The effectiveness of the treatment of severe exercise-induced asthma in schoolchildren

M.N. Garas, G.V. Lekhkun

Abstract


Background. Bronchial asthma is one of the most common chronic multifactorial diseases of the lungs. At least 10–12 % of patients with bronchial asthma are suffering from a severe form of the disease. One aspect of inadequate severe asthma control is its phenotypic heterogeneity, interest of experts increases to the problem of exercise-induced asthma. The purpose of the study was to increase efficiency of treatment for severe exercise-induced asthma in schoolchildren based on the analysis of the attack dynamics and to achieve disease control according to main inflammatometric and spirometric indices. Materials and methods. We examined 46 children with severe persistent bronchial asthma, in particular, 15 schoolchildren suffering from severe exercise-induced asthma, the second clinical group (comparison one) consisted of 31 children suffering from severe type of the disease, with no signs of exercise-induced bronchoconstriction. Basic therapy effectiveness was determined prospectively by assessing the disease control using AST-test with an interval of 3 months. The severity of bronchial obstruction syndrome in patients on admission to hospital during exacerbation was assessed by score scale. Airway hyperresponsiveness was evaluated according to the results of bronchoprovocation with histamine. Results. Children of I clinical group had more significant manifestations of bronchial obstruction during the week of inpatient treatment than the comparison group of patients, including significantly more severe manifestations of bronchial obstruction were verified on 1st and 7th day of hospitalization. Due to the analysis of basic therapy effectiveness, only a quarter of I clinical group patients and a larger part of schoolchildren in comparison group achieved the partial control after a 3-month course of anti-inflammatory treatment. Eosinophilic inflammation was observed in most children with severe exercise-induced asthma (60.1 %) and in 47.2 % of patients from the comparison group. More significant bronchial hyperresponsiveness in schoolchildren suffering from severe exercise-induced asthma is confirmed by a significantly larger part of patients with severe airway hypersensitivity to histamine (PC20H < 0.5 mg/ml) in 1st clinical group (87.5 %) than in children with no signs of exercise-induced bronchoconstriction (54.5 %, рφ > 0.05). Exercise-induced bronchoconstriction is associated with an increased risk of severe bronchial hyperresponsiveness to histamine in schoolchildren suffering from severe asthma. For instance, the relative risk of severe bronchial hyperresponsiveness to histamine in children with severe exercise-induced asthma was 1.6 (95 % confidence interval (CI) 0.6–55.7), the odds ratio of 5.8 (95 % CI 0.6–55.7). Conclusions. Lower effectiveness of relief therapy and basic treatment of severe asthma in schoolchildren with symptoms of exercise-induced bronchoconstriction can be explained by significantly larger part of schoolchildren with hypereosinophilia in induced sputum and more severe airway hypersensitivity to histamine.

Keywords


bronchial asthma; children; treatment; airway inflammation; bronchial hyperresponsiveness

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DOI: https://doi.org/10.22141/2224-0551.12.2.2017.99775

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