RU2407451C1 - Method of diagnosing bronchial asthma in children of early age using data of induces sputum cytology - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to clinical immunology and allergology, and can be used in pediatrics for diagnostics of bronchial asthma in children of early age. Method includes analysis of anamnesis data, estimation of clinical symptoms, as well as studying of allergologic status, which is carried out taking into account index of eosinophils in general blood test and level of general immunoglobulin E in blood serum. Additionally carried out is analysis of induced sputum with determination of eosinophil percentage in it. If said index is higher or equal 5%, it is considered to be main proof for diagnosis "bronchial asthma".

EFFECT: method allows for the first time to establish diagnosis of disease in children under 5 years old from group of risk on bronchial asthma development.

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Description

The invention relates to medicine, namely to clinical immunology and allergology, in particular to means for diagnosing bronchial asthma in children under 5 years of age, and can be used in pediatrics.

The complexity of the problem is as follows.

In 70-80% of cases, bronchial asthma makes its debut in young children and is characterized by high clinical variability. The widespread belief about a favorable prognosis of childhood asthma is not fully justified. If asthma manifests up to 3 years, then it is more severe. [Tatochenko V.K., 2004]. Bronchial asthma, which debuted in childhood, continues in 60-80% of cases in patients who have reached adulthood [Nat. program 2008; Tatochenko V.K., 2006].

Diagnosis of bronchial asthma in young children is based mainly on the history and assessment of clinical symptoms. A study of the function of external respiration in order to diagnose bronchial asthma in children of this age group is not carried out. Evaluation of the results of an allergological examination can help in identifying a causally significant allergen that provokes the development of bronchial asthma in a particular patient. [Nat. Program 2008; Global treatment and prevention strategy ..., 2006; Clinical recommendations. Pediatrics 2005-2006]. The timely diagnosis of bronchial asthma, including its mild forms, which often remain undiagnosed, is extremely important, children do not receive adequate therapy, and the disease becomes more severe with age. When diagnosing asthma in young children, it is important to exclude other causes of bronchial obstruction. Thus, in children aged 5 years and younger, additional studies may be required to diagnose bronchial asthma [Global treatment and prevention strategy ..., 2008; Furman E.G., 2006].

In addition, there are features of the course of bronchial asthma in young children.

Bronchial asthma in young children is often masked under such diagnoses as SARS with obstructive syndrome, recurrent bronchitis, obstructive bronchitis, bronchiolitis [Nat. Program 2008; Besh L.V., 2008]. The national program "Bronchial asthma in children ..., 2008" says that if episodes of obstruction in a child occur more than 2 times during the year, you should think about a possible debut of bronchial asthma. Although according to Tatochenko V.K. in some children, the first episodes of obstruction may already be the beginning of bronchial asthma (2004).

Broncho obstructive syndrome (bronchial obstruction syndrome) is a complex of clinical symptoms that develop as a result of a generalized narrowing of the lumen of the bronchi. Clinical manifestations (expiratory dyspnea, cough, initially dry or unproductive with hard expectorant sputum, and then moist) and physical data (boxed shade of percussion pulmonary sound, dry rales against the background of prolonged expiration auscultatory) [Korovina N.A., 2007; Tatochenko, 2006]. Bronchial obstructive syndrome is the main clinical manifestation of obstructive bronchitis.

The differential diagnosis of obstructive bronchitis and bronchial asthma, especially at the first manifestations, presents sufficient difficulties, which is associated with the same clinical picture, similar radiological, functional and laboratory (including immunological) changes [Nat. program 2008; Besh L.V., 2008; Geppe N.A., Kolosova N.G., 2006, Meshcheryakov V.V., 2006; Misernitsky Yu.L., 2005]. In this case, the diagnosis of bronchial asthma is also complicated by the fact that approximately 30% of children may not be burdened by heredity, there may be no signs of allergy at an early age, bronchial asthma will form more quickly in these children, since we do not take them into account [Kitarova G.S., 2006; Belan, 2006].

The results of long-term observations (4-8 or more years after hospitalization due to severe bronchial obstructive syndrome in ARI from one to 3 years of age) indicate that more than 50% of these children suffer from typical bronchial asthma that was not recognized in early age when it would be possible to influence the natural nature of the disease [Nat. Program 2008; Sejal Saglani 2007, Meshcheryakov V.V., 2006; Misernitsky, 2005]. Thus, only after years the picture of "obstructive bronchitis" acquires the features of typical bronchial asthma.

Given the existence of many recommendations, tables and indices for the differential diagnosis of bronchial asthma, we can conclude that the line between obstructive bronchitis and bronchial asthma remains uncertain [Nat. Program 2008; Besh L.V., 2008].

In addition to the difficulties of differential diagnosis of bronchial obstructive syndrome in children, there is another problem - the atypical course of bronchial asthma, its so-called cough form [Nat. Program 2008; Geppe N.A., 2006; Golevtsova Z.Sh., Bagisheva N.V., Ovsyannikov I.V., 2005]. In the early stages, bronchial asthma can be manifested by small signs - episodic or mainly nightly attacks of cough, periodically wheezing, shortness of breath during exercise [National Program 2008; Global strategy for the treatment and prevention of bronchial asthma ... 2006; Geppe N.A., 2006; Minkailov K.-M.O., Minkailov E.K., 2006; Meshcheryakov V.V., 2006; Lyapunov A.V., 2003; Gushchin I.S., 2002; Chuchalin A.G., Abrosimov V.N., 2000]. According to some authors, up to 86% of patients with bronchial asthma do not fall into the field of vision of pulmonologists due to the absence of typical seizures [Golevtsova Z. Sh., Bagisheva NV, Ovsyannikov IV, 2005].

Thus, the conclusion suggests itself that the urgent diagnosis of bronchial asthma is an urgent task of modern medicine, namely the identification of allergic inflammation of the respiratory tract in young children from the risk group for the development of bronchial asthma, i.e. suffering from allergic rhinitis, atonic dermatitis, recurrent obstructive bronchitis, often sick children and children with a persistent cough after a respiratory infection [Nat. Program 2008; Zaitseva O.V. 2008; Kozyritskaya D.V., Ogorodova L.M., Deev I.A. et al., 2007; Zabolotskikh T.V., Misernitsky Yu.L., Dorovskikh V.A. et al., 2005].

A known method for the diagnosis of atopic forms of bronchial asthma, presented in p. RF No. 2339951 for class. G01N 33/53.

The known method consists in the fact that lymphocytes are isolated from a venous blood sample, monoclonal antibodies CD23 and CD19 are simultaneously added to them, the mixture is incubated at room temperature, the number of cells with a label (CD19) and cells with a double label (CD19CD23) are counted on a flow cytometer, calculate the index of allergic inflammation according to the formula: ((CD19CD23) / (CD10)) × 100% and with an index greater than 70%, the atopic form of bronchial asthma is diagnosed.

The disadvantages of this method are its limited operational capabilities, since it is invasive, time-consuming, expensive, it cannot be routinely used as a screening diagnostic method and it is suitable only for the diagnosis of atopic form of bronchial asthma.

There is a method of differential diagnosis of bronchial asthma and obliterating bronchiolitis in children, described in the same patent of the Russian Federation No. 2159935 by class. G01N 33/52, 33/483, 33/68.

The known method consists in measuring the intrinsic fluorescence intensity of the bronchoalveolar lavage fluid cells, and intrinsic pyrinucleotides (NADH) intrinsic fluorescence intensities are measured at an excitation wavelength of 356 nm and a recording wavelength of 420-480 nm and flavoproteins (AF) at an excitation wavelength of 440 -480 nm and a recording wavelength of 510-550 nm, determine the ratio of intrinsic fluorescence intensities of intracellular pyrinucleotides and flavoproteins, and when the ratio is greater than 1 d agnostiruyut bronchial asthma, and in value of the ratio is less than 1 - bronchiolitis obliterans.

The disadvantages of this method are its not very high reliability, as well as invasiveness, complexity, high cost.

A known method for the diagnosis of bronchial asthma in young children, described in the "Clinical Protocol for the diagnosis and treatment of bronchial asthma" in Appendix 7 to the order No. 807 of the Ministry of Health of the Republic of Belarus "from 10.25.02 (chap. 3, p.205-214) ( see site:

http://minzdrav.by/med/docs/sprav/DiagnBronhAstma.doc).

The known method is based on the history, the assessment of clinical symptoms, the study of the function of external respiration and the assessment of bronchial reactivity (in children over 5 years old and adults) and the study of allergological status.

More specifically, it includes the following operations as mandatory: collection of medical history, complaints; assessment of clinical syndromes through percussion, auscultation, respiratory rate measurements; study of the function of external respiration using peak flowmetry, radiography of the lungs and paranasal sinuses, spirography and pneumotachography, as well as a study of the function of external respiration when exposed to bronchodilators, with drug provocation, and with provocation by physical exertion; hyperventilation breakdown; the study of allergological status provides for a general analysis of blood + platelets; cytological examination of mucus from the nose; sputum smear microscopy; cytological examination of sputum for eosinophils; examination of feces for lamblia and helminths; electrocardiogram; consultation of a doctor of an allergist-immunologist; consultation of a doctor - otolaryngologist; consultation of a doctor - pulmonologist.

If necessary, an immunogram with the determination of general and specific IgE can also be used, if necessary. If additional elements of diagnosis can also be used, if necessary, an immunogram with the definition of general and specific IgE; coagulogram: Lee-White coagulation time, activated partial thromboplastin time, prothrombin time, ethanol test, fibrinogen A, blood clot retraction, spontaneous fibrinolysis; determination of blood gas composition (PaO2, PACO2, SatO2); determination of acid-base state parameters; high resolution computed tomography of the chest; bronchoscopy; Ultrasound of the heart; consultation of a psychotherapist.

At the same time, symptoms such as episodic expiratory dyspnea, wheezing, chest tightness, coughing, as well as the dependence of these manifestations depending on sensitization, namely, a manifestation of food allergies, household sensitization, and isolated sensitization, are identified as clinical manifestations of bronchial asthma. allergens of domestic animals, manifestations of professional allergic lesions of the nasal mucosa and eyes. With manifestations of professional bronchial asthma, peak flowmetry is performed, bronchoalveolar lavage is examined (according to indications), and laboratory immunological tests are performed.

External respiratory function (VFD) is assessed using peak flowmetry, spirography, pneumotachography (computer flowmetry) with registration of FVC and FEV1 and FEV1 / FVEL ratio, as well as PEFV (where FVC is the forced vital capacity of the lungs, FEV1 is the forced expiratory volume in 1 -th second, PEFV - peak volume expiratory flow rate). Tests are also carried out with bronchodilators to detect latent bronchospasm, a sample in the interictal period for hypersensitivity of the bronchi. In children, nonpharmacological methods are used to determine nonspecific hyperresponsiveness of the bronchi: tests with physical activity, tests with hyperventilation with dry, cooled air.

The assessment of the allergological status in bronchial asthma is carried out using skin tests, in particular, “scarification and injection” during the period of clinical remission of bronchial asthma. In severe asthma, modern laboratory tests (radioimmunoassay, enzyme immunoassay and chemiluminescent) are used to determine specific IgE and IgG antibodies in the blood and sensitized lymphocytes.

Psychological aspects are also analyzed.

The following criteria were chosen as clinical criteria for the differential diagnosis of bronchial asthma and obstructive syndrome against the background of acute respiratory infection in young children: age; manifestations of obstructive syndrome; recurrence of obstructive syndrome; hereditary burden of allergic diseases, incl. with the presence of bronchial asthma on the maternal side; the presence in the history of allergic reactions to food products, medicines, preventive vaccinations; excessive antigenic load.

Probably, such a diagnostic method with such a complete list of mandatory procedures and measures is diagnostically very reliable. However, from the point of view of applicants, the disadvantages of this method are its complexity, as well as some inaccuracy and inconvenience of implementation due to the richness of procedures that cannot be performed or that are not informative in a child under 5 years old, such as radiography of the lungs and sinuses, study of the function of the external breathing with tests with bronchodilators, physical activity and hyperventilation of the lungs.

A known method for the diagnosis of bronchial asthma in children, described in the eponymous A. USSR No. 1413532 by class G01N 33/53 claimed 02/18/87, publ. 07/30/88 and selected for the prototype.

The known method consists in the fact that they analyze the anamnesis data, evaluate clinical symptoms, and also study the allergological status, while determining the level of eosinophils and the level of total serum immunoglobulin E, and also determine the titer of complement-binding antibodies to parainfluenza viruses and respiratory syncytial and with its value of 1/40 or more, the non-atopic form of bronchial asthma is diagnosed, and with a titer of 1 / 10-1 / 20, the atopic form is diagnosed.

The disadvantage of this method is that it is intended for differential diagnosis of already identified bronchial asthma, i.e. clarification of the already established diagnosis, namely its division into atopic and non-atopic forms, and does not allow to detect bronchial asthma in children under 5 years old at an early stage of a child’s disease, i.e. first establish a diagnosis of asthma in children at risk for the development of bronchial asthma.

The objective of the proposed method is to enable detection at an early stage of a disease of bronchial asthma in children under 5 years of age.

The problem is solved in that in a method for the diagnosis of bronchial asthma in children under 5 years of age, which includes analyzing anamnesis data, evaluating clinical symptoms, and examining allergological status, which is carried out using a general blood test, which determines the level of eosinophils and the level of total immunoglobulin E serum, according to the invention additionally conduct a cytological study of induced sputum, determining the percentage of eosinophils in it, at a level which is greater or equal to 5%, consider it the main evidence-based laboratory indicator of the diagnosis of bronchial asthma.

The use of such an additional biological marker for the diagnosis of bronchial asthma as the level of eosonophils in sputum ≥5% in conjunction with confirming blood tests for eosinophils and the level of total immunoglobulin E in blood serum makes it easy and convenient for a child to reliably determine the diagnosis of “bronchial asthma "in a child under 5 years old.

The technical result is the provision of detecting bronchial asthma in children under 5 years old at an early stage of the disease with a high level of reliability of the diagnosis and ease of diagnosis for the child.

The inventive method has a novelty in comparison with the prototype, differing from it by such an essential feature as the use of the result of a cytological study of induced sputum on eosinophils as their main evidence for the diagnosis of bronchial asthma when their sputum level is greater than or equal to 5%, ensuring the achievement of a given result.

Although in the well-known analogue (see above), as one of the essential elements for diagnosing bronchial asthma in children, a cytological examination of sputum for eosinophils appears, however, it is not included in evidence-based biological parameters, there is no acceptable level of eosinophils in sputum in any quality agreed, therefore, the applicant believes that the claimed method, having the indicated distinguishing features, ensuring the achievement of a given result, meets the criterion of "inventive step".

The inventive diagnostic method can be widely used in pediatrics for the diagnosis of bronchial asthma in children under 5 years old, and therefore meets the criterion of "industrial applicability".

The invention is illustrated by drawings, which are presented in:

- figure 1 is a table with data on the average level of eosinophils in induced sputum in the examined children at the beginning of the study and after 18 months of observation;

- figure 2 is a characteristic curve of the method for the diagnosis of bronchial asthma in children according to the level of eosinophils in induced sputum (%);

- figure 3 is a characteristic curve of the method for the diagnosis of bronchial asthma in children according to the level of eosinophils in the general blood test (%) (AUC-ROC 0.61);

- figure 4 is a characteristic curve of the method for the diagnosis of bronchial asthma in children by the level of total IgE in the blood (IU / ml) (AUC-ROC 0.67).

The inventive method for the diagnosis of bronchial asthma in children under 5 years is as follows.

A method for the diagnosis of bronchial asthma in children under 5 years of age includes the analysis of anamnesis data, the assessment of clinical symptoms, the study of allergological status. At the same time, the evaluation of the clinical manifestations of bronchial asthma consists in identifying symptoms such as episodic expiratory dyspnea, wheezing, squeezing in the chest and coughing through auscultation and percussion. The study of indicators of allergological status is carried out using a general blood test, as well as a cytological study of a number of secretions, namely sputum. In this case, the level of eosinophils and the level of total immunoglobulin E are determined in the blood, and the level of eosinophils is also determined by cytological examination of sputum. Such a biological marker as the result of a cytological examination of sputum for eosinophils with their level in the sputum greater than or equal to 5% is used as the main evidence-based laboratory indicator of the diagnosis of bronchial asthma.

The method is as follows.

First, an analysis of the history data is carried out.

When collecting an anamnesis, it is necessary to clarify the following:

- the presence of a hereditary burden of asthma or other atopic diseases, concomitant allergic diseases (atonic dermatitis, allergic rhinoconjunctivitis, etc.) in a child at present or in a history;

- the presence of cough, intensifying mainly at night; recurrent wheezing; repeated episodes of difficulty breathing; feelings of tightness in the chest, episodes of bronchospasm caused by physical exertion;

- the presence in the history of repeated episodes of bronchial obstruction, especially occurring against a background of normal temperature;

- deterioration in the daytime, nighttime or early morning hours, when exposed to allergens or triggers. The possibility of changing the severity of symptoms during the day and during the year, depending on the spectrum of sensitization. The disappearance of symptoms upon elimination of contact with the allergen (elimination effect), improvement after bronchodilators.

Clinical symptoms are evaluated. In most children, the appearance of the first typical attacks of expiratory dyspnea is usually preceded by manifestations of atopic dermatitis, acute allergic reactions to various foods, medicines (in the form of exanthema, urticaria, Quincke's edema). Attacks of obstruction develop at any time of the day and manifest themselves clinically as expiratory or mixed with a predominance of the expiratory component shortness of breath with retraction of the compliant areas of the chest, its emphysematous bloating, an obsessive (sometimes until vomiting) dry or unproductive cough, diffuse dry wheezing in the lungs, and also widespread different wet wheezing, persisting for a long time, for 5-10 days or more, detected by percussion and auscultation. Noisy wheezing is heard even at a distance, pallor of the skin is expressed, cyanosis of the nasolabial triangle, acrocyanosis are noted. Often the child takes a forced position (orthopnea), is pale, his health is impaired. The clinical symptoms of bronchial asthma change during the day. The entire set of symptoms should be discussed over the past 3-4 months, with particular attention to those who have been bothered in the previous two weeks. Wheezing should be confirmed by a doctor, as parents may misinterpret the sounds their children make when breathing.

In the remission stage, pathological symptoms may be absent, which does not exclude the diagnosis of bronchial asthma.

Due to the anatomophysiological features of young children (narrow lumen of the bronchial tree, underdeveloped muscle layer, significant development of blood and lymph vessels), bronchospasm is usually not their leading mechanism in the pathogenesis of asthma attacks. Inflammation of the bronchial mucosa, its edema and hypersecretion of mucus come in first, which causes a peculiar clinical picture of “wet asthma” at this age, less acute and longer duration of attacks.

They study the allergological status of the patient. To do this, find out the hereditary burden of allergic diseases (especially on the maternal side), establish the frequency of allergic reactions to food products, medicines, preventive vaccinations, determine if there are severe skin allergic manifestations, manifestations of allergic rhinitis, conjunctivitis. In the process of studying the allergological status, a general blood test is taken to determine the level of eosinophils in it, a study is made of the level of total immunoglobulin E (IgE) in the blood serum. Sputum is also taken for the purpose of its cytological examination with determination of the level of eosinophils (%).

Given the fact that the main pathological changes in bronchial asthma occur at the level of the bronchial tree, sputum analysis is carried out in order to study cyto-immunological changes at the topical level. Sputum in young children is obtained using the method of induced sputum modified and patented by the authors (see application No. 2008116364, decision on the grant of a patent dated 02/18/09).

In order to identify cytological criteria for the diagnosis of bronchial asthma in induced sputum, the authors conducted a cohort study.

The cohort study included 72 children aged 22 to 48 months. (average age - 36 months) with a history of atopy and episodes of obstructive bronchitis. To account for the laboratory and clinical manifestations of bronchial asthma for 18 months, children were monitored with a follow-up examination, history taking and determination of the cellular composition of induced sputum every 6 months.

Of 72 children with episodes of obstructive bronchitis in the anamnesis for 18 months. observation bronchial asthma was formed in 43 children (60%). To identify cytological criteria for the formation of bronchial asthma, 72 children were divided into 2 groups:

Group 1 - children without bronchial asthma at the end of the study;

Group 2 - children with manifest bronchial asthma during the observation period. (see figure 1).

The predictive ability of the diagnostic method can be represented as the area under the characteristic curve (AUC-ROC): the larger this area, the more effective the diagnostic method (see figure 2). With AUC-ROC 0.5, it is believed that the diagnostic value of the method is practically zero.

In order to be able to compare the sensitivity and specificity of the currently used indicators for the diagnosis of bronchial asthma, the ROC curve was constructed using other diagnostic tests. Characteristic diagnostic curves were constructed by the level of eosinophils in the general blood test (figure 3) and the total IgE in the blood (figure 4). These indicators were used, as they are the only laboratory criteria reflecting the presence of allergies and / or atopy, and are used by allergists in the diagnosis: Bronchial asthma.

Figures 3 and 4 show that the characteristic curve is closer to the diagonal connecting the lower left and upper right corners, AUC-ROC is 0.61 and 0.67, respectively, which indicates the low information content of these tests in the diagnosis of bronchial asthma, rather than atopic status in general.

In this study, AUC-ROC (see figure 2) is 0.95, which indicates a rather high informativeness of the method for diagnosing bronchial asthma in terms of eosinophils in sputum. In a similar study, Rytila P. (2002), involving children over 5 years of age, also demonstrated that the percentage of eosinophils in sputum (AUC-ROC 0.88) is the most sensitive and specific marker in comparison with blood eosinophilia and the level of total IgE in bronchial asthma.

An additional opportunity to analyze ROC-curves is to establish a critical level of the indicator (the so-called cut off points - separation points).

Using the ROC curve (see figure 2), you can determine the optimal value of the separation point. The split point should be near the shoulder of the curve. In this study, the optimal value for the separation point was the level of eosinophils in sputum ≥5%.

Thus, if as a criterion for the diagnosis of bronchial asthma, take the level of eosinophils in induced sputum ≥5%, then 96% of children with this indicator have bronchial asthma.

Diagnosis of bronchial asthma in young children with an assessment of the level of eosinophils in induced sputum (≥5%) is a highly sensitive and specific test.

Clinical example.

Child Maxim K., 2.5 years old, was admitted to the children's department of early pathology at the Municipal Clinical Hospital No. 1 in December 2005 for the first time for the purpose of examination. Upon receipt of a complaint of a rough, unproductive cough, it appears in the evening after running, panting with wheezing, sputum accumulates in the upper respiratory tract, and coughs badly.

Anamnesis of life and disease: A child from the 2nd pregnancy proceeding against the background of a burdened obstetric-gynecological history. After birth - surgery for atresia of the esophagus and tracheoesophageal fistula. The child was often sick up to 8 times a year. In the 1st year he suffered 2 episodes of obstructive bronchitis. Over the year, he suffered from obstructive bronchitis up to 2 times a year. It was observed by a pulmonologist - with a diagnosis of Recurrent obstructive bronchitis. Microaspiration syndrome. Cicatricial stenosis with / 3 trachea, dyskinesia of the trachea of the 1st century, bilateral, diffuse, catarrhal endobronchitis.

Inspected by Ass. Departments of the UMMADO - conclusion: Recurrent bronchial obstructive syndrome, bronchial hyperreactivity syndrome.

Burdened by the grandmother’s heredity - chronic bronchitis.

Allergic history is aggravated - from birth, manifestations of ECD, at 6 months - atop. dermatitis.

Given the corrected concomitant malformation of the respiratory tract in this child, tracheal stenosis, and bronchopulmonary dysplasia in the history of changes in the respiratory tract, many specialists, including pulmonologists, were regarded as a consequence of this condition, adequate therapy was not prescribed, episodes of bronchial obstruction were repeated in the child.

To clarify the diagnosis and selection of therapy, the child was hospitalized in the Department of Pathology of Young Children, Municipal Clinical Hospital №1.

Given the complex diagnostic case of a young child with concomitant corrected malformation of the respiratory tract, tracheal stenosis, the child underwent a study of the induced sputum cytology using the authors modified sputum induction protocol for children who cannot cough up sputum on their own (see application No. 2008116364, decision on the grant of a patent dated 02/18/09).

The resulting portion of sputum was subjected to cytological examination according to standard methods.

Cytology of induced sputum

date of eosinophils
in s / sp. neutrophils
in s / sp. macrophages
in s / sp. lymphocytes
in s / sp. epithelium
in s / sp. slime Bacteria, fungi 12/19/05 17% 22% 53% 8% one +++ cocci

Considering repeated episodes (more than 3) of bronchial obstruction (on the background of a respiratory infection, after physical exertion), an increased level of eosinophils in the peripheral blood, an increased level of total immunoglobulin E, a burdened allergic history (allergic rhinitis, atopic dermatitis) and taking into account the increased level of eosinophils in the induced sputum (Guide. Clinical recommendations for the diagnosis, treatment and prevention of bronchial asthma, shortness of breath. Edited by the chairman of the Russian Respiratory Society tva, academician of RAMS, professor Chuchalina, Moscow, 2005 - p.16) - the detection of sputum eosinophilia during its cytological examination is an important criterion for confirming the diagnosis of asthma), according to the Scientific and Practical Program "Bronchial asthma in children: diagnosis, treatment and prevention , Moscow, 2008 "the child was diagnosed with asthma. Recommendations are given for basic therapy.

In comparison with the prototype of the proposed method is simpler to implement, has a very high degree of reliability and is more convenient for the child.

Claims (1)

A method for the diagnosis of bronchial asthma in children under 5 years of age, which includes analyzing anamnesis data, evaluating clinical symptoms, and examining allergological status, which is carried out using a general blood test, which determines the level of eosinophils and the level of total immunoglobulin E in blood serum the fact that they additionally conduct a cytological study of induced sputum, determining the percentage of eosinophils in it, at a level of which is greater than or equal to 5%, consider it the main evidence tion of laboratory parameters of the diagnosis "asthma."

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