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"Child`s Health" 2 (61) 2015

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Basic aspects study risk factors for diseases of the respiratory tract at children of early and preschool age.

Authors: Shumna T.E., Mazur V.I., Klyackaya L.I., Solovieva S.V. — Zaporozhye State Medical University, Ukraine

Categories: Pediatrics/Neonatology

Sections: Clinical researches

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The problem of morbidity in early and pre-school childhood remains a live issue and for the last years it has continually been covered in different medical scientific publications. The general morbidity among pre-school children has increased by 3.3 % in the year of 2013 comparing to 2012. In addition, according to certain sources, from 15 to 75% of pediatric population is related to the group of frequently and chronically ill children with incidence peak in early and pre-school childhood [12]. For many years the leading morbidity patterns of such age category have displayed diseases of the respiratory system, moreover, acute respiratory viral infections are the most frequent in pre-school children, especially junior classes and its prevalence rate has essentially increased lately (from 65471 per 100000 of population in the year of 2004 to 72632 per 100000 of population in 2012.) [1, 5, 8, 13].
Pre-school children with frequent acute respiratory diseases have tension of general host defense mechanisms, formation of secondary immunodeficiency, divergent defects of cellular and humoral immunity. A number of researchers point to defects in 
interferonogenesis process and genetic determination of individuals to production of interferon in terms of frequent infections. Recurring of the diseases contributes to disimmunoglobulinamia, hyper-IgE production, bronchial hyperactivity progress and sensitization to infectious allergen. Recurrent, debilitating acute respiratory diseases also lead to defects in physic and neuropsychic development of children, contribute to decrease in functional immunologic activity, formation of both acute and chronic  inflammatory process in respiratory organs [2, 6, 11].  
In Ukraine pneumonia as a complication of respiratory infections is registered in 15% of pre-school children, suffered from ARVI, and takes the third place among the reasons for child death [9]. In Russia in 2009 the registered number of pneumonia patients was about 200000 children and these indicators are tending to increase [4]. In the western countries more than 18% of children aged from 1 to 4 are recorded to have repeated occasions of acute respiratory viral infections, attended by complication progress such as acute bronchitis and pneumonia [9].
The high rate of respiratory disease morbidity in the so called “organized” pre-school children is caused by many reasons. They are the following:
- immunity age peculiarities (the so called third period of immunogenesis);
- accumulating of immunological experience towards most respiratory viruses;
- epidemiological reasons (extension of contacts, frequent occurrence of infectious agents in the group without proper compliance, high contagiosity index of agents)
- Psychoemotional stress, caused by entry into children’s group, the so called early socialization) [2, 9].
Infants, being raised at home but living in big industrial cities, are also affected by a big number of ARVI agents, including air pollution in the city, overcrowding in the place of living, inappropriate usage of air conditioners, unhealthy diet, birth overweight, inappropriate way of feeding, which has a negative impact on a growing organism and suppresses local respiratory and general immune defense system of  a child [2, 9].
  Regarding to pre-school childhood, the following significant risk factors of recurring respiratory diseases are distinguished:
     - pathology in gestation course;
     - burdened familial history;
     - early-age hypotrophy, artificial feeding;
     - bowel dysbacteriosis;
     - secondhand smoking
     - unfavourable hereditary and individual allergological history[9, 12].
The children, who are the secondhand smokers, are more inclined to respiratory infections with frequent complications and chronic nasopharyngeal diseases than children from nonsmoking families. Thus, among children aged 3-6, having two smokers in the family, 70% have a complicated respiratory process disease, having one smoker – 66.7%. In addition, 19.6% of children are recorded to have pneumonia, 15% - obstructive bronchitis, and 30 % of such children have allergic pathology [10].  
City air pollution is one of the most important problems of the present days, influencing the health of the population. Child’s organism is vulnerable to unfavorable environmental factors. It is caused by various physical peculiarities, such as: high dermal absorption, mucous tunic of gastro-intestinal and respiratory tract, blood-brain barrier, hypoacidity, immaturity of hepatic enzyme system, low value of glomerular filtration, immunological immaturity. Therefore, unfavorable environmental factors influence children’s morbidity. The research shows that in the industrial zone with high emission of chemical productions the incidence of the upper  airway diseases of children increase  1,5-2 times, near the steel and metallurgic  manufactures  it’s 4-5 times  higher, than in a bedroom communities, which are  less polluted areas [4]. 
The pre-school children, especially living in industrial zones, are more often characterized by having defects in physical development, psychoemotional status, 
chronic adenotonsillar pathology, caused by medical and biological factors, first of all,  by humoral immunity imbalance with both - growing of cytology markers and forming of  hyperimmunoglobulinamia [11, 15].
That is why children at the age of 6 are more frequently affected by not only acute respiratory infections, in particular, acute pharyngitis, tonsillitis, laryngitis, adenoiditis, bronchitis and pneumonia, but clinical features of AtD, rhinallergosis and bronchial allergy [6, 7, 9, 14, 17]. So today the question for the researchers is – whether they are frequent infections that lead to allergic diseases or, vice versa, it is an allergic process that leads to recurrent respiratory diseases in childhood [3, 16]. 
Studying the structure of respiratory tract pathology displays that the proportion of acute lower respiratory diseases for children suffering from bronchial allergy makes 49.5% before visiting preschool institution and 50.3% during visiting preschool institution. Thus, the high proportion of lower respiratory infections shows the risk of further bronchial allergy progress for children [2].
    As a result of bibliography analysis, the main reasons affecting the course of the diseases of early and pre-school childhood were emphasized. .The learning of various risk factors causing respiratory tract diseases will enable more effective planning and implementation of preventive and health-improving activities for children. The implementation of preventive care focused on preparing the future parents for healthy childbearing, healthy lifestyle promotion in families, involving parents into the health improvement activities for children, tempering, practicing rehabilitation exercises and massage, normalization of day regimen as well as persistent infection sanation, associated disease treatment, usage of immunotropic medications, creation and promotion of health improvement programs in pre-school institutions.


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