Recurrent Obstructive Bronchitis Research Articles

THE IMPORTANCE OF MODIFIED BRONCHOPHONOGRAPHY IN THE DIAGNOSIS OF RECURRENT BRONCHOOBSTRUCTIVE SYNDROME IN CHILDREN

Abstract. Purpose of the study: to establish the diagnostic and prognostic significance of modified bronchophonography in bronchobstructive syndrome in children. Material and methods of research. The paper presents the results of examinations of children with bronchoobstructive syndrome. The patients were divided into 3 groups of 60 patients: Group I - patients with acute obstructive bronchitis (AOB), acute bronchiolitis (ABL), Group II - children with recurrent obstructive bronchitis (ROB) and bronchial asthma (BA), Group III - patients with acute bronchitis without bronchial obstruction (BA). Results of the study and discussion. Analysis of modified bronchophonography indices in groups I-II showed that on admission, E:I index>1.6 indicating bronchial obstruction of the II degree (P<0.001). On the 2nd day of observation, E:I index significantly decreased in patients with ROB, BA and was significantly lower in comparison with indices of patients with OOB, OBL (P<0,05). On the 3rd day of observation and at discharge, the indices were relatively equal, no significant difference was observed (P>0.2; P>0.1). When constructing the ROC-curve and analysing the curve coordinates, it was found that in determining the risk of ROB and AD in children, the diagnostic significance of the E:I index≥1.78, with a sensitivity of 71.7% and specificity of 61.1%. Conclusions. The values of E:I index≥1.78 are predictors of the risk of ROS and BA development, the diagnostic significance of which is confirmed by high sensitivity and specificity, which can be recommended for detecting the risk of recurrent course of BOS in children.

PREDICTORS OF THE DEVELOPMENT OF RECURRENT BRONCHIAL OBSTRUCTION IN CHILDREN

Abstract. Purpose of the study: to determine the significance of risk factors for the development of recurrent bronchial obstruction in children. Material and methods of research. A total of 240 children were examined and divided into 3 groups: Group I - patients with acute obstructive bronchitis (AOB), acute bronchiolitis (ABL), Group II - children with recurrent obstructive bronchitis (ROB) and bronchial asthma (BA), Group III - patients with acute bronchitis without bronchial obstruction (BA). To assess the significance of risk factors for the development of recurrent and relapsing course of BOS, we analysed genealogical, biological and social anamnesis, premorbid and family background, in children of the studied groups, characterising the state of family health and features of child development in the ante- and postnatal periods, as well as in the first years of the child's life. Results of the study and discussion. When studying the causes and factors influencing the development and course of BOS in children, the most important is the study of background diseases that aggravate and prolong the course of bronchial obstruction. The study of pre-mobilisation background in patients of the compared groups showed that a number of factors were significantly more frequent in patients with acute and recurrent course of bronchobstructive syndrome. Conclusions. It was found that the risk factors for the development of recurrent course of bronchial obstruction in children are: artificial feeding (P<0.002; OR=4.80), rickets (P<0.02; OR=2.15), overweight (P<0.002; OR=5.40), atopy (P<0.001; OR=18.32), first episode of BOS before the age of 1 year (P<0.002; OR=3.01), absence of fever (P<0.002; OR=12.95) and catarrhal syndrome (P<0.001; OR=60.0) during the episode of illness.

Resolution of the Expert Council on the use of the anti-inflammatory drug ammonium glycyrrhizinate in the treatment of acute respiratory infections and allergic diseases of the respiratory tract

In June 2022, within the XI International Educational Consensus on Respiratory Medicine in Pediatrics, an expert council on the anti-inflammatory agent ammonium glycyrrhizinate in treating acute respiratory infections and allergic diseases of the respiratory tract was held in Vladimir. The resolution of the Expert Council is presented. Based on these studies, experts recommend the use of ammonium glycyrrhizinate in patients with acute respiratory tract infection (including COVID-19); in the rehabilitation period of patients who recovered from the new coronavirus infection with lung involvement; patients with recurrent obstructive bronchitis, including those at high risk of bronchial asthma; patients with allergic rhinitis; patients with mild to moderate asthma.

Характеристика особливостей клініко-діагностичних аспектів сезонного алергічного риніту в дітей Полтавського регіону

The high prevalence of seasonal allergic rhinitis (SAR) among children continues to rise steadily. However, there is not only an increase in the frequency of allergy, as an independent nosology, but also its combination with other atopic diseases. It should be noted that the comorbidity of SAR with asthma, allergic conjunctivitis, atopic dermatitis significantly impairs the daily activities and quality of children’s life. Purpose - to study the peculiarities of seasonal allergic rhinitis in children on the background of comorbidities depending on the age of the patient and to analyze the structure of pollen sensitization taking into account the retrospective results of skin allergy testing. Materials and methods. For a retrospective study, 890 case histories of children with SAR aged 3-15 years from 2010 to 2020 were selected and analyzed. The inclusion criteria were children with positive skin allergy testing for at least one pollen allergen in the test panel. During the analysis, patients were divided into three age subgroups: preschool children (3-6 years), primary school age (7-10 years) and middle school age (11-15 years). Results. Our results show that the comorbidity of SAR depended in some ways on the age of the child. Thus, among children of the first group the combination of SAR with recurrent obstructive bronchitis and atopic dermatitis was mostly often registered, while in patients of the second and the third groups - with allergic conjunctivitis and asthma. It was also found that the clinical picture of the disease did not differ significantly from the patient’s age and was characterized by moderate severity of allergic rhinitis. The study of the spectrum of sensitization to pollen allergens revealed a significant prevalence of children with hypersensitivity to ragweed allergen. It was found that more than a third of preschool and primary school children were also more likely to be sensitive to wormwood and corn, while middle school children - timothy, fescue, wormwood, ryegrass and cyclachaena. Conclusions. Therefore, the study allowed to establish the features of the clinical course, severity, combination of SAR with other diseases and identify the most etiologically significant pollen allergens, which are a priority in the occurrence of seasonal allergic rhinitis in children of Poltava region. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: children; seasonal allergic rhinitis; clinical and diagnostic features; sensitization spectrum.

Genetic testing of allelic variants of PIZ (GLU342Lys, RS28929474) and PIS (GLU264Val, RS17580) of SERPINA1 gene in children with bronchial asthma

According to world publications, mutations in the SERPINA1 gene may be a genetic risk factor for severe chronic obstructive pulmonary disease and, consequently, rapid progression of respiratory dysfunction. This disease leads to a decrease in the level of alpha-1-antitrypsin protein. It is inherited by autosomal recessive type, but there are registered cases of codominance. In the absence of treatment, diseases of the respiratory system become chronic and lead to disability in adulthood.
 Early diagnosis of AAT deficiency is important to prevent complications and reduce mortality among people with this pathology. Due to these factors, genetic testing of SERPINA1 gene mutations in children with chronic lung diseases is appropriate to detect and prevent severe complications, associated with AATD.
 The aim of this work is to improve the effectiveness of early diagnosis of AAT deficiency in children with bronchial asthma and recurrent obstructive bronchitis by identifying different genotypes and phenotypes of A1AT deficiency, studying their relationship with the clinical course of respiratory diseases in children

Age-related evolution of bronchial asthma in pediatric practice and approaches to improving prognosis

The main high-risk group for a diagnosis of bronchial asthma (BA) are children with recurrent obstructive bronchitis, complicated by a widespread form of acute respiratory viral infections. Basic therapy of BA is aimed at suppressing inflammation of the bronchial wall. In addition to inhaled glucocorticosteroids, the antileukotriene drug montelukast has a proven anti-inflammatory effect. This article discusses published work on the effect of montelukast on inflammation biomarkers in real clinical practice and remodeling of the bronchial wall in the experiment. A comparative study of the clinical efficacy of an antileukotriene drug and inhaled glucocorticosteroids in patients of different age groups and asthma phenotypes is presented. The use of montelukast in children at high risk of developing BA, with an indication for allergic rhinitis, is discussed. Presented current information on the risk of psychiatric AE against the background of using an antileukotriene drug. Literature review is illustrated by our own observation: a cohort of 127 patients was formed on the basis of the dispensary group of the City Allergy Cabinet of the Children’s City Polyclinic No. 44 in St. Petersburg in 2018, a prospective observation was conducted, which lasted 2 years. The inclusion criteria were age of 5 years to 5 years 11 months (5 ± 0.5 years) and an established diagnosis of mild BA. The patients were followed up for 2 years with evaluation of the change of basic therapy, control of the disease and functional indices achieved with therapy with the original drug montelukast. This observation showed high clinical efficacy of montelukast monotherapy in the group of preschool-age patients, which was expressed by a significant proportion of patients who had no exacerbations of BA for a year, a high score on the Asthma Control Test, statistically insignificant increase in forсed expiratory volume in 1 second after bronchodilator. Today Montelukast is a safe, effective and widely prescribed component of therapeutic regimen in patients with varying degrees of severity of bronchial asthma over the age of 2 years.

Pathogenetic Reasoning for Use of Monteleukast (Singlon) in Acute Respiratory Viral Infections with Broncho-Obstructive Syndrome in Infants and Preschool Age Children

The Article considers the argumentative issues of the diagnosis of the virus-induced bronchial asthma and recurrent obstructive bronchitis in the children of infant and preschool age, the commonality of their pathogenesis, the feasibility and efficiency of their therapy using the monteleukast – the antileukotriene receptor inhibitor. Along with the anti-inflammatory properties of the monteleukast, the potential antiviral activity discovered in it was considered, in particular, against the SARS-CoV-2 virus, which causes COVID-19.

Finding a molecular genetic marker for the incidence of recurrent episodes of acute obstructive bronchitis in children.

Over the last ten years, the incidence of the pathology of the bronchus-pulmonary system in children has increased 3.6 times, mainly due to acute and recurrent inflammatory diseases of the upper and lower respiratory tract. Thus, the problem of identifying children with recurrent episodes of acute obstructive bronchitis and an increased risk of developing asthma is relevant and promising. The goal of this study was to find molecular genetic markers associated with increased susceptibility of children to repeated episodes of acute obstructive bronchitis. The molecular genetic testing of the IL4 gene of a single nucleotide polymorphism C-33T was performed in 35 children with recurrent episodes of acute obstructive bronchitis and 35 children with acute bronchitis. The results were statistically processed on a personal computer with the calculation of values the arithmetic mean (M), of the errors arithmetic mean (m), Student criterion (t), the degree of probability (p), Pearson criterion (χ2), and the odds ratio (OR). Statistically significant differences were figured at p<0.01 and p<0.05. It has been proved that the presence of a child’s genotype 33CT IL4 increases the risk of recurrent acute obstructive bronchitis four times.

Reduced expiratory variability index (EVI) is associated with controller medication withdrawal and symptoms in wheezy children aged 1-5 years.

BackgroundLung function testing is an essential part of diagnostic workup and monitoring of asthma, but young children are lacking easy, routine testing methods. However, recent discoveries show reduced tidal breathing variability measured using impedance pneumography (IP) at home during sleep as a sign of airway obstruction. In this study, we assessed (a) the discriminative capacity of expiratory variability index (EVI) between healthy controls and young children with recurrent wheeze on‐and‐off controller medication, (b) association between EVI and parentally perceived obstructive symptoms (need for bronchodilator) and (c) measurement success rate.MethodsWe included 68 patients (aged 1.0‐5.6) and 40 healthy controls (aged 1.0‐5.9 years). The patients were prescribed a three‐month inhaled corticosteroid (ICS) treatment due to recurrent obstructive bronchitis. We measured EVI using IP at home at the end of the treatment (0W) and 2 (2W) and 4 (4W) weeks after ICS withdrawal.ResultsEVI was higher in controls than in patients, and significant within‐patient reduction occurred at 4W as compared to 2W or 0W. Area under curve of the ROC curve (controls vs all patients) at 4W was 0.78 (95% CI 0.70‐0.85). Children who were administered bronchodilator by parental decision had lower EVI than those without bronchodilator need at 4W, but not at 0W or 2W. Patients with parent‐reported airway infection, but no bronchodilator need, had normal EVI. Measurement success rate was 94%.ConclusionEVI was lower in patients than in controls and it reduced further after controller medication withdrawal, especially in the presence of parentally perceived wheeze symptoms. This technique shows a significant potential for routine lung function testing of wheezy young children.

Noninvasive Cardiorespiratory Signals Analysis for Asthma Evolution Monitoring in Preschool Children.

Despite its increasing prevalence, diagnosis of asthma in children remains problematic due to their difficulties in producing repeatable spirometric maneuvers. Moreover, low adherence to inhaled corticosteroids (ICS) treatment could result in permanent airway remodeling. The growing interest in a noninvasive and objective way for monitoring asthma, together with the apparent role of autonomic nervous system (ANS) in its pathogenesis, have attracted interest towards heart rate variability (HRV) and cardiorespiratory coupling (CRC) analyses. HRV and CRC were analyzed in 68 children who were prescribed ICS treatment due to recurrent obstructive bronchitis. They underwent three different electrocardiogram and respiratory signals recordings, during and after treatment period. After treatment completion, they were followed up during 6 months and classified attending to their current asthma status. Vagal activity, as measured from HRV, and CRC, were reduced after treatment in those children at lower risk of asthma, whereas it kept unchanged in those with a worse prognosis. Results suggest that HRV analysis could be useful for the continuous monitoring of ANS anomalies present in asthma, thus contributing to evaluate the evolution of the disease, which is especially challenging in young children. Noninvasive ANS assessment using HRV analysis could be useful in the continuous monitoring of asthma in children.

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

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.

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

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.

Molecular-genetic testing of single-nucleotide polymorphism C-33T of IL4 gene in children with recurrent episodes of acute obstructive bronchitis.

The molecular genetic testing of the IL4 gene of a single nucleotide polymorphism C-33T was performed in 35 children with recurrent episodes of acute obstructive bronchitis and 35 children with acute bronchitis. It has been proved that the presence of a child's genotype 33СT IL4 increases the risk of recurrent acute obstructive bronchitis by 4 times.

ROLE OF "ATYPICAL" MICROORGANISMS ON THE FORMATION OF BRONCHIAL ASTHMA IN CHILDREN WITH ACUTE AND RECURRENT OBSTRUCTIVE BRONCHITIS

Objective: This study was undertaken to determine the link between the presence of “atypical” infections in patients with acute obstructive andrecurrent obstructive bronchitis (AOB/ROB) and bronchial asthma (BA) development based on the concept of risk.Methods: The materials for the study were the data records of patients hospitalized with AOB or ROB and whose analysis was performed to identifyantibodies to “atypical” microflora (796 patients). The study period was 4 years from 2008 to 2011. In the analyzed period, immunosorbent assay forthe detection of antibodies to “atypical” microflora (Chlamydophila pneumoniae, Mycoplasma pneumoniae, Mycoplasma hominis) was performed. Theconcept of risk identification was based on the determination of the absolute risk, attributable risk (AtR), relative risk, population attributable risk, aswell as on the definition of the standard errors for each type of risk and the confidence interval.Results and Conclusion: Methodical aspects of determining the relationship between the presence of “atypical” infections in patients with AOBor ROB and BA development were based on the concept of risk. The analysis showed a direct link between the increase of cases of BA formationagainst the backdrop of “atypical” infections. Therefore, the performed analysis of atypical pathogens influences on BA occurrence in patients withAOB/ROB which indicates direct dependence increase of BA incidence on atypical infection. In experimental group, Frequency of event is 14.84% inexperimental group. Frequency of event is 1.67% in control group. The risk factor increases probability of event by 13.17%, the risk factor increasesprobability of event by 13.17%. Presence of atypical infection leads to increase of BA incidence by 8.9 times. Number needed to harm (NNH) is 7.59,i.e., in the presence of atypical infection in patients with AOB/ROB, each eighth exposed person develops BA in addition to background level of BAincidence.Keywords: Acute obstructive bronchitis, Recurrent obstructive bronchitis, Bronchial asthma, The concept of risk, Risk factor, The absolute risk,Relative risk, Attributable risk, Population attributable risk, Number needed to harm.

The concept of risk factors in evaluation of «atypical» agents effecting formation of bronchial asthma in children with acute and recurrent obstructive bronchitis

The study was carried out to establish relationship between occurrence of «atypical» infections in patients with acute obstructive and recurrent obstructive bronchitis and development of bronchial asthma based on concept of risks. Material and methods. As regards material for study the data of medical histories of patients hospitalized with acute obstructive and recurrent obstructive bronchitis and who were applied analysis for antibodies to «atypical» microflora (796 patients). The time-period of study made up four years from 2008 to 2011. During analyzed period immune enzyme analysis was implemented concerning antibodies to «atypical» microflora (Chlamydia pneumonia, Micoplasma pneumonia, Micoplasma hominis). The concept of risks’ identification was based on identification of ultimate risk in exposed and non-exposed groups, attributive risk, relative risk, population attributive risk. The standard errors and confidence interval for every type of risk were applied. Results. The methodical aspects of detection of relationship between occurrences of «atypical» infections in patients with acute and recurrent obstructive bronchitis and development of bronchial asthma were considered on the basis of concept of risks. The applied analysis demonstrated direct dependence of increasing of number of cases of development of bronchial asthma against the background of «atypical» infections. In the risk group the rate of occurrence makes up to 14,84%, in the control group - 1,67%, risk factor increases probability of development of bronchial asthma on 13,17%. The occurrence of “atypical” infection leads to increasing of cases of development of bronchial asthma up to 8.9 times. The index of potential harm made up to 7.59 i.e. if there are «atypical» infections in patients with acute and recurrent obstructive bronchitis every eighth exposed individual bronchial asthma is developed.

The study of immune system state, substance P, hemostasis and interrelation between these systems in respiratory diseases in frequently ill children

Aim. To study immune system state, hemostasis system, the neuropeptide level (substance P) and their interrelation in respiratory diseases in frequently ill children.Methods. 340 frequently ill children, 125 rarely ill children and 30 apparently healthy children aged 6 months to 6 years were studied in the acute period of the disease, and in the period of clinical remission. Diagnosis was made on the basis of medical history, clinical signs, instrumental and laboratory assessment results. CD3+, CD4+, CD8+, CD19+ lymphocytes count, serum immunoglobulin classes A, G, M, E levels, interleukin-1β, -2, -6, -8, tumor necrosis factor α, substance P were determined.Results. Strong negative correlation was revealed between the CD4+-cells level, interleukin-2, interferon γ and hemostasis system parameters. Substance P, interacting mainly with interleukin-1β and -2, CD4+-cells, interferon γ, indirectly interacts with the hemostasis system. In recurrent obstructive bronchitis and complicated acute pneumonia course substance P content increase was higher (4.6-fold compared with healthy children). The fact that the immune system indicators, including cytokine status, substance P and hemostasis system do not normalize during respiratory disease clinical remission in frequently ill children indicates the infection persistence, the inflammatory process continuation during clinical remission.Conclusion. Along with the immune system, the nervous system and hemostasis system play an important role in respiratory diseases severity in frequently ill children, their complications, prolonged duration, recurrence and transition into a chronic condition.

ЧИ ВІДПОВІДАЄ КЛІНІЧНА РЕМІСІЯ РЕЦИДИВНОГО ОБСТРУКТИВНОГО БРОНХІТУ ВІДСУТНОСТІ ІМУНОЛОГІЧНИХ ЗМІН У РЕСПІРАТОРНОМУ ТРАКТІ ДІТЕЙ?

&lt;p&gt;Проведено дослідження ролі вмісту інтерлейкінів&lt;br /&gt;(ІЛ)-4, -6, -8, -10 в слині у пацієнтів з рецидивним об-&lt;br /&gt;структивним бронхітом (РОБ) під час ремісії і здорових&lt;br /&gt;дітей. Встановлено, що за відсутності клінічних про-&lt;br /&gt;явів РОБ у цих дітей тривають імунопатологичні про-&lt;br /&gt;цеси. Показано, що за даними анамнезу, особливостями&lt;br /&gt;клінічних проявів і результатами визначення ІЛ-4, -6,&lt;br /&gt;-8, -10 в слині в групі дітей з РОБ можна розмежувати&lt;br /&gt;дві підгрупи: пацієнтів з інфекційно-асоційованим РОБ&lt;br /&gt;і захворюванням, що має алергічний генез. Для дітей з&lt;br /&gt;алергічним генезом хвороби характерним є обтяжений&lt;br /&gt;алергологічний анамнез у сім’ї, атопічний дерматит&lt;br /&gt;на першому році життя, розвиток загострення після&lt;br /&gt;контакту з тваринами або переважно під час цвітіння&lt;br /&gt;рослин, відсутність вираженої температурної реакції&lt;br /&gt;під час розвитку бронхообструктивного синдрому в по-&lt;br /&gt;єднанні з істотно підвищеним вмістом ІЛ-4 в слині. Для&lt;br /&gt;пацієнтів з інфекційно-асоційованим РОБ характерна&lt;br /&gt;відсутність алергічних захворювань у батьків та інших&lt;br /&gt;членів сім’ї, сезонність загострень з листопада по&lt;br /&gt;квітень, розвиток загострень бронхообструктивного&lt;br /&gt;синдрому в поєднанні з фебрильною температурою&lt;br /&gt;тіла і катаральними явищами, а також підвищенням&lt;br /&gt;вмісту в слині рівнів ІЛ-6, -8 і зниженням вмісту ІЛ-10.&lt;br /&gt;Зазначені особливості можуть враховуватися при&lt;br /&gt;оцінці прогнозу перебігу захворювання та визначенні&lt;br /&gt;підходів до диференційованої терапії.&lt;br /&gt;Ключові слова: діти, респіраторні інфекції, реци-&lt;br /&gt;дивний обструктивний бронхіт.&lt;/p&gt;

Comparative characteristics of bronchial obstruction formation trigger mechanisms in children with bronchial asthma and recurrent obstructive bronchitis

Aim. To study the comparative characteristics of the causative significant factors involved in the bronchial obstruction development in children with bronchial asthma and recurrent obstructive bronchitis.Methods. A cross-sectional (transversal) study of 50 children with bronchial asthma, 38 children with recurrent obstructive bronchitis was conducted. The differences and similarities of etiopathogenetic factors of the bronchial obstruction occurrence were revealed. According to medical history, in all patients regardless of the severity and duration of the disease at the time of examination, the impact of the factors, acting as triggers of bronchial asthma, according to patients, such as infectious agents, infectious allergens and aeroallergens, nighttime, climatic conditions deterioration, physical and/or emotional stress, was registered.Results. The main triggers that influence the bronchial obstruction occurrence in children with asthma were infectious factors impact, allergens and aeroallergens, and in patients with recurrent obstructive bronchitis more important in the bronchial obstruction development were infectious agents and weather conditions worsening (high humidity, fog, rain). However, unlike the other factors involved in the bronchial obstruction development in asthma, nighttime, allergens and aeroallergens did not have significant impact on the bronchial obstruction occurrence in children with recurrent obstructive bronchitis. In both groups, physical stress (jogging, gymnastics) and emotional stress (loud laugh, crying) contributed to the bronchial obstruction syndrome development with the corresponding clinical picture, but in the second group of children with recurrent obstructive bronchitis duration of cough lasted 2 times less (1-1,5 h) than in children with bronchial asthma (over 3 hours).Conclusion. Conducted comparative characteristics showed that there is a clear link with the trigger mechanisms of bronchial obstruction occurrence in bronchial asthma and recurrent obstructive bronchitis, and triggers, regardless of the severity and duration of disease, have the same effect on the recurrent obstructive bronchitis outcome.

Respiratory Syncytial Virus. Clinical Epidemiological Pattern and lethality Associated Factors in Children Admitted in a Pediatric Hospital: 15 Years' Experience

Respiratory Syncytial Virus. Clinical Epidemiological Pattern and lethality Associated Factors in Children Admitted in a Pediatric Hospital: 15 Years' Experience

PP‐16 WEAK ACID REFLUX A TRIGGER FOR RECURRENT RESPIRATORY DISEASES IN CHILDREN

Introduction:The main advantage of multichannel intraluminar impedance (MII) compared with pH monitoring is its ability to detect both acid and non‐acid gastroesophageal reflux (GER) and to determine the characteristics of reflux (liquid or gas).Aim:To compare the value of pH monitoring and MII for diagnosis of GER in children who present with refractory respiratory symptoms.Materials:A prospective study that included 37 patients, aged 4.25 ± 3.15 years, using combined MII‐pH monitoring was performed. Patients were referred for investigation because of suspected GER as the etiology of recurrent respiratory diseases, including recurrent obstructive bronchitis, recurrent pneumonia, laryngitis, and chronic cough. We analyzed the percentage of time during which the pH was less than 4, the numeric and percentile values of acid, weak acid, and non‐acid reflux episodes, and the values of liquid and mixed reflux. Diagnostic values were determined separately for pH monitoring and MII using Fisher's exact test.Results:Reflux was detected in 31 patients. pH monitoring was positive in 20 patients (% time during which pH &lt;4 was 17.72 ± 12.06) and negative in 17 patients (2.93% ± 1.67). Both pH and MII were positive in 19 patients: in 11 patients, MII was positive and pH was negative, and in 6 patients, both were negative. Fisher's exact test showed significant statistical difference and superiority of MII in diagnosing GER (p = 0.033). Out of 30 patients with MII‐positive results, 15 had both acid and weak acid reflux episodes, 3 had only acid reflux, 8 had weak acid reflux, and 3 had non‐acid reflux. Sixteen patients had mixed (liquid and gas) reflux, and 14 had both liquid and mixed reflux.Conclusions:This study suggests that significant numbers of GER include weak acid reflux that cannot be detected by pH probes alone. The weak acid reflux could be a trigger for recurrent respiratory symptoms. Combining pH with MII monitoring is a valuable diagnostic method for diagnosing GER in children.