Частота, факторы риска, особенности бронхиальной астмы у детей с бронхолегочной дисплазией и ведение коморбидных пациентов

Bronchopulmonary dysplasia (BPD) and bronchial asthma (BA) are the most common chronic lung diseases in children, but the relationship between these diseases has not been fully defined. The incidence of atopic diseases (atopic dermatitis, allergic rhinitis, and BA) in children with BPD are significantly different according to national and international studies. There is not enough data on risk factors for the development, clinical and laboratory features of the course and treatment of BA in children with BPD. Material and methods. The case histories of 1104 patients (2004-2017) with BPD criteria were analyzed at the Department of Pediatrics at the RUDN University. On the basis of clinical and anamnestic data, allergological examination, and study of respiratory function, the frequency of asthma was determined. The comparative study was conducted in patients with isolated diseases - BPD (without BA) and BA (without BPD) - to determine the risk factors and characteristics of BA in children with BPD. Results and discussion. The frequency of BA was 7%, atopic dermatitis - 3.8% and allergic rhinitis - 3.6%. The risk factors for the development of BA in children with BPD were determined for low birth weight (LBW) (p=0.0037), late prematurity (p=0.0007), family history of allergy through asthma (p=0.0334), concomitant atopic dermatitis (p=0.0018) and allergic rhinitis (p=0.0022). Severe BPD (p=0.0002), episodes of bronchial obstruction in the first 3 years of life (p=0.0272). It was found that BA in children with BPD, compared with children without BPD is statistically significant. It characterized by an earlier onset (p=0.0168), a mild intermittent course (p=0.0003), a rarer need for inhaled bronchodilators (p=0.0034) and more frequent administration of inhaled corticosteroids as basic therapy (p=0.0399). Conclusion. We suggested that BA in children could be a respiratory consequence of BPD and a comorbid disease with a separate phenotype. The management of children suffering from BA and BPD should include the registration and evaluation of epidemiology, risk factors, clinical and laboratory features. It would be necessary to implement the clinical and allergological examination and the development of an individualized management program for patients.Бронхолегочная дисплазия (БЛД) и бронхиальная астма (БА) являются самыми частыми хроническими заболеваниями легких у детей, однако связь между данными заболеваниями до конца не определена. Частота развития атопических заболеваний (атопического дерматита, аллергического ринита и БА) у детей с БЛД существенно отличается; по данным отечественных и зарубежных исследований, немногочислены данные о факторах риска развития, клинико-лабораторных особенностях течения и терапии БА у детей с БЛД. Материал и методы. Были изучены истории болезней пациентов с БЛД и БЛД в анамнезе, наблюдавшихся на кафедре педиатрии ФГАОУ ВО «Российский университет дружбы народов» (Москва) на базе консультативно-диагностического отделения с дневным стационаром ГБУЗ «Детская инфекционная клиническая больница № 6» Департамента здравоохранения г. Москвы с 2004 по 2017 г. Среди этих больных на основании клинико-анамнестических данных, аллергологического обследования и исследования функции внешнего дыхания определена частота БА, проведено сравнительное исследование с пациентами с изолированными заболеваниями: БЛД (без БА) и БА (без БЛД) для определения факторов риска и особенностей БА у детей с БЛД. Результаты и обсуждение. Проанализировано 1104 медицинских карт пациентов, удовлетворяющих критериям диагноза БЛД, определена частота развития у них атопических заболеваний. Частота БА составила 7%, атопического дерматита - 3,8%, аллергического ринита - 3,6%. Определены факторы риска развития БА у детей с БЛД: низкая масса тела при рождении (р=0,0037), поздняя недоношенность (р=0,0007), отягощенный семейный аллергоанамнез по БА (р=0,0334), сопутствующие атопический дерматит (р=0,0018) и аллергический ринит (р=0,0022), тяжелая БЛД (р=0,0002), эпизоды бронхиальной обструкции в первые 3 года жизни (р=0,0272). Установлено, что БА у детей с БЛД по сравнению с детьми без данного хронического заболевания легких новорожденных статистически значимо чаще характеризуется более ранним началом (р=0,0168), легким интермиттирующим течением (р=0,0003), более редкой потребностью в ингаляционных бронхолитиках (р=0,0034) и более частым назначением ингаляционных глюкокортикоидов в качестве базисной терапии (р=0,0399). Заключение. БА у детей является респираторным последствием БЛД, коморбидным заболеванием с отдельным фенотипом. Оказание медицинской помощи детям, страдающим БА и БЛД, должно предусматривать учет и оценку эпидемиологии, факторов риска развития, клинико-лабораторных особенностей с реализацией этапного клинического и аллергологического обследования и выработкой программы индивидуализированного ведения пациентов

Palivizumab: Four seasons in Russia

In 2010, the Russian Federation (RF) registered palivizumab - innovative drug, based on monoclonal antibodies for passive immunization of seasonal respiratory syncytial virus (RSV) infection in children of disease severe progress risk group, which include primarily premature infants, children with bronchopulmonary dysplasia and hemodynamically significant congenital heart disease. Currently, palivizumab is included in the list of recommended medicines and medical care standards of different countries, including Russia. In the review the results of Russian research on the progress of RSV infection, its epidemiology and immunization experience gained over the 2010-2014 period are summarized in relation to the foreign data. During the four epidemic seasons palivizumab immunization covered more than 3,200 children of severe RSV infection risk group with a progressive annual increase in the number of patients who received the drug. Geography of palivizumab immunization is also greatly expanded in our country during this time. If during the first two seasons measures of immunization were taken mainly in Moscow and St. Petersburg, at the present time, thirty one territorial entities of the Russian Federation have the experience in the drug application. Analysis of the results of RSV infection immunization (made in several regions) confirms the high clinical efficacy and palivizumab safety already demonstrated in international studies. In addition, the analysis presents the potential to improve the efficiency of the integrated RSV infection immunization programs, realizing in the establishment of high-risk child group register, adequate counseling for parents, as well as the development of the routing of patients and coordination of interaction between different health institutions during the immunization. © 2014, Izdatel'stvo Meditsina. All rights reserved

Palivizumab: Four seasons in Russia

In 2010, the Russian Federation (RF) registered palivizumab - innovative drug, based on monoclonal antibodies for passive immunization of seasonal respiratory syncytial virus (RSV) infection in children of disease severe progress risk group, which include primarily premature infants, children with bronchopulmonary dysplasia and hemodynamically significant congenital heart disease. Currently, palivizumab is included in the list of recommended medicines and medical care standards of different countries, including Russia. In the review the results of Russian research on the progress of RSV infection, its epidemiology and immunization experience gained over the 2010-2014 period are summarized in relation to the foreign data. During the four epidemic seasons palivizumab immunization covered more than 3,200 children of severe RSV infection risk group with a progressive annual increase in the number of patients who received the drug. Geography of palivizumab immunization is also greatly expanded in our country during this time. If during the first two seasons measures of immunization were taken mainly in Moscow and St. Petersburg, at the present time, thirty one territorial entities of the Russian Federation have the experience in the drug application. Analysis of the results of RSV infection immunization (made in several regions) confirms the high clinical efficacy and palivizumab safety already demonstrated in international studies. In addition, the analysis presents the potential to improve the efficiency of the integrated RSV infection immunization programs, realizing in the establishment of high-risk child group register, adequate counseling for parents, as well as the development of the routing of patients and coordination of interaction between different health institutions during the immunization. © 2014, Izdatel'stvo Meditsina. All rights reserved

The structure of interstitial lung diseases in children of the first two years of life

For the first time in Russia, the article provides data on interstitial lung diseases structure in children of the first two years of life, based on a series of observations of 68 patients with these rare diseases, as a part of multi-center ambispective study. Interstitial lung diseases in observed children included: Wilson-Mikity syndrome (23,4%), neuroendocrine hyperplasia of infancy (22%), bronchiolitis obliterans with organizing pneumonia (7,4%), primary pulmonary hypoplasia (1,5%), secondary pulmonary hypoplasia with Jeune syndrome (10,3%), secondary pulmonary hypoplasia with Edwards syndrome (2,9%), secondary pulmonary hypoplasia with other associated pathology (omphalocele - 1,5%, non-immune fetal hydrops - 1,5%), subpleural cysts in patients with Down syndrome (5,9%), congenital deficiency of surfactant protein B (1,5%), brain-lung- thyroid syndrome (2,9%), congenital alveolar-capillary dysplasia (1,5%), interstitial lung diseases with systemic diseases (Langerhans cell histiocytosis - 16,2%, Niemann-Pick disease - 1,5%). The article summarizes clinical features, the results of image diagnosis and disease outcomes. © 2015, Pediatria Ltd. All rights reserved

The structure of interstitial lung diseases in children of the first two years of life

For the first time in Russia, the article provides data on interstitial lung diseases structure in children of the first two years of life, based on a series of observations of 68 patients with these rare diseases, as a part of multi-center ambispective study. Interstitial lung diseases in observed children included: Wilson-Mikity syndrome (23,4%), neuroendocrine hyperplasia of infancy (22%), bronchiolitis obliterans with organizing pneumonia (7,4%), primary pulmonary hypoplasia (1,5%), secondary pulmonary hypoplasia with Jeune syndrome (10,3%), secondary pulmonary hypoplasia with Edwards syndrome (2,9%), secondary pulmonary hypoplasia with other associated pathology (omphalocele - 1,5%, non-immune fetal hydrops - 1,5%), subpleural cysts in patients with Down syndrome (5,9%), congenital deficiency of surfactant protein B (1,5%), brain-lung- thyroid syndrome (2,9%), congenital alveolar-capillary dysplasia (1,5%), interstitial lung diseases with systemic diseases (Langerhans cell histiocytosis - 16,2%, Niemann-Pick disease - 1,5%). The article summarizes clinical features, the results of image diagnosis and disease outcomes. © 2015, Pediatria Ltd. All rights reserved