Age-related evolution of bronchial asthma in pediatric practice and approaches to improving prognosis

Abstract

The main high-risk group for a diagnosis of bronchial asthma (BA) are children with recurrent obstructive bronchitis, complicated by a widespread form of acute respiratory viral infections. Basic therapy of BA is aimed at suppressing inflammation of the bronchial wall. In addition to inhaled glucocorticosteroids, the antileukotriene drug montelukast has a proven anti-inflammatory effect. This article discusses published work on the effect of montelukast on inflammation biomarkers in real clinical practice and remodeling of the bronchial wall in the experiment. A comparative study of the clinical efficacy of an antileukotriene drug and inhaled glucocorticosteroids in patients of different age groups and asthma phenotypes is presented. The use of montelukast in children at high risk of developing BA, with an indication for allergic rhinitis, is discussed. Presented current information on the risk of psychiatric AE against the background of using an antileukotriene drug. Literature review is illustrated by our own observation: a cohort of 127 patients was formed on the basis of the dispensary group of the City Allergy Cabinet of the Children’s City Polyclinic No. 44 in St. Petersburg in 2018, a prospective observation was conducted, which lasted 2 years. The inclusion criteria were age of 5 years to 5 years 11 months (5 ± 0.5 years) and an established diagnosis of mild BA. The patients were followed up for 2 years with evaluation of the change of basic therapy, control of the disease and functional indices achieved with therapy with the original drug montelukast. This observation showed high clinical efficacy of montelukast monotherapy in the group of preschool-age patients, which was expressed by a significant proportion of patients who had no exacerbations of BA for a year, a high score on the Asthma Control Test, statistically insignificant increase in forсed expiratory volume in 1 second after bronchodilator. Today Montelukast is a safe, effective and widely prescribed component of therapeutic regimen in patients with varying degrees of severity of bronchial asthma over the age of 2 years.