The State of the Autonomic Nervous System in Children with Bronchial Asthma

Background: Violation of vegetative regulation (VR) is a component of the pathogenesis of bronchial asthma (BA).

Purpose: Determine the relationship of VR parameters with the parameters of asthma control level in children using methods available in a wide clinical practice.

Method: 88 patients (54 boys and 34 girls) aged 5 to 17 years with atopic bronchial asthma were examined. Quantitative assessment of bronchial asthma control was carried out using questionnaires Asthma Control Questionnaire-5 (ACQ-5), Childhood Asthma control test (ACT-C) in children under 12 years old, and Asthma control test (ACT) in children and adolescents aged 12 years and older. All children underwent a standard examination with determination of blood pressure, pulse, respiratory rate, with the calculation of Kerdo and Hildebrandt indices, characterizing vegetative regulation. Taking into account the age-dependent changes in heart rate, we used for the first time a relative heart rate index equal to the ratio of the patient`s heart rate to the median heart rate for this age group.

Results: Correlation with ACQ-5 was obtained for the Hildebrandt index (r=0,45 p=0,0003), the respiratory rate (r=-0,27, p=0,032) and the relative pulse index (r=0.40, p=0,0012). The association of Kerdo index with ACT-C test values (r=-0,32, p=0,045) was established. In the group of patients with no BA control the Hildebrandt index was statistically significantly higher than in patients with control of the disease. In children with uncontrolled asthma it was 5,23±0,25 units that exceeds normal values and may reflect a mismatch in the work of cardiovascular and respiratory systems.

Conclusion: The interrelation of changes of vegetative regulation and the level of control of bronchial asthma in children is established, as well as the mismatch of the functioning of the cardiovascular and respiratory systems in children with uncontrolled asthma.