Мультиморбидность патологии верхних дыхательных путей у детей с бронхиальной астмой

Bronchial asthma (BA) is a systemic allergic disease and is associated with upper respiratory tract (URT) pathology. In recent years, attention was focused on allergic diseases multimorbidity, while the spectrum of URT pathology in children with BA is not characterized enough. Objective of the research - to study the structure of URT pathology in children with atopic BA. Study materials and methods: 358 children with atopic BA were examined, the average age of children was 9,91 (9,47, 10,35) years, of which 67,9% were boys (192/358), and 108 children with nasal breathing disorders, comparable in age and sex, but without BA. In addition to the standard all - clinical, allergological, functional examination, all patients underwent video endoscopic examination of the nasal cavity and nasopharynx. Results: аП children with BA were diagnosed with allergic rhinitis (AR) and/ or allergic rhinosinusitis (ARS) with a predominance of persistent forms. The «isolated» course of AR/ARS occurred in 11,7% (42/358) of patients; other children had nasal symptoms due to a combination of AR/ARS with other variants of URT pathology. Pharyngeal tonsilhypertrophy occurred in 61,2% (219/358) of patients, hypertrophic rhinitis - in 9,2% (33/358) of children with BA, nasal architectonics disorders were diagnosed in 50% (179/358) of patients. The combination of two nosological variants of nose pathology occurred in 47,8% (117/358) of patients with BA; 40,5% (145/358) of children with BA had multimorbidity of the nasal pathology - a combination of three or more nosological units. Conclusion: for children with atopic BA and nasal symptoms often have combined and multimorbid forms of URT pathology. Verification of nasal obstruction causes allows to individualize therapy for patients with BA and minimize negative impact of URT pathology on BA course.Бронхиальная астма (БА) является системным аллергическим заболеванием и ассоциирована с патологией верхних дыхательных путей (ВДП). В последние годы акцентируется внимание на мультиморбидности аллергических заболеваний, при этом спектр патологии ВДП у детей с БА охарактеризован недостаточно. Цель исследования - изучить структуру патологии ВДП у детей с атопической БА. Материалы и методы исследования: обследованы 358 детей с атопической БА, средний возраст детей составил 9,91 (9,47; 10,35) лет, из них мальчиков 67,9% (192/358), а также 108 детей с жалобами на нарушения носового дыхания, сопоставимых по возрасту и полу, но не имевших БА. Помимо стандартного общеклинического, аллергологического, функционального обследования у всех пациентов выполнено видеоэндоскопическое исследование полости носа и носоглотки. Результаты: у всех детей с БА был диагностирован аллергический ринит (АР) и/или аллергический риносинусит (АРС) с преобладанием персистирующих форм. «Изолированное» течение АР/АРС имело место у 11,7% (42/358) пациентов, у остальных детей назальные симптомы были обусловлены сочетанием АР/АРС с иными вариантами патологии ВДП. Гипертрофия глоточной миндалины имела место у 61,2% (219/358) пациентов, гипертрофический ринит - у 9,2% (33/358) детей с БА, нарушения архитектоники носа были выявлены у 50% (179/358) пациентов. Сочетание двух нозологических вариантов патологии носа имело место у 47,8% (117/358) пациентов с БА, у 40,5% (145/358) детей с БА была отмечена мультиморбидность назальной патологии - сочетание трех и более нозологических единиц. Заключение: для детей с атопической БА и назальными симптомами характерны сочетанные и мультиморбидные формы патологии ВДП. Верификация причин назальной обструкции позволяет индивидуализировать терапию у пациентов с БА и нивелировать отрицательное влияние патологии ВДП на течение БА

Thymic stromal lymphopoietin as a predictor of hypertrophic changes in the nasal mucosa in children with atopic bronchial asthma and allergic rhinitis

Th2-dependent allergic inflammation in patients with bronchial asthma (BA) and allergic rhinitis (AR) can be associated with nasal mucosa remodeling, accompanied by hypertrophic and hyperplastic processes. Thymic stromal lymphopoietin (TSLP) is a key cytokine produced by epithelial cells and is actively involved in allergic inflammation. Objective of the research: to study TSLP content in nasal secretion of children with atopic BA and AR. Materials and methods: in 43 patients aged 4-17 years with atopic BA and AR, nasal mucosa state was assessed using rhino-endoscopy and TSLP content in nasal secretion by the enzyme immunoassay. Results: hypertrophic or polypouschanges in the nasal mucosa and/or paranasal sinuses were detected in 30% (13/43) of patients. TSLP content in the nasal secretion in these patients was 908, 5 [48, 9; 2098, 7] pg/mg, which is statistically significantly higher than in patients with BA and AR without sinonasal hypertrophy (132, 3 [4, 2; 325, 9] pg/mg, p=0, 036). AR exacerbation was accompanied by a statistically significant increase of TSLP content in the nasal secret compared with the remission period (p=0, 002). Conclusion: hypertrophic changes in the nasal mucosa are accompanied by a statistically significant increase of TSLP content in the nasal secret in children with atopic BA and AR, which allows to consider this biomarker as a potential non-invasive predictor of pathological airway remodeling in patients with chronic allergic airway inflammation. © Springer Nature Switzerland AG 2020

The effect of nasal microbiota on the level of total immunoglobulin e in blood serum of children with bronchial asthma

Objective of the research: to study the relationship between the level of total IgE in serum and the nature of the nasal microbiota composition in children with bronchial asthma (BA). Materials and methods: 332 patients with BA were examined, mean age 10,34±0,4 years, 72% boys (239/332), the levels of total IgE and IgA, IgM, IgG in blood serum were determined, the composition of the nasal microbiota was studied by culture method. Results: 21,7% (72/332) of children had no St. aureus and St. epidermidis and other conditionally pathogenic flora in nasal microbiota; in 74,1% (246/332) of children S. aureus or St. epidermidis was revealed, in 40,7% (135/332) of them St. aureus was isolated; in 4,2% (14/332) another conditionally pathogenic microflora was found. The level of total IgE in blood serum in patients who had St. aureus in nasal microbiota was the highest and amounted to 218 [172,5; 264,3] IU/ml (p=0,002). Conclusion: St. aureus on the nasal mucosa of the upper respiratory tract in children with BA is accompanied by a higher level of total IgE in blood serum. © 2020, Pediatria Ltd.. All rights reserved

Effect of Nasal Obstructive Disorders on Sinonasal Symptoms in Children with Different Levels of Bronchial Asthma Control

Allergic rhinitis (AR) and allergic rhinosinusitis (ARS) are typical upper airway pathologies (UAP) in children with bronchial asthma (BA) frequently accompanied with nasal obstructive diseases (NOD). In order to establish the effect of NOD on correlations between nasal and synonasal symptoms with clinical assessments of asthma control, 82 children, 9.8 [8.9; 10.7] years old, with atopic BA were assessed using ACQ-5 for the BA control level, TNSS for nasal symptoms, and SNOT-20 for synonasal quality of life in combination with rhinovideoendoscopy for NOD. All patients had AR/ARS; in 76.3% (63/82) of children, UAP had a multimorbid character with the presence of NOD. Significant correlations were found between ACQ-5 and TNSS (R=0.40, p<0.0001) and ACQ-5 and SNOT-20 (R=0.42, p<0.0001). Correlations between TNSS/ACQ-5 and SNOT-20/ACQ-5 were higher in patients who do not have a combination of AR/ARS with NOD (R=0.67, p=0.0012; R=0.50, p=0.022, resp.) than in patients who have AR/ARS combined with NOD (R=0.30, p=0.015; R=0.26, p=0.04, resp.). Thus, the association of BA control level with the expression of nasal and synonasal symptoms is higher in children who do not have multimorbid UAP. © 2018 T. I. Eliseeva et al

Мультиморбидность патологии верхних дыхательных путей у детей с бронхиальной астмой

Bronchial asthma (BA) is a systemic allergic disease and is associated with upper respiratory tract (URT) pathology. In recent years, attention was focused on allergic diseases multimorbidity, while the spectrum of URT pathology in children with BA is not characterized enough. Objective of the research - to study the structure of URT pathology in children with atopic BA. Study materials and methods: 358 children with atopic BA were examined, the average age of children was 9,91 (9,47, 10,35) years, of which 67,9% were boys (192/358), and 108 children with nasal breathing disorders, comparable in age and sex, but without BA. In addition to the standard all - clinical, allergological, functional examination, all patients underwent video endoscopic examination of the nasal cavity and nasopharynx. Results: аП children with BA were diagnosed with allergic rhinitis (AR) and/ or allergic rhinosinusitis (ARS) with a predominance of persistent forms. The «isolated» course of AR/ARS occurred in 11,7% (42/358) of patients; other children had nasal symptoms due to a combination of AR/ARS with other variants of URT pathology. Pharyngeal tonsilhypertrophy occurred in 61,2% (219/358) of patients, hypertrophic rhinitis - in 9,2% (33/358) of children with BA, nasal architectonics disorders were diagnosed in 50% (179/358) of patients. The combination of two nosological variants of nose pathology occurred in 47,8% (117/358) of patients with BA; 40,5% (145/358) of children with BA had multimorbidity of the nasal pathology - a combination of three or more nosological units. Conclusion: for children with atopic BA and nasal symptoms often have combined and multimorbid forms of URT pathology. Verification of nasal obstruction causes allows to individualize therapy for patients with BA and minimize negative impact of URT pathology on BA course.Бронхиальная астма (БА) является системным аллергическим заболеванием и ассоциирована с патологией верхних дыхательных путей (ВДП). В последние годы акцентируется внимание на мультиморбидности аллергических заболеваний, при этом спектр патологии ВДП у детей с БА охарактеризован недостаточно. Цель исследования - изучить структуру патологии ВДП у детей с атопической БА. Материалы и методы исследования: обследованы 358 детей с атопической БА, средний возраст детей составил 9,91 (9,47; 10,35) лет, из них мальчиков 67,9% (192/358), а также 108 детей с жалобами на нарушения носового дыхания, сопоставимых по возрасту и полу, но не имевших БА. Помимо стандартного общеклинического, аллергологического, функционального обследования у всех пациентов выполнено видеоэндоскопическое исследование полости носа и носоглотки. Результаты: у всех детей с БА был диагностирован аллергический ринит (АР) и/или аллергический риносинусит (АРС) с преобладанием персистирующих форм. «Изолированное» течение АР/АРС имело место у 11,7% (42/358) пациентов, у остальных детей назальные симптомы были обусловлены сочетанием АР/АРС с иными вариантами патологии ВДП. Гипертрофия глоточной миндалины имела место у 61,2% (219/358) пациентов, гипертрофический ринит - у 9,2% (33/358) детей с БА, нарушения архитектоники носа были выявлены у 50% (179/358) пациентов. Сочетание двух нозологических вариантов патологии носа имело место у 47,8% (117/358) пациентов с БА, у 40,5% (145/358) детей с БА была отмечена мультиморбидность назальной патологии - сочетание трех и более нозологических единиц. Заключение: для детей с атопической БА и назальными симптомами характерны сочетанные и мультиморбидные формы патологии ВДП. Верификация причин назальной обструкции позволяет индивидуализировать терапию у пациентов с БА и нивелировать отрицательное влияние патологии ВДП на течение БА

Connection between body mass index, relative body mass index and bronchial patency indicators in children with bronchial asthma

Objective of the study: To study the relationship between nutritional status parameters and spirometric parameters reflecting bronchial patency in children with bronchial asthma (BA). Materials and methods of research: A retrospective non-randomized single-center comparative study of 417 children, 297 boys (71,2%) and 120 girls (28,8%), age 10,5 [10,2; 10,9] years with atopic BA. All children underwent spirometry and anthropometry. Results: An increase in body weight from underweight to obesity was accompanied by a decrease in the FEV1/FVC ratio from 80,4 [48,8; 97,9]% to 73,7 [47,4; 88,1]%, p=0,003, MEF 25% (% pred) from 70,9 [19,4; 171,5]% to 55,1 [20,2; 110,0]%, p=0,003 and FEF 25-75 (% pred) from 79,2 [28,6; 173,6]% to 65,9 [24,8; 103,5]%, p=0,02; at the same time, there is an increase in FVC% pred from 104,88±17,26 to 112,13±16,22%, р=0,01, which may be associated with the phenomenon of dysanapsis. The body mass index (BMI) and relative BMI values negatively correlate with the FEV1/FVC index (r=-0,20 and r=-0,19, respectively, p=0,0001). Similar data for the general cohort was collected in the cohort of boys. Conclusion: Indicators of nutritional status, as well as spirometric indicators, can be important components of an objective assessment of the condition of children with asthma for individual effective therapy of the disease. © 2021, Pediatria Ltd.. All rights reserved

Effect of Nasal Obstructive Disorders on Sinonasal Symptoms in Children with Different Levels of Bronchial Asthma Control

Allergic rhinitis (AR) and allergic rhinosinusitis (ARS) are typical upper airway pathologies (UAP) in children with bronchial asthma (BA) frequently accompanied with nasal obstructive diseases (NOD). In order to establish the effect of NOD on correlations between nasal and synonasal symptoms with clinical assessments of asthma control, 82 children, 9.8 [8.9; 10.7] years old, with atopic BA were assessed using ACQ-5 for the BA control level, TNSS for nasal symptoms, and SNOT-20 for synonasal quality of life in combination with rhinovideoendoscopy for NOD. All patients had AR/ARS; in 76.3% (63/82) of children, UAP had a multimorbid character with the presence of NOD. Significant correlations were found between ACQ-5 and TNSS (R=0.40, p<0.0001) and ACQ-5 and SNOT-20 (R=0.42, p<0.0001). Correlations between TNSS/ACQ-5 and SNOT-20/ACQ-5 were higher in patients who do not have a combination of AR/ARS with NOD (R=0.67, p=0.0012; R=0.50, p=0.022, resp.) than in patients who have AR/ARS combined with NOD (R=0.30, p=0.015; R=0.26, p=0.04, resp.). Thus, the association of BA control level with the expression of nasal and synonasal symptoms is higher in children who do not have multimorbid UAP. © 2018 T. I. Eliseeva et al