Prognostic Significance of Factors Influencing the Course of Bronchoobstructive Syndrome in Early Childhood

The dissertation is devoted to the study of the prognostic significance of factors influencing the course of bronchoobstructive syndrome in early childhood. The research focuses on a comprehensive analysis of clinical, biochemical, and immunological indicators that allow for the assessment of the severity and type of bronchial obstruction in children of the first three years of life. Special attention is given to changes in the lipid spectrum in blood serum and erythrocyte membranes, as well as immune status indicators depending on clinical forms and disease severity.

The work is aimed at identifying the most significant prognostic factors of bronchoobstructive syndrome and determining their role in the development of recurrent disease. The obtained results are intended for use in pediatric practice for predicting the severity of obstruction and planning timely correction of identified deviations. The research results have been implemented in the work of children's specialized centers and are used in the educational process at pediatric departments.

Relevance of the problem.

Respiratory diseases occupy one of the leading positions in the structure of childhood morbidity and mortality. Bronchoobstructive syndrome (BOS) is one of the most common forms of bronchial conductance impairment [162]. In the majority of patients, clinical signs of BOS most often arise against the background of respiratory infections, but recurrent episodes raise questions about the cause of the disease and the management strategy for the patient [26, 7, 124, 85, 34].

Age-specific features inherent in children of the first three years of life play a certain role in the development of bronchial obstruction.

Bronchial obstruction syndrome is not, in the strict sense, a nosological concept; it is a specific case of impaired bronchial patency. The occurrence of bronchial obstruction is the result of pathological changes: hypersecretion and dysfunction, impaired mucociliary clearance of bronchial and pulmonary contents, mucosal edema, and increased transudation of fluid into the bronchi. Bronchospasm is formed through stimulation of bronchial smooth muscle, hypersecretion of biologically active substances by mast cells and alveolar macrophages [162].

Of importance are contamination of inhaled air, certain pharmacological agents, and congenital anomalies [75, 76, 184, 186, 46, 180, 6, 7, 155, 73, 18, 19, 43].

Most methods of diagnosing external respiratory function disorders and studying pulmonary ventilation are designed for older children [255, 145, 72, 186, 44, 45]. The greatest difficulties in studying external respiratory function arise in children of the first four years of life, as they are unable to perform traditional respiratory maneuvers [146, 187, 56, 58]; therefore, the characterization of respiratory insufficiency in this category of patients is based on the assessment of clinical symptoms [185, 86, 87, 59].

Predictive methods are finding increasing application in pediatrics. The preventive orientation of healthcare makes the problem of predicting health status at the earliest stages of child development relevant, with a view to timely prevention of deviations. In recent years, the literature has seen a growing number of publications devoted to the study of various aspects of prediction [60, 65, 96, 141, 177]. In medico-biological prediction, two aspects can be distinguished: a population-level prognosis and individual prediction. From the physician's perspective, the greatest interest lies in the ability to compose individual prognoses.

A prognosis is a probabilistic, scientifically substantiated judgment about possible future states of an object [177, 52]. The predictive approach is particularly important in pediatrics [65, 96], whose primary task is not only to safeguard the child's life but also to maintain their health at a high level [28, 141]. To ensure harmonious development of the child, it is necessary to foresee what influence various factors acting in the past and present will have on their future condition [177, 65, 141]. From these positions, the predictive approach will contribute to the most effective organization of care for children and the preservation and strengthening of the health of the rising generation [131].

Despite numerous studies devoted to the problem of bronchial obstruction syndrome, questions regarding the dependence of severity on changes in certain immune status indicators and blood lipid profiles, as well as the prognostic significance of these indicators in the development of recurrent disease, remain insufficiently studied.

Research objective: based on a comprehensive analysis, to identify the most significant factors of bronchoobstructive syndrome and determine their prognostic significance.

Main research objectives:

1. To provide a clinical characterization of bronchoobstructive syndrome in children of early age depending on the severity of the course and the type of bronchial obstruction.

2. To study the values of lipid spectrum indicators in blood serum and erythrocyte membranes in children of early age with bronchial obstruction syndrome depending on clinical forms and disease severity.

3. To determine the significance of individual immunological blood indicators in children of early age with bronchial obstruction syndrome depending on clinical forms and disease severity.

4. To determine the prognostic significance of the studied indicators for the course of bronchoobstructive syndrome in children of early age.

Scientific novelty

A clinical characterization of bronchoobstructive syndrome in children of early age depending on the severity of the course and the type of bronchial obstruction has been provided.

For the first time, features of lipid spectrum indicators in blood serum and erythrocyte membranes in children of early age with bronchial obstruction syndrome have been identified, depending on the severity of the course and the type of obstruction. A characterization of immunological indicators in children of early age with bronchial obstruction syndrome depending on the severity of the course and the type of obstruction has been given.

For the first time, a dependence of the severity of bronchoobstructive syndrome and the type of bronchial obstruction on quantitative values of the lipid spectrum and phospholipids in blood serum and erythrocyte membranes in children of early age has been established.

For the first time, a dependence of the severity of bronchoobstructive syndrome and the type of bronchial obstruction on quantitative changes in individual immune indicators in children of early age has been established.

For the first time, the prognostic significance of clinical, biochemical, and immunological indicators in various types of bronchoobstructive syndrome in children of early age has been established.

Practical significance

The results of the dissertation research have substantial significance for pediatrics and practical healthcare as a whole.

The identified changes in the lipid spectrum in blood serum and erythrocyte membranes and immunological indicators should be used for assessing the severity and type of obstruction in bronchoobstructive syndrome in children of early age.

The comparison of clinical manifestations with the identified changes in lipid and immune status in bronchoobstructive syndrome in children of early age guides physicians toward a differentiated approach in the conduct of pathogenetic therapy. The calculated prognostic coefficients of individual clinical, biochemical, and immunological indicators can be used for assessing the severity and type of bronchial obstruction in children of early age.

Practical application of the results The research results can be used in pediatric practice for predicting the severity and type of obstruction in bronchoobstructive syndrome in children of early age, as well as for timely correction of these deviations. The lipid spectrum and immune status indicators identified by the author in children with bronchoobstructive syndrome have been implemented in the practice of physicians working in children's departments of the regional children's specialized center and the city children's clinical hospital named after G.K. Filippovsky. The research results are used in lectures to students of the 4th, 5th, and 6th years of the pediatric faculty at the departments of propedeutics of children's diseases and polyclinical pediatrics and children's diseases No. 1 of Stavropol State Medical Academy.

Scope and structure of the dissertation

The dissertation consists of an introduction, 5 chapters, a conclusion, findings, practical recommendations, and a bibliography listing 193 domestic and 122 foreign sources. The dissertation is presented on 130 pages of text and contains 27 tables.