Bronchial Obstruction Syndrome Research Articles

#1182 Arterial hypertension and chronic obstructive pulmonary disease—problems of choice of therapy

Abstract Background and Aims The development of hypertension in COPD is based on the early formation of endothelial dysfunction in the small and large circulatory circles, increased sympathetic activity with an imbalance in the synthesis of catecholamines, a violation of the role of the lungs in the metabolism of vasoactive substances, oxidative stress, chronic systemic inflammation, an imbalance in the renin-angiotensin-aldosterone system (RAAS). There are few studies confirming the role of RAAS components in the pathogenesis of cardiovascular changes in patients COPD. The activity of angiotensin converting enzyme (ACE) increases with hypoxia, which may play an important role in increasing the degree of systemic hypertension. An increase in the function of the RAAS is possible both under the direct influence of hypoxia and indirectly through activation of the sympathoadrenal system. To evaluate the efficacy and tolerability of the angiotensin II receptor antagonist valsartan (Nortivan) at a dose 80-160 mg per day in patients with hypertension of 1-2 degrees and COPD of stage II-IV. Method The study design is a local, open, incomparable study on the efficacy and safety of the drug Nortivan in patients with hypertension in combination with COPD. We examined 18 patients with stage II-IV in remission, suffering from grade I and II hypertension, determined in accordance with the generally accepted classification of blood pressure levels (VNOK, 2010). Results The criteria for exclusion from the study were the presence in patients of complications of hypertension, coronary heart disease, decompensated chronic pulmonary heart, endocrine diseases requiring drug correction, kidney pathology, chronic heart failure, oral steroid therapy. 10 days in the last 6 months before inclusion in the study, oncological diseases and any other conditions that could interfere with the interpretation and evaluation of the results of the study. Patients who had not previously received antihypertensive treatment were included in the study immediately, and the rest underwent a washing period for 2 weeks. Patients received Nortivan as antihypertensive therapy for 24 weeks. The effectiveness of therapy was controlled by daily monitoring blood pressure. The choice of quality criteria for the effectiveness of therapy parameters SMAD is associated with literature data and own observations on the prevalence of diurnal blood pressure profiles in patients with hypertension and COPD with no decrease or increase in blood pressure at night, when office blood pressure figures are to a lesser extent reflect the effectiveness of antihypertensive therapy. The initial dosage was 80 mg/day. With insufficient hypotensive effect, the dose of the drug was doubled at the 4th week of treatment. The basic COPD therapy did not change throughout the study period and included anticholinergic drugs (ipratropium bromide, tiotropium bromide), beta2-adrenomimetic (fe-noterol) or a combination thereof. Initially and after 24 weeks of treatment, a complete laboratory examination was performed: a clinical blood test, a biochemical blood test. The thickness of the intima-media complex of the carotid arteries and ECG was also studied. The criterion The safety of the therapy was assessed by the indicators of respiratory function, daily pulse oximetry. Conclusion The use of the drug Nortivan has shown high efficacy and safety in patients Grade I–II hypertension in combination with stage II-IV COPD. A statistically and clinically significant normalization of SMAD indicators with correction of pathological types of daily curves due to a decrease in the number of patients with an increase in or the absence of a decrease in blood pressure during the night period. The safety of using the drug in the clinical group with bronchial obstruction syndrome was confirmed by the dynamics of ventilation indicators according to spirometry and the results of daily pulse oximetry, which showed the absence of exacerbation of hypoxia during therapy.

Analysis of exhaled breath condensate in patients with asthma and recurrent wheezing

Wheezing is the most common clinical symptom of bronchial obstructive syndrome. The functions of pulmonary surfactant (PS) depend directly on the level of total phospholipids (TP). This can be used to assess the integrity of the cell membrane structure. Objective. To determine the level of total phospholipids and calcium in exhaled breath condensate in young children with recurrent wheezing and asthma. Materials and methods. The study included 77 patients divided into 3 groups. Group 1 included 30 patients (20 girls and 10 boys) with no more than 2 episodes of recurrent wheezing in their lifetime; Group 2 -10 patients (6 boys and 4 girls) with more than 3 episodes of recurrent wheezing, and 37 patients (15 girls, 22 boys) with asthma. The control group consisted of 20 conditionally healthy children (11 girls, 9 boys). All patients were aged from 3 months to 6 years. The determination of phospholipid levels and calcium (Ca) in the exhaled breath condensate was performed in dynamics - during the period of clinical manifestations and remission. Results. The level of phospholipids in the exhaled breath condensate was the highest in patients of all groups at the stage of clinical manifestations compared with the period of remission, while its lowest level was noted in the control group. During the peak of the disease, the level of Ca in the exhaled breath condensate was significantly lower compared to the period of remission. The control group had the highest level. Conclusions. The exhaled breath condensate's high level of phospholipids in the first days of the disease confirms cell damage in the presence of inflammation. Additionally, the exhaled breath condensate's Ca level is lowest during this period, possibly indicating its involvement in cell damage

Синдром бронхиальной обструкции у детей

Одним из проявлений обструкции дыхательных путей у детей является синдром бронхиальной обструкции, имеющий полиэтиологическую природу, требующий диагностического поиска с целью уточнения причины развития и оказания квалифицированной помощи как для купирования данного патологического состояния, так и лечения основного заболевания, имеющего клинические проявления бронхообструкции. Наиболее часто синдром бронхиальной обструкции у детей является проявлением острой респираторной вирусной инфекции. Немаловажное значение в развитии бронхообструктивного синдрома имеют герпес-вирусы. Инфицированность детской популяции вирусами семейства герпесов высока, клинические проявления разнообразны. Для герпес-вирусных инфекций у детей, особенно дошкольного возраста, характерно поражение верхних и нижних дыхательных путей, в том числе с развитием бронхообструкции. Иммуносупрессивное действие герпес-вирусов способствует рецидивированию патологического процесса. Начальные проявления бронхиальной астмы у детей раннего, дошкольного возраста часто носят характер рецидивирующего синдрома бронхиальной обструкции на фоне острых респираторных вирусных инфекций. Это диктует необходимость углубленного обследования детей с рецидивирующей инфекцией дыхательных путей, в том числе с синдромом бронхиальной обструкции, включая в комплекс обследования определение маркеров активности герпес-вирусов. Применение противовирусной терапии препаратами, оказывающими влияние не только на респираторные вирусы, но и вирусы семейства герпесов в острый период, пролонгированные схемы при рецидивирующем характере процесса в сочетании с антилейкотриеновыми препаратами дают выраженный положительный эффект в отношении как рецидивов бронхообструкции, так и предупреждения развития или/и контроля течения бронхиальной астмы. One of airway obstruction manifestations in children is bronchial obstruction syndrome, having a polyetiological nature, requiring a diagnostic search for clarifying causes and providing qualified assistance both for relieving this pathological condition and managing the underlying disease presenting clinical manifestations of bronchial obstruction. Most often bronchial obstruction syndrome in children is manifested by acute respiratory viral infection. An important role in bronchial obstruction syndrome development is played by herpes viruses. The incidence of herpes family viruses’ infection among pediatric population is high, and its clinical manifestations are various. Herpesvirus infections in children, especially of preschool age ones, are characterized by upper and lower respiratory tract involvement, including bronchial obstruction development. The immunosuppressive effect of herpes viruses contributes to pathologic process recurrence. The initial manifestations of bronchial asthma in children of early and preschool age are often characterized by recurrent bronchial obstruction syndrome against the background of acute respiratory viral infections. This requires in-depth examination of children with recurrent respiratory tract infection, including those with bronchial obstruction syndrome, with detection of herpes viruses’ activity markers within comprehensive examinations. The use of antiviral therapy with drugs products affecting not only respiratory viruses, but also herpes family viruses in the acute period, prolonged regimens in recurrent nature of the process in combination with antileukotriene drugs produce a pronounced beneficial effect in terms of both recurrences of bronchial obstruction and preventing the development or/and monitoring of bronchial asthma.

Diagnosing disorders of respiratory mechanics in refractory workers

Introduction. The current decrease in occupational exposures complicates expert examination of the link between job and disease, thus requiring the use of more sensitive and high-tech diagnostic techniques. In addition, a low incidence rate of occupational diseases against the background of poor working conditions indicates a possible increase in the incidence of “hidden” occupational diseases mimicking common non-communicable diseases.
 The purpose of our study was to assess the respiratory function in refractory workers using body plethysmography and measurements of the diffusing capacity of the lungs.
 Materials and methods: One hundred six male workers aged of 45.62±0.8 years, all engaged in refractory manufacturing for the average of 15.5±0.88 years and at risk of dust-related respiratory diseases, were examined in our Occupational Health Center within the regular health check-up.
 Results. The results of body plethysmography (a pulmonary function test) showed a decrease in the FEV1/FVC ratio, i.e. the ratio of the forced expiratory volume over the first one second to the forced vital capacity of the lungs, to the group average of 77.87±0.76% of the normal value. We also observed increased bronchial resistance during exhalation and total bronchial resistance in 65% and 50.9% of the workers, respectively. We registered a decreased transfer factor in the examined subjects with the group average of 73.9±1.37%. Neither chest X-ray nor CT scan showed significant changes in most of workers. Signs of emphysema were registered in 5.7% of those examined cases. No significant differences in the prevalence of obstructive disorders were found between smoking and non-smoking workers. Bronchial obstructive syndrome in combination with impaired pulmonary gas exchange and respiratory muscle fatigue was registered 
 in 16 workers (15%), thus necessitating specific therapy to interfere with disease progression.
 Limitations. Our findings cannot be extrapolated to the workforce as a whole, since only men included in the study cohort.
 Conclusions. Indicators of the diffusing capacity of the lungs, which simultaneously reflect both pulmonary ventilation and perfusion, in combination with findings of body plethysmography and chest CT scan, can provide important information about functional changes in the respiratory system. Early diagnosis of bronchial obstructive syndrome allows timely beginning therapy and prevention of disease progression.

Treatment of children with bronchial obstruction syndrome on the background of connective tissue dysplasia: realities and prospects

Treatment of children with bronchial obstruction syndrome on the background of connective tissue dysplasia: realities and prospects

Bronchial obstruction syndrome in children with connective tissue dysplasia

A systematic analysis of the data available in modern literature concerning the problem of connective tissue dysplasia in children and adolescents, and the results of studying the course of bronchial obstruction syndrome in patients with this pathology, was carried out. Mechanisms of connective tissue dysplasia is imperfect, elucidation of the genetic causes of hereditary connective tissue disorders has not yet led to cardinal improvements in diagnosis, prevention and treatment. Connective tissue dysplasia is characterized by the presence of changes in the bronchopulmonary system: tracheobronchial dyskinesia (expiratory collapse of the trachea and large bronchi), tracheobronchomalacia and tracheobronchomegaly, apical bullae, confirmed by radiographic and spontaneous pneumothorax (more common in young men), the presence of thoracodiaphragmatic syndrome, which includes an asthenic form of the chest, deformities chest and / or spine, change in standing height and excursions of the diaphragm. The etiological and pathogenetic factors in the development of bronchiectasis remain ambiguous. Patients with connective tissue dysplasia require special attention and deeper study. The presence of thoracodiaphragmatic and bronchopulmonary syndrome in children contributes to a longer course of broncho-obstructive syndrome, a brighter, vegetative color of seizures is described. It is noted that these patients need more aggressive and long-term therapy.

The role of surfactant system dysfunction in the formation of dyspnea in patients with COVID-19-associated pneumonia

OBJECTIVE. To determine the contribution of surfactant system dysfunction (by level surfactant protein A (SP-A) of serum) to the formation of dyspnea in the subacute post-COVID (coronavirus disease) period in patients with COVID-19-associated pneumonia.
 MATERIALS AND METHODS. We screened 102 patients with dyspnea who had COVID-19-associated pneumonia in April – November 2021. The study was conducted in the subacute period of COVID-19 on day 47 (38; 62) after the first symptoms of coronavirus infectious. We excluded 25 patients whose dyspnea was associated with bronchial obstructive syndrome, signs of heart failure or anemia, and formed the main group of 77 patients with dyspnea due to lung parenchyma damage: mean age – 56 (49; 65) years, men – 37 (48.1 %), women – 40 (51.9 %). The control group consisted of 15 practically healthy individuals: mean age – 51 (45; 60) years, men – 6 (40.0 %), women – 9 (60.0 %). The main group was divided into three subgroups depending on the severity of COVID-19 in the acute period: subgroup 1 – 26 patients with dyspnea (mean age – 57 (53; 64) years; men – 12 (46.2 %), women – 14 (53.8 %)) who had a moderate course of the acute period of the disease; subgroup 2 – 36 patients (mean age – 55 (49; 61) years, men – 18 (50.0 %), women – 18 (50.0 %)) who had a severe course of the acute period of COVID-19; subgroup 3 – 15 patients (mean age – 55 (52; 63) years, men – 7 (46.7 %), women – 8 (53.3 %)) who had a critical course of the acute period of COVID-19. The examination of patients had consist general clinical methods, determination of level SpO2, assessment of dyspnea severity by the modified Borg scale, the 6-minute walk test (6MWD), and measurement levels SP-A of serum.
 RESULTS AND DISCUSSION. Patients of subgroups 3 of COVID-19 in the subacute period had quite severe dyspnea both before 6MWD (4 (3; 6) points on the Borg scale) and after it (7 (5; 9) points on the Borg scale), whereas patients of subgroups 1 and 2 had less severe dyspnea both before 6MWD (1 (0.5; 2) and 2 (1; 4) points, respectively) and after it (2 (1; 3) and 5 (4; 7) points, respectively). The level of SP-A in the subacute period was significantly higher in patients of subgroups 2 and 3 compared to patients of subgroup 1 (73.8 (59.0; 87.2), 88.1 (51.1; 100.8) ng/ml and 46.6 (21.1; 77.1) ng/ml, respectively) (p<0.05). There was no significant difference between patients in subgroup 1 and the control group (46.6 (21.1; 77.1) vs 29.6 (14.0; 53.1) ng/ml) (p>0.05). Analysis of the area under the ROC curve between patients in subgroup 1 and subgroups 2 and 3 showed a high diagnostic ability of the test: AUC 0.866 (95 % confidence interval 0.766-0.935; p<0.0001) with an optimal cut-off point of 59 ng/ml (sensitivity – 78.4 %, specificity – 95.5 %). At a serum SP-A level >59 ng/ml, the risk of lung surfactant system dysfunction in severe or critical patients in the subacute period of the disease increases 6-fold (odds ratio 6.1; 95 % confidence interval 2.2-17.3; p=0.0006).
 CONCLUSIONS. The severity of dyspnea in the subacute period of COVID-19 due to lung parenchymal damage depends on the severity of the acute course of the disease. Elevated SP-A levels (>59 ng/ml) in the subacute period of COVID-19 are observed in patients with severe or critical acute disease and reflect the presence of signs of long-term surfactant system dysfunction.

Congenital vascular rings as a cause of respiratory and esophageal problems in children

Congenital anomalies of the aortic arch include a wide range of anatomic pathologies, which may be completely asymptomatic or accompanied by severe respiratory and/or esophageal symptoms, especially in the case of complete vascular rings (VR). Purpose - to draw the attention of pediatricians and family phisicians to possible clinical presentations of aortic arch anomalies, namely VR, to increase their awareness of this pathology, that will contribute to differential diagnosis. VR, are anomalies of the aortic arch that result from abnormal development of the embryonic aortic arches. The prevalence of VR is approximately 1%, of which 55% are double aortic arch. This congenital heart defect can be either isolated or combined with other congenital heart defects. Associated cardiac pathology occurs in 12.6%, and includes ventricular septal defect and Tetralogy of Fallot. Sometimes this defect is associated with DiGeorge’s and Turner’s syndrome. The timing of appearance of clinical symptoms varies from the early neonatal period to adulthood. However, most patients develop clinical symptoms in the first months after birth, and they indicate the need of cardiac surgery during the first year of life. Given the serious consequences of this anomaly, VR should be included in the list of differential diagnoses of wheezing, stridor, difficulty swallowing and bronchial obstruction syndrome in children, especially when these symptoms appear since birth, are persistent and respond poorly to standard therapeutical approaches. Therefore, it is important for pediatricians to be alert for a congenital heart defect such as VR as one of the possible causes of congenital stridor, wheezing, and swallowing disorders in infants. Contrast-enhanced computed tomography and magnetic resonance imaging of the heart are the diagnostic modalities of choice for VR diagnosis. These diagnostic methods provide accurate location, nature of branching and dominance of the aortic arch as well as the degree of compression of the airway and esophagus. Three-dimensional reconstruction helps to plan future surgical intervention. No conflict of interests was declared by the authors.

Interleukins in serum and bronchoalveolar lavage in patients with chronic obstructive pulmonary disease or bronchial asthma after pulmonary tuberculosis or pneumonia

The spread of respiratory diseases has become a topical issue of modern medicine. The prevalence of the diseases caused the rising rates of disability and mortality among people affected by respiratory diseases. The clinical course of respiratory diseases includes the disorders of general and local adaptive and protective mechanisms and cell-mediated connections. Objective — to determine the interleukin profile of serum and bronchoalveolar lavage for the verification of chronic obstructive pulmonary disease (COPD) or bronchial asthma in patients with pulmonary tuberculosis or pneumonia with bronchial obstruction syndrome. Materials and methods. 67 patients affected by chronic obstructive pulmonary disease and 33 patients diagnosed with bronchial asthma who were hospitalized in the Pulmonology Lviv Regional Diagnostic Center during 2015—2020, were examined. The patients were verified with a non-complicated tuberculosis without any destructive changes evident in the lungs (the first or third clinical category of patients), the community-acquired pneumonia with the bronchial obstruction syndrome. Pro-inflammatory interleukins IL-1β, IL-2, IL-6, TNF-α and anti-inflammatory IL-4 in serum and bronchoalveolar lavage were revealed during the lobar and tertiary bronchi fiber-optic bronchoscopy. Results and discussion. The interleukins misbalance was evident: the decrease in IL-1β and IL-2 and the increase in IL-6 and TNF-α by 4.5 times as compared to the unaffected donors was revealed in the patients with chronic obstructive pulmonary disease. The significant decrease in IL-4 was revealed pointing at the high probability of the severe and prolonged COPD and leading to frequent exacerbation and compilations of the disease. By contrast, the patients diagnosed with bronchial asthma showed higher IL-1β and IL-2 as compared to the unaffected patients; the level of IL-6 was higher as compared to the COPD patients, while TNF-α was lower. The patients with bronchial asthma showed higher IL-4 than the unaffected donors and the patients with COPD. Conclusions. The intensity of interleukins expression (especially pro-inflammatory) revealed the level of inflammation based on the acute-phase proteins in the proteolytic-antiproteolytic balance, which may be also used as the additional criteria for the differential diagnostics and justification for the treatment optimization.

Development and implementation in outpatient practice of an electronic computer program “Diagnostics of bronchial asthma in children”

BACKGROUND: Currently, the criteria for the differential diagnosis of bronchial asthma and several respiratory diseases in children, accompanied by bronchial obstruction syndrome, remain insufficiently effective. Moreover, timely administration of anti-inflammatory therapy is important.
 AIM: To develop and introduce a computer program for the timely diagnosis of asthma in children and appointment of basic therapy into outpatient practice.
 MATERIALS AND METHODS: A comparative comprehensive analysis of risk factors for disease development in 155 children with bronchial asthma and 155 clinically healthy children who suffered episodes of bronchial obstruction at an early age was conducted, and a computer program that allows timely diagnosis of asthma was developed. The program was tested during the observation of 68 children with episodes of bronchial obstruction.
 RESULTS: Sixty-two most significant signs (disease predictors) were established, which formed the basis of the computer program Diagnostics of bronchial asthma in children. The application of the program in clinical conditions showed a high consistency of the result with the conclusion of an allergist-immunologist. The sensitivity and specificity of the method were 88.2% and 94.1%, respectively (p 0.05). The program was introduced into outpatient practice.
 CONCLUSION: The data obtained determine the possibility of using the proposed computer program as a tool for the timely diagnosis of bronchial asthma in children.

EFFICACY OF PRIMARY REHABILITATION MEASURES ASSOCIATED WITH THE DEVELOPMENT OF RECURRENT BRONCHIAL OBSTRUCTION SYNDROME IN YOUNG CHILDREN WITH RESPIRATORY DISORDERS IN NEONATAL PERIOD.

The aim: To improve primary prophylactic measures associated with the development and progression of recurrent bronchial obstruction syndrome in young children, who had suffered respiratory disorders in neonatal period. Materials and methods: Algorithm of primary prophylactic measures implied adequate balanced nutrition, sanation of living conditions, restriction of contact with infectious agents, sanation of chronic foci of infection, systematic training and general fitness. The investigation included 160 young children (1 day - 3 years of age). The basic group (n=80) involved children, who had experienced respiratory disorders in neonatal period and received appropriate respiratory therapy (artificial ventilation and / or spontaneous breathing with continuous positive airway pressure and supply of free oxygen), control group - children, who did not have respiratory disorders and respiratory therapy (n=80). Results: Conducted investigation throughout 12-month monitoring enabled to record the development of recurrent bronchial obstruction syndrome in 43 children (respectively, 30 - 37.50% patients of the basic group versus 13 - 16.25% of control group; p 0.05), could not be obtained. Conclusions: Comparative analysis within groups did not show a reliable difference in the development of recurrent bronchial obstruction syndrome in children (р>0.05), which can be explained by partial following of doctor's recommendations. There is the need in further study of the issue involving more patients for a longer period of monitoring.

Variability of the pharmacological response in children with different ADRB2 gene polymorphisms in recurrent bronchial obstruction and bronchial asthma

To date, methods of studying the effects of drugs at the molecular-genetic level are widely used in pediatric practice. The aim of our work was to evaluate the effectiveness of the effect of β2-agonists on the clinical course of recurrent bronchial obstruction (RBO) in children, depending on the variants of polymorphism of the ADRB2 gene. The effectiveness of salbutamol in children with RBO and bronchial asthma(BA) was evaluated depending on the distribution of alleles and genotypes of the ADRB2 Argl6Gly and Gln27Glu genes according to the degree of reversibility of bronchial obstruction. In the group of children with RBO carriers of the heterozygous A/G genotype of the Arg16Gly locus and the Gln27Glu locus of the ADRB2 gene, high efficacy of salbutamol therapy as a bronchodilator was noted. At the same time, in children with RBO representatives of the G/G genotype, the effectiveness of using the drug is low. In children with BA, the change in functional activity is associated with the polymorphism of the Gln27Glu gene locus and is associated with a low therapeutic response to β2–agonists in children with the G\G mutational genotype and a good effect in carriers of the homozygous variant with the A/A genotype. Knowledge of the genotype of polymorphic variants of the ADRB2 gene will make it possible to evaluate one of the factors of predisposition and effectiveness of therapy in the recurrent course of bronchial obstruction syndrome and bronchial asthma.

Функціональний стан дихальної системи у хворих із задишкою, які перенесли негоспітальну пневмонію, асоційовану з COVID-19

Функціональний стан дихальної системи у хворих із задишкою, які перенесли негоспітальну пневмонію, асоційовану з COVID-19

Diagnostics of bronchial obstruction syndrome with portal wheezing detector in children

Objective. To determine the efficiency of diagnostics of the clinical syndrome of bronchial obstruction with WheezeScan detector in children, to assess the sensitivity and specificity of this method. Electronic medical devices used for registration and analysis of breath sounds can help to diagnose different syndromes in pediatric pulmonology.
 Materials and methods. The study involved 15 children aged 1 to 17 years, who were hospitalized to Pulmonology Unit of the Regional Childrens Clinical Hospital. The children were divided into two groups depending on the presence or absence of wheezes in auscultation. The detector WheezeScan HWZ-1000T-E (Omron) was used to study the presence of wheezes. The control group included children without any objective signs of bronchial obstruction.
 Results. It was detected while examining children that in auscultation 20 % (n=3) of children had dry wheezes, and in detector diagnostics the result was positive in 100 % of cases. In auscultation, 80 % (n=12) of children did not show clinically marked bronchial obstruction syndrome, the result of WheezeScan detector was 73 % (n=11). Diagnostic sensitivity and specificity was 100 %.
 Conclusions. Screening diagnostics of bronchial obstruction syndrome in children by means of electronic detector of wheezing is effective and can be applied for ambulatory patients of different ages in a pediatric hospital unit.

Bronchial Obstruction Syndrome in Children

Bronchial Obstruction Syndrome in Children

Features of carbohydrate metabolism in asthma patients with obesity

Asthma (As) and metabolic disturbances are widespread and socially significant states, obesity (Ob) being also one of them. The comorbidity of As and Ob both affects physiological mechanisms of bronchial obstruction syndrome, the course and prognosis of these two diseases and significantly complicates their treatment. A combination of changes in ventilation and a complex architectonics of the bronchi may contribute to worsening control over As. The performed study deals with the problem of early diagnosis and progression of the course in patients with As and Ob comorbidity. The study involved 62 patients with As. Of them, there were 24 cases with the normal body mass (Group I) and 38 cases with As+Ob (Group II). Along with evaluation of respiratory function values and anthropometric examination, all the patients underwent controlling of carbohydrate metabolism. It was found out that As combined with Ob were accompanied by a cascade of metabolic disorders: hyperinsulinemia, insulin resistance, and higher levels of HbA1с and fasting glucose versus the control group (р<0.05). According to correlation analysis data, in Group II negative correlations between values of HOMA-IR and 40≤FEV1<50% (r= -0.53; р<0.05), HOMA-IR and 50%≤FEV1<60% (r= -0.49; р<0.05), insulin level and 40≤FEV1<50% (r= -0.42; р<0.05) as well as a positive correlation between HPMA-IR value and BMI (r=0.39; р<0.05) were revealed. Patients with As, degree 1 Ob and a disorder of FEV1>60% revealed hyperinsulinemia and an increased level of insulin resistance index; this fact can be regarded as a prognostic criterion for an improved diagnosis, prognostication of unfavorable consequences and optimization of treatment approaches. In order to detect carbohydrate metabolic disturbances in patients with As+Ob it is not enough to determine levels of glucose and glycated hemoglobin. The necessity of studying insulin resistance and insulin level for systematization and determination of development of concomitant metabolic disturbances in patients to whom iGCS are prescribed is proved.

Bronchial obstruction in pre-school children

Based on the analysis of foreign and domestic literature, the authors present the approaches to determining the phenotypes of bronchial obstructive syndrome in preschool children. They outline the data on the main foreign studies devoted to the peculiarities of the bronchial obstruction syndrome course depending on age and clinical outcome. They discuss the risk factors leading to the recurrent course of bronchial obstruction, tools for predicting bronchial asthma, and the choice of phenotype-dependent therapy strategy.

Assessment of efficacy of secondary prophylactic complex of bronchial obstruction syndrome in young children with respiratory disorders in neonatal period: analysis of symptoms and serological markers

<abstract> <p>Diseases of respiratory tract in young children are often accompanied by the development of bronchial obstruction syndrome. Recurrent episodes of bronchial obstruction are a common problem in young children with respiratory disorders in neonatal period. The aim of our work was to test secondary prophylactic measures concerning development and progression of recurrent bronchial obstructive syndrome in young children, who had suffered respiratory disorders in neonatal period. Prophylactic complex included basic therapy (inhalation of glucocorticosteroids—fluticasone propionate or budesonide), administration of immunomodulating drug Ribomunyl and conducting of prophylactic vaccination in specialized inpatient department after prior preparation whith antihistamines.</p> <sec> <title>Objectives</title> <p>The feature of disease course was assessed based on the need of using drugs with symptomatic action, frequency of exacerbations, their mean duration and severity in 60 children, who had breathing disorders in neonatal period. Children were randomly divided into two groups. The study of efficacy of secondary prophylactic measures was conducted in 30 children (basic group) and in other 30 patients secondary prophylactic complex was not used (control group).</p> </sec><sec> <title>Methods</title> <p>Algorithm of secondary prophylactic complex included basic therapy involving inhalation glucocorticosteroids, administration of immunomodulatory drug Ribomunyl as recommended and conduction of planned prophylactic inoculations with the use of antihistamines.</p> </sec><sec> <title>Conclusions</title> <p>In children, who were administered secondary prophylactic complex was a positive dynamics in clinical picture and laboratory data.</p> </sec><sec> <title>Results</title> <p>Administration of secondary prophylactic complex enabled, to a certain extent, to prevent progression of bronchial obstructive syndrome and achieve a reliable increase in γ-INF, IgA, IgM, IgG levels and decrease in IL-4 (р < 0.01).</p> </sec></abstract>

CLINICAL PECULIARITIES AND PATHOGENETIC DETERMINANTS OF DEVELOPMENT AND PROGRESSION OF CHRONIC PULMONARY HEART WITH ARTERIAL HYPERTENSION

The aim: To investigate the clinical and pathogenetic peculiarities of formation and course of CCP and the relationship between clinical, hemodynamic and neurohumoral factors of comorbidity development in COPD combined with arterial hypertension (AH). Materials and methods: The object of the study were 484 patients with COPD. Among them, 350 patients with CCP as a result of cardiac insufficiency/severe congestive heart failure (COPD III-IV) out of aggravation, combined with AH II stage (non-symptomatic organ damage) and 1 - 3 grades, including 55 patients (43 men, 12 women) with compensated CCP (average age 43.7 ± 3.4 years), and 295 patients (212 men and 83 women) with decompensated CCP and chronic heart failure (CHF), average age 63.2 ± 8.9 years. Results: It was found that the development and progression of the left and right CHF in patients with CCP combined with AH occurs due to the disorders of the central hemodynamic, progression of pulmonary hypertension, bronchial obstruction syndrome, neurohumoral and systemic immunoinflammatory activation, disorders of endothelial regulation of vascular tension, overproduction of epithelial and mitogenic growth factors, inducers of apoptosis, and is accompanied by increasing levels of natriuretic peptides. Conclusions: The main pathogenetic formation mechanisms of the heart failure on the background of CCP combined with AH are: neurohumoral and systematic immune-inflammatory activation with the development of endothelial dysfunction and (neo)angiogenesis, induction of pathological apoptosis, increase in the intrathoracic pressure, and deposition of blood in the extrathoracic tissues, which result in pulmonary and systemic hypertension, metabolic and hemodynamic remodelling and heart dysfunction.

Bronchial obstruction syndrome in children

Bronchial obstruction syndrome in children