Dubetska T. Clinical Value of Eosinophil Granulocyte Reactions in Optimization of Bronchial Asthma Management in Children

Object - eosinophilic bronchial asthma in children; goal - to improve treatment and prevention measures in school-age children with asthma by studying the functions of eosinophils and the activity of eosinophil-mediated inflammatory process of the respiratory tract and their impact on the clinical course of the disease; methods - clinical, general clinical and laboratory studies, biochemical, immunological, histochemical, allergological, spirometric, cytological, sociometric, statistical; results - it is shown that in children with signs of hypereosinophilic subphenotype of bronchial asthma is determined by clinical resistance to emergency therapy in exacerbation of the disease, and in patients with insufficient control at the prehospital stage is dominated by severe bronchial obstruction. Enhanced processes of oxygen-dependent microbicidality of blood eosinophils allow to verify this subphenotype with a specificity of 75-76.7%, and depletion of these oxygen-dependent processes was the most specific sign of sputum hypereosinophilia with increasing risk of this subphenotype; accumulation of acidophilic granulocytes in the airways in children of group I was associated with an increase in matrix metalloproteinase-9, tumor necrosis factor-alpha in sputum supernatant, and an increase in the need for antiradical protection with accumulation in sputum concentrations of ; the concentration of nitrogen monoxide metabolites in the pulmonary expiratory more than 40.0 μmol / ml probably increased the chances of eosinophilic asthma phenotype; shown a higher risk of the need for children of the first clinical group of anti-inflammatory basic therapy in the amount of 4 steps according to GINA, increased risk of the need for systemic glucocorticosteroids during exacerbations; It is shown that the most informative in the assessment of asthma control are clinical and instrumental scales (КIO, ACSS), which allowed to establish an increase in the absolute risk of improving control over the symptoms of persistent bronchial asthma.