Актуальная тактика ведения детей с бронхиальной астмой

The article is devoted to the problem of timely diagnosis and current principles of management of children with bronchial asthma. Given the  increase in the prevalence of allergic pathology stated over the past  decades, the issues of differential diagnosis, integrated approach to the  treatment and management of children with allergies are extremely  relevant. Strategies of sequential therapy and monitoring of the  patient’s condition, adherence principles are key links in achieving and  maintaining control over bronchial asthma. The publication presents the  main provisions of national clinical guidelines developed and approved  by the professional association «Union of Pediatricians of Russia».Статья посвящена проблеме своевременной диагностики и современным принципам ведения детей с бронхиальной астмой. Учитывая рост распространенности аллергической патологии,  зафиксированный на протяжении последних десятилетий, вопросы дифференциальной  диагностики, комплексного подхода к лечению и ведению детей с аллергией крайне актуальны. Стратегии ступенчатой терапии и мониторинга состояния пациента, принципы приверженности  — ключевые звенья в достижении и поддержании контроля над бронхиальной астмой. В  публикации представлены основные положения национальных клинических рекомендаций,  разработанных и утвержденных профессиональной ассоциацией «Союз педиатров России»

Первые результаты оценки качества медицинской помощи на догоспитальном и госпитальном этапах детям с острой аллергической патологией

Background. Differential diagnosis of exacerbations of allergic diseases in children at pre-hospital and hospital stages of rendering emergency medical care (EMC) remains a relevant issue. One of the reasons is that medical care does not always comply with current clinical guidelines.Objective. Our aim was to analyze the quality of emergency medical care for children with acute allergic pathology.Methods. A retrospective study with a retrospective analysis and extraction of data from medical records (in 2 stages) was conducted.Results. The study analyzed the data of 595 children with acute allergic pathology who applied for emergency medical care (girls — 215; 36.13%). The average age of patients was 43.12 ± 41.09 months, 455 (76.47%) were under 5 years of age. 513 (86.22%) children applied for medical care for the first time, 24 (4.03%) children — for the second time; in 58 (9.75%) emergency team call records, this column was not filled. Based on the complaints and diagnoses indicated in the medical documentation, the children were divided into 3 groups: Croup, Cutaneous Manifestations of Allergy, and Bronchopulmonary Manifestations. We analyzed the reliability and validity of final diagnoses made at pre-hospital and hospital stages and assessed the adequacy of the carried out pharmacotherapy.Conclusion. According to our study, the quality of medical care at pre-hospital and hospital stages does not always correspond to current standards, algorithms, and available clinical guidelines.Дифференциальная диагностика обострений аллергических заболеваний у детей на догоспитальном и госпитальном этапах оказания скорой медицинской помощи (СМП) остается актуальной проблемой. Одна из причин в том, что медицинская помощь не всегда проводится в соответствии с современными клиническими рекомендациями.Цель исследования — проанализировать качество оказания скорой и неотложной медицинской помощи детям с острой аллергической патологией.Методы. Проведено ретроспективное исследование с ретроспективным анализом и выкопировкой данных из медицинской документации (в 2 этапа).Результаты. В исследовании проанализированы данные 595 детей с острой аллергической патологией, обратившихся за скорой медицинской помощью (девочек — 215; 36,13%). Средний возраст пациентов — 43,12±41,09 мес, из них 455 (76,47%) — в возрасте до 5 лет. Первично за медицинской помощью обратились 513 (86,22%) детей, повторно — 24 (4,03%); в 58 (9,75%) картах вызова бригады СМП заполнение данной графы отсутствовало. На основании указанных в медицинской документации жалоб и выставленных диагнозов дети разделены на 3 группы: «Круп», «Кожные проявления аллергии» и «Бронхолегочные проявления». Проанализированы достоверность и обоснованность уточненных диагнозов, выставленных на догоспитальном и госпитальном этапах, оценена адекватность проведенной фармакотерапии.Заключение. По данным нашего исследования, оказание медицинской помощи на догоспитальном и госпитальном этапах не всегда соответствует современным стандартам, алгоритмам и имеющимся клиническим рекомендациям.Конфликт интересовЛ.С. Намазова-Баранова — получение исследовательских грантов от фармацевтических компаний Пьер Фабр, Genzyme Europe B. V., ООО «Астра зенека Фармасьютикалз», Gilead/PRA «Фармасьютикал Рисерч Ассошиэйтс СиАйЭс», «Bionorica», Teva Branded Pharmaceutical products R&D, Inc/ООО «ППД Девелопмент (Смоленск)», «Сталлержен С. А.»/«Квинтайлс ГезмбХ» (Австрия)

Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multinational cohort

Background The interplay between COVID-19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes.Methods The PeARL multinational cohort included 1,054 children with asthma and 505 non-asthmatic children aged between 4 and 18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID-19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control.Results During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks, and hospitalizations due to asthma, in comparison with the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre-bronchodilatation FEV1 and peak expiratory flow rate were improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits, or hospitalizations during the pandemic. However, an increased risk of URTIs emerged.Conclusion Childhood asthma outcomes, including control, were improved during the first wave of the COVID-19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID-19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.</p

25th annual computational neuroscience meeting: CNS-2016

The same neuron may play different functional roles in the neural circuits to which it belongs. For example, neurons in the Tritonia pedal ganglia may participate in variable phases of the swim motor rhythms [1]. While such neuronal functional variability is likely to play a major role the delivery of the functionality of neural systems, it is difficult to study it in most nervous systems. We work on the pyloric rhythm network of the crustacean stomatogastric ganglion (STG) [2]. Typically network models of the STG treat neurons of the same functional type as a single model neuron (e.g. PD neurons), assuming the same conductance parameters for these neurons and implying their synchronous firing [3, 4]. However, simultaneous recording of PD neurons shows differences between the timings of spikes of these neurons. This may indicate functional variability of these neurons. Here we modelled separately the two PD neurons of the STG in a multi-neuron model of the pyloric network. Our neuron models comply with known correlations between conductance parameters of ionic currents. Our results reproduce the experimental finding of increasing spike time distance between spikes originating from the two model PD neurons during their synchronised burst phase. The PD neuron with the larger calcium conductance generates its spikes before the other PD neuron. Larger potassium conductance values in the follower neuron imply longer delays between spikes, see Fig. 17.Neuromodulators change the conductance parameters of neurons and maintain the ratios of these parameters [5]. Our results show that such changes may shift the individual contribution of two PD neurons to the PD-phase of the pyloric rhythm altering their functionality within this rhythm. Our work paves the way towards an accessible experimental and computational framework for the analysis of the mechanisms and impact of functional variability of neurons within the neural circuits to which they belong

Заболеваемость COVID-19 у детей с астмой и аллергией

Background. The morbidity of new coronavirus infection remains high (in children as well). Children with bronchial asthma are not at risk this disease development and severe course of COVID-19 according to the previous studies results.Objective. The aim of the study is to compare the morbidity rate of COVID-19 among children with and without bronchial asthma between May 2020 and October 2021 with the results from the beginning of pandemics. Methods. Online questionnaires in Google form have been developed and sent to parents of 83 patients aged from 7 to 17 years who have been interviewed at the beginning of the pandemics. The main group includes 49 patients diagnosed with bronchial asthma, and the control group includes 25 children without bronchial asthma.Results. 45% (22) of patients had COVID-19 in the main group and 32% (8) — in the control group (p = 0.636). 80% of patients had mild course of disease and 20% — moderate in the main group, and 62% and 37% in the control group respectively. Febrile fever was observed in 40% of respondents in the main group and in 33% — in the control group; anosmia — in 35% in the main and in 14% — in the control group; pulse oximetry was used by 44% of patients in the main group (SpO2 94–98%) and 42% in the control group (SpO2 98–99%); 66% of patients had baseline therapy and 6% had rescue medications in the main group. No one from both groups has been hospitalized.Conclusion. Pediatric patients both with and without bronchial asthma have COVID-19 more often compared to the pandemics beginning. The disease in most cases had mild course and did not require hospitalization, aggravations of bronchial asthma were rare, and saturation values did not decrease below 94%.Обоснование. Заболеваемость новой коронавирусной инфекцией остается на высоком уровне, в том числе среди детей. Дети с бронхиальной астмой, по результатам ранее проведенных исследований, не находятся в группе риска по заболеванию и тяжелому течению COVID-19.Цель исследования — сравнить уровень заболеваемости COVID-19 среди детей с бронхиальной астмой и без астмы в период с мая 2020 по октябрь 2021 г. с результатами, полученными в начале пандемии.Методы. Разработаны онлайн-опросники с использованием Google-формы и разосланы родителям 83 пациентов в возрастной группе от 7 до 17 лет, проходившим опрос в начале пандемии. В основную группу включены 49 пациентов с диагнозом «бронхиальная астма», а в контрольную — 25 детей без диаг ностированной астмы. Результаты. В основной группе COVID-19 болели 45% (22), в контрольной — 32% (8) пациентов (р = 0,636). В основной группе легкое течение коронавирусной болезни отметили 80%, средней тяжести — 20%, в контрольной — 62 и 37% пациентов соответственно. Фебрильная лихорадка отмечалась у 40% ответивших пациентов в основной и у 33% — в контрольной группе; потеря обоняния — у 35% в основной и у 14% — в контрольной группе; пульсоксиметрию использовали 44% пациентов в основной (SpO2 — 94–98%) и 42% — в контрольной группе (SpO2 — 98–99%); в основной группе базисную терапию применяли 66%, препараты скорой помощи — 6% детей. В обеих группах ни один пациент не был госпитализирован.Заключение. Пациенты детского возраста — как с бронхиальной астмой, так и без астмы — стали чаще болеть COVID-19 по сравнению с началом пандемии. Болезнь у большинства протекала в легкой форме, не требовала госпитализации, обострения бронхиальной астмы отмечались редко, а значения сатурации не снижались &lt; 94%

The Long-Term Omalizumab Therapy in Children with Severe Persistent Uncontrolled Asthma: Evaluation of the Outcomes According to the Data of the Hospital Patient Registry

Background: Patient registries help to obtain relevant information about the peculiarities of certain diseases, as well as the safety and effectiveness of different medical technologies. Moreover, it allows conducting a continuous monitoring in a studied group. Objective: to analyze the effectiveness and safety of a long-term target therapy with Omalizumab (more than 4 years) in children with severe persistent uncontrolled asthma based on the electronic clinical cases database (registry). Methods. The outcomes of the treatment were evaluated based on the data from the registry of patients with severe uncontrolled asthma. Time period: November 2007- March 2018. The main goal of the research was to identify the number of patients who achieved the disease control (20 points С-АСТ-test in children aged 6–11 years or 25 points АСТ-test in children aged 12–17 years) at least in one of the time points — in 4; 6; 12 or 48 months. Results. The results of the treatment of 26 children were analyzed (males — 73%), median age — 17 years. The posology of Omalizumab was 75 to 600 mg, median (Me) 300 mg [225; 375]. Asthma control test (ACT) before the start of the treatment was 14 points (Me 14 [12; 17,5], in 48 mo — 21 points (Me 22 [20; 24]; p=0,0017). The decrease of the amount of the daily therapy was demonstrated. The median dose of the ICS (fluticasone) was 575 mcg/day (Me 500 [437,5; 750]) before the start of the treatment, in 48 mo — 492 mcg/day (Me 500 [250; 562,5]; p=0,066). The decrease of the number of exacerbations and the use of SABA from 12 (Me 10,5 [9,75; 13,25]) to 0,8 times/month (Me [1; 0;1]) was observed after 4 years of treatment (р=0,000). No adverse events were observed. Conclusions. Long-term therapy with Omalizumab increases the disease control in children with severe persistent asthma. The registry as a continuous monitoring tool enables to conduct a complex evaluation of the effectiveness and safety of the treatment

Actual Surveillance of Children with Bronchial Asthma

The article is devoted to the problem of timely diagnosis and current principles of management of children with bronchial asthma. Given the  increase in the prevalence of allergic pathology stated over the past  decades, the issues of differential diagnosis, integrated approach to the  treatment and management of children with allergies are extremely  relevant. Strategies of sequential therapy and monitoring of the  patient’s condition, adherence principles are key links in achieving and  maintaining control over bronchial asthma. The publication presents the  main provisions of national clinical guidelines developed and approved  by the professional association «Union of Pediatricians of Russia»

Innovative Management Methods for Patients Allergic to Cats

The prevalence of allergies to domestic animals increases due to the increase in the number of pets worldwide, followed by serious medical and social problems. Domestic cat (Felis domesticus) is one of the most common pets and one of the most frequent (after dust mite) source of indoor allergens and risk factor for bronchial asthma and allergic rhinitis. This review collects relevant information on the issues of hypersensitivity to cat allergens (the term «cat allergy» will be used later). The authors consider issues of diagnosis, treatment and prevention of this condition. Special attention is given to the management of patients with cat allergies and particularly usage of special nutrition for cats that can reduce the level of the main cat allergen Fel d 1 in the environment. Whereas, this leads to decrease of allergic diseases symptoms severity

Клинические случаи: ошибки в диагностике кожных форм мастоцитоза у детей

Background. Mastocytosis refers to the group of rare diseases with pathological mast cells accumulation in tissues. Although diagnosis of cutaneous mastocytosis is not usually difficult for experienced physicians, misdiagnosis is possible.Clinical cases description. The authors describe two clinical cases of patients with mastocytosis cutaneous form, observed due to the skin rashes and without any correctly established diagnosis.Conclusion. Patients with mastocytosis require specific living conditions and regular dynamic monitoring to prevent disease progression and complications development.Обоснование. Мастоцитоз относится к группе редких заболеваний, при которых происходит патологическое накопление тучных клеток в тканях. Несмотря на то, что постановка диагноза кожного мастоцитоза обычно не представляет трудности для опытных врачей, часто имеет место неправильная диагностика.Описание клинических случаев. Авторами приведено описание двух клинических случаев пациентов с кожными формами мастоцитоза, наблюдавшихся в связи с высыпаниями на коже без правильно установленного диагноза.Заключение. Пациенты с мастоцитозом требуют соблюдения определенных условий жизни и регулярного динамического наблюдения с целью профилактики прогрессирования заболевания и развития осложнений