Study of clinical manifestations and pathogenesis of bronchial asthma (BA) complicated by comorbid diseases, foci of chronic infection as well as the elaboration of differential and diagnostic criteria of its variants taking into account clinical, allergologic, genetic and immunologic aspects are the urgent problems in modern medicine.
Purpose of the study. To establish the criteria of various clinical and laboratory genotypes of bronchial asthma complicated by comorbid pathology
Materials and methods. 120 patients aged 3–17 years were evaluated. Group I included 48 children with BA resulting from frequent ARVI/ARD and respiratory pathology. Group II consisted of 28 children with nonallergic BA phenotype and associated gastro-intestinal pathology. 23 children with mixed type of BA were included in group III. All children underwent general clinical laboratory investigations, immunologic blood tests, determination of respiratory function, esophagogastroduodenoscopy, ultrasound examination of abdominal organs, chest X-ray, microbiological investigation of nasopharynx. Statistical data processing was done with Statistica 6.0 programs using statistical parametric and nonparametric methods.
Results of the investigation. The study found essentially higher values of total IgЕ concentration in the patients of group 3 ((201.2±3.1) IU/ml) when compared with those in group 1 — (115.3±3.2) IU/ml, and group 2 — (25.9±5.7) IU/ml (p=0.0001, respectively). 24.6% of patients with BA associated with ARVI/ARD had specific IgE antibodies to Staphylococcus aureus: 8.8% — of high, 8.6% — of medium and 7.2% — of low levels. Among the deviations of immunologic parameters there was considerable decreased number of CD8+-lymphocytes (р=0.0002), induced НСТ-test (р=0.0001), increased number of CD4+-lymphocytes (р=0.004) and immunoregulatory index CD4+/CD8+ (р=0.0001) when compared to normal values.
Conclusions. Patients with BA and comorbid pathology have disturbances presented as functional insufficiency of neutrophil phagocytosis and imbalance between the values of T-cell and humoral components of immunty. Combination of BA with associated GIT pathology and predominance of Th1 immune response in pathogenesis, normal total IgE level appeared to be common for nonallergic phenotype of BA, while in mixed phenotype of BA severe non-controlled clinical course associated with intake of high doses of IGCS is observed, and combination of Th1 and Th2 immune response types dominates in pathogenesis.