Інформація призначена тільки для фахівців сфери охорони здоров'я, осіб,
які мають вищу або середню спеціальну медичну освіту.

Підтвердіть, що Ви є фахівцем у сфері охорони здоров'я.

день перший
день другий




день перший
день другий






"Child`s Health" 2 (61) 2015

Back to issue

Gender features of bronchial asthma in school age children.

Authors: Koloskova O.K., Bilous T.M., Bilyk G.A. — Bukovinian State Medical University, Ministry of Health of Ukraine

Categories: Pediatrics/Neonatology

Sections: Clinical researches

print version


Achievements and retaining of control is the primary goal of the Global Initiative on prevention and treatment of bronchial asthma (BA) and conciliatory documents in many countries [1,2], but the questionnaires using for evaluation of control of asthma are subjective, their result depends on psychological state of children and parents. The role of eosinophils in beginning and persistence of airway inflammation in asthma is known. Damaging effect of eosinophils appears indirectly through the production of cytotoxic substances, especially eosinophilic cationic protein (ECP). Therefore, studying of ECP may indicate the degree of activation of eosinophils and the severity of inflammation of the bronchi.

The objective of the study. To explore the clinical features and markers of inflammation in the bronchi depending on the gender features of school age children in order to optimize achievements and retain control of asthma.
Material and methods. There were examined 93 pupils with bronchial asthma: 62 boys - I group, and 31 girls - II observation group. These groups were comparable on the main clinical characteristics. The comprehensive examination, which involved study of cytomorphologycal consist of induced sputum, study ECP concentrations in sputum supernatant liquid and intracellular ECP in blood eosinophils has been conducted for all children. Controlling of asthma was determined by clinical and instrumental scale and ACT questionnaires at the beginning and the end of a 3-month course of basic anti-inflammatory treatment.
Results and discussion. The results have shown that astha has often appeared in boys of preschool age, predominantly eosinophilic inflammatory disease phenotype AR = 15.64%, RR = 1.34 (95% CI 1,0-1,83) OR = 1.89 (0,77-4,70), in the absence of peripheral blood eosinophilia AR = 32.2%, RR = 1.86 (95% CI 1,0-3,61) OR = 3.86 (95% DI 1,51-9,84). With the prevalence of atopic asthma form among girls, on the frequency of other atopic pathology groups probably were not differed. Statistical confirmation worse controlled asthma in girls compared with boys at the beginning of treatment, we have not received: OR = 2.16 (95% CI 0,34-13,75) RR = 1.74 (95% CI 1,01-3, 07) and AR = 15.0%, although the rate of response to anti-inflammatory therapy in the past was better: decrease in the relative risk of asthma uncontrolled compared with girls was 15.0% at the minimum required number of patients - 6,67. It may be due to greater migration of eosinophils to the airways, their activation with the release of ECP (2.41 ng /ml in boys and 1.88 ng /ml in girls) or it reflected subjectivity in its self-evaluation condition inherent teenage girls.
1. The features of asthma in school-age boys compared with girls include: three times more frequent onset of the disease in early childhood, eosinophilic phenotype in 66.13% of cases, the lack of blood eosinophilia (OR = 3.8) at moderate eosinophilia sputum (OR = 1.89) with the extracellular accumulation of eosinophilic cationic protein in sputum that, in general, contributes to a better response to designed anti-inflammatory therapy.
2. Asthma often debuts in girls at over 6 years age in comparison with boys at school age ("asthma of late start" - 60.0%), dominated by its atopic form (66,67%), eosinophilia was determined in peripheral blood of each third patient, tendency to intracellular accumulation of eosinophilic cationic protein in peripheral blood leukocytes was observed in girls, and the disease is worse controllable, that is determined mainly by the results of self-appraisal.


1. Andersson M, Hedman L, Bjerg A, Forsberg B, Lundbäck B, Rönmark E. Remission and Persistence of Asthma Followed From 7 to 19 Years of Age. Pediatrics 2013;132:435-442. doi: 10.1542/peds.2013-0741.
2. Pedersen SE, Hurd SS, Lemanske RF Jr, Becker A, Zar HJ, Sly PD, Soto-Quiroz M, Wong G, Bateman ED; Global Initiative for Asthma. Pediatr Pulmonol. 2011 Jan;46(1):1-17. doi: 10.1002/ppul.21321. Epub 2010 Oct 20.
3. Abisheganaden J. Asthma: The Need for Good Control. Ann Acad Med Singapore. 2009 Jul;38(7):567-2. PMID: 19652845.          
4. Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, Gibson P, Ohta K, O'Byrne P, Pedersen SE, Pizzichini E, Sullivan SD, Wenzel SE, Zar HJ. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2008 Jan;31(1):143-78. doi: 10.1183/09031936.00138707.
5. van den Nieuwenhof L, Schermer T, Eysink P, Halet E, van Weel C, Bindels P, Bottema B. Can the Asthma Control Questionnaire be used to differentiate between patients with controlled and uncontrolled asthma symptoms? A pilot study. Fam Pract. 2006 Dec;23(6):674-81. PMID: 1688017.
6. Yoo KH, Jeong JW, Yoon HJ, Chang SI, Moon HB, Choi BH, Kim YY, Cho SH. Customized Asthma Control Test with reflection on sociocultural differences. J Korean Med Sci. 2010 Aug;25(8):1134-9. doi: 10.3346/jkms.2010.25.8.1134. PMID: 20676322.
7. Swartz EC, Bossard MK,  McCarthy K, López R, Lang  DM. No Correlation Between Airway Obstruction Measured by FEV3/FVC and Asthma Control Test Scores. J. Allergy Clin. Immunol. 2007;119,1:9. DOI: http://dx.doi.org/10.1016/ j.jaci.2006.11.051
8. Hanxiang N,  Jiong Y,  Yanwei C,  Dunshuang W,  Xuhong D,  Xiaojun W, Changsheng L. Persistent airway inflammation and bronchial hyperresponsiveness in patients with totally controlled asthma. Int. J. Clin. Pract. 2008;62(4):599–605. DOI: 10.1111/j.1742-1241.2007. 01373.x.
9. Tantisira KG, Colvin R, Tonascia J, Strunk RC, Weiss ST, Fuhlbrigge AL. Airway responsiveness in mild to moderate childhood asthma: sex influences on the natural history. Am J Respir Crit Care Med. 2008 Aug 15;178(4):325-31. doi: 10.1164/rccm.200708-1174OC. Epub 2008 Apr 17.
10. Balbi B, Pignatti P, Corradi M, Baiardi P, Bianchi L, Brunetti G, Radaeli A, Moscato G, Mutti A, Spanevello A, Malerba M. Bronchoalveolar lavage, sputum and exhaled clinically relevant inflammatory markers: values in healthy adults. Eur Respir J. 2007 Oct;30(4):769-81. Review. PMID: 17906085.
11. Van Muylem A, Knoop C, Estenne M. Early detection of chronic pulmonary allograft dysfunction by exhaled biomarkers. Am J Respir Crit Care Med. 2007 Apr 1;175(7):731-6. Epub 2007 Jan 18. PMID: 17234904.
12. Dodig S, Cepelak I. Exhaled breath condensate--from an analytical point of view. Biochem Med (Zagreb). 2013;23(3):281-95. PMID:  24266297.
13. Rees P.J. New guidelines on the management of asthma. BMJ 2003;15(7385):346-347.  doi: http://dx.doi.org/10.1136.
14. Koha Gerald C-H, Shekb Lynette P-C, Goh Daniel Y-T, Bever Hugo Van, Koh David S-Q. Eosinophil cationic protein: is it useful in asthma? A systematic review. Respiratory Medicine (Impact Factor: 2.92). 05/2007; 101(4):696-705. DOI: 10.1016/j.rmed.2006.08.012.
15. Douwes J, Gibson P, Pekkanen J, Pearce N. Non-eosinophilic asthma: importance and possible mechanisms. Thorax. 2002 Jul;57(7):643-8. PMID: 12096210. PMCID: PMC1746367. doi:  10.1136/thorax.57.7.643.
16. Khan MS, Khan MS, Sismanidis C, Godfrey-Faussett P. Factors influencing sex differences in numbers of tuberculosis suspects at diagnostic centres in Pakistan. Int J Tuberc Lung Dis. 2012 Feb;16(2):172-7. doi: 10.5588/ijtld.11.0265.
17. Michael Schatz, Sunday Clark, Jennifer A. Emond, Donald Schreiber, Carlos A. Camargo. Sex differences among children 2–13 years of age presenting at the emergency department with acute asthma. Pediatric Pulmonology, 2004;37(6):523-529. DOI: 10.1002/ ppul.20018.
18. Mandhane PJ, Greene JM, Cowan JO, Taylor DR, Sears MR. Sex differences in factors associated with childhood- and adolescent-onset wheeze. Am J Respir Crit Care Med. 2005 Jul 1;172(1):45-54. Epub 2005 Apr 1. PMID: 15805179. PMCID: PMC2718447. doi: 10.1164/rccm.200412-1738OC.
19. Almqvist C,  Worm M,  Leynaert B. Impact of gender on asthma in childhood and adolescence: a GALEN review. Allergy 2008;63:47-57. DOI: 10.1111/j.1398-9995.2007. 01524.x.
20. Sekerel BE, Civelek E, Karabulut E, Yildirim S, Tuncer A, Adalioglu G. Are risk factors of childhood asthma predicting disease persistence in early adulthood different in the developing world? Allergy. Volume 61, Issue 7, pages 869–877, July 2006. DOI: 10.1111/j.1398-9995. 2006.01082.x.

Back to issue