Frequency, risk factors, features of bronchial asthma in children with bronchopulmonary dysplasia and management of comorbid patients
AbstractBronchopulmonary dysplasia (BPD) and bronchial asthma (BA) are the most common chronic lung diseases in children, but the relationship between these diseases has not been fully defined. The incidence of atopic diseases (atopic dermatitis, allergic rhinitis, and BA) in children with BPD are significantly different according to national and international studies. There is not enough data on risk factors for the development, clinical and laboratory features of the course and treatment of BA in children with BPD.
Material and methods. The case histories of 1104 patients (2004-2017) with BPD criteria were analyzed at the Department of Pediatrics at the RUDN University. On the basis of clinical and anamnestic data, allergological examination, and study of respiratory function, the frequency of asthma was determined. The comparative study was conducted in patients with isolated diseases - BPD (without BA) and BA (without BPD) - to determine the risk factors and characteristics of BA in children with BPD.
Results and discussion. The frequency of BA was 7%, atopic dermatitis - 3.8% and allergic rhinitis - 3.6%. The risk factors for the development of BA in children with BPD were determined for low birth weight (LBW) (p=0.0037), late prematurity (p=0.0007), family history of allergy through asthma (p=0.0334), concomitant atopic dermatitis (p=0.0018) and allergic rhinitis (p=0.0022). Severe BPD (p=0.0002), episodes of bronchial obstruction in the first 3 years of life (p=0.0272). It was found that BA in children with BPD, compared with children without BPD is statistically significant. It characterized by an earlier onset (p=0.0168), a mild intermittent course (p=0.0003), a rarer need for inhaled bronchodilators (p=0.0034) and more frequent administration of inhaled corticosteroids as basic therapy (p=0.0399).
Conclusion. We suggested that BA in children could be a respiratory consequence of BPD and a comorbid disease with a separate phenotype. The management of children suffering from BA and BPD should include the registration and evaluation of epidemiology, risk factors, clinical and laboratory features. It would be necessary to implement the clinical and allergological examination and the development of an individualized management program for patients.
Keywords:bronchopulmonary dysplasia, bronchial asthma, risk factors, children, comorbidity
For citation: Kravchuk D.A., Ovsyannikov D.Yu., Bolibok A.M., Larina V.N., Gitinov Sh.A., Krsheminskaya I.V., Nazarova V.V., Petruk N.I., Khaled M., Alekseeva O.V., Zhestkova M.A., Pushko L.V., Illarionova T.Yu., Nazarova T.I., Bystrova O.V., Nguen B.V., Biryukova M.V., Pavlova E.S., Turina I.E., Marchenkov Ya.V., Zhdanova O.I., Kuzmenko L.G., Degtyareva E.A., Petryaykina E.E. Frequency, risk factors, features of bronchial asthma in children with bronchopulmonary dysplasia and management of comorbid patients. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2019; 7 (3): 27-39. doi: 10.24411/2308-2402-2019-13004 (in Russian)