Therapeutic and prophylactic methods of respiratory diseases in children. Echinacea purpurea uses

The leading place in the structure of the general morbidity of children is occupied by diseases of the upper respiratory tract and bronchopulmonary system.

In recent years, there has been a clear trend towards an increase in the frequency of this pathology, and more and more often this problem is encountered in older children and adolescents.

Diseases manifest themselves as protracted and recurrent forms, often resistant to conventional methods of therapy, including antibacterial ones.

Most common diseasesat CBD manifests itself in the form of infectionstions:

Upper respiratory tract: rhinitis, nasopharyngitis, tonsillitis, tonsillopharyngitis, laryngotracheitis, tracheitis, bronchitis.

Lower respiratory organs - bronchopneumonia.

3. ENT organs: otitis media, eustachitis, adenoiditis, sinusitis.

Etiological factors of acute respiratory infections:

specific contribution of viruses - 70-90%;

mixed viral-bacterial infection - 20-25%;

among viral pathogens, influenza viruses, parainfluenza, enteroviruses, respiratory syncytial virus, rhinoviruses, adenoviruses, etc. are more common.

among bacterial pathogens: Str. Pneumonie., Haemophil. Infl. ,Str. Pyogenes., Staphyl. aureus, etc.

in recent years, the role of gram-negative bacteria, as well as protozoa (mycoplasma, ureaplasma, chlamydia, etc.) has increased.

2.3. Factors contributing to the formation of the bdb group:

Significant prevalence in the environment of a viral infection, pathogenic microbial flora, protozoa.

Frequent viral and bacterial loads initiate the development of secondary immunodeficiency states in a child.

More often, secondary IDS are formed in children with reduced functionality of the immune system and minor anomalies.

The nature of the ARI clinic is largely due to the properties of the pathogen.

How younger child, the fewer specific signs the disease has.

Very often, a primary viral infection leads to the activation of endogenous opportunistic flora.

The reason for the transformation of this microflora into pathogenic in a number of children is associated with the characteristics of the immune response determined by the corresponding gene of the HLA histocompatibility system.

The hypothesis of "antigenic mimicry of microorganisms" is based on the antigenic similarity of some opportunistic bacteria and antigens of the HLA system.

This hypothesis explains the causes of bacterial complications in ARI in most children from the FDI group, which is essentially one of the clinical masks of secondary immune deficiency.

2.4. Factors contributing to the development of secondary immunodeficiency states and the formation of the bdb group:

AT first of all, it is a hereditary predisposition, characterized by the presence of any “minor anomalies” of immunity in a child from birth.

The impact of adverse environmental and social factors that quickly deplete the child's immune system.

Unfavorable ante- and postnatal development of the child (prematurity, immaturity, rickets, anemia, early artificial feeding) can lead to transient or persistent defects in the immune system.

Allergic disposition and dysbacteriosis of mucous membranes, skin, gastrointestinal tract, and other localization also lead to impaired immune reactivity of the body and to its increased sensitivity to infectious agents.

Violations of the state of the central nervous system in a child often contribute to violations of its immunoreactivity.

Various variants of immunodiathesis reflect the genetic predisposition of the child to various forms and types of immunopathological reactions and diseases.

The presence of various environmental pollutants adversely affecting the growing child's body (xenobiotics, including heavy metals, radionuclides, smoking in the family) also helps to reduce the reactivity and resistance of the child's body.

A special role in the formation of secondary immunodeficiency states is played by frequent psycho-emotional stress, poor nutrition, lack of vitamins and microelements in the diet.

A certain role is played by the social and economic instability of the family, unfavorable social and living conditions, and the low material and cultural level of the population.

Contribute to frequent diseases chronic foci of infection (chronic tonsillitis, adenoids, carious teeth).

Against the background of the existing trouble, frequent "viral-bacterial" loads deplete the physiological resources of the child's body's immune defense and lead to the development of secondary immunodeficiency states, which creates conditions for the "persistence" of the infection in the body and is a serious threat to the chronicity of the inflammatory process.

Based on the above data, we can draw the most important practical conclusion:

due to the inertness of the specific immune response to opportunistic pathogens in children from the group of respiratory diseases for the prevention and treatment of acute respiratory infections, the use of methods to increase the effectiveness of nonspecific protection factors is pathogenetically justified.

Ministry of Sports, Tourism and Youth Policy Russian Federation Volgograd State Academy physical education Department of Theory and methods of adaptive physical culture Adaptive physical culture in the complex rehabilitation of often long-term ill children of primary school age Course work in the specialty 032102 "Physical culture for people with disabilities (Adaptive physical culture)" Supervisor: Volgograd 2012 CONTENTS INTRODUCTION.2 Chapter 1. Definition and characteristics of a group of often and long -term sick children 6 Chapter 2. Principles of the healing of children who often suffer from acute respiratory diseases14 Chapter 3. Features of physical rehabilitation of children from a group of often and long -suffering 24 conclusion. 35 List of literature36 Introduction The problem of preservation and purposeful formation of children's health and youth in modern conditions development of Russia is exceptionally significant and relevant. In recent years, there has been a significant qualitative deterioration in the health of adolescents in Russia. According to studies, only 10% of children from 15 to 17 years old can be considered healthy, 40% have various chronic pathologies. Every second student has a combination of several chronic diseases [Polyakov S.D. et al., 2006]. During the period of schooling, the number of children with various health disorders increases several times. Thus, according to the results of preventive examinations, various diseases are recorded in 94.5% of adolescents. A special status in school-age children is occupied by acute respiratory diseases, which cause not only a deterioration in academic performance due to forced absences from classes, but lead to a significant decrease in functional reserves and the formation of chronic pathology of the external respiratory system [Gazhev B.N., Vinogradova T.A., Martynov V.N., 2007]. A decrease in the functional reserves of children adversely affects their physical and neuropsychic development, and the variety of causes leading to frequent viral infectious diseases puts before parents and doctors the problem of not only treatment and rehabilitation, but also prevention [Gritchenko N.V., 2006] . One of the important aspects of the prevention and rehabilitation of frequently and long-term ill children is dosed physical activity and special breathing exercises aimed at restoring the function of external respiration in combination with measures aimed at increasing the body's immune defense [Aparin V.E., Platonova V.A. ., Popova T.P. et al., 2003]. At the same time, deterioration in the functioning of the cardiorespiratory system can contribute to the development of various painful disorders in the body, because insufficient oxygen supply leads to increased fatigue, a decrease in efficiency, a decrease in the body's resistance and an increase in the risk of various diseases. All of the above determined the relevance of this work. The purpose of the study - Study and analysis modern methods complex prevention and rehabilitation of often long-term ill children. Hypothesis. It is assumed that the development of an optimal methodology for physical rehabilitation (including special outdoor games in combination with the use of natural factors of nature) for children who are often ill for a long time, taking into account their age, physical and psycho-emotional state, functional state of the cardiorespiratory system, will increase the healing effect of adaptive training. physical culture. This will find confirmation in improving the health of children, increasing their adaptive capabilities of the body, physical, mental performance and mood. The theoretical and practical significance of the study lies in the substantiation of the selection of special exercises and outdoor games in combination with natural factors for often long-term ill children, taking into account their functional state, age and performance, as well as in the development of methods for assessing and improving the effectiveness of the physical education process. The results of the study can be used in the organization and conduct of AFC classes in special. honey. and preparatory groups with frequently ill children. The inclusion of specially selected physical exercises, outdoor games and game elements in physical education classes for children who are often ill for a long time, in combination with hardening procedures, contributes both to enhancing the healing effect of classes and increasing the child's motivation to attend classes, and also stimulates his initiative, imagination, enhances the emotional background. Chapter 1. Definition and characterization of the group of frequently and long-term ill children The results of numerous epidemiological studies indicate that, on average, each child suffers from 3 to 5 episodes of acute respiratory viral diseases (ARI) per year. Population-based studies show that acute respiratory infections are most common in children. early age, preschoolers and junior schoolchildren. In children aged 10 years and older, the frequency of tolerated acute respiratory infections during the year is almost 2-2.5 times lower than in children of the first 3 years of life. At the same time, it was noted that a certain part of the child population is prone to frequent repeated respiratory diseases [Zaprudnov A.M., 2006]. Children, often and for a long time suffering from acute respiratory infections, are usually allocated to a separate group of dispensary observation - the group of children with respiratory diseases. A child is eligible to be classified in the CSD group in cases where the increased incidence of viral and bacterial respiratory infections is not associated with persistent congenital, hereditary or acquired pathological conditions. These children deserve special attention, because frequent respiratory infections can cause a breakdown of the main adaptive mechanisms, lead to significant impairment of the functional state of the body and contribute to the early development of chronic pathology [Tatochenko V.K., Kaganov B.S., 2000]. Domestic pediatricians classify children in the NCH group based on the criteria proposed by V.Yu. Albitsky and A.A. Baranov (1986) (Table 1). In children over the age of 3 years, as a criterion for inclusion in the FDI group, you can use the infectious index (II), defined as the ratio of the sum of all cases of acute respiratory infections during the year to the age of the child: AI \u003d (the sum of all cases of acute respiratory infections during the year) / ( child's age (years). IS in rarely ill children is 0.2-0.3, and in children from the FDI group - 1.1-3.5 [Romantsov M.G., 2003]. Criteria for inclusion of children in the group of children with respiratory diseases (Yu.V. Albitsky, A.A. Baranov, 1986) Table 1. Age of children Frequency of acute respiratory infections (episodes per year) moreChildren older than 5 years4 and more It should be noted that CHD is not a nosological form of the disease and not a diagnosis. Often, frequent and prolonged acute respiratory infections are a manifestation of hereditary, congenital or acquired pathology (for example, cystic fibrosis, congenital stridor, Nezelof's disease, Swiss type of immunoparesis, etc.). In every specific case it is necessary to determine the cause of increased respiratory morbidity. When establishing the cause of recurrence of acute respiratory infections in children, rehabilitation programs for specific nosological forms should be built taking into account the regulatory requirements for clinical examination. Timely detection of the underlying disease makes it possible to purposefully and effectively carry out therapeutic and preventive measures and significantly reduce the risk of developing repeated respiratory diseases. The group of frequently and long-term ill children is usually classified as children prone to frequent respiratory diseases due to transient, correctable deviations in the body's defense systems and not having persistent organic disorders in them [Shcheplagina L.A., Rimarchuk G.V., Kruglova I.V. ., Borisova O.I., 2008]. Clinical forms and etiology of respiratory children from the FDB group. Acute respiratory diseases in children from the BCH group are most often manifested as infections of: 1. Upper respiratory tract (rhinitis; nasopharyngitis; tonsillitis; tonsillopharyngitis; laryngotracheitis; tracheitis; bronchitis; laryngotracheobronchitis). 2. Terminal respiratory sections and pulmonary parenchyma (bronchopneumonia). 3. ENT organs (otitis media; eustachitis; adenoiditis; sinusitis). Among the etiological factors of acute respiratory infections in children, viruses play a leading role. The share of viruses among the etiological factors of acute respiratory infections is 65-90%. It should be noted the possibility of a "mixed" viral-bacterial infection (up to 25% of cases). Among the viral pathogens of acute respiratory infections in children, influenza A viruses, parainfluenza (serotypes 1-3), respiratory syncytial viruses, adenoviruses (serotypes 1-4, 5, 7), rhinoviruses, ECHO enteroviruses (serotypes 2, 4, 9) and Coxsackie (serotypes 2, 4, 6, 8). Among the bacterial pathogens that cause acute respiratory infections in children, the leading places are occupied by Strept. pneumoniae, Haemophylus influenzae, Strept. pyogenes, Staphyl. aureus. In recent years, the increased role of mycoplasmas, ureaplasmas, chlamydia and gram-negative bacteria in the development of acute respiratory infections has attracted attention. The high content of various xenobiotics in air, water, food is accompanied by their accumulation in the body, which ultimately leads to changes in cellular metabolism, homeostasis disorders and perversions of immune defense [Sharmanov G.Sh., Zeltser M.E., Nikov P .S., 2003]. FIC is characterized by an immature, infantile type of immunological response that does not provide optimal adaptation of the child to the external environment. At the same time, insufficiency of various parts of the immune system can be detected, which is transient in nature and is associated with age-related features of the formation of immunity [Makarova G. A., 2004]. Immunity is a way of protecting the body from living bodies and substances that bear signs of alien information that ensure the survival of a person as a species in conditions of exogenous and endogenous aggression. Microorganisms (bacteria, fungi, protozoa, viruses) are exogenous agents. To endogenous - human cells modified by viruses, aging; tumor cells, etc. Immune protection is provided by the immune system, which consists of central and peripheral organs. The central organs of the immune system include the bone marrow (B cells, macrophages, granulocytes) and the thymus gland (T cells). To the peripheral organs of the immune system - the spleen, lymph nodes, lymphoid tissue of the mucous membranes. The human immune system begins its formation before the birth of a child. From birth to the end of puberty, step by step, the structure and functions of the immune system are formed. The development of the immune system goes through a number of critical stages. There is evidence that, in general, children are more susceptible to infection during critical periods in the development of the immune system, when the risk of a paradoxical reaction of the immune system to an antigen is maximum. The first critical period includes the age up to the 29th day of life, the second - 4-6 months of life, the third - the second year of life, the fourth - 6-7 years, the fifth - 12-13 years in girls and 14-15 years in boys. The first critical period is characterized by the fact that the child's immune system is suppressed. Immunity is passive (maternal antibodies). The phagocytosis system is not developed. A tendency to generalization of microbial-inflammatory processes, to septic conditions is characteristic. High sensitivity to viral infections, against which the child is not protected by maternal antibodies. The second critical period is due to the destruction of maternal antibodies. The first immune response to the penetration of infection develops due to the synthesis of Ig M and leaves no immunological memory. Insufficiency of the local immunity system is manifested (repeated acute respiratory viral infections, intestinal infections, skin diseases). High sensitivity to viruses. The frequency of food allergies is on the rise. Third critical period. The primary response (the synthesis of Ig M) to many antigens is preserved and the switching of immune responses to the formation of antibodies of the Ig G class begins. The system of local immunity remains undeveloped. Therefore, children remain susceptible to viral and microbial infections. Children are prone to repeated viral and microbial-inflammatory diseases of the respiratory organs, ENT organs. The fourth critical period differs in that the average concentration of IgG and Ig M in the blood corresponds to the level of adults. The content of Ig E in blood plasma differs by the maximum level in comparison with other age periods. Serum Ig A remains below normal. This is considered as a risk factor for the formation of many chronic diseases, and allergic pathology may increase. The fifth critical period occurs against the backdrop of rapid hormonal changes in the body. Against the background of increased secretion of sex steroids, the volume of lymphoid organs decreases. The secretion of sex hormones leads to suppression of the cellular link of immunity and stimulation of its humoral link. The content of Ig E in the blood decreases. The influence of exogenous factors (smoking, xenobiotics, etc.) on the immune system is growing. Increased sensitivity to mycobacteria. After a certain decline, there is an increase in the frequency of chronic inflammatory diseases [Zmanovsky Yu.F., 2002]. There are many reasons and factors for a decrease in immunity. Reduced immunity is caused by: - ​​insufficient protein and energy nutrition, deficiency of micronutrient intake, especially vitamins A, C, E, D, polyunsaturated fatty acids; - the presence of chronic diseases of the digestive system; - infectious diseases; - frequent and prolonged use of antibacterial agents, salicylates, etc.; - violation of the composition of the intestinal microflora; - passive smoking reduces local immunity, nonspecific hypersensitivity of the mucous membranes of the upper respiratory tract develops; - environmental violations of the environment. Currently, there are five groups of FIC: Group 1 - children with predominant allergy symptoms. In children belonging to this group, a paratrophic habitus is detected at birth. Repeated acute respiratory infections are associated with the transfer to artificial feeding and the beginning of visits to preschool institutions. Group 2 - children with neurological pathology. The imbalance of central regulatory mechanisms in children of this group creates conditions for the manifestation of various organotypic diatheses, against which viral and bacterial infections, helminthic-protozoal invasions develop. Children get sick from birth, preschool institutions, as a rule, are not attended. Group 3 - children with primary vegetative dysfunctions of a congenital and acquired nature. ARI is manifested by prolonged low-grade fever and periods of prolonged (up to several months) coughing. A high incidence of diseases of the gastrointestinal tract is characteristic. Group 4 - children with a predominant congenital lesion of the lymphatic system, which causes the possibility of a high incidence of various diseases with severe clinical symptoms, hyperthermia, followed by subfebrile condition. Allergosis in these children is manifested by dermatorespiratory syndrome. The frequency of repeated acute respiratory infections increases with antigenic load. Group 5 - children with predominant violations of the metabolic-constitutional nature and involvement of the urinary organs in the pathological process. Diseases are predominantly bacterial in nature. Identification of five groups of FAI is aimed at helping the practitioner in developing rehabilitation measures for this category of children, although, without a doubt, it is conditional, since it cannot cover the entire variety of clinical manifestations [Pyagay L.P., 2001]. By the nature of the incidence of M.G. Romantsov (2006) also distinguishes "conditionally" (they get sick no more than 4-5 times a year, IR = 0.33-0.49) and "true" (they get sick 6-7 times or more, IR > 0.5) CHBD. In turn, according to clinical features, there are three main clinical types of "true" FAI [Zaitseva O.V., 2004]: 1. somatic, the formation of which occurs against the background of perinatally caused encephalopathy and allergic diathesis. The frequency of acute respiratory infections - 8 or more times a year, IR ≥ 0.67. Diseases proceed with severe intoxication, high temperature body, febrile convulsions. In the period of convalescence, a prolonged cough is noted. Complications are manifested in the form of bronchitis, including obstructive, and pneumonia; 2. otorhinolaryngological, formed against the background of complications in early ontogenesis and lymphatic diathesis. ARIs are registered with a frequency of 4-6 times a year; characterized by a long and undulating course; 3. mixed. It includes the heaviest contingent of "true" FBD. For them, the polysystemic and multiorgan nature of deviations in the state of health is typical. From the foregoing, it follows that the system of rehabilitation of frequently and long-term ill children requires a systematic implementation of a complex of medical and social measures. Chapter 2 To carry out effective preventive and rehabilitation measures, it is necessary to search for individual methods of recovery, taking into account the etiological and pathogenetic mechanisms of the occurrence of such a condition. Comprehensive rehabilitation of CBD should be carried out at all stages of recovery: family, organized team, clinic, sanatorium. With an increased incidence of ARI in a child, the pediatrician determines him to the 2nd group of dispensary observation, which must be regarded as a risk group, which requires increased attention to the patient and both additional examinations and complexes of preventive and rehabilitation measures, which should include not only medical, but also psychological, pedagogical, speech therapy methods of influence [Makarova Z.S., 2005]. The main directions of rehabilitation activities of the CHBD are [Zelinskaya D.I., 2006]: 1. Mandatory organization of an individual optimal day regimen for a child. Since PIS in most cases have functional disorders of the central and autonomic nervous system, they require a full, sufficient sleep, overwork and overexcitation are unacceptable, long enough walks are necessary, but without hypothermia, restriction of visits to places large cluster people, etc. 2. Development of an individual diet. At the same time, the protein content should exceed the age standards by 5-10%. The daily diet should include fresh vegetables, fruits, juices. During epidemic outbreaks, it is necessary to include in the daily diet products containing phytoncides - fresh onions and garlic. It is recommended to rinse the mouth and throat with infusions of herbs that have an antiseptic effect (St. John's wort, calendula, chamomile, celandine, eucalyptus, plantain, sage). 3. Hardening and physical education contribute to an increase in resistance to low temperatures by reducing the excitability of thermoreceptors, which makes it possible to stabilize thermoregulation systems and adaptation mechanisms. It is important to remember that hardening does not require very low temperatures. The contrast of exposure and gradualness matter. Hardening procedures should be combined with physical exercises. Properly organized physical education helps to reduce the frequency of acute respiratory infections, and after a year of training, the physical development of children begins to outstrip that of their peers, not only in terms of the results of running and long jumps, but also in functional tests of Stange, Genche, as well as in the strength of the muscles of the arms, back and belly. The maximum effect can be obtained only with the systematic conduct of classes, observing the principle of a gradual increase in physical activity. 4. Medical rehabilitation includes: - rehabilitation of chronic foci of infection (if necessary); - elimination of micronutrient deficiencies (in the case of iodine deficiency conditions - the use of iodized salt, additional intake of potassium iodide and, possibly, appropriate medicines); - physiotherapeutic methods (inhalation, phototherapy, massage, speleotherapy, as well as ultraviolet irradiation); - the use of drugs with so-called adaptogenic properties that increase the overall resistance of the body. These include plant adaptogens (extract of Rhodiola and Eleutherococcus; infusions of zamaniha, Schisandra chinensis, aralia, ginseng root), propolis (containing the essential amino acids arginine, valine, methionan, tryptophan, etc.), biologically active substances and vitamins (B1, B2, B3, B6, B12, C, PP, E, folic acid, biotin), homeopathic remedies with proven effectiveness by numerous studies (Immunokind, Echinacea compositum); - immunomodulation as one of the main components of pathogenetic therapy and prevention of recurrent acute respiratory infections. Since the immune system of a growing organism is extremely fragile, and unjustified exposure to it leads to irreversible changes, immunomodulatory therapy should be carried out with extreme caution. Specific active immunization against the most common pathogens of acute respiratory infections compares favorably with non-specific immunostimulation in its purposefulness and effectiveness. The development of effective preventive and rehabilitative measures for children with frequent respiratory diseases is not only a medical but also a social problem. For each child, it is necessary to search for individual methods of recovery, taking into account the etiological and pathogenetic mechanisms of the disease, as well as environmental factors that form the predisposition of the child's body to frequent respiratory diseases. Comprehensive rehabilitation of frequently ill children at all stages of recovery (family, organized team, clinic, sanatorium) includes preventive measures aimed at preventing diseases and improving the health of children, as well as therapeutic effects that contribute to the correction of identified pathological abnormalities. The choice of means and methods of recovery and rehabilitation is carried out by a pediatrician during dispensary observation of frequently ill children, which is carried out 2-4 times a year. Twice a year, children should be examined by an ENT - a doctor, a dentist and, according to indications, other specialists. A blood and urine test is being carried out. The criteria for deregistration is the decrease in the number of acute diseases to 3 or less during the year, the absence of their severe, complicated course. The system of rehabilitation measures includes the creation of optimal conditions for the maturation of the immune system, the implementation of general health measures [Korovina N.A., Cheburkin A.V., Zakharova I.N., 2006]. Immunorehabilitation: - stage 1 - the use of drugs and non-pharmacological agents with non-specific immunomodulatory and immunostimulating properties; - Stage 2 - the use of immunotropic drugs. Preventive measures to prevent respiratory infections are divided into exposure and disposition. Exposure prophylaxis aims to prevent the child from coming into contact with the source of infection. Taking into account the spread of influenza and SARS, the isolation of the child from the patient and the potential source of infection plays a leading role in the prevention of acute respiratory infections. The main measures that can be taken in this regard are as follows: 1. limiting the contact of the child during the seasons of increased respiratory morbidity; 2. reducing the use of urban transport for trips with children; lengthening the time spent by the child in the air; 3. wearing masks by family members with signs of acute respiratory infections; 4. Thorough washing of hands after contact with a patient with acute respiratory infections or items of care for him; 5. limiting visits to childcare facilities by children with fresh catarrhal symptoms. In dispositional prophylaxis, the main methods of increasing the child's resistance to infectious agents are vaccination and hardening. Hardening, restorative and physiotherapy exercises. Considering that one of the reasons contributing to their high morbidity in children from the BCH group is often the immaturity of the thermoregulation system with reduced resistance to changing climatic and heliogeographic environmental factors, methods of rational hardening and physical education are gaining more and more popularity. Under the influence of hardening measures, along with a decrease in the incidence rate, the normalization of immunological parameters also occurs. Systematic contrast air or water hardening is accompanied by an increase in the body's resistance to temperature fluctuations in the environment and an increase in the immunobiological reactivity of the body. Hardening by contrast methods contributes to the normalization of ion homeostasis and is manifested by a decrease in the release of ionized calcium from the body, an increase in the release of sodium and chlorine by cells, which indicates an improvement in autonomic regulation. For children in the period of convalescence after acute respiratory infections, contrast hardening procedures can be used under gentle conditions using motor loads, approximately half the volume in the first 5-7 days. It is very important to carry out hardening procedures systematically and observe the principle of gradual increase in load. Hardening procedures must be combined with gymnastics and chest massage. These procedures increase the functional efficiency of the respiratory system. Massage is carried out 2-4 times a year, the course is 14 days [Machek M., Shtefonova N., Shveytsarova B., 2003]. Children in the PDD group often experience excessive sweating due to dysfunction of the autonomic nervous system. Therefore, the recommendations of frequent (2-3 times a day) change of underwear (panties, T-shirts, socks) during the day are justified. It is advisable to wear cotton clothing. It is recommended to systematically carry out the so-called foot therapy, which is a foot massage. It is performed as follows: with the palm, fingertips or fingers folded into a fist, stroking, rubbing and again stroking the soles of bare feet is carried out. In the rehabilitation of frequently ill children, the systematic implementation of special complexes of physiotherapy exercises aimed at ensuring good drainage of the bronchi and increasing the tone of the respiratory muscles is important [Kiselev OI, 2004]. Daily routine and rational nutrition. One of the important activities is the rational regime of the day. Due to the fact that functional disorders of the central and vegetative nervous system are observed in children from the FDB group, it is necessary to exclude overwork and overexcitation. It is advisable to increase the duration of sleep by 1-1.5 hours. Obligatory is daytime sleep or rest. In the presence of sleep disorders, other astheno-neurotic disorders, walks in the fresh air before going to bed, as well as taking sedative herbs (such as motherwort, valerian), are shown. As a herbal medicine, you can use ready-made dosage forms from herbs such as sanosan (extract of hop cones and valerian roots), persen (drops and capsules containing extracts of valerian, peppermint and lemon balm), altalex (mixtures essential oils of 12 medicinal herbs, including lemon balm). These drugs have a calming effect, relieve irritability, normalize sleep [Shapkova L.V., 2004]. The nutrition of frequently ill children should be varied, high-calorie, containing the optimal amount of proteins, fats, carbohydrates, mineral salts and vitamins. It is important to include fresh fruits and vegetables in your daily diet. Children with food allergies are recommended a hypoallergenic diet with the exclusion of obligate allergens. It is important to remember that timely detection of a causally significant allergen and specific hyposensitization can prevent the development of severe forms of allergies, which are the background for the formation of a contingent of frequently ill children [Albitsky V.Yu., Baranov A.A., 2006]. Natural natural factors in immunorehabilitation. Halotherapy is a method of treatment and rehabilitation based on the use of an artificially created microclimate of salt caves and the use of natural factors. It was developed on the basis of speleotherapy - a method of treatment in the microclimate of salt mines. Halotherapy is carried out in specially equipped rooms - halochambers, where controlled microclimate conditions are created with a controlled concentration of dry highly dispersed sodium chloride aerosol, hypoallergenic, hypobacterial air environment, comfortable climatic conditions, as well as comfortable audiovisual effects. Halotherapy is most indicated for frequently ill children with an allergic predisposition. It is prescribed for children from 2 years of age. The course of halotherapy is 20 sessions daily. In the absence of a pronounced clinical effect after the first course of halotherapy, it can be repeated at intervals of at least 4-6 months. Halotherapy goes well with breathing exercises, massage, physical therapy, herbal medicine, hydrotherapy. At the same time, aromatherapy, thermotherapy (sauna), physiotherapy procedures should not be prescribed [Berezhnoy V.V., 2004]. Aerophytotherapy (aromatherapy) is a method based on modeling the natural phytoorganic background of the air above plants. Essential oils are used in the form of unsaturated vapors in controlled concentrations. Essential oils have a wide range of biological activity, have antibacterial, antiviral, anti-inflammatory, spasmo- and bronchodilator, sedative, expectorant, immunomodulatory effects. The most commonly used essential oils are mint, lavender, sage, anise, fennel. The procedure can be prescribed to children from one and a half years. The course of rehabilitation is 20 sessions, daily. Aromatherapy courses can be held 2 times a year with an interval of at least 4 - 6 months. When selecting children, special attention should be paid to the presence of allergic diseases in the child's family, pollinosis, reactions to flowering herbs, intolerance to odors. Aromatherapy is most indicated for frequently ill children suffering from sleep disorders, appetite disorders, increased excitability, and neurotic reactions. It is advisable to combine aromatherapy sessions with breathing exercises and massage. Children can visit the swimming pool, sauna. Joint use with halotherapy and physiotherapy is undesirable [Baranov A.A., Dedov I.I., 2003]. Phytotherapy. Phytotherapy is one of the components of rehabilitation programs for frequently and long-term ill children. Phytotherapy can be used in the form of oral (through the mouth) intake of herbal medicines, therapeutic inhalations and local therapy. For the rehabilitation of foci of chronic inflammation of the oropharynx, washing the nasal passages, rinsing the mouth and throat with phyto-infusions and decoctions is indicated. Decoctions and infusions of herbs are used that have antibacterial and protective properties (St. John's wort, calendula, chamomile, celandine, eucalyptus, plantain, sage). Experts recommend oxygen cocktails with herbal infusions (plantain, St. John's wort, chamomile). It is better to use oxygen foam on an empty stomach 30 minutes before meals. Course duration - up to 3 weeks. It is desirable to conduct 2 courses per year. It should be remembered that oxygen cocktails with herbal decoctions are recommended to be used with caution in children with a burdened allergic history [Zaitseva O.V., 2004]. The most commonly used plants have the following properties: 1. Immunostimulating (eleutherococcus root and rhizomes, aralia root, zamanihi, marshmallow, flax, kelp, plantain leaf, coltsfoot, blackcurrant, blueberry, tricolor violet herb, St. John's wort, burdock root, elecampane, lemon peel). 2. Anti-allergic (violet tricolor grass, licorice root, succession grass, birch leaves). 3. Normalizing intestinal microflora (divyasil root, herb oregano, thyme, St. John's wort, yarrow, chamomile flowers, blueberries). 4. Sedative (valerian root, motherwort herb, hop seeds, fennel fruit, peppermint leaves). 5. Anti-inflammatory (chamomile flowers, calendula, sage leaves, eucalyptus, oregano, thyme). 6. Expectorant (fruits of anise, fennel, herb oregano, thyme, elecampane root, licorice, coltsfoot leaves). 7. Containing vitamins (rose hips, sea buckthorn, mountain ash, black currant, strawberry fruits and leaves, nettle leaves, calendula flowers). Vitamin therapy Rational vitamin therapy is an obligatory component of health improvement programs for children with frequent and long-term acute respiratory infections. Vitamins are cofactors of enzymes involved in almost all types of metabolism in the body. In infectious diseases, the body's need for vitamins rises sharply, which is often accompanied by the development of relative vitamin deficiency. The latter, in turn, negatively affects the functional status of the immune system, reduces the body's resistance to infections and contributes to the development of allergic conditions [Sharmanov G.Sh., Zeltser M.E., Nikov P.S., 2003]. Vitamin deficiency in frequently ill children is not limited to ascorbic acid deficiency, but, as a rule, has the character of a combined polyhypovitaminosis. Along with a lack of vitamin C, the most common deficiency of vitamins B, B2, B6, PP, folic acid and carotene. Violating the metabolism, weakening the body, vitamin deficiency aggravates the course of respiratory infections in children, reduces the effectiveness of preventive and therapeutic measures, and contributes to the chronicity of inflammatory processes. Taking multivitamin preparations significantly reduces the incidence of acute respiratory infections. Thus, fortification in Moscow schools reduced acute respiratory morbidity in schoolchildren by 30% compared with the control [Doskin V.A., 2008]. When conducting vitamin therapy in children with frequent and prolonged respiratory infections, it is advisable to use multivitamin complexes enriched with microelements. Trace elements are activators of various biochemical reactions in cells, including immunocompetent ones. So, cobalt is involved in the exchange of nucleic acids, protein synthesis and, accordingly, in the synthesis of blood cells. Manganese and zinc increase the content of vitamin C in tissues, participate in protein synthesis, and have antitoxic and anti-inflammatory effects. Copper and manganese regulate the metabolism of vitamin A. Molybdenum activates the enzyme xanthine oxidase, which is involved in the metabolism of purine and pyrimidine bases, which are components in the synthesis of nucleic acids [Zelinskaya D.I., 2006]. Chapter 3. Features of physical rehabilitation of children from the group of frequently and long-term ill children The process of rehabilitation of frequently and long-term ill children solves general and particular problems. The general tasks of rehabilitation are [Popov S.N., 2004]: 1. Achievement of regression of reversible and stabilization of irreversible changes caused by frequent respiratory pathology and secondary hypokinesia; 2. Restoration and improvement of the function of external respiration and cardio - vascular system, psychological status and working capacity. The implementation of these tasks may vary depending on the individual characteristics of the child, the state of his immunity. Particular tasks of rehabilitation in case of frequent respiratory diseases include: 1. Elimination of inflammatory foci; 2. Improvement of bronchial patency; 3. Increased lung ventilation; 4. Improving the drainage function of the bronchi; 5. Strengthening the muscular corset; 6. Increasing the tolerance of physical activity; 7. Increasing the body's defenses. Physical rehabilitation of children from the group of frequently and long-term ills has its own specifics and features of methods. This is first of all individual approach in the methodology and dosage of physical exercises, the systematic, regularity and duration of classes, as well as the mandatory gradual increase in load and the "novelty effect" - the introduction of new exercises. The child's body reacts to exercise therapy more quickly and directly than the body of an adult. The results of the exercises affect earlier and are irreversible. This is due to the greater reactivity and regenerative capacity of the child's body [Zakharova L.S., Ivanova N.L., 2008]. All used means of physical rehabilitation can be divided into active, passive and psychoregulatory. These include: 1. General developmental physical exercises. 2. Breathing exercises 3. Massage. 4. Hardening. 5. Physiotherapeutic methods. 6. Therapeutic gymnastics. 7. Air and water procedures. 8. Outdoor games. Active means of physical rehabilitation include all forms of exercise therapy: morning hygienic gymnastics, therapeutic exercises, a set of special breathing exercises, mass games, dosed walks, walking, running, swimming. The therapeutic effect of exercise therapy is based on strictly dosed training. According to the level of physical activity, they distinguish [Gritchenko N.V., 2006]: 1. general health training aimed at restoring age-related functional capabilities and motor skills; 2. special health-improving training aimed at eliminating respiratory dysfunction. When working with frequently and long-term ill children, general strengthening and breathing exercises must be included in the LH procedure. General strengthening physical exercises include gymnastic, game and sports. The leading place in exercise therapy is occupied by gymnastic exercises: general strengthening and breathing [Lenorsky L.A., 2009]. General strengthening exercises according to the method of execution are divided into: 1. Reflex. 2. Passive. 3. Active. 4. Aimed at relaxation [Kaptelin A.A., Lebedeva I.P., 2005]. Breathing exercises are classified as general breathing exercises - that is, a system of exercises in natural rhythmic breathing, as well as in the correct use of inhalation and exhalation during simple and more complex gymnastic movements, and the rhythm of breathing and movement form one rhythmic whole. In addition, for children with frequent respiratory diseases, special breathing exercises are also recommended, which are a system of exercises that consciously affect the neuromuscular mechanism of breathing, which gives them the opportunity to influence the depth, rhythm and strength of breathing. There are many methods of respiratory gymnastics, the most famous, which have proven their worth in the treatment of the respiratory system, developed by A.N. Strelnikova and K.P. Buteyko. Doctors, as Alexandra Nikolaevna Strelnikova stated, do not attach importance to the importance and correctness of breathing through the nose. The oral cavity is designed by nature for the use of water and food. With a pathology of the respiratory system, the mouth can become just an "emergency inlet" for air. But inhaling through the nose is deeper, besides, it protects the body from dust and microbes, protects from hypothermia. Breathing exercises should be carried out in small rooms with clean air, with an open window, on an empty stomach or an hour and a half after eating. In the starting position, you should stand straight. Hands along the body, legs slightly less than shoulder width. "Take short, momentary breaths - "sniff", do not be shy about this sound. Force the nostrils to close, as if squeezing a rubber bulb filled with water to splash out of it. You need to pinch the wings of the nose so as to force air into the body. Feel how the nostrils move and obey you," Strelnikova points out. Such an inhalation is helped by touching the upper teeth with the tip of the tongue. When inhaling, the shoulders should not rise, but, on the contrary, go down [Kochetova I.N., 2009]. In the first lesson, with a satisfactory, calm state, the exercise should first be done for 4, 8 or 16 breaths - movements with a rest of 2-4 seconds between them, increasing their number and striving to complete thirty. In a row, you should carry out as many breaths - movements as it does not tire and gives pleasure. Don't rush and follow the rhythm. Breaths - movements per minute should be equal to the pulse rate or even more often, making sure that the breaths are noisy and the exhalations are inaudible. The most important measure of breaths is their depth, which determines the level of ventilation of the lungs. The deeper the breath, the shorter the pause after exhalation and the delay after it, the more severely the person is ill, and it is necessary to correct his breathing as soon as possible [Kamenev Yu.Ya., 2004]. For more than fifty years of practice, K.P. Buteyko and his colleagues have established that incorrect breathing can be corrected by will. They developed fundamentally new methods for early diagnosis, prevention and drug-free treatment of diseases by the VLHD method. The essence of the Buteyko method is a gradual volitional decrease in the depth of breathing at rest, during motor activity and during physical exertion by constantly relaxing the respiratory muscles during exercise until a slight feeling of lack of air appears. Breathing method according to K.P. Buteyko, as well as the method of A.N. Strelnikova, requires certain qualities from the practitioner - willpower, perseverance, diligence, discipline and a conscious desire to prevent the onset of the disease or "overcome" it [Popova N.M., Kharlamova E.V., 2004]. According to K.P. Buteyko, due to deep breathing and increased pulmonary ventilation, excessive removal of carbon dioxide from the body occurs, which in turn leads to narrowing of the bronchi, arterial vessels in various areas of the human body, their damage and a decrease in the flow of oxygen to cells, tissues and organs. As a result of their oxygen starvation, all types of metabolism are disrupted, which is expressed in the appearance of allergic reactions, a tendency to colds, and salt deposits. Numerous diseases arise and progress, including bronchial asthma, manifested by various symptoms: excitation of the nervous system, sleep disturbance, shortness of breath and suffocation, headache and other forms of pain [Kamenev Yu.Ya., 2004]. Passive means of physical rehabilitation include massage, manual therapy, physiotherapy, natural and preformed natural factors. Of the massage effects, the most common massage of the face and chest. It is known that the violation of nasal breathing causes a number of pathological conditions of various organs and systems. Violation of the drainage of the nasal cavity and paranasal sinuses caused by various diseases can lead to the reflex development of asthma attacks. Anatomical and physiological features of the structure of the upper respiratory tract and lungs explain the therapeutic effect of facial massage, which leads to the restoration of the protective properties of the nasal mucosa and paranasal sinuses. Chest massage is performed in patients bronchial asthma to improve the work of the respiratory muscles, improve sputum discharge and increase immunity [Zmanovsky Yu.F., 2009]. Hardening is the training of the physiological mechanisms of adaptation by periodically repetitive irritation. skin, and the intensity of stimulation is constantly increasing. A person does not feel the temperature of the water when it is close to body temperature (33 °), water at a temperature of 23 ° is felt as cool, and at 13 ° - as cold. Water at temperatures below 23°C has an irritating effect, to which the body responds by changing the intensity of thermoregulation processes and physiological adaptation processes. Under the influence of cooling, the processes of heat generation in the body are accelerated, with intense exposure to cold, the functions of the adrenal glands and the thyroid gland are stimulated [Kokosov A.N., Streltsova E.V., 2001]. Hardening does not require very low temperatures; temperature contrast and systematic procedures are important. Well tempered effects on the soles of the feet, on the skin of the neck, lower back, however, to obtain a uniform effect, it is better to act on the skin of the entire body. The maximum duration of cold exposure to a child should not exceed 10-20 minutes, its repetition and gradualness are much more important. Hardening, if the child is kept in greenhouse conditions, will not give an effect, it is important to create a stimulating temperature environment: clothing appropriate for the weather, normal temperature in the apartment (18-20 ° during the day and 2-4 ° C lower at night). Already from the 1st year, the child should be accustomed to walks (up to 4 hours a day), while avoiding excessively warm clothes. It is necessary to start hardening from the first weeks of life - these are air baths during swaddling, gymnastics, before bathing. For this, the child is left undressed in the air for several minutes at a temperature of 22 ° C, followed by a gradual decrease to 20 ° C at the age of 2-3 months and 18 ° C by 4-6 months. Bathing should also be used for hardening: at the end of the bath, it is appropriate to pour water over the child with a temperature 2-4 ° C lower than the water in the bath, i.e. start with a temperature of 32-34 ° C, reducing it every 3 days by 2-3 ° C. At this rate of decrease in water temperature, 18 ° C can be reached in a month, and it should not be lowered for a baby. After dousing the child should be rubbed with a towel. Swimming babies in the pool hardens not so much in itself (the water temperature in it usually does not fall below 26 ° C), but in combination with air baths before and after the pool. In the second year, after bathing (2-3 times a week), you can add daily wash feet with cool water. Treatments start with a water temperature of 27-28°C, lowering it every 1-2 days by 2-3°C to a final temperature of 15°C (slightly colder than room temperature). A contrast shower has a good hardening effect: changing warm water (up to 40 ° C for 30-40 seconds) with cold water (14-15 ° C) - extending its effect from 15-20 seconds to 30 seconds. It is unacceptable to bring cold effects to unpleasant (i.e., use too cold water or leave a child under a cold shower for more than 30-40 seconds) - not because of a possible "cold", but because of the danger of causing a negative attitude of the child to hardening. Any tempering procedure should evoke positive emotions, if the child "shivers", is afraid, he should not be forced. For preschoolers, it is not difficult to organize contrasting air baths at home. To do this, in the child’s bedroom, before waking up, by opening the transom, the temperature is lowered to 14-15 ° C, and then, after waking the child, they play with him with dashes from a warm to a cold room [Kuts A.S., Shiyan B.M. , 2003]. A visit to the sauna provides even more opportunities for contrasting effects, for young children the temperature in the sauna should be around 90 ° C, the duration of the stay is gradually increased to 10 minutes, sitting on the 1st step. In the Russian bath, lower temperatures are used (from 60° C with an exposure of 2-3 minutes, increase to 80° C for 6-8 minutes). In one session, children visit the steam room 2-3 times, in between they take a shower or air bath at room temperature or swim (slowly) in a pool with a water temperature of about 25 ° C [Zhuravleva A.N., Graevskaya N.D., 2002] . Winter swimming, walking barefoot in the snow are unsafe types of hardening. If parents carry them out, this should be done very gradually and the duration of the procedure should not exceed 40-60 seconds, since, having a large body surface area relative to weight, the child cools much faster than an adult. The same can be said about dousing with cold water. For a preschooler, with a gradual decrease, it is quite possible to bring the water temperature to 8-10 ° C, although this is not necessary, the hardening effect will be good if you stop at 12-14 ° C. Cold pouring as a therapeutic measure should be strictly prohibited for a child with a fever : Sudden cooling, leading to a sharp narrowing of the skin vessels, can be life-threatening. Hardening after a mild acute respiratory disease can be resumed (or started) after 7-10 days, with a disease with a duration of a temperature reaction of more than 4 days - after 2 weeks, and after a 10-day fever - after 3-4 weeks [Gazhev B. N., Vinogradova T.A., Martynov V.N., 2001]. Physical education, with its rich arsenal of recreational tools, plays a huge role in the prevention and rehabilitation of frequent respiratory infections. It is also important to normalize the function of external respiration and blood circulation by means of physical culture. After all, a respiratory disease often causes such disorders as blockage of the respiratory tract, abundant secretion of the glands of the bronchial mucosa, emphysema, in the formation of areas of the lungs that are completely turned off from the act of breathing. Exercise therapy for frequent colds contributes to balancing the processes of excitation and inhibition in the cerebral cortex, the creation of a competing dominant, eliminates pathological cortico-visceral reflexes and restores a normal breathing pattern. Methodically correctly delivered exercises of exercise therapy contribute to the elimination of antigenic material, reduce the reactivity of the bronchi, adapt patients to (special) increasing physical exertion, and help maintain their performance. When using physical exercises, some compensation for respiratory failure can be achieved by improving local ventilation of the lungs (functioning of the pulmonary capillaries), as a result of which conditions are created for enhancing gas exchange. The main task of exercise therapy in broncho-pulmonary pathology is to restore the impaired function of the bronchial tree and lungs. With frequent SARS, the blood supply to the lungs and bronchi deteriorates, there is a small excursion (mobility) of the chest, shallow breathing, a decrease in the strength of the respiratory muscles contributes to venous and lymphatic stagnation and disrupts sputum discharge. In addition, congestion leads to hypostatic pneumonia. The use of physical exercises in frequently and long-term ill children is aimed at normalizing blood and lymph circulation and thereby eliminating congestion in the lungs. Exercise therapy helps to restore the mobility of the ribs, improve ventilation of the lungs by increasing microcirculation in the pulmonary capillaries, facilitates the work of the heart, strengthens the respiratory muscles, etc. [Makarenko T.M., 2009]. When working with children from the group of those who are often and for a long time ill, in no case should one forget about the mental component. Most children suffering from this disease have certain features of a neurotic. Physiotherapy has a positive effect on the mental state of the patient, the strength of attacks and frequency are directly dependent on a variety of emotional factors. Children are characterized by increased mental excitability, as well as high reactivity of the autonomic nervous system. In the first years, the functional parameters of the respiratory apparatus were not changed in patients during calm periods. Children of this group in the intervals between attacks can be given the same load as healthy ones. Some children have a sharp, jerky, exercise stress can cause an irritating cough that turns into an asthma attack. Therefore, when dosing physical stress, it is necessary to choose slower movements [Boguslavskaya Z.M., Smirnova E.O., 2001]. Conclusion Recently, the number of frequently and long-term ill children has significantly increased, which limits their motor activity and leads to impaired physical development , decrease in the functional capabilities of the body, the formation of a hypokinetic syndrome. The inclusion of specially selected physical exercises in combination with tempering procedures for children from the group of frequently and long-term ill patients in AFC classes not only increases the health-improving effect of classes, increases the adaptive capabilities of their body and improves the psycho-emotional background. Thus, physical exercises of a special orientation in combination with natural factors of nature, when practicing AFC, contribute to the complex rehabilitation of children from the group of frequently and long-term sick people, as well as the prevention of respiratory diseases, optimization of their motor activity and, in general, improvement of health. To assess the rehabilitation impact of physical exercises on the state of external respiration, the cardiovascular system, the state of physical fitness, as well as to determine the optimal motor regimen for frequently and long-term ill children, dynamic medical and pedagogical observations are appropriate. The choice of methods of medical and pedagogical control should be carried out taking into account individual morphological and functional characteristics, the characteristics of the course of the disease and the psycho-emotional state of schoolchildren. References 1. Albitsky V.Yu., Baranov A.A. In: Frequently ill children. Clinical and social aspects, ways of recovery. - Perm, 2006. - 86 p. 2. Aparin V.E., Platonova V.A., Popova T.P. Therapeutic physical culture in the complex staged treatment, rehabilitation and prevention of lung diseases in children. - M.: Medicine, 2003. - 170s. 3. Berezhnoy V.V. Immunocorrection in Pediatrics // Health of Ukraine. - 2004. - No. 108. - P. 25. 4. Binchuk I.I., Molotkova V.I. Outdoor games in the physical education of students special. honey. groups. - Minsk, 2006. - 48s. 5. Boguslavskaya Z.M., Smirnova E.O. Educational games for children of primary school age. - M.: Enlightenment, 2001. - 206s. 6. Byleeva L.V., Korotkov I.M. Outdoor games. - M.: Physical culture and sport, 2002. - 207p. 7. Vavilova V.P., Perevoshchikova N.K. Educational program for pediatricians and general practitioners "Rehabilitation of frequently ill children". - M., 2004. - 44 p. 8. Gazhev B.N., Vinogradova T.A., Martynov V.N. Treatment of respiratory diseases in adults and children. St. Petersburg: Ed. House "Mim", 2007. -256 p. 9. Gasilin V.S., Romanov A.I. Nonspecific lung diseases and their prevention. - M.: Knowledge, 1973. - 93p. 10. Geller E.M. Rhythmic gymnastics for schoolchildren. - M.: Knowledge, 2004. - 190s. 11. Gritchenko N.V. Fundamentals of therapeutic physical culture and medical control. M .: "Medicine" 2006. - 243 p. 12. Dedov I.I., Melnichenko G.A., Troshina E.A. Prophylaxis and treatment of iodine deficiency diseases in high-risk groups (a manual for doctors). - M., 2004. - 55 p. 13. Dobrovolsky V.V. The effect of exercise. L., 1970 - 39 p. 14. Doskin V.A., Outpatient pediatrics. Tutorial. M.: LLC "Medical Information Agency", 2008 15. Dubrovsky V.I. Exercise therapy: Textbook. - M: VLADOS, 2001. - 680s. 16. Evseev S.P. Private methods of AFC: Textbook. - M.: Soviet sport. 2004.- 464p. 17. Zhukova T.P. The state of health of children from mothers with endemic goiter and the prevention of its disorders: Abstract of the thesis. dis. ... doc. honey. Sciences. - Ivanovo, 2007. - 40 p. 18. Zhuravleva A.N., Graevskaya N.D. Sports medicine and exercise therapy: a textbook. - M.: Medicine, 2002 - 433s. 19. Zaitseva O.V. Frequently ill children: some aspects of prevention and treatment // Pediatrics. - 2004. - No. 3. - S. 14-16. 20. Zaplatnikov A.L. Clinical and immunological substantiation of immunotherapy and immunoprophylaxis of viral and bacterial diseases in children: Abstract of the thesis. dis. ... doc. honey. Sciences. - M., 2003. - 48 p. 21. Zaprudnov A.M. Clinical and pathogenetic aspects of respiratory diseases in frequently ill children. - Kovrov: BEST-V Publishing House, 2006. - 243 p. 22. Zakharova D.S., Ivanova N.L. Complex rehabilitation of children of primary school age with bronchial asthma. - M.: FKiS, 2008. - No. 2. - 290s. 23. Zakharova L.S. Exercise therapy for diseases of the respiratory system: Toolkit. - M.: FKiS, 2006. - 22 p. 24. Zakharova N.S., Mukhin V.N. Exercise therapy for diseases of the respiratory system: guidelines. - M.: GTSOLIFK, 2002 - 26 p. 25. Zelinskaya D.I. Rehabilitation as a complex problem of restoring impaired functions of the child's body. Ros. vestn. perinatology and pediatrics., 2006 № 2. 26. Zmanovsky Yu.F. Raising children healthy. - M.: Medicine, 2000. - 170s. 27. Ivanov S.M. Medical supervision and exercise therapy. - Medicine, 2000. - 433 p. 28. Iodine deficiency diseases in children and adolescents: diagnosis, treatment, prevention. Scientific and practical program of the Union of Pediatricians of Russia and the International Foundation for Maternal and Child Health / Ed. A.A. Baranova and I.I. Grandfather. - M.: International Foundation for Maternal and Child Health, 2005. - 48 p. 29. Kamenev Yu.Ya. Respiratory gymnastics in the system of natural therapy. How to use the methods of A. Strelnikova and K. Buteyko for recovery. Physician experience. - St. Petersburg: ID "Ves", 2004. - 128s. 30. Kaptelina A.G., Lebedeva K.V. Therapeutic exercise and medical control. - M.: Medicine, 2005. - 398s. 31. Kiselev O.I. Standardized principles for the diagnosis, treatment and emergency prevention of influenza and other acute respiratory infections in children. SPb., 2004 32. Kokosov A.N., Streltsova E.V. Exercise therapy in the rehabilitation of patients with lung diseases. L .: "Medicine", 2001. - 168s. 33. Korovina N.A., Cheburkin A.V., Zakharova I.N. Immunorehabilitation of frequently and long-term ill children: a textbook. Kovrov: Publishing house "BEST-V", 2006. - 127 p. 34. Corrective outdoor games and exercises for children with developmental disabilities: a teaching aid / Ed. ed. prof. L.V. Shapkova. - M., 2002. - 212s. 35. Kochetova I.N. Strelnikova's paradoxical gymnastics. ("Physical culture against illness") - M .: Soviet sport, 2009. - 32s. 36. Kurdybailo S.F., Evseev S.P., Gerasimov G.V. Medical control in AFC. - M.: Soviet sport. 2004. - 144p. 37. Kuts A.S., Shiyan B.M. The technique of physical Education of various groups of the population. - Kyiv, 2003. - 320s. 38. Lenorsky L.A. Therapeutic physical culture in the clinic of internal diseases. - M.: "Medicine", 2009. - 216s. 39. Makarenko T.M. Prevention and restoration of the functions of the respiratory system in schoolchildren. - Volgograd: VGAFC, 2009. - 86s. 40. Makarova G.A. Sports medicine: textbook. - M.: "Soviet sport", 2004. - 480s. 41. Makarova Z.S. Frequently ill children and their rehabilitation in a children's clinic // Polyclinic. - 2005. - No. 1. - P. 14. 42. Machek M., Shtefonova N., Shveytsarova B. Exercise therapy for diseases in childhood. - M.: "Medicine", 2003. - 400s. 43. Popova N.M., Kharlamova E.V. Breathing exercises for children at home. - M.: ICC "March", 2004. - 160s. 44. Pyagay L.P. Differentiated approach in building a program of physical rehabilitation of patients with chronic nonspecific lung diseases: Abstract of the thesis. dis. Cand. Ped Sciences. Omsk: Sib.GAFK, 2001. - 23s. 45. Romantsov M.G. Respiratory diseases in children. - M., 2003. - 75 p. 46. ​​Sinyakov A.F. Breathing exercises. - M.: "Knowledge", 1991. - 82s. 47. Strakovskaya V.L. 300 outdoor games for children from 1 to 14 years old. - M.: New school, 2004. - 288 p. 48. Strakovskaya V.L. Outdoor games in the therapy of sick and debilitated children. - M.: Medicine, 1999. - 238s. 49. Tatochenko V.K., Kaganov B.S. Convalescents, often ill and persons with bronchopulmonary pathology. /Vaccinal prophylaxis in case of health disorders. - M., 2000. - 38 p. 50. Physical rehabilitation: a textbook for academies and institutes of physical culture. /Under the general editorship of prof. S.N. Popova. - Rostov N / D .: Phoenix publishing house, 2004. - 175p. 51. Shapkova L.V. Private methods of adaptive physical culture: Textbook. - M.: Soviet sport, 2004. - 464 p. 52. Sharmanov G.Sh., Zeltser M.E., Nikov P.S. Resistance to infection in conditions of chronic iodine deficiency in the diet. - M.: Medicine, 2003. - S. 6-32. 53. Shestopalov S.V. Physical exercises - Rostov N / D .: Prof. Press Publishing House, 2001. - 192p. 54. Shcheplyagina L.A., Rimarchuk G.V., Kruglova I.V., Borisova O.I. New technologies in the treatment of acute respiratory diseases in children: a lecture for physicians. - Moscow, 2008. - 24 p. 55. Shcheplyagina L.A., Chernov V.M., Kruglova I.V., Delyagin V.M. Age features immunity in children: a lecture for physicians. - M., 2008. - 22 p. 2

Korovina N. A., Cheburkin A. V., Zaplatnikov A. L., Zakharova I. N.

DEFINITION AND GENERAL CHARACTERISTICS OF THE GROUP OF FREQUENTLY AND LONG-TERM ILLNESS CHILDREN

The results of numerous epidemiological studies indicate that, on average, each child suffers from 3 to 5 episodes of acute respiratory infections per year. As evidenced by population studies J. Monto (1987), the most common acute respiratory infections occur in young children, preschoolers and younger schoolchildren. In children aged 10 years and older, the frequency of tolerated acute respiratory infections during the year is almost 2-2.5 times lower than in children of the first 3 years of life.

At the same time, it was noted that a certain part of the child population is prone to frequent recurrent respiratory diseases. Children, often and for a long time suffering from acute respiratory infections, are usually allocated to a separate group of dispensary observation - the group of children with respiratory diseases. A child is eligible to be classified in the CSD group in cases where the increased incidence of viral and bacterial respiratory infections is not associated with persistent congenital, hereditary or acquired pathological conditions. These children deserve special attention, since frequent respiratory infections can cause a breakdown in the main adaptive mechanisms, lead to significant impairment of the functional state of the body and contribute to the early development of chronic pathology.

Domestic pediatricians classify children in the NCH group based on the criteria proposed by V.Yu. Albitsky and A.A. Baranov (1986) (Table 1).

In children over the age of 3 years, as a criterion for inclusion in the FDI group, you can use the infectious index (II), defined as the ratio of the sum of all cases of acute respiratory infections during the year to the age of the child: AI \u003d (the sum of all cases of acute respiratory infections during the year) / ( child's age (years). IS in rarely ill children is 0.2-0.3, and in children from the FDI group - 1.1-3.5.

Table 1.

Criteria for the inclusion of children in the group of children with disabilities (V. Yu. Albitsky, A. A. Baranov, 1986)

It should be noted that CHD is not a nosological form of the disease and not a diagnosis. Often frequent and prolonged acute respiratory infections are a manifestation of hereditarynatural, congenital or acquired pathology (for example, cystic fibrosis, congenital stridor, Nezelof's disease, selective slgA deficiency, Swiss type immunoparesis, etc.). In each case, it is necessary to determine the cause of increased respiratory morbidity. When establishing the cause of recurrence of acute respiratory infections in children, rehabilitation programs for specific nosological forms should be built taking into account the regulatory requirements for clinical examination. Timely detection of the underlying disease makes it possible to purposefully and effectively carry out therapeutic and preventive measures and significantly reduce the risk of developing repeated respiratory diseases.

The group of frequently and long-term ill children is usually referred to as children prone to frequent respiratory diseases due to transient, correctable deviations in the body's defense systems and not having persistent organic disorders in them.

CLINICAL FORMS AND ETIOLOGY OF RESPIRATORY DISEASES IN CHILDREN FROM THE CHD GROUP

Acute respiratory diseases in children from the PCH group most often manifest themselves in the form of infections:

1. Upper respiratory tract: rhinitis;nasopharyngitis; angina;tonsillopharyngitis; laryngotracheitis; tracheitis; bronchitis; laryngotracheobronchitis.

2. Terminal respiratory sections and lung parenchyma: bronchopneumonia.

3. ENT organs: otitis media; eustachitis; adenoiditis; sinusitis.

Among the etiological factors of acute respiratory infections in children, viruses play a leading role. The share of viruses among the etiological factors of acute respiratory infections is 65-90%. It should be noted the possibility of a "mixed" viral-bacterial infection (up to 25% of cases). Among the viral pathogens of acute respiratory infections in children, influenza A viruses, parainfluenza (serotypes 1-3), respiratory syncytial viruses, adenoviruses (serotypes 1-4, 5, 7), rhinoviruses, ECHO enteroviruses (serotypes 2, 4, 9) and Coxsackie (serotypes 2, 4, 6, 8) (Zhovnirenko L.P., 1980; Gvozdilova D.A. et al., 1982; Karpova L.S., 1982; WHO, 1980) . Among the bacterial pathogens that cause acute respiratory infections in children, the leading places are occupied by Strept. pneumoniae, Haemophylus influenzae, Strept. pyogenes, Staphyl. aureus. In recent years, the increased role in the development of acute respiratory infections of mycoplasmas, ureaplasmas, chlamydia and gram-negative bacteria has attracted attention (Kaganov S.Yu. et al., 1996).
High content of various xenobiotics in air, water, productsnutrition is accompanied by their accumulation in the body, which leads toultimately, to changes in cellular metabolism, violations ofmeostasis and perversions of immune protection.

From the foregoing, it follows that the system of rehabilitation of frequently and long-term ill children requires a systematic implementation of a complex of medical and social measures.

PRINCIPLES OF HEALTH AND TREATMENT OF CHILDREN FREQUENTLY ILL WITH ACUTE RESPIRATORY DISEASES

The development of effective preventive and therapeutic measures for children with frequent respiratory diseases is not only a medical but also a social problem. For each child, it is necessary to search for individual methods of recovery, taking into account the etiological and pathogenetic mechanisms of the disease, as well as environmental factors that form the predisposition of the child's body to frequent respiratory diseases.

Comprehensive rehabilitation of frequently ill children at all stages of recovery (family, organized team, clinic, sanatorium) includes preventive measures aimed at preventing diseases and strengthening the health of children, as well as therapeutic effects that contribute to the correction of identified pathological abnormalities.

Daily routine and rational nutrition

One of the important activities is the rational regime of the day. Due to the fact that functional disorders of the central and vegetative nervous system are observed in children from the FDB group, it is necessary to exclude overwork and overexcitation. It is advisable to increase the duration of sleep by 1-1.5 hours. Obligatory is daytime sleep or rest. In the presence of sleep disorders, other astheno-neurotic disorders, walks in the fresh air before going to bed, as well as taking sedative herbs (such as motherwort, valerian), are shown. As herbal medicine, you can use ready-made dosage forms from herbs such as sanosan (extract of hop cones and valerian roots), persen (drops and capsules containing extracts of valerian, peppermint and lemon mint), alta-lex (a mixture of essential oils from 12 medicinal herbs, including lemon balm). These drugs have a calming effect, relieve irritability, normalize sleep.

The nutrition of frequently ill children should be varied, high-calorie, containing the optimal amount of proteins, fats, carbohydrates, mineral salts and vitamins. It is important to include fresh fruits and vegetables in your daily diet. Children with food allergies are recommended a hypoallergenic diet with the exclusion of obligate allergens. It is important to remember that timely detection of a causally significant allergen and specific hyposensitization can prevent the development of severe forms of allergies, which are the background for the formation of a contingent of frequently ill children.

Hardening, restorative and physiotherapy exercises

Considering that in children from the BCH group, one of the reasons contributing to their high morbidity is often the immaturity of the thermoregulation system with reduced resistance to changing climatic and heliogeographic environmental factors (Zmanovsky Yu.F., 1989; Chukanin N.N. , 1990), methods of rational hardening and physical education are gaining more and more popularity. Under the influence of hardening measures, along with a decrease in the incidence rate, normalization of immunological parameters also occurs (Alymkulov R.D., 1991). Systematic contrast air or water hardening is accompanied by an increase in the body's resistance to temperature fluctuations in the environment and an increase in the immunobiological reactivity of the body.Hardening by contrast methods contributes to the normalization of ion homeostasis and is manifested by a decrease in the release of ionized calcium from the body, an increase in the release of sodium and chlorine by cells, which indicates an improvement in the vegetative active regulation (Kuznetsova M.N., 1994). For children in the period of convalescence after acute respiratory infections, contrast hardening procedures can be used under gentle conditions using motor loads, approximately half the volume in the first 5-7 days. It is very important to carry out hardening procedures systematically and observe the principle of gradual increase in load. Hardening procedures must be combined with gymnastics and chest massage. These procedures increase the functional efficiency of the respiratory system. Massage is carried out 2-4 times a year, the course is 14 days.

Children in the PDD group often experience excessive sweating due to dysfunction of the autonomic nervous system. Therefore, the recommendations of frequent (2-3 times a day) change of underwear (panties, T-shirts, socks) during the day are justified. It is advisable to wear cotton clothing. It is recommended to systematically carry out the so-called foot therapy, which is a foot massage. It is performed as follows: with the palm, fingertips or fingers folded into a fist, stroking, rubbing and again stroking the soles of bare feet is carried out.

In the rehabilitation of frequently ill children, the systematic implementation of special complexes of physiotherapy exercises aimed at ensuring good drainage of the bronchi and increasing the tone of the respiratory muscles is important.

Phytotherapy

Phytotherapy is one of the components of rehabilitation programs for frequently and long-term ill children. Phytotherapy can be used in the form of oral herbal medicines, therapeutic inhalations and local therapy.

For the rehabilitation of foci of chronic inflammation of the oropharynx, washing the nasal passages, rinsing the mouth and throat with phyto-infusions and decoctions is indicated. Decoctions and infusions of herbs are used that have antibacterial and protective properties (St. John's wort, calendula, chamomile, celandine, eucalyptus, plantain, sage).

We can recommend oxygen cocktails with herbal infusions (plantain, St. John's wort, chamomile). It is better to use oxygen foam on an empty stomach for 30minutes before meals. Course duration - up to 3 weeks. It is desirable to conduct 2 courses per year. It should be remembered that oxygen cocktails with herbal decoctions are recommended to be used with caution in children with a burdened allergic history.

vitamin therapy

Rational vitamin therapy is a mandatory component of health improvement programs for children with frequent and long-term acute respiratory infections. Vitamins are cofactors of enzymes involved in almost all types of metabolism in the body. In infectious diseases, the body's need for vitamins rises sharply, which is often accompanied by the development of relative vitamin deficiency. The latter, in turn, negatively affects the functional status of the immune system, reduces the body's resistance to infections and contributes to the development of allergic conditions (P.M. Khaitov, 1995).

Vitamin deficiency in frequently ill children is not limited to ascorbic acid deficiency, but, as a rule, has the character of a combined polyhypovitaminosis. Along with a lack of vitamin C, the most frequently observed deficiency of vitamins B, B 2 , B 6 , PR folic acid and carotene. Violating the metabolism, weakening the body, vitamin deficiency aggravates the course of respiratory infections in children, reduces the effectiveness of preventive and therapeutic measures, and contributes to the chronicity of inflammatory processes. Taking multivitamin preparations significantly reduces the incidence of acute respiratory infections. Thus, fortification in Moscow schools reduced acute respiratory morbidity in schoolchildren by 30% compared with the control (Trofimenko L.S., 1994).

When conducting vitamin therapy in children with frequent and prolonged respiratory infections, it is advisable to use multivitamin complexes enriched with microelements. Trace elements are activators of various biochemical reactions in cells, including immunocompetent ones. So, cobalt is involved in the exchange of nucleic acids, protein synthesis and, accordingly, in the synthesis of blood cells. Manganese and zinc increase the content of vitamin C in tissues, participate in protein synthesis, and have antitoxic and anti-inflammatory effects. Copper and manganese regulate the metabolism of vitamin A. Molybdenum activates the enzyme xanthine oxidase, which is involved in the metabolism of purine and pyrimidine bases, which are components in the synthesis of nucleic acids. You can use individual preparations of trace elements to stimulate immunity (gluconate or zinc citrate). For preventive vitaminization, domestic or imported multivitamin complexes approved for use in the Russian Federation can be used (Tables 2 and 3).

As a physiological method of treating vitamin deficiency in children, it can be recommended to include drinks enriched with a set of essential vitamins in the diet. The concentrate of the refreshing drink "Golden Ball" containing 12 necessary for the body human vitamins: A, E, D, B, B 2 , B 6 , B 12 , C, niacin, pantothenic acid, folic acid, biotin and beta-carotene. One glass of drink (15 g of concentrate per 200 ml of water) provides 100% of the daily requirement for these vitamins for children aged 1 to 6 years, 75% of the need for children 7-10 years old and 50% of the

children aged 11-17 years old. Concentrates of vitamin drinks similar in composition can be used, such as: Vibovit (Polfa, Poland), Kaltsinova (KRKA, Slovenia), Vitanova (KRKA, Slovenia).

Table 2.

Multivitamin preparations and vitamin-mineral complexes of domestic production

Table 3

Multivitamin and vitamin-mineral complexes of foreign production

Continuation of the table. 3.

children with frequent respiratory illnesses can use beta-carotene as an immune system regulator. It is a valuable food substance of plant origin and is an inhibitor of singlet oxygen and free radicals. Beta-carotene is not only a precursor of vitamin A, but also performs antioxidant functions. Vitamin A formed from beta-carotene plays an extremely important role in ensuring the physiological functions of the body (growth and development processes, renewal of epithelial tissues and regulation of immune responses). Synthesized from vitamin A, retinoic acid performs protective functions against carcinogenic effects of the external environment. As an antioxidant, beta-carotene inhibits the processes of premature aging, reduces the risk of developing cardiovascular and oncological diseases (Bukin Yu.V., 1996; Kipe G.A. et al., 1992; Gey K.F. et al., 1994; Buring J.E.,1995). The daily intake of beta-carotene should be at least 5-6 mg per day. At present, the production of domestic water-soluble liquid food beta-carotene, produced under the name Vetoron (NPP AQUA-MDT), has been launched. 1 ml of Vetoron contains 20 mg of beta-carotene, 8 mg of vitamin E and 8 mg of vitamin C. For preventive purposes, Vetoron drops are diluted in water or any 1 drink, taken orally after meals once a day. Daily age-related prophylactic dosages of Vetoron are presented in Table 4.

Adaptogens and biogenic stimulants

Adaptogens and biogenic stimulants are substances that increase the overall resistance of the body. These include products of plant or animal origin, as well as synthetic drugs.

As an adaptogen, you can use apilactose, which is the royal jelly of bees and contains essential amino acids (arginine, valine, methionine, tryptophan and others), biologically active substances (acetylcholine, cholinesterase), vitamins (B v B 2, B 3, B 6 , B 12 , C, H, PR E, folic acid, biotin). Apilactose has a tonic, antimicrobial, immunogenic, metabolic stimulating effect. Available in hard gelatin capsules of 0.25 g.

An interesting new drug is apilikvirit - royal jelly with licorice. It is a polycomponent mixture of lyophilized apilac, licorice root extract and milk sugar. Royal jelly with licorice has a stimulating effect on the central nervous system, activates metabolic processes, immunogenesis, has anti-inflammatory and tonic effects. Apiliquirit is available in hard gelatin capsules of 0.25 g.

Honey ginseng (a mixture of ginseng powder and natural honey) is used as a biological food supplement. Ginseng root, thanks to its biologically active substances, has a tonic effect, regulates metabolism and increases the body's immunological reactivity. Available in hard gelatin capsules of 0.1 g.

Politabs is a preparation from fermented pollen specially cultivated

Table 4

Age-related daily doses of VETORON for prophylactic use

Notes - in regions of ecological trouble, daily preventive doses can be increased by 1.5-2 times.

cultivated plants. Contains proteins, fats, carbohydrates, growth hormones, a complex of vitamins, coenzymes. Politabs normalizes metabolism, enhances the action of corticosteroids, stimulates their binding to proteins.

Cernilton - dry pollen extract, contains amino acids, enzymes, coenzymes, all known vitamins, 13 trace elements. Indications: frequent respiratory diseases.

Propolis - bee glue, consisting of resins, 50-80% wax, essential oils, tannins, proteins, pollen containing vitamins A, E, C, group B. The antimicrobial activity of propolis is directed to more than 100 species of fungi and bacteria. The antiviral activity of propolis has also been proven. The drug stimulates phagocytosis, leukopoiesis, antibody formation, increases the activity of complement, properdin. Stimulates the hypothalamic-pituitary and immune systems.

Herbal adaptogens include extracts of Rhodiola rosea, Levzea, Eleutherococcus; infusions of lure, Chinese magnolia vine, aralia (saparal), sterculin, ginseng root. Preparations of this group stimulate metabolism, increase the body's resistance to the action of adverse factors, and have an antitoxic effect. Contraindication to the appointment of these drugs is irritability, epilepsy, arterial hypertension. It is advisable to use them in the spring, with pronounced climatic fluctuations, for 1-3 weeks. after illnesses.

It should also be noted that medicines prepared from echinacea purpurea (echinacin, immunal, homeopathic preparation echinacea compositum C, etc.). The therapeutic effect of these drugs is associated with adaptogenic, biostimulating and non-specific immunostimulatory effects of echinacea alkaloids on the body. At the same time, activation of cellular immunity, phagocytic activity of macrophages, granulocyte chemotaxis, and cytokine production are noted.

Effective with frequent acute respiratory viral infections in children, linetol is a preparation from flaxseed oil, which is a mixture of esters of unsaturated fatty acids that are precursors of prostaglandins.

Among the adaptogens of animal origin, pantocrine can be distinguished - a liquid 50% extract from non-ossified deer antlers. However, it should be remembered that the drug is contraindicated in nephritis, diarrhea, thrombophilia.

Anabolic agents (potassium orotate, nerobol, retabolil) contribute to the stimulation of nonspecific protective factors. Orotic acid is involved in the synthesis of uridine phosphate, which is a precursor of nucleic acids. Safinor is a complex preparation containing riboxin (0.2 g), potassium orotate (0.25), saparal (from aralia - 0.02 g), floverin (0.5 g). It is used to prevent frequent respiratory diseases in children.

It should be especially noted that tuberculosis, oncological diseases, collagenosis, multiple sclerosis are absolute contraindications for the appointment of adaptogens and biostimulants.

Pharmacological immunocorrection

Increasing the general reactivity of the body is an important and generally recognized section of recreational activities for frequently and long-term ill children. At the same time, special hopes are placed on immunorehabilitation measures, including modern pharmacological immunotherapy.correction (Stefani D.V., Veltishchev Yu.E., 1996; Korovina N.A. et al., 1996). Immunocorrection is considered as one of the main components of the pathogenetic therapy of recurrent respiratory infections, and is also used to prevent frequent acute respiratory infections.

According to the classification proposed by J. H. Madden (1993) and supplemented by domestic immunologists, all pharmacological immunostimulants and immunocorrectors are divided into 4 main groups: preparations of microbial origin, preparations of thymus, bone marrow and "chemically pure" preparations (Khaitov P.M., 1995). The latter are understood as drugs, the active substrate of which are compounds obtained by chemical or genetic engineering synthesis. The preparations of microbial origin include prodigiosan, pyrogenal, sodium nucleinate. Thymus preparations are thymalin, timaktid, timoptin, taktivin, thymos-timulin. Myelopid is a bone marrow preparation. "Chemically pure" immunocorrectors are chemicals with pronounced immunostimulatory properties, but having no natural analogues (levamisole, polyoxidonium, dibazol, diucifon, inosine, etc.), as well as synthesized analogues of natural immunomodulators, biologically active substances (recombinant interferons, thymogen , lycopid, etc.)(Khaitov R.M., 1995). A detailed description of pharmacological immunocorrective agents registered and approved for use in the Russian Federation, their therapeutic efficacy, as well as the basic principles of immunocorrective therapy for children with frequent and prolonged acute respiratory infections are presented in the next section.

PHARMACOLOGICAL IMMUNOCORRECTION IN CHILDREN WITH FREQUENTLY AND LONG-TERM ILLNESS WITH ACUTE RESPIRATORY INFECTIONS

Classification of immunocorrective drugs registered and approved for use in the Russian Federation

The classification of immunocorrectors presented in the previous section is based on the origin of medicinal substances. This approach allows us to present both the main (positive) and negative (side, undesirable) pharmacological effects of drugs. Thus, all drugs of thymic origin, to a greater or lesser extent, normalize the functional state of the T-system of immunity, stimulate the synthesis of lymphokines. Preparations of microbial origin mainly modulate the phagocytosis system, stimulating the activity of macrophages. Bone marrow preparations are characterized by nonspecific immunomodulation, differentiation and neurotropic effects (Petrov R.V., 1984, 1995).

Taking into account the positive aspects of the classification under discussion, it is still worth paying attention to the need to make some additions to it. The latter are of great practical importance and are based on the fact that the group of "chemically pure" immunocorrectors is heterogeneous in terms of clinical, pharmacological and genetic parameters. A targeted and in-depth study of biological immunostimulants has made it possible not only to identify the active substances included inbecoming these substances, but also artificially synthesize them. Drugs obtained by chemical or genetic engineering synthesis of only the "active component" retain, and sometimes significantly exceed the initial positive biological effects of a similar natural immunomodulator. Therefore, it would be reasonable to refer these drugs to the groups of natural drugs, derivatives (synthetic analogues) of which they are.

Table 5

Classification of pharmacological immunocorrectors registered and approved for use in the Russian Federation

Given the above, we consider it necessary to present a modified classification of pharmacological immunocorrectors (Table 5).

Characteristics of the main immunocorrective drugs registered and approved for use in the Russian Federation

Preparations of microbial origin

All immunostimulants of microbial origin are divided into 3 main groups:

Purified bacterial lysates,

Immunostimulating membrane fractions,

Bacterial ribosomes in combination with membrane fractions.

Analyzing the action of preparations of microbial origin containing lipopolysaccharides of gram-negative bacteria (pyrogenal, prodigiosan) and membrane fractions (licopid), it should be noted that the main mechanism of their action is associated with an activating effect on the functional status of macrophages (Table 6). These drugs stimulate phagocytosis and through it can affect immunocompetent cells. Bacterial lysates (IRS-19, bron-homunal) initiate a specific immune response to bacterial antigens present in the preparation. The combined immunocorrector ribomunil, which combines antigenic carriers of bacteria (ribosomes) and active non-antigenic components of the bacterial membrane (proteoglycans), causes vaccinal and immunomodulatory effects.

Purified bacterial lysates

Bacterial lysates are designed to stimulate the body's specific defense against the pathogenic effects of those microbes whose antigenic substrates are part of the preparation. With immunotherapy with bacterial lysates, there is an increase in the content of specific antibodies to the microbes that make up the drug.

Currently, new purified bacteriolysis, approved for use, have appeared on the pharmaceutical market of our country - IRS-19 and bronchomunal.

Table 6

Macrophages and the immune response

Participation of macrophages in the body's immune defense system

The main component of nonspecific immune protection;

- “preparation” of foreign antigens for their recognition by B-cells (“processing” of the antigen and connection with HLA-Dr);

Synthesis and secretion of interleukin-1 with subsequent activation of T-lymphocytes-amplifiers;

Regulation of the processes of interaction between T- and B-lymphocytes;

Cytolytic or suppressive activity with the participation of lymphokines;

cytotoxic activity.

IRS-19 (Solvay Pharma, Germany). The drug is prepared from 19 strains of the most common bacterial pathogens of respiratory tract infections: Dipplococcus pneumoniae, Streptococcus faecalis, Streptococcus pyogenes, Hemophilus influenzae, Klebsiella pneumoniae, Micrococcus pyogenes, Neisseria catarralis, Neisseria perflava, Gaffkya tetragena, Neisseria flava, Moraxella. IRS-19 is a drug for local immunotherapy. It enhances natural specific and non-specific immunity. The drug has a direct therapeutic effect aimed at direct stimulation of local specific immunity, increases the phagocytic activity of macrophages (qualitative and quantitative enhancement of phagocytosis), increases the activity of lysozyme. IRS-19 simultaneously has a preventive effect due to the stimulation of local immunity (increase in secretory immunoglobulins). The desensitizing effect of IRS-19 has also been shown. The drug contains elements of a polypeptide structure, the entry of which into the body prevents the formation of sensitizing antibodies. The latter are found in allergies caused by microbes.

IRS-19 is produced in the form of an aerosol, after spraying which a thin layer is formed that covers the nasal mucosa and contributes to the rapid penetration of the drug into it. IRS-19 reduces swelling in the nasal cavity, liquefies the exudate of the mucous membrane and facilitates its outflow. This prevents the development of complications such as sinusitis and otitis media. The drug is well tolerated. Sometimes there may be transient rhinorrhea. It is advisable not to use simultaneously with vasoconstrictors. The drug is prescribed for children at any age for the prevention and treatment of rhinitis and nasopharyngitis, as well as for the prevention of complications (otitis media, sinusitis, etc.). In the acute stage of the disease, depending on age, 1 dose of the drug is sprayed into each half of the nose 2 to 5 times a day until the symptoms of infection disappear. For prevention: spray 1 dose of the drug in each half of the nose 2 times a day for 2 weeks.

Bronchomunal - contains lyophilized bacterial lysates of the most common bacterial pathogens of respiratory diseases. Increases humoral and cellular immunity. By acting on Peyer's patches in the intestinal mucosa, it stimulates peritoneal macrophages. In the blood serum, the number of T-lymphocytes, IgA, G, M increases. The amount of antibodies in the inhalation tract increases. The drug is used both for therapeutic and prophylactic purposes - 1 capsule 1 time per day. In the acute period, the course lasts from 10 to 30 days. Preventive course - 10 days of each month for 3 months. For use in lediatric practice, Bronchomunal P is used, which contains a half adult dose of bacterial lysate (0.0035 g). Among the adverse reactions are possible: dyspepsia, epigastric pain, rarely - hypersensitivity to the drug.

Membrane fractions

Selective non-antigenic membrane fractions of bacteria stimulate non-specific factors of the body's immune defense. Membrane fractions have different points of application to cells and immune mediators. They affect macrophages, stimulate the production of interleukin-1 and colony-stimulating factor, stimulate B-lymphocytes through a response to mitogens, and increase antibody secretion.fractions of bacteria lead to the mobilization of 3 levels of protection of phagocytosis;cellular immunity (indirectly); humoral immunity (indirectly).

Preparations containing selective non-antigenic structures of bacterial membranes increase the non-specific resistance of the organism, but do not affect the production of specific antibodies. Besides. the duration of the immunostimulatory effect after the withdrawal of these drugs is limited

Likopid is a representative of preparations of selective membrane fractions. Licopid is a synthetic analogue of the bacterial cell wall (mura-mil dipeptide). Structurally, licopid is represented by a repeating fragment of the peptidoglycan of the cell wall of all known bacteria. The mechanism of action is associated with the ability to stimulate phagocytosis and, indirectly, T- and B-links of immunity.

Combined immunocorrective preparations (ribosomes + membrane fractions)

Theoretical background on the need for a compound in a single preparation positive sides bacterial lysates (specific immuno-stimulation) and membrane fractions of bacteria (non-specific immuno-correction) to enhance the therapeutic effect rallied in practice to create a unique pharmaceutical agent - ribomunil (Pierre Fabre Medicament, France).

Specific active immunization against the most common pathogens of acute respiratory diseases compares favorably with non-specific immunostimulation in its effectiveness. However, it has not yet found wide application in Russia. At the same time, in recent years, polycomponent preparations containing ribosomes and membrane fractions of bacteria (Lacomme Y., Narsy Ph., 1985; Boissier M.C., 1987; Clot J. et al., 1987); Haguenauer J.P., 1988; Bremont F. et al., 1989 and others).

Ribomunyl (Pierre Fabre Medication, France) deserves special attention - a complex preparation containing ribosomal fractions of bacteria that most often complicate viral diseases of the respiratory tract and ENT organs, as well as proteoglycans of the Klebsiella pneumomae cell membrane (Table 7).

The bacterial ribosomes that make up this preparation have the antigenic properties of the corresponding microorganisms, which determines the possibility of specific immunization (vaccination). Non-antigenic structures of bacterial membranes (proteoglycans) of Klebsiella pneumoniae have immunomodulatory effects on the non-specific part of the immune response, and are also adjuvants that potentiate specific immunization. The entire spectrum of the immunocorrective effects of ribomunil is presented in Table 8 (Khaitov P.M. et al., 1994; Gordienko S.M. et al., 1995; Michel G. et al., 1978; Mantovani A. et al., 1988; Faure G., 1989, etc.).

The use of ribomunil leads to the active production of secretory IgA, specific antibodies against Klebsiella pneumoniae, Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and the creation of post-vaccination immunity. Enhancement of the immunogenic effect of ribosomes that make up

Table 7

The composition of RIBOMUNILA includes

Ribosomes :

*Klebsiella pneumoniae;

* Streptococcus pneumoniae;

* Streptococcus pyogenes;

* Haemophylus influenzae.

Selective membrane fractions:

cell membrane proteoglycans of Klebsiella pneumoniae

ribomunil is achieved due to the presence in the preparation of non-antigenic membrane proterglycans Klebsiella pneumoniae, which stimulate phagocytosis, the synthesis of alpha-interferon, interleukins-1, 6 and killer cells. The available convincing clinical and immunological data indicate the high efficiency of ribomunil in pediatric practice (Bremont F. et al., 1989; Lebranchu Y. et al., 1989, J.P. Haguenauer et al., 1989). When studying the effectiveness of the use of ribomunil in a double-blind method in 38 children aged 2-5 years with recurrent infectious diseases of the ENT organs, it was noted that after 6 months the frequency of relapses decreased by more than 40%, and the duration of antibiotic therapy courses and the average duration of episodes of the disease decreased by 2 times compared with placebo and with baseline values. A. Grimpheld et al. (1989) found that the appointment of ribomunil for 6 months to children suffering from bronchial asthma was accompanied by a decrease in both the number of attacks (2.7 times) and a decrease in the incidence of acute respiratory infections (2.3 times). In 80% of children with IgA deficiency who received ribomunil for 6 months, there was a 4-5-fold significant increase in the synthesis of specific IgG class antibodies against Klebsiella pneumoniae, Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae compared with baseline and placebo (Lebranchu Y. et al., 1989). It has been established that in children suffering from an acute infection of the ENT organs or the respiratory tract and requiring antibiotic therapy due to the severity of the condition, the simultaneous use of ribomunil with antibiotics increases the adhesion of polynuclear neutrophils, which can be considered as a synergistic effect of basic therapy (Bremont F. et al., 1989 ).

Most often in pediatric practice, the oral method of using ribomunil is used.

Forms of release of ribomunil:

Tablets (1 tablet contains 0.25 mg of bacterial ribosomes and 0.375 mg of membrane proteoglycans), 12 pieces per pack;

Granulate for the preparation of a drinking solution in sachets (1 sachet contains 0.75 mg of ribosomes and 1.125 mg of membrane proteoglycans), 4 sachets per package. Dosage regimen and duration of ribomunil therapy courses

are presented in table 9.

We have conducted a study of the clinical efficacy of various courses of treatment with ribomunil for children with frequent and long-term acute respiratory infections. Under observation were children aged 5-6 years, often and long-term ill with acute respiratory infections (CHD): the main group consisted of patients without concomitant chronic inflammatory diseases, the comparison group - children with foci of chronic inflammation in the nasopharynx. Ribomunil therapy continued for 3 months. The control group was comparable with the main and comparison groups and met the principles of clinical paracopy. All children permanently lived in the countryside (Sergievs-Posadsky district, Moscow region) and attended one v let the same Kindergarten(Chief doctor of the polyclinic - Kangina N.G., doctor of the kindergarten - Seliverstova N.N.). The inclusion criteria for the study were the frequency of acute respiratory morbidity - at least 4-5 episodes per year, the absence of the effect of the traditional health-improving and non-specific immunocorrective therapy (dibazole, eleutherococcus) carried out earlier. Selection of children in observation groups

Table 8

Immunomodulatory effects of Ribomunil

Impact on humoral immunity:

1. Synthesis of specific antibodies (vaccinal effect) against

2. Moderate increase in serum total Ig A, G, M

Influence on cellular immunity:

1. Normalization of the content of mature T-lymphocytes, T-helpers, cytotoxic suppressor T-lymphocytes

2. Increasing T-helper/T-suppressor index

3. Increasing the activity of natural killers

Influence on nonspecific resistance:

1. Increased adhesion of polynuclear neutrophils

2. Stimulation of leukocyte migration

3. Induction of secretion of interleukins-1 and 6

4. Increasing the enzymatic activity of macrophages

Influence on local immunity:

1. Increased levels of secretory IgA and IgD

2. Increase in the mucous membranes of the respiratory tract of plasmacyte populations synthesizing antibodies against the antigens of Klebsielo pneumoniae, Streptococci pneumoniae et pyogenes, Haemophilus influenzae

The treatment was carried out with the obligatory implementation of the WHO recommendations on biomedical research and respect for the rights of patients, and therapy began only after an interview with the parents and obtaining their informed voluntary and informed consent. The study protocol analyzed the frequency, duration, severity of acute respiratory infections and the resulting complications. Separately, the frequency of use of antibacterial agents for acute respiratory infections and exacerbations of the underlying disease was taken into account. Side and undesirable effects from the use of ribo-munil were especially recorded. Epidemiological analysis was supplemented by dynamic clinical and laboratory monitoring of children's health.

Therapy with ribomunil began during the period of seasonal rise in the incidence of acute respiratory infections. The drug was administered orally according to the traditional scheme.

In the case of acute respiratory disease, the use of the drug did not stop. Prior to the start of treatment, anamnestic data were analyzed and a clinical examination of the children was carried out.

Table 9

Dosage regimen and duration of therapy with Ribomunil

The data obtained were processed by the methods of variational statistics with the determination of the Student's criterion of reliability.

A retrospective analysis of the level and structure of acute morbidity in children of the studied groups showed that upper respiratory tract infections prevailed among acute respiratory diseases - nasopharyngitis was 72%, laryngotracheitis - 9%, tonsillitis - 7% and bronchitis - 5%. At the same time, the average total duration of all acute respiratory infections during the previous year in each child was 35.83+3.53 days in the main group, 60.33+9.34 days in the comparison group and 42.09+4.54 days in control group (p<0,05). В течение года каждый ребенок из основной и контрольной группы получил в среднем по 1-2 курса антибактериальной терапии. Частота применения антибиотиков и сульфаниламидов при ОРЗ у детей из группы сравнения составляла 2,5-3 курса в год. Среди хронических заболеваний носоглотки у детей группы сравнения преобладали хронический тонзиллит, синусит. В 2 случаях имели место также и сочетанные варианты (хронический тонзиллит + рецидивирующий средний отит).

In children who often suffer from acute respiratory infections, but do not have chronic inflammatory diseases, the positive effect of ribomunil was noted already in the first 3 months of treatment - during this period, 36.4% of them never had respiratory infections. It should be noted that among the children of the main group, who continued to get sick during the first quarter of observation, there was not a single case of recurrent or prolonged course of acute respiratory infections. The absence of severe forms of respiratory diseases and their smooth course made it possible to refuse the use of antibiotics in 89.8% of cases. At the same time, there were no significant changes in the duration of acute respiratory infections during the first 3 months of observation, both in comparison with the initial data and with the control (respectively - 8.1 ± 1.3; 7.2 ± 1.5 and 8.0 ±1.7 days; p>0.1).

Children with chronic diseases of the nasopharynx, as well as children in the control group, continued to suffer from acute respiratory infections during this period with almost the same frequency as before treatment. However, in contrast to the control group, children from the comparison group had a milder course and a tendency to a decrease in the duration of the disease compared with the baseline data. Thus, the average duration of acute respiratory infections before treatment and by the end of a 3-month course of ribomunil therapy in children with chronic inflammatory diseases of the nasopharynx was 10.05±1.11 and 8.37±1.67 days, respectively (p>0.05) . Against the background of treatment with ribomunil in children of this group, the frequency of use of antibiotics and sulfonamides in acute respiratory infections decreased by 3.3 times.

Over the next 3 months after the use of ribomunil, only 29.4% of the children of the main group fell ill with acute respiratory infections. However, it should be noted that in the control group during the 4-6th month of observation there was also a decrease in the level of acute respiratory morbidity - only 27.3% of children were ill. The latter could be associated with the seasonal and epidemic decline in acute respiratory morbidity during this period. It was noted that in children with chronic inflammatory diseases of the nasopharynx already 3 months after the end of the course of treatment with ribomunil, the incidence of acute respiratory infections and the frequency of recurrent acute respiratory infections did not differ from the initial ones. However, only 41.1% of the children of the main group, 66.6%children from the comparison group and 81.1% of children from the control group (p<0,05). Следует отметить, что у всех детей основной группы, перенесших в этот период респираторные инфекции, заболевания протекали легко, без осложнений и рецидивов и не требовали применения антибактериальных препаратов. В то же время в контрольной группе у 55,6% детей, болевших ОРЗ, отмечалось рецидивирующее течение, у 1 ребенка ОРЗ осложнилось гнойным средним отитом. У 27,3% детей контрольной группы при этом пришлось применять перораль-ные курсы антибиотиков. Только 33,3% детей группы сравнения на этом этапе наблюдения не заболели ОРЗ. У остальных частота ОРЗ сохранялась на прежнем уровне. При этом в половине случаев отмечались осложнения в виде бронхита, евстахиита, синусита, что требовало подключения в терапию антибиотиков или сульфаниламидов. Аналогичная ситуация сохранялась и в течение IV квартала наблюдения.

Dynamic observation data during the first year after the use of a 3-month oral course of ribomunil indicate a significant decrease in the incidence of acute respiratory infections in children of the main group. It was noted that the average annual frequency of acute infectious diseases of the upper respiratory tract in children of the main group decreased by 2.28 times (p<0,05). Выявлена тенденция к более легкому течению и уменьшению средней продолжительности ОРЗ. Установлено, что суммарная продолжительность в течение года всех острых респираторных инфекций у детей основной группы уменьшилась в 2,48 раз (р<0,05). В контрольной группе и группе сравнения отмечена только тенденция к снижению уровня заболеваемости и продолжительности острого периода ОРЗ. Применение рибомунила 3-месячным курсом у детей из группы ЧДБ, не имеющих хронических воспалительных очагов в носоглотке, приводило к достоверному снижению уровня заболеваемости и более легкому течению ОРЗ.

The absence of a stable therapeutic effect from a 3-month course of treatment with ribomunil in children with chronic inflammatory diseases in the nasopharynx emphasizes the need for a strictly individual approach to determining the duration of therapy, since a short course of ribomunil therapy in this category of patients was not accompanied by a significant decrease in morbidity and frequency recurrence of ARI. When choosing the duration of the course of treatment with ribomunil, it is mandatory to analyze the premorbid background, the duration of the course of acute respiratory diseases, the combination of pathological conditions and the individual characteristics of the child. Obviously, in children without chronic inflammatory diseases, in order to obtain a clinical effect, it is possible to prescribe ribomunil for a 3-month course. However, to achieve a more stable therapeutic effect, especially in children with chronic foci of inflammation, it is advisable to use a 6-month course of treatment with ribomunil, which was shown in our previous reports (Korovina N.A. et al., 1997). The use of ribomunil contributed not only to a reduction in the frequency of acute respiratory infections, but also to a decrease in their duration and severity. This significantly reduced the need for antibiotic treatment. Ribomunil was well tolerated, significant side effects and

no undesirable effects were found when administered orally (Table 10). Conclusions:

1. The positive clinical effect of ribomunil in children with frequent and long-term acute respiratory infections, but without chronic foci of infection in the nasopharynx, was noted already during the first 3 months of its use - 36.4% of children never fell ill with acute respiratory infections during this period, by 89 8% decreased the frequency of use of antibacterial drugs, and there were no cases of recurrent and protracted course of the disease.

2. In children from the FCH group who do not have chronic inflammatory diseases of the upper respiratory tract, there was a decrease in the frequency of acute respiratory infections by 2.28 times (p<0,05), суммарной продолжительности ОРЗ в 2,48 раза (р<0,05), частоты применения антибактериальных препаратов в 2,13 раза (р<0,05) и более легкое течение заболевания в течение 1 года после 3-х месячного курса терапии рибомунилом.

3. To achieve a stable therapeutic effect of ribomunil in children with chronic inflammatory diseases of the upper respiratory tract, a longer (up to 6 months) course of treatment is advisable. When choosing the duration of the course of treatment with ribomunil, it is obligatory to analyze the premorbid background, the duration and severity of the course of acute respiratory diseases, the combination of pathological conditions and the individual characteristics of the child.

It should be noted the need for an individual approach to the choice of both the method of prescribing the drug and the duration of its use. Mandatory strict accounting of anamnestic data and analysis of the course of concomitant diseases. In cases where there are no aggravating factors (atopy, combined multiple organ pathology, chronic inflammatory processes, etc.), a short course of ribomunil therapy is possible for 3-4 months.

When prescribing ribomunil, taking into account the individual characteristics of the child (his premorbid background, state of health, duration of diseases and combination of pathological conditions), the most stable effect is achieved. Combined immunocorrective effect of ribomunil (specific immunization with simultaneous activation of nonspecific

Table 10

effects when using Ribomunil

Notes: + - the presence of a feature; ? - unidentified relationship with the drug; +- - single case; - - absence of a sign.

immune defense factors) allows its use both to create long-term post-vaccination protection of the child's body against Klebsiella pneumoniae, Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, and to actively stimulate the processes of nonspecific resistance in the acute period of the disease.

Thymic immunocorrectors

Preparations of thymic origin (timalin, taktivin, timoptin, thymactide, thystimulin, vilozen) are a complex of polypeptide fractions obtained from the thymus gland of mammals. The main mechanism of action of thymus preparations is the potentiation of the functional activity of T-lymphocytes, which leads to an increase in anti-infectious and antitumor resistance, slowing down the regression of immunocompetent cells.

Preparations of thymic origin are indicated in complex therapy in immunodeficiency states with a predominant lesion of the T-system of immunity (both in primary and secondary defects in cellular immunity).

A similar mechanism of action and the same indications for use has a synthetic analogue of thymus preparations - thymogen. At the same time, thymogen exhibits its activity at therapeutic concentrations much lower than natural thymic peptides.

There is evidence of a high clinical efficacy of the use of thymus preparations in children from the BCH group with a lymphatic type of constitution (Kuzmenko L.G. isoauthor, 1997)

Immunocorrectors of bone marrow origin

A representative of the group of immunocorrectors of bone marrow origin is myelopid. Myelopid is a complex of low molecular weight peptides (myelopeptides) isolated from the bone marrow of mammals. Myelopid is a bioregulator of the immune system, which also has neurotropic activity (Petrov R.V., 1984, 1995). In various variants of secondary immunodeficiency, myelopid increases the absolute number of B- and T-lymphocytes, mature plasma cells, blood phagocytes and peripheral lymphoid organs (Petrov R.V., Stepanenko R.N., 1997). The drug is indicated for transient immunodeficiencies that have developed against the background of surgical interventions, injuries, chemotherapy or radiotherapy. The effectiveness of myelopide in protracted and sluggish infectious and inflammatory diseases in frequently and long-term ill adults was noted (R.N. Stepanenko, 1997).

CYTOKINES AND THEIR SYNTHETIC ANALOGUES

Interferons

Interferon alpha preparations (alfaferon, human interferon, lokferon) contain a mixture of various subtypes of natural alpha interferon from human blood leukocytes. They have antiviral, immunomodulatory and antiproliferative effects. At the heart of the antiviral effect of alpha-interferon is the tropism for cytoreceptors of non-virus-infected cells. The interaction of alpha-interferon with cell membrane receptors is accompanied by stimulation of specific enzymes, which prevents virus replication. The immunomodulating effect is associated with the activation of killer (NK) cells. Stimulation of NK also causes an antiproliferative effect.

Indications for use: for intranasal use - prevention and treatment of SARS; for rectal use - acute and chronic viral hepatitis; for parenteral use - hepatitis C, genital warts, hairy cell leukemia, multiple myeloma, non-Hodgkin's lymphoma, mycosis fungoides, Kalosha's sarcoma in AIDS patients.

Interferon alpha-2a preparations (roferon-A, reaferon) contain a highly purified recombinant protein similar to human leukocyte interferon alpha-2a. The main biological effects are antiviral, antitumor and immunomodulating activity.

Indications for the use of interferon alfa-2a preparations:

Acute and prolonged viral hepatitis B,

Chronic active hepatitis B and C,

Viral, viral-bacterial and mycoplasmal meningo-encephalitis,

Viral conjunctivitis, keratitis, keratoconjunctivitis,

Oncological diseases.

Interferon alfa-2b preparations (Viferon, Intron A, Realdiron) contain a highly purified recombinant protein identical to human leukocyte interferon alfa-2b. It has antiviral, immunomodulatory and antiproliferative effects. Immunomodulatory activity is associated with the activation of phagocytosis, stimulation of the synthesis of antibodies and lymphokines.

Indications for the use of interferon alfa-2b drugs: chronic hepatitis B, C, mycosis fungoides, genital warts, myeloma, oncological diseases (primary T-cell lymphosarcoma, basal cell carcinoma, bladder cancer, etc.).

Interferon alfa-n1 (wellferon) preparations contain purified human interferon alfa, obtained from lymphoblastoid cells as a result of induction of the Sendai virus. It has antiviral, immunomodulatory and antiproliferative activity, but the mechanism of action has not been definitively established.

Indications for the use of interferon alfa-p1 preparations:

Acute and chronic hepatitis C,

Chronic hepatitis B,

Refractory form of genital warts,

Hairy cell leukemia.

Interferon beta preparations (rebif, fron) contain purified human fibroblastic species-specific glycoprotein (interferon beta). The mechanism of action is associated with antiviral, immunomodulatory and antiproliferative activity.

Indications for the use of interferon beta drugs: acute, recurrent and chronic diseases caused by herpes and adenoviruses, chronic active hepatitis B and C, oncological diseases.

Interferon beta-lb (Betaferon) preparations contain a non-glycosized form of human interferon beta. The mechanism of action is based on the inhibition of viral replication, inhibition of the synthesis of gamma-interferon, activisualization of suppressor T-lymphocytes.

Indications for prescribing drugs interferon beta-lb: relapsing course of multiple sclerosis.

Side and undesirable effects when using interferon preparations. Side effects are much more common with parenteral administration than with other routes of administration. Flu-like conditions, dyspeptic disorders, asthenia, granulocytopenia are possible. Rarely - liver dysfunction, neuropsychiatric changes, allopecia, skin manifestations (dryness, exanthema).

Special instructions. Alpha interferons slow down the metabolism of cimetidine, phenytoin, warfarin, theophylline, diazepam, propranolol and, therefore, may increase their toxicity.

The simultaneous use of interferon beta preparations with non-steroidal or steroidal anti-inflammatory drugs can lead to a decrease in the biological activity of interferon beta.

Contraindications to the appointment of interferon preparations: hypersensitivity to the components of the drug, severe organic diseases of the heart, liver, kidneys, autoimmune hepatitis, thyroid diseases uncontrolled by traditional therapy, epilepsy. Appointment to pregnant women is possible only if the expected benefit to the mother outweighs the potential risk to the fetus. In the case of prescribing interferon preparations to lactating women, it is necessary to resolve the issue of the possibility of breastfeeding.

Despite the existing positive clinical experience with the use of interferon preparations for various diseases in pediatric practice, the authors did not find reliable and convincing results of the effectiveness of interferons in the rehabilitation of children from the PCH group obtained in a double-blind study with placebo in the available literature. At the same time, there are data on significant changes in the interferon status in frequently ill children, which required interferon replacement therapy (Pikuza OI et al., 1997). There is an obvious need to conduct multicenter placebo-controlled studies in compliance with the GCP rules to study the efficacy and safety of recombinant interferons in children with frequent and long-term respiratory infections.

Interferon inducers

Drugs that enhance the synthesis of endogenous interferon include cycloferon, amixin, ridostin, megosin, poludan. Among the presented interferon inducers, cycloferon is of particular interest.

Cycloferon is a synthetic analogue of a natural alkaloid obtained from Citrus grandis. The mechanism of action is stimulation of the synthesis of alpha, beta, and gamma interferon by immunocompetent cells of the body. Under the influence of cycloferon, an increase in the synthesis of endogenous interferon by leukocytes, macrophages, fibroblasts and epithelial cells was noted. The effectiveness of the drug in adults in the complex therapy of herpes and cytomegalovirus infections, viral hepatitis A, B, C, reactive arthritis and degenerative-dystrophic joint diseases, chronic viral and bacterial infections, chlamydia has been proven. It is planned to study the effectiveness and safety of cycloferon in pediatric practice. In experimental studies, mutagenic, teratogenic, embryotoxic and carcinogenic effects of cycloferon were not detected. Contraindication to the appointment of the drug is pregnancy and breastfeeding.

Reliable data on the safety and efficacy of the use of the presented interferon inducers in pediatric practice were not found in the literature available to the authors.

Synthetic immunostimulants of different groups

The group of synthetic immunostimulants is heterogeneous and is represented by pyrimidine derivatives (methyluracil, pentoxyl, diucifon), imidazole derivatives (levamisole, dibazol), carbamoylaziridine (leakadin), polyethylenepiperrosine derivative (polyoxidonium).

Pyrimidine derivatives are traditionally and most often used for nonspecific immunostimulation and anabolic effects in pediatric practice. Methyluracil, pentoxyl, diucifon accelerate the synthesis of nucleic acids, proteins, promote cell division, increase the activity of neutrophils and macrophages, stimulate leukopoiesis and are antioxidants. It should be remembered that these drugs alone can only be used to prevent an infectious disease, while in the event of the development of the disease, pyrimidine derivatives should be prescribed only in combination with anti-infective agents. Otherwise, pyrimidines will be utilized by microbes with a possible activation of the infectious process (Gusel V.A., Markova I.V., 1989). When choosing drugs, preference is given to methyluracil and diucifon because of their better tolerability.

Imidazole derivatives are also often used in pediatric practice. The prophylactic administration of dibazol in the autumn-winter period is based on its ability to gradually increase nonspecific immunostimulatory effect. With a duration of administration of at least 3-4 weeks, the phagocytic activity of macrophages is stimulated, the synthesis of interferon is accelerated, and the bactericidal activity of the skin and blood increases. Levamisole is used to normalize the T-link of immunity. At the same time, the number and activity of T-lymphocytes, mainly T-suppressors, increases. At the same time, there is an increase in the phagocytic activity of neutrophils, macrophages, and induction of the synthesis of endogenous interferon.

Experimental data and clinical studies in adults have shown that polyoxidonium, by stimulating the cooperation of T- and B-lymphocytes, cell proliferation, natural migration of leukocytes, the functional state of phagocytosis, helps to normalize the immune status and improve the condition of patients with secondary immunodeficiencies against the background of severe acute and chronic bacterial infections. and viral diseases, various intoxications, chemotherapy and radiation therapy (Petrov R.V., 1983; Petrov R.V., Khaitov R.M., 1988).

Rational choice of immunocorrective therapy

The number of means and methods for correcting the immune system is not limited to those listed in the previous sections. There are numerous other non-specific means of enhancing immune function. For example, one's own blood is a physiological immunostimulant.

not with its introduction (autohemotherapy). The immunostimulatory properties of blood irradiated with ultraviolet or laser are well known. Immunore-activity increases with adequate hyperthermia. There is evidence that cytostatics in exceptionally high dilutions have a strong immunostimulatory effect. Vitamin B 12, polyene antibiotics (amphotericin B, nystatin, levorin) have an immunocorrective effect. Beta-adrenomimetics promote stem cell proliferation, thymocyte proliferation and differentiation, and enhance the helper function of lymphocytes. At the same time, when cholinomimetics are introduced into the body, antibody genesis is enhanced.

Immunocorrection should be carried out taking into account the leading cause of predisposition to infection: with lymphatism, thymus preparations can be used; innate immune tolerance is eliminated by drugs that suppress the activity of suppressor leukocytes; in allergic or autoimmune conditions, drugs that activate T-suppressors are used; insufficiency of phagocytosis is an indication for the appointment of drugs that activate phagocytosis.

Carrying out nonspecific immunostimulation raises many objections. The fact is that in most cases both helper and suppressor cells are activated. As a result, a multidirectional effect is possible. To take into account the different degree of activity of these cells for differentiated therapy, to select the appropriate doses of drugs is a very difficult task due to both individual reactivity and the polymorphism of pathogenetic factors that implement a predisposition to a pathological condition.

The appointment of immunostimulating therapy without taking into account the "points of application" of drugs and the pathogenetic foundations of the disease can lead to the activation of both suppressors and helpers, cytotoxic cells (killers) and, ultimately, lead to an even greater imbalance in the immune system (Table 11).

The following examples demonstrate the difficulty in predicting the outcome of therapy.

Example 1. A child has frequent viral and bacterial infections with a protracted course due to the allergic (atonic) component. From the activation of suppressors in this case, one can expect a positive effect due to a decrease in the production of antibodies in the composition.

Table 11

Possible positive and negative effects of nonspecific immunostimulation in various pathologies

Simultaneous activation of helpers will not only lead to the production of protective antibodies with a positive result, but will also increase the synthesis of IgE. The latter will increase the already pronounced allergic component of inflammation in this child.

Example 2. A child has a congenital persistent viral infection as a result of immunological tolerance. Activation of helpers is expedient, suppressors - is contraindicated. It is advisable to prescribe drugs that activate cytotoxic cells, which provide antiviral protection. However, at the same time, suppressors are also activated, which enhance the tolerogenic effect.

Example 3. A child from an organized team often suffers from acute respiratory diseases. Due to continuous re- and superinfection, the B-system is working hard, it is possible to produce both protective and anti-idiotypic antibodies that block the action of protective ones. The effect of total stimulation is doubtful.

Example 4. A frequently ill child with a burdened family history of cancer. Activation of helpers can promote the production of anti-cancer antibodies and the elimination of power cells. Activation of suppressors will increase the risk of developing a tumor process. At the same time, drugs that activate suppressors also activate antitumor natural killer cells.

Example 5. A "late starter" child is predisposed to frequent viral and bacterial infections. Activation of suppressors is contraindicated, B-cells is impractical due to the possible disruption of the natural formation of cooperative interactions of various cell populations.

Since the vast majority of drugs used to increase resistance have low selectivity, the use of stimulating and modulating methods of immunotherapy is possible only after a comprehensive assessment of the history, clinical condition of the child and analysis of immunological changes in his body.

Combined immunocorrective therapy with new generation drugs (ribomunil), including active specific immunization against the most common bacterial pathogens of acute respiratory diseases and activation of nonspecific immune defense factors, primarily phagocytosis, favorably differs in its focus and effectiveness.

CONCLUSION

Restoring the health of frequently and long-term ill children is of great medical and socio-economic importance. Among the reasons contributing to frequent respiratory viral and viral-bacterial diseases in children, a special place is occupied by individual and age-related characteristics of immunity. Immuno-rehabilitation is one of the most pressing problems in the system of health improvement of children from the ChDB group. For a number of years, pharmacological agents of various groups (pyrimidine and imidazole derivatives, nucleic acid preparations, thymic factors, yeast and bacterial polysaccharides, bone disease preparations) have traditionally been used to obtain an immunocorrective effect.origin, etc.). At the same time, it is impossible to reliably predict the final therapeutic effect of the listed immunostimulants in each specific case due to their rather conditional “selectivity” and the individual characteristics of the immune imbalance in the child’s body. Specific active immunization against the most common pathogens of acute respiratory diseases compares favorably with non-specific immunostimulation in its purposefulness and effectiveness.

The appearance in the therapeutic arsenal of practitioners of modern highly effective pharmacological preparations that combine the properties of a vaccine and non-specific immunomodulators determines new tactical approaches to the rehabilitation of frequently and long-term ill children, and also expands the prospects for immunocorrective measures in general.

With all the variety of drugs that have an immunomodulatory effect, a strictly individual approach is needed to include a particular drug in a comprehensive immunorehabilitation program, taking into account:

The age of the child;

Frequency and severity of acute respiratory infections carried by the child;

Concomitant pathology of the child;

The state of the child's immune system;

Seasons.

It must be borne in mind that none of the existing immunomodulating agents is capable of restoring the health of the child "for the rest of his life." Only consistent and comprehensive rehabilitation therapy with the strict implementation of all recommendations for 2-3 years in a row will lead to a noticeable decrease in the incidence of acute respiratory diseases in children and the preservation of their health.

A huge number of antiviral and immunomodulatory drugs exist in modern medicine for the treatment of acute viral infections of the respiratory tract. At the same time, the clinician has a difficult task: which drug to choose? The task is even more complicated in the presence of an extensive medical history of the child. Solving this problem is not so simple and the answer may be ambiguous. One thing is clear - these drugs are necessary for children who often suffer from acute respiratory infections.

Features of clinical manifestations of acute respiratory viral infections and acute respiratory infections

Respiratory viral infections are considered one of the most common diseases. Various similar infections manifest themselves in the same way:

• cough and rhinitis;
• headache and swollen lymph nodes;
• hyperthermia and abdominal pain;
• arthralgia, etc.

: effects

There are several opinions about the consequences of respiratory infections in children. Approaching on the one hand, it is worth noting the undoubted benefits of diseases for the formation of active immunity. On the other hand, with the development of lower respiratory tract infections in children under 3 years of age, bronchospasm inevitably develops by the age of seven.

If diseases occur frequently, there is an increase in the allergic mood of the body, the development of chronic inflammation and, as a result, chronic respiratory diseases. Chronic diseases disrupt the functioning of the organs of the respiratory system.

Differences Between Respiratory Infections

In addition to the fact that there are similar symptoms, there are undeniable differences in terms of symptoms, duration, course, and duration of the incubation period. For example, influenza is characterized by a fairly short period of latent manifestations, and this is from 2-5 hours to a week. The disease occurs suddenly, body temperature rises, intoxication develops. With the development of rhinovirus infection, the incubation period usually lasts from 11 to 12 hours. Adenovirus infection is characterized by a long incubation period - from 2.5 to 14 days.

Acute respiratory viral infection and acute respiratory infections: syndromes with them

The occurrence of broncho-obstructive syndrome (BOS) most often occurs with the development of rhinovirus, respiratory syncytial, adenovirus, metapneumovirus infections.

Abdominal syndrome, or a syndrome of gastrointestinal manifestations, can appear in the form of mesadenitis, abdominal pain, gastroenteritis due to the defeat of certain body structures by the virus. This syndrome occurs with adenovirus infection (measdenitis), coronavirus, enterovirus, bocavirus infections (gastroenteritis).

The syndrome of lesions of the central nervous system is more rare and occurs mainly with influenza and enterovirus infection.

Catarrhal syndrome is always present in any viral infection in one form or another and the degree of manifestation. The symptomatology of the disease develops as a result of the tropism of the virus to a certain type of body tissue.

Respiratory syncytial viral infection is becoming more and more relevant and attracts more and more attention, as it affects the lower parts of the respiratory tract and, thus, the likelihood of developing bronchial asthma in children increases several times.

fever period

There are also differences in the level of fever in children with various respiratory tract infections:

1. Flu. At the onset of the disease, body temperature rises to 38.5-40C. It stays at this level for about 1-2 days;
2. Parainfluenza. The temperature rises to 37.5-38.5C and the febrile period lasts up to 5 days;
3. adenovirus infection. The fever is high and in some cases can linger up to 14 days;
4. Rhinovirus infection. Fever of low intensity and duration. Subfebrile condition is usually observed.

Frequently and long-term ill children (CHDI)

It is quite difficult to treat these children, since they are poorly amenable to therapy, for them it is sometimes necessary to use the entire arsenal of medications. Such children should be carefully examined. It is necessary to carry out the correct and rational treatment of such a disease as, and also not to forget about preventive measures. Almost every fifth small patient can be attributed to the PDD group.

Treatment of patients in the PDD group

The main principle of adequate therapy is the etiologically correct choice of antibiotic therapy.

Before treatment, a number of instrumental and laboratory examinations are prescribed. Of these, we can distinguish:

• Ultrasound of the abdominal organs;
• Echoscopy of the heart, ECG;

After the examination, the patient may experience the presence of several pathogens, and at the same time there may be a banal flora and atypical representatives of the microworld, viruses. Thus, in the presence of viruses, antibacterial drugs are combined with the appointment of antiviral drugs. The most common and preferred antibiotics are drugs of the group of aminopenicillins, cephalosporins, macrolides.
Immunomodulatory drugs are widely used in the treatment of children with respiratory depression, both for treatment in the acute period and for prophylaxis during the period of the epidemic rise. Of course, not all drugs can be given to children, as there are age restrictions or there is no evidence base for the use of this medication.

The history of the use of plant-based immunomodulators

Herbal preparations, for example, echinacea, have long been used as immunomodulators. Her official form is Immunal.

This plant was first described in 1752 by Linnaeus. He then named the plant rudbeckia purpurea in honor of his teacher.

Echinacea purpurea grows in the USA and Mexico. The indigenous people of these countries used the plant to treat various diseases. The plant was brought to Europe shortly after the discovery of the continent.

What is in Echinacea?

Echinacea roots and herb contain phytosterols, carbohydrates, essential oils, fatty oils, isobutylamides. In addition, there are biologically active substances: vitamins, flavonoids, alkylamides, essential phospholipids, caffeic acid derivatives.

Polysaccharides are the main substances that have a healing effect.

Benefits of Echinacea

Echinacea is effective for diseases of the urinary tract, furunculosis, urticaria, eczema, herpes, burns, abscesses, insect bites and many other pathological conditions. Echinacea also has antifungal, antiviral and antibacterial effects.

Where is Immunal used in modern medicine?

Immunal refers to exogenous immunomodulators. It is used at the beginning of an acute respiratory disease as a treatment and also for prevention. It is reliably known that the drug is effective, safe and appropriate for use in ARVI and acute respiratory infections.

Numerous studies have recognized the effectiveness of only the ground parts of echinacea.

Research data

In 2004, a study was conducted, the purpose of which was to determine the safety of the drug in children with bronchial asthma. It turned out that the use of Immunal contributed to the shortening of the duration of allergic diseases.
The following effects of Immunal have also been proven:

• Strengthening of phagocytic activity;
• Strengthening the synthesis of antibodies;
• Increased activity of killer cells;
• Stimulation of interferon synthesis;
• Stabilization of cellular barriers;
• Antioxidant effect.

The drug has been used in CHD children. At the same time, the normalization of the cellular link of the immune system occurred.

If Immunal was turned on at the onset of the disease, the severity of the acute infection decreased, and the patient's condition became better.

Indications for Immunal

• Secondary immunodeficiency states, for example, caused by a disease such as acute respiratory infection;
• The period of adaptation in preschool and school children's institutions;
• Adjunct in long-term antibiotic treatment.

Contraindications.