Objective. To assess the effectiveness of achieving and maintaining control of bronchial asthma in children during dynamic observation, depending on the characteristics of the onset of the disease. Material and methods. In order to study the peculiarities of the course and controllability of bronchial asthma in children, depending on the alternative onset of the disease, 319 children were comprehensively examined by the "experience-control" method in parallel groups using a simple random sample on the basis of the Regional Children's Clinical Hospital in Chernivtsi. In 257 patients (I clinical group), bronchial asthma developed on the background of chronic obstructive bronchitis, the II clinical group included 43 children in whom BA debuted after suffering community-acquired pneumonia, and the third (III) clinical group was formed by 19 children in whom BA was verified after inpatient treatment for status asthmaticus. Research results. It was shown that the representatives of the III clinical group, compared with other patients, probably more often had the phenotype of early asthma and severe disease, and the ratio of the chances of severe asthma in the future for these children compared with the cohort of group I was 6.8. According to the results of self-assessment of asthma control on standardized questionnaires GINA and AST, as well as using a clinical-instrumental assessment scale, it was found that the level of disease control in all groups was insufficient, and the distribution of children in clinical groups in group III relative to other patients with partially controlled and uncontrolled asthma predominated. The conducted standard anti-inflammatory basic treatment allowed to achieve certain positive changes in patients of clinical observation groups, and the representatives of the III clinical group required more active basic anti-inflammatory therapy, in particular, the volume of the 1st step in GINA compared to patients of the I group was prescribed twice less often, and the 4th - 6.9 times more often. Conclusion. Patients with the onset of bronchial asthma in the form of status asthmaticus further retain a worse level of control over the disease as compared to patients with chronic obstructive bronchitis or pneumonia in history. This cohort of patients requires a larger volume of basic treatment, as well as a personalized approach to prescribing therapy with the obligatory consideration of the characteristics of asthma onset.

Respiratory diseases always account for a significant proportion of visits to the pediatrician or family doctor, and bronchitis is usually a frequent clinical manifestation of acute respiratory diseases. The doctor often faces the question of how to objectively assess the clinical picture of bronchitis, and now the assessment of respiratory symptoms is often based on criteria such as cough, shortness of breath or wheezing on auscultation. However, today there are practically no data on the severity of bronchitis in children depending on the above criteria. A cohort of 158 children with bronchitis was created at the pulmonology and allergology Department of the Municipal Medical Institution "Regional Children's Clinical Hospital" in Chernivtsi. The severity of bronchitis was assessed at the beginning and on the 3rd and 7th day of inpatient using the Bronchitis Severity Score (BSS). According to this scale, mild bronchitis was verified in 30 patients which formed the I clinical group, and 128 children had moderate bronchitis (II clinical comparison group). Aggressive inflammation of the bronchi in children with moderate inflammation of the bronchial tree compared with patients with mild bronchitis was accompanied 1.6 times more often by recurrence, a history of episodes of community-acquired pneumonia in 9.4% of patients, long-term inpatient treatment (odds ratio 2.6) and halving the duration of the outpatient treatment period. The study of clinical severity of bronchitis in children of the comparison groups made it possible to establish an increase in the chances of a more severe course of the disease on the 7th day of hospitalization in children with moderate bronchitis (odds ratio 4.8) with persistence of cough in 68.7% of children in this group (odds ratio 3.8). Evaluation of inpatient treatment tactics indicated the need to increase the volume of complex therapy in patients with moderate bronchitis relative to children with mild disease (odds ratio 12.0, relative risk 8.8), as well as increasing the risk of the need for antibacterial therapy (odds ratio 3.7, relative risk 2.8) and the appointment of intravenous antibiotics for more than 3 days (odds ratio 5.0, relative risk 1.1).

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.

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