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Introduction: In recent years accumulated results of the study of the atopic markers, airway hyperresponsiveness and the character and activity of the local inflammatory process of the airways of asthma in childhood. Aims: Select high-risk groups on forming the bronchi remodeling to improve the management of asthma in children. Materials and methods: We examined 117 school-age children with bronchial asthma, whose average age was 11,5±0,29 years, duration of the disease was on average 5,4±0,33 years, the boys were 65.25%. Results: It was revealed 3 cluster groups of children with asthma. 1st cluster that determines moderate risk of bronchial remodeling have formed boys with early onset asthma, low index of bronchoconstriction (3.1%), high levels of interferon-γ (71,7 pg/ml) and interleukin-6 (4.27 pg/ml) in the supernatant of sputum. In the 2nd cluster, which is associated with a high risk of remodeling, have entered girls with severe asthma and later its debut, genotypes GSTM 1 , GSTT 1 , high index of bronchoconstriction (47.7%), eosinophilia in sputum (20.0%), high concentration of VEGF (400,0 pg/ml) and interleukin-13 (90.0 pg/ml) in the supernatant of sputum. 3rd cluster with low probability of irreversible changes of airways have formed children of high level of nitrogen oxide metabolites (63.9 mkmol/L) and proteolytic activity of lysis of azokol (0.24 ml/h) in exhaled air, elevated concentration of MMP-9 (6.9 pg/ml) and TNF-α (1,0 m/ml) in the supernatant of sputum. Conclusions: In spite of the detected cluster groups of school-age children with asthma it is recommended to determine the risk of airway remodeling and further tactics of the basic anti-inflammatory treatment.

Background: This study investigated to detect the content of remodeling markers of the respiratory tract in the exhaled breath condensate (EBC) of children with bronchial asthma (BA). Materials and Methods: The study was in clinical groups of children with BA were formed on the indices in sputum supernatant: the Group I - “a high risk group” of bronchial remodeling (37 patients with vascular endothelial growth factor (VEGF) more than 80 ng/ml, and matrix metalloproteinase-9 (MMP-9) more than 5.2 ng/ml), the Group II - “a moderate risk” of bronchial remodeling (41 patients with VEGF more than 80 ng/ml, and MMP-9

OBJECTIVE 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. PATIENTS AND METHODS 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 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. CONCLUSION 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.