Clinical and pathogenetic features and prognosis of the course of occupational bronchial asthma in various phenotypes

Babanov S.A., Strizhakov L.A., Lavrentyeva N.E., Baykova A.G., Artemyeva M.S., Babanov A.S.

1) Samara State Medical University, Samara, Russia; 2) Izmerov Research Institute of Occupational Medicine, Moscow, Russia; 3) Samara City Hospital No. 5, Samara, Russia; 4) Reaviz Medical University, Samara, Russia

Background. Currently, occupational bronchial asthma is considered a phenotypically and genotypically heterogeneous disease. Evaluation of clinical data, functional characteristics and immunopathogenesis opens up new possibilities in assessing the development, predicting the course characteristics and personalized approach to pharmacotherapy of occupational bronchial asthma (OBA), as well as in developing an individual strategy for its prevention.
Objective. Determination of the clinical, immunological markers of the risk of developing OBA under conditions of exposure to sensitizing substances in various phenotypes of this disease.
Methods. The study included 170 patients with various phenotypes (PT) of OBA and 50 people in the control group (CG). The pulmonary function was assessed using a computer spirograph «Care Fusion» by MicroLab UK (Great Britain). Determination of the IL-17, TNF-α, vascular endothelial growth factor (VEGF), MCP-1, IFN-γ, total IgE levels in the blood serum was carried out by the method of solid-phase enzyme immunoassay using kits and reagents (OOO «Protein Contour», «Vector-Best», «Diatex-E», «DIA-plus», «Pharmacia diagnostika»).
Results. For the first time, the features of clinical and immunological manifestations in allergic, non-allergic phenotypes of OBA, as well as phenotypes of a combination of OBA with occupational chronic obstructive pulmonary disease (OCOPD) and metabolic (MT) syndrome were established, the features of formation, immunopathogenesis and prognosis for various phenotypes of OBA were revealed. This allows to recommend determining these immunological parameters during in-depth periodic medical examinations of individuals working under conditions of exposure to sensitizing and irritating substances for differential diagnostics of various phenotypes of occupational asthma in the conditions of specialized inpatient examination.
Conclusion. The identified clinical, immunological and genotypic features of various phenotypes of occupational asthma, the established profiles of the genotypes of occupational asthma can optimize the approach to early diagnostics, prognosis, prevention and pharmacotherapy of this pathology, as well as expand the list of immunological studies used in preliminary and periodic medical examinations, in-depth examination of patients with occupational asthma in clinics for occupational diseases and occupational pathology centers. New reliable criteria can be used to predict the course of this pathology.

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About the Authors

Corresponding author: Sergey A. Babanov, Dr. Sci. (Med.), Professor, Head of the Department of Occupational Diseases and Clinical Pharmacology n.a. Honored Scientist of the Russian Federation, Professor V.V. Kosarev, Samara State Medical University, Samara, Russia; s.a.babanov@mail.ru

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