URTICARIAL VASCULITIS IN CHILDREN

URTICARIAL VASCULITIS IN CHILDREN O. M. Оkhotnikova, O. A. Oshlyanskaya Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine Abstract. Different autoimmune diseases can present with organs malfunctioning and chronic urticaria symptoms in particular such urticarial vasculitis. This variant of vasculitis can be a separate nosological form, which includes a rare disease as hypocomplementemic urticarial vasculitis syndrome. In addition to chronic urticaria symptoms, hypocomplementemic urticarial vasculitis syndrome is characterized by severe systemic manifestations in different organs, decreased serum level of complement components, and appearance of specific markers, such as anti-C1q-antibodies. The diagnosis is confirmed by the results of skin biopsy, which is the «gold standard» of diagnosis. The condition often requires combined treatment with two immunosuppressive drugs. Hypocomplementemic urticarial vasculitis syndrome is a very rare disease, but, because of the multisystem manifestations, it can be encountered by any specialist (pediatrician, general practitioner, allergist, rheumatologist, ophthalmologist, dermatologist, nephrologist, etc.), therefore doctors should consider this condition when dealing with such patients in order to reduce the risk of hypocomplementemic urticarial vasculitis syndrome misdiagnosis as the variants of chronic urticaria or another immunopathogenetic disease. That is why doctors should be well aware of the features of the course of this disease, not only to reduce the likelihood of erroneous diagnosis of urticarial vasculitis as chronic urticaria or another disease of immunopathological genesis, but also because modern therapy of these conditions is radically different from each other: сhronic idiopathic urticaria requires adherence to a modern patient management algorithm with the initial use of H1-antihistamines with a possible increase in the dose (up to a 4-fold increase), and with their low efficiency — the transition to the use of cytostatics, monoclonal antibodies against immunoglobulin E –omalizumab, and is extremely limited and only for short-term use of glucocorticosteroids. Key words: urticarial vasculitis, its forms, hypocomplementemia, chronic urticaria, children. Olena Okhotnikova MD, PhD, professor, Head Department of Pediatrics #1, Shupyk National Healthcare University of Ukraine, 9, Dorogozhytska str., 04112, Kyiv, Ukraine e-mail: [email protected] Аsthma and Allergy, 2021, 3, P. 16–29.

IMPACT OF THE TREATMENT WITH COMBINATION OF TIOTROPIUM/OLODATEROL ON THE QUALITY OF LIFE IN PATIENTS WITH COPD

IMPACT OF THE TREATMENT WITH COMBINATION OF TIOTROPIUM/OLODATEROL ON THE QUALITY OF LIFE IN PATIENTS WITH COPD K. D. Dmytriiev Vinnytsia National Pirogov Memorial Medical University Vinnytsia, Ukraine Abstract. Materials and methods. 100 patients with the diagnosis of COPD were included into the study, their average age was (64.09 ± 1.94) years, there were 66 men (66 %) and 34 women (34 %). The average duration of COPD was (9.35 ± 2.42) years. Clinical course of COPD was assessed based on the clinical documentation of the patients. All patients filled out questionnaires for the assessment of the COPD severity — mMRC and CAT; and quality of life — SF-36, SGRQ at visit 1, visit 2 (4-6 weeks) and visit 3 (1 year). Results. Treatment with combination of tiotropium/olodaterol reliably improve COPD course, by decrease in the amount of exacerbations from (2.63 ± 0.29) to (1.63 ± 0.21) and hospital admissions from (1.2 ± 0.2) to (0.37 ± 0.11); dyspnea severity according to mMRC questionnaire from (2.3 ± 0.14) to (1.87 ± 0.15); САТfrom (23.28 ± 1.71) to (15.77 ± 1.58). Treatment with combination of tiotropium/olodaterol reliably improve quality of life according to SF-36 questionnaire, specifically physical and emotional role functioning from (16 ± 5.57) % to (35.10 ± 7.15) % and from (27.35 ± 7.83) % to (50.29 ± 7.99) %, exerted vitality from (38.26 ± 3.86) % to (49.49 ± 3.7) %, mental health from (51.56 ± 3.76) % to (61.49 ± 3.59) %, social functioning from (57.61 ± 5.93) % to (69.22 ± 5.08) % and pain intensity from (66.92 ± 5.99) % tо (81.00 ± 4.17) %. Treatment with combination of tiotropium/olodaterol reliably improve quality of life according to SGRQ questionnaire, specifically «Symptoms» scale from (76.72 ± 3.85) tо (61.37 ± 4.59), «Activity» from (65.26 ± 4.18) to (51.97 ± 3.86), «Impact» from (52.36 ± 4.65) to (35.19 ± 4.25) and Total score from(60.31 ± 3.95) tо (44.62 ± 3.89). Conclusions. Combination of tiotropium/olodaterol showed its efficacy in real clinical practice. This combination is effective in the improvement of the clinical course of COPD and decrease of symptoms intensity, which is also accompanied by the improvement of the quality of life. Key words: COPD, quality of life, tiotropium/olodaterol. K. D. Dmytriiev Vinnytsia National Pirogov Memorial University Department of the Propedeutics of Internal Medicine PhD student str. Khmelnytske highway 96, 20129, Vinnytsia, Ukraine e-mail: [email protected] Аsthma and Allergy, 2021, 3, P. 36–42.

CURRENT ISSUES OF BRONCHIAL ASTHMA 2021: WORLD ASTHMA DAY AND THE IMPACT OF THE COVID-19 PANDEMIC

This year’s World Asthma Day has the theme “Uncovering Asthma Misconceptions”. This position calls for action and action to clarify common myths and misconceptions about asthma that prevent asthma sufferers from receiving optimal benefits from major success in treating the condition. According to GINA experts, the most common mistakes in the world about asthma are as follows: 1. Myth: asthma is a childhood disease; people “outgrow” it as they age. True: asthma can occur at any age. 2. Myth: Asthma is an infectious disease. Truth: asthma is not contagious disease. 3. Myth: People with asthma should not exercise. Truth: When asthma is well controlled, individuals with asthma can exercise and achieve high performance in sports. 4. Myth: asthma can only be controlled with high doses of steroids. Truth: Most often, asthma is controlled with low doses of inhaled steroids. To a large extent, these theses refer to one of the most important challenges of our time — the management of patients with bronchial asthma in the context of the COVID-19 pandemic. Patients with asthma have a lower susceptibility to COVID-19, a less severe course, and a lower risk of hospitalizations due to COVID-19. Allergic asthma or its eosinophilic phenotype, intake of inhaled corticosteroids (ICS) have a positive effect on the course of the COVID-19 disease, since in such patients the lower expression level of ACE 2 receptors in the upper and lower respiratory tract, which are input receptors for SARS-CoV-2 virus. ICS such as budesonide or ciclesonide are capable of inhibiting the replication of genomic SARS-CoV-2 RNA due to the influence of viral endonuclease NSP15 and TMPRSS2 (transmembrane serine protease 2), a protease involved in viral entry into the cell. Some ICS (including budesonide) reduce or block SARS-CoV-2 replication in vitro. Experts from international asthma groups note that in the face of the COVID-19 pandemic, asthma patients should continue to take basic therapy, including corticosteroids. And in current studies, ICS budesonide in COVID-19 patients reduces the risk of hospitalization or emergency care by 91 % and significantly improves clinical recovery. Key words: bronchial asthma, COVID-19, inhaled corticosteroids, World Asthma Day.

SENSITIZATION TO PET ALLERGENS AMONG THE PATIENTS OF AALERGOLOGIC CLNIC

SENSITIZATION TO PET ALLERGENS AMONG THE PATIENTS OF ALLERGOLOGIC CLINIC M. A. Lykova Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine KIA «Forpost», Kyiv, Ukraine Abstract. The aim: to study the prevalence and structure of sensitization to pet allergens among patients of the allergy clinic. Material and methods of research. The results of a multiplex study (determination of specific IgE to 112 allergenic proteins using the ImmunoCap ISAC test system) in 553 patients who came to the immunology and allergology clinic "Forpost" with complaints of respiratory and / or skin manifestations of allergopathology were analyzed. Results. Sensitization to animal allergens was found in 46.1 % of children of group 1 (0–6 years), 62.8 % of children of group 2 (7–18 years) and 42.6 % of adults. Most patients of all ages (96 %) were also sensitized to other (food and / or inhalation) allergens. In all groups of subjects, sensitization to cat allergens prevailed (44.6 % of all animals sensitized to allergens in the group of children 0–6 years, 43.4 % in the group of children 7–18 years, and 42.7 % in the group of adults) and dogs 12.3 %, 6.6 % and 17.7 % respectively). In all age groups, sensitization to the main cat allergen Fel d1 (uteroglobin) prevailed, in children age groups lipocalin also caused a high frequency of sensitization, in particular Can f1 and Fel d4, while in the adult group the frequency of sensitization to prostatic falkrelin canine was in second place. Conclusions. Animal allergens, especially cats and dogs, play an important role in the development of allergic diseases. Most patients with sensitization to one animal species have specific IgE to cat or dog proteins, suggesting that sensitization to horse and mouse allergens may be more frequent due to cross-reactivity. In the structure of sensitization, the most common allergen in all age groups is the major cat allergen Fel d1. In the younger age group, serum albumin is also important, and in adults — prostatic kallikrein Can f5, which should be considered when choosing the appropriate allergen molecules for diagnosis in patients with hypersensitivity to animal allergens before allergen-specific immunotherapy. Key words: hypersensitivity, sensitization, animal allergens, allergic rhinitis, bronchial asthma. Maryana A. Lykova Shupyk National Healthcare University of Ukraine Post-graduate student of the department of phthisiology and pulmonology, KIA «Forpost», physician allergist-immunologist 10, M. Amosova str., 03038, Kyiv, Ukraine, [email protected] Аsthma and Allergy, 2021, 3, P. 43–49.

COVID-19 TREATMENT GUIDELINES FOR HOSPITALIZED PATIENTS AT ST. VINCENT’S MEDICAL CENTER, A LICENSED 473-BED COMMUNITY TEACHING HOSPITAL WITH A LEVEL II TRAUMA CENTER IN THE UNITED STATES

КЕРІВНИЦТВО З ЛІКУВАННЯ COVID-19 ДЛЯ ГОСПІТАЛІЗОВАНИХ ПАЦІЄНТІВ В ЛІЦЕНЗОВАНОМУ 473-ЛІЖКОВОМУ НАВЧАЛЬНОМУ МЕДИЧНОМУ ЦЕНТРІ СВ. ВІНСЕНТА З ТРАВМАТОЛОГІЧНИМ ЦЕНТРОМ ІІ РІВНЯ В СПОЛУЧЕНИХ ШТАТАХ АМЕРИКИ В. Клименко1 , Х. Мупуру1 , А. Алві1 , М. Морель1 , Н. Дятлова2 , М. Еліас1 , Д. Регелманн1 1 Медичний центр Святого Вінсента, Медична допомога Гартворда, Бріджпорт, СТ (США); 2 Програма Резидентури Внутрішньої Медицини Чиказької Медичної Школи в Північно-Західній Лікарні Мак-Генрі, Мак-Генрі, Іллінойс, США Резюме. Мета публікації — обговорення власного досвіду для підвищення ефективності медичної допомоги пацієнтам з коронaвірусною інфекцією. У статті представлено покази для госпіталізації, основні принципи спостереження і терапії хворих з інфекцією COVID-19 у великій університетській клініці США (St. Vincent's Medical Center, штат Коннектикут). В основу гайдлайну покладені дані досліджень RECOVERY, ACTT-1, SOLIDARITY, EMPACTA, REMAP-CAP, BLAZE-1, BLAZE-4. Розглянуто питання противірусної, імуносупресивної, протизапальної, антикоагулятної терапії, застосування моноклональних антитіл. Ключові слова: COVID-19, керівництво, лікування, США. Valeriia Klymenko, MD — medical resident, PGY-2, Tel: +15512578615, email: [email protected], Астма та Алергія, 2021, № 3, С. 50–55.

RHINITIS MEDICAMENTOSA: PRINCIPLES OF DIAGNOSIS AND TREATMENT

RHINITIS MEDICAMENTOSA: PRINCIPLES OF DIAGNOSIS AND TREATMENT Ye. Bogomolov1, S. V. Zaikov2, S. O. Zubchenko3 1 National Pirogov memorial medical university, Vinnitsya, Ukraine 2 Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine 3 Danylo Halytsky Lviv National Medical University, Lviv, Ukraine Abstract. Nasal congestion is a common symptom that affects up to 30 % of the world’s population. Uncontrolled intake of nasal decongestants to relieve nasal congestion leads to rhinitis medicamentosa (RM), a subtype of drug-induced rhinitis, which is a chronic dysfunction of the nasal mucosa due to prolonged use of local vasoconstrictors. RM occurs with equal frequency in men and women, but is more common in young and middle-aged adults, and the described incidence into laryngological clinics ranges from 1 % to 7 %. In Ukraine, the problem is not statistically studied, but almost 2 billion hryvnias were spent by Ukrainians on the purchase of 40 million packages of decongestants per year (August 2019 — July 2020), which means that every Ukrainian, including newborns, used at least 1 package of this drug. The main diagnostic criteria for RM, in addition to detecting the presence of nasal obstruction (hyperemia, edema of the nasal mucosa with disorders of nasal breathing and nasal congestion) and reduction of edema of the nasal mucosa with the use of vasoconstrictors, are indications of a history of long-term nasal decontamination. The only drugs whose efficacy in RM has been proven not only in experimental but also in clinical randomized placebo-controlled studies are intranasal glucocorticoids (GCS). Currently, intranasal GCS are considered the most effective drugs available for the treatment of RM. Key words: rhinitis medicamentosa, nasal congestion, nasal decongestants.

EFFICACY OF PROTON PUMP INHIBITORS IN CHILDREN WITH ASTHMA COMBINED WITH GASTROESOPHAGEAL REFLUX DISEASE AND REFLUX ESOPHAGITIS

EFFICACY OF PROTON PUMP INHIBITORS IN CHILDREN WITH ASTHMA COMBINED WITH GASTROESOPHAGEAL REFLUX DISEASE AND REFLUX ESOPHAGITIS Yu. G. Antipkin, V. F. Lapshin, T. R. Umanets, А. А. Buratynska, N. G. Chumachenko, L. S. Stepanova, S. I. Tolkach O. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine Abstract. The most common comorbid pathology in children with asthma is gastroesophageal reflux disease associated with reflux esophagitis, which ranges from 32 % to 80 %. To date, the effectiveness of proton pump inhibitors in this category of children and their effect on the level of asthma control remains controversial. The aim is to study the effectiveness of treatment with proton pump inhibitors in children with asthma, combined with gastroesophageal reflux disease and reflux esophagitis. Materials and methods. Forty-six children aged 6–17 years with asthma combined with gastroesophageal reflux disease and reflux esophagitis were examined. They were taking omeprazole 20 mg once daily for 4-8 weeks to control the symptoms of gastroesophageal dysfunction. Criteria for the effectiveness of the prescribed treatment were the dynamics of symptoms of gastroesophageal reflux disease and the level of asthma control, which were assessed at 4 and 8 weeks of treatment. Assessment of symptoms of gastroesophageal reflux disease was performed according to the questionnaire. The degree of control of asthma was determined using the Asthma Control Test. Results and discussion. There was a complete regression of symptoms of gastroesophageal reflux disease after 4 weeks of treatment with omeprazole in 40 (87.0 %) patients. Only 6 (46.2 %) patients with severe asthma had episodic symptoms of gastroesophageal dysfunction after 4 weeks of omeprazole treatment that were not recorded at 8 weeks of treatment. An increase in the number of children with controlled asthma was observed with omeprazole treatment, but no significant difference was found. Conclusions. Proton pump inhibitors are effective in controlling the symptoms of gastroesophageal reflux disease in children with asthma, but not likely in the short-term level of asthma control. Key words: asthma, treatment, children, reflux esophagitis, gastroesophageal reflux disease.

VENTILATION AND DIFFUSIONAL DISORDERS IN PERSONS AFTER COMMUNITYACQUIRED PNEUMONIA, ASSOCIATED WITH CORONAVIRUS DISEASE (COVID-19). POSSIBILITIES OF INHALATION THERAPY

VENTILATION AND DIFFUSIONAL DISORDERS IN PERSONS AFTER COMMUNITYACQUIRED PNEUMONIA, ASSOCIATED WITH CORONAVIRUS DISEASE (COVID-19). POSSIBILITIES OF INHALATION THERAPY T. O. Pertseva, L. I. Konopkina, K. O. Bielosludtseva, O. O. Shchudro, K. V. Fuhol Dnipro State Medical University, Dnipro, Ukraine Abstract. The aim of the study was to evaluate the results of our own observations of persons after communityacquired pneumonia associated with coronavirus disease (COVID-19), to determine options of functional disorders that may be observed in the post COVID-19 period, and to justify the possibility of inhalation therapy in patients with certain clinical symptoms in the post COVID-19 period, and demonstrate its effectiveness. Materials and methods. The results of our own observations are presented in the form of descriptions of ten clinical cases of functional state of the respiratory system in persons after community-acquired pneumonia associated with COVID-19. Conclusions. At the end of the acute period of COVID-19, the ventilatory function of the lungs in patients may be different: normal, with restrictive disorders (varying degrees of severity), with obstructive disorders (usually mild), with mixed disorders (without prevalence of certain types of changes, or with prevalence, most often, restrictive disorders). In this case, impaired diffusion capacity of the lungs is an extremely common phenomenon. Most likely, in COVID-19 in a certain category of patients, not only interstitial lung tissue but also bronchial tree tissue (mucous membrane, submucosal layer, muscles, vessels) may be involved in the pathological process. It is possible that this process may be of autoimmune origin. If there are bronchoobstructive disorders in the post COVID-19 period, patients should be prescribed bronchodilator therapy; long-acting β2 -agonists, in particular formoterol, may be the drugs of choice. If there is a long-term recovery of lung tissue structure, given that coronavirus disease is an autoimmune disease, the use of inhaled corticosteroids should be considered individually. The combined drug Bufomix Easyhailer® , prescribed according to the indications, has shown good efficacy and safety in the management of the patient in the post COVID-19 period. Key words: coronavirus disease; COVID-19; pneumonia, associated with COVID-19; post COVID-19 period; spirometry; diffusion lung capacity of carbon monoxide; DLCO.

THE EFFICACY OF COMBINED THERAPY IN PATIENTS WITH NEUTROPHILIC BRONCHIAL ASTHMA

THE EFFICACY OF COMBINED THERAPY IN PATIENTS WITH NEUTROPHILIC BRONCHIAL ASTHMA Yu. I. Feshchenko, L. A. Iashyna, G. L. Gumeniuk, V. I. Ignatieva, M. A. Polianska, S. G. Opimakh, I. V. Zvol, S. M. Moskalenko, N. A. Vlasova, L. A. Halai State organization «F. G. Yanovsky National institute of phthisiology and pulmonology National Academy of medical sciences of Ukraine» , Kyiv, Ukraine Abstract. Background: Issues of neutrophilic bronchial asthma remain unresolved and the investigations of the pathogenesis and treatment of this disease endotype are currently continuing. The aim of the study: This study aimed to develop the technology of the treatment of the neutrophilic asthma with the use of available drugs in Ukraine. Methods. The study involved 30 patients with neutrophilic asthma. The first (control) group consisted of 15 patients who received standard therapy with a combination of budesonide and formoterol. The second (main) group consisted of 15 patients who received the treatment according the technology (ultrafine beclomethasone dipropionate, formoterol, tiotropium bromide and additionally for the first 10 days — inhalation of 10.0 % acetylcysteine solution through a nebulizer). All patients were surveyed with the Asthma Control Test (ACT), the Asthma Control Questionnaire (ACQ). The quality of life of patients was assessed by a St. George’s Respiratory Questionnaire. All patients underwent spirometry and a 6-minute walking test (6MWT). Results: In the prescription of complex therapy to patients with neutrophilic asthma clinical and functional efficacy was achieved in 93.3 % of patients. There were observed statistically significant increase in the ACT from (14.3 ± 1.3) to (20.3 ± 0.8) points (p < 0.05), a decrease in the ACQ from (2.3 ± 0.2) ) to (1.1 ± 0.1) points (p < 0.05), clinically significant reduction in the number of symptoms from (71.4 ± 5.6) points to (51.3  5.0) points, p < 0.05 according to the results of the St. George’s Respiratory Questionnaire, and a statistically significant increase in MEF50 from (28.9 ± 4.5) % to (41.6 ± 4.2) %, p < 0.05, MEF25 — from (19.1 ± 2.9) % to (27.6 ± 2.6) %, p < 0.05 and FEV1 /FVC from (67.2 ± 3.5) % to (76.1 ± 2.3) %, p < 0.05 after 3 months of complex treatment, as well as a statistically significant increase in the number of meters passed in the 6MWT from (266.3 ± 16.2) m to (312.0 ± 14.4) m, p < 0.05, reduction of shortness of breath on the Borg scale before test from (2.5  0.3) points to (1.5 ± 0.1) points, p < 0.05 and after the test — from (4.1 ± 0.3) points to (3.1 ± 0.3) points, p < 0.05. Conclusions: The technology of treatment of patients with neutrophilic asthma allows to improve the control of the asthma symptoms and quality of life of the patients, bronchial patency at the small airways and reduce fixed bronchial obstruction, as well as increase exercise tolerance. Key words: bronchial asthma, neutrophilic inflammation, combined therapy.