Vol 12, No 5 (2015)

Background. To study the clinical and functional features in interrelationship between the level of proinflammatory and antiinflammatory cytokines in young patients with bronchial asthma and alimentary obesity for optimization of therapy. Methods. 133 persons were examined: 93 patients with bronchial asthma were divided into 2 groups depending on body weight index (BWI): the 1st group included patients with bronchial asthma with BWI less than 25 kg/m2, the 2nd group included patients with bronchial asthma with BWI 30 kg/m2 and more. The group of control included 40 almost healthy persons. We studied external respiration function, cellular structure of the induced sputum, the level of TNFα, IL-2, IL-4, IL-6, IL-15, Creactive protein in blood. Results. The results of cytokines at patients with bronchial asthma depending on BWI out of an exacerbation of the disease within the last 2 months. We found the signs of more significant systemic inflammation in the group with obesity the increasing of the level of IL2, IL6, TNFa and Creactive protein in plasma was found. Conclusion. We found that there was more sever course of bronchial asthma in young patients with obesity, decreased external respiration functions, increased level of proinflammatory cytokines and proteins of acute phase in peripheral blood.

This review presents the results of scientific research studies, systematical and metaanalyses data which confirm clinical efficiency of allergen specific immunotherapy (ASIT) in atopic dermatitis (AD) children. This review shows prospects for the use of combined immunotherapy, including ASIT and immunomodulators.

For the first time in Russian economic conditions clinical and economic evaluation of the appropriateness of tiotropium bromide as adjunctive therapy (in addition to the standard therapy) was carried out in patients with severe asthma. Markov model was built using direct and indirect costs, data efficiency and effectiveness; research horizon was 1 year. An additional model was comparing tiotropium bromide (plus standard therapy) and omalizumab (plus standard therapy) with standard therapy. Sensitivity analysis and the budget impact analysis were done. The modeling showed that the use of the strategy of «tiotropium plus standard therapy» increased the likelihood of patients to remain in a state of controlled asthma compared to other strategies. The strategy «tiotropium plus standard therapy» reduced the likelihood of a severe exacerbation compared with standard therapy. Thus, taking into account high frequency of hospitalization of patients with asthma in Russia that was shown in pharmacoepidemiological studies, the use of tiotropium is absolutely appropriate medical technology from the standpoint of clinical and economic analysis. The strategy of using tiotropium is the most preferred strategy in terms of the budget impact analysis when compared with the strategy of omalizumab: the use of tiotropium strategy allows to save substantial budget funds that can be further used to treat a considerable number of patients.

Background. To evaluate the tolerability of the industrial complementary feeding products (grain, fruit and vegetables, meat-based) in healthy children and children at high risk of allergies developing. Methods. The study included 90 children aged 4-6 months with breastfeeding, mixed or artificial feeding, who had not received any complementary food before. The children were healthy or had a high risk for development of allergic disease. Complementary foods (porridge, vegetables, meat and fruits) were administered based on an individual plan depending on age, nutritional status and nature of feces. Tolerability of products, dynamics of weight and height and laboratory parameters were evaluated. At the beginning and at the end of the study, capillary blood was taken to determine the specific IgE (sIgE) to the proteins of cow’s and goat milk, apples, pears, prunes, zucchini, broccoli, cauliflower, rice, maize, buckwheat, turkey meat, and rabbit meat (quantitative allergy diagnostics using an express method). In addition, a scatological study was performed. Results. The level of specific IgE to food allergens in all children under the study was within normal range (0-135 IU/ml) both initially and after the administration of all studied complementary foods. Conclusion. The investigated complementary foods have a low sensitizing potential, including children with a high risk for development of allergic disease. This allows us to describe the industrial complementary feeding products as hypoallergenic.

Bronchial asthma is a serious socio-economic problem despite of the availability of highly effective therapy for control of symptoms. The gold standard of asthma therapy is high effective and safe combination of ICS+LABA. However, even use of these drugs leave more than half of patients around the world without full control over the symptoms of the disease. This leads for necessity of the search of new therapies - molecules as new drugs and new means for delivery, allowing to minimize technical errors during the inhalation manoeuvre, improving patient treatment adherence. This drug is Relvar Ellipta® containing a combination of new molecules of ICS and LABA in a new, improved delivery system for use 1 time per day.