Allergic diseases, which have a certain stage in their development from food allergy to bronchial asthma / allergic rhinitis, are much more common in children than in adults. The aim of this study was to analyze data on the prevalence and incidence of atopic dermatitis, bronchial asthma and allergic rhinitis as components of the allergic march, in children of Ukraine from 1994 to 2017 to determine the possible impact of adverse environmental factors on their development. During the same period, due to the influence of a number of factors, in particular environmental, there were significant changes in the structure of allergic diseases making up the stages of the allergic march due to an increase in the proportion of allergic rhinitis with the reduced one of asthma and atopic dermatitis. Within 24 years, the incidence of atopic dermatitis in children aged 0-6 years including, increased by 27.6%, in adolescents - by 40.5% and significantly decreased by 39.5% in children aged 7-14 years including. Most cases of allergic rhinitis and bronchial asthma were observed in schoolchildren (47.6 and 54.0%, respectively) with a slight decrease compared to 1994. In general, allergic diseases in recent years have become more common in children from 0 to 6 years and their detection has decreased in school-age children and adolescents. Over the past 24 years, in children of Ukraine a steady increase in the incidence and prevalence of allergic diseases that form an allergic march has been noted: the prevalence of bronchial asthma has increased by 69.3% and the incidence has increased by 22.9%; the prevalence of atopic dermatitis increased by 43.9% and the incidence increased by 8.3%; the prevalence of allergic rhinitis increased by 488.3% and the incidence of allergic rhinitis increased by 380.3%, with a predominance of detection of this pathology in children from regions with developed infrastructure and industry, where there are significant emissions of pollutants into the atmosphere, that have a direct moderate effect on the increase in the prevalence of bronchial asthma, the incidence and prevalence of allergic rhinitis in children.

Bacterial, allergic, parasitic and fungal skin lesions are much more common among children than among adult patients. The aim of this study was to analyze data on the prevalence and incidence of diseases of skin and subcutaneous tissue with allergic and non-allergic origin among children of Ukraine in period from 1994 to 2017. Our main purpose was to determine the possible impact of different adverse environmental factors on children`s  growth, including radiation, connected with the Chernobyl disaster in 1986. Over the past 24 years Ukraine has witnessed a 10.3% increase in prevalence of diseases of skin and subcutaneous tissue among children and 8.6% raise of incidence rate with a predominance of detection of this pathology in children affected by the Chernobyl accident and children from areas of radiological control. We have found a direct influence of moderate strength on the connection between population-weighted effective dose of total human exposure (in millizieverts) in different regions of the country in the period of 1997-2011 and the incidence and prevalence of skin diseases among children aged 0-14 years, including 2011 (p<0.05).This fact may indicate the impact of this disaster on the occurrence and pathogenesis of skin diseases and its consequences among children. During the same period, due to the influence of a number of environmental factors, there was a significant transformation in the structure of skin diseases in children. We have witnessed double increasing of the proportion of allergic lesions of the skin and its elements. The prevalence of diseases of the skin and its elements in general has reached 28.7%  against the corresponding reduction of skin infections.

The objective: was to investigate the level of asthma control in adolescents using the PAQLQ questionnaire and spirometry. Materials and methods. The study included 60 adolescents aged 12 to 18 years, patients with asthma, without clinical and functional signs of exacerbation. 43.4% of adolescents (26 people) had a controlled course, and 56.6% of children (34 people) had a partially controlled asthma. Results. According to the results of bronchodilation tests 3 times more often showed a positive response when using a combined bronchodilator, compared with salbutamol (χ2y=4.37; p=0,04). The average increase in FEV1 was 1,4 times greater in children after the use of ipratropium bromide / fenoterol – 8,9±0,8%, compared with the results of the test using salbutamol – 6,2±0,6% (p<0,05). After evaluating the results of spirometry, the proportion of children with incomplete asthma control was 63,3%. Detected 38,5% of patients with a total QOL PAQLQ <6 points in controlled asthma. After conducting a survey on the PAQLQ questionnaire and spirometric examination, the percentage of children with incomplete control of asthma increased 1,6 times from 43,3% to 73,3% (χ2=11,1; p<0,05). Conclusion. Clinical monitoring is not always sufficient to properly assess the level of asthma control in adolescents. Consideration of several assessment methods makes it possible to more accurately determine the level of asthma control in a patient.

Introduction. The problem of controlling bronchial asthma in adolescents remains relevant, and its monitoring is more difficult than in other age categories, since during the period of long-term remission the disease can be accompanied by signs of bronchial hyperreactivity to nonspecific irritants, and pulmonary ventilation disorders can have a «latent» character, persisting much longer than the clinical symptoms of the disease, which leads to tactical errors in determining the level of bronchial asthma control and is a risk factor for its progression. Aim: to develop a method for assessing the level of bronchial asthma control in adolescents, when there are no clinical, anamnestic and functional signs of insufficient control of asthma, by using a quality of life questionnaire and an additional bronchodilatory test. Materials and methods. The study included 43 adolescents with mild (41.9 %) and moderate (58.1 %) controlled bronchial asthma. To identify cases of «latent» bronchospasm, a bronchodilatory test with salbutamol was performed and the increase in forced expiratory volume in 1 second (FEV1) was calculated. In the case of an increase in FEV1 ≥ 12.0 %, the presence of «latent» bronchospasm was confirmed. If the increase in FEV1 turned out to be < 12.0 %, a questionnaire was performed using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and if the value of the integral indicator of the overall quality of life PAQLQ ≤ 6.5 points, an additional bronchodilator test with a combined bronchodilator (fenoterol / ipratropium bromide). Results. The absence of changes in the initial levels of spirometric parameters was found in all 43 patients (FEV1 > 80.0 %). When carrying out a bronchodilatory test with salbatamol, 7 patients (16.3 %) with a positive response (increase in FEV1 ≥ 12.0 %) were identified, which indicated cases of «latent» bronchospasm and partial control of asthma, and 36 people (83.7 %) with a negative answer (increase in FEV1 < 12.0 %). Among 36 patients with an increase in FEV1 < 12.0 % in the test with salbutamol applied the PAQLQ questionnaire and identified 24 people or 66.7 % with an overall quality of life of ≤ 6.5 points, which reflected the negative impact of adolescents asthma on the quality of life and lack of complete asthma control. This was confirmed in 7 out of 24 people (29.2 %) in an additional bronchodilatory test with a combined bronchodilator, in which they gave a positive response (increase in FEV1 ≥ 12.0 %; r = -0.4, p = 0.02). The reasons for the decrease in the overall quality of life of ≤ 6.5 points in the remaining 17 adolescents were due to psychoemotional states or vegetative-vascular dysfunction, and not to the latent course of «latent» bronchospasm. As a result, among 43 adolescents, 14 patients or 32.6 % with «latent» bronchospasm were found. At the same time, the relative risk of a positive patient response to a bronchodilator test with a combined bronchodilator was 2.1 times higher than during a bronchodilator test with salbutamol (OR = 2.1, 95 % CI 1.1–7.0). Conclusions. Conducting bronchodilatory tests with bronchodilators of various pharmacological groups and questioning patients using the PAQLQ questionnaire on the quality of life makes it possible to establish cases of «latent» bronchospasm even with a negative response to salbutamol, when there are no clinical and anamnestic signs of insufficient asthma control and the FEV1 index exceeds 80.0 % of proper values. Keywords: adolescents, bronchial asthma, control, bronchospasm.

Инородные тела дыхательных путей — достаточно частая и опасная проблема в педиатрии. По данным литературы, 70 % от всех случаев составляют инородные тела бронхов, чаще всего — правого (до 80 %). Диагностика основывается преимущественно на анамнестических данных и клинических проявлениях, характерных для того или иного вида обструкции. Рентгенологические исследования проводятся во всех случаях подозрения на инородное тело, но рентгеноконтрастными они бывают не более чем в 20 % случаев. То есть если факт аспирации был забыт или незамечен, постановка диагноза затрудняется, особенно при инородных телах мелких бронхов, которые долгое время себя никак не проявляют. Клинические признаки уже появляются, когда в этом месте развивается хроническое воспаление с гнойным процессом, что приводит к появлению осложнений — бронхоэктазов, фиброза или легочного кровотечения. При этом лечение часто только оперативное. Для наглядности представляем клинический случай поздней диагностики инородного тела мелкого бронха у ребенка подросткового возраста. Его особенности: отсутствие анамнестических данных об аспирации, относительно взрослый возраст ребенка, рентгенонеконтрастность инородного тела, нетипичное размещение, сохраненная вентиляция легких на поврежденном участке. Данный случай лишний раз подчеркивает необходимость настороженности педиатров в отношении этой патологии у детей любого возраста. Единственным надежным методом ранней диагностики инородных тел дыхательных путей является трахеобронхоскопия.