The cell pattern of bronchi inflammatory infiltrate has a significant impact on the course of the disease and may affect the achievement and maintenance of the asthma control. The aim of the study was to determine the influence of neutrophilic component of the bronchial inflammation on the asthma control, lung function and airway responsiveness. 114 patients with mild persistent asthma were assessed upon the level of the asthma control by Asthma Control Test (ACT); lung function (FEV1) by spirometry; airway responsiveness (∆FEV1) to 3-minute isocapnic hyperventilation with cold air (-20ºС) (IHCA) and 3-minute ultrasound inhalation with distilled water (IDW). The cell composition of the induced sputum (IS) was also studied. The patients were divided into groups with low contents of neutrophils in IS (39 people; 1st group) and with high contents of neutrophils (75 people, 2nd group). The contents of neutrophils in the 1st group was 10.9±0.53%, eosinophils – 19.4±2.1%; in the 2nd group – 29.9±1.6% (р=0.0001) and 20.4±1.4% (р=0.66), respectively. By ACT data the people of the 2nd group managed their disease worse than in 1st group (15.0±0.6 and 19.0±0.8 points, respectively; р=0.0001). They also had lower FEV1 (88.0±2.0 and 96.7±2.4%; р=0.009) and more intensive airway response to IHCA and DW (-13.7±1.7% and -11.2±1.9%, respectively) in comparison with the 1st group (-2.7±0.86%; р=0.0001 and -5.3±1.90%; р=0.055). The patients of the 2nd group had a close correlation between baseline neutrophils in IS and ∆FEV1 in response to IHCA (r=-0.22; р=0.045) as well as the content of myeloperoxidase in IS (r=0.31; р=0.0008). A level of myeloperoxidase in IS correlated with ∆FEV1 in response to IDW (r=0.29; р=0.030) in these patients. The increase of neutrophilic component of inflammation in asthma patients worsens the asthma control, lung function and enhances airway responsiveness to exogenous stimuli.
The character of changes of inflammatory-cellular pattern of bronchial secretion in patients with asthma in association with cold airway hyperresponsiveness (CAHR) under the influence of standard therapy has been studied little. The aim of the present work is to study dynamics of cellular profile, neutrophilic component of bronchial inflammation under the combination therapy of asthmatics with CAHR. 12 asthma patients with CAHR were studied upon the number of cells of the induced sputum (IS), peroxidase, cytolytic and destructive activity of eosinophils and neutrophils in the sputum, lung function and asthma control with the help of questionnaire Asthma Control Test (АСТ) before and after the therapy with the combination of budesonide/formoterol. Before the therapy the patients had a low level of asthma control (14.4±1.2 points of ACT), FEV1 was 87.4±3.3% from predicted values; in IS neutrophils prevailed (26.4±1.7%) over eosinophils (18.5±2.6%); the level of myeloperoxidase (mean cytochemical coefficient) was 65.9±5.4 pixels. After 48 weeks of the observation only in 58% of patients the criteria of good control of asthma and the improvement of lung function were achieved. In IS there was a decrease of eosinophils (11.4±3.2%; p=0.045); the intensiveness of eosinophils and neutrophils cytolysis dropped; intracellular concentration of myeloperoxidase grew (98.2±14.1 pixels; p=0.0637); destructive changes in granulocytes were registered but the number of neutrophils remained high (34.0±8.2%, р=0.34), which was considered as the factor of stable initiation of inflammation and oxidative stress. Thus, the use of anti-inflammatory treatment regime lasting 48 weeks with combination of budesonide/formoterol oriented to achieve clinical criteria of asthma control in patients with CAHR does not allow to achieve correction of the level of neutrophilic inflammatory component. Quantitative index of neutrophils in IS in these patients has prognostic value for the possible loss of achieved asthma control.
Worldwide in recent years there has been a big interest in the problem of diagnosis and treatment of asthma in the gestation period, occurring, according to various sources, in 1–13.8% of pregnant women. The aim of the work was to determine the clinical and functional characteristics of the course of asthma during pregnancy and the postpartum period, including patients with repeated pregnancies and childbirth. 102 patients with asthma were examined in dynamics of pregnancy and the postpartum period lasting from 3 months to 3 years. There were used clinical and medical history data, integrated monitoring of clinical syndromes, testing using Asthma Control Test (ASTTM), research of lung function, day monitoring of airway conductance parameters, evaluation of the impact of birth stress on adaptation reserves and the condition of the natural resistance of the body by the blood count. Dynamics of asthma course in the gestation period looked as follows: worsening of the course was observed in 44% of patients, often with non-allergic and mixed forms of the disease; without significant dynamics there were 39.2% of patients, improvement was observed in 9.8%, mainly at mild persistent allergic asthma. In the postpartum period 34.3% of patients showed improvement, 41.2% did not have any dynamics, and 24.5% had worsening of symptoms, mainly they were with moderate and severe asthma. The influence of some factors on the asthma dynamics during gestation and the postpartum period was found out. They were the severity of the disease, the presence of extra pulmonary allergic diseases, multivalent sensitization, chronic diseases of upper respiratory tract, ARVI and the way medical recommendations were followed by patients.
The aim of the research was to identify the frequency of development of the syndrome of post-exercise bronchial spasm in patients with asthma against physical load and the study of clinical-functional features of its course. 197 patients (122 women and 75 men) with mild persistent partially controlled and uncontrolled asthma were observed. The mean age of the patients was 36.1±0.73 years old; the mean height was 168.8±0.63 cm; the mean weight was 74.6±1.03 kg. The patients did not have strong obstructive disorders of the ventilation pulmonary function; forced expiratory volume for the first second (FEV1) was 91.6±2.5% from the predicted value. All the patients had clinical-anamnestic test and the assessment of apnoea degree by the scale of mMRC and identification of disease control by validated questionnaire Asthma Control Test; the airway response was evaluated in reaction to dosed physical load calculated and fulfilled at the research complex for ergospirometric studies OxyconPro (VIASYS Healthcare, Germany); basic study of the lung function at the device Easyone-PC (Switzerland) was done. As a result of the study post-exercise bronchial spasm was diagnosed in 18.3% of patients with asthma. Close positive correlation between the baseline FEV1 (in %) and bronchial response to the dosed physical load measured at the first minute of the recovery period (r=0.19; р<0.05) as well as the intensity of the further bronchial response at the 10th minute of the recovery period (r=0.19; р<0.05) was registered. The intensity of bronchial response at the 10th minute of the recovery period in patients with airway hyperresponsiveness to dosed physical load was directly related with the degree of asthma control (r=0.56; р˂0.05). It was found out that the degree of the asthma control correlated with the airway hyperresponsiveness to physical load.
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