Borislav Kamenov

Atopy and pregnancy: Does it has any influence on fetal immune status?

Background: Induction of T-cell memory is frequently initiated intrauterine, and it is likely that maternal factors exert their influences during this period. Method: dynamically investigated immunological changes of 10 fetuses of atopic mothers (in most cases suffering bronchial asthma) at 25 to 35 weeks gestation. In the control group were concluded 20 healthy fetuses. The fetal blood samples obtained by cordocentesis technique at the necessary to exclude a genetic pathology, congenital malformations, development hemolytic disease and/or during the premature labor. Enzyme-linked immunoassay was used to measure serum concentrations of interleukin (IL)-2 (Th1) and IL-4 (Th2). Results: It was shown that the concentration of IL-2 in fetal plasma had approximately same low level during the second and third trimester of pregnancy in both normals and atopics. The increasing of IL-2 was revealed at the period of 35 weeks until the labors. The IL-4 has demonstrated the low level at 25-38 and 25-35 weeks with increased parameters during 32-35 weeks9 gestation. The infants of asthmatic mothers had reduced IL-4 at birth. Conclusion: These findings support the hypothesis that the fetus maintains a Th1 biased environment to counteract the Th2 biased maternal and placental influences. The IL-2 can play the role in promotion of fetal rejection. So, understanding the underlying mechanisms whereby immunological responses are initiated and modified at the beginning of life can offer alternative targets for therapeutic intervention.

Lung function and respiratory infections in children exposed to pasiv smoking

Background: Exposure to smoke has been shown to be a risk factor for respiratory diseases. The aim of the study was to discover the influence of exposure to cigarette smoke and its relation to respiratory health. Method: In 2010-2015 450 children aged 6-15 years and their parents were examined. They were asked to fill the questionnaire. Exposure to cigarette smoke was determined by an answer “everyday” or “sometimes” to the question “How often is your child in surrounding where someone smokes?”. The parameters of respiratory function (FVC, FEV1, FEV1/FVC, FEF25, FEF50, FEF75, PEF) were by spirometry Results: At home 46 % of children were exposed to cigarette smoke. Cough that lasted for at least three weeks during the past year was experienced by 16.8% and 7.5% of children with and without exposure to cigarette smoke . Wheeze in the past was found in 46% and 13.5% of children in groups compared . There was a significant difference in prevalence of rhinitis when a child did not have a cold between children with and without exposure to cigarette smoke . FEF25, FEF50, FEF75 and PEF of exposed girls were significantly lower than that of girls not exposed to cigarette smoke. Multiple regression analysis that included variables such as cigarette smoke , family history of allergy, smoked mother during pregnancy, gas stove and pets at child9s room showed that in girls FEF25, FEF50 were related to cigarette smoke. Conclusion: Our data show that more than 40% of children are exposed to environmental cigarette smoke is associated with increased prevalence of chronic cough, wheezing, running nose and sneezing without cold. Passive smoking is also related to decreased lung function, especially for small airway flows.

Response to bronchodilators in school children with asthma and normal FEV1

Background: Asthma is a chronic inflammatory disorder of the airways, associated with variable airflow obstruction that is at least partly reversible, either spontaneously or with treatment. When assessing asthma, FEV1 is often the only functional parameter considered. Aim: To evaluate if there is a positive response to bronchodilators in school children with asthma and normal FEV1. To correlate this results with clinical parameters of disease. Method: 190 asthmatic children with normal FEV1 were included and submitted to lung function testing with bronchodilation. We evaluated bronchodilator response (BDR) and questioned them about several clinical aspects (daily medication, rescue medication, asthma exacerbations, nocturnal symptoms and exercise-induced symptoms), in the past 3 months. We considered a normal FEV1 when it was 80% of the predicted value (PV) and a positive BDR when FEV1 increased for at least 12% after administration of bronchodilators. Results: 85 male and 105 female patients; 75 were atopic; 25 patients had intermittent asthma, 48 mild persistent and 42 moderate persistent asthma. There was a positive BDR in 52 patients (I group). In this group, 15 patients referred nocturnal and/or exercise-induced symptoms vs. 138 from those with a negative BDR (II group). Regarding daily medication, 21/52 patients with positive BDR and 50/138 from those with negative BDR were on inhaled corticosteroids. Conclusion: In this study 27.3% of asthmatic children had a positive BDR, although presenting normal FEV1. A positive BDR correlated with clinical parameters, mainly with recent asthma exacerbations.