Tysh O. Recurrent bronchitis in the practice of a family doctor: the role of microbiocenosis of the bronchi and bowel in the treatment and prevention.

The dissertation is devoted to the issues of increasing the effectiveness of prevention and treatment of young patients with recurrent bronchitis, on the basis of in-depth study of the pathogenesis role of qualitative and quantitative composition of the microflora of the bronchi and bowel, the state of the cellular and humoral parts of the immune system. It has been determined that in patients with recurrent bronchitis of young age, the main factors influencing the development of the disease are changes in the microbiocenosis of the bronchi: bifidobacteria (χ2=25,55; p<0.001; RR=12,2; SI 1,7-83,3), Lactobacillus (χ2=23,20; p<0,001; RR=3,4; CI 1,8-6,4) and the bowel: bifidobacteria (χ2=35,70; p<0,001; RR=4,4; CI 2,3-8,4), lactobacilli (χ2=16,06; p<0,001; RR=2,5; CI 1,4-4,5), smoking (χ2=14,82; p<0,001; RR=1,5; SI 1,2-1,8); elevated BMI (χ2= 6,10; p<0,01; RR=1,3; CI 1,0-1,6); taking antibiotics (χ2=15,08; p<0,001; RR=1,5; CI 1,2-1,9). Changes in the microbiocenosis of the bronchi and bowel in the future will take their role in the formation of the concept of the bronchoalveolar continent. This is an important mechanism that includes all pathophysiological processes of transition of risk factors to the disease. A family physician who receives an indicator of lactobacillus in faeces, using the formula Bbl=0,83×Lf-2,18; Lbl=0,91×Lf-1,87 can predict the indicator of lactobacillus and bifidobacteria in bronchoalveolar lavage individually for each the patient and for 80-85 % of patients this indicator will be reliable. For the first time, predictors of possible reps of bronchitis and their weighting factors in the patients under investigation were determined. An questionnaire was developed to determine the risk of recurrence of episodes of bronchitis. The results of the treatment according to the adapted integral scale of medical treatment outcomes (IMOS) showed that after a year, “complete recovery” was statistically significantly more frequent in the treatment groups using probiotic in II-Б and II-B subgrup (χ2=5,47; φ=0,32; p=0,02 and χ2=6,04; φ=0,34; p=0,01 respectively). The risk of poor health in groups using probiotic was less than 2 times (RR=1,8; 95 % CI 1,1-2,9). The algorithm of management of patients with recurrent bronchitis in young patients is developed and proposed, depending on the risk of recurrent episodes of bronchitis.