Prematurely born children with severe respiratory distress-syndrome are at risk of bronchopulmonary dysplasia (BPD) development. Treatment of BPD is extremely difficult and sometimes non-effective; therefore, prevention of this disease is an actual problem. Efficacy of budesonide for BPD prevention in comparison to children not treated with this drug has been proven in recent studies but its action differed according to the gestation age and body weight. The present study was aimed to compare efficacy of inhaled budesonide in newborns with various gestation ages. To evaluate the efficacy of the therapy, all the children involved in the study were divided into 2 groups: 18 children with the body weight >1500 g and gestation age of > 31 weeks (the 1st group) and 21 children with the body weight < 1500 g and the gestation age of > 30 weeks (the 2nd group). Budesonide was given via a nebulizer 400 μg b.i.d. for 15 days. We assessed FiO 2 in the gas mixture, maximal pressure within mechanical ventilation, the mean pressure in the airways, index of the lung injury, dynamical extension of the chest — lung system. The systemic haemodynamics, carbohydrate metabolism, length of mechanical ventilation and of oxygen therapy, and number of complications were also evaluated. The study demonstrated that inhaled budesonide as a preventive measure against BPD was the most effective in premature newborns with gestation age of < 30 weeks. This drug has not affected the systemic haemodynamics nor carbohydrate metabolism. As a result, number of pulmonary complications and time of treatment in the ICU were reduced.

Efficiency of different regimens of long-term maintenance combined therapy with budesonide / formoterol (fixed doses in the 1st group and flexible doses in the 2nd group) was evaluated in 60 moderate or severe bronchial asthma children during 12 weeks. The 2nd group patients demonstrated more prominent improvement in all asthma symptoms. Frequency of asthma attacks decreased significantly in both the groups within the followup period (from 3.5 ± 0.18 to 1.27 ± 0.14 (p < 0.05) in the 1st group and from 2.5 ± 0.2 to 0.25 ± 0.09 (p < 0.01) in the 2nd group). Three months after starting the treatment, need in short-acting β₂ -agonists greatly decreased in the 2nd group (1.37 ± 0.19 vs 0.5 ± 0.09; p < 0.044). Lung function parameters (PEF, FEV₁) came to normal in both the groups. The total number of doses of budesonide / formoterol spent for 12 weeks differed between the groups: 168 ± 4.2 doses per 1 children, or 262.8 ± 8.3 μg of budesonide per 1 day per 1 children in the 1st group and 114 ± 3.9 doses per 1 children, or 185.6 ± 5.6 μg of budesonide per 1 day per 1 children in the 2nd group (p < 0.05). Therefore, the maintenance therapy with flexible-dose budesonide / formoterol was more effective that fixed-dose regimen in terms of reduction in exacerbation rate, need in short-acting β2 -agonists and the total amount of inhaled corticosteroids used.

Expression of mRNA apoptosis effectors, antagonists (bcl-2), prodeath protein (bax) and matrix activity of IL-5 in peripheral blood eosinophils were evaluated in children with asthma before and after therapy. Expression of bcl-2 was not revealed in peripheral blood eosinophils of healthy children, however increased expression of IL-5 gene mRNA and increased bcl-2 activity were found in children with asthma. After the course of basis therapy in asthma children, activity of antiapoptotic effectors of bcl-2 family decreased and mRNA expression of proapoptotic factors increased. These modifications were associated with improvement in asthma symptoms and functional parameters.

The aim of the study was to analyse sensitisation to fungal allergens in asthmatic children living in different climatic and geographic regions of Azerbaijan. This work was a part of the "ISAAC" international programme (International Study of Asthma and Allergy in Childhood). We examined 233 school children aged 13 to 14 (119 boys and 114 girls) from 4 regions of the country. Fungal sensitisation was evaluated using prick-tests with fungal allergens. At the semi-desert climate, children living at cities were sensitised more often to Cladosporium herbarum (36.5 %) and Alternaria tenuis (33.8 %) and rarer to Phoma betae (13.5 %) and Penicillium notatum (18.9 %); rural children were sensitised more often to Epicoccum purpurascen (35.8 %) and rarer to Aspergillus fumigatus (15.1 %) and Candida albicans (17 %). The prevalence of sensitisation to Phoma betae in rural children was twice higher than in urban children. Fungal sensitisation in children living in the subtropical climate zone was more frequent compared to other regions; those children were sensitised more often to Epicoccum purpurascen (43.4 %), Alternaria tenuis (41.5 %), and Phoma betae (39.6 %) and rarer to Candida albicans (28.3 %). Children from mountainous regions were sensitised to the fungi relatively rare. Urban children from the semi-desert and subtropical regions had the most prominent sensitisation to Аlternaria tenuis, rural children from the semi-desert region were more sensitised to Epicoccum purpurascen and Phoma betae allergens. While worsening the asthma course, rate and severity of fungal sensitisation increase independently on the habitation region.

Sometimes timely detection of asthma is difficult so as mild asthma is often underestimated. This point is of particular importance in adolescents due to medical expertise for future military service. Three hundred and sixty one young men aged 15 to 18 were referred to the Republic clinical immunology centre of Kazan from military registration offices to confirm the diagnosis of asthma. Asthma was diagnosed according to the algorithm included analysis of medical records, clinical examination, special allergologic tests, and challenge tests with inhaled allergen, histamine, hypertonic solution or physical exercise if necessary. The results of the combined examination have confirmed the diagnosis in 344 patients (95.3 %); 77.3 % of the asthmatic patients had mild asthma.

We determined serum levels of soluble adhesion antigens CD50, CD54, soluble HLA class I molecules, HLA-DR, and relative number of antigenpositive blood mononuclears in asthmatic children. Increased concentrations of soluble CD54 and CD54 antigens and reduction in relative number of CD50+ and CD54+ mononuclear cells were revealed. In children with asthma, the level of serum soluble HLA-DR antigens and relative number of peripheral blood mononuclears were elevated. The worsening of asthma course was accompanied by the increase in CD50, CD54, HLA-DR serum levels. The inverse correlation between the serum levels of soluble CD54 and HLA-DR antigens and FEF₅₀ was revealed.

The aim of the study was to evaluate the usefulness of the -703С/Т polymorphism in IL-5 gene, Q551R polymorphism in IL-4RA gene, and GSTM1 and GSTТ1 gene polymorphism as biological markers of bronchial asthma (BA) in children with atopic dermatitis (AD). We genotyped children with AD (n = 72; mean age, 9.4 ± 0.28 years), children with AD in combination with BA (n = 68; mean age, 7.5 ± 0.7 years) and control subjects (n = 147; mean age, 9.9 ± 0.42 years). We found the associations between BA and the -703С allele of the interleukin-5 (IL-5) gene (OR = 1.73, p = 0.013) and -703СС / 551RR genotype combination (OR = 3.15; p = 0.015) in children with AD; between the 551RR genotype of the IL-4RA gene and atopy (p < 0.05). -703CT / GSТТ1 0/0 genotype combination was found rarer in children with BA than in controls (OR = 0.15; p = 0.049). Thus, -703С/Т allele of the IL-5 gene and -703СС / 551RR genotype combination were associated with BA and could be used as valuable markers of the disease in children with AD, whereas the Q551R polymorphism in the IL-4RA gene was associated with predisposition to atopic disease and could be used for administration of preventive therapy of allergic disorder in early childhood. The -703CT / GSТТ1 0/0 genotype combination can prevent BA occurrence in children with AD.

This article has analyzed a relationship between quality of theoretical knowledge of pediatricians at outpatient clinics and asthma diagnosis. Questionnaires revealed insufficient theoretical knowledge on current therapeutic and diagnostic approaches for asthma which depended on length of time after last postgraduate education course. The late diagnosis of asthma in childhood outpatient clinics was made in 95.7 %. A mean delay in diagnosis was 4 years and the more the knowledge was worse. The late diagnosis of asthma was proven to be related to more severe course of the disease and wider sensitization spectrum. The more informative and available in primary care predictors of asthma onset were defined. A diagnostic table has been created which contains the most informative criteria of asthma and allows a quantitative prognosis of the disease in children with recurrent respiratory syndrome.

This comparative clinical and immunological trial investigated clinical efficacy of Seleksen combined with ascorbic acid as a part of complex rehabilitation of children with recurrent respiratory diseases in sanatorium pre-school child care settings. We assessed serum levels of IgA, IgG, IgM, IgE, and interleukin-8, leucocyte luminol-induced chemiluminescence, secretory IgA level in saliva, erythrocyte glutathione peroxidase activity, serum superoxide dismutase activity, serum concentrations of malone dialdehyde and diene conjugates. The follow-up period was 12 months. The complex rehabilitation with Seleksen and ascorbic acid led to clear improvement in clinical, immunological, and metabolic parameters. It allows significant reduction in rate of upper and particularly lower respiratory infections in children attending pre-school child care facilities. This therapy was the most effective in children with allergic respiratory diseases and recurrent tracheobronchitis.

The purpose of this work was to study NO-synthase gene polymorphic variants in term of asthma occurrence. Clinical and functional characteristics of asthma with regards to different NO-synthase gene polymorphic variants were analyzed in 250 asthmatic children aged 7 to 14 years under the 12-wk standard basic therapy for asthma. We used the typical spectrum of tests for children with asthma and molecular genetic methods. Polymorphism at the promotor region of the NO-synthase gene was found to be associated with phenotype of pathogenic features of asthma and was an important part of inherited predisposition to asthma.

Asthma patients (n = 79, 7 to 17 years of age) were divided into 3 groups according to asthma severity: mild (n = 23), moderate (n = 24), and severe asthma (n = 32). Asthma was diagnosed according to GINA (2002). Echocardiography, ultrasound evaluation of endothelium vasomotor function and measurement of nitrite anion concentration in exhaled breathe condensate (EBC) were performed in the all patients. Right ventricle dilatation and increase in the total pulmonary vascular resistance were revealed only in patients with severe asthma compared to the control group. Increase in pulmonary artery systolic pressure was significantly higher in the severe asthma patients compared both to the control group and mild asthma patients. Increased right ventricle pressure was accompanied by endothelium dysfunction in 48.1 % (38 patients). High EBC nitrite anion concentration (12.11 ± 1.72 μmol/L) was revealed in asthmatic children compared to control group (3,34 ± 1,58 μmol/L). The results suggest that childhood asthma is associated with morphological and functional abnormalities of pulmonary hemodynamics and endothelium function depending on severity of the disease.

We have assessed diagnostic value of impulse oscillometry for recognition of early respiratory dysfunction in asthmatic adolescents. There were 242 adolescents aged 10 to 17 under the supervision. Of them, 223 had mild stable asthma and 19 were as controls without respiratory dysfunction. According to clinical features, asthma control level and treatment all the asthmatic adolescents were subdivided into 5 groups. Lung ventilation was examined with MasterScreenBody (Erich Jaeger, Gmbh) MasterIOS including impulse oscillometry and spirometry. The impulse oscillometry can be very helpful in assessment of severity and location of respiratory obstruction in asthmatic adolescent with normal spirometric parameters.

The aim of this study was to analyze clinical importance of exhaled nitric oxide (NOex) measurement for early detection, differential diagnosis and control of treatment of chronic respiratory pathology in children. The study involved 412 children of 5 to 18 years old with different chronic bronchopulmonary diseases. Apart from a typical clinical, laboratory, and instrumental diagnostic methods, NOex was measured in all the children using the chemiluminescent gas analyzer 280i (Sievers, USA). The control group included 30 healthy children aged 5 to 18 with mean NOex 14.8 ± 1.4 ррb (9.2 ÷ 21.4 ррb). The majority of asthmatic children had high NOex (> 20 ppb in 284 (90 %) asthmatic children), р < 0.01, both in stable asthma and exacerbation. The NOex level was directly correlated to the severity and period of the disease (frequency of asthma attacks, time from the last asthma attack, lung function parameters), and blood levels of allergic markers (eosinophils, total IgE, circulating immune complexes, IL-4). Therefore, NOex monitoring was useful in evaluating the efficacy of different treatment modes. In other chronic respiratory diseases, NOex level was also elevated but to lesser degree. In children with primary ciliary dyskinesia, NOex was significantly below the normal level that could be used as a preliminary screening tool. In conclusion, NOex measurement is a reliable and objective method to control allergic inflammation in the airways. It is of great clinical importance and is helpful in differential diagnosis of chronic respiratory diseases and confirmation of the diagnosis. It allows individual choice of therapy, control of the patient's adherence to treatment and prognosis of future exacerbations.