Мета -вивчити ефективність і переносимість препарату «Есберітокс» у дітей з бронхіальною астмою (БА) та гострими респіраторними вірусними інфекціями (ГРВІ). Пацієнти та методи. Обстежено 34 дитини віком 6-14 років із БА різного ступеня тяжкості та ГРВІ. Дітей розподілено методом простої рандомізації на дві групи. В основній групі (n=20) отримували лікування відповідно до міжнародних рекомендацій GINA (2019) та додатково «Есберітокс» у віковому дозуванні протягом 10 діб. У групі порівняння (n=14) отримували на тлі базисної терапії симптоматичну терапію (жарознижувальні, туалет носової порожнини, антисептичні місцеві засоби). Критеріями ефективності проведеного лікування були: регрес симптомів катару верхніх дихальних шляхів, динаміка показників місцевого імунітету (імуноглобулінів та лізоциму слини, експресія СD56+ клітин у мазку відбитку зі слизової носа та мигдаликів, кількість макрофагів в індукованому мокротинні), кількість дітей із загостренням БА. Результати. Застосування «Есберітокс» у комплексному лікуванні обстежених дітей сприяло: регресу симптомів катару верхніх дихальних шляхів на 3-5 ту добу (порівняно зі збереженням симптомів у дітей групи порівняння); підвищенню кількості експресуючих СD56+ клітин у слизовій носа та мигдаликів, sIgA та лізоциму в слині, макрофагів у індукованому мокротинні; зменшенню ризику загострення БА (відсутність загострень у 65,0% основної групи та 35,7% групи порівняння). На тлі застосування цього препарату не зареєстровано побічних реакцій. Висновки. Клінічна ефективність та високий профіль безпеки «Есберітокс» у дітей з БА та ГРВІ дає змогу рекомендувати його для лікування й профілактики вірус індукованих загострень бронхообструктивних захворювань у дітей. Дослідження виконано відповідно до принципів Гельсінської Декларації. Протокол дослідження ухвалено Локальним етичним комітетом зазначеної в роботі установи. На проведення досліджень отримано поінформовану згоду дітей (або їхніх опікунів). Автори заявляють про відсутність конфлікту інтересів. Ключові слова: бронхіальна астма, вірусна інфекція, діти, «Есберітокс».
Currently, little is known about the sensitization profile of children with asthma, allergic rhinitis (AR) and comorbid asthma in Ukraine. Aim. To study the sensitization profile in children with allergic respiratory diseases. Material and methods. Ninety-three children aged 5-17 years with allergic respiratory diseases were examined, including: 51 children with AR (1st group), 31 children with AR combined with asthma (2nd group) and 11 children with isolated asthma (3rd group). All children underwent multicomponent molecular diagnostics in the form of a multiplex test ALEX. Results. In monosensitized (17.2 %) and polysensitized (82.8 %) children with isolated asthma, with isolated AR and AR combined with asthma, sensitization to Fel d 1 was most common. Monosensitization to the ragweed molecule (Amb a 1) is characteristic only for children with AR, AR combined with asthma; to the cat molecule Fel d 1-for children with all allergic respiratory diseases. In monosensitized children with isolated AR, sensitization occurs only to the mold molecules Alt a 1, the fenugreek Lol p 1, timothy-grass (Phl p 1, Phl p 2, Phl p 5.0101, Phl p 6), in children with AR combined with asthma-to mites household dust (Der f 1, Der p 1), in children with isolated asthma-to the dog's epidermal allergen (Can f 1). In polysensitized children with respiratory allergy, the most common molecules to which sensitization is detected are Fel d 1, Bet v 1, Lol p 1, Phl p 1, Amb a 1 and Alt a 1.Conclusions.Children with allergic respiratory diseases exhibit different sensitization profiles. Sensitization to only one group of allergens was significantly more common in children with isolated asthma than in children with isolated AR and AR combined with asthma. Sensitization to Fel d 1 looks like a marker of respiratory allergy.
Among the comorbid conditions in children with asthma a significant place is occupied by lesions of the upper digestive tract+in particular, gastroesophageal reflux disease (GERD). It is known that asthma can provoke the development of reflux, and reflux in turn leads to a worsening of the course of asthma. Scientific studies indicate a better ability to control asthma in children after appropriate treatment for GERD. Purpose — to study the features of the clinical course of asthma combined with gastroesophageal reflux disease in children. Materials and methods. Ninety+nine children aged 6–17 years with asthma of varying severity and level of control were examined. These children which were randomly divided into two groups: group 1–79 children with asthma combined with GERD, and group 2–20 children with asthma without GERD. A questionnaire was administered, an assessment of day and night symptoms of asthma according to the scoring system was conducted, and an ACT test according to age was performed on all examined children. With the consent of the parents, twenty-two children who had complaints characteristic of gastrointestinal lesions, underwent fibroesophagogastroduodenoscopy with biopsy from the proximal and distal esophageal mucosa. Results. In children with asthma combined with GERD, atopic dermatitis is probably more common (in 46.8% of patients), and symptoms of hypersensitive reactions to food are registered (in 74.6% of patients). Children in group 1, in contrast to children in group 2, had a longer and more severe course of asthma and probably more frequent nocturnal symptoms of the disease, which was associated with poorer control of asthma and the need for bronchodilator therapy (8.5±0.5 inhalations per month against 4.5±0.5 inhalations per month, respectively, p<0,05). Peculiarities of GERD in children with asthma were: nonspecific complaints, catarrhal changes of the lower third of the esophagus (reflux esophagitis in 98.7%), focal hyperplasia of the basal layer of the epithelium and intraepithelial eosinophilia up to 5% (9%). Girls and boys of different ages experience significant differences in complaints from the gastrointestinal tract. Conclusions. The presence of GERD has been shown to affect the control of asthma in children, associated with nocturnal symptoms, the need for bronchodilator therapy, more severe and prolonged course of the disease, concomitant atopic dermatitis and food hypersensitivity reactions. 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 these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Keywords. asthma, gastroesophageal reflux disease, children.
The prevalence of gastroesophageal reflux disease (GERD) in children with asthma ranges from 32% to 80%. The intensity of respiratory symptoms, bronchial obstruction are more pronounced in children with asthma combined with GERD than in children with isolated asthma. However, there are limited and conflicting data on the difference between the induced sputum in asthmatic children with or without GERD. Purpose — to examine the status of lung function and features of airway inflammation in children with asthma combined with gastroesophageal reflux disease. Materials and methods. Sixty-seven children ages 6–17 years with moderate asthma and 30 healthy children ages 6–17 years were observed. They were assigned to three groups: group 1 (32 children with isolated asthma), and group 2 (35 children with asthma and GERD) and group 3 (30 healthy children). All children included in the study were identical in age and gender. Clinical assessment, spirometry with test of reversibility of airway obstruction, and cytological analysis of induced sputum samples were performed on all patients. Upper gastrointestinal endoscopy was done in the asthmatic groups. Results. There were 10 (28.57%) children in the 2nd group with first degree obstructive spirometry pattern and none in the 1st group of children. First degree restrictive spirometry pattern was more significant observed in the 1st group of children — 10 (31.25%) than in the 2nd group of children — 2 (5.71%) (OR, CI 95% 7.50 (1.50–37.57)). In the 2nd group of children, induced sputum had a significantly higher number of neutrophils, lymphocytes and macrophages compared to the 3rd group (p<0.05). Also the difference between these parameters were significant compared to the 1st group of children. The number of induced sputum epithelial cells in 2nd group was significantly less than in 1st group of children. Conclusions. GERD negatively affects the parameters of lung function in children with asthma. Airway inflammation in children with asthma combined with GERD appears to be more significant compared to isolated asthma. 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 an participating institution. The informed consent of the child's parents was obtained from the studies. No conflict of interest was declared by the authors. Key words: asthma, gastroesophageal reflux disease, children, spirometry, induced sputum.
The most common comorbid pathology in children with asthma is gastroesophageal reflux disease (GERD) associated with reflux esophagitis (RE), which ranges from 32 % to 80 %. Histological changes of the esophageal mucosa in RE have been described in adults and children, but there are only isolated studies that describe the morphological features of the esophageal mucosa in combined pathology, taking into account the severity of asthma. The aim is to study the histological and immunohistochemical features of the esophageal mucosa in children with asthma combined with reflux esophagitis. Materials and methods. In 43 children aged 6–17 years with RE and severe asthma (group 1), with mild/moderate asthma (group 2) and without asthma (group 3), mucosal biopsies from the distal and proximal esophagus were examined by histological and immunohistochemical methods. Immunohistochemical research was performed in serial paraffin sections according to standard protocols using monoclonal antibodies to Ki-67, MMP-9, VEGF, BCL-2, IgE and CD68. Results. In children with asthma combined with RE, the structural changes of the esophageal mucosa differed depending on the severity of asthma. Severe basal epithelial hyperplasia was registered in 92.31 % of children in group 1, and its frequency was significantly different from children in groups 2 and 3. A characteristic feature of children with asthma and reflux esophagitis was dyschronosis, which was characterized by foci of hypo- and hypertrophy of basal layer cells (92.31 % of children in group 1 and 37.50 % of children in group 2). Severe elongation of the “papillae” was found only in 38.46 % of children in group 1. Immunohistochemical features of the esophageal mucosa of children with asthma and reflux esophagitis revealed the expression of Ki-67 antigen, IgE and a weak macrophage response (CD68), the severity of which differed from children with reflux esophagitis without asthma. Conclusions. Morphological changes in the esophageal mucosa of children with reflux esophagitis and asthma differ from children with reflux esophagitis without asthma in the presence of severe epithelial damage, dyschronosis of changes, severe elongation of the “papillae”, pronounced cell proliferation (Ki-67) and local IgE expression.
EFFICACY OF PROTON PUMP INHIBITORS IN CHILDREN WITH ASTHMA COMBINED WITH GASTROESOPHAGEAL REFLUX DISEASE AND REFLUX ESOPHAGITIS Yu. G. Antipkin, V. F. Lapshin, T. R. Umanets, А. А. Buratynska, N. G. Chumachenko, L. S. Stepanova, S. I. Tolkach O. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine Abstract. The most common comorbid pathology in children with asthma is gastroesophageal reflux disease associated with reflux esophagitis, which ranges from 32 % to 80 %. To date, the effectiveness of proton pump inhibitors in this category of children and their effect on the level of asthma control remains controversial. The aim is to study the effectiveness of treatment with proton pump inhibitors in children with asthma, combined with gastroesophageal reflux disease and reflux esophagitis. Materials and methods. Forty-six children aged 6–17 years with asthma combined with gastroesophageal reflux disease and reflux esophagitis were examined. They were taking omeprazole 20 mg once daily for 4-8 weeks to control the symptoms of gastroesophageal dysfunction. Criteria for the effectiveness of the prescribed treatment were the dynamics of symptoms of gastroesophageal reflux disease and the level of asthma control, which were assessed at 4 and 8 weeks of treatment. Assessment of symptoms of gastroesophageal reflux disease was performed according to the questionnaire. The degree of control of asthma was determined using the Asthma Control Test. Results and discussion. There was a complete regression of symptoms of gastroesophageal reflux disease after 4 weeks of treatment with omeprazole in 40 (87.0 %) patients. Only 6 (46.2 %) patients with severe asthma had episodic symptoms of gastroesophageal dysfunction after 4 weeks of omeprazole treatment that were not recorded at 8 weeks of treatment. An increase in the number of children with controlled asthma was observed with omeprazole treatment, but no significant difference was found. Conclusions. Proton pump inhibitors are effective in controlling the symptoms of gastroesophageal reflux disease in children with asthma, but not likely in the short-term level of asthma control. Key words: asthma, treatment, children, reflux esophagitis, gastroesophageal reflux disease.
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