Acute respiratory tract infections accompanied by cough play a significant role in respiratory pathology in childhood. The incidence of acute respiratory infections among children is 4–5 times higher than among the adult population and accounts for more than 90% of all infectious and parasitic diseases registered in Russia. The highest rates of acute respiratory infections are observed among children of preschool age, especially in the first three years of life. As in adults, children’s cough, described as a symptom of «upper respiratory infection» or «acute bronchitis», is the most commonly diagnosed acute manifestation in primary care. These 2 diagnoses represent 75% of all cough cases. The most common etiological agents in acute bronchitis are respiratory viruses: adenovirus, influenza viruses and parainfluenza viruses, respiratory syncytial virus, rhinovirus, human Bocavirus, Coxsackievirus, herpes simplex virus, etc. Drug therapy for coughing is prescribed when there is a nonproductive cough that does not perform its protective function, meaning it does not contribute to the purification of the respiratory tract, and is aimed at dilution of sputum, reducing its adhesiveness (viscosity) and thus increase the effectiveness of coughing. The main groups of mucoactive drugs that are usually considered in this case are mucolytics, mucoregulators, mucokinetics, expectorants, and combination drugs. Combination drugs created to eliminate various elements of pathogenesis of respiratory diseases, accompanied by a nonproductive cough and bronchoobstruction, deserve close attention due to the possibility of using several active substances in fixed drug combinations with accurate dosages and proven clinical effectiveness, reducing the number of simultaneously taken drugs, reducing the risk of developing undesirable events. Oral administration of combined medicines becomes especially important in conditions when inhalation therapy is impossible.

COVID-19 у детей с бронхиальной астмой: клинические проявления, варианты течения, подходы к терапии 1 Федеральное государственное автономное образовательное учреждение высшего образования Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет), 119991, г. Москва, Российская Федерация 2 Государственное бюджетное учреждение «Детский бронхолегочный санаторий № 15 Департамента здравоохранения города Москвы», 117647, г. Москва, Российская Федерация 3 Государственное бюджетное учреждение здравоохранения Московской области «Детский клинический многопрофильный центр Московской области», 141009, г. Мытищи, Российская Федерация Резюме Введение. Бронхиальная астма (БА) -одно из самых распространенных хронических заболеваний легких у детей. В начале пандемии COVID-19 БА, как и другие заболевания легких, считалась фактором риска тяжелого течения COVID-19.Цель исследования -анализ основных клинических проявлений COVID-19 у детей с БА.Материал и методы. Проведено анкетирование 500 детей с БА, наблюдавшихся в пульмонологическом отделении УДКБ Сеченовского Университета с января 2020 г. по январь 2021 г., из которых COVID-19 болели 3 % (15 детей). Кроме того, проанализирована клиническая картина COVID-19 у 75 детей с БА и 53 детей без БА, наблюдавшихся амбулаторно и в пульмонологическом санатории № 15 ДЗ г. Москвы.Результаты. Показано, что симптомы COVID-19 могут быть схожи с симптомами обострения астмы и проявляться сухим кашлем, одышкой и повышением температуры, которое может наблюдаться и при обострениях астмы на фоне респираторной инфекции любого генеза.Заключение. На основании фактического клинического материала было показано, что новая коронавирусная инфекция протекает у детей легче, а у пациентов с БА среди заболевших -с менее выраженными клиническими симптомами.

Introduction. Cough is the most common manifestation of respiratory infections of the upper and lower respiratory tract and indicates impaired mucociliary clearance. The cause of cough must be determined to choose the management tactics for children with cough. The most commonly used mucoactive drugs liquefy sputum as a result of a direct action of the components on the tracheobronchial secretion and/or mucosa of the respiratory tract. Given the mucoactive effect of hypertonic salines, we conducted an open clinical study of the effectiveness of 3% hypertonic saline with hyaluronic acid in acute bronchitis in children.Aim of the study. To evaluate the clinical effect of 3% hypertonic saline with hyaluronic acid in acute bronchitis in children.Materials and methods. Clinical efficacy and safety of 3% hypertonic saline with hyaluronic acid in 50 patients aged 3 to 12 years old with acute bronchitis were evaluated in the dynamics on the 1st, 3rd, 7th days of treatment with the score assessment of symptoms (cough, stuffy nose, auscultation data) and an indication of adverse events (if any).Results. Improvement of condition was noted in most patients by the 3rd day of therapy (mean score 1.88 ± 0.3), temperature normalized in all patients, manifestations of rhinitis decreased. By the 5th day of treatment, the intensity of cough did not exceed 1 point in all patients (0.7 ± 0.14 points). According to the patient’s diary data, by the 7th day of treatment 74% of the children had no cough. On the 7th day of treatment, some children had a rare residual cough (0.36 ± 0.06 points), minor rhinitis (0.16 ± 0.1 points). No rales were heard in the lungs in all patients, rigid breathing was heard in 11 patients (mean score 0.22 ± 0.05).Conclusions. The conducted study demonstrated that 3% hypertonic saline with hyaluronic acid is an effective drug in the treatment of cough in acute bronchitis in children.

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Bronchial asthma is one of the most common chronic lung diseases observed in children. According to the international and Russian guidelines, the long-term objectives of asthma treatment in children and adolescents are to achieve good symptom control, minimize the risk of asthma exacerbations, reduce hospital admissions, decrease the use of short-acting bronchodilators, reduce restrictions in the airflow and side effects, and ensure that normal activity levels are maintained. The asthma treatment is based on the use of inhaled corticosteroids as a backbone therapy and addition of adjunctive therapy if the disease control is poor or worsening. Tiotropium bromide is the first anticholinergic drug that has been approved for children and adults with poorly controlled asthma and is currently used as a treatment option for moderate to severe bronchial asthma. Randomized clinical trials in children and adolescents with persistent bronchial asthma showed high efficacy and safety of tiotropium. The addition of tiotropium in the form of 2 inhalations of 2.5 μg once a day to the bronchial asthma therapy in children over 6 years old, including medium doses of inhaled corticosteroids, is a preferred and safe option to increase the therapy coverage compared to an increase of a dose of inhaled corticosteroids to high levels, regardless of the disease phenotype (In atopic, non-atopic bronchial asthma, bronchial asthma with obesity, etc.). Tiotropium adjunctive therapy may also be a therapeutic option for children using inhaled corticosteroids, who have asthma that does not respond well to long-acting β2-agonist therapy, or for those, who are worried about the safety of long-acting β2-agonists.