Оптимизация комбинированной терапии и клинико-лабораторного контроля при использовании формотерола у детей, больных бронхиальной астмой

Searching for exact ways and scheme of treatment and supervising asthma patients on long-acting form of b 2-agonist (Formoterol) therapy is still very actual. We studied 31 children (from 7 to 11 years) with moderate non-controled bronchial asthma during 12 weeks. As a basic therapy inhaled corticosteroids-mono or in a combination with Foradyle were used. Corresponding data on Childhood Asthma Control Test, lung function, electrocardiogram, serum potassium and glucose concentrations were monitoring clinically. No adverse reactions were seen. The results obtained for the case of combined therapy with formoterol point out the necessity of more frequent than prescribed observation of the patient state trend, with taking electrocardiography and especially compliance into account.Поиск конкретных схем лечения и тактики наблюдения за больными при применении пролонгированного b 2-агониста формотерола, широко использующегося в качестве средства для базисной терапии бронхиальной астмы у взрослых и детей, остается до сих пор актуальным. Статья посвящена оценке состояния больных бронхиальной астмой детей в период перехода от лечения ингаляционными глюкокортикостероидами на комбинированную терапию с использованием аэролайзера форадила («третья ступень» терапии в соответствии с рекомендациями GINA). Применялся опросник Asthma Control Test, функциональные и лабораторные исследования. Под наблюдением в течение 12 недель лечения находился 31 ребенок в возрасте от 7 до 11 лет c частично контролируемой среднетяжелой бронхиальной астмой. Полученные результаты позволяют рекомендовать более частый контроль состояния больных, обязательное исследование ЭКГ в динамике, особенно при наличии сопутствующей сердечно-сосудистой патологии. Принципиально важен комплайнс и индивидуальный подход при назначении форадила

Clinical and laboratory markers of bacterial infection in children of different ages

Based on current data from domestic and foreign studies, the article presents relevant information on clinical, hematological and biochemical markers of bacterial infection (BI) in children of different ages, which are indications for antibiotic therapy. The article provides criteria for the clinical differential diagnostics of viral, bacterial and severe bacterial infections in children. Clinical and laboratory signs of systemic BI in newborns are described separately. Depending on age, starting from birth, the cut-off values and prognostic potential of leukocytes, neutrophils, C-reactive protein and procalcitonin levels as the most informative laboratory markers of BI are presented. Numerous alternative reasons for increasing the level of these indicators, which justify the need to simultaneously identify several markers are listed. © 2019, Pediatria Ltd.. All rights reserved

Severe rhinovirus bronchiolitis in premature infant with bronchopulmonary dysplasia

Acute bronchiolitis is an inflammatory disease of the lower respiratory tract with a predominant lesion of small bronchi and bronchioles developing in children under 2 years of age. The main etiological factor of bronchiolitis is the respiratory syncytial virus (RSV), the second place in the etiologic structure belongs to rhinovirus, which causes bronchiolitis usually at 6 months age. Severe bronchiolitis is characterized by the need for auxiliary or artificial lung ventilation (ALV). The main risk groups for severe bronchiolitis include premature infants with or without bronchopulmonary dysplasia (BPD), children with hemodynamically significant congenital heart defects. The article presents a clinical observation of rhinovirus bronchiolitis severe course in a preterm infant aged 4,5 months (post-conceptual age-42 weeks) with severe BPD manifesting with an apnea episode followed by the development of severe respiratory failure requiring mechanical ventilation accompanied by sinus tachycardia. The study demonstrates the possibility of acute bronchiolitis severe course in a premature infant with BPD, not only because of RSV infection, but with rhinovirus infection in the first half of life, which should be considered during virus examination. © 2017, Pediatria Ltd. All rights reserved

Severe rhinovirus bronchiolitis in premature infant with bronchopulmonary dysplasia

Acute bronchiolitis is an inflammatory disease of the lower respiratory tract with a predominant lesion of small bronchi and bronchioles developing in children under 2 years of age. The main etiological factor of bronchiolitis is the respiratory syncytial virus (RSV), the second place in the etiologic structure belongs to rhinovirus, which causes bronchiolitis usually at 6 months age. Severe bronchiolitis is characterized by the need for auxiliary or artificial lung ventilation (ALV). The main risk groups for severe bronchiolitis include premature infants with or without bronchopulmonary dysplasia (BPD), children with hemodynamically significant congenital heart defects. The article presents a clinical observation of rhinovirus bronchiolitis severe course in a preterm infant aged 4,5 months (post-conceptual age-42 weeks) with severe BPD manifesting with an apnea episode followed by the development of severe respiratory failure requiring mechanical ventilation accompanied by sinus tachycardia. The study demonstrates the possibility of acute bronchiolitis severe course in a premature infant with BPD, not only because of RSV infection, but with rhinovirus infection in the first half of life, which should be considered during virus examination. © 2017, Pediatria Ltd. All rights reserved

Практикум по педиатрии: учебное пособие для студентов 5-го курса

Practicum in Pediatrics includes 132 clinical cases of diseases of newborns, infants and older children. In the cases, there are discharge reports from the medical records of real patients with common diseases in pediatric practice (perinatal and neonatal diseases, deficiency conditions, anemia, as well as diseases of lungs, heart, joints, gastrointestinal tract, kidney and allergy). After discharge reports, there are questions and at the end of each section – diagnostic keys. The method of case studies refers to a non-gaming simulation methods of interactive learning and allows to apply theoretical knowledge to solve practical problems, trains making the right decisions in particular situations. Cases are designed to discuss them at classroom practice sessions, for self-study and for control of knowledge at the exam. The manual is aimed at students, residents, graduate students, pediatricians. Prepared by the Department of Pediatrics, Medical Faculty of Peoples' Friendship University of Russia

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