Bronchial asthma is the most common chronic pathology in childhood. Chronic inflammatory process of the respiratory tract forms bronchial hyperreactivity which is manifested by typical clinical symptoms. Like any other chronic disorder, the course of bronchial asthma consists of periods of exacerbation and remission. A productive cough in the post-attack period determines the prescription of mucolytic drugs by doctors to liquefy viscous sputum, to remove it more quickly, especially among the paediatric population. There are different approaches to prescribing mucolytic drugs during exacerbation of symptoms of bronchial asthma in scientific publications. The purpose of the study was to evaluate the clinical effectiveness of mucolytic therapy in children with bronchial asthma to optimize the treatment of disease exacerbations. Material and methods. One hundred two medical records of patients treated for asthma exacerbation in pulmonological department of the Chernivtsi Regional Children Clinical Hospital were analyzed. Four clinical groups were formed depending on the prescription of mucolytic drugs. There were not any significant differences by sex, place of residence, however the average age of patients who were prescribed carbocisteine. It was significantly less than in children of other clinical groups. Results and discussion. It was determined that acetylcysteine and carbocysteine were prescribed to patients on the first day of the productive cough onset. Instead to children of the IV clinical group where ambroxol was prescribed on average 1.6 days before the wet cough onset. The study results showed that the average duration of hospitalization in patients receiving ambroxol was 1.5 days less than in children taking acetylcysteine or carbocysteine. The difference was significant. However, the duration of hospitalization for children of I clinical group was not significant longer in comparison with patients received drugs with mucolytic effect in the complex therapy of asthma exacerbation. Conclusion. Despite the fact that acetylcysteine and carbocysteine were significantly more often prescribed for more severe and pronounced asthma exacerbation a decrease in the relative and absolute risks of longer hospitalization was observed in patients taking carbocysteine
Bronchial asthma is considered an umbrella diagnosis for various diseases with certain pathophysiological mechanisms (endotypes) and variable clinical manifestations (phenotypes). The phenotype of exercise-induced asthma is one of the most common variants of the disease in children and adolescents. The treatment tactic of acute asthma attack is unified and depends of the severity in contrast to preventive therapy the vector of which provides an individualized approach. However, the issues concerning the duration, frequency of administration and amount of drugs prescription not finally resolved. The purpose of the study was to evaluate the blood immunological parameters in patients with exercise-induced asthma phenotype to predict the severity of disease exacerbation and optimize the reliever therapy. Material and methods. We examined 43 children suffering from exercise-induced asthma. Two clinical groups were formed according to the severity of the exacerbation. The first group included 22 patients with moderate exacerbation of asthma, and the second group had 21 children with severe symptoms of the disease, which was interpreted as a severe asthma attack. There were not any significant differences by sex, place of residence, age and diseases duration among comparison groups. The obtained results showed a significant increase in the level of B-lymphocytes in patients of first clinical group (26.64 %) compared with children with severe exacerbation (20.40 %), increase content of T-lymphocytes (due to T-helper cells) in schoolchildren of the second clinical group (42.32 %) compared with patients with moderate asthma attack (33.32 %). The attributive risk of more severe disease exacerbation with B-lymphocytes ≤20 % and T- helper cells ≥20 % was 36.6 %, the relative risk was 1.9 with odds ratio 5.0. A significantly higher level of pharmazan-positive neutrophils in spontaneous and stimulated modifications of the nitro blue tetrazolium test was recorded in patients with moderate exacerbation (35.18 % and 45.09 %) compared with children of the second clinical group (19.33 % and 27.81 %). The content of neutrophils in the spontaneous nitro blue tetrazolium test ≤15 % allowed evaluating severe compared with moderate asthma attack with specificity of 95.5 %, positive predictive value of 90.9 %, and positive likelihood ratio 10.5. Conclusion. The use of certain immunological parameters allows working out an individual plan for asthma attacks and may reduce the frequency of severe exacerbations in children suffering from exercise-induced bronchial asthma
The results of the clinical efficacy of basic treatment of school-age children with bronchial asthma have been presented. It has been found that patients with an early-onset phenotype of asthma had a higher risk of not gaining control over the symptoms of the disease (odds ratio – 6,0) and exacerbations (odds ratio – 2,7) compared with children whose disease set in after six years.
Вищий державний навчальний заклад України «Буковинський державний медичний університет», м. Чернівці Резюме. У роботі проаналізована ефективність симптоматичного лікування нападного періоду неатопічного фенотипу бронхіальної астми в дітей залежно від типу ацетиляторних процесів. Виявлено, що вихідні показники тяжкості бронхообструкції суттєво не залежать від механізму ацетил яторних процесів. Не зважа-ючи на адекватний обсяг полегшувальної терапії, більш виражений синдром бронхообструкції в динаміці відзначався серед пацієнтів із швидким типом ацетилювання. Ключові слова: бронхіальна астма, діти, лікування, фенотип, ацетиляторні механізми.
The effectiveness of symptomatic treatment of bronchial asthma in children has been studied. It has been found that patients with non-atopic asthma phenotype were characterized by more severe bronchial obstruction during exacerbations compared with atopic patients. Children afflicted with nonatopic phenotype of the disease were characterized by more pronounced signs of airway obstruction during the whole hospitalization period despite the identical standard regimens in the comparison groups.
An analysis of changes of the hyperresponsiveness of the airways has been made in the paper against a background of an antiinflammatory treatment in children with different phenotypes of the incipience of bronchial asthma. It has been established that an increase of the indicators of bronchial hyperresponsiveness to indirect provoking factors is intrinsic to patients with the phenotype of an early onset of the disease.
bronchial asthma is an important medical and social issue directly affects the health of patients, their quality of life, and the direct and indirect economic costs associated with the disease are quite significant. Due to the pandemic caused by a new strain of coronavirus SARS-CoV-2, international and domestic regulations documents have updated the management of patients with asthma. In particular, there have been recommendations for remote visits to assess the patients’ complaints however physical analysis and objective examination are not available during such consultations. It can lead to errors in diagnostic of asthma exacerbation severity and treatment tactic for prescription the reliever therapy. So it is actuality to find out additional indicators to improve the diagnostic and prediction of the severity of the disease exacerbations. Given the urgency of the problem, the aim of the study is to evaluate the clinical and paraclinical parameters in children with virus-induced bronchial asthma exacerbation to predict the severity of the asthma attack and personify the management of patients. Have been examined 47 patients who were hospitalized for disease exacerbation. The severity of a asthma attack was considered a group-forming feature. Statistical analysis was performed using parametric and nonparametric calculation methods, methods of clinical epidemiology and biostatistics. The results of the study give grounds to predict a more severe asthma attack among urban residents who have a phenotype of late-onset asthma. An additional, anamnestic risk of more severe exacerbation of the disease is body weight at birth, which exceeds 3500 g. Among spirometric indicators the highest prognostic criterion for severe bronchial asthma exacerbation was the general index of bronchodilation, which was 15% and above, as well as the index of bronchodilation at the level of the distal airways with a cut-off point of 30% and above. In the presence of the above risk factors for severe asthma attack on the background of confirmed infection with the coronavirus strain SARS-CoV-2 the patient needs hospitalization, antiviral treatment, increasing the dose of inhaled steroids and additional β2-agonists. When predicting a mild or moderate asthma attack provoked by the coronavirus SARS-CoV-2, it is advisable to continue remote monitoring by an allergist and the management of exacerbation includes a temporary increase daily dose of inhaled glucocorticosteroids and additional using of β2-agonists. It is recommended to avoid taking nebulizers and use individual metered powder or aerosol inhalers in cases of inpatient treatment.
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