Chronic bronchopulmonary diseases in children with bronchial obstruction syndrome

Introduction. The results of long-term observations of children with chronic bronchopulmonary diseases occurring with bronchoobstructive syndrome and poorly responding to standard therapy are presented. To optimize treatment, it is necessary to accurately determine the nosological variant of the pathology, to identify the main causes of the formation of dysontogenetic disorders.Aim. To study the main nosological options and clinical and diagnostic criteria for chronic obstructive pulmonary diseases in children to justify an individual approach to treatment and follow-up.Materials and methods. 148 children with chronic bronchopulmonary diseases occurring with bronchial obstruction syndrome (excluding bronchial asthma and cystic fibrosis) were exаmined according to the differential diagnostic algorithm developed by us, including anamnestic, clinical, X-ray, functional and morphological methods.Results. The main group of 148 cases consisted of 73 children (49,3%) with lung malformations with insufficiency of the muscular-elastic and cartilaginous framework of the trachea and bronchi, local malformations, with impaired lung growth and development, causing bronchial obstruction. Acquired variants of chronic obstructive pulmonary diseases in children were noted by us in the form of chronic obstructive bronchitis (25.2%) and in the outcome of bronchopulmonary dysplasia (11.5%), chronic obliterating bronchiolitis (6.1%), gastroesophageal reflux disease (0.7%). Acquired local forms of obstruction (foreign object, scar stenosis, tumors) were noted in 4.5% of cases. Hereditary lung diseases, including primary ciliary dyskinesia, were detected in 2.7% of cases.Conclusion. Chronic obstructive pulmonary diseases are diseases of various etiology and pathogenesis that occur at an early age in children with perinatal disorders against the background of various lung malformations, bronchial dysplasia, lung tissue malformations and are the pathomorphological basis for the further formation of chronic obstructive pulmonary disease in adult patients.

EVALUATION OF OXIDATIV STATE PROTEINASE-INHIBITORY SYSTEM AND ENDOTOXICOSIS IN PATIENTS WITH COPD

The aim of the work was to study the relationship between indicators of proteinase-inhibitory system, oxidative stress and endotoxicosis in patients with COPD. 67 patients with COPD, men with an average age of 53.12.2 years, with the duration of the disease on average 12.51.7 years, in the stable phase of the pathological process with II-IV degrees of ventilation disorders according to the GOLD were examined. The activation of trypsin as an indicator of the state of the proteinase-inhibitory system involved in bronchopulmonary diseases pathogenesis, a probable decrease in the activity of its obligate α1-antitrypsin inhibitor, lipid peroxidation secondary metabolites accumulation, total antioxidant activity, molecules of average weight level increase in serum of COPD patients were found. At the examined patients endotoxicosis with initiation of disturbances of mechanisms of recovery in bronchopulmonary system is noted. Together, these events lead to a vicious circle of persistent inflammation, accompanied by chronic oxidative stress and the process persistence. In our opinion, further studies should focus on identifying the molecular mechanisms determining the heterogeneity of COPD progression, since it is known that in some patients the disease can progress rapidly, while other patients may remain relatively stable for many years.

DIFFERENTIAL DIAGNOSTICS OF CHRONIC BRONCHITIS IN CHILDREN

Currently, the diagnosis of chronic bronchitis as an independent nosological form in children is being improved. This direction provides for the differentiation of chronic bronchitis from other bronchopulmonary diseases occurring with bronchitis syndrome. It is known that chronic bronchitis is a constant companion of bronchiectasis, primary ciliary dyskinesia and its main form - Kartagener's syndrome, and is also one of the manifestations of cystic fibrosis. The viciousness of the development of the bronchopulmonary system (aplasia, hypoplasia of the lungs, Mounier-Kuhn syndrome, Williams-Campbell syndrome, polycystic lung disease, bronchial branching anomalies), as a rule, predisposes to the formation of chronic bronchitis.

The application of domestic specialized mixtures for enteral nutrition in children with bronchopulmonary pathology

Adequately organized nutritional support allows avoiding the development of protein-energy malnutrition in patients with bronchopulmonary diseases and cystic fibrosis (CF). The satisfying of increased protein and energy needs of CF patients can only be implemented under the administration. The aim of the study is to analyze the tolerance and effectiveness of the use of domestic sterilized liquid specialized high-protein high-calorie mixtures «Nutrien Pulmo» and «Nutrien Energiya with Dietary Fibers» in children over three years of age with acute (pneumonia) and chronic (cystic fibrosis) forms of bronchopulmonary pathology. Patients and methods. Fifty-five children, including 41 patient suffered from CF, 14 cases with pneumonia, aged from 3 to 18years, were under observation. Of these, 23 (42%) children received Nutrien Pulmo, 32 (58%) children received Nutrien Energiya with Dietary Fibers. Nutritional status was assessed using the WHO-Anthro programs (for children from 3 to 5 years old) and WHO-Anthro Plus (for patients over five years) and clinical and biochemical blood test indices. The observation period was accounted for three weeks. Results. All patients highly appreciated the taste of the products, there were no refusals to take specialized mixtures, neither adverse events during the observation period. While taking specialized mixtures, there was a positive trend in anthropometric indices and a significant improvement in biochemical markers of nutritional status: an increase in prealbumin, total protein, transferrin level. Conclusion. The use of specialized domestic products «Nutrien Pulmo» and «Nutrien Energiya with Dietary Fibers» in the diet therapy of children with acute and chronic bronchopulmonary pathology has the safe and positive effect on the nutritional status of patients.

Peculiarities Of The Current Of Acute Bronchopulmonary Diseases In Children With Adverse Premorbid Condition

The article also examines the consequences of family relations, the health and age of the mother, the course of pregnancy, premorbid background in the form of childhood rickets, anemia, the state of the immune status in acute pneumonia, bronchiolitis, obstructive bronchitis in children. Sociopathic families and children with dangerous factors are more likely to suffer from acute respiratory infections, fever, shortness of breath, prolonged coughing and pathological changes in the lungs. Compared to 2014, the incidence of pneumonia decreased by 22.7%, and the number of children with obstructive syndrome increased from 33.4% to 47.5%.

Respiratory microbiota disorders in children with neurological disabilities at repeated respiratory diseases

The relevance of the problem of recurrent respiratory diseases in children with severe neurological pathology is due to the high frequency, severity of clinical symptoms and the protracted nature of their exacerbations, as well as the tendency to chronicity of the pathological process. The aim of the research was to study the respiratory microbiota to optimize antibacterial therapy of recurrent respiratory diseases. Materials and methods: the 16 children with severe neurological pathology at repeated respiratory diseases were examined. We used a microbiological examination of the upper respiratory tract using a deep smear from the oropharynx to identify a possible causative agent of the disease. Research results: the pronounced imbalance of the respiratory microbiota, corresponding to II and III degrees of dysbiotic disorders, was revealed in the examined children. The feature of the microflora of the upper respiratory tract was the dominance of Pseudomonas aeroginosa, intestinal opportunistic microflora (Klebsiella pneumoniae, Proteus vulgaris) and their frequent combination with Streptococcus pyogenus, Staphylococcus aureus and yeast-like mushrooms of the Сandida genus. The maximum degree of respiratory microbiota disorders was noted in the group of children with congenital malformations of the brain and correlated with the severity of bronchopulmonary diseases. The analysis of the pathogenic microflora sensitivity to antibiotics showed high resistance of the identified microorganisms to most medicines. Conclusions: respiratory pathology in children with neurological disabilities is characterized by a recurrent and chronic bronchitis with a tendency of a protracted course which determines the duration of antibiotic therapy. The use of a non-invasive technique for the respiratory microbiota studying makes it possible to identify suspected pathogens of bronchopulmonary diseases and optimize their treatment

INFLUENCE OF THYROID HORMONES AND CORTISOL ON IMMUNE RESPONSE IN CASE OF CHILDREN’S BRONCHOPULMONARY DISEASES

The problem of acute respiratory tract infections (including acute bronchitis) remains urgent in the whole world independent of human age, especially when disease rates are considered. The World Health Organization reports annually on 1.5 billion cases of acute respiratory diseases. In Ukraine, the disease rate is 3.6 times higher among children than among adults (totally, it is equal to 67,000 cases per 100,000 individuals). The highest rate is observed among under-6-year-old children. In contrast to the average bronchopulmonary disease rate in Europe, the same Ukrainian index remains slightly higher for the last decades. Among children, the acute bronchitis rate is 6.2–25.0% within all bronchopulmonary diseases, reaching 50.0–90.0% if there are recurrences. Our literature review aims to compare different researchers’ perspectives, selecting articles and analyzing data as to how thyroid hormones and cortisol influence immune response in children’s bronchopulmonary diseases. In the literature review, the modern perspective of children’s hormonal state in bronchopulmonary diseases is studied. The hypothalamus-hypophysis-thyroid and hypothalamus-hypophysis-paranephros interaction roles in bronchopulmonary adaptive responses are explained. The thyroid hormone and cortisol importance for organism resistance are regarded. The manifestation, pathogenetic progress mechanisms, diagnosing methods, and treatment of different subclinical hormonal shifts (particularly euthyroid sick syndrome) are researched. The interconnection of hormonal and immunological indicators is covered (whose change is a predictively significant marker – that can foresee the disease progress, its duration and consequences for patients). Therefore, the relevance consists in researching the influence of thyroid hormones and cortisol on immune response by different pathological states of children’s bronchopulmonary diseases.

Correlation between bronchopulmonary diseases and vitamin D level

The review presents data from 56 publications about functions of vitamin D in the human body, the mechanisms of its action and the relationship between lung diseases and the level of vitamin D in the blood. Low serum vitamin D levels are associated with impaired lung function and an increase in inflammatory, infectious, or neoplastic diseases. The results of numerous studies allow considering vitamin D not only a marker of different courses of bronchopulmonary diseases but also as a therapeutic target in the treatment of patients with chronic obstructive pulmonary disease while maintaining the immune system and anti-infectious protection.

A role of thiamphenicol glycinate acetylcysteinate for therapy of respiratory diseases (a review)

This article is a review of published studies on the clinical application of thiamphenicol glycinate acetylcysteinate (TGA) in the treatment of acute and chronic upper and lower respiratory tract diseases. Search for literature in Medline and eLibrary databases was performed. The special place that the drug holds in clinical practice, due to the specific properties of its components - mucolytic N-acetylcysteine (NAC) and antibiotic tiamphenicol. In addition to the usual mucolytic effects, NAC has antioxidant properties, which extends the range of its clinical effectiveness. The antibiotic thiamphenicol has antimicrobial activity against staphylococci, streptococci and gram-negative microorganisms. TGA can be administered by parenteral and inhalation routes. Inhalation route of drug injection is preferable in the treatment of acute and chronic bronchopulmonary diseases, because it allows to create a higher concentration of the drug in the respiratory tract, is associated with much less systemic effects and less often accompanied by the development of side effects. The results of TGA application in the treatment of both acute and chronic upper respiratory diseases (rhinosinusitis, otitis, pharyngotonsillitis) and bronchopulmonary diseases (chronic obstructive pulmonary disease, bronchoectasis) are considered in this review. It has been shown that the drug is quite effective in most patients and its effectiveness sometimes exceeds that of standard oral antibiotics. TGA also allows you to effectively combat biofilms, which have high antibacterial resistance. Thus, the published data allow us to speak about the high antibacterial effectiveness of TGA in acute and chronic infectious diseases of the upper and lower respiratory tract, including cases with the formation of biofilms.

Features of remodeling of the right heart in comorbid patients with chronic heart failure

Objective: to identify the features of structural and functional remodeling of the right heart in patients with chronic heart failure (CHF) against the background of a combination of atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD), to assess the effect on the concentration of the heart failure marker NT-proBNP.Materials and methods: the study included 120 patients who were divided in to 4 groups depending on the presence of CHF, AF and COPD. Patients underwent an echocardiographic (EchoCG) study, and the concentration of the N-terminal fragment of the brain natriuretic peptide precursor (NT-proBNP) was determined.Results: comparison of EchoCG parameters of the right heart in patients with CHF of different groups was performed in pairs to determine the effect of diseases on the remodeling of the right atrium (RA) and right ventricle (RV) in comorbid conditions. In patients with CHF, AF and COPD, in comparison with patients with CHF and AF without COPD, lower volume parameters of RA (p=0.004), greater wall thickness of the RV (p<0.001), lower values of the indexed end-diastolic area (EDA) of the RV (p=0.007) and its fractional area measurement (FAM) (p=0.011) were revealed, which allows us to judge the effect of chronic bronchoobstruction on heart remodeling in patients with CHF and AF. When compared with patients with CHF and COPD without AF in patients with CHF, AF and COPD have large size of RV (p=0.012), its indexed end-systolic area (ESA) (p<0.001), lower ejection fraction (EF) of RV (p=0.002), FAM (p<0.001), systolic excursion of the tricuspid valve plane (TAPSE) (p=0.012), indicating the influence of concomitant AF in EchoCG parameters in patients with CHF and COPD. A higher concentration of NT-proBNP was found in patients with CHF, AF and COPD compared to the marker level in both patients with CHF and AF without COPD (p=0.010) and in patients with CHF and COPD without AF (p<0.001), due to more pronounced remodeling of the RV.Conclusions: In patients with CHF, AF and COPD were the features of the remodeling of the right heart, caused by influence of, on the one hand, AF, on the other, with COPD the structural and functional parameters of heart in patients with this combined pathology. Using the extended protocol EchoCG studies identify additional characteristics of structural-functional state of the right heart (ESA and EDA RV, RV EF, TAPSE and FAM) will optimize early diagnosis of CHF and cardiovascular and bronchopulmonary diseases.