Kolisnyk V. Prognostic significance of calcium sensing receptor proteins in the development of childhood asthma

Asthma is a major medical and social problem worldwide. Patients of all ages have a significant impact on their quality of life. More than 300 million people suffer from asthma, according to the World Health Organisation. At present, there are no accurate methods for the diagnosis of asthma in children. Despite modern scientific progress, the issue of diagnosing asthma in preschool children remains open. The "golden" methods of diagnosing asthma in children <5 years of age are practically impossible and uninformative. The main aim of the study was to improve the diagnosis of asthma in young children by looking at calcium sensitive receptor proteins, the state of the epithelial layer of the airway barrier and the immune response. To achieve the objectives, the study included 77 children (38 boys and 39 girls) aged 3 months to 5 years 11 months. 29 days with repeated episodes of wheezing and asthma. Patients were divided into groups according to the number of cases of bronchial obstruction in their medical history. Group 1 included 30 children with no more than 2 episodes of wheezing in their lifetime; group 2 included 10 children with repeated episodes of wheezing, the number of which was 3 or more in their lifetime; group 3 included 37 patients diagnosed with mild to moderate persistent asthma, exacerbations of mild to moderate severity, partially or fully controlled. Children participating in the study were selected according to inclusion and exclusion criteria. The method of verifying diagnosis was based on anamnestic and clinical data, following the treatment protocols for children with acute bronchitis No. 18 of January 13, 2005, asthma No. 2856 of December 23, 2021, and GINA 2020-2022 recommendations. The study included a control group of 20 healthy children of similar age and gender who had not experienced any upper respiratory tract disease or other acute pathology in the last month. Clinical, anamnestic, immunological, biochemical, and statistical diagnostic methods were used. The study aimed to determine the levels of calcium-sensing receptor proteins in the serum of patients during the first 1-2 days of the disease and after the clinical manifestations were eliminated. The levels of total phospholipids and calcium in the exhaled air condensate were measured using a spectrophotometric method. Statistical analysis was conducted to obtain accurate results. The analysis of clinical and anamnestic data has identified certain factors that, through their complex interaction, can act as triggers for the development of asthma. Data analysis allowed us to gain a comprehensive understanding of the pathophysiological processes involved in the development of childhood asthma. The reliable correlations of calcium-sensing receptor proteins in the blood serum and other indicators suggest a correlation with the age of sick children. The significant correlation between CaSR and IgE (r=+0.50, p<0.05) serum levels in children during the peak of clinical manifestations of asthma is noteworthy, indicating the full affinity of their action. The ROC analysis data indicated that CaSR levels in children's serum <4.213 ng/ml can be used as a diagnostic criterion for asthma in patients with repeated cases of wheezing during the peak of clinical manifestations of the disease, with a sensitivity of 97.3% and specificity of 70.0%. The study results indicate that in patients with asthma, a possible exacerbation of the condition may be indicated by a level of phospholipides in the air condensate above 131.16 mmol/l and Ca below 0.354 mmol/l. The corresponding sensitivity and specificity values for phospholipides are 100% and 91.9%, respectively, and for Ca are sensitivity 91.9% and specificity 97.3%, respectively. In children with frequent episodes of wheezing (more than 3), an increase in air condensate phospholipides levels above 106.61 mmol/l may indicate the probable development of asthma, with corresponding sensitivity and specificity values of 86.5% and 72.5%, respectively.