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The goal of our research was to find out, whether asthma phenotyping, based on presence of accompanying allergic diseases is significant for asthma classification or not. Research was conducted on the basis of questioning of random and representative cohorts of Tbilisi children's population, by cross-section method of epidemiological research. Special extended screening questionnaire was developed for epidemiological study of allergic diseases. Diagnostic criterion for allergy was analyzed and representative cohort was selected. Research was conducted in 2010-2014 period. Studied population included 1450 children from 2 to 17 years age representing Tbilisi general population (of them, 850 girls and 600 boys). As a result of research the following findings were made: asthma was confirmed where at least two of the listed was present: diagnosis of asthma made by doctor, asthma symptoms and consumption of drugs against asthma. Allergic rhinitis was confirmed, where more than one of the listed symptoms was present and children should not have caught cold, rhinorrhea, nasal obstruction or snore, combined or IgE with some inhalation allergen. Atopic dermatitis was confirmed if the subject had atopic dermatitis at a time of interview or clinical study. Markers of asthma severity were based on number of asthma episodes and number of symptoms, or regular consumption of corticosteroids, number of missed days at school and answer of subjects to the question: for the past year what was the degree of discomfort attributable to asthma ("very high" - "absolutely not"). Allergic sensitization was assessed based on the skin prick-test and test of specific immunoglobulin E in serum and was deemed positive where the average diameter of blebs in skin prick tests was 3 mm larger than negative control and IgE-0,35kU/l. Lung function was assessed by means of respirometers, by evaluating maximal forced expiration data and flow-volume curves. Allergic rhinitis was regarded as the most common accompanying disease. Subjects with non-specific hyperresponsiveness of bronchi and asthma before age of 12, were classified only as being in remission and having accompanying allergic disease and subjects without obstruction and asthma were classified as absence of asthma and were designated as independent group. Population was divided into "active" (indicate presence of symptoms or are subjected to treatment) and "ever" (diagnosis was made before involvement into the study) groups. Main finding is identification of correlation between airways inflammation and phenotype accompanying asthma in children of age from 2 to 16. Research showed than of 860 children (398 males and 462 females) of age from 2 to 8, 62 children had asthma (17 females and 45 males) with at least accompanying disease. Of 590 children (311 males and 279 females) of age from 9 to 17, 81 children had asthma (26 females and 55 males) with at least accompanying allergic disease. The most common asthma phenotype was only asthma, in 32.8%, further asthma and allergic rhinitis (27.9%), asthma with allergic rhinitis and atopic dermatitis (13%), asthma with atopic dermatitis (4.9%). Asthma phenotypes did not differ significantly, with respect of asthma severity and need of anti-inflammation medication. Gender was notably correlated with only one phenotype of asthma; boys are more susceptible to asthma and allergic rhinitis, compared with the girls (9.5% boys and 4.9% girls) p=0.001. Lung function is significantly correlated with hyperresponsiveness of bronchi associated with asthma phenotype with the lowest FEV 2% data - in case of asthma, allergic rhinitis and atopic dermatitis. Our research showed than asthma in adults is accompanied with allergic rhinitis or atopic dermatitis (approximately 14.9%). In puberty, asthma phenotypes with allergic rhinitis was mostly associated with non-specific hyperresponsiveness of bronchi and airways inflammation (p0.05). In the combinations of allergic diseases the association of the phenotypes with gender was mostly found in males (p=0.001). |
