Diseases of the respiratory system in children occupy approximately 2/3 of all childhood diseases, which is explained by the lack of maturity of the respiratory system and is typical for this age group. According to the «Yearbook 2021 for the Primorsky Territory» in the section «Morbidity of the population», the number of patients who applied to medical organizations with respiratory diseases aged 0-14 years is 66.81% (out of 1895.2 of the total number of diseases, 1266.3 are respiratory diseases) [1, p.123]. This indicator encourages the study of the peculiarities of living in the Primorsky Territory, because many of these diseases take the form of chronic course, complications, and death.

The purpose of the study

 Respiratory diseases in childhood consistently occupy the first place in the morbidity structure of the Russian Federation and account for almost 60% in children and 50% in adolescents. Especially taking into account anthropogenic environmental factors, taking into account the regional characteristics of the nature and duration of action of the complex of etiotropic factors. On the territory of the Primorsky Territory, the incidence of respiratory organs among the child population remains at a fairly high level, which requires an analysis of the dynamics of morbidity.

Results

The climate in the Far Eastern region is determined by the geographical and landscape features of the territory. The result is, due to the pronounced roughness of the terrain by tectonic formations, its environment from the north by such bodies of water as the Arctic Ocean, and from the east by the Japanese, Okhotsk and Bering Seas, which have different temperature characteristics of air masses, therefore different types of weather are created.

Basically, climatologists distinguish three climatic zones: monsoon, subarctic and continental. Against the background of a significant regional diversity of climatic conditions, the determining factor is the duration of the cold season (October-May), during which outdoor activities should be limited, including work. Another unfavorable factor for human life in the conditions of the Far Eastern region is a shortage of solar radiation, including ultraviolet radiation, which means that the natural source of vitamin D necessary for sustained immunity is reduced, which is characterized by a reduced risk of acute and chronic inflammatory diseases. The predominance of high clouds and frequent fogs also reduces the transmission capacity of sunlight. In winter, the low temperature worsens with a high speed (up to 8-15 m/s) of air movement [2, p. 59].

Thus, all these factors form severe climatic conditions, which are a feature of the Far Eastern region, in particular the Primorsky Territory, which affect the health of both adults and children. The low level of natural and climatic conditions of the region affects the quality of public health, the phenotype and the state of body stability.

We assessed the epidemiological dynamics of respiratory morbidity in the territory of the PC among children aged 0-14 years in the period from 2017 to 2021 (Table 1).

Table 1

Incidence of respiratory diseases in children aged 0-14 years (https://25.rosstat.gov.ru/storage/mediabank/Ezhegodnik%202021%20na%20sait.pdf)

Analysis of negative statistics data showed that the dynamics of respiratory diseases changed from year to year relative to all diseases, the peak results are 2017 and 2021, so the situation in this area has not changed much over 5 years, which means that the epidemiological situation in the Primorsky Territory is not improving (Fig.1).

Fig.1. Indicators of respiratory diseases 2017-2021

Among the main pathophysiological processes developing in the respiratory system, it is necessary to identify several nosological units of this section: chronic diseases of the tonsils and adenoids, bronchial asthma, allergic rhinitis, ARVI, and pneumonia, which are characteristic mainly for children.

Chronic diseases of the tonsils (adenoids) — adenoid growths, or adenoids, are an excessive proliferation of lymphoid tissue, which forms the basis of the tonsils, and acute adenoiditis often occurs after a viral infection of the upper respiratory tract (ARVI). After encountering the virus, immune barriers are weakened, and bacterial agents come into play, which multiply and affect the tonsils and surrounding tissues, which leads to inflammation, and an increase in exudate production, edema and hyperemia. Symptoms include rhinorrhea, postnasal congestion, nasal congestion, snoring, fever and bad breath. Chronic adenoiditis is characterized by similar symptoms, but the bacteriological agent persists for 90 days and is often the result of polymicrobial infections with the formation of biofilms.

Bronchial asthma — this is a chronic non-communicable inflammatory disease in which many cells and cellular elements play a role. Chronic inflammation contributes to increased airway hyperactivity, leading to recurring episodes of wheezing, shortness of breath, chest tightness and coughing, especially at night or early in the morning. These episodes are usually associated with widespread but variable bronchial obstruction, which is often reversible.

It can be represented as two simultaneous processes that have a stimulating effect on the symptoms of exacerbation: smooth muscle dysfunction, leading to bronchoconstriction, bronchial hyperreactivity, hyperplasia, and the release of inflammatory mediators. Inflammation of the respiratory tract, which will result in infiltration of inflammation, swelling of the mucous membrane, cell proliferation, thickening of the basement membrane.

Allergic rhinitis — inflammation of the cells of the epithelial layer of the nose, which occurs in response to exposure to an allergen. The condition is accompanied by swelling of the mucous membrane and abundant liquid secretions. Nasal breathing becomes difficult, and the sense of smell decreases.

Acute respiratory viral infection (ARVI) — it can occur in the form of rhinitis, rhinoconjunctivitis, otitis media, nasopharyngitis, laryngitis, tracheitis. The severity of general (lethargy, malaise, fever, headache, etc.) and local (hyperemia of the mucous membrane of the nasopharynx and oropharynx, sore throat, cough, sneezing, runny nose, etc.) symptoms can be different and depends on the type of pathogen (certain viruses are tropic to certain parts of the respiratory tract), as well as on individual and age-related characteristics of the body. It occupies a leading place 96.6% among children in Primorye. The reason for such a massive spread is also the unfavorable climate, which lowers the tension of immunity.

Pneumonia — this is a group of acute focal infectious and inflammatory lung diseases of various etiology, pathogenesis and morphological characteristics with predominant involvement of respiratory departments in the pathological process and the obligatory presence of intraalveolar inflammatory exudation (ICD — X, 1992) [3, pp. 11-12].

From a pathophysiological point of view, pneumonia is the result of the multiplication of pathogens and damage to the respiratory tract of the lungs.

The trigger point of inflammation in the lungs is the adhesion of microorganisms to the surface of the cells of the bronchial tree, which is facilitated by the previous dysfunction of the ciliated ciliated epithelium and violations of mucociliary clearance. After adhesion, the colonization of microorganisms in epithelial cells occurs. Epithelial cell membranes are damaged, which leads to the release of cytokines (IL-1, IL-8, IL-12, etc.). Under the action of which the chemotaxis of effector cells into the lesion is carried out. Further, invasion and intracellular persistence of microorganisms are carried out, the production of exo- and endotoxins as a result, inflammation and clinical symptoms develop.

            The causes of the development of an inflammatory reaction in the respiratory parts of the lungs may be a decrease in the effectiveness of the protective mechanisms of the macroorganism, as well as the massive dose of microorganisms or their high virulence [4, p.9].

Prevention of respiratory diseases in children:

Primary prevention respiratory diseases are synonymous with a healthy lifestyle: regular physical activity, hardening, stress reduction, living in ecologically clean areas — all this helps to prevent the development of respiratory diseases.

At the same time, an important component of a child is a full, balanced diet according to age. If a child consumes foods with sufficient amounts of protein, vitamins and trace elements, then this is the basis for increasing the immunological resistance of the body and the ability to resist pathogens. Due to the modification properties in relation to cellular and humoral immunity, as well as non-specific and native.

To prevent infectious diseases of the respiratory system, carry out specific prophylaxis, vaccination against the influenza virus and vaccination of pneumococcal infection (since the causative agent of pneumonia is most often pneumococcus), to increase the body’s resistance [5, paragraph 7].

 Secondary prevention consists in the early diagnosis of diseases and their treatment, which is due to the fact that many diseases develop against the background of other pathologies. Timely rehabilitation of chronic foci of infection in the nasopharynx is necessary, especially in children who are often ill.

Tertiary prevention of respiratory diseases is to prevent the deterioration of the course of the disease and the occurrence of complications, which is formed by properly selected etiotropic and pathogenetic therapy and rehabilitation.

Conclusions

A comparative analysis of the spread of respiratory diseases in children aged 0-14 years in the period from 2017 to 2021 showed that among children living in the Primorsky Territory, the prevalence dynamics is not the most favorable and it has been at the same high level for 5 years, which is associated with multifactorial causes, namely:

— Firstly, non-compliance with preventive measures aimed at maintaining and strengthening the immune system necessary for the body’s resistance to various pathogens of these diseases.

— Secondly, the climatic features of the factors of the region (wind, humidity) they contribute to the development of diseases of the respiratory system.