The clinical significance of the parameters of the capillary bed, heart rate variability, and computer bronchophonography in the differential diagnosis of diseases accompanied by prolonged cough in children

Differential diagnosis of the causes of prolonged cough is difficult because of its multifactorial nature. Diagnostics in case of a cough that persists for more than 4 weeks is based on clinical data, but sometimes it is not enough to establish a diagnosis. This issue led to the development of algorithms based on additional diagnostic criteria evaluated with modern non-invasive functional methods for diagnosing diseases accompanied by a prolonged cough in children.

Aim. To determine the differential diagnostic value of the functional parameters of the capillary bed, respiratory tract, and autonomic nervous system in children with diseases accompanied by a prolonged cough (more than 4 weeks).

Methods. 238 children aged from 2 to 17 years with prolonged cough were examined in inpatient or outpatient settings and divided into 4 groups: Group 1 (n = 68) - patients with acute or exacerbation of the chronic infectious upper respiratory tract diseases; Group 2 (n = 53) - patients with lower respiratory tract infection; Group 3 (n = 39) - patients with allergic rhinitis; Group 4 (n = 78) - patients with bronchial asthma. All patients underwent standard clinical examination. The diagnostic test also included functional assessment of microcirculation, autonomic nervous system, and respiratory system via computer capillaroscopy of the nail bed, evaluation of heart rate variability, and computer bronchophonography.

Results. Patients with allergic diseases of the respiratory tract, especially with asthma, show a change in all parts of the capillary bed and a significant increase in the zone of perivascular edema in combination with parasympathicotonia, in contrast to children with infectious diseases of the respiratory system, who showed a change in microcirculation parameters mainly in the venous capillaries in combination with sympathicotonia. In addition, children with prolonged coughing, regardless of its origin, showed functional changes in the high-frequency acoustic parameters of the respiratory system in the form of an increase in the coefficient of the high-frequency acoustic component of breathing (ф3), which indicates bronchial hyperreactivity.

Conclusion. The functional parameters of the microvasculature, autonomic nervous system, and respiratory tract can be used as additional differential diagnostic criteria and included in algorithms for diagnosing respiratory diseases of various origins in childhood, contributing to the early detection of the pathology and timely targeted therapy.

1. Chuchalin A.G., Abrosimov V.N. [Cough]. M.: GEOTAR-Media; 2017 (in Russian).

2. Rhee C.K., Jung J.Y., Lee S.W. et al. The Korean cough guideline: recommendation and summary statement. Tuberc. Respir. Dis. (Seoul). 2016; 79 (1): 14-21. DOI: 10.4046/trd.2016.79.1.14.

3. Usta Guc B., Asilsoy S., Durmaz C. The assessment and management of chronic cough in children according to the British Thoracic Society guidelines: Descriptive, prospective, clinical trial. Clin. Respir. J. 2014; 8 (3): 330-337. DOI: 10.1111/crj.12076.

4. Mizernitskiy Yu.L., Mel’nikova I.M., Udal’tsova E.V. [Differential diagnosis of protracted and chronic cough in children]. Consilium Medicum. 2017; 19 (11.1): 7-16. Available at: https://cyberleninka.ru/article/n/differentsialnaya-diagnostika-zatyazhnogo-i-hronicheskogo-kashlya-u-detey/viewer (in Russian).

5. Song W.J., Chang Y.S., Morice A.H. Changing the paradigm for cough: does ‘cough hypersensitivity’ aid our understanding? Asia Pac. Allergy. 2014; 4 (1): 3-13. DOI: 10.5415/apallergy.2014.4.1.3.

6. Mel’nikova I.M., Udal’tsova E.V., Mizernitskiy Yu.L. [Algorithms for differential diagnosis of diseases accompanied by protracted and chronic cough in children]. Pediatriya. Zhurnal imeni G.N.Speransk-ogo. 2018; 97 (2): 8-18. DOI: 10.24110/0031-403X-2018-97-2-8-18 (in Russian).

7. Cutolo M., Sulli A., Smith V. How to perform and interpret capil-laroscopy. Best Pract. Res. Clin. Rheumatol. 2013; 27 (2): 237-248. DOI: 10.1016/j.berh.2013.03.001.

8. Gorska A., Kowal-Bielecka O., Urban M. et al. Impairment of microcirculation in juvenile idiopathic arthritis - studies by nailfold videocapillaroscopy and correlation with serum levels of sICAM and VEGF. Folia Histochem. Cytobiol. 2008; 46 (4): 443-447. DOI: 10.2478/v10042-008-0062-z.

9. Pavlenko V.A., Mel’nikova I.M., Mizernitskiy Yu.L. [Clinical and diagnostic aspects of prediction ofbronchial asthma in early children]. Meditsinskiy sovet. 2017; (9): 70-75. DOI: 10.21518/2079-701X-2017-9-70-75 (in Russian).

10. Melnikova I.M., Mizernitsky Yu.L., Berezhansky P.V. [The clinical significance of microcirculatory disorders in the evaluation of the forecast ofbronchial asthma in young children]. Voprosy prakticheskoy pediatrii. 2014; 9 (4): 8-13. Available at: https://www.phdynasty.ru/katalog/zhurnaly/voprosy-prakticheskoy-pediatrii/2014/tom-9-no-mer-4/8465 (in Russian).

11. Huseynov A.A., Aisanov Z.R., Chuchalin A.G. [Potential to use bronchophonography during bronchodilating tests]. Pul’monolo-giya. 2010; (6): 73-77. DOI: 10.18093/0869-0189-2010-6-73-77 (in Russian).

12. Tsyplenkova S.E., Mizernitsky Yu.L. [Current possibilities of functional diagnosis of external respiration in children]. Rossiyskiy vestnik perinatologiii pediatrii. 2015; 60 (5): 14-20. Available at: https://www.ped-perinatology.ru/jour/article/view/149/190 (in Russian).

13. [National program “Bronchial asthma in children. Treatment and prevention strategy”]. Moscow: Original-maket; 2017. Available at: http://astgmu.ru/wp-content/uploads/2018/10/Natsionalnaya-programma-BA-u-detej.-Strategiya-lecheniya-i-profilaktika.pdf (in Russian).

14. Bogomil’skiy M.R., Chistyakova V.R. [Diseases of the ear, throat, nose in childhood: A national guide. A short edition]. M.: GEOTAR-Media; 2015 (in Russian).

15. [Modern classification of clinical forms of bronchopulmonary diseases in children]. Pediatriya. 2010; 89 (4): 6-15. Available at: http://pedi-atriajournal.ru/files/upload/mags/306/2010_4_2687.pdf (in Russian).

16. [RADAR. Allergic rhinitis in children: recommendations and an algorithm for childhood allergic rhinitis]. M.: Original-maket; 2015. Available at: https://mosgorzdrav.ru/uploads/imperavi/ru-RU/029_2015.pdf (in Russian).

17. Fedorovich A.A. [Capillary hemodynamics in the eponychia of the upper limb]. Regionarnoekrovoobrashhenieimikrocirkulyaciya. 2006; 5 (1): 20-29 (in Russian).

18. Baevsky R.M., Ivanov G.G., Chireikin L.V. et al. [Analysis of heart rate variability when using various electrocardiographic systems (guidelines)]. Vestnik aritmologii. 2001; (24): 65-87. Available at: http://www.vestar.ru/atts/1267/24baevsky.pdf (in Russian).

19. Geppe N.A., Malyshev V.S., eds. [Computer bronchophonography of the respiratory cycle]. Moscow: Media Sfera; 2016. Available at: http://astgmu.ru/wp-content/uploads/2018/10/Kompyuternaya-bron-hofonografiya-respiratornogo-tsikla.pdf (in Russian).

20. Cash H., Trosman S., Abelson Т. et al. Chronic cough in children. JAMA Otolaryngol. Head Neck Surg. 2015; 141 (5): 417-423. DOI: 10.1001/jamaoto.2015.0257.

21. Mizernitsky Yu.L., Kosenkova T.V., Marinich V.V. et al. [Influence of perinatal damage to the central nervous system on the formation and course of bronchial asthma in children]. Allergologiya. 2004; (3): 27-31 (in Russian).

22. Fuentes-Leonarte V., Estarlich M., Ballester F. et al. Pre- and postnatal exposure to tobacco smoke and respiratory outcomes during the first year. Indoor Air. 2015; 25 (1): 4-12. DOI: 10.1111/ina.12128.

23. Su X., Taniuchi N., Jin E. et al. Spatial and phenotypic characterization of vascular remodeling in a mouse model of asthma. Pathobi-ology. 2008; 75 (1): 42-56. DOI: 10.1159/000113794.

24. Yan W.W., Liu Y., Fu B.M. Effects of curvature and cell-cell interaction on cell adhesion in microvessels. Biomech. Model. Mechanobiol. 2010; 9 (5): 629-640. DOI: 10.1007/s10237-010-0202-1.

25. Lerhendorf Yu.A., Lukina O.F., Petrenets T.N. et al. [Bronchophonography in children 2-7 years old with bronchial obstructive syndrome]. Prakticheskaya meditsina. 2017; 2 (103): 134-137. Available at: https://cyberleninka.ru/article/n/bronhofonografiya-u-detey-2-7-let-pri-bronhoobstruktivnom-sindrome/viewer (in Russian).