Maternal diabetes during pregnancy, regardless of the type, is a risk factor for macrosomia or excessive fetal growth. Macrosomia and subsequent complications are the main short-term consequences of intrauterine exposure to gestational diabetes mellitus (GDM). Additionally, they have an increased risk of neonatal complications, such as congenital heart defects (CHDs) and central nervous system (CNS) congenital birth defects, hyperbilirubinemia, hypoglycemia, hypocalcemia, and polycythemia with their subsequent complications. More and more indisputable data are evidencing long-term consequences on offspring health in the case of diabetes. While most of this research has focused on metabolic and cardiovascular consequences, there is a growing body of evidence suggesting an impact of maternal diabetes on respiratory health, which is influenced by intrinsic and extrinsic environmental factors during fetal and postnatal development, with important implications for respiratory disorders in later life.

This article presents an overview of modern statements of the induced sputum method; detailed description of the methods and protocols for taking sputum in adults and children, methods for processing the obtained substance. The paper describes in detail the features of the cellular composition of induced sputum in healthy individuals and in patients with bronchial asthma, emphasizes the importance of the eosinophilia level as a prognostic and diagnostic criterion of asthma and also determines the functions of other induced sputum cells such as neutrophils, macrophages, basophils. The article is illustrated with photographs of sputum microscopy. In addition to sputum cytology, we give accent to the possibility of using other research methods such as an identification of viral and bacterial pathogens, genomics, proteomics, lipidomics, metabolomics, determination of the concentration of various mediators in the sputum supernatant. The paper presents the ideas on biochemical inflammatory markers and remodelling of the respiratory tract in asthma, which can be determined in sputum (C3a anaphylatoxin, clusterin, periostin, eosinophil-derived neurotoxin, folliculin). In addition, we summarize the information on inflammatory phenotypes of bronchial asthma, emphasize their variability and modification depending on the period of the disease, prescribed treatment, intercurrent respiratory infections, and smoking. The article also presents detailed characteristics of eosinophilic, neutrophilic, mixed and small granulocyte phenotypes of bronchial asthma, and describes the most frequent correlations of phenotypes with the severity and course of the disease, with lung function parameters and other indicators. The paper gives an account of the possibilities of using the induced sputum method for a comprehensive assessment of the course, asthma controllability and the effectiveness of drug therapy, as well as for a personalized selection of an antiinflammatory drug considering the inflammatory phenotype.

: The article provides an overview of modern concepts of induced sputum analysis and a description of the methodology and protocols for the collection of induced in adults and children. This paper describes the cellular composition of induced sputum in healthy people and in patients with asthma in detail, analyses the significance of the sputum eosinophil count as a prognostic and diagnostic criterion and the role of other cells, such as neutrophils, macrophages, basophils. In this article, we review several asthma biomarkers of inflammation and remodeling of the airways in asthma, which can be determined in sputum (anaphylatoxin C3a, clusterin, periostin). In addition, we summarize recent data about asthma phenotypes and describe the possibilities of using induced sputum analysis as a diagnostic and therapeutic tool for personalized anti-inflammatory therapy for asthma.