• Recurrent respiratory diseases in children: the physician’s action algorithm (lecture)

Recurrent respiratory diseases in children: the physician’s action algorithm (lecture)

SOVREMENNAYA PEDIATRIYA.2018.3(91):92-97; doi 10.15574/SP.2018.91.92

Chernyshova L. I.
Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

Respiratory infections in the world rank first among all diseases, 85% of these infections occur in children. Recurrent respiratory diseases (RRD) are the main cause of parents' anxiety, a visit to a doctor, a decrease in visits to a kindergarten and a school, and hospitalization. Immunodeficiency as a cause of RRD appears not more than in 10% of children. One of the leading causes of repeated respiratory symptoms is allergy, an appropriate specific therapy of which is worked out. In 1.5% of children with RRD, the serious, but not immune, violations are found; the majority of children are apparently healthy. It is considered that 6–10 episodes of ARVI per year for some children are necessary to form the immunity against different respiratory virus. The trigger factors of RRD include visiting organized preschool groups, passive smoking, and air pollution in the cities. According to the WHO, human health, general resistance to infections by 60% depends on lifestyle, including nutrition, motion activity, and emotional state. Colonizational resistance of mucous membranes is provided by microflora. At the early stages of life, the microbiota «educates» the immune system to fight with pathogens. Probiotics are used to support microflora. The article presents the results of meta-analyses, which prove the possibility of loss in frequency and duration of RRD when using probiotics. Emphasize is made on the strain3specific effect of probiotic bacteria. To prevent and/or treat respiratory infections, there was developed and patented a probiotic, which in Europe is registered under the brand name BIFIVIR, and in Ukraine as FLUVIR. The microorganisms of this multiprobiotic increase the Th1 response, which is known to provide antimicrobial and antiviral immunity, and in addition, not only do not stimulate the Th2 response, but also reduce it, that is, reduce allergisation.

Key words: recurrent respiratory infections, children, probiotics.


1. Abaturov O.Ye., Agafonova E.A., Babich V.L., Dityatkovskyi V.A.. (2016). New possibilities of treatment and prevention of acute respiratory infections in children. Sovremennaya pediatriya. 1(73): 93—96. doi 10.15574/SP.2016.73.93

2. Aryayev N.L., Senkovskaia L.I., Shevchenko I.M. (2013). Results of clinical approvals of Fluvir in preschool and school age children with recurrent upper respiratory tract diseases. Sovremennaya pediatriya. 5(53): 116—119. doi 10.15574/SP.2013.53.116

3. Chernyshova LI, Haidai NV, Kostiuk OP, Kovalenko OF. (2000). Imunoterapiia ta imunoprofilaktyka u ditei z chastymy respiratornymy zakhvoriuvanniamy. Pediatriia, akusherstvo ta hinekolohiia. 3: 84.

4. Chernysheva L.I., Gilfanova A.M., Bondarenko A.V., Yakimovitch S.A., Rabosh O.V., Yanovskaya V.V., Glushkevichi T.G., Limar T.V., Pomaz G.M., Vlasenko N.O. (2014). Effect of early social activity in S. pneumoniae nasopharyngeal carriage and distribution of pneumococcus serotypes in children of the first five years of life. Sovremennaya pediatriya. 2(58): 58—63. doi 10.15574/SP.2014.58.58

5. Chernyshova LI, Syniachenko VV, Naumenko NV. (2001). Mukozalnyi imunitet ta yoho korektsiia pry infektsiiakh verkhnikh dykhalnykh shliakhiv. Perynatologiya i pediatriya. 3: 76—78.

6. Chernyshova LI, Yakymovych SA, Chernyshov AV, Donskoi BV, Halaziuk LV. (2009). Faktory vrodzhenoho ta adaptyvnoho mistsevoho imunitetu u ditei z povtornymy respiratornymy infektsiiamy. Perynatologiya i pediatriya. 3(39): 151—152.

7. Chopyak V.V., Potemkina G.A., Bilyanskaya L.N., Kril' I.I., M.V. Mzurak, Lishchuk-Yakimovitch K.A. (2013). Examination of regulatory immune mechanisms in friqantlly ill children and their correctability. Sovremennaya pediatriya. 7: 80—87. doi 10.15574/SP.2013.55.80

8. Al Faleh K, Anabrees J (2013). Efficacy and safety of probiotics in preterm infants. J Neonatal Perinatal Med. 6: 1—9.

9. Al Kassaa I, Hober D, Hamze M, Chihib NE, Drider D. (2014). Antiviral potential of lactic acid bacteria and their bacteriocins. Probiotics Antimicrob Proteins. 6: 177—185. https://doi.org/10.1007/s12602-014-9162-6; PMid:24880436

10. Amaral MA, Guedes GHBF, Epifanio M, Wagner MB, Jones MH, Mattiello R. (2017). Network meta-analysis of probiotics to prevent respiratory infections in children and adolescents. Pediatr Pulmonol. 52(6): 833—843. https://doi.org/10.1002/ppul.23643. Epub 2017 Jan 3.

11. Andrews T, Thompson M, Buckley DI et al. (2012). Interventions to influence consulting and antibiotic use for acute respiratory tract infections in children: a systematic review and meta-analysis. PLoS One. 7: 30334. https://doi.org/10.1371/journal.pone.0030334; PMid:22299036 PMCid:PMC3267713

12. Bogaert D, Keijser B, Huse S, Rossen J, Veenhoven R et al. (2011). Variability and diversity of nasopharyngeal micro biota in children: a metagenomic analysis. PLoS One. 6: e17035. https://doi.org/10.1371/journal.pone.0017035; PMid:21386965 PMCid:PMC3046172

13. Ehlken B, Ihorst G, Lippert B et al. (2005). Economic impact of community-acquired and nosocomial lower respiratory tract infections in young children in Germany. Eur J Pediatr. 164: 607—615. https://doi.org/10.1007/s00431-005-1705-0; PMid:15965766

14. Fendrick AM, Monto AS, Nightengale B, Sarnes M. (2003). The economic burden of non-influenza-related viral respiratory tract infection in the United States. Arch Intern Med. 163: 487—494. https://doi.org/10.1001/archinte.163.4.487; PMid:12588210

15. Food and Agriculture Organization of the United Nations, World Health Organization. Guidelines for the Evaluation of Probiotics in Food. Joint FAO/WHO Working Group Report (2002). London, Canada: Food and Agriculture Organization of the United Nations, World Health Organization.

16. Fooks LJ, Gibson GR. (2002). Probiotics as modulators of the gut flora. Br J Nutr. 88; suppl 1: 39—49. https://doi.org/10.1079/BJN2002628; PMid:12215180

17. Gerritsen C, Ormel G. (2016, Sep/Oct). Probiotics to prevent upper respiratory tract infections Monographic special issue: PRE/PROBIOTICS — Agro FOOD Industry Hi Tech. 27(5).

18. Grzeskowiak Å ‚ Isolauri E, Salminen S, Gueimonde M. (2011). Manufacturing process influences properties of probiotic bacteria. Br J Nutr. 105: 887—894. https://doi.org/10.1017/S0007114510004496; PMid:21059281

19. Guarner F, Khan AG, Garisch J, Eliakim R, Gangl A. (2012). https://doi.org/10.1097/MCG.0b013e3182549092; PMid:22688142

World Gastroenterology Organization World Gastroenterology Organisation Global Guidelines: probiotics and prebiotics October 2011. J Clin Gastroenterol. 46: 468—481.

20. Guillemard E, Tanguy J, Flavigny A et al. (2010). Effects of consumption of a fermented dairy product containing the probiotic Lactobacillus casei DN-114 001 on common respiratory and gastrointestinal infections in shift workers in a randomized controlled trial. J Am Coll Nutr. 29: 455—468. https://doi.org/10.1080/07315724.2010.10719882; PMid:21504972

21. Hardy H, Harris J, Lyon E, Beal J, Foey A. (2013). Review Probiotics, Prebiotics and Immunomodulation of Gut Mucosal Defences: Homeostasis and Immunopathology Nutrients. 5: 1869—1912. https://doi.org/10.3390/nu5061869.

22. Hendley JO, Hayden FG, Winther B. (2005). Weekly point prevalence of Streptococcus pneumoniae, Hemophilusinfluenzae and Moraxella catarrhalis in the upper airways of normal young children: effect of respiratory illness and season. APMIS. 113: 213—220. https://doi.org/10.1111/j.1600-0463.2005.apm1130310.x; PMid:15799766

23. Hickey L, Jacobs SE, Garland SM. (2012). Probiotics in neonatology. J Paediatr Child Health. 48: 777—783. https://doi.org/10.1159/000329094; PMid:21912185

24. Hidalgo-Cantabrana C, Sanchez B, Milani C et al. (2014). Genomic overview and biological functions of exopolysaccharide biosynthesis in Bifidobacterium spp. Appl Environ Microbiol. 80: 9—18. https://doi.org/10.1128/AEM.02977-13; PMid:24123746 PMCid:PMC3910989

25. Kilic SS. (2004). Recurrent respiratory tract infection. Recent Advances in Pediatrics. New Delhi: Jaypee Brothers Medical Publishers: 1–18. ISBN 81-8061-297-X.

26. Lambert SB, Allen KM, Carter RC et al. (2008).The cost of community-managed viral respiratory illnesses in a cohort of healthy preschool-aged children. Respir Res. 9: 11. https://doi.org/10.1186/1465-9921-9-11; PMid:18215329 PMCid:PMC2266731

27. Lange K, Buerger M, Stallmach A et al. (2016). Effects of antibiotics on gut microbiota. Dig Dis. 34: 260—268. https://doi.org/10.1159/000443360; PMid:27028893

28. Luoto R, Isolauri E, Lehtonen L (2010). Safety of Lactobacillus GG probiotic in infants with very low birth weight: twelve years of experience. Clin Infect Dis. 50: 1327—1328. https://doi.org/10.1086/651694; PMid:20367236

29. Massin MM, Montesanti J, Gerard P et al. (2006).Spectrum and frequency of illness presenting to a pediatric emergency department. Acta Clin Belg. 61: 161—165. https://doi.org/10.1179/acb.2006.027; PMid:17091911

30. Mogna G, Strozzi GP. United States Patent, Mogna et al., Patent No.: US 9,233,130 B2, Date of Patent: Jan. 12, 2016. Probiotic bacteria based composition and use thereof in the prevention and/or treatment of respiratory pathologies and/or infections and in the improvement of the intestinal functionality.

31. Nicholson KG, McNally T, Silverman M, et al. (2006). Rates of hospitalisation for influenza, respiratory syncytial virus and human metapneumovirus among infants and young children. Vaccine. 24: 102—108. https://doi.org/10.1016/j.vaccine.2005.02.004; PMid:16310899

32. Nokso–Koivisto J, Pitkaranta A, Blomqvist S et al. (2002). Viral etiology of frequently recurring respiratory tract infections in children. Clin Infect Dis. 35: 540—546. https://doi.org/10.1086/341773; PMid:12173127

33. Oliva S, Di Nardo G, Ferrari F et al. (2012). Randomised clinical trial: the effectiveness of Lactobacillus reuteri ATCC 55730 rectal enema in children with active distal ulcerative colitis. Aliment Pharmacol Ther. 35: 327—334. https://doi.org/10.1111/j.1365-2036.2011.04939.x; PMid:22150569

34. Pregliasco F, Anselmi G, Fonte L, Giussani F, Schieppati S, Soletti L. (2008). A New Chance of Preventing Winter Diseases by the Administration of Synbiotic Formulations. Clin Gastroenterol. 42: 224—233. https://doi.org/10.1097/MCG.0b013e31817e1c91; PMid:18685511

35. Raniszewska A, Gorska E, Kotula I, Stelmaszczyk–Emmel A, Ciepiela O. (2015). Recurrent respiratory tract infections in children — analysis of immunological examinations. Cent Eur J Immunol. 40(2): 167—173. https://doi.org/10.5114/ceji.2015.52830; PMid:26557030 PMCid:PMC4637391

36. Salminen MK, Tynkkynen S, Rautelin H, Saxelin M, Vaara M et al. (2002). Lactobacillus bacteremia during a rapid increase in probiotic use of Lactobacillus rhamnosus GG in Finland. Clin Infect Dis. 35: 1155—1160. https://doi.org/10.1086/342912; PMid:12410474

37. Stiehm ER, Ochs HD. (2004). Winkelstein. Immunologic disorders in infants and children (5th ed.). Elsevier Saunders: 1512.

38. Szajewska H, Konarska Z, Kolodziej M. (2016). Probiotic bacterial and fungal strains: claims with evidence. Dig Dis. 34: 251—259. https://doi.org/10.1159/000443359; PMid:27028756

39. Vesa S, Kleemola M, Blomqvist S et al. (2001). Epidemiology of documented viral respiratory infections and acute otitis media in a cohort of children followed from two to twenty-four months of age. Pediatr Infect Dis J. 20: 574—581. https://doi.org/10.1097/00006454-200106000-00006; PMid:11419498

40. Yizhong W, Xiaolu Li, Ting Ge, Yongmei Xiao, Yang Liao, Yun Cui, Yucai Zhang, Wenzhe Ho, Guangjun Yu, Ting Zhang. (2016). Probiotics for prevention and treatment of respiratory tract infections in children A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 95(31): 4509. Published online 2016 Aug 7. https://doi.org/10.1097/MD.0000000000004509; PMid:27495104 PMCid:PMC4979858