Peculiarities of Clinical Effectiveness of the Anti-Inflammatory Treatment in Childhood Asthma Depending On Airway Remodeling Risk
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 10
Abstract
Goal of research is to assess the features and clinical effectiveness of basic protocol treatment of asthma in school-age children depending on airways remodeling risk. Material and methods. To achieve the goal 116 children suffering from persistent bronchial asthma (BA) were examined in parallel groups selected by means of simple randomized sampling using the “experiment-control” method. Three clinical groups of observation were formed on the basis of detected concentrations of VEGF and ММР-9 in the sputum supernatant of the examined patients. The first clinical group that further is marked as a “high risk group” considering bronchial remodeling formation, the second group marked as a “moderate risk group” of bronchial remodeling and the third clinical group was marked as a “low risk group” concerning respiratory tract remodeling. The bronchi lability was assessed using graduated jogging with inhalation of 200 mkg of salbutamol test and further calculation of Bronchospasm Index (BSI, %), Bronchodilatation Index (BDI, %), and of Bronchus Lability Index (BLI, %). To obtain sputum the procedure of its inducing was performed by means of inhalation of serial hypertonic sodium chloride solutions, biological markers of bronchial remodeling in the sputum supernatant were determined in the following way: VEGF, MMP-9. The level of BA control and severity was determined by means of the following questionnaires: by АСТ-test, GINA-test, clinical-instrumental evaluation (CIE) scale. Results and discussion. The effectiveness of treatment control of children from the Compared groups was assessed during consistent 3 years using three different assessment scales (АСТ-test (Asthma Control Test), clinical-instrumental evaluation (CIE), and GINA-2009 test). The effectiveness of basice treatment assessed according to different constellation tables with different level of sensibility and specificity prouves that the three-year treatment significantly succeeded only in children with low risk of bronchi remodeling. This is reflected in increasing number of controlled asthma cases. At the same time number of cases with partial and absent control changed circumstantial or didn’t change at all. According to our data, at the beginning of stady cases of Low Bronchi Lability in period of complete control of the disease were observed only in group of children with high risk of bronchi remodeling. Meantime, low bronchi lability cases were found in patients suffering from partially controlled asthma from all compared groups in the beginning or in the end of research. These results reliably illustrate increased bronchus rigidity in process of inflammation. Futhermore, in the above groups of patiens we found higher frequency of low bronchi lability with high concentration of Nitrogen Monoxide metabolite in exhaled air condensate in cases of non-complete control over the disease. Assessmen of effectiveness of Basic treatment shows hihger level of complete asthma control in patients with low risk of bronchi remodeling versus groups of high and moderate risk. Hence, effectiveness of the protocol controlling treatment is significantly lower in BA patients with risk of bronchus remodeling. Sign of bronchus inflammation, marked hyper-reactivity, and decreased lability of bronchi diminishing the treatment impact in this cases. Conclusions: High or medium risk level of bronchi structural changes considerably reduces the effectiveness of protocol controlling treatment of patients with asthma. The results of treatment in those groups of children are even less significant in presence of bronchial inflammation, marked hyperreactivity, and decreased lability of bronchi. Long-term controlling anti-inflammatory treatment with inhaled glucocorticoids according to the de-escalation scheme is required for children suffering from asthma with high risk of bronchi remodeling.
Authors and Affiliations
Tetiana Bilous
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