In the genesis of bronchial obstruction are various pathogenetic mechanisms, the main of which are bronchospasm, inflammatory infiltration, edema, hypersecretion of viscous mucus, mucociliary insufficiency, obstruction or deformation of the bronchi and others. Obviously, the clinical and laboratory manifestations of biofeedback have not only common characteristics, but largely depend on the causes of the development of biofeedback due to the underlying disease. Studying the characteristics of the course of biofeedback in young children can reveal the presence of factors predisposing to the recurrent course of bronchial obstruction and develop a set of preventive and therapeutic measures to improve the prognosis of the disease.
We studied the results of clinical and medical history and laboratory characteristics in 132 young children with biofeedback of various origins who received treatment in a hospital (table 18).
The clinical group of young children with biofeedback.
|Total children||Of these, aged|
|3-12 months||1-3 years|
|I groupBOS I||68||51.5||48||70.6||twenty||29.4|
|II groupBOS rec.||64||48.5||23||35.9||41||64.1|
BOS I – children with the first episode of bronchial obstruction
BOS rec. – children with recurrent course of biofeedback
Taking into account the history data, 2 groups of children were formed: patients with the first (at the time of examination) episode of bronchial obstruction (68 patients) and children with recurrent course of biofeedback who had a history of 2 or more episodes of bronchial obstruction (64 patients). As can be seen from the table, in the first year of life, the first episode of bronchial obstruction occurred significantly more often (in 70.6% of cases), while the recurrence of biofeedback before the age of one year was established only in 35.9% of children. In patients older than a year, the first episode of biofeedback occurred in 29.4% of cases, repeated cases of biofeedback – in 64.1% of children. In both groups, biofeedback in boys was almost 2 times more common than in girls.
Children with newly established bronchial obstruction occurring against the background of an acute respiratory viral infection were admitted to the hospital, as a rule, after 2-3 days of illness (Table 19). The main reason for hospitalization was the presence of severe signs of intoxication (in 23.5% of cases), respiratory failure (DN) of 1-2 degrees (in 27.9% of children), suspected acute pneumonia and early age of the child (16.2% and 17 , 6%, respectively). At the same time, children with acute pneumonia occurring with biofeedback were hospitalized a little later, on the 4-5th day of the disease, usually after the onset of signs of DN (table 20). Two children with severe signs of post-vaccination allergy were delivered to the hospital on the first day of clinical manifestations of the disease. 1 child at the age of 8 months with acute bronchitis, 1 episode of biofeedback, was hospitalized on the 14th day from the onset of the disease, only with signs of DN.
Terms of hospitalization of children with biofeedback (number of children).
|Day from the onset of the disease|
Frequent relapses of bronchial obstruction served as a reason for hospitalizing children with a relapsing course of BFB in 1/3 of patients. Hospitalization, as a rule, had a planned character and was carried out later, on the 4-7th day of the disease. At the same time, in 18.7% of patients the reason for inpatient treatment was the presence of DN, in 17.2 – the child’s early age. This group of children was mainly admitted to the hospital on days 2-4 from the first manifestations of biofeedback. So 2 children (1 and 3 years old) with acute 2-sided focal pneumonia, grade 2 DN were hospitalized for 1-2 days of illness, in these patients there were frequent (more than 8 times) relapses of biofeedback. The combination with severe concomitant allergic pathology – a common form of atopic dermatitis – was the reason for hospitalization in 10.9% of children with recurrent course of biofeedback.
Thus, the presence of DN 1-2 degrees was the most common cause of hospitalization of children with the first episode of biofeedback, with a relapsing course of bronchial obstruction, this symptom was noted 1.5 times less often. The presence of severe toxicosis also turned out to be more characteristic for children with newly diagnosed BF (in 23.5% of children compared with 9.4% in children of group 2). The early age of the child became the reason for hospitalization with the same frequency in both groups. In children of the 2nd group, in 1/3 of cases, the cause of inpatient treatment was frequent relapse of bronchial obstruction, requiring in-depth examination in order to identify the genesis of the disease. It is noteworthy that children with newly diagnosed bronchial obstruction were admitted to the hospital in more than half of cases on the 2nd – 3rd day of the disease, while patients with recurrent course of BF were hospitalized in 40% of cases on the 4th – 5th day of the disease, and 28% of the children groups – on the 6-7th day from the first signs of the appearance of biofeedback.
Hereditary burden of allergic diseases was detected in 24 children (35.2%) of the 1st group and more than half (in 59.4%) of the children of the 2nd group. Of these, on the maternal side, the frequency of burdened hereditary history in children with a relapsing course of bronchial obstruction was slightly higher than in children with the first episode of biofeedback (38.5% and 21.3%, respectively) (Table 21).
The pathological course of pregnancy and childbirth in mothers of the examined children was revealed in 55.9% of cases in group 1, and 60.9% of mothers in group 2. The most frequently observed threat of abortion and the presence of intercurrent diseases, however, their frequency was approximately equal in both groups. Premature (1 degree) were born 2 children of the 1st group and 1 – 2nd group. Mechanical ventilation was not used in any of their children. Perinatal encephalopathy of posthypoxic and / or traumatic genesis occurred in 17.6% of children with the first episode of BFB and in 32.8% of children with recurrent bronchial obstruction. 66.2% of the children of the 1st group and 67.1% of the children of the 2nd group were at the early artificial feeding.
In the analysis of social conditions and the frequency of smoking we were not able to establish a significant difference between the studied groups, however, it should be noted that if the social conditions in more than half of the children were good (55.9% and 56.3%), then the vast majority of families were smokers (83.8% and 81.2%).
In the life history of the examined children, there were indications of acute infectious respiratory diseases, however, the frequency of intercurrent infections was higher in children of the 2nd group (51.5% and 100%). In addition, “often ill children” in the age group of 1 to 3 years among patients with recurrent course of biofeedback were significantly more frequent (40% and 65.8%, respectively).
Concomitant diseases were noted in children of both groups with biofeedback. Analyzing the frequency of concomitant pathology, we did not reveal a significant difference between children of groups 1 and 2 who were diagnosed with rickets of the 1-2 degree (in 36.8% and 37.5% of cases), thymic hyperplasia (23.5% and 26.6% ), mild iron deficiency anemia (7.4% and 12.5%), acute pyelonephritis (4.4% and 6.25%). At the same time, atopic dermatitis was significantly more common in children with recurrent course of biofeedback (in 22% of children in group 1 and 37.5% of children in group 2).
Thus, premorbid background was aggravated in most children with biofeedback. However, in children with a relapsing course of bronchial obstruction, significantly more often than in the group of children with the first episode of biofeedback, there were aggravated heredity for allergic diseases, perinatal damage to the central nervous system, atopic dermatitis and a relapsing course of acute respiratory diseases. At the same time, the pathological course of pregnancy and childbirth, the frequency of some concomitant diseases, the nature of social conditions did not differ significantly. The vast majority of children in both groups received early artificial feeding and had smokers in the family, however, the frequency of these factors in the groups was also approximately the same.
Analyzing the clinical course of biofeedback in children of the first three years of life, we identified several clinical options.
1 variant of the clinical course of biofeedback . For this variant of the course of BF, the development of signs of bronchial obstruction was characteristic against the background of an acute respiratory infection with an acute onset of the disease, fever up to febrile numbers, mucous rhinitis, the presence of intoxication phenomena: the child becomes lethargic, capricious, sleeps poorly, refuses to breast, appetite decreases . The cough is unproductive, “dry”, as a rule, short with a rapid transition to wet. On days 2-4, already against the background of pronounced catarrhal phenomena and an increase in body temperature, bronchial obstructive syndrome developed: expiratory dyspnea without pronounced tachypnea (40-60 breaths per minute), sometimes distance rales in the form of noisy, wheezing breathing, percussion-box tint of sound , at auscultation – an extended exhalation, dry, buzzing rales, wet rales of different sizes on both sides. Bronchial obstructive syndrome lasted for 3-7-9 or more days depending on the nature of the infection and gradually disappeared, parallel to the subsidence of inflammatory changes in the bronchi. The course of biofeedback according to this clinical variant was established in the majority of children examined by us: in 70.5% of patients of the 1st group and in 59.4% of the second group.
Option 2 of the clinical course of biofeedback. A slightly different clinical picture was observed in 8.8% of children of the 1st group (all children under the age of one year) and 6.3% of the children of the 2nd group (of which half of the children were older than a year). The main clinical symptoms in these patients were moderate catarrhal manifestations and signs of severe respiratory failure: perioral cyanosis, acrocyanosis, tachypnea up to 60-90 breaths per minute, with the prevalence of the expiratory component, retraction of compliant places of the chest. Percussion over the lungs is determined by the boxed shade of percussion sound; During auscultation, many small moist and creaking rales were heard in all fields of the lungs during inhalation and exhalation, the exhalation was elongated and difficult, with shallow breathing, the exhalation could have a normal duration with a sharply reduced tidal volume. This clinical picture of the disease developed gradually, over several days, less often – acutely, against the background of a respiratory infection and was accompanied by a sharp deterioration in the condition. In this case, a cough of a paroxysmal nature arose, appetite decreased, anxiety appeared. The temperature was often subfebrile. Bronchial obstruction persisted quite a long time, at least two weeks to three weeks.
3 variant of the clinical course of biofeedback. The following symptoms were characteristic of the third variant of the clinical course of biofeedback: the absence of intoxication phenomena, distant wheezing, expiratory dyspnea in some children with the participation of auxiliary muscles. Dry wheezing and a few wet wheezing were heard in the lungs, the number of which was increased after stopping bronchospasm. In some children, pronounced anxiety, bloating of the chest, tachypnea with a slight predominance of the expiratory component, impaired breathing in the basal parts of the lungs, pronounced perioral cyanosis were noted. The attack occurred, as a rule, “for no reason” or against the background of minimal catarrhal manifestations and was eliminated within 3-5 days. The frequency of occurrence of this variant of the clinical course of biofeedback was higher in children with relapse of bronchial obstruction and amounted to 16.2% and 29.7% in the groups as a whole.
4 variant of the clinical course of biofeedback. In a small group of children, moderate signs of bronchial obstruction without symptoms of respiratory failure appeared against a background of non-infectious factors: with a generalized allergic reaction of post-vaccination genesis (2 children of the 1st group and 1 from the 2nd observation group), with a bee sting (1 patient of the 2nd group, previously there were signs of biofeedback against the background of acute respiratory viral infections), 2 children smell of paint (1 of them had the first episode of biofeedback, the second child suffered acute bronchitis a month earlier with moderate manifestations of biofeedback). The clinical manifestations of bronchial obstruction in these children were limited by the appearance of multiple scattered dry wheezing. The condition of the child in this case depended on the severity of the underlying disease (generalized allergic reaction, Quincke’s edema, etc.). Signs of biofeedback were stopped within 4-7 days.
The frequency of clinical variants of the course of biofeedback in the observed group of children is presented in table 22.
Thus, based on the clinical features of biofeedback in young children, we have identified 4 different flow patterns that occur in children with the first episode of bronchial obstruction, and with a relapse of biofeedback. For the majority of children in both groups, the first variant of the course was characteristic, but in group 1 it was more common than in group 2 (in 70.5% and 59.4% of children, respectively). The third variant of the course occurred in 16.2% of children of group 1 and 29.7% of the second, therefore, in children with the first episode of biofeedback, the third variant was 4.36 times less likely than the first, and in children with recurrent course of biofeedback – 2.1 times less often. The second and fourth variants of the course of biofeedback were detected in the observed children with a low frequency (4-8%), which did not differ significantly in the comparative analysis of the groups. In the characteristics of the biofeedback, there were no significant differences between boys and girls.
The difference in the clinical manifestations of biofeedback can be due to many factors, such as the patient’s age, features of his genotype and premorbid background, environmental and other factors, but above all, the disease that caused the development of bronchial obstruction. A timely diagnosis of the underlying disease is a prerequisite for adequate treatment of biofeedback. For this purpose, the observed children underwent a comprehensive clinical, laboratory, radiological and allergological examination.
We conducted a comparative analysis of the results of the survey both between the observed groups of children, and depending on the variant of the clinical course of biofeedback (table 23).
Analyzing peripheral blood indices, we found that leukocytosis above 9×10 9 / l was detected in half of the patients of both groups, and in the vast majority of cases, the lymphocytic nature of leukocytosis took place. At the same time, leukocytosis in the first clinical variant of the course of BF was more common in children with recurrent bronchial obstruction than in the first episode of BF (in 68.4% and 52%, respectively). In addition, almost all children of the 1st group (5 out of 6 examined) with the second variant of the clinical course expressed leukocytosis. Leukopenia was rare in the examined children. We did not observe absolute lymphopenia (<1.0 × 10 9 / L) in the examined children.
Peripheral blood eosinophilia was detected in 1/3 of cases, with the same frequency in the 1st and 2nd comparison groups (in 32.3% and 34.4%). However, significantly more often eosinophilia, both relative and absolute, was characteristic of the third and fourth clinical variants of the course of biofeedback.
We did not establish a reliable difference in the number of monocytes in peripheral blood between children of groups 1 and 2, however, in general, the frequency of absolute increase in the number of monocytes was higher than the frequency of relative monocytosis.
The erythrocyte sedimentation rate also did not significantly differ in children of groups 1 and 2; accelerated ESR was characteristic of 1/3 of all children. At the same time, in the third clinical variant of the course of biofeedback in children of group 1, an increase in ESR was recorded 3 times more often than in children of group 2. In addition, in no child with BFB according to option 4 acceleration of ESR was recorded.
Thus, we did not reveal any distinguishing signs of peripheral blood in children with the first episode of biofeedback and with recurrent bronchial obstruction, however, some hemogram parameters significantly differed in different clinical variants of the course of biofeedback.
The examination of children with biofeedback, conducted in a hospital, included the study of some immunological parameters in some patients. We conducted an analysis of the group-average indicators of total IgE (examined 63 children), IL-4 and interferon status (examined 19 children) in patients with primary bronchial obstruction and with relapse of biofeedback. The comparison group were 10 healthy children (table 24).
As a result of the study, it was found that the average level of total serum IgE in children with BF is significantly higher than in healthy ones (M + m = 45.8 ± 15.4 IU / ml). We revealed a tendency for this indicator to increase in children with recurring BFB compared with the average indicators for children with primary bronchial obstruction, however, no statistically significant difference was found (M + m = 154.7 ± 25.9 IU / ml and 129.8 ± 18, 4 IU / ml).
Characterization of some immunological parameters in children of the first three years of life with biofeedback (M + m).
|I group||II group||Healthy|
|Total IgE IU / ml||129.8 ± 18.4 *||154.7 ± 25.9 *||45.8 ± 15.4|
|IL-4 PG / ml||82.7 ± 14.1 *||96.4 + 17.1 *||35.09 + 2.7|
|IFN-g Ind. U / ml||12.3 + 1.2 *||9.2 + 1.4 *||19.5 + 1.98|
|IFN-a Ind. U / ml||98.1 + 15.3 *||75.23 + 4.48 *||132.7 + 2.48|
|Ifn Syv. U / ml||12.2 + 2.57 *||9.17 + 3.4 *||3.12 + 0.9|
* – p < 0.01
The serum IL-4 content on average in groups exceeded the level of healthy children by 2.5-3 times, the average indicators of children of group 2 were higher than the first, but the difference was not statistically significant (M + m = 82.7 ± 14, 1 pg / ml; 96.4 + 17.1 pg / ml; 35.09 + 2.7 pg / ml). An individual analysis showed that 48.2% of children with primary BF and 76.3% of patients with BF recurrences had high levels of IgE and / or IL-4, while in other children these indicators corresponded to the level of healthy ones. We found a direct correlative relationship between IgE and IL-4 (r = 0.6; p <0.05).
A study of the production of interferons (IFN) in children with biofeedback revealed an increased content of serum IFN in both groups, and the level of this cytokine was significantly higher in the first version of the clinical course, both in children with primary bronchial obstruction and in relapse of biofeedback.
The production of IFN-a by peripheral blood cells during in vitro induction was reduced on average in groups (M + m = 98.1 + 15.3 U / ml; 75.23 + 4.48 U / ml compared to healthy 132.7 + 2 , 48 U / ml), at the same time, when an individual analysis turned out that children with biofeedback are heterogeneous in this indicator. Reduced ability to produce IFN-a was more characteristic for children who often have acute respiratory viral infections and for patients with frequent (more than 3) relapses of biofeedback.
The production of IFN-γ by peripheral blood cells in children with BF was reduced compared to healthy ones (M + m = 12.3 + 1.2 U / ml; 9.2 + 1.4 U / ml and 19.5 + 1, 98U / ml), and in children with a relapsing course, a statistically significant decrease in this indicator was established compared with children with the first episode of biofeedback.
Thus, we found that in children with biofeedback, on average, in groups, there was an increase in the content of total IgE, IL-4 and IFN in blood serum, while the production of IFN-a and IFN-g? In peripheral blood cells was reduced. It is known that this variant of the immune response is characteristic of individuals with atopy. However, in our study, hyperproduction of IgE and IL-4 in combination with interferonogenesis dysfunction occurred in some children with all variants of the clinical course of biofeedback, including patients without an atopic history. At the same time, in patients with a burdened allergic history, atopic dermatitis and in the third variant of the clinical course, this type of immune response was more common. So, children with biofeedback turned out to be heterogeneous according to the studied immunological parameters.
Some authors have shown that antibodies to certain “intracellular pathogens”, such as Chlamydia pneumoniae and Mycoplasma pneumoniae, are found in children with biofeedback with high frequency, which suggests a possible role of these microorganisms in the genesis of bronchial obstruction (36.63.95). In this regard, it seemed to us relevant to study the frequency of these infections in children with biofeedback according to the results of a serological study (table 25). The presence of antibodies by ELISA was determined in 48 children with biofeedback, of which 19 were with newly diagnosed bronchial obstruction, 29 with a relapsing course of biofeedback. In 1/3 of the children, the study was conducted in dynamics.
The frequency of chlamydial and mycoplasma infections in children of the first three years of life with biofeedback (n = 48).
|Chlamydia trachomatis||Chlamydia pneumoniae||Mycoplasma pneumoniae|
+ – reliable antibody titer (taking into account the examination in dynamics)
+ – low titer of antibodies
Analysis of the results of the study showed a high degree of infection of children with biofeedback “atypical” pathogens. Association with chlamydial infection was established in 15.8% of children of the 1st group and in 31% of children of the second group, and C.pn infection was more often detected. (in 10.5% and 24.1%, respectively). Association with M.pn. in children with BF, it was found in 26.3% of children with newly diagnosed BF and in 34.5% of children with relapse of bronchial obstruction. At the same time, specific antibodies of both C.pn. and M.pn. were detected in 10.4% of children, i.e. there was a mixed infection.
The titers of specific antibodies below the diagnostic ones were determined in a small number of children and could be related both to the debut of the infection (in the absence of the results of the study in dynamics) and to be traces of a previous or persistent infection (“serological scars”).
Thus, our study showed a high degree of infection with “atypical” pathogens of children with biofeedback, and the frequency of association with infection was higher in children with a recurrent course of biofeedback.
A comprehensive examination of children with biofeedback included an X-ray examination of the lungs, which was carried out by the vast majority of children with newly diagnosed bronchial obstruction and 2/3 of children with relapse of biofeedback (table 26). The most characteristic of bronchial obstruction in children of the first three years of life were signs of pulmonary emphysema: increased transparency of lung tissue, horizontal location of ribs, wide intercostal spaces, high standing of the dome of the diaphragm, however, the severity of these signs was different. Also, an increase in bronchovascular pattern, expansion and / or change in the structure of pulmonary roots was often noted . Atelectases are usually subsegmental, and focal shadows are less common.
A comparative analysis of the radiological signs of children with biofeedback showed that signs of emphysema were characteristic of half of the children in both groups (51.4% and 55%), and the maximum frequency was found in 1 and 3 clinical variants of biofeedback. However, in children with the first episode of biofeedback, pronounced emphysema pulmonary distention was observed 1.5 times less often than moderate manifestations of emphysema, while in the case of a recurrent course of biofeedback, an inverse ratio was observed (42.5% and 12.5%, respectively).
Strengthening of the bronchovascular pattern, compaction of the roots of the lungs, focal shadows in the lung tissue were detected with the same frequency in children of groups 1 and 2, at the same time, these signs were found significantly more often in patients with 1 and 2 clinical variants of biofeedback.
Atelectases were significantly more likely to occur with recurrent bronchial obstruction (in 15% of children compared to 7.3%) and, as a rule, disappeared quite quickly.
Thus, the most common distinguishing radiological signs of the first episode and relapse of the biofeedback were the presence of pulmonary emphysema, and with a relapsing course of bronchial obstruction, more pronounced radiological signs of emphysema were significantly more likely. In addition, the propensity to develop atelectasis was also higher in children of group 2.
Comprehensive treatment was performed for all patients with biofeedback, taking into account the etiology, pathogenesis and severity of the course of the disease, accompanied by bronchial obstruction. Therapeutic measures were consistent with generally accepted standards and were not differentiated by comparison groups. During therapy, there was a positive trend during biofeedback, the signs of which were stopped in most patients on days 3-8. The average duration of bronchial obstruction in children with the first episode of biofeedback and with a relapsing course of biofeedback did not differ significantly (M + m = 5.2 + 2.1 days and 6.1 + 2.9 days).
An expert evaluation of the results of a comprehensive examination conducted in a hospital setting for children of the first three years of life with clinical manifestations of biofeedback made it possible to decipher the diagnosis of biofeedback in accordance with accepted nosological classifications. The children of the study group have the following diagnoses:
- acute obstructive bronchitis – in 42.4% of patients (children of the 1st group with 1.3 and 4 variants of the clinical course of biofeedback);
- bronchiolitis – in 6% of patients (children of groups 1 and 2 with 2 clinical variants of the course of biofeedback);
- acute pneumonia with bronchial obstructive syndrome – in 8.3% of patients (children of groups 1 and 2 with 1 and 2 variants of the clinical course);
- recurrent obstructive bronchitis – in 24.2% of patients (children of 2 groups of 1, 3 and 4 variants of the clinical course);
- bronchial asthma – in 15.9% of patients (children of 2 groups with 1 and 3 clinical option, 1 child – from 1 group, 3 variant of the clinical course);
- toxic-allergic reaction – in 2.3% of patients (children of groups 1 and 2, option 4 of the clinical course);
- a foreign body of the right main bronchus – in 1 child (0.8%) with recurrent bronchial obstruction, proceeding according to 3 clinical variants.
So, as a result of a survey of children in the first three years of life with biofeedback who were hospitalized in the city clinical hospital, it was found that bronchial obstruction syndrome is a consequence of various diseases. Most often, BFB was found in acute obstructive bronchitis (in 42.4% of cases), recurrent obstructive bronchitis (in 24.2%), bronchial asthma (in 15.9%). The clinical course of biofeedback depended on the cause of the disease, premorbid background, and some other factors. Therefore, all children with biofeedback need a comprehensive examination to identify the disease that caused the development of biofeedback. The same course of bronchial obstruction may result from various diseases that require differentiated therapeutic approaches.
At the same time, in most patients, BFW develops against the background of bronchitis or is a manifestation of AD. The complexity of the differential diagnosis lies in the fact that the debut of AD in young children often coincides with the development of intercurrent respiratory disease.
Our study indicates that both the first occurring and the recurring biofeedback may have the same clinical variants of the course. Currently, the most relevant is the early, optimally preclinical, diagnosis of AD in young children. At this stage of the study, we did not reveal any reliable clinical and laboratory signs that allow us to confidently predict the course of biofeedback, in particular, to diagnose asthma during the first episode of bronchial obstruction. The solution to these problems is not possible without a thorough study of the factors determining the outcome of biofeedback in young children.
3.3. BOS outcomes in young children according to long-term follow-up.
We studied the long-term outcomes of bronchial obstructive syndrome (BOS) in children with manifestation of bronchial obstruction at an early age.
To this end, 100 children were examined, of which 50 patients were hospitalized for biofeedback in 1990 (10-year follow-up observation of biofeedback) and 50 patients in 1995 (5-year follow-up). The selection of children was carried out by random sampling.
All children were examined according to a single program, including anamnestic, genealogical, allergological, immunological, clinical laboratory and functional research methods.
Given the outcomes of biofeedback, we formed 4 groups:
Group 1 – children whose BOS was implemented in BA;
Group 2 – children suffering from other forms of atopy, but without signs of biofeedback for 2 years or more;
Group 3 – children who have formed other chronic lung diseases;
Group 4 – children who have no clinical manifestations of atopy and chronic lung disease.
The results of the survey are presented in tables 27, 28.
Outcomes of biofeedback in young children when examined in distant follow-up (n = 100).
|1 group(BA)||2group(atopy without biofeedback)||3 group(RB)||4 group(healthy)|
|Catamnesis 5 years||nineteen||38||eleven||22||fifteen||thirty||5||10|
|Catamnesis 10 years||24||48||eleven||22||10||twenty||5||10|
In the group of children with a 5-year follow-up observation of biofeedback, under the age of 3 years, 13 (26%) children were diagnosed with AD. To date, the diagnosis of asthma has been established in 19 (38%) children, of which equally children with moderate and mild form of asthma, a severe course of the disease occurs in only one child (2%). The survey showed that 15 (30%) children in this group currently suffer from recurrent bronchitis (RB), in 11 (22%) patients there were no repeated episodes of bronchial obstruction, but other forms of atopy were detected (pollinosis – in 2, allergic rhinosinusitis – in 1 and atopic dermatitis in 8 children). Only in 10% of patients who had BFB debut at an early age, after 5 years, recurrent and chronic respiratory diseases or atopic diseases were not detected.
The severity of AD in children hospitalized for early biofeedback.
|Total childrenwith BA||Easy flow||Moderate||Severe course|
|Catamnesis 5 years||nineteen||9||48||9||48||1||2|
|Catamnesis 10 years||24||9||37.6||8||33.3||7||29.1|
In the group with a 10-year follow-up observation under the age of 3 years, 22% of all children with biofeedback were diagnosed with AD. To date, the diagnosis of asthma has been established in 24 (48%) children, of which 7 (29.1%) patients have a severe form of the disease, 8 (33.3%) – moderate and 9 (37.6%) – mild form of asthma. In 20% of children in this group, recurrent bronchitis (RB) was diagnosed. In 22% of cases, biofeedback is not observed, but there are other forms of atopic diseases (hay fever in 1 child, atopic dermatitis in 10 children). No recurrent and chronic diseases of the respiratory system or atopic diseases were detected, as in the previous group, in 10% of the examined children.
When planning the design of the study, we assumed that some of the children who had BOS debut at an early age, after 5-10 years, can form chronic lung diseases of non- atopic origin. However, our survey of 100 children did not reveal a single case of chronic bronchitis, chronic pneumonia, or other chronic respiratory diseases. At the same time, part of the examined children (30% with 5-year follow-up and 20% with 10-year follow-up) had frequent (from 3 to 6 times a year) bronchitis, which, as a rule, developed against the background of acute respiratory infection . Clinical and instrumental examination of these children in a specialized hospital, which included not only radiological, but also, in some children, bronchological research methods, also did not reveal chronic lung pathology.
According to the current classification, these children are diagnosed with recurrent bronchitis (RB). RB in children is seen as a clinical manifestation of the respiratory tract tendency of a particular patient to develop inflammatory reactions to various pathogens or other aggressive factors. Such a predisposition may be based on various aspects of both congenital and acquired genesis.
We found that in children who had BFB debut at an early age, after 5-10 years, RB occurs in the form of obstructive bronchitis in the vast majority (in 22 of 25 examined) of most cases. In all the children of this group examined by us, during follow-up observation, the biofeedback was not accompanied by shortness of breath, asthma attacks. Typically, against the background of an acute respiratory infection, characteristic physical data were determined: common dry wheezing, mainly on expiration, was heard, which was combined with different-sized moist, non-localized wheezing. The biofeedback during the follow-up examination was reversible. Indicators of FVD, including a test for latent bronchospasm, were within the age norm.
Of course, the debut of biofeedback in young children can be due to many reasons, including being the first manifestations of chronic respiratory diseases. However, in our study there were no such patients, which is probably due to a rather rare frequency of these diseases, on the other hand, these children are usually observed in specialized hospitals.
Thus, according to our study, in young children with biofeedback there is a hypodiagnosis of asthma (Figure 2). In the first five years, asthma is diagnosed in more than a third of all cases of biofeedback, and after 10 years, almost half of these children are diagnosed with asthma. In addition, a fifth of children with BFB have a history of other forms of atopic diseases that occur without symptoms of bronchial obstruction. However, these children are certainly threatened by AD.
20-30% of children, when observed in distant follow-up, have recurrent bronchitis, in the vast majority of cases (88%) accompanied by episodes of bronchial obstruction. In these children, we did not find convincing data for AD or other chronic respiratory diseases.
Only 10% of children with BFB debut at an early age do not subsequently have a respiratory pathology or other forms of atopy.
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