ВОПРОСЫ КЛАССИФИКАЦИИ, КЛИНИЧЕСКАЯ КАРТИНА И БАЗИСНАЯ ТЕРАПИЯ ЮВЕНИЛЬНОЙ СКЛЕРОДЕРМИИ

Представлены современные сведения о классификации, клинической картине,  диагностике и лечении  склеродермии  у детей по данным литературы и собственных  исследований

Безопасность и эффективность – основа выбора ингаляционных глюкокортикостероидов в терапии бронхиальной астмы у детей

Safety and efficacy as fundamental choice of inhaled steroids for treatment of childhood asthma.Безопасность и эффективность – основа выбора ингаляционных глюкокортикостероидов в терапии бронхиальной астмы у детей

Prevention of new respiratory episodes in children with recurrent respiratory infections: An expert consensus statement

In healthy infants and young children, the development of respiratory tract infections (RTIs) is extremely common. In this paper, we present an international consensus of the available approaches for the prevention of recurrent RTIs in children, including the atopic/allergic ones as well as those with asthma. Few convincing measures for reducing the frequency and clinical relevance of recurrent respiratory episodes in RTI-prone children have been developed until now. Among the most recently suggested measures, immunotherapy is attractive, but only for OM-85 is there a sufficient number of well-conducted clinical trials confirming efficacy in RTIs prevention with an adequate safety profile. In the case of probiotics, it is not clear which bacteria can offer the best results and which dosage and schedule of administration are the most effective. The problems of dosage and the schedule of administration are not solved also for vitamin D, despite some promising efficacy results. While we wait for new knowledge, the elimination or reduction as much as possible of the environmental factors that favor RTIs, vaccination when available and/or indicated, and the systematic application of the traditional methods for infection prevention, such as hand washing, remain the best measures to prevent recurrent infections in RTI-prone children

Prevention of New Respiratory Episodes in Children with Recurrent Respiratory Infections: An Expert Consensus Statement from the World Association of Infectious Diseases and Immunological Disorders (WAidid)

In healthy infants and young children, the development of respiratory tract infections (RTIs) is extremely common. In this paper, we present an international consensus of the available approaches for the prevention of recurrent RTIs in children, including the atopic/allergic ones as well as those with asthma. Few convincing measures for reducing the frequency and clinical relevance of recurrent respiratory episodes in RTI-prone children have been developed until now. Among the most recently suggested measures, immunotherapy is attractive, but only for OM-85 is there a sufficient number of well-conducted clinical trials confirming efficacy in RTIs prevention with an adequate safety profile. In the case of probiotics, it is not clear which bacteria can offer the best results and which dosage and schedule of administration are the most effective. The problems of dosage and the schedule of administration are not solved also for vitamin D, despite some promising efficacy results. While we wait for new knowledge, the elimination or reduction as much as possible of the environmental factors that favor RTIs, vaccination when available and/or indicated, and the systematic application of the traditional methods for infection prevention, such as hand washing, remain the best measures to prevent recurrent infections in RTI-prone children

Опыт комбинированного использования бесфреонового ультрамелкодисперсного препарата беклометазона дипропионата и формотерола в терапии среднетяжелой бронхиальной астмы у детей

Open non-comparative 3-month study of efficacy of combined therapy with beclomethasone (Beclason ECO Easy Breathe) and formoterol (Foradil) was performed in children 6 to 11 years old with moderate bronchial asthma. The study involved 35 patients (the average age was 8.64 ± 0.65 yrs), 69 % were boys. The length of the disease was 2 to 10 yrs (6.01 ± 0.83 yrs). All the patients were given Beclason ECO Easy Breathe 200 meg and Foradil 9 meg twice a day. We evaluated inhalation technique, clinical and functional dynamics, possibilities of achieving the full asthma control, need in short-acting β1-agonists, tolerability and safety of the therapy. No one patient experienced technique problems when using Beclason ECO Easy Breathe. By the 8-th week of the treatment asthma symptoms disappeared in all the patients, breathing rate and lung auscultation became normal. Significant improvement in lung function was noted by the 12-th week of the therapy. The FEV1 growth under the bronchodilating test diminished indicating more bronchial stability. Peak expiratory flow rate increased even in children with initial normal parameters. The need in short-acting β2-agonists reduced from 1,9 ± 0,4 to 0,6 ± 0,2 doses daily. The treatment was well tolerated.Thus, the combination of Beclason ECO Easy Breathe and Foradil in moderate asthma children results in achieving the full asthma control, clinical stability, elimination of the asthma signs, improvement in lung function.Нами проведено открытое несравнительное исследование эффективности комбинированной терапии беклометазоном (Беклазон ЭКО "Легкое дыхание") и формотеролом (Форадил) у детей 6-11 лет с бронхиальной астмой (БА) средней тяжести в течение 3 мес. В исследование были включены 35 пациентов (средний возраст 8,64 ± 0,65 лет), 69 % составили мальчики. Длительность заболевания варьировалась от 2 до 10 лет (в среднем — 6,01 ± 0,83 года). Всем пациентам был назначен Беклазон ЭКО "Легкое дыхание" 200 мкг дважды в день в комбинации с Форадилом 9 мкг дважды в день. На фоне этой терапии каждые 3 мес. мы оценивали технику использования ингалятора "Легкое дыхание" и Аэролайзера; динамику клинического и функционального статуса, возможности достижения полного контроля; потребность в β2-агонистах короткого действия, переносимость и безопасность терапии. Ни у кого из пациентов не возникло трудностей в использовании Беклазона ЭКО "Легкое дыхание" и Аэролайзера. К 8-й нед. терапии у всех детей исчезли клинические проявления БА, нормализовалась ЧД, отсутствовали физикальные изменения в легких. Достоверное улучшение показателей функции внешнего дыхания, по сравнению с исходными, отмечалось через 12 нед. терапии. В пробе с бронхолитиком достоверно уменьшился прирост FEV1, что свидетельствует о нормализации бронхиальной проходимости и снижении бронхолабильности. Пиковая скорость выдоха в динамике увеличивалась даже у детей, исходно имевших нормальные показатели. Потребность в короткодействующих β2-агонистах в ходе исследования снизилась с 1,9 ± 0,4 до 0,6 ± 0,2 инг./сут. Отмечена хорошая переносимость терапии.Проведенное исследование показало, что комбинация Беклазона ЭКО "Легкое дыхание" и Форадила у детей со среднетяжелой БА приводит к достижению контроля заболевания, стабилизации состояния, исчезновению симптомов БА, улучшению функции внешнего дыхания

Body Height of Children with Bronchial Asthma of Various Severities

© 2017 Tatiana I. Eliseeva et al. Influence of bronchial asthma (BA) severity on physical development in children patients was evaluated in comparison with healthy population. Materials and Methods. 1042 children and adolescents (768 boys) with atopic BA were evaluated. All children underwent standard examination in a clinical setting, including anthropometry. The control group included 875 healthy children of a comparable age (423 boys). Results. The fraction of patients with the normal, lower, and increased height among the whole group of patients with BA is close to the corresponding values in the healthy population (χ 2 =3.32, p=0.65). The fraction of BA patients with the reduced physical development is increased monotonically and significantly when the BA severity increases: healthy group, 8.2% (72/875), BA intermittent, 4.2% (6/144), BA mild persistent 9% (47/520), BA moderate persistent, 11.7% (36/308), and BA severe persistent, 24.3% (17/70) (χ 2 =45.6, p=0,0009). Conclusion. The fraction of the children with the reduced height is increased monotonically and significantly in the groups of increasing BA severities. At the same time, the fraction of such children in groups of intermittent and mild persistent BA practically does not differ from the conditionally healthy peers

Relative body mass index as a new tool for nutritional status assessment in children and adolescents with bronchial asthma

© 2017, Nizhny Novgorod State Medical Academy. All rights reserved.The aim of the investigation was to estimate the possibilities of using relative body mass index (RBMI) for determining age- and gender-specific aspects of nutritional status in children and adolescents with bronchial asthma (BA) of different severity degrees. Materials and Methods. The study involved 887 children and adolescents with BA of different severities, aged 5–17 years (61– 215 months), of them 655 were boys. Their body mass index (BMI) was evaluated based on the Z-score criterion and nutritional status was determined as recommended by the World Health Organization (WHO). To unify nutritional status assessment in patients of different age and gender groups, there was introduced RBMI representing the ratio of the patient’s BMI to gender- and age-specific median BMI value presented in the WHO reference data. Results. Nutritional status and its relation to BA were studied in children and adolescents using two parameters: the standard nutritional status indicator based on BMI Z-scores as recommended by WHO, and a new parameter, RBMI, representing the ratio of the patient’s BMI to gender- and age-specific median BMI value recommended by WHO. No significant nutritional status differences were found in the studied sample of patients with various degrees of BA severity. There was revealed a tendency to a decrease in the proportion of children with normal body weight and an increase in the proportion of overweight children as BA severity increased, χ2=26.82; р=0.08. Conclusion. Using RBMI for assessment of BA patients makes it possible to significantly facilitate clinical data analysis and obtain new data unavailable when standard parameters are applied