A 26-Year-Old Woman with Bronchial Asthma and COVID -19 Treated by Stand Alone Siddha Medicine: A Case Report

Background: Corona virus disease 2019 (COVID-19) is a public health emergency of international concern. The global population lacks immunity to COVID-19 and is generally susceptible. Underlying conditions, especially chronic respiratory diseases, may affect progression, treatment and prognosis of COVID-19. The majority of people who exposed to COVID-19 suffer only mild respiratory symptoms like cough, cold, difficulty in breathing, etc and these symptoms were correlated with Kaba Suram in the Siddha literature. Case Summary: Siddha Clinical Research Unit, New Delhi (CCRS), Ministry of AYUSH, Govt. of India had reported a patient with confirmed COVID-19 by RT-PCR with bronchial asthma as a co-morbid condition. Recovery time from disease onset to negative test for COVID-19 was 19 days. Conclusion: Since the patient residing in Dwaraka, New Delhi has bronchial asthma as a co-morbid condition, both air pollution and the winter season are likely to increase the severity of the disease. But it was observed that the patient’s condition did not deteriorate, so it could be presumed that the management of COVID-19 with the given Siddha internal medicines and external therapies as a standalone treatment ceased the progress of the disease to a severe stage. Key words: Bronchial Asthma, Corona virus, COVID-19, Kaba Suram, Siddha Medicine.

Comorbidity of bronchial asthma and allergic rhinitis in its alternative course in school-age children

The study of the comorbidity of bronchial asthma (BA) and allergic rhinitis (AR) in children will expand the understanding of the pathogenetic mechanisms of the most trending childhood allergic diseases. Purpose — to investigate some clinical and paraclinical features of AR in its alternative course in schoolchildren for the optimization of the personalized antiinflammatory therapy of patients with comorbidity of BA and AR. Materials and methods. A comprehensive clinical and paraclinical examination of 66 of school-age children with BA with concomitant AR has beenperformed. Depending on the course of AR, patients have been divided into 2 groups: group I — 34 children with BA and intermittent AR (mean age — 13.4±0.8 years, the proportion of boys — 70.5%), group II — 32 asthma patients, which have signs of persistent AR (mean age — 12.1±1.1 years) (p>0.05), the proportion of boys — 81.2% (p>0.05). The diagnosis of BA and AR was established according to the modern requirements. All children underwent a study of bronchial lability by assessing their response to dosed exercise and inhalation of short-acting β2-adrenomimetics (200 mcg salbutamol) followed by calculation of bronchial lability, considered as the sum of its components — indicies of bronchospasm and bronchodilation. Results. Patients with persistent allergic rhinitis have had a more severe and less controlled course of bronchial asthma with a 3.0-fold increased risk. The baseline spirographic examination has showed that patients with intermittent allergic rhinitis were three times more likely to have FEV1<80% and the higher chances of marked airway lability at the level of small bronchi, including by forced midexpiratory flow rate as well. Conclusions. The comorbid course of bronchial asthma and intermittent allergic rhinitis in children was accompanied by a lower chance of uncontrolled asrhma, along with a higher probability of developing nonspecific airway hyperreactivity. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: bronchial asthma, allergic rhinitis, children.

CURRENT ISSUES OF BRONCHIAL ASTHMA 2021: WORLD ASTHMA DAY AND THE IMPACT OF THE COVID-19 PANDEMIC

This year’s World Asthma Day has the theme “Uncovering Asthma Misconceptions”. This position calls for action and action to clarify common myths and misconceptions about asthma that prevent asthma sufferers from receiving optimal benefits from major success in treating the condition. According to GINA experts, the most common mistakes in the world about asthma are as follows: 1. Myth: asthma is a childhood disease; people “outgrow” it as they age. True: asthma can occur at any age. 2. Myth: Asthma is an infectious disease. Truth: asthma is not contagious disease. 3. Myth: People with asthma should not exercise. Truth: When asthma is well controlled, individuals with asthma can exercise and achieve high performance in sports. 4. Myth: asthma can only be controlled with high doses of steroids. Truth: Most often, asthma is controlled with low doses of inhaled steroids. To a large extent, these theses refer to one of the most important challenges of our time — the management of patients with bronchial asthma in the context of the COVID-19 pandemic. Patients with asthma have a lower susceptibility to COVID-19, a less severe course, and a lower risk of hospitalizations due to COVID-19. Allergic asthma or its eosinophilic phenotype, intake of inhaled corticosteroids (ICS) have a positive effect on the course of the COVID-19 disease, since in such patients the lower expression level of ACE 2 receptors in the upper and lower respiratory tract, which are input receptors for SARS-CoV-2 virus. ICS such as budesonide or ciclesonide are capable of inhibiting the replication of genomic SARS-CoV-2 RNA due to the influence of viral endonuclease NSP15 and TMPRSS2 (transmembrane serine protease 2), a protease involved in viral entry into the cell. Some ICS (including budesonide) reduce or block SARS-CoV-2 replication in vitro. Experts from international asthma groups note that in the face of the COVID-19 pandemic, asthma patients should continue to take basic therapy, including corticosteroids. And in current studies, ICS budesonide in COVID-19 patients reduces the risk of hospitalization or emergency care by 91 % and significantly improves clinical recovery. Key words: bronchial asthma, COVID-19, inhaled corticosteroids, World Asthma Day.

THE EFFICACY OF COMBINED THERAPY IN PATIENTS WITH NEUTROPHILIC BRONCHIAL ASTHMA

THE EFFICACY OF COMBINED THERAPY IN PATIENTS WITH NEUTROPHILIC BRONCHIAL ASTHMA Yu. I. Feshchenko, L. A. Iashyna, G. L. Gumeniuk, V. I. Ignatieva, M. A. Polianska, S. G. Opimakh, I. V. Zvol, S. M. Moskalenko, N. A. Vlasova, L. A. Halai State organization «F. G. Yanovsky National institute of phthisiology and pulmonology National Academy of medical sciences of Ukraine» , Kyiv, Ukraine Abstract. Background: Issues of neutrophilic bronchial asthma remain unresolved and the investigations of the pathogenesis and treatment of this disease endotype are currently continuing. The aim of the study: This study aimed to develop the technology of the treatment of the neutrophilic asthma with the use of available drugs in Ukraine. Methods. The study involved 30 patients with neutrophilic asthma. The first (control) group consisted of 15 patients who received standard therapy with a combination of budesonide and formoterol. The second (main) group consisted of 15 patients who received the treatment according the technology (ultrafine beclomethasone dipropionate, formoterol, tiotropium bromide and additionally for the first 10 days — inhalation of 10.0 % acetylcysteine solution through a nebulizer). All patients were surveyed with the Asthma Control Test (ACT), the Asthma Control Questionnaire (ACQ). The quality of life of patients was assessed by a St. George’s Respiratory Questionnaire. All patients underwent spirometry and a 6-minute walking test (6MWT). Results: In the prescription of complex therapy to patients with neutrophilic asthma clinical and functional efficacy was achieved in 93.3 % of patients. There were observed statistically significant increase in the ACT from (14.3 ± 1.3) to (20.3 ± 0.8) points (p < 0.05), a decrease in the ACQ from (2.3 ± 0.2) ) to (1.1 ± 0.1) points (p < 0.05), clinically significant reduction in the number of symptoms from (71.4 ± 5.6) points to (51.3  5.0) points, p < 0.05 according to the results of the St. George’s Respiratory Questionnaire, and a statistically significant increase in MEF50 from (28.9 ± 4.5) % to (41.6 ± 4.2) %, p < 0.05, MEF25 — from (19.1 ± 2.9) % to (27.6 ± 2.6) %, p < 0.05 and FEV1 /FVC from (67.2 ± 3.5) % to (76.1 ± 2.3) %, p < 0.05 after 3 months of complex treatment, as well as a statistically significant increase in the number of meters passed in the 6MWT from (266.3 ± 16.2) m to (312.0 ± 14.4) m, p < 0.05, reduction of shortness of breath on the Borg scale before test from (2.5  0.3) points to (1.5 ± 0.1) points, p < 0.05 and after the test — from (4.1 ± 0.3) points to (3.1 ± 0.3) points, p < 0.05. Conclusions: The technology of treatment of patients with neutrophilic asthma allows to improve the control of the asthma symptoms and quality of life of the patients, bronchial patency at the small airways and reduce fixed bronchial obstruction, as well as increase exercise tolerance. Key words: bronchial asthma, neutrophilic inflammation, combined therapy.

RANSFORMING GROWTH FACTOR-β1 IN PATIENTS WITH BRONCHIAL ASTHMA: PATHOGENETIC, CLINICAL AND THERAPEUTIC ASPECTS (LITERATURE REWIEW AND OWN RESULTS)

The goal of our research was to analyze the role of transforming growth factor-β1 (TGF-β1 ) in airway remodeling, inflammation, clinical course, treatment efficacy in patients with bronchial asthma (BA) according to the literature data, as well as determination of this biomarkers level in the blood of BA patients. Material and research methods. The publications is containing the results of studies on the role of TGF-β1 in the course of BA have been analyzed. The level of TGF-β1 in the blood was determined within enzyme-linked immunosorbent assay using kits “IBL International GMBH, Germany” in 553 BA patients and in 95 healthy individuals. Results. The article presents data about TGF-β1 influence on the processes of airway remodeling in BA patients, its role in microcirculation disorders, mucus production, eosinophilic inflammation and severity of clinical symptoms of the disease. The level of TGF-β1 expression was associated with disease control, severity and duration of the disease, despite conflicting data that require further study. In addition, there were presented recent research data about TGF-β1 as a marker of airway remodeling and as a therapeutic target in the treatment of BA patients. Glucocorticoids, tiotropium bromide, methylxanthines, selective inhibitors of TGF-β1 , resveratrol, simvastatin and montelukast and their mechanisms of influence were presented in detail. Significantly higher level of TGF-β1 in the blood of patients with BA was found (38.5 ± 0.7) pg/ml compared with healthy individuals (33.9 ± 1.0) pg /ml, p = 0.007. Conclusion. A significantly higher level of TGF-β1 was revealed in the blood of BA patients. In our opinion, a differentiated analysis of the content of this marker depending on the phenotype of the disease is important, which would explain the conflicting results of different studies, deepen understanding of its pathophysiological and clinical role in order to develop methods for slowing airway remodeling. Key words: bronchial asthma, transforming growth factor-β1 (TGF-β1), airway remodeling.

SENSITIZATION TO ALLERGENIC COMPONENTS OF HOUSE DUST MITES IN CHILDREN WITH BRONCHIAL ASTHMA IN KHARKIV REGION

SENSITIZATION TO ALLERGENIC COMPONENTS OF HOUSE DUST MITES IN CHILDREN WITH BRONCHIAL ASTHMA IN KHARKIV REGION V. A. Klymenko1 , T. V. Kulik1 , V. M. Belous2 , O. V. Pyontkovskaya3 , O. M. Savvo3 1 Kharkiv National Medical University, Kharkiv, Ukraine 2 Ecomed Medical Center, Kharkiv, Ukraine 3 Municipal non-profit enterprise of Kharkiv Regional Council «Regional Children’s Clinical Hospital G1», Kharkiv, Ukraine Abstract. The aim of the work is to determine the molecular profile of sensitization to house dust mites in children with bronchial asthma in the Kharkiv region. Object and methods of study. 42 children aged from 6 to 18 years were under observation. Evaluation of the sensitization profile was performed by the method of multicomponent photometric analysis ALEX. Results and discussion. Boys predominated among the patients — 76 %. Patients had intermittent (46 %), mild persistent (31 %), moderate persistent (15 %) and severe persistent asthma (8 %). Allergic rhinitis was noted in 88 % of patients. Elevated IgE levels were observed in 69 % of patients. The median IgE is 385.50 [122.75; 991.00] kU/L. Sensitization to house dust mites was detected in 23 (54 %) patients, of which monosensitization — 10 %; co-sensitization with other aeroallergens — 44 %. Among pediatric patients in the Kharkiv region, the leading sensitization is sensitization to D. farinae (44 %) and D. pteronyssinus (48 %). Molecular sensitization profile: Der f1 — 38.1 %; Der f2 — 38.1 %; Der p1 — 33.33 %; Der p2 — 38.1 %; Der p5 — 14.29 %; Der p7 — 16.67 %; Der p10 — 9.52 %; Der p20 — 2.38 %; Der p23 — 26.19 %. Only minor components (Der p5, 7, 10, 20 or 21) were found in 7.14 % of patients, which proves the need for molecular diagnosis when prescribing immunotherapy. Among the «new» allergens for our region — Blomia tropicalis — sensitizationin 11.9 %; molecular profile: Blo t1 — 2.38 %; Blot 10 — 9.52 %; Blo t21 — 4.76 %. Isolated cases of sensitization to ticks Glycyphagus domesticus, Tyrophagus putrescentiae, Lepidoglyphus destructor have been identified. Conclusions. Differences in sensitization to molecular components of house dust mites in children of the Kharkiv region were proved . It should be taken into account in the diagnosis and treatment of patients with allergic diseases. Key words: bronchial asthma, sensitization, house dust mites, molecular components.

ADAPTED EVIDENCE-BASED CLINICAL GUIDELINES: BRONCHIAL ASTHMA (PART 3)

C. Clinical guideline is the result of an agreed decision of experts, adopted on the basis of a thorough analysis of literature data, as well as recommendations of foreign guideline GINA: Global Strategy For Asthma Management And Prevention. Updated 2019. The document provides an updated definition of bronchial asthma (BA), gives new approaches to the classification and diagnosis of the disease, proposes modern treatment regimens based on the results of multicenter international clinical trials, which justifies the high evidence for such therapeutic tactics. New principles for the distribution of patients to phenotypes, which should be taken into account when choosing treatment regimens, are presented, algorithms for initial and maintenance therapy, and new approaches to the treatment of exacerbations of the disease are presented. In previous publications of the manual (Asthma and Allergy, 2020, № 2, № 3), an updated definition and pathogenetic mechanisms of BA were presented, new approaches to the classification and diagnosis of the disease were outlined, and the definition and assessment of asthma control were given. The principles of assessing the severity of asthma, as well as the difference between severe and uncontrolled asthma are considered. Standards for the treatment of asthma patients according symptoms control and minimize risk are presented. The basic principles of asthma management and alternative correction strategies of treatment are considered. The third part of the manual presents a stepwise approach to the correction of therapy, immunotherapy with allergens, vaccination, indications for referral to a specialist consultation. The guideline is addressed to doctors at all levels of medical care – family doctors, general practitioners, pulmonologists, allergists, cardiologists, rehabilitologists. Key words: bronchial asthma, pathogenesis, classification, diagnosis, therapy

Recurrent episodes of bronchial obstruction in children: onset of chronic respiratory diseases in adults?

Recurrent episodes of bronchial obstruction are most common in young children. Various phenotypes of wheezing/bronchial obstruction in preschool children have been described. Large cohort studies demonstrated that it is possible to estimate the risk of chronic bronchopulmonary diseases (developing in adolescence or adulthood) among children with recurrent episodes of bronchial obstruction. All children with recurrent bronchial obstruction should be carefully followed-up and receive timely rational therapy. In children with mild bronchial obstruction, the combination of bromhexine, guaifenesin, and salbutamol in fixed doses has demonstrated high efficacy. Key words: bronchial asthma, bronchial obstruction, children, bromhexine + guaifenesin-salbutamol, prognosis, wheezing phenotypes, COPD

Моніторинг побутових тригерних чинників бронхіальної астми

МОНІТОРИНГ ПОБУТОВИХ ТРИГЕРНИХ ЧИННИКІВ БРОНХІАЛЬНОЇ АСТМИ - У статті представлено результати вивчення регіональних особливостей структури агрокомплексу домашнього пороху житлових приміщень міста Львова і проведено оцінку частоти кліщової сенсибілізації у хворих на бронхіальну астму. Показано, що структура акарокомплексу домашнього пороху характеризується не лише загальними рисами, але й має свої регіональні особливості. Отримані дані можуть бути передумовою для розширення діагностичної панелі алергенів у Львівському регіоні за рахунок введення алергенів кліщів Tyrophagus longior. Широке розповсюдження кліщів у домашньому поросі квартир, де проживають хворі на бронхіальну астму, свідчить про існування потужного алергізуючого фону, що підтверджується позитивними результатами шкірного алерготестування з кліщовими алергенами у 78,8 % хворих.<br />МОНИТОРИНГ БЫТОВЫХ ТРИГГЕРНЫХ ФАКТОРОВ БРОНХИАЛЬНОЙ АСТМЫ - В статье представлены результаты изучения региональных особенностей структуры акарокомплекса домашней пыли жилых помещений Львова и проведена оценка частоты клещевой сенсибилизации у больных бронхиальной астмой. Показано, что структура акарокомплекса домашней пыли характеризуется не только общими чертами, но и имеет свои региональные особенности. Полученные данные могут быть предпосылкой для расширения диагностической панели аллергенов во Львовском регионе за счет введения аллергенов клещей Tyrophagus longior. Широкое распространение клещей в домашней пыли квартир, где проживают больные бронхиальной астмой, свидетельствует о существовании мощного аллергизирующего фона, что подтверждается положительными результатами кожного аллерготестирования с клещевыми аллергенами в 78,8 % больных.<br />MONITORING OF DOMESTIC ASTMA TRIGGERS - The article considers the results of regional peculiarities study of the household dust acarological complex structure of the residential premises of Lviv and estimated mite sensibilization frequency of asthmatic people. It was shown that household dust acarological complex structure is characterized not only by general features but also has its regional peculiarities. The received data may serve as a prerequisite for creation of broader diagnostic panel of allergens in Lviv region by means of introduction of Tyrophagus longior mite’s allergens. A wide spread occurrence of mites in household dust in the apartments if asthmatic dwellers gives evidence of existence of powerful allergenic background which is proved by positive results of skin allergy testing by mites allergens in 78.8 % of patients.<br />Ключові слова: бронхіальна астма, алергени кліщів домашнього пороху.<br />Ключевые слова: бронхиальная астма, аллергены клещей домашней пыли.<br />Key words: bronchial asthma, house dust mite allergens

Prospective Study of Bronchial Asthma

Bronchial asthma is an atopic disease characterized by chronic airway inflammation and hyper-responsiveness. Severe acute asthma is a medical emergency and sometimes difficult to treat. This prospective study was done at Dhaka Medical College Hospital from January 1997 to January 1998. Total 30 patients of bronchial asthma were included in this study. Diagnosis was established on the basis of symptoms, evidence of airflow obstruction and its reversibility by bronchodilator therapy. The age range was 18 to 80 years with a mean 36.64±4.91. Of them, 63% were male and 37% were female. It revealed that all patients had classical triad of dyspnoea, wheeze and cough. Almost all patients (80%) had some precipitating agents for their attack. Regarding treatment of severe acute asthma - Nebulized salbutamol is superior to conventional intravenous aminophylline, as p value of nebulized salbutamol group is <0.001 which is significant. So, severe acute asthma should be managed with nebulized salbutamol instead of intravenous aminophylline. Key words: Bronchial asthma; Bronchodilator; Nebulized salbutamol; Aminophylline. DOI: http://dx.doi.org/10.3329/fmcj.v6i2.9211 FMCJ 2011; 6(2): 100-103