Optimization of therapy in children with mild bronchial asthma to improve the disease control during seasonal acute respiratory infections

Background. Children with mild bronchial asthma (BA) are prone to poor control of symptoms during seasonal acute respiratory infections (ARIs). Objective. To optimize therapy in children with mild BA to improve disease control during seasonal ARIs. Patients and methods. This single-blind placebo-controlled prospective single-center trial evaluating the efficacy of ammonium glycyrrhizinate (Reglisam, ‘VIFITECH,’ Russia) and lasting 4 months included 63 children with mild BA (21 in the placebo group) aged 5 to 10 years with a disease duration of at least 3 months. We assessed respiratory function, FeNO level, results of the asthma control test, characteristics of BA exacerbations, and the need for betamimetics and budesonide via a nebulizer. We used the Student's t-test and Wilcoxon test to evaluate the differences in mean and median values; the differences were considered significant at р < 0.05. Results. The frequency and mean duration of ARIs were lower in the group of active therapy (1.06 ± 0.35 episodes and 6.52 ± 2.19 days) than in the placebo group (1.77 ± 0.26 episodes and 10.83 ± 3.07 days). The differences were statistically significant (р = 0.036 and р = 0.019, respectively). Patients receiving placebo required longer budesonide administration per one BA exacerbation: 11.72 ± 1.98 days vs 8.65 ± 2.17 days in patients receiving active therapy (р = 0.026). Significant differences in the respiratory function and FeNO level were observed only in the subgroup of patients who had incomplete asthma control upon enrollment. We observed no new adverse events that had not been reported earlier. Conclusion. Our findings suggest high efficacy of ammonium glycyrrhizinate used to enhance basic therapy for mild BA in children, in whom respiratory infections are the most common triggers of BA exacerbations. Key words: ammonium glycyrrhizinate, basic therapy, children, mild bronchial asthma, acute respiratory infections (ARIs)

Mild bronchial asthma: a modern treatment concept

Mild bronchial asthma (BA) occurs in 50–75% of patients with this disease. It is characterized by clinical symptoms that are controlled by low doses of inhaled glucocorticoids (IGCS) or anti-leukotriene drugs. Mild BA reduces the quality of life of patients, is accompanied by the development of severe, in some cases fatal exacerbations, and is characterized by a significant cost of treatment. One of the main problems in the management of patients with this disease is their low adherence to IGCS treatment and the excessive use of short-acting 2-adrenomimetic agents. Several clinical studies have shown that the use of a combination of budesonide/formoterol (Symbicort® Turbuhaler®) in an «as needed» mode reduces the incidence of severe exacerbations of mild BA as well as low doses of budesonide, and is characterized by a lower cumulative dose of this glucocorticoid. The results obtained were the basis for the creation of a new treatment concept, which gives preference to the combination of IGCS / formoterol «as needed» in mild BA as a supporting therapy, and for the management of symptoms of the disease.

Experience of the use of bronchophonography in the diagnosis of hyperventilation syndrome

Aim. To study the capability of applying the method of acoustic analysis of respiration (bronchophonography) in the diagnosis of hyperventilation syndrome and mild bronchial asthma and in differential diagnosis between them. Methods. 97 subjects were examined (35 men and 62 women, average age 36.4±13.4 years), divided into the groups: control (healthy subjects) - 38 subjects (18 men and 20 women, average age 33.6±14.0 years), patients with mild bronchial asthma - 37 subjects (12 men and 25 women, average age 40.7±13.7 years), patients with hyperventilation syndrome - 22 subjects (5 men and 17 women, average age 35.0±12.6 years). All patients, except for general clinical examination, underwent spirometry, bronchophonography and Nijmegen questionnaire. Results. Acoustic breathing patterns of all groups were formed, spirometric and bronchophonographic indicators were analyzed. Bronchophonography revealed significant intergroup differences in different frequency ranges in groups of patients with bronchial asthma and hyperventilation syndrome as well as the absence of those between healthy individuals and patients with hyperventilation syndrome. At the same time, the data of spirometry did not allow differentiation of mild bronchial asthma and hyperventilation syndrome and in most cases did not differ from those of healthy individuals. Conclusion. Spirometry cannot serve as a reliable diagnostic criterion in the diagnosis and differential diagnosis of hyperventilation syndrome and mild bronchial asthma; differences in acoustic indices of respiration in bronchophonography allow such differentiation.