ЖУРНАЛ КАРДИОРЕСПИРАТОРНЫХ ИССЛЕДОВАНИЙ | JOURNAL OF CARDIORESPIRATORY RESEARCH
№2 | 2020
47
ОРИГИНАЛЬНЫЕ СТАТЬИ
UDC 616.248 - 053.3 / 053.6
Ganiev Abdurashid Ganievich,
Associate Professor, Department of Hospital Pediatrics,
Andijan State Medical Institute. Andijan, Uzbekistan
Nazarov Komil Dadaevich,
associate professor of the department of hospital pediatrics,
Urgench branch of the Tashkent Medical Academy. Urgench, Uzbekistan
CHARACTERISTIC OF SEVERE FORMS OF BRONCHIAL ASTHMA
IN CHILDREN OF THE ANDIJAN REGION
For citation:
Ganiev A.G., Nazarov K.D. Characteristics of severe forms of bronchial asthma in children of the Andijan region. Journal of
cardiorespiratory research. 2020, vol. 2, issue 1, pp. 47-49
http://dx.doi.org/10.26739/2181-0974-2020-2-6
ANNOTATION
To study the characteristics of severe bronchial asthma, 140 children were examined. A survey, clinical, allergological and functional
examinations were carried out. Studies have shown that in boys, asthma becomes severe earlier. Polyvalent sensitization to epidermal allergens
and the presence of bronchial asthma in the mother of the child, severe asphyxia at birth are risk factors for severe asthma in children.
Keywords:
severe bronchial asthma, children.
Ганиев Абдурашид Ганиевич,
доцент кафедры госпитальной педиатрии Андижанского государственного
медицинского института. г. Андижан, Узбекистан
Назаров Комил Дадаевич,
доцент кафедры госпитальной педиатрии Ургенчского филиала
Ташкентской медицинской академии. г.Ургенч, Узбекистан
ХАРАКТЕРИСТИКА ТЯЖЕЛЫХ ФОРМ БРОНХИАЛЬНОЙ АСТМЫ
У ДЕТЕЙ АНДИЖАНСКОЙ ОБЛАСТИ
АННОТАЦИЯ
Для изучения характеристик тяжелой бронхиальной астмы было обследовано 140 детей. Был проведен опрос, клинические,
аллергологические и функциональные обследования. Исследования показали, что у мальчиков астма в более ранние сроки становится
тяжелой. Поливалентная сенсибилизация к эпидермальным аллергенам и наличие бронхиальной астмы у матери ребенка, тяжелая
асфиксия при рождении являются факторами риска тяжелого течения астмы у детей.
Ключевые слова:
тяжелая бронхиальная астма, дети.
Ganiev Abdurashid Ganievich,
Andijon davlat tibbiyot instituti gospital
pediatriya kafedrasi dotsenti. Andijon, O'zbekiston
Nazarov Komil Dadaevich,
Toshkent tibbiyot akademiyasining Urganch filiali,
gospital pediatriya kafedrasi dotsenti. Urganch, O'zbekiston
АNDIJON VILOYАTI BOʼYICHА BOLАLАRDА
BRONXIАL АSTMА KАSАLLIGI OGʼIR FORMАSINING XАRАKTERISTIKАSI
АNNOTАTSIYA
Ogʼir kechuvchi bronxial astma xususiyatlarini oʼrganish uchun 140 bola tekshirildi. Klinik, allergologik va funktsional tekshiruvlar
oʼtkazildi. Tadqiqotlar shuni koʼrsatdiki, erta yoshidagi bolalarda astma borligi kasallikni kechishi ogʼirlashtiradi, epidermal allergenlarga
sezuvchanlik oshadi. Bolaning onasida astma borligi, bola uchun xavfli omil boʼlib, tugʼilishda ogʼir asfiksiyaga olib kelishi mumkin.
ЖУРНАЛ КАРДИОРЕСПИРАТОРНЫХ ИССЛЕДОВАНИЙ | JOURNAL OF CARDIORESPIRATORY RESEARCH
№2 | 2020
48
Kalit soʼzlar:
ogʼir bronxial astma, bolalar.
The problem of asthma continues to be relevant throughout
the world, despite numerous studies and a sufficient amount of
treatment and preventive measures. In childhood, asthma is one of
the most common chronic diseases [1,2,3,16].
According to the results of a number of researchers, the
prevalence of asthma in the Republic of Uzbekistan varies from 1.1%
to 8.2%, which is due not only to the influence of external regional
factors, but also to the use of various diagnostic methods [4,7,6,11].
However, as shown by almost all studies conducted under the ISAAC
(International Study of Asthma and Allergy in Children) program in
all regions of the planet, the true incidence of asthma was
significantly higher than official statistics [7,9,10,13]. According to
the results of a number of researchers, the prevalence of asthma in the
Republic of Uzbekistan varies from 3.1% to 8.2%, which is due not
only to the influence of external regional factors, but also to the use
of various diagnostic methods [4,5,6]. However, as shown by almost
all studies conducted under the ISAAC (International Study of
Asthma and Allergy in Children) program in all regions of the planet,
the true incidence of asthma was significantly higher than official
statistics [1,7,17]. The discrepancies between official statistics on
employment and the results of epidemiological studies are also
associated with the under diagnosis of bronchial asthma in different
age groups.
Analysis of epidemiological studies in the city of Andijan
showed that in the structure of the prevalence of allergic diseases,
bronchial asthma is in 2nd place (5.6 + 0.03%), yielding to allergic
rhinitis (12.7 + 0.19%) [3,8,15].
Despite the use of increasingly effective means for anti-
inflammatory therapy of respiratory allergies, up to a third of patients
continue to complain about the persistence of symptoms of the
disease even when it is carried out in an adequate age dosage.
Unfortunately, treatment with inhaled corticosteroids,
being the most effective currently used, has a number of side effects,
including depression of the axis of the hypothalamus-pituitary-
adrenal cortex, the formation of local candidiasis and others
[2,9,10,16].
The
discrepancies
between
official
statistics
on
employment and the results of epidemiological studies are also
associated with the under diagnosis of bronchial asthma in different
age groups [17]. These data determine the high urgency of the
problem, explain the need and significance of research on the problem
of severe asthma in children [2,11].
Objective:
to study the characteristics of severe asthma in
children of the Andijan region
Materials and methods.
A survey of
60 children from 2 to 17 years old, living on the territory of the
Andijan region. The average age of the patients was 8.5 ± 1.9 g. The
average duration of asthma was 3.5 g. All children were divided into
two groups: the first group consisted of boys with severe asthma (n =
49, 70%), the second is girls with severe BA (n = 21, 30%). As a
comparison group, in the analysis of some indicators, children with
moderate asthma —25 people — appeared (the average age of the
group was 8.2 ± 1.7 g, the average duration of asthma was 5.2 g). The
average age of boys with severe BA (group 1) was 7.7 ± 2.1 g., The
average age of girls with severe asthma (group 2) was 8.9 ± 3.8 g. The
average duration of the disease course in boys it was 5.2 years old,
for girls is 5.8 years old. The diagnosis of asthma in all patients was
confirmed by the data of the disease history, clinical, allergic and
functional examination. Allergological examination, in addition to a
detailed history, included skin tests and determination of whey level
of total IgE by ELISA. The statistical processing of the material was
carried out in Excel (group average and its standard deviation,
criterion X2 and student's criterion).
Results and discussion.
The average age of patients at the
time of setting diagnosis in boys was 3.6 ± 0.7 g., in girls is 4.8 ± 1.6
g. (p> 0.05). In 85.7% of children, until obstruction of asthma was
established, obstructive bronchitis was observed. The average age of
onset of asthma, based on the fixation of the first symptoms of
obstruction, was 1.8 ± 0.3 g in boys, and in girls 2.8 ± 1.0 g. The time
between the appearance of the first symptoms and the establishment
of the diagnosis was insignificantly different and amounted to 2.0 ±
0.4 g., in boys and 2.3 ± 0.7 g., in girls. Most boys (67.3%) and girls
(76.2%) were immediately diagnosed with severe asthma, others had
asthma as mild and moderate, and then became severe. On average,
from the time of the diagnosis of BA to the establishment of a severe
course of the disease, 3.8 g passed. in examined children. Most
areas of the Andijan region are industrial. It is suggested that the
adverse role of the external environment in the formation of the severe
course of asthma plays a leading role [1,13]. In addition, among
children living in ecologically unfavorable areas since birth, the
number of patients with severe asthma increases compared with
children who arrived in an ecologically unfavorable area after 3 years
of age [5]. Confirmation of these facts obtained in our study. The
largest number of children with severe asthma (32.9%) are in the age
group of 3-6 years (Fig. 1). Moreover, this distribution, mainly due
to the boys - 38.8% of boys from the severe BA group are in the age
group of 3-6 years. Whereas the majority (28.6%) of girls are in the
age group of 9-12 years old. The predominance of the age range of 3–
6 years in the group of severe asthma in boys is due to the fact that
the boys' lungs are late in structure development in early childhood
compared with the lungs in girls. The male sex in this age period is
associated with large lung volumes, but with proportionally narrow
bronchs. When analyzing the age of onset of the first asthma
symptoms, it was found that in 91.8% of boys the symptoms of the
disease are found under the age of 3 years, against 66.7% of girls of
the same age (p <0.05). Which is probably also associated with the
anatomical features of the bronchs in boys. In hypoxia (a score of 7
or less on the Apgar scale) 54.3% of children with severe asthma were
born, which is comparable with the comparison group is 59.1%.
Mechanical ventilation of the lungs (ALV) at birth lasting
more than 5 days was found in 5.7% of children with severe asthma
and ranged from 10 days to 2 months. In the comparison group,
mechanical ventilation was not performed at birth for more than 5
days (p <0.05). A history of pneumonia was more common in girls
— 27.4% versus 17.1% in boys (p> 0.05). Allergic rhinitis (AR) and
food intolerance were insignificantly more common in boys (90.8%
versus 74.8% for AR and 25.5% versus 15.3% for food allergies).
Atopic dermatitis (AD) in severe asthma in boys was found in 47.9%
of cases, whereas in girls only in 18% of cases (p <0.05).
Table 1
Sensitization spectrum in children with asthma of severe
and moderate course
Allergen
Children with severe
BA,%
Children with moderate
BA,%
Level
of significance
Pollen
Allergens
60,0
48,1
p>0,05
Epidermal
Allergens
68,6
46,2
P<0,05
ЖУРНАЛ КАРДИОРЕСПИРАТОРНЫХ ИССЛЕДОВАНИЙ | JOURNAL OF CARDIORESPIRATORY RESEARCH
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Household allergens
71,4
76,9
p>0,05
Cat hair
57,1
42,3
p>0,05
The coat of dogs
37,1
19,2
p>0,05
D. farine
31,4
55,8
P<0,05
D. Pteronissinus
37,1
63,5
P<0,05
Polyvalent
Sensitization
77,8
48,1
P<0,05
The combination of AR and BP was significantly more
common among boys (36.7%) with severe asthma than among girls
— 14.9, (p <0.05). A diverse allergic pathology among the relatives
of patients with severe BA was found in 59%.
Allergic diseases in
mothers of children with severe asthma were observed in 22.9%,
against 12.5% in the comparison group, p> 0.05. BA in mothers of
children with severe asthma occurred in 8.6% of cases, whereas in the
comparison group this indicator was 1.1%, (p <0.05). The results
obtained in the analysis of the spectrum of sensitization in severe BA
in children are presented in tab. one. The table shows that in
severe asthma sensitization to epidermal allergens (cat's fur, dog's and
rabbit's fur) is significantly more common. Polyvalent sensitization
occurred with a greater frequency and is also more common in
children from the group of severe asthma. This fact is consistent with
the studies of L.M. Ogorodovoy, who established that multivalent
sensitization is a risk factor for severe BA [4]. Sensitization to house
dust mites, in contrast, was significantly more common in the
comparison group. Thus, it is characteristic of severe asthma: a large
percentage of sensitization among children to domestic, epidermal
and pollen allergens. Sensitization to epidermal antigens, polyvalent
sensitization, asthma in the mother of the child, mechanical
ventilation for more than 5 days at birth are factors of severe asthma
in children. In boys, asthma at an earlier date becomes severe.
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