The aim of the study was to study the role of fine suspended particles in the atmospheric air in the formation of allergic, non-allergic and mixed phenotypes of bronchial asthma in adults. Methods. The analysis of atmospheric air pollution by fine particles in Kazan was carried out according to the database of social and hygienic monitoring of the FBUZ "Center for Hygiene and Epidemiology in the Republic of Tatarstan" for 2014-2020. To study the relationship between the level of atmospheric air pollution with fine particles and bronchial asthma in adults (18-65 years old), a retrospective analysis of the incidence of bronchial asthma (ICD-10 codes J45.0, J45.1, J45.8) was carried out during the same period among the population of Kazan. The regional medical information system "Electronic Health of the Republic of Tatarstan" was used. Statistical modeling was carried out using the method of mixed models based on the Poisson distribution or the negative binomial distribution. Results. The average annual absolute risk of bronchial asthma in the adult population of Kazan was 0.51 per 100 people aged 18-65 years, an increase of 0.09 per 100 people (17.6%) per year (p = 0.039). An increase in the annual maximum concentrations of PM2.5 by 10 g increased the absolute risk of non-allergic bronchial asthma by 0.066 per 100 people aged 18-65 years (p=0.043). Similar dependences, but without statistical significance at the level of p0.05, were found for such exposure parameters as the mass concentration of PM10 and the mass of particles deposited in the tracheobronchial and respiratory sections of the lungs. For allergic and mixed asthma, no statistically significant relationships with mass concentrations and deposited doses of suspended particles were found. Conclusions. Air pollution with fine suspended particles increases the risk of developing a non-allergic phenotype of adult bronchial asthma, which may be associated with specific pathogenetic mechanisms, including the reaction of the epithelium to the deposition of fine particles.

Air pollution with suspended particles and gaseous substances is assumed to be a possible risk factor for bronchial asthma. Bronchial asthma (BA) is one of the most common chronic non-communicable diseases in children and adults, characterized by variable respiratory symptoms and airflow limitation. Asthma is a heterogeneous disease with different underlying disease processes. The most common asthma phenotypes are allergic and non-allergic asthma, differing in the presence of atopy, the type of airway inflammation, responses to inhaled corticosteroid treatment. Meta-analyses, including cohort studies, support the role of fine particles in asthma in children. The question of whether the incidence of asthma in adults is associated with exposure to ambient particulate matter remains open. The chapter describes the effect of fine particles in the ambient air on the formation, course, and underlying mechanisms of different phenotype of bronchial asthma in adults. The role of ambient fine particles in the development of the eosinophilic non-allergic phenotype of bronchial asthma in adults (18–65 years old) has been proven. The hypothesis about different underlying mechanisms in response to exposure to particulate matter for various phenotypes of bronchial asthma was confirmed.

The aim of the study was to investigate the effect of fine suspended particles in the atmospheric air on the formation and course of allergic and non-allergic phenotypes of the T2 endotype of bronchial asthma (BA) using the case-control study. Materials and methods. BA patients were selected in the course of seeking medical help. The groups were formed on the base of matching criteria (gender, age, body mass index, level of education), supplemented by the collection of information about potential cofounders. Based on the data on monitoring the content of fine suspended particles in the atmospheric air of Kazan, the average annual and maximum concentrations of PM2.5 and PM10 fractions were determined in the residential areas. The group of “cases” included forty patients with an allergic phenotype and 42 patients with an eosinophilic non-allergic phenotype of bronchial asthma, the control group included forty eight people. Additionally, sampling of atmospheric air was carried out using an 8-stage impactor to assess the content of bacterial endotoxin, and elemental composition. Results. Higher levels of pollution with fine suspended particles were demonstrated in the areas of residence of BA patients, comparing to the control group. An increase in the average annual concentration of the PM2.5 by 10 µg/m3 increases the odds of the eosinophilic non-allergic BA phenotype in adults by 4.76 times. The odds of the allergic phenotype of bronchial asthma increases in the presence of bacterial endotoxin - 1.32 times per 0.01 EU/m3 of endotoxin in the 3.2-18 µm size fraction. A more severe course of the eosinophilic non-allergic BA phenotype was noted at higher average annual concentrations of the PM2.5. The control of allergic asthma depends on the bacterial contamination of the aerosol. Limitations of the study are related to the use of geospatial approach to assess personalized average annual and maximum annual concentrations. Conclusion. The role of fine suspended particles in the atmospheric air in the development of bronchial asthma in adults has been shown. Various mechanisms were established to be involved in the formation of the clinical picture of the eosinophilic non-allergic and allergic phenotypes of bronchial asthma.