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Introduction Asthma is a complex condition characterized by the presence of chronic inflammation in the lower respiratory tract resulting in many disturbing symptoms. The study of the clinical profile of the population with asthma allows us to understand a trend of a specific disease taking into account several indicators and its clinical characteristics. Aim Evaluation of the clinical profile of patients with chronic bronchial asthma in Poland. Material and methods The study included 10400 adult patients, of both sexes, diagnosed with chronic bronchial asthma who started therapy based on inhaled glucocorticosteroids accompanied by salmeterol, and 52 allergists. The examination was performed in a doctor's surgery. Standardized questionnaire interviews were used in order to carry out the procedure. Results The age of the patients ranged from 18 up to 97 years. Most of them suffer from overweight and obesity. 45.3% of the patients smoked cigarettes or declared to be passive smokers. Current asthma control was poor: over 56% of the patients suffered from diurnal symptoms more often than twice a week, almost 55% from nocturnal symptoms, in 72% of the patients' physical activity was limited, whereas 57% required immediate treatment. Most commonly used drugs were inhaled glucocorticosteroids and short acting β2-mimetics. After treatment change, fewer patients suffered from asthma symptoms. Conclusions Adjusting the therapy according to the current guidelines and to the patient's needs helps to improve asthma control.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease that combines various clinical manifestations and pathophysiological mechanisms. It underlies the separation of patients with COPD by phenotypes, endotypes and a personalized therapy of this disease. The implementation of this approach is possible only with the use of appropriate biomarkers. One of the most important biomarkers of COPD is eosinophilia of blood and/or sputum, which is considered as a predictor of frequent exacerbations and the effectiveness of inhaled glucocorticosteroids in patients with COPD. The literature discusses the impact of eosinophilic inflammation on the prognosis, clinical and functional parameters in COPD, and the role of the targeted therapy in the treatment of eosinophilic COPD.Хроническая обструктивная болезнь легких (ХОБЛ) - гетерогенное заболевание, сочетающее в себе различные клинические проявления и патофизиологические механизмы, что лежит в основе разделения больных ХОБЛ по фенотипам, эндотипам и персонифицированной терапии этого заболевания. Реализация данного подхода возможна только при использовании соответствующих биомаркеров. Одним из наиболее важных биомаркеров при ХОБЛ является эозинофилия крови и/или мокроты, рассматриваемая как предиктор частых обострений и эффективности ингаляционных глюкокортикостероидов у пациентов с ХОБЛ. В литературе обсуждаются вопросы влияния эозинофильного воспаления на прогноз, клинические и функциональные показатели при ХОБЛ, а также роли таргетной терапии в лечении эозинофильной ХОБЛ.

The search for factors affecting the efficacy of bronchial asthma (BA) therapy in children is an actual problem. subject of many modern scientific studies. Authors note that adherence to therapy in patients with asthma ranges from 30 to 70%. Often this index does not exceed 50%. Analysis of adherence to medical recommendations in children with asthma and the search for compliance reduction factors is one of the ways for optimizing therapy and improving the quality of life for children with asthma.Purpose. In order to optimize bronchial asthma therapy in pediatric practice, we analysed adherence to medical recommendations and its effect on the controllability of the disease in children with asthma.Materials and methods. The study included 94 children aged 6 to 17 years with an established diagnosis of bronchial asthma. All patients had previously been recommended basic therapy in the form of inhaled glucocorticosteroids (ICS) or their fixed combinations with long-acting beta2-adrenomimetikami (LABA). An assessment of BA control symptoms was carried out, and factors affecting adherence to medical recommendations were analyzed. The effect of decreased patient compliance on the control of asthma symptoms was evaluated.Results. 61.7% of children with asthma have insufficient disease control. In 42.55% of patients, a survey revealed insufficient adherence to medical recommendations. 88.3% of children and their parents reported the presence of factors capable of influencing the decrease in compliance. The most frequently occurring factor in reducing adherence to therapy turned out to be insufficient patient awareness of the disease itself, the mechanisms of therapy action, and the prospect of treatment. Statistical data processing showed a statistically significant decrease in adherence to medical recommendations in the group of patients with insufficient asthma symptom control (p = 0.038).Conclusion. Only 38.3% of children had complete asthma symptom control. The statistically significant reduction in adherence to medical recommendations in the group of children with insufficient symptom control suggests the need for educational activities for children with BA and their parents in order to increase adherence to medical recommendations, optimize the effectiveness of therapy and improve the quality of patients’ life.

Inhaled glucocorticosteroids are the main drugs used to control bronchial asthma in children. P450-cytochrome of 3A (CYP3A) family is involved in their metabolism. CYP3A5-isoenzyme plays the leading role in the respiratory tract. We described 6986A>G polymorphism in the CYP3A5 gene encoding this isoenzyme.Aim of the study. To evaluate the association of CYP3A5 (6986A> G) gene polymorphism with the effectiveness of drugs in children with bronchial asthma.Materials and methods. We examined 108 children from 6 to 17 years with bronchial asthma. The allergist carried out the dynamic outpatient polyclinic follow-up of patients, assessed the symptoms of the disease and corrected the corresponding basic therapy. All children underwent genotyping for the 6986A> G polymorphic marker of the CYP3A5 gene.Results. Ten (9.26%) children were heterozygous for the 6986A> G polymorphic marker of the CYP3A5 gene (AG genotype). The authors obtained statistically significant differences in the frequency of the AG genotype between the patients receiving control therapy for bronchial asthma of the 1st – 2nd stage and the patients with control therapy of the 3rd and higher stages in accordance with GINA criteria (p=0.031). In the group with severe bronchial asthma, the number of heterozygotes for the 6986A> G polymorphic marker of the CYP3A5 gene was significantly higher than among children with a mild course of the disease (p=0.029).Conclusion. The AG genotype and A-allele (CYP3A5 gene, A6986A> G polymorphism) are associated with the need for greater volume of control therapy for bronchial asthma and they are risk factors of a more severe course of the disease.

The purpose of the study is to investigate the state of the upper gastrointestinal tract (UGIT) in various types of basic treatment of children’s bronchial asthma. There was conducted a clinical-instrumentalsurvey of children with bronchial asthma. They have been receiving a basic anti-inflammatory therapy inhaled glucocorticosteroids (IGCS) (1st group, n=33) or anti-inflammatory cromone drugs (2nd group, n=33) for 3 years and more. Most of the children with the bronchial asthma complained about the gastrointestinal problems, mostly abdominal pain; the heartburn was recorded reasonably oftener in the children of 1st group. While conducting endoscope survey, 97% of children of 1st group were revealed having the UGIT pathology. As the result of microscopy of gastric mucosa bioptic sample, most of the patients of 1st group appeared having fungal infection; the significant lymphoplasmacytic or eosinophilic infiltration in own layer of the gastric mucosa was determined. Moreover, H. pylori was revealed more frequently for the children of 1st group, and the level of invasion was higher. The data given indicate the need for measures limiting the entry of steroids into GIT, as well as the use of medicines that reduce damaging effect of IGCS on the mucous layers.

Objective — assessment of the prevalence and incidence of bronchial asthma (BA) and analysis of prospects for establishing disease control in the light of new clinical guidelines GINA 2019.Materials and methods. We used various full-text and abstract databases.Results and discussion. In Ukraine, according to official statistics for 2017, the prevalence of BA was 501.9 patients per 100 thousand adults, which, for its part, represents only 0.3 % of the total population and contradicts real world statistics. According to experts, the real prevalence of BA in Ukraine can reach 7—8 %. In recent years, the prevalence of BA amongst the adult population has increased significantly — by almost 44.2 % compared to 1991. Statistics show an increase in the incidence of BA in Ukraine 1.6 times in the last four years (from 22.2 patients per 10 thousand population in 2014 to 35.4 patients per 100 thousand population in 2017).The new GINA guidelines are based on basic therapy containing inhaled glucocorticosteroids — to reduce the risk of severe exacerbations and to control symptoms. With mild BA, GINA recommends using low doses of formoterol if necessary. In the case where formoterol is unavailable, low doses of inhaled glucocorticosteroids (IGCS) may be used as an alternative, together with short-acting b-adrenomimetics.Conclusions. In the near future, as a result of prognostic linear analysis, an increase in the incidence of BA is expected in the world, due to the constant presence of risk factors that provoke the development of the disease, as well as due to the rapid growth of allergic population. The use of fixed or free IGCS/long-acting b-adrenomimetics combinations is a priority strategy in patients who are unable to achieve disease control with low/medium doses of IGCS.

The aim of research was to evaluate retrospectively the dose-depended effect of the use of inhaled steroids on the anthropometrical indices of children and adolescents with bronchial asthma.Material and methods. Based on the pulmonological department of the Regional children clinical hospital in Chernivtsi city there has been conducted the evaluation of the physical development of 50 asthma patients who were under long-term use of inhaled glucocorticosteroids (IGCS). All patients underwent anthropometric study: weight and height measurements with calculation of body mass index (BMI). The assessment of physical development of patients has been performed by a centile method, taking into account the age of patients (using percentile tables "anthropometric indices to age").Results. Analysis of the data has showed that a patients' height was, on average, 50±4.4 percentile, which was corresponding to the average age-related normative values. At the same time height below (10-25 percentiles) average regarding to the age was recorded in 12 % of all examined patients, but an low (5-10 percentile) or very low ( 25 kg/m2), and only one person out them (2 %) had clinically significant (BMI> 30 kg/m2) obesity.Conclusion. From the perspective of evidence-based medicine, negative impact of the long-term use of IGCS, in medium-high or high doses as well, on growth and body weight of the asthmatic children and adolescents had not been confirmed. At that, statistically significant data on the association of obesity and short stature with prolonged use of medium-high or high doses of IGCS had not been found: the attributive risk of excessive (body mass index> 25 kg/m2) body weight was 24 %, the odd ratio=3.2 (95 % confidence interval: 0.33-30.94), but at the same time the attributive risk of short stature (height, Целью нашей работы была ретроспективная оценка дозозависимого влияния ингаляционных стероидов на антропометрические показатели детей и подростков, страдающих бронхиальной астмой.Материали и методы. На базе пульмонологического отделения Областной детской клинической больницы г. Черновцы проведена оценка физического развития 50 детей, страдающих бронхиальной астмой (БА) и длительно применяющих ингаляционные глюкокортикостероиды (ИГКС). Всем пациентам проводили антропометрическое обследование: измерение массы и роста с вычислением индекса массы тела (ИМТ). Оценку физического развития пациентов проводили центильным методом с учетом возраста пациентов (с использованием центильных таблиц «антропометрический показатель к возрасту»).Результаты. Показатель роста в перцентилях относительно возраста пациентов составлял в среднем 50±4,4, что соответствует средней возрастной норме. При этом рост ниже среднего (в коридоре 10-25 перцентилей) относительно возраста зарегистрировано у 12 % пациентов, а низкий (в коридоре 5-10 перцентилей) или очень низкий рост ( 25 кг/м2) отмечалась у 5 обследованных детей (10 %), из которых только у одного пациента (2 %) отмечалось клинически значимое (ИМТ> 30 кг/м2) ожирение.Выводы. С позиции доказательной медицины, не подтверждено негативного влияния длительного применения ИГКС, в т.ч. в средне-высоких или высоких дозах, на рост и массу тела детей и подростков, страдающих БА. При этом не найдено статистически значимых данных об ассоциации ожирения и низкорослости с пролонгированным применением средне-высоких или высоких доз ИГКС: атрибутивный риск избыточной (индекс массы тела > 25 кг/м2) массы тела составлял 24 % при соотношении шансов=3,2 (95 % доверительный интервал: 0,33-30,94), а атрибутивный риск возникновения низкорослости (рост, Метою нашої роботи було оцінити ретроспективно дозозалежний вплив інгаляційних стероїдів на антропометричні показники хворих на бронхіальну астму дітей і підлітків.Матеріали та методи. На базі пульмонологічного відділення Обласної дитячої клінічної лікарні м. Чернівці проведена оцінка фізичного розвитку 50 хворих на бронхіальну астму дітей, які тривало застосовують інгаляційні глюкокортикостероїди (ІГКС).Усім пацієнтам проводили антропометрічне дослідження: вимірювання ваги та зросту з обчисленням індексу маси тіла (ІМТ). Оцінку фізичного розвитку пацієнтів проводили за центильним методом із урахуванням віку пацієнтів (із використанням центильних таблиць «антропометричний показник до віку»).Результати. Показник зросту у перцентилях відносно віку пацієнтів становив, у середньому, 50±4,4, що відповідає середній віковій нормі. При цьому зріст нижче середнього (10-25 перцентилей) відносно віку зареєстровано у 12 % пацієнтів, а низький (5-10 перцентилей) або дуже низький зріст ( 25 кг/м2) відмічалася лише у 5 обстежених хворих (10 %), з яких лише у однієї особи (2 %) відмічалося клінічно значуще (ІМТ> 30 кг/м2) ожиріння.Висновки. З позиції доказової медицини, не доведено негативного впливу тривалого застосування ІГКС, у т.ч. в середньо-високих або високих дозах, на зріст та масу тіла хворих на БА дітей та підлітків. При цьому, не знайдено статистично значущих даних щодо асоціації ожиріння та низкорослості із пролонгованим застосуванням середньо-високих або високих доз ІГКС: атрибутивний ризик надлишкової (ІМТ>25 кг/м2) маси тіла становив 24 % при співвідношенні шансів =3,2 (95 % довірчий інтервал: 0,33-30,94) та атрибутивний ризик виникнення низкорослості (зріст

Theaimof research was to evaluate retrospectively the dose-depended effect of the use of inhaled steroids on the anthropometrical indices of children and adolescents with bronchial asthma. Material and methods.Based on the pulmonological department of the Regional children clinical hospital in Chernivtsi city there has been conducted the evaluation of the physical development of 50 asthma patients who were under long-term use of inhaled glucocorticosteroids (IGCS). All patients underwent anthropometric study: weight and height measurements with calculation of body mass index (BMI). The assessment of physical development of patients has been performed by a centile method, taking into account the age of patients (using percentile tables "anthropometric indices to age"). Results.Analysis of the data has showed that a patients' height was, on average, 50±4.4 percentile, which was corresponding to the average age-related normative values. At the same time height below (10-25 percentiles) average regarding to the age was recorded in 12 % of all examined patients, but an low (5-10 percentile) or very low (2, which was corresponding to the normostenic structure. Simultaneously, only 5 of examined patients (10 %) were overweight (BMI> 25 kg/m2), and only one person out them (2 %) had clinically significant (BMI> 30 kg/m2) obesity. Conclusion.From the perspective of evidence-based medicine, negative impact of the long-term use of IGCS, in medium-high or high doses as well, on growth and body weight of the asthmatic children and adolescents had not been confirmed. At that, statistically significant data on the association of obesity and short stature with prolonged use of medium-high or high doses of IGCS had not been found: the attributive risk of excessive (body mass index> 25 kg/m2) body weight was 24 %, the odd ratio=3.2 (95 % confidence interval: 0.33-30.94), but at the same time the attributive risk of short stature (height

Objective of the Study: improving the treatment of mild persistent bronchial asthma based on the development of differential program for antiinflammatory therapy. Of 120 children we have formed 3 groups depending on the effective basic therapy (leukotrien modifier, fluticasone propionate or their combination), which made it possible to achieve control of the disease.Results. The highest concentrations of leukotrienes in blood serum were observed in children of the 3rd group, they were higher even after treatment, than in children from the control group. At the level of leukotrienes from 500 to 1000 pg/ml chances of achieving bronchial asthma control using leukotrien modifier were 5.9 times higher compared with inhaled glucocorticosteroids (CI95% 2.01–18.2). And when the level of leukotrienes (C4/D4/E4) exceeded 1000 pg/ml, combination therapy is more effective than treatment with leukotrien modifier (odds ratio (OR) = 6.7; CI95% 2.5–17.8) and fluticasone propionate (OR = 83.3; CI95% 9.9–667.9).Conclusions. Leukotrien modifier as monotherapy is indicated to 6–7-year-old children with mild persistent bronchial asthma and serum levels of leukotrienes from 500 to 1000 pg/ml. At the level of leukotrienes below 500 pg/ml it is advisable to administer fluticasone propionate, above 1000 pg/ml — combination of leukotrien modifier and inhaled corticosteroid., Цель работы: усовершенствовать лечение легкой персистирующей бронхиальной астмы на основании разработки дифференциальной программы противовоспалительной терапии. Из 120 детей сформированы 3 группы в зависимости от эффективной базисной терапии (антилейкотриеновый препарат, флутиказона пропионат или их комбинация), которая позволяла достичь контроля над заболеванием.Результаты. Наиболее высокие концентрации лейкотриенов C4/D4/E4 в сыворотке наблюдались у детей 3-й группы, даже после лечения они были выше, чем у детей контрольной группы. При уровне лейкотриенов 500–1000 пг/мл шансы достичь контроля над бронхиальной астмой с помощью антилейкотриенового препарата были в 5,9 раз выше в сравнении с ингаляционными глюкокортикостероидами (95% доверительный интервал 2,01–18,2). При концентрации лейкотриенов (C4/D4/E4) свыше 1000 пг/мл максимально эффективным оказалось комбинированное лечение по сравнению с антилейкотриеновым препаратом (отношение шансов (OR) = 6,7; СІ95% 2,5–17,8) и флутиказона пропионатом (OR = 83,3; СІ95% 9,9–667,9).Выводы. Антилейкотриеновый препарат в качестве монотерапии показан детям 6–7 лет с легкой персистирующей бронхиальной астмой при сывороточных уровнях лейкотриенов от 500 до 1000 пг/мл. При уровне лейкотриенов ниже 500 пг/мл целесообразно назначать флутиказона пропионат, выше 1000 пг/мл — комбинацию антилейкотриенового препарата и ингаляционного глюкокортикостероида., Мета роботи: удосконалення лікування легкої персистуючої бронхіальної астми на підставі розроблення диференційної програми протизапальної терапії. Зі 120 дітей сформовані 3 групи залежно від ефективної базисної терапії (антилейкотрієновий препарат, флутиказону пропіонат або їх комбінація), яка дозволила досягти контролю над захворюванням. Результати. Найбільш високі концентрації лейкотрієнів C4/D4/E4 у сироватці крові спостерігалися у дітей 3-ї групи, навіть після лікування вони залишалися вищими, ніж у дітей контрольної групи. При рівні лейкотрієнів від 500 до 1000 пг/мл шанси досягти контролю над бронхіальною астмою за допомогою антилейкотрієнового препарату у 5,9 раза вищі порівняно з інгаляційними глюкокортикостероїдами (95% довірчий інтервал 2,01–18,2). А коли рівень лейкотрієнів (C4/D4/E4) перевищував 1000 пг/мл, комбіноване лікування є ефективнішим, ніж терапія антилейкотрієновим препаратом (відношення шансів (OR) = 6,7; СІ95% 2,5–17,8) та флутиказону пропіонатом (OR = 83,3; СІ95% 9,9– 667,9).Висновки. Антилейкотрієновий препарат як монотерапія показаний дітям 6–7 років з легкою персистуючою бронхіальною астмою при сироваткових рівнях лейкотрієнів від 500 до 1000 пг/мл. При рівні лейкотрієнів нижче від 500 пг/мл доцільно призначати флутиказону пропіонат, вище від 1000 пг/мл — комбінацію антилейкотрієнового препарату та інгаляційного глюкокортикостероїду.

Many lines of previous studies have reported that differences and similarities between bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD). The pathological and physiological abnormalities of these diseases have been also discussed. BA and COPD have some similarities such as airflow obstruction, pulmonary inflammation, and airway hyperresponsiveness (AHR). However, both two diseases are regarded different diseases since their mechanisms of development are quite different. Therefore, both two diseases require different assessment, monitoring, and pharmacological treatments. In this paper, we describe the pharmacological treatment of asthma in adults and COPD based on recently updated guideline by the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD), respectively.

Inhaled glucocorticosteroids are the first line anti-inflammatory agents for the long term treatment of asthma.1 2 They are also frequently prescribed in chronic obstructive pulmonary disease (COPD),3 even if their efficacy in this condition is still controversial.4 The inhalatory mode of administration maximises the delivery to the airways and minimises the systemic delivery of glucocorticosteroids, increasing the therapeutic ratio.5 However, long term treatment of asthma6 and COPD7 with inhaled corticosteroids is associated with a significant risk of dose related systemic adverse events. This risk is particularly worrying in patients with moderate to severe asthma who require continuous treatment with high dose inhaled steroids to keep the disease under control and to prevent exacerbations, and who also require recurrent cycles of systemic glucocorticosteroids to treat exacerbations.2 3The biomarkers most frequently used to assess systemic availability of glucocorticosteroids are serum cortisol, urinary cortisol and its metabolites, and serum osteocalcin. The most worrying potential systemic effects are osteoporosis, growth suppression, adrenal insufficiency, cataracts, and glaucoma.8 Several studies have assessed the systemic activity of inhaled steroids by looking at short term effects in normal subjects and/or mild asthmatics, with the assumption that results obtained in normal subjects could be transferred to more obstructed subjects such …

H2O2 is elevated in the exhaled air condensate in several inflammatory disorders of the lung, including bronchial asthma, and thus may reflect inflammatory processes in the airways. Exhaled H2O2 may be used to guide the anti-inflammatory treatment of patients with asthma. Therefore in this study we analysed the effect of inhaled glucocorticosteroid beclomethasone for 4 weeks on H2O2 level in the exhaled air condensate. Seventeen asthmatics and 10 healthy subjects were included to the study. Eleven patients were given inhaled beclomethasone and six were given placebo (3M Health Care). In all patients pulmonary function tests were performed. H2O2 in the expired air condensate was measured spectrofluorimetically (homovanillic acid method). Inhaled beclomethasone significantly decreased H2O2 in the expired air condensate in the active-treatment group, with a fall from baseline on day 1 which remained on day 43 (follow-up) (P0.05). Exhaled H2O2 in the active-treatment group was significantly lower than that in placebo group (P0.05). A negative correlation between H2O2 and forced expiratory volume in 1 sec (FEV1) on day 29 was observed. The decrease in exhaled H2O2 in the active-treatment group was accompanied by an improvement in pulmonary function tests results. Inhaled glucocorticoids reduce the level of H2O2 in the expired air condensate of asthmatic patients over a 4-week period and this may reflect their anti-inflammatory activity in lung diseases.