scholarly journals Mechanisms of formation of airway hyperreactivity in view of phenotypical heterogeneity and clinical deviation of bronchial asthma in adolescents (literature review)

2021 ◽  
pp. 47-54
Author(s):  
О.К. Koloskova ◽  
◽  
О.О. Shakhova ◽  
S.І. Tarnavska ◽  
O.V. Vlasova ◽  
...  
Keyword(s):  
Bronchial Asthma ◽  
Inhaled Corticosteroids ◽  
Persistent Asthma ◽  
High Body Mass Index ◽  
Airway Hyperreactivity ◽  
Extremely Low Birth Weight ◽  
Chronic Obstructive ◽  
Bronchial Obstruction ◽  
Bronchial Inflammation ◽  
Mechanisms Of Formation

Bronchial asthma is a disease characterized by recurrent episodes of variable bronchial obstruction, chronic bronchial inflammation, bronchial hypersensitivity and remodulation. Modern therapy of the disease was aimed at these links of pathogenesis, and this concept postulated the need for long-term use of anti-inflammatory drugs and, above all, topical inhaled corticosteroids. However, it should be recognized that the coherent inflammatory theory currently requires revision and new understanding, or even replacement with a new theory, which, considering these characteristics of the disease as an epiphenomenon, will serve as a basis for new approaches in treatment and prevention. The aim of our work — to analyze the mechanisms of formation of bronchial hyperreactivity, taking into account the phenotypic heterogeneity and clinical deviation of bronchial asthma in adolescence (based on the analysis of scientific sources). It is extremely important to determine the risk of transition of the adolescents' bronchial asthma into adulthood, when chronic obstructive pulmonary diseases might develop. Among the main predictors of this risk such factors as age, obesity, early puberty, body weight at birth and in the newborn period and sex can be distin guished. Thus, some authors associate the risk of persistence of the disease with its onset in early childhood, and others — at the age of 6 years old. High body mass index and early onset of puberty are considered to be the predictors of persistent bronchial asthma. It is noted that low and extremely low birth weight of premature infants or rapid weight gain in the neonatal period are associated with a decrease in lung ventilation and the risk of persistent asthma in the future. It is believed that bronchial asthma in children is more common in boys than in girls, in contrast, during puberty, allergic diseases and asthma are more common in girls. Conclusions. The above mentioned literature data give reason to believe that, despite advances in the scientific understanding of the pathogenesis of the main characteristics of bronchial asthma, there are great difficulties in using them in practice. Moreover, current inflammatory paradigm of bronchial asthma needs to be revised because it being a dogma becomes unproductive from a clinical point of view. No conflict of interest was declared by the authors. Key words: asthma, adolescents, hyperreactivity, remission.

scholarly journals Combination of asthma and chronic obstructive pulmonary disease: features of etiology, pathogenesis, diagnosis, pharmacotherapy

2016 ◽  
Vol 97 (3) ◽  
pp. 394-400 ◽  
Author(s):  
O M Uryasev ◽  
S V Faletrova ◽  
L V Korshunova
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Diagnostic Criteria ◽  
Bronchial Asthma ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Bronchial Obstruction ◽  
World Population ◽  
Obstructive Pulmonary Disease ◽  
Long Acting

Bronchial asthma and chronic obstructive pulmonary disease are the most common obstructive diseases of the respiratory system. 230 million people suffer from chronic obstructive pulmonary disease, from bronchial asthma - 300 million people worldwide. Annually 200-300 people in Europe and 2.74 million of world population die from chronic obstructive pulmonary disease, from asthma - 250 thousand people a year. The social and economic significance of these diseases determine the need for in-depth study of their combination in the same patient. Each disease has its own phenotypes, but in 10-20% of patients, there are symptoms of both chronic obstructive pulmonary disease and asthma. In spite of clear diagnostic criteria, in some cases it is difficult to distinguish these diseases. Morphological basis of these diseases is a chronic inflammation in the bronchial tree that causes damage to the epithelial continuity that initiates bronchoconstrictive reaction and leads to irreversible airway obstruction attributable for both severe bronchial obstruction and chronic obstructive pulmonary disease. However, the treatment strategy of bronchial asthma and chronic obstructive pulmonary disease has significant differences, it is important to have a clear diagnostic criteria to distinguish different phenotypes, including those of combined phenotype of asthma and chronic obstructive pulmonary disease. Rational starting therapy of asthma and chronic obstructive pulmonary disease overlap syndrome includes drugs acting on the pathogenic mechanisms of both diseases, and is a combination of inhaled corticosteroids with combined bronchodilator therapy - long-acting β2-agonists and long-acting anticholinergics.

CLINICAL AND SPIROGRAPHIC FEATURES OF BRONCHIAL ASTHMA IN SCHOOLCHILDREN DEPENDING ON THE DIFFERENT REGIMENS OF BASIC ANTI-INFLAMMATORY THERAPY

2020 ◽  
Vol 73 (1) ◽  
Author(s):  
Olena Koloskova ◽  
Tetiana Bilous ◽  
Galyna Bilyk ◽  
Kristina Buryniuk-Glovyak ◽  
Olena Korotun ◽  
...  
Keyword(s):  
Bronchial Asthma ◽  
Inhaled Corticosteroids ◽  
Persistent Asthma ◽  
High Specificity ◽  
Clinical Feature ◽  
Clinical Group ◽  
Comparison Groups ◽  
Anti Inflammatory ◽  
High Doses ◽  
Persistent Bronchial Asthma

The aim: To study the clinical and spirographic features persistence of the bronchial asthma in schoolchildren against the background of the alternative daily doses of inhaled corticosteroids to increase the effectiveness of anti-inflammatory therapy for this disease. Materials and methods: A complete comprehensive clinical-paraclinical examination of 65 schoolchildren with persistent asthma was conducted. According to the average daily dose of inhaled corticosteroids (ICS) the patients were divided into two clinical groups. The first (I) group consisted of 46 children who received ICS in the regimen of low-to-medium equipotent doses (253.95±9.98 μg per day), and the second (II) comparison group was formed of 19 patients who controlled the pBA using high doses of ICS (494.74±5.56 μg per day). Results: The patients of the І clinical group compared to patients of the ІІ group have a higher risk of the mild bronchial obstructive syndrome during asthma attacks. In assessing the level of control of persistent bronchial asthma using the CIA-scale, it was found that in II group cases of the controlled course of the disease were observed almost two times less than in children of the I group of comparison. In conducting spirography in children of comparison groups, it was shown that the ratio of indices of bronchospasm (FEV1/ FVC) was worse in patients receiving high doses of ICS. Conclusions: So, сharacteristic clinical feature of asthma controlled by high doses of ICS is more severe nature of bronchial obstructive syndrome during the period of exacerbation (OR=1.9-3.0). In the management of persistent bronchial asthma, the Gensler index which has high specificity (94.4%) and accuracy (92.2%) should be used for disease control verification.

ОСОБЕННОСТИ ЛЕЧЕНИЯ БРОНХИАЛЬНОЙ АСТМЫ В ПЕРИОД БЕРЕМЕННОСТИ

2019 ◽  
Author(s):  
O.V. Lavrova ◽  
M.A. Petrova ◽  
G.B. Fedoseev
Keyword(s):  
Pregnant Women ◽  
Bronchial Asthma ◽  
Pregnancy Complications ◽  
Inhaled Corticosteroids ◽  
Combined Therapy ◽  
Persistent Asthma ◽  
Asthma Therapy ◽  
Complete Control ◽  
Basic Therapy ◽  
Standard Procedures

Цель. Анализ характера терапии бронхиальной астмы, а также течения беременности у пациенток с бронхиальной астмой в период с 2002 по 2017 г. Материалы и методы. С 2002 по 2017 г. обследованы и проходили наблюдение в период беременности 3890 пациенток, страдающих бронхиальной астмой. Проводилось комплексное клинико-функциональное обследование. Пациентки находились под наблюдением акушера-гинеколога весь срок беременности, проходили стандартное обследование, оценивалась частота осложнений беременности. Было проведено сравнение характера базисной терапии бронхиальной астмы в группах пациенток с персистирующим течением заболевания, наблюдавшихся с 2002 по 2009 г. (1-я группа) и с 2010 по 2017 г. (2-я группа) в сопоставлении с частотой встречаемости осложнений беременности в данных группах. Результаты. При сравнении частоты встречаемости угрозы прерывания беременности, гипертензивных расстройств, преэклампсии выявлена достоверно более низкая частота встречаемости этих осложнений беременности во 2-й группе (2010-2017 гг.). При этом частота назначения ингаляционных глюкокортикостероидов (ИГКС) в составе комбинированных препаратов возросла с 21,79 до 63,87, что практически в три раза превышает данный показатель в 1-й группе (2002-2009 гг.). Заключение. При сопоставлении изменений в характере базисной терапии, произошедших с 2002 по 2017 г., с достоверным снижением частоты встречаемости осложнений беременности в группе, наблюдавшейся с 2010 по 2017 г., можно предположить, что именно терапия комбинированными препаратами ИГКС/ агонистов Р2-адренорецпторов длительного действия позволяет наиболее полноценно обеспечивать контроль бронхиальной астмы, приводя к снижению частоты осложнений беременностиStudy goal. To analyse asthma therapy in pregnant women with bronchial asthma at a period since 2002 to 2017. Materials and methods. 3890 pregnant women with asthma were examined and followed up during pregnancy at a period since 2002 to 2017. Comprehensive clinicalfunctional examination was conducted. Patients were under surveillance of the obstetriciangynecologist during the whole pregnancy, standard procedures were carried out, and the frequency of complications of pregnancy was estimated. Basic therapy of asthma was compared in groups with the persistent asthma duration, followed up since 2002 to 2009 (1 group) and since 2010 to 2017 (2 group). Also, frequency of pregnancy complications was estimated in these groups. Results. The second group (2010-2017) demonstrated reliably lower frequency of threatening abortion, hypertension and preeclampsia. At the same time the frequency of inhaled corticosteroids (ICS) administration as a part of the combined therapy increased from 21.79 to 63.87 (almost to three times) in comparison with the first group (2002-2009). Conclusions. Combined therapy with ICS/LABA provides most complete control of bronchial asthma, and decreases frequency of pregnancy complications in pregnant women with BA.

ОСОБЕННОСТИ ЛЕЧЕНИЯ БРОНХИАЛЬНОЙ АСТМЫ В ПЕРИОД БЕРЕМЕННОСТИ

2019 ◽  
pp. 14-19
Author(s):  
O.V. Lavrova ◽  
M.A. Petrova ◽  
G.B. Fedoseev
Keyword(s):  
Pregnant Women ◽  
Bronchial Asthma ◽  
Pregnancy Complications ◽  
Inhaled Corticosteroids ◽  
Combined Therapy ◽  
Persistent Asthma ◽  
Asthma Therapy ◽  
Complete Control ◽  
Basic Therapy ◽  
Standard Procedures

Цель. Анализ характера терапии бронхиальной астмы, а также течения беременности у пациенток с бронхиальной астмой в период с 2002 по 2017 г. Материалы и методы. С 2002 по 2017 г. обследованы и проходили наблюдение в период беременности 3890 пациенток, страдающих бронхиальной астмой. Проводилось комплексное клиникофункциональное обследование. Пациентки находились под наблюдением акушерагинеколога весь срок беременности, проходили стандартное обследование, оценивалась частота осложнений беременности. Было проведено сравнение характера базисной терапии бронхиальной астмы в группах пациенток с персистирующим течением заболевания, наблюдавшихся с 2002 по 2009 г. (1я группа) и с 2010 по 2017 г. (2я группа) в сопоставлении с частотой встречаемости осложнений беременности в данных группах. Результаты. При сравнении частоты встречаемости угрозы прерывания беременности, гипертензивных расстройств, преэклампсии выявлена достоверно более низкая частота встречаемости этих осложнений беременности во 2й группе (20102017 гг.). При этом частота назначения ингаляционных глюкокортикостероидов (ИГКС) в составе комбинированных препаратов возросла с 21,79 до 63,87, что практически в три раза превышает данный показатель в 1й группе (20022009 гг.). Заключение. При сопоставлении изменений в характере базисной терапии, произошедших с 2002 по 2017 г., с достоверным снижением частоты встречаемости осложнений беременности в группе, наблюдавшейся с 2010 по 2017 г., можно предположить, что именно терапия комбинированными препаратами ИГКС/ агонистов Р2адренорецпторов длительного действия позволяет наиболее полноценно обеспечивать контроль бронхиальной астмы, приводя к снижению частоты осложнений беременностиStudy goal. To analyse asthma therapy in pregnant women with bronchial asthma at a period since 2002 to 2017. Materials and methods. 3890 pregnant women with asthma were examined and followed up during pregnancy at a period since 2002 to 2017. Comprehensive clinicalfunctional examination was conducted. Patients were under surveillance of the obstetriciangynecologist during the whole pregnancy, standard procedures were carried out, and the frequency of complications of pregnancy was estimated. Basic therapy of asthma was compared in groups with the persistent asthma duration, followed up since 2002 to 2009 (1 group) and since 2010 to 2017 (2 group). Also, frequency of pregnancy complications was estimated in these groups. Results. The second group (20102017) demonstrated reliably lower frequency of threatening abortion, hypertension and preeclampsia. At the same time the frequency of inhaled corticosteroids (ICS) administration as a part of the combined therapy increased from 21.79 to 63.87 (almost to three times) in comparison with the first group (20022009). Conclusions. Combined therapy with ICS/LABA provides most complete control of bronchial asthma, and decreases frequency of pregnancy complications in pregnant women with BA.

scholarly journals Inhaled corticosteroid withdrawal may improve outcomes in elderly patients with COPD exacerbation: a nationwide database study

2020 ◽  
Vol 6 (1) ◽  
pp. 00246-2019 ◽  
Author(s):  
Taisuke Jo ◽  
Hideo Yasunaga ◽  
Yasuhiro Yamauchi ◽  
Akihisa Mitani ◽  
Yoshihisa Hiraishi ◽  
...  
Keyword(s):  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Bronchial Asthma ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Obstructive Pulmonary Disease ◽  
Inverse Probability ◽  
Propensity Score Matching Analysis

BackgroundInhaled corticosteroids (ICSs) are used for advanced-stage chronic obstructive pulmonary disease (COPD). The application and safety of ICS withdrawal remain controversial.This study aimed to evaluate the association between ICS withdrawal and outcomes in elderly patients with COPD with or without comorbid bronchial asthma, who were hospitalised for exacerbation.Patients and methodsWe conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2016. We identified patients aged ≥65 years who were hospitalised for COPD exacerbation. Re-hospitalisation for COPD exacerbation or death, frequency of antimicrobial medicine prescriptions and frequency of oral corticosteroid prescriptions after discharge were compared between patients with withdrawal and continuation of ICSs using propensity score analyses, namely 1–2 propensity score matching and stabilised inverse probability of treatment weighting.ResultsAmong 3735 eligible patients, 971 and 2764 patients had ICS withdrawal and continuation, respectively. The hazard ratios (95% confidence intervals) of re-hospitalisation for COPD exacerbation or death for ICS withdrawal compared to continuation were 0.65 (0.52–0.80) in the propensity score matching and 0.71 (0.56–0.90) in the inverse probability of treatment weighting. The frequency of antimicrobial prescriptions but not corticosteroid prescriptions within 1 year was significantly less in the ICS withdrawal group. Among patients with comorbid bronchial asthma, ICS withdrawal was significantly associated with reduced re-hospitalisation for COPD exacerbation or death only in the propensity score matching analysis.ConclusionICS withdrawal after COPD exacerbation was significantly associated with reduced incidences of re-hospitalisation or death among elderly patients, including those with comorbid bronchial asthma.

scholarly journals Clinical and functional features of bronchial asthma AMONG MALE ADOLESCENTS

2019 ◽  
pp. 88-94
Author(s):  
Т. A. Zhadova ◽  
М. V. Tarasova
Keyword(s):  
Bronchial Asthma ◽  
Inhaled Corticosteroids ◽  
Young Men ◽  
Bronchial Obstruction ◽  
Sustained Remission ◽  
Male Adolescents ◽  
Examination Protocol ◽  
Functional Features ◽  
Remission Phase ◽  
Stage 1

The study is aimed at studying the clinical and functional features of BA in young men of military age. Methods. A total of 346 men aged 16–28 years (mean age 18 ± 1.7) were examined. The examination protocol corresponded to the algorithm “Medical Examination of Young Men and Draftees with Bronchial Asthma” in 2008. All patients underwent a general clinical and specific allergological examination, a functional lung examination assessing the reversibility of bronchial obstruction. Results. The diagnosis of BA was confirmed in 283 patients, and newly diagnosed in 23 (8.1%) patients. The mild BA was identified in 277 (97.9%) young men. The majority of patients - 240 (84.8%) - were in the remission phase of the disease, and 5 (1.8%) of them had a sustained remission. Allergic BA was diagnosed in the absolute majority of the examined - 261 (92.2%) people, and predominantly mild intermittent BA in 209 patients (73.8%). Symptoms of allergic rhinitis were reported by 198 (70%) patients with allergic BA and 85 (30%) patients with mixed asthma. House dust, library dust were the most common allergens. 68.2% of patients had the burdened heredity of BA and/or atopy. Most of the examined (79.9%) showed no significant changes in the respiratory function, however, 172 (60.8%) patients showed positive results of the β2-agonist test. At the time of the examination, 56 (19.8%) patients received antiasthma basic therapy, the other used only bronchodilators. Replacement of short-acting bronchodilator monotherapy for a combination of above bronchodilator and inhaled corticosteroids as an adjuvant therapy for stage 1 or 2 GINA patients ensures the early and regular administration of the baseline drug and eliminates the problem of excessive dependence on fast-acting bronchodilators. Conclusion The allergic phenotype of the disease with a predominance of milder form dominates in adolescents with asthma. Treatment with a fixed combination of beclomethasone salbutamol 250 μg/100 μg (SabaComb®) can increase compliance, improve the efficacy of the therapy and reduce the risk of BA exacerbations.

scholarly journals THE FUNCTIONAL STATUS OF NEUTROPHILS IN PATIENTS WITH BRONCHIAL ASTHMA, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, BRONCHIAL ASTHMA IN COMBINATION WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND COMMUNITY-ACOUIRED PNEUMONIA

2017 ◽  
Vol 14 (6) ◽  
pp. 43-58
Author(s):  
G B Fedoseev ◽  
V I Trofimov ◽  
K V Negrutsa ◽  
V G Tymchyk ◽  
V I Golubeva ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Bronchial Asthma ◽  
Community Acquired Pneumonia ◽  
Control Group ◽  
Chronic Obstructive ◽  
Bronchial Obstruction ◽  
Obstructive Pulmonary Disease ◽  
Oxygen Blast ◽  
Neisseria Perflava

217 people were examined including BA patients (n=78), patients with COPD (n=38), patients with combined asthma and COPD (n=39), and community-acquired pneumonia patients (n=17). The control group represented patients with essential hypertension and coronary heart disease (n=25) and 20 healthy persons. NE, AAT, phagocytic activity of neutrophils (FGC), oxygen blast, respiratory function and FeNO, serum IgE and IgG antibodies to Strept. pneumoniae, Neisseria perflava, Haemofil. influenzae and Staph. aigai were determined in all patients. The indicators of the functional state of neutrophils reflected the degree and severity of bronchopulmonary inflammation. Patients with bronchial asthma in combination with COPD had bacterial inflammation, manifested by bronchial obstruction with increasing level of AAT. These features were absent in patients with BA and COPD.

scholarly journals Features of asthma treatment during pregnancy

2019 ◽  
Vol 16 (2) ◽  
pp. 14-19
Author(s):  
O V Lavrova ◽  
M A Petrova ◽  
G B \\Fedoseev
Keyword(s):  
Pregnant Women ◽  
Bronchial Asthma ◽  
Pregnancy Complications ◽  
Inhaled Corticosteroids ◽  
Combined Therapy ◽  
Persistent Asthma ◽  
Asthma Therapy ◽  
Asthma Treatment ◽  
Complete Control ◽  
Standard Procedures

Study goal. To analyse asthma therapy in pregnant women with bronchial asthma at a period since 2002 to 2017. Materials and methods. 3890 pregnant women with asthma were examined and followed up during pregnancy at a period since 2002 to 2017. Comprehensive clinicalfunctional examination was conducted. Patients were under surveillance of the obstetriciangynecologist during the whole pregnancy, standard procedures were carried out, and the frequency of complications of pregnancy was estimated. Basic therapy of asthma was compared in groups with the persistent asthma duration, followed up since 2002 to 2009 (1 group) and since 2010 to 2017 (2 group). Also, frequency of pregnancy complications was estimated in these groups. Results. The second group (2010-2017) demonstrated reliably lower frequency of threatening abortion, hypertension and preeclampsia. At the same time the frequency of inhaled corticosteroids (ICS) administration as a part of the combined therapy increased from 21.79% to 63.87% (almost to three times) in comparison with the first group (2002-2009). Conclusions. Combined therapy with ICS/LABA provides most complete control of bronchial asthma, and decreases frequency of pregnancy complications in pregnant women with BA.

scholarly journals The Role of ICS/LABA Fixed-Dose Combinations in the Treatment of Asthma and COPD: Bioequivalence of a Generic Fluticasone Propionate-Salmeterol Device

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Donald P. Tashkin ◽  
Jill A. Ohar ◽  
Arkady Koltun ◽  
Richard Allan ◽  
Jonathan K. Ward
Keyword(s):  
Fluticasone Propionate ◽  
Inhaled Corticosteroids ◽  
Persistent Asthma ◽  
The United States ◽  
Fixed Dose ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Beta Agonists ◽  
Treatment Plans ◽  
Long Acting

Both asthma and chronic obstructive pulmonary disease (COPD) are inflammatory chronic respiratory conditions with high rates of morbidity and mortality worldwide. The objectives of this review are to briefly describe the pathophysiology and epidemiology of asthma and COPD, discuss guideline recommendations for uncontrolled disease, and review a new generic option for the treatment of asthma and COPD. Although mild forms of these diseases may be controlled with as-needed pharmacotherapy, uncontrolled or persistent asthma and moderate or severe COPD uncontrolled by bronchodilators with elevated eosinophilia or frequent exacerbations may require intervention with combination therapy with inhaled corticosteroids (ICS) and long-acting beta agonists (LABAs), according to international guidelines. Fixed-dose combinations of ICS/LABA are commonly prescribed for both conditions, with fluticasone propionate (FP) and salmeterol forming a cornerstone of many treatment plans. An oral inhalation powder containing the combination of FP and salmeterol has been available as Advair Diskus® in the United States for almost 20 years, and the first and only substitutable generic version of this product has recently been approved for use: Wixela™ Inhub™. Bioequivalence of Wixela Inhub and Advair Diskus has been established. Furthermore, the Inhub inhaler was shown to be robust and easy to use, suggesting that Wixela Inhub may provide an alternative option to Advair Diskus for patients with asthma or COPD requiring intervention with an ICS/LABA.

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