP) of BA). The average index of the relative content of eosinophils in the peripheral blood among the representatives of group I was 5.82 ± 0.63%, and in children with the signs of NPBA – 6.02 ± 0.74% (P > 0.05), and average indices in the groups of absolute eosinophil number in the blood were 0.37 ± 0.04 and 0.41 ± 0.05 respectively (P > 0.05). The negative reserve of NBT eosinophils in the sputum as a test to verify EPBA showed the following diagnostic values: specificity – 83.3%, predicted value of a positive result – 95.6%. IL-5 content in the blood serum of children with EPBA was 5.99 ± 1.74 ng/ml, in patients of group ІІ – only 1.99 ± 0.49 ng/ml (P < 0.05). Eosinophil cationic protein (ЕСР) in the sputum of patients of group I reached 2.72 ± 0.35 ng/ml, and in the comparison group – only 1.74 ± 0.34 ng/ml (P < 0.05), when the content of ECP in sputum was >1.0 ng/ml the risk of EPBA showed a statistically significant increase: OR = 4.13, RR = 2.02, and AR – 0.34. The efficacy of the standardized basic anti-inflammatory therapy in patients of clinical group I was higher as compared to the children with the signs of NPBA, which was illustrated by the reduced risk of inadequate control of the disease: the index of absolute risk decrease was 31.7%, relative risk – 57.1% with necessary minimal number of patients – 1.75.
Highlights
Nowadays bronchial asthma in children is considered as a disease characterized by chronic inflammation of the bronchi, in the development of which various cells and cellular elements play a certain role (Global Strategy for Asthma Management and Prevention, 2016)
The male gender was associated with an increased risk of eosinophil phenotype of bronchial asthma (EPBA): odds ratio (OR) index was 7.3 (95% CІ: 1.69–8.23), relative risk (RR) – 1.63 (95% CІ: 1.02–2.59), attributive risk (АR) – 0.3
The indices of asthma control during initial examination did not differ among the patients with alternative phenotypes of bronchial asthma (BA), and on completion of the 3rd month of the basic therapy they appeared to be significantly worse among patients with noneosinophil phenotype of bronchial asthma (NPBA)
Summary
Nowadays bronchial asthma in children is considered as a disease characterized by chronic inflammation of the bronchi, in the development of which various cells and cellular elements play a certain role (Global Strategy for Asthma Management and Prevention, 2016). In case of antigenic stimulation, primary effector cells (epithelial cells of the respiratory tract, mast cells, macrophages) bound with IgE are considered to release mediators of inflammation resulting in the development of an inflammatory reaction both of an immediate and late type. Eosinophils constitute from 1% to 4% of the total number of leukocytes (120–350 cells/mm). Eosinophils constitute from 1% to 4% of the total number of leukocytes (120–350 cells/mm2) They are of a specific granularity approximately 200 granules per cell. Proinflammatory properties have been found in eosinophils due to those substances which are characterized by cytotoxicity and aid stimulation of mast cells and basophils degranulation, and detection of the content of cationic proteins and peroxidase can be indicative of the degree of activation of the major proinflammatory cells of an allergic inflammation, and indirectly – of severity of this inflammatory process. Eosinophils are mainly tissue cells and this fact complicates the study of their functional peculiarities (Novitskiy et al, 2006)
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