Prospects for the drug use based on common ivy for bronchopulmonary pathology in childhood

Respiratory diseases persistently lead in the structure of general morbidity in both children and adolescents. Acute respiratory infections are the most common among them. Interest of pediatricians to phytotherapy is not accidental and is due to the fact that it has a mild therapeutic effect, enhances the effectiveness of complex therapy, has few side effects. Of particular interest are herbal remedies containing ivy extract (Hedera helix), the active ingredients are mainly found in ivy leaves, they are biologically active substances: Triterpene saponins, glycosides, also contain carbohydrates, essential oils, steroids, phenolcarboxylic acids, coumarins, flavonoids, carotenoids, tocopherols (vitamin E), B and C vitamins, tannins, phytoncides. Ivy preparations are prescribed as an expectorant in the treatment of infectious and inflammatory diseases of the upper and lower respiratory tract due to their proven multidirectional effects: secretolytic, mucolytic, bronchospasmolytic. They also have anti-inflammatory, reparative, antioxidant effects.This article presents a clinical example of an officinal ivy-based preparation used in the treatment of a 3.5 year old patient diagnosed with acute respiratory viral infection. Temperature increased to 38 °C, runny nose; on the second day of illness the temperature remained subfebrile and a dry cough appeared. Nasal vasoconstrictor drops and oral acetylcysteine were prescribed, but there was no relief. On the third day of the illness, against the background of subfebrile temperature, the cough persisted, single dry rales were heard in the lungs, wheezing appeared during physical exertion. Acetylcysteine was withdrawn and replaced by ivy-based drops (16 drops 3 times a day orally after meals in a small amount of water). After 2 days the cough was moist, the sputum was easily expectorated, the wheezing in the lungs was almost gone, there was no more wheezing and the temperature was normal. By the sixth day of treatment the cough was gone and the girl had almost recovered. Nevertheless, Gedelix was continued for another 4 days. Prospective results and detailed study of the effects of herbal preparations on the basis of ivy extracts served as the basis for their recommendation as a complex therapy of cough in children

Experience of inhaled hypertonic saline use in pediatric pulmonology

Impaired secretion and removal of mucus from the respiratory tract are important pathophysiological links in the development of several pulmonary pathologies: chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, cystic pulmonary fibrosis, etc. In the article, modern approaches to the use of inhaled hypertonic (3-7%) sodium chloride solutions in children with various recurrent and chronic bronchopulmonary pathologies are analysed. The combination of hypertonic sodium chloride solution and hyaluronic acid can minimize the unpleasant effects of hypertonic solution, such as irritating cough caused by the effect of salt on the cough receptors of the upper respiratory tract. At the same time, hyaluronic acid has unique water-retaining properties, therefore it plays an important role in regulating the fluid balance in the lung interstitium, moistens the airways, reduces bronchial hyperresponsiveness, decreases inflammation and destroys the biofilm associated with chronic infection. The use of nebulizer inhalations with a combination drug containing hypertonic sodium chloride solution and hyaluronic acid has proved to be successful in pulmonological pediatric practice. The authors have learned first-hand that this combination is highly efficient. The described clinical cases demonstrate the positive experience of inhaled use of the domestic combination drug of 3% hypertonic sodium chloride solution and hyaluronic acid in the treatment of preschool patients (5 years old) with the following diagnoses: recurrent bronchitis, primary ciliary dyskinesia (Kartagener's syndrome). This inhalation therapy helped not only to improve the rheological properties of sputum, quickly restore the bronchi to health, reduce signs of inflammation of the respiratory tract, but also generally improve the patients' breathing and quality of life

SEVERE ASTHMA IN CHILDREN

The definition of severe asthma is based on the criteria for clinical control, the treatment received, as well as the response to therapy, the assessment of future risk. In severe bronchial asthma, control can be achieved only at the highest possible level of therapy, namely, in treatment corresponding to the 4th or 5th stage. The article highlights the features of the clinical phenotype of severe bronchial asthma in children. Purpose: to identify the predictors of severe phenotype in children, the analysis of clinical and anamnestic features, to study the dynamics of disease control. Materials and methods: a group of patients with different degrees of severity of bronchial asthma aged 3 to 12 years, both sexes, was studied. The clinical aspects of the disease, the dynamics of control over bronchial asthma have been studied. Functional tests were carried out: examination of the function of external respiration, pyclofometry. Data of a specific allergic diagnosis (skin tests with non-bacterial allergens, detection of specific IgE antibodies), self-monitoring tests were studied. Statistical methods used a nonparametric method, a c2 distribution, a Pearson test, using conjugacy tables. Results and discussion: the family female phenotype is a predictor of severe bronchial asthma in patients in this group. The severity of the disease on the background of therapy for five years in a group of patients was revised only in a third of children. With this phenotype, partial control over the disease was achieved. The ineffectiveness of control is associated with the presence of a comorbid background: the pathology of the nervous system, the gastrointestinal tract, endocrine disorders. The severe phenotype of bronchial asthma, independently of age debut, was significantly less frequent than in the case of moderate disease

Влияние табакокурения на течение бронхиальной астмы у подростков

Comparative epidemiological research on studying prevalence tobacco smoking and respiratory symptoms among rural teenagers with bronchial asthma. Control group have made non-smoking (n = 59), and skilled — smoking teenagers (n = 72). Prevalence of smoking among adolescents with bronchial asthma has made 55% against 44,3% on the average at adolescents (p < 0.05). At smokers sick of a bronchial asthma the presence of respiratory complaints, level of СO in exhaled air and urinary cotinine has been raised. Authentic communication of smoking with a series of symptoms bronchial asthma and chronic bronchitis in teenagers, shown is taped by a high and average parity of chances.Проведено сравнительное исследование, посвященное изучению распространенности табакокурения и респираторных симптомов среди сельских подростков, страдающих бронхиальной астмой (БА). Контрольную группу составили некурящие (59 человек), а опытную — курящие (72 человека) подростки. Распространенность курения среди подростков с БА составила 55% против 44,3% у подростков в среднем (p < 0,05). У курильщиков с БА достоверно чаще определялись респираторные жалобы, повышенный уровень оксида углерода в выдыхаемом воздухе и котинина в моче. Выявлена достоверная связь курения с рядом симптомов БА, хронического бронхита у подростков, проявлявшаяся высоким и средним соотношением шансов

Редкий вариант первичной цилиарной дискинезии в сочетании с наследственной геморрагической телеангиэктазией 1-го типа: клиническое наблюдение

Primary ciliary dyskinesia (PCD) is a rare genetic disease belonging to the group of ciliopathies. The disease develops because a defect in the ultrastructure of the epithelial cilia in the respiratory tract and similar structures (sperm flagella, villi of the fallopian tubes, ventricular ependyma, etc.) disturbs their motor function. Currently, various clinical and genetic variants of the disease are distinguished, increasing the effectiveness of dynamic examination and treatment.Aim. In this article, we describe a patient with a rare variant of PCD that we identified in combination with a mutation in the ENG gene responsible for the development of hereditary hemorrhagic telangiectasia type 1 (HHT-1). HHT-1 is a rare hereditary disease that manifests as various vascular dysplasias, including arteriovenous malformations (AVM) in the lungs, which can significantly worsen the course of the disease and be a predictor of an unfavorable outcome.Conclusion. The presented case demonstrates a combination of two rare genetic diseases in a child. The uniqueness of the case also lies in the fact that the identified rare mutation in the DRC1 gene responsible for the development of PCD is not associated with a loss of motility of the cilia of the ciliated epithelium, which makes the testing and the correct diagnosis even more difficult.Первичная цилиарная дискинезия (ПЦД) — редкое генетически детерминированное заболевание из группы цилиопатий, основу которого составляет дефект ультраструктуры ресничек эпителия респираторного тракта и аналогичных им структур (жгутики сперматозоидов, ворсины фаллопиевых труб, эпендимы желудочков и др.), в результате которого нарушаются их двигательные функции. В настоящий момент выделяются различные клинико-генетические варианты заболевания, что позволяет повысить эффективность проводимого динамического обследования и лечения.Целью работы явилось описание собственного клинического наблюдения за пациенткой с выявленным редким вариантом ПЦД в сочетании с мутацией в гене ENG, ответственном за формирование наследственной геморрагической телеангиэктазии (НГТ) 1-го типа, которая также является редким наследственным заболеванием, проявляющимся различными сосудистыми дисплазиями, в т. ч. артериовенозными мальформациями в легких, что может существенно ухудшать течение заболевания и быть предиктором неблагоприятного исхода.Заключение. По данным клинического наблюдения продемонстрировано сочетание двух редких генетических заболеваний у ребенка. Уникальность случая состоит также в том, что выявленная редкая мутация в гене DRC1, отвечающая за формирование ПЦД, не сопровождается потерей подвижности ресничек мерцательного эпителия, что является фактором, еще более затрудняющим диагностику

Первичная цилиарная дискинезия: обзор проекта клинических рекомендаций 2022 года

Primary ciliary dyskinesia (PCD) is a rare hereditary disease from the group of ciliopathies, which is based on a defect in the cilia ultrastructure of the respiratory epithelium and similar structures (sperm flagella, villi of the fallopian tubes, ventricular ependyma, etc.), leading to motor function impairment. The prevalence of the disease varies significantly around the world and is not known reliably in the Russian Federation.The aim of the review was to analyze literature data on modern approaches to the diagnosis and treatment of PCD.Methodology. The data of 90 articles and the opinions of experts providing care to patients with PCD were used.Results. The classic manifestations of PCD depend on age. The leading manifestations of the disease in patients with PCD are recurrent inflammatory diseases of the upper and lower respiratory tract (bronchitis, pneumonia), with the formation of bronchiectasis, damage to the ENT organs (chronic rhinitis, rhinosinusitis, nasal polyposis, repeated otitis media, progressive hearing loss). Currently, there is no single method which could serve as a “gold” standard for diagnosing PCD. The diagnosis of PCD is based on the characteristic clinical picture in combination with the results of special tests (nitric oxide in exhaled air, DNA diagnostics, high-speed video microscopy, transmission electron microscopy). The genetic diagnostics has not been developed sufficiently in the global practice yet and is unavailable in our country. The approach to the treatment of a patient with PCD should be multidisciplinary due to multiple organ lesions. According to the European consensus, the goal of PCD therapy is to restore or maintain normal lung function. There have been no randomized trials of treatment for PCD, and therefore all treatment recommendations are based on very low-level evidence or extrapolated from cystic fibrosis guidelines. Recommendations on mucolytic, antibacterial and anti-inflammatory therapy of PCD are given with consideration for the international and domestic experience.Conclusion. The development of a new version of clinical guidelines containing up-to-date relevant information will improve the diagnosis and treatment of PCD in the Russian Federation.Первичная цилиарная дискинезия (ПЦД) – редкое наследственное заболевание из группы цилиопатий, основу которого составляет дефект ультраструктуры ресничек эпителия респираторного тракта и аналогичных им структур (жгутики сперматозоидов, ворсины фаллопиевых труб, эпендимы желудочков и др.), приводящий к нарушению их двигательной функции. Распространенность заболевания значительно различается во всем мире, в Российской Федерации она достоверно неизвестна.Целью обзора явился анализ данных литературы о современных подходах к диагностике и лечению ПЦД.Методология. Использовались данные 90 статей и экспертное мнение специалистов, оказывающих помощь пациентам с ПЦД.Результаты. Классические проявления ПЦД зависят от возраста. Ведущими проявлениями болезни у пациентов с ПЦД являются рецидивирующие воспалительные заболевания верхних и нижних дыхательных путей (бронхиты, пневмонии) с формированием бронхоэктазов (БЭ), поражение ЛОР-органов (хронический ринит, риносинусит, полипоз носа, повторные отиты, прогредиентное снижение слуха). В настоящее время нет единого метода – «золотого стандарта» – диагностики ПЦД. Диагноз ПЦД устанавливается на основании характерной клинической картины в сочетании с результатами специальных исследований (определение оксида азота в выдыхаемом воздухе, ДНК-диагностика, высокоскоростная видеомикроскопия, трансмиссионная электронная микроскопия). Подходы к генетической диагностике недостаточно разработаны в мировой практике и отсутствуют в нашей стране. Подход к терапии пациента с ПЦД должен быть мультидисциплинарным в связи с полиорганностью поражений. Согласно Европейскому консенсусу, целью терапии ПЦД является восстановление или поддержание нормальной функции легких. Рандомизированных исследований лечения ПЦД не проводилось, следовательно, все рекомендации по лечению основаны на доказательствах очень низкого уровня или экстраполированы из руководств по муковисцидозу. Даны рекомендации по муколитической, антибактериальной и противовоспалительной терапии ПЦД с учетом мирового и отечественного опыта.Заключение. Разработка нового варианта клинических рекомендаций, содержащих современную актуальную информацию, позволит усовершенствовать диагностику и лечение ПЦД в Российской Федерации

Persistent and prolonged cough in children: differential diagnosis and treatment algorithms

The article presents data on the etiology, modern methods for diagnosis and treatment of respiratory system diseases and examines in detail cough as the main symptom. Particular attention is paid to hypertussivity, which is defined as a cough that occurs in the absence of obvious reasons. In addition, the emphasize was put on the role of anatomical and physiological features in the development and characteristics of cough, especially in young children. The authors draw attention to the complex mechanism of the cough, which development involves many body systems such as nervous, immune, endocrine and respiratory. The article describes the main treatment methods, drugs prescribed to the patients with cough, which are divided into «antitussive» drugs used as cough suppressants and «protussive» drugs used in situations, in which mobilization of secretions is desired, combined drugs. The role of new combined drugs, in particular, Rengalin, which affects the central and peripheral links of the cough reflex, was noted

NEW POSSIBILITIES OF THE STUDY OF RESPIRATORY FUNCTION IN CHILDREN

Тhe article provides an overview of modern methods of assessing the respiratory function in children taking into account their age peculiarities. The emphasis is made on high-precision ultrasonic spirometry, evaluation of static pulmonary volumes and determination of the ventilation inhomogeneity index by means of nitrogen washout with oxygen compared to the traditionally used methods. Authors’ own results of approbation of these test methods are presented and their comparative assessment is provided

Influence of the tobacco smoking on the bronchial asthma in teenagers

Comparative epidemiological research on studying prevalence tobacco smoking and respiratory symptoms among rural teenagers with bronchial asthma. Control group have made non-smoking (n = 59), and skilled — smoking teenagers (n = 72). Prevalence of smoking among adolescents with bronchial asthma has made 55% against 44,3% on the average at adolescents (p < 0.05). At smokers sick of a bronchial asthma the presence of respiratory complaints, level of СO in exhaled air and urinary cotinine has been raised. Authentic communication of smoking with a series of symptoms bronchial asthma and chronic bronchitis in teenagers, shown is taped by a high and average parity of chances