Resolution of the online-teleconference "Respiratory infections - what to prepare for this season?"

Almost 5 500 health care specialists have registered to participate in the Teleconference "Respiratory diseases should be treated locally. Respiratory infections - what to prepare for this season?", September 15, 2022, Kyiv, Ukraine. 

As part of the event the leading experts and practitioners in Allergology, Pulmonology, Pediatrics, and Dietology have shared their expert opinions and experience related to management of patients with acute respiratory viral infections, asthma, bronchiolitis and broncho-obstructive syndrome (wheezing). 

Special attention was paid to the issue of management of patients with acute respiratory infections in the epidemic season 2022/2023 during the war and the spread of COVID-19, possibilities of etiotropic and symptomatic treatment of patients and new methods of preventive measures. 

Seven main reports were offered to the participants for review and they were dealing with the following issues:

• ARVI treatment on the background of Covid-19 pandemics.
• Prevention of respiratory infections. Let’s talk frankly...
• Exacerbation of asthma on the background of ARVI.
• Trends in methods of targeted treatment for respiratory diseases.
• Updates in NHSU program: what do “Affordable drugs” offer today?
• The experience of respiratory cytoprotection in patients with asthma.

Conclusions and decisions based on discussion of reports: 

1. Bronchiolitis is an acute viral infection of lower respiratory tract affecting children below 24 months of age and which is characterized by respiratory distress, hissing respiration and crepitation in lungs. According to recommendations of ААP and SIGN, from the point of view of evidence-based medicine, the treatment of acute bronchiolitis is primarily concerned with providing adequate child care (nutrition and hydration) and supporting normal blood SatO2. The effectiveness of routine use of bronchodilators, glucocorticosteroids (GCS), antibiotics, antiviral drugs is not proven. Administration of sodium chloride (3%) hypertonic solution reduced the duration of hospital stay and improved clinical symptoms. 
2. Broncho-obstructive syndrome (wheezing) is a heterogeneous pathological condition that can be a manifestation of different nosologies, it is one of the most common symptomatic complexes in pediatric and therapeutic practice. 
3. In accordance with international recommendations, inhaled bronchodilators and steroids should be used in the treatment of bronchial obstructive diseases (e.g., asthma, acute obstructive bronchitis). Inhaled salbutamol is a priority in the recommendations and has advantages in efficiency and safety over oral salbutamol. Nebulized fluticasone propionate is an alternative to oral steroids. 
4. The first step in the treatment of wheezing caused by bronchial spasm is the application of salbutamol via a nebulizer, or spacer. Ipratropium bromide is added only in severe wheezing. Oral bronchial spasmolytics are not recommended due to the large number of side effects and lower efficiency compared to inhaled bronchial spasmolytics. In children with frequent virus-induced wheezing episodes and periodic symptoms of asthma, the occasional use of inhaled corticosteroids can be considered. Nebulized fluticasone propionate is considered a drug of choice for wheezing. For nebulizer inhalations, solutions in single-dose containers with minimal preservatives in auxiliary substances are recommended. 
5. In children with wheezing of atopic genesis and periodic symptoms of asthma, the occasional use of inhaled corticosteroids can be considered. Nebulized fluticasone propionate is considered a drug of choice for atopic wheezing. 
6. The lack of asthma control is noted in about 60% of patients. The cause is the use of short-acting bronchodilators, which reduce symptoms, and the omission of inhaled glucocorticostroids. Fixed combination of formoterol/budesonide let us use one inhaler in two modes – baseline therapy and symptomatic therapy (in brief: MART-mode). According to international recommendations fixed combination of formoterol/budesonide is considered as a high-priority therapy due to high efficiency of MART-mode. It is also important that the inhaler be convenient for rapid reduction of symptoms and affordable for many patients. Combination of formoterol/budesonide in Easyhaler inhaler meets such criteria. 
7. Nebulizer therapy is a well-founded evidence-based medicine method of targeted delivery of drugs to the respiratory tract. Since the application of therapy requires certain skills, it is important to consider typical errors.
8. New estimates suggest that at least 1.27 million deaths per year are directly related to antimicrobial resistance (AMR), which requires urgent action by policymakers and the medical community to avoid further preventable deaths. 
9. Antiseptic inhalation is indeed clearly and rightly noted, as a valuable treatment for a large and important class of diseases; and I believe it is capable of much greater development and continuation, and that it will ultimately play a crucial role in future therapeutic therapy. But, while there is no doubt that its use is justified, it will not be adopted too quickly and fully. This recognition means that its value is very valuable in the hands of physicians, who will now conduct a long and extensive trial of this method.
10. Bronchiolitis is a generalized inflammatory disease of bronchia, and is increasingly found not only in children under 2 years of age. Among the reasons for the spread of the disease in older patients can be identified Covid-19, in particular caused by the strain of Omicron, and alternative methods of smoking common among adolescents - electronic cigarettes and vaping. Nebulizer treatment with NaCl hypertonic solution in combination with hyaluronic acid is a promising method to eliminate wheezing in patients with bronchiolitis.
11. Respiratory cytoprotection has demonstrated its effectiveness in improving control of asthma in children. The use of an ectoin-based inhalation cytoprotector in children with acute asthma reduced the intensity and duration of symptoms and improved external respiration.
12. Intranasal use of amino caproic acid demonstrates a high potential for the prevention, emergency prevention and treatment of viral respiratory infections. In the context of an increase in the incidence of Covid-19 and an increase in the incidence of influenza, it is worth paying more attention to the prevention and emergency ARVI incl. with the help of intranasal use of amino caproic acid. 

You can download the text of the Resolution by this link.

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