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0ANTILEUKOTRIENE DRUGS IN THE TREATMENT OF ALLERGIC BRONCHITIS: MODERN APPROACH AND
CLINICAL EFFECTIVENESS
1Ulugov A.I., 2Yunusov D.M.
1Tashkent Pediatric Medical Institute 2Andijan State Medical Institute https://doi. org/10.5281/zenodo. 13879481
Abstract. The article analyzes the results of treatment of 63 children aged 2 to 10 years hospitalized with a diagnosis of allergic bronchitis in the pulmonology department of Tashkent Pediatric Medical Institute in the period from 2021 to 2022. The study is aimed at assessing the effectiveness of antileukotriene drugs in the treatment of this disease.
Keywords: allergic bronchitis, cough, antileukotriene drug, children.
Allergic bronchitis in children is an inflammatory disease of the respiratory tract caused by an allergic reaction to various allergens, such as dust, pollen, animal dander or food [1,2,3]. Risk factors for the development of allergic bronchitis in children may include genetic predisposition (if the parents had similar problems), early childhood, atopic constitution, living in a polluted environment or contact with allergens [4,6,7].
Features of the clinical course of allergic bronchitis in children may include:
1. Frequent coughing attacks: Children with allergic bronchitis often suffer from coughing, especially at night or after contact with an allergen.
2. Shortness of breath: Shortness of breath may be present during physical activity or during an asthma attack.
3. Dry and irritated throat: This can be caused by persistent coughing and inflammation of the airways.
4. Intensification of symptoms upon contact with an allergen: Symptoms may intensify upon contact with an allergen.
5. Decreased physical activity: Children may resort to exercise due to shortness of breath and other symptoms.
6. Decreased appetite and sleep disturbances: Symptoms of allergic bronchitis can affect the overall well-being of the child, leading to decreased appetite and sleep disturbances.
7. Worsening with changing seasons: Symptoms may worsen at certain times of the year, such as spring, when the air is full of pollen.
The pathogenesis of allergic bronchitis in children involves a complex set of mechanisms associated with the immune system and the reaction of the respiratory tract to allergens. Here are the main points:
Immunological response: In allergic bronchitis, a child's immune system reacts to inhalant allergens as if they were dangerous to the body, when in fact they are harmless. This leads to the activation of various cells of the immune system, including T lymphocytes and eosinophils.
T lymphocytes play a key role in regulating the immune response. They can produce cytokines such as interleukins, which can stimulate other cells of the immune system, such as eosinophils, into action. Eosinophils, in turn, are a type of white blood cell specialized in fighting
parasitic infections, but they also play a role in allergic reactions. Their activation can lead to the release of various substances, such as histamine and leukotrienes, which contribute to inflammation and narrowing of the bronchial passages. This process of activation of immune cells and subsequent inflammation in the bronchial tract is a key point in the pathogenesis of allergic bronchitis in children.
Inflammatory changes in the airways: The reaction to allergens causes inflammation in the airways. This is manifested by an increase in the permeability of the bronchial mucosa, activation of eosinophils, release of cytokines (for example, interleukins and interferons) and other inflammatory mediators.
Bronchospasm: Under the influence of allergens, a narrowing of the bronchial lumens occurs, which leads to a deterioration in air permeability and the appearance of characteristic symptoms: cough, shortness of breath, wheezing.
3. Remodeling of the bronchial walls: Repeated episodes of inflammation and bronchospasm can lead to remodeling of the bronchial walls, which is accompanied by changes in their structure and function.
Bronchial hyperreactivity: As a result of inflammation and remodeling, the bronchial walls become more sensitive to various irritants, which leads to bronchial hyperreactivity.
These mechanisms together form the pathogenesis of allergic bronchitis in children, which usually leads to characteristic clinical manifestations and complications, such as deterioration in quality of life, frequent respiratory infections and air obstruction syndrome.
Complex treatment of allergic bronchitis in children usually includes the following measures:
1. Avoiding allergens: This is important to prevent attacks of bronchitis. Parents should try to minimize their child's exposure to known allergens.
2. Use of anti-inflammatory drugs: Your doctor may prescribe inhaled corticosteroids or other anti-inflammatory drugs to reduce inflammation in the airways.
3. Use of bronchodilators: These can help widen the airways and make breathing easier during bouts of bronchitis.
4. Immunotherapy: In some cases, your doctor may recommend immunotherapy to reduce sensitivity to allergens.
5. Parent and Child Education: It is important to educate parents and children about symptom management, recognizing warning signs, and following treatment recommendations.
6. Maintaining a healthy lifestyle: This includes regular exercise, healthy eating and adequate rest, which helps strengthen the immune system and improve the overall health of the child.
Treatment of allergic bronchitis in children should be under the supervision of a doctor who can select the optimal treatment strategy, taking into account the individual characteristics of each child.
Antileukotriene drugs indeed occupy an important place in the basic therapy of allergic bronchitis in young children. They are a class of medications aimed at blocking the action of leukotrienes, substances that play a key role in the development of inflammatory processes in the respiratory tract during allergic reactions [5].
The introduction of antileukotriene drugs into widespread medical practice is not a panacea for all problems in the treatment of allergic bronchitis and its forms, since each case requires an
individual approach. However, they have proven their effectiveness and safety in the treatment of certain clinical and pathogenetic variants of the disease [7,8,9,10,11,12].
Benefits of antileukotriene drugs include:
1. Fewer side effects: Unlike some other drugs, antileukotriene drugs are generally well tolerated and can be used even in young children.
2. Prevention of attacks: They help prevent attacks of allergic bronchitis, especially when used regularly.
3. Addition to other types of medications: They can be used in combination with other medications such as corticosteroids and bronchodilators to achieve maximum effect.
4. Shown in clinical studies: Many clinical studies confirm the effectiveness of antileukotriene drugs in the treatment of allergic bronchitis in children [9,10].
The good prospects for the use of antileukotriene drugs in pediatrics are due to their ability to control inflammatory processes in the respiratory tract and prevent attacks of the disease, which significantly improves the quality of life of children with allergic bronchitis. However, the decision to prescribe a specific drug should always be made by the doctor, taking into account the individual characteristics of the patient and the nature of the disease.
The purpose of the work was to study the clinical and laboratory effectiveness of the antileukotriene drug Brisezi (montelukast) for allergic bronchitis in children.
Material and methods. Under our supervision from October 2021 to July 2022, there were 63 patients suffering from allergic bronchitis. Among them there were 27 girls and 36 boys aged from 2 to 10 years. Of these, boys accounted for 57.14%, girls - 42.8%. Children aged 2 to 3 years were 16/25.4%, from 4 to 6 years -25/39.6%, from 7 to 10 years - 22/34.92%. Most often, the diagnosis of AB was made at the age of 4-10 years - in 74.5% of children.
Results and discussion. When distributing patients by gender, it was noted that the complicated course of allergic bronchitis and upper respiratory tract diseases is more typical for boys (n = 57.14%), which is also comparable with the literature data.
Analysis of anamnestic data made it possible to establish unfavorable heredity for allergies in 46.3% (29) of children: among them, on the mother's side - in 14/22.2%, on the father's side - in 9/14.2%, allergopathology occurred in both parents in 6 /9.5% of observations and in 23/36.5% of cases patients had a history of seasonal allergic rhinitis.
The main diagnosis in all children was allergic bronchitis; in addition, 23 of them additionally had allergic rhinitis, 3 had allergic tracheitis, 1 had atopic dermatitis, and 2 had allergic eczema.
The children were divided into 2 groups. Treatment of patients with AB should be comprehensive and individual, taking into account the characteristics of the course of the disease and the nature of sensitization in each child.
In the 1st (main) group, against the background of complex treatment, all children received the antihistamine drug Brisezi (aged 2 to 4 years - 4.0 mg, from 5 to 10 years - 5 mg) for 2 weeks, in the 2nd group (comparison), the antihistamine was cetirizine, which was prescribed to children from 2 to 4 years old - 2.5 mg, from 5 to 10 years - 5 mg per day.
The diagnosis of allergic bronchitis was based on patient complaints, medical history, pulmonary examination, examination of the functional state of the nasal mucosa, data from a paraclinical examination, as well as consultation with a pediatrician, allergist, and pulmanologist. A history can also help identify risk factors and triggers for the disease.
The groups of patients were comparable in gender, age, severity, duration of the disease, severity of clinical and functional symptoms of allergic bronchitis. All children underwent blood testing for eosinophils and blood serum for immunoglobulin E (IgE) before and after treatment.
Before the start of treatment, all patients were bothered by a persistent and obsessive, daytime and predominantly nighttime cough against a background of normal body temperature, and 14.3% of patients were mistakenly diagnosed and prescribed treatment. Children who also suffered from allergic rhinitis had nasal congestion, sneezing attacks, rhinorrhea and itching of the nasal mucosa.
In 77.8% (49) of children with AB, a dry paroxysmal cough was more often detected (p <0.05) (Table No. 1). The duration of cough in children in the general AB group was 25.6±6.0 days, the nature of the cough had distinctive features. 41/65.07% had rhinorrhea (watery, mucous discharge from the nose, mucus running down the back of the throat), nasal congestion in 74.6%, itching of the nasal mucosa in 57.1%, sneezing in 46.03% and skin allergic reactions in 12/ 19.04%, swelling in 17.4% and urticaria and conjunctivitis in 22.2%. According to parents, the consequences of AB in many children were sleep disturbance (39.7%) and decreased daily activity (46.03%).
Table 1
Structure of complaints in observed patients
Complaints 1st group and 2nd group
Cough 63/100%
- dry 49/77,8%
- wet. unproductive. 11/17,5%
- wet. productive. 3/4,8%
Difficulty in nasal breathing 74,6%
Rhinorrhea 57,1%
Decreased daily activity 46,03%
Sneezing 46,03%
Urticaria and conjunctivitis 17,4%
Sleep disturbance 39,7%
According to allergological examination, 32/50.8% of children with AB had an increased level of total IgE in the blood serum (91.67 IU/ml), in six patients its level exceeded 1000 IU/ml. Eosinophilia in the peripheral blood during allergic bronchitis in children of group 1 reached high levels (8-23%) and was stable, and in children from group 2 - 20% (p > 0.05). After completing a 2-week course of treatment with antihistamines, the symptoms of allergic bronchitis decreased in both groups. No deterioration was observed in any of the groups. However, in children from the main group (Brizezi), the effect was obtained in all patients, and complete remission and significant improvement were observed more often than in the comparison group (cetirizine).
The clinical picture data were confirmed by the results of laboratory examination. Thus, the values of eosinophils in all children from group 1 decreased to normal values, and in 2 children from the comparison group they continued to remain above 5%. In 7 children from group 2 (cetirizine), the IgE level remained approximately the same as before treatment.
At the same time, in all children from group 1 (Brisesi), the IgE level decreased by almost 1.5-2 times. And only in 4 (6.34%) children the IgE level decreased within 30.31 IU/ml. After the first course, 52/82.5% of patients noted significant relief of their condition, a decrease in the frequency of registration of main complaints and the severity of objective clinical symptoms of the disease.
Conclusions.
Allergic bronchitis in children is a chronic disease that requires constant management and attention from parents and medical professionals. Timely diagnosis and treatment can significantly improve the child's quality of life and prevent the development of complications.
When using the drug Brisezi for the treatment of allergic bronchitis in children, it is important to follow the doctor's recommendations regarding dosage and frequency of administration. It is also important to take into account the individual characteristics of each child and the reaction to the drug.
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