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Abstract

Submit Manuscript | http://medcraveonline.com HT and IHD (comparison group) and 20 were healthy subjects. All patients signed informed consent before the study. The Protocol of the study was passed review and was approved by the local ethics Committee of our University. The presence of IgE was determined to tick and house dust allergens, as well as the combined allergens of grass pollen, trees, weeds and flowers, S. pneumon, H. influenzae, and N. rerflava. The following cytokines were investigated: IL-4, IL-6, IL-10, IL-17, IFNγ, TNFα. All patients were examined during disease exacerbation. The INFP and ATP were determined for each subject. The results of the study of CK levels and CK combinations, the so-called cytokine profile, indicate that they cannot be used for clinical diagnosis, including nosological diagnosis, the assessment of disease severity, and for selecting individual therapy, including anti-cytokine medications.The incredible heterogeneity of bronchial asthma (BA) is becoming more and more clear. More than 30 years ago, in 1977, we pointed out the existence of seven clinical and pathogenetic types of BA in patients, subsequently called the following phenotypes: infection-dependent, atopic, hormonal, neuropsychological, autoimmune, significant adrenergic imbalance, and primary bronchial hyperreactivity [1]. Individual methods of diagnosis and treatment were developed for each of these options, and the results of their testing have been repeatedly published. Subsequently, the phrase "primary bronchial hyperreactivity" was replaced with the idea of exercise-induced BA, peri-menstrual and aspirin-related clinical and pathogenetic types (phenotypes) of BA. The methods of individual diagnosis and treatment continued to improve and their efficacy continued to increase.Inhalation corticosteroids (ICS) are considered to be the most effective in the treatment of BA. However, in 5-10% of patients with BA, comprehensive treatment is ineffective even with the inclusion of ICS [2]. Although the percentage of patients resistant to ICS, is quite low, they make up 50% of the overall cost of treatment for patients with BA [3]. The insufficient treatment efficacy of existing methods for a group of patients with BA is a reason for examining the BA phenotypes and the endotypes that form them. Knowledge of the mechanisms (endotypes) that form the phenotypes creates the prospects for developing new treatment methods, which take into account the individual characteristics of BA in a particular patient. A cluster analysis of two large European cohorts identified two phenotypes. The first refers to patients with early onset allergic BA, while the second comprises mainly women with late onset disease, without atopy, and with a high body mass index [4].Seven parameters were selected to classify the endotypes in patients with BA after the cluster analysis: clinical characteristics, biomarkers, lung physiology, genetics, histopathology, epidemiology, and response to treatment. The following BA endotypes were proposed based o...