Severe bronchial asthma in children

S.V. Zaitseva 1, O.V. Zaitseva 1, E.E. Lokshina 1, A.K. Zastrozhina 2, O.A. Murtazaeva 1

1 Moscow State University of Medicine and Dentistry named after A.I. Evdоkimov, Moscow, Russia
2 Children’s City Polyclinic No.42 of the Moscow Healthcare Department, Moscow, Russia

ALLERGOLOGY AND IMMUNOLOGY IN PEDIATRICS, Volume 58 • Number 3 • September 2019, pp. 4 – 14
DOI: 10.24411/2500-1175-2019-00011

Severe, difficult to control bronchial asthma in children is still a serious problem in pediatrics and allergology. The disease significantly reduces the quality of life of patients and their families and increases health care costs.
According to GINA 2019, 24% of patients use the amount of therapy corresponding to severe asthma, of which in 17% of patients it is possible to establish the factors of low symptom control. These factors include low adherence to therapy, poor compliance, errors in the technique of using drugs, concomitant diseases, and in some cases incorrect diagnosis. However, severe refractory asthma, is diagnosed in 3,7% of patients.
The article presents clinical, diagnostic and treatment features of severe bronchial asthma in children.

  1. Поликарпов А.В., Александрова Г.А., Голубева Н.А. Общая заболеваемость детского населения России (0–14 лет) в 2017 году: cтатистические материалы. Ч. VI. 2018. 144 с. Доступен по ссылке: https://www.rosminzdrav.ru/ministry/ Доступ от 20.04.2019.
  2. Centers for Disease Control and Prevention. Asthma in the US. Available from: https://www.cdc.gov/vitalsigns/asthma/. Accessed 2019 April 20.
  3. Asthma status and severity affects missed school days / S.A. Moonie, D.A. Sterling, L. Figgs et al. // J. Sch. Health. 2006. Vol. 76. P. 18–24.
  4. Severe asthma in childhood: assessed in 10 year olds in a birth cohort study / Lang A., Carlsen K.H., Haaland G. et al. // Allergy. 2008. Aug. Vol. 63, № 8. P. 1054–1060.
  5. Клыкова Т.В., Терещенко Ф.М. Распространенность и клинико-аллергологические особенности тяжелой бронхиальной астмы у детей и подростков г. Казани // Практическая медицина. 2009; 35: 52-54. 22
  6. Арестова Н.Е. Распространенность и факторы риска формирования бронхиальной астмы у детей на примере Санкт-Петербурга и Ленинградской области: автореф. дис. … канд. мед. наук. СПб., 2009. 24 с.
  7. Stress and quality of life in urban caregivers of children with poorly controlled asthma: a longitudinal analysis / M.H. Bellin, P. Osteen, J. Kub et al. // J. Pediatr Health Care. 2015. Vol. 29. P. 536–546.
  8. Costs of asthma are correlated with severity: a 1-yr prospective study / P. Godard, P. Chanez, L. Siraudin et al. // Eur. Respir. J. 2002, Jan. Vol. 19, № 1. P. 61–67. Epub 2002/02/15. eng.
  9. Centers for Disease Control and Prevention // Asthma in the US. Available from: https://www.cdc.gov/vitalsigns/asthma/.
  10. Puig-Junoy J., Pascual-Argente N. Socioeconomic Costs of Asthma in the European Union, United States and Canada: A Systematic Review // Rev. Esp. Salud. Publica. 2017. Vol 91. P. 1-15.
  11. Global Initiative for Asthma. Global strategy for asthma management and prevention. Revised 2018. Available from: www.ginasthma.com Accessed 2019 April 20.
  12. Бронхиальная астма у детей: cтратегия лечения и профилактика. Национальная программа. 5-е изд., перераб. и доп. М.: Оригинал-макет, 2017.
  13. Бронхиальная астма у детей: федеральные клинические рекомендации. 2017. Союз педиатров России. Российская ассоциация аллергологов и клинических иммунологов. Доступно: https://www.pediatr-russia.ru/. Доступ04.2019.
  14. Guilbert T.W., Bacharier L.B., Fitzpatrick A.M. Severe asthma in children // J. Allergy Clin. Immunol. Pract. 2014. Vol. 2, № 5. P. 489–500.
  15. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma / K.F. Chung, S.E. Wenzel, J.L. Brozek et al. // Eur. Respir. J. 2014. Vol. 43. P. 343–373.
  16. Global Initiative for Asthma. Difficult-to-treat and Severe Asthma in adolescent and adult patients. Diagnosis and Management. Pocket Guide for half professional. Available from: https://ginasthma.org/gina-ebooks. // Accessed 2019. Apr 20.
  17. Тяжелая бронхиальная астма: согласительный доклад объединенной группы экспертов. Состав объединенной группы экспертов: Барановская Т.В., Белевский А.С., Восканян А.Г. и др. Доступен по ссылке http://spulmo.ru/
  18. Current asthma guidelines may not identify young children who have experienced significant morbidity / S.P. Galant, T. Morphew, S. Amaro et al. // Pediatrics. 2006. Apr. Vol. 117, № 4. P. 1038–1045.
  19. Gelfand E.W., Kraft M. The importance and features of the distal airways in children and adults // J. Allergy Clin. Immunol. 2009. Dec. Vol. 124 (6 Suppl). S. 84–87.
  20. Severe childhood asthma: a common international approach? / A. Bush, G. Hedlin, K.H. Carlsen et al. // Lancet. 2008. Sep 20. Vol. 372 (9643). P. 1019–1021. Epub 2008/09/23. eng.
  21. Fitzpatrick A.M. Severe asthma in children: lessons learned and future directions // J. Allergy Clin. Immunol. Pract. 2016. № 4. P. 11–19.
  22. A comparison of the clinical characteristics of children and adults with severe asthma / H.A. Jenkins, R. Cherniack, S.J. Szefler et al. // Chest. 2003. Vol. 124, № 4. P. 1318–24.
  23. Classifying asthma severity in children: mismatch between symptoms, medication use, and lung function / L.B. Bacharier, R.C. Strunk, D. Mauger et al. // Am. J. Respir. Crit. Care Med. 2004. Aug 15. Vol. 170, № 4. P. 426–432. Epub 2004/06/03. eng.
  24. Is forced expiratory volume in one second the best measure of severity in childhood asthma? / Spahn J.D., Cherniack R., Paull K. et al. // Am. J. Respir. Crit. Care Med. 2004. Apr 1. Vol. 169, № 7. P. 784–786. Epub 2004/02/03.
  25. Ramratnam S.K., Bacharier L.B., Guilbert T.W. Severe Asthma in Children // Journal of Allergy and Clinical Immunology: In Practice. Vol. 5, № 4. P. 889–898.
  26. Зайцева С.В. Оценка эффективности и возможности оптимизации терапии бронхиальной астмы у детей: дис. … канд. мед. наук. М.: РГМУ, 2001. 161 с.
  27. The use of inhaled corticosteroids in pediatric asthma: update. / E. Hossny, N. Rosario, B.W. Lee et al. // World Allergy Organ J. 2016. № 9. P. 26. Published 2016. Aug 12.
  28. World Health Organisation (2003): Adherence to longterm therapy, evidence for action. Geneva: [Электрон. ресурс]. – доступ
  29. Psychological factors associated with medication nonadherence in asthmatic children / B. Bender, H. Milgrom, C.S. Rand et al. // Journal of Asthma. 1998. Vol. 35, № 4. P. 347–353.
  30. Factors associated with levels of adherence to inhaled corticosteroids in minority adolescents with asthma / G. Mosnaim, H. Li, M. Martin et al. // Ann. Allergy Asthma Immunol. 2014. Feb. Vol. 112, № 2. P. 116–120. doi: 10.1016/j.anai.2013.11.021. Epub 2013 Dec 21.
  31. The prevalence of nonadherence in difficult asthma / J.I. Gamble, M. Stevenson, E. McClean et al. // Am. J. Respir. Crit. Care Med. 2009. Nov 1. Vol. 180, № 9, P. 817–822. doi: 10.1164/rccm.200902-0166OC. Epub 2009 Jul 30.
  32. Krishnan Jerry A. et al. // Am. J. Respir. Crit. Care Med. 2004. Vol. 170. Р. 1281–1285.
  33. Williams L.K. et al. // J. Allergy Clin. 2004. Vol. 114. P. 1288–1293.
  34. Ильенкова Н.А., Черепанова И.В., Вохмина Т.А. Проблемы приверженности терапии у детей с бронхиальной астмой // Педиатрическая фармакология. 2016. Т. 13, № 6. С. 565–570.
  35. Association of atopic and non-atopic asthma with emotional symptoms in school children / G. Kohlboeck, S. Koletzko, C.-P. Bauer et al. // Pediatr Allergy Immunol. 2013. Vol. 24. P. 230–236.
  36. Goodwin R.D., Fergusson D.M., Horwood, L.J. Asthma and depressive and anxiety disorders among young persons in the community // Psychol. Med. 2004. Vol. 34. P. 1465–1474.
  37. Perception of pulmonary function and asthma control: the differential role of child versus caregiver anxiety and depression / Feldman J.M., Steinberg D., Kutner H. et al. // J. Pediatr Psychol. 2013. Vol. 38. P. 1091–1100.
  38. Easter G., Sharpe L., Hunt C.J. Systematic review and meta-analysis of anxious and depressive symptoms in caregivers of children with asthma // J. Pediatr. Psychol. 2015. Vol. 40. P. 623–632.
  39. Depressive symptoms amongst asthmatic children’s caregivers / A. Szabó, G. Mezei, E. Kovári et al. // Pediatr. Allergy Immunol. 2010. 21. 667–673.
  40. Posttraumatic stress in adolescents with asthma and their parents / E.M. Kean, K. Kelsay, F. Wamboldt et al. // J. Am. Acad. Child. Adolesc. Psychiatry. 2006;45:78–86
  41. Муртазаева О.А. Патогенетические аспекты бронхиальной астмы тяжелого течения у детей: автореф. дис. … канд. мед. наук. М., 2012. 24 с.
  42. Booster G.D., Oland A.A., Bender B.G. Psychosocial factors in severe pediatric asthma // Immunol. Allergy Clin. North Am. 2016. Vol. 36. P. 449–460.
  43. Effects of inhaled corticosteroids on pathology in asthma and chronic obstructive pulmonary disease / P. Chanez, A. Bourdin, I. Vachier et al. // Proc. Am. Thorac. Soc. 2004. № 1. P. 184–90. doi: 10.1513 / pats.200402-006MS
  44. Schwiebert L.M., Stellato C., Schleimer R.P. The epithelium as a target of glucocorticoid action in the treatment of asthma // Am. J. Respir. Crit. Care Med. 1996. Vol. 154. S. 16–19. doi: 10.1164 / ajrccm / 154.2_Pt_2.S16
  45. Step-up therapy for children with uncontrolled asthma receiving inhaled corticosteroids / R.F. Lemanske Jr, D.T. Mauger, C.A. Sorkness et al. // N. Engl. J. Med. 2010. Vol. 362. P. 975–985.
  46. Randomized trial of omalizumab (anti-IgE) for asthma in inner-city children / Busse W.W., Morgan W.J., Gergen P.J. et al. // N. Engl. J. Med. 2011. Mar 17. Vol. 364, № 11. P. 1005–1015. Epub 2011/03/18.
  47. Rubinsztajn R., Chazan R. Monoclonal Antibodies for the Management of Severe Asthma // Adv. Exp. Med. Biol. 2016. Vol. 935. P. 35–42.
  48. Wenzel S.E., Wang L., Pirozzi G. Dupilumab in persistent asthma // N. Engl. J. Med. 2013. Sep 26. Vol. 369, № 13. P. 1276.
  49. Lebrikizumab treatment in adults with asthma / J. Corren, R.F. Lemanske, N.A. Hanania et al. // N. Engl. J. Med. 2011. Sep 22. Vol. 365, № 12. P. 1088–1098. Epub 2011/08/05. eng.
  50. Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial / I.D. Pavord, S. Korn, P. Howarth et al. // Lancet. Aug 18. Vol. 380 (9842). P. 651–659.
  51. Княжеская Н.П. Влияние тиотропиума бромида на состояние пациентов с хронической обструктивной болезнью легких и сопутствующей бронхиальной астмой // Справочник поликлинического врача. 2008, № 4. С. 34–37.
  52. O’Connor B.J., Towse L.J., Barnes P.J. Prolonged effect of tiotropium bromide on methacholine-induced bronchoconstriction in asthma. // Amer. J. Respir. Crit. Care Med. 1996.Vol. 154. P. 876-880
  53. Barnes P.J. The role of anticholinergics in chronic obstructive pulmonary disease // Amer. J. Med. 2004. Vol. 20. P. 24S-32S
  54. Haddad E.B., Mak J.C., Barnes P.J. Characterization of [3H] Ba 679 BR, a slowly dissociating muscarinic antagonist, in human lung: radioligand binding and autoradiographic mapping // Mol. Pharmacol. 1994. Vol. 45, № 5. P. 899–907.
  55. Restrepo R.D. Use of inhaled anticholinergic agents in obstructive airway disease // Respir. Care. 2007. Vol. 52, № 7. P. 833–851.
  56. Wollin L., Pieper M. Tiotropium bromide exerts anti-inflammatory activity in a cigarette smoke mouse model of COPD // Pulm. Pharmacol. Ther. 2010. Vol. 23. P. 345–354.
  57. A role for M (2) and M (3) muscarinic receptors in the contraction of rat and human small airways / S.M. Brown, A. Koarai, R.G. Sturton et al. // Eur. J. Pharmacol. 2013. Vol. 702. P. 109–115.
  58. Tiotropium increases PPAR and decreases CREB in cells isolated from induced sputum of COPD patients / A. Holownia, R.M. Mroz, T. Skopinski et al. // Adv. Exp. Med. Biol. 2013. Vol. 756. P. 9–14.
  59. Суровенко Т.Н., Глушкова Е.Ф. Новые возможности терапии бронхиальной астмы у детей // Медицинский совет. 2018. № 17. С. 192–19
  60. Ненашева Н.М. Новые возможности достижения контроля астмы с помощью тиотропия бромида // Эффективная фарматека. Пульмонология и оториноларингология. 2014. № 2 (29). С. 4–14.
  61. Tashkin D.P. Long acting anticholinergic use in chronic obstructive pulmonare disease effecacy and safety // Curr. Pulm. Med. 2010. Vol. 16. Р. 97 –105.
  62. Сочетание бронхиальной астмы и хронической обструктивной болезни легких / В.В. Архипов и др. // Пульмонология. 2014. № 4. С. 87–94.
  63. Рылеева И.В. Патогенетические основы эффективности аллергенспецифической иммунотерапии и иммунофармакотерапии атопической бронхиальной астмы у детей: автореф. дис. … д-ра. мед. наук. М., 2004. 46с.

Zaitseva SV, Zaitseva OV, Lokshina EE, Zastrozhina AK, Murtazaeva OA. Severe bronchial asthma in children. Allergology and Immunology in Pediatrics. 2019;58(3):4-14. (In Russ.) https://doi.org/10.24411/2500-1175-2019-00011

For correspondense

S.V. Zaitseva
e-mail:  zcv16@mail.ru

O.V. Zaitseva
e-mail:  olga6505963@yandex.ru

E.E. Lokshina
e-mail:  elokshina@yandex.ru

A.K. Zastrozhina
e-mail:  etc_@bk.ru

O.A. Murtazaeva
e-mail:   msmsu@msmsu.ru

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