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15«ШуШ(шшим-Ши©ма1> #3(и62)), 2023 / MEDICAL SCIENCES
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MEDICAL SCIENCES
УДК : 616.248-053.2-07-085.357:547.918'92(048.8)
Buryniuk- Hloviak Khrystyna Petrivna
Bukovinian State Medical University PhD, Assistant of Department of Pediatrics and Children Infectious Diseases
of, Teatralna Sq., 2, Chernivtsi, Ukraine,58002 DOI: 10.24412/2520-6990-2023-3162-17-19 THE ROLE OF INHALATED GLUCOCORTICOSTEROIDS IN THE BASIC THERAPY OF BRONCHIAL ASTHMA IN CHILDREN (LITERATURE REVIEW)
Abstract..
Bronchial asthma remains one of the most common and difficult to treat diseases of the bronchopulmonary system. The chronic inflammation that occurs in asthma is a complex network filled with various cellular mechanisms that play an important role. In addition, sometimes this ailment, with insufficient treatment and poor control, can cause disability in children.
Currently, there are many pharmacological drugs aimed both at alleviating symptoms and at preventing exacerbations of bronchial asthma. That is why the treatment of exacerbations, the search for the correct schemes of basic therapy, including taking into account the occurrence of possible undesirable effects from the use of certain drugs, remains an important issue that requires detailed study.
Keywords: Bronchial asthma, treatment, inhaled glucocorticosteroids, children.
Bronchial asthma (BA) is a heterogeneous disease usually associated with chronic respiratory tract infections, defined by respiratory symptoms such as wheezing, shortness of breath, chest tightness, and cough which change over time and have different degrees of severity associated with variable airway obstruction [1]. Asthma is caused by various mechanisms, such as mechanisms of immune regulation of allergic, inflammatory and neuroendocrine reactions [2].
This disease is one of the most common chronic and difficult to treat inflammatory diseases, characterized by many different clinical phenotypes in children [3]. The main characteristics of asthma are reversible bronchial obstruction, bronchial hypersensitivity and airway inflammation. Chronic inflammation associated with asthma involves a complex network in which various cells and cellular factors play an important role [4]. Chronic inflammation in the respiratory tract leads to recurrences of the vising syndrome, shortness of breath, cough, a feeling of tightness in the chest, and the long course of the disease with poor control is always associated with disability.
Asthma is one of the most common chronic diseases in the world, and the incidence has increased over the past 20 years, especially among the pediatric population. According to various estimates, almost 300 million people worldwide currently suffer from episodes of wheezing, and more than 100 million people will have symptoms of this disease by 2025 [5]. Despite the heterogeneity of the nature of bronchial asthma in children, the main phenomenon of the disease is considered to be chronic inflammation of the respiratory tract, and the basic therapy schemes used to control the disease are aimed at eliminating this pathophysiological component. Achieving and maintaining control over the disease is the main goal of the Global Initiative for the Prevention and Treatment of Asthma and local protocols of many countries.
Inhaled glucocorticosteroids are recommended as first-line drugs, starting with a mild degree of persistent BA [6, 7]. In order to stop exacerbations and to prevent their occurrence, a wide range of pharmacological drugs is currently used, which are divided into first aid and basic medicines that reduce the frequency and severity of exacerbations. To achieve a deobstructive effect during attacks of bronchial asthma, fast-acting short-acting beta2-agonists, M-cholinergic agents and systemic glucocorticosteroids are used. Inhaled gluco-corticosteroids, long-acting beta2-agonists, leukotriene modifiers, cromons, methylxanthines, leukotriene modifiers, and anti-IgE antibodies are indicated for disease control [8].
Glucocorticosteroids are the most potent and effective anti-inflammatory agents for effective asthma management. Inhaled corticosteroids (ICS) are the first-line drugs of choice for the treatment of persistent bronchial asthma, due to their local application, they have a significantly better therapeutic index than oral corticosteroids and have almost completely replaced the latter drugs in the prevention and treatment of asthma and vising syndrome in children and adults. Thus, a number of clinical studies have proven the achievement of a significant reduction in airway hyper-sensitivity, effective prevention of asthma exacerbations, improvement of lung function, and reduction in the severity of symptoms [9]. The anti-inflammatory effectiveness of ICSs and their role in reducing airway hypersensitivity is the main factor in the widespread use of these agents as initial therapy in the treatment of severe and moderately severe persistent asthma [10]. Thus, national [11] and international [12] guidelines define the guiding principles of asthma treatment, which, with the aim of optimal asthma management, currently recommend ICS as first-line drugs in low doses for mild persistent and medium doses (in combinations) to achieve control over the symptoms of moderately severe asthma [13]. Inhaled corticosteroids are
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critical to the successful long-term management of asthma and are generally considered safe, and the systemic side effects reported in children are somewhat rare. They are mostly associated with high doses of drugs prescribed at the start of treatment to improve disease control. However, ICSs have a number of disadvantages: the inability of patients to use inhaled drugs correctly, difficulties in mastering the inhalation technique, the development of systemic effects when using ICSs in high doses, the refusal of patients or their parents to use any hormonal agents due to steroid phobia. Leukotriene receptor antagonists, which are also anti-inflammatory drugs and are recommended in modern manuals (GINA, PRACTALL), are free of the listed disadvantages as an alternative method of treatment, which allows: 1) reduce the amount of hormone therapy or even replace it with mild persistent bronchial asthma; 2) affect the leukotriene pathway of inflammation; 3) to ensure high adherence of patients to treatment and achieve stable and long-term remission [14, 15].
Currently, in clinical practice, beclomethasone di-propionate, budesonide, fluticasone, and mometasone furoate are used in equipotent doses [16].
The effectiveness of ICS for stopping asthma attacks has been proven in comparative studies with placebo, where it has been shown that the use of ICS in high doses (more than 1 mg of budesonide or fluticasone) in patients with severe exacerbations exceeds the placebo effect [17]. However, the studies conducted were quite heterogeneous in terms of asthma severity, doses, frequency of ICS administration, and outcome assessment.
Thus, the search for optimal schemes of the basic treatment of corticosteroids continues, which, on the one hand, allowed to maintain control over BA in the regime of minimally sufficient doses, and on the other hand, would minimize the side effects of systemic glu-cocorticosteroid therapy, which currently has a limited field of application. In particular, a short course of oral corticosteroids is currently recommended for the treatment of moderate to severe asthma exacerbations.
Thus, one of the latest studies conducted in Texas [18] emphasizes the probable side effects of oral corticosteroids, which are prescribed in 28% of cases to children with asthma, with insufficient use of ICS. It is interesting that children under the age of 5 were even more often prescribed oral corticosteroids compared to older children (49.0% versus 38.8%), and oral cortico-steroids were least prescribed by certified pediatricians (up to 42%), most often by internal medicine doctors, family doctors, or general practitioners (46% - 47%).
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Белоус Денис Андреевич,
Студент
5 курс 1 медицинского факультета «Лечебное дело» «Медицинская академия имени С.И. Георгиевского» ФГАОУ ВО «КФУ им. В.И. Вернадского» Россия, г.Симферополь Толстихина Диана Михайловна Студент
5 курс 1 медицинского факультета «Лечебное дело» Институт «Медицинская академия имени С.И. Георгиевского» ФГАОУ ВО «КФУ им. В.И. Вернадского» Россия, г.Симферополь Зайцев Юрий Александрович Кандидат медицинских наук, доцент кафедры Кафедра Фтизиатрии «Медицинская академия имени С.И. Георгиевского» ФГАОУ ВО «КФУ им. В.И. Вернадского» Россия, г.Симферополь
ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ТУБЕРКУЛЕЗА ВНУТРИГРУДНЫХ ЛИМФАТИЧЕСКИХ
УЗЛОВ
Belous Denis Andreevich,
Student
5 th year of the 1st Faculty of Medicine "Medicine" "Medical Academy named after S.I. Georgievsky" FGAOU VO "KFU im. IN AND. Vernadsky" Russia, Simferopol Tolstikhina Diana Mikhailovna, Student
5 th year of the 1st Faculty of Medicine "Medicine" Institute "MedicalAcademy named after S.I. Georgievsky" FGAOU VO "KFU im. IN AND. Vernadsky" Russia, Simferopol
Zaitsev Yury Alexandrovich Candidate of Medical Sciences, Associate Professor of the Department
Department of Phthisiology "Medical Academy named after S.I. Georgievsky" FGAOU VO "KFU im. IN AND. Vernadsky" Russia, Simferopol
SURGICAL TREATMENT OF TUBERCULOSIS OF INTRATHORACIC LYMPH NODES Аннотация.
Представлен обзор хирургического лечения детей больных туберкулезом внутригрудных лимфатических узлов, который включает в себя поражение паратрахеальных, трахеобронхиальных, бифуркационных и бронхопульмональных групп, а степень выраженности изменений может варьировать от легкой до крайне тяжелой. Осложненное течение специфического процесса при данной локализации зачастую требует хирургического вмешательства. Abstract.
A review of the surgical treatment of children with tuberculosis of the intrathoracic lymph nodes is presented, which includes damage to the paratracheal, tracheobronchial, bifurcation and bronchopulmonary groups, and the severity of changes can vary from mild to extremely severe. The complicated course of a specific process with a given localization often requires surgical intervention.
Цель: определить методы хирургического лечения при туберкулезе внутригрудных лимфатических узлов.
