The PhD thesis is devoted to the study of ways to decrease the frequency of development of prolonged course of acute bronchitis in children through improvement of its treatment. More specifically, the given work includes a new solution of the scientific and practical task, which implies individualized treatment of acute bronchitis in children allowing for unfavorable impact of clinical and anamnestic risk factors, clinical presentation features, as well as response of mucosal immune system of respiratory tract during the disease.
The combination of catarrhal and generally lammatory syndrome has been shown to be a hallmark of acute bronchitis in children. According to the data of bronchitis severity score (BSS) the most persistent sign of acute bronchitis in children of 1to 6 years old is cough, whereas auscultatively detectable rhonchi are the most regressive. Furthermore, persistent changes in cell architectonics of nasal cavity mucosa are found in children aged 1to 6 with acute bronchitis indicating inflammation and increased epitheliocyte death, which are further preserved in recovery period.
Features of changes in antimicrobial peptide level in oropharyngeal fluid and serum in children of 1 to 6 years old with acute bronchitis were assessed for the first time, which allowed clarification of pathogenetic mechanisms of the disease development. It was established that acute bronchitis is associated with the phasic change in the content of interferons and antimicrobial molecular components of mucosal respiratory tract defense. The content of antimicrobial peptides and dynamics of its changes in acute and recovery period of acute bronchitis were proved to underpin the features of clinical presentation of the disease course.
The most important sign characterizing a normal, non-protracted course of acute simple bronchitis in children of 1 to 6 years old is a credible increase in HNP 1-3 concentration in oropharyngeal fluid until recovery, while the main risk factors of prolonged acute bronchitis course is the following clinical, anamnestic and laboratory data: perinatal injury of the central nervous system in anamnesis, mother’s smoking and such characteristics of acute bronchitis as subfebrile temperature, mild exudative syndrome, increased HNP 1-3 level (2,2-3,1 ng/ml) in oropharyngeal fluid in acute period of the disease.
On the basis of studying phasic changes in antimicrobial peptide concentration, it is pathogenetically justified to conduct correction of changes in mucosal immunity of young children with acute bronchitis. The use of recombinant interferon and a probiotical agent Bacillus subtilis contributes to decreased production of IFN- in serum, as well as the increase in lactoferrin in oropharyngeal fluid; in turn, the use of bacterial lysates contributes to the increase in IFN-α in serum.
Further, the use of recombinant α2β-interferon, ОМ-85 and Bacillus subtilis in the scheme of treatment of acute bronchitis in children was assessed for effectiveness and suitability. According to the BSS, prescription of the above-mentioned agents leads to faster resolution of clinical signs of the disease preventing development of protracted course in children aged 1 to 6 years old.
Prescription of Ivy extract preparation is usually associated not only with expectorant effect, but also with increase in lactoferrin concentration in oropharyngeal fluid. Taking into account the fact Ivy extract induces production of lactoferrin in respiratory tract, this drug can be considered as a component of pathogenetic therapy.
To increase efficacy of in-patient healthcare provided to children with acute bronchitis the analysis of the results of clinical and immunological effectiveness of different molecules was conducted. It allowed the development of an algorithm of differential drug choice, the use of which helps to personalize the treatment of acute bronchitis in children aged 1 to 6 years old and forms favorable course of the disease, thus, preventing the risk of its protraction.
