Bronchial reactivity to inhaled hypertonic saline solutions in children with cystic fibrosis

Abstract

Background. Inhaled hypertonic saline solutions (IHSS) are included in the list of mandatory prescriptions in the treatment of cystic fibrosis (CF). However, some patients with CF may develop bronchial hyperreactivity (BHR), which may be the cause of violation of the treatment protocol. The purpose is to study the state of bronchial reactivity to IHSS and its dependence on the clinical, functional and microbiological features of CF course in children. Materials and methods. Forty children with CF were examined. All of them underwent general clinical, molecular genetic, laboratory and microbiological examination. Instrumental methods included spirometry, measurement of fractional exhaled nitric oxide, X-ray and computer tomography of the chest. To determine the individual tolerance of inhalations of hypertonic sodium chloride solution (HSCS), the research protocol proposed by E.P. Dellon et al. was used. Results. According to the results of the research protocol, 17 (42.5 %) patients with CF had BHR to HSCS. The highest frequency of BHR was found in children with a severe CF course. There was no dependence of BHR in CF patients on allergic pathology and a burdened allergic history. Assessment of the tolerance of HSCS before prescribing basic therapy is important. Early functional signs of BHR, which may require the preventive administration of short-acting β2-agonists when using HSCS in children with CF, are as follows: reduction in forced expiratory volume in 1 second by 7 % and maximal expiratory flow at 25 % by 6 % when using 3% HSCS. Conclusions. The presence of BHR in patients with CF may interfere with adequate basic therapy by inhalation. The prescription of IHSS to patients with CF should be personalized with the determination of individual sensitivity of a person to predict a positive therapeutic effect.

Predicting the tolerability of inhalation therapy as a stage of a personalized approach in the treatment of children with cystic fibrosis

“…The results of foreign studies and our own experience show that approximately half of patients with CF have BHR to HS, which is characterized by airway obstruction, shortness of breath, wheezing, and cough [4,7]. It has been found that BHR complicates the course of the bronchopulmonary process -it leads to the intensification of the infectious process and the formation of a vicious circle (obstruction-infection-inflammation with damage to lung tissues).…”

“…A clinical manifestation of a vicious circle is a progressive decrease in the functional parameters of breathing [3]. For a long time, BHR was considered the leading pathophysiological mechanism in the development of bronchial asthma, however, today BHR plays an important role in the deve lopment of bronchial obstruction syndrome in patients with CF [4,13]. The determinants of BHR in CF differ that of bronchial asthma and are not yet fully understood.…”

“…Considering the features of the basic therapy for chronic inflammatory bronchopulmonary process in CF, which includes almost daily inhalation of pharmacological drugs (mucolytics, hypertonic saline (HS), antibiotics), determining their tolerability is relevant in practice. As defined earlier, the tolerability of inhalation therapy depends on the genotypic and phenotypic characteristics of the course of the disease (including the level of bronchial sensitivity), comorbid conditions [2][3][4]. When prescribing basic CF therapy, a practicing physician should take into account the possibility of reducing the effectiveness of therapy due to the presence of the phenomenon of bronchial hyperreactivity (BHR) [5,6].…”

“…Among them, the most common trigger is HS, which is part of the treatment protocol for patients with CF [7][8][9]. BHR to inhaled HS is quite common (from 10 to 50 % according to various studies) in CF patients, manifests itself in various symptoms (sore throat, difficulty breathing, spastic cough, hyperactive secretion of induced sputum, auscultative signs of broncho-obstruction) and can interfere with adequate implementation of basic therapy by the inhalation method [3,4,8]. The presence of BHR in CF patients depends on many factors, including severity of the course of the disease, damage to the bronchopulmonary system, chronic colonization of the respiratory tract by Pseudomonas aeruginosa, allergic bronchopulmonary aspergillosis (ABPA) [10,11].…”

Психолого-Педагогічні Аспекти Профілактики Тютюнопаління Серед Учнів У Професійній Діяльності Вчителя

“…Про рівень і тенденції поширення та профілактику тютюнопаління серед учнівської молоді України зазначається у працях таких науковців, як О. В. Добрянської, Н. С. Польки, О. В. Бердник [7], Л. Гармаш і Л. Товкун [5], О. В. Грузєвої [6], С. І. Ільченко, А. О. Фіалковської, С. Г. Іванус [8], О. М. Балакірєвої, Т. В. Бондар, Н. О. Рингач, Т. І. Андреєвої [4], К. С. Красовського, В. Захожи, Н. Король [1; 2]. Г. О. Латіної, Г. Л. Заікіна, М. М. Завадської [13], О. О. Кваши, І. М. Горбась, І. П. Смирнової [9], В. П. Мельник, О. О. Панасюк, О. О. Петренко [14] та ін.…”