Acute respiratory diseases (ARDs) remain among the most common pathologies of childhood and constitute a significant medical and social problem in modern pediatrics. The high incidence of ARD episodes in children leads to reduced adaptive capacity of the organism, formation of chronic infectious foci, and impairment of physical and psychoemotional development. Particular attention should be paid to recurrent acute respiratory diseases (RARDs), which are characterized by repeated episodes of infection, a more prolonged and severe clinical course, a higher predisposition to bacterial complications, and a marked deterioration in the quality of life of affected children and their families. An important predisposing factor for the development of RARDs is lymphadenoid hypertrophy (LAH), which contributes to impaired mucociliary clearance, disturbed nasopharyngeal ventilation, and persistent chronic antigenic stimulation of lymphoid tissue.
The aim of the study was to determine the clinical and pathogenetic features of recurrent acute respiratory diseases in children with lymphadenoid hypertrophy, to evaluate their impact on quality of life, and to substantiate effective therapeutic and preventive approaches for optimizing patient outcomes. An open controlled comparative study included 138 children aged 3–10 years with RARDs. The main group consisted of 62 children with recurrent respiratory diseases and grade II–III palatine tonsil hypertrophy, whereas the comparison group included 56 children without significant hypertrophy. All patients underwent clinical, laboratory, and instrumental examinations. Clinical symptoms and severity of ARD episodes were assessed using the WURSS-21 scale. Parameters of local and systemic immunity, ferritin, vitamin D, IgA, IgG, IL-6, endothelin-1, and stable nitric oxide metabolites were evaluated. Instrumental examination included cardiorespiratory polysomnographic monitoring and Holter electrocardiographic monitoring. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), psychoemotional status using the Pediatric Symptom Checklist-17 (PSC-17), and quality of life using the Pediatric Quality of Life Inventory (PedsQL).
It was established that the presence of lymphadenoid hypertrophy in children with RARDs was associated with a significantly higher frequency and longer duration of ARD episodes, a more severe course of infection, a higher incidence of bacterial complications, and an increased need for antibiotic therapy. Children in the main group more frequently experienced prolonged cough, rhinorrhea, nasal obstruction, and fever. The negative impact of LAH on sleep quality and overall quality of life was demonstrated. Patients with RARDs and LAH showed frequent nocturnal awakenings, increased apnea-hypopnea index, elevated desaturation index, and respiratory sleep disturbances. These alterations were accompanied by impaired physical, emotional, and social functioning, psychoemotional and behavioral difficulties, and lower PedsQL scores. For the first time, it was established that children with RARDs associated with LAH develop a pronounced reduction in cardiovascular adaptive capacity manifested by decreased heart rate variability, reduced vagal influence, and predominance of sympathetic autonomic nervous system tone. Signs of systemic endothelial activation with elevated endothelin-1 levels were identified, which may represent a pathogenetic basis for the more severe course of respiratory infections. Children with RARDs and LAH demonstrated an imbalance of local and systemic immune factors, including reduced salivary secretory IgA levels, vitamin D and ferritin deficiency, and increased concentrations of IgG and stable nitric oxide metabolites, indicating chronic antigenic stimulation and tension of compensatory immune response mechanisms. Age-related features of RARDs were identified: younger children more frequently exhibited severe and prolonged disease episodes, whereas older children demonstrated signs of endothelial dysfunction and exhaustion of autonomic adaptation mechanisms. The effectiveness of course therapy with bacterial lysates in children with RARDs and LAH was proven. Administration of the preparation was associated with a reduction in the number and duration of ARD episodes, improvement of local and systemic immune protection parameters, normalization of heart rate variability indices, enhancement of sleep quality, and improvement of overall quality of life. The obtained results substantiate the feasibility of including bacterial lysates in the comprehensive prevention and treatment of recurrent respiratory diseases in children with lymphadenoid hypertrophy. Keywords: children, recurrent acute respiratory diseases, lymphadenoid hypertrophy, palatine tonsil hypertrophy, quality of life, sleep disorders, heart rate variability, immunity, bacterial lysates, prevention, treatment.
