The role of eosinophil-mediated inflammation in the formation of respiratory remodeling in patients with bronchial asthma of school age children

Objective. To investigate the features of inflammatory changes in the airways, taking into account remodeling markers, determined directly in the sputum of school age children with bronchial asthma, and to optimize the management of this disease.Material and methods. To study the features of the formation of airway remodeling 75 children with persistent bronchial asthma were comprehensively examined on the basis of the Regional Communal Non-Commercial Enterprise "Chernivtsi Regional Children's Clinical Hospital". The children were divided into 2 clinical groups depending on the level of vasoendothelial growth factor (VEGF) and matrix metalloproteinase 9 (MMP-9) in the sputum supernatant. The first (I) group included 37 schoolchildren whose VEGF concentration exceeded 80.0 ng / ml, and MMP-9 was more than 5.2 ng / ml. The second (II) comparison group was formed by 38 children in whom BA was not accompanied by accumulation of airway remodeling markers in the sputum supernatant above the indicated distribution point.Research results. The features of the formation of airway remodeling based on the accumulation of sputum markers such as VEGF> 80.0 ng / ml, MMP-9> 5.2 ng / ml were established. It was shown that bronchial remodeling is associated with a decrease in the group of patients with mild persistent asthma, loss of control over its symptoms, prevalence of family allergic history burdens according to both parental pedigrees and the negative effect of maternity smoking. The most sensitive marker in the verification of bronchial remodeling turned out to be a high marginal content of total IgE (> 750 IU / ml) in blood serum (test sensitivity - 95.8% (95% CI 89.7-98.8), which is advisable to combine in the diagnostic algorithm with more specific tests to optimize airway remodeling verification and develop personalized treatment strategies.Conclusion. The formation of bronchial remodeling in bronchial asthma in school age children is associated with the eosinophilic nature of bronchial inflammation, which is accompanied by an increase in the level of blood eosinophilia (> 10%) and sputum (on average 10.5 ± 1.0%) with an increase in myeloperoxidase activity and signs of degranulation of acidophilic granulocytes in sputum, as well as a high marginal concentration of total IgE (> 750 IU / ml) in blood serum in 95.8% of patients.