FEATURES OF BRONCHIAL ASTHMA CLINICAL COURSE IN PATIENTS WITH ISOLATED AND COMBINED AIRWAY HYPERRESPONSIVENESS TO COLD AND HYPOSMOTIC STIMULI

The complex examination of 304 patients (185 women and 119 men) was done to find the correlation between the airway hyperresponsiveness to cold and hyposmotic stimuli and the pulmonary ventilation function impairment at bronchial asthma (BA). The protocol of the study included the detailed interview, objective examination to identify the severity of the disease and the features of its course, the questioning to estimate the clinical signs of cold airway hyperresponsiveness (CAHR), the study of the ventilation function of lungs by forced expiration spirometry method, the bronchodilation test with salbutamol and bronchial challenge test with isocapnic cold air hyperventilation (CAHV) and distilled water inhalation. By the results of bronchial challenge tests the patients were divided into groups: 1^st group included the patients with airway hyperresponsiveness to both stimuli (cold and osmotic), the 2^nd group was with hyperresponsiveness only to the inhalation with distilled water, the 3d group only to CAHV, the 4^th group without any response to both triggers. The frequency of CAHR in the population of BA patients was higher than osmotic hyperresponsiveness. The patients with hyperresponsiveness to hyposmotic stimuli complained about the worsening of the state at the contact with both cold and humid air. In patients with isolated CAHR the symptoms to cold prevailed and exceeded the frequency of its occurrence in response to the excessive air humidity in 2.5 times (χ²=11.6; p<0.001). The significant part of the patients of the 1^st group had a more full-scale clinical picture, uncontrolled (57%) and partly controlled (30%) course of the disease. The original bronchi patency (FEV₁, %) significantly influenced the intensity of the response (ΔFEV₁, %) obtained under bronchial challenge test and had a linear character (r=0.39; р˂0.05) in the test with the distilled water. Under CAHV this dependence was reverse (r=-0.44; р˂0.05). Thus, in the total population of BA patients in more than 30% of cases there is extremely high sensitivity of bronchi to the combined effect of natural-climatic factors in the form of physical characteristic of the air (low temperature and high humidity), which worsens their control over the disease. It can be suggested that there is a similar mechanism of formation of cold induced and osmoinduced response of bronchi mediated by the receptors of TRP family.

бронхиальная астма, гиперреактивность дыхательных путей, холодный воздух, осмотический стимул, воспаление, оксидативный стресс, asthma, airway hyperresponsiveness, cold air, osmotic stimulus, inflammation, oxidative stress

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