E.S. MIKHALEVA, S.YA. YAROSHENKO, E.A. KONTOVSKY, A.V. DUBOVAYA, E.V. BUKHTIYAROV

1. Gorky Donetsk State Medical University, Donetsk

 Contact details:

Mikhaleva E.S.  p—ost-graduate student, Department of Propaedeutics of Pediatrics

Address: 16 prospekt Illyicha, 83003 Donetsk, Donetsk People’s Republic, tel.: +7-949-326-91-38, e-mail: mihalyovalizaveta@yandex.ru

 The purpose — to summarize current data on the relationship between bronchial asthma and cardiovascular comorbidity in children, to analyze the main pathophysiological mechanisms underlying cardiovascular disorders, and to assess the role of basic anti-asthmatic therapy in cardiovascular risk formation.

Material and methods. An analytical review of Russian and international scientific publications devoted to the relationship between bronchial asthma and cardiovascular disorders in the pediatric population was performed. Epidemiological, clinical and experimental studies describing the role of systemic inflammation, hypoxia, endothelial dysfunction, autonomic dysregulation and pharmacotherapy in the development of cardiovascular comorbidity were analyzed.

Results. Bronchial asthma may be considered a factor contributing to cardiovascular risk already in childhood. Children with asthma often demonstrate subclinical cardiovascular changes, including cardiac rhythm disturbances, signs of myocardial diastolic dysfunction, vascular wall alterations, and endothelial dysfunction. Chronic systemic inflammation, oxidative stress, recurrent hypoxic episodes and autonomic imbalance play a key role in the pathogenesis of these changes. Pharmacological factors are also important: frequent use of β₂-agonists may be associated with cardiovascular effects, whereas adequate basic therapy, particularly inhaled corticosteroids, contributes to the inflammation control and may potentially reduce cardiovascular risks.

Conclusion. Bronchial asthma in children is associated with systemic changes that may involve the cardiovascular system and contribute to the development of early cardiovascular comorbidity. Early detection of subclinical cardiovascular abnormalities, optimization of basic therapy and comprehensive cardiovascular assessment are essential for preventing long-term complications and improving prognosis in this group of patients.

Key words: bronchial asthma, children, cardiovascular comorbidity, endothelial dysfunction, cardiovascular risk, basic therapy

 REFERENCES

1. Ng C.A., Knuiman M.W., Murray K. et al. Childhood asthma and cardiovascular morbidity and mortality in adulthood. Pediatric Pulmonology, 2021,  vol. 56 (7),  pp. 1915–1923.
2. Tattersall M.C., Guo M., Korcarz C.E. et al. The relationship between asthma and cardiovascular disease. Chest, 2020,  vol. 157 (5),  pp. 1278–1286.
3. Ostroumova O.D., Goloborodova I.V., Voyevodina N.Yu. et al. Bronchial asthma and cardiovascular diseases. Consilium Medicum, 2018,  vol. 20, no. 5,  pp. 8–16 (in Russ.).
4. Hosny E., Adachi Y., Anastasiou E. et al. Comorbidities in childhood asthma: global implications and unmet needs. World Allergy Organization J, 2024,  vol. 17 (5). Art. 100909.
5. Klishin I.V., Drannikov M.A., Shulenin D.K. Comorbid conditions in children with bronchial asthma. Vestnik UGMU, 2024,  no. 4,  pp. 80–94 (in Russ.).
6. Papadopoulos N.G., Arakawa H., Carlsen K.H. et al. International consensus on (ICON) pediatric asthma. Allergy, 2012,  vol. 67 (8),  pp. 976–997.
7. Hua M.L., Li L., Diao L.L. Bronchial asthma and risk of specific cardiovascular diseases: a meta-analysis. Eur. Rev. Med. Pharmacol. Sci, 2022,  vol. 26 (14),  pp. 5081–5091.
8. Karakaya Z., Cavkaytar O., Tosun O. et al. Subclinical cardiovascular dysfunction in children with asthma. J. Asthma, 2022,  vol. 59 (3),  pp. 451–461.
9. Jiang Y., Huang S., Yu D. et al. Asthma and the risk of cardiovascular diseases and mortality: a meta-analysis. Therap. Adv. Resp. Dis, 2025,  vol. 19. DOI: 10.1177/17534666251333965
10. Steinmann M., Abbas S., Singer F. et al. Increased arterial stiffness in children with asthma. Eur. J. Pediat, 2015,  vol. 174 (4),  pp. 519–523.
11. Bazhenova Yu.L., Zakharova S.Yu., Tsar′kova S.A. Prediction of the development of cardiovascular disorders in children with bronchial asthma. Ural′skiy meditsinskiy zhurnal, 2017,  vol. 149, no. 5,  pp. 67–73 (in Russ.).
12. Andreadis A.A., Hazen S.L., Comhair S.A., Erzurum S.C. Oxidative and nitrosative events in asthma. Free Radic. Biol. Med, 2003,  vol. 35,  pp. 213–225.
13. Reitsma S., Slaaf D.W., Vink H. et al. The endothelial glycocalyx: composition, functions, and visualization. Pflugers Arch, 2007,  vol. 454,  pp. 345–359.
14. Becker B.F., Jacob M., Leipert S. et al. Degradation of the endothelial glycocalyx in clinical settings: searching for the sheddases. Br. J. Clin. Pharmacol, 2015,  vol. 80,  pp. 389–402.
15. Timm S., Letto M., Hegermann J. et al. The unrecognized alveolar epithelial glycocalyx. Histochem. Cell. Biol, 2023,  vol. 160,  pp. 83–96.
16. Milusev A., Rieben R., Sorvillo N. The endothelial glycocalyx: a possible therapeutic target in cardiovascular disorders. Front. Cardiovasc. Med, 2022,  vol. 9,  p. 897087. DOI: 10.3389/fcvm.2022.897087
17. Kreslova M., Kirchnerova O., Rydl D. et al. Bronchial asthma as a cardiovascular risk factor: prospective observational study. Biomedicines, 2022,  vol. 10 (10),  p. 2614. DOI: 10.3390/biomedicines10102614
18. Khalifa A., Kheirandish-Gozal L., Bhattacharji R. et al. Circulating microRNAs as potential biomarkers of endothelial dysfunction in obese children. Chest, 2016,  vol. 149,  pp. 786–800.
19. Bokov P., Dudoyon B., Delclaux C. Hypoxic load as a cause of cardiovascular diseases in obstructive sleep apnea in children. Pediatr. Res, 2026,  pp. 270–275.
20. Ignatenko G.A., Bagriy A.E., Ignatenko T.S. et al. Possibilities and prospects of using hypoxic therapy in cardiology. Arkhiv′′ vnutrenney meditsiny, 23, vol. 13, no. 4,  pp. 245–252 (in Russ.).
21. Ignatenko G.A., Denisova E.M., Sergiyenko N.V. Hypoxytherapy as a Promising Method for Improving the Efficiency of Complex Treatment of Comorbid Pathology. Vestnik neotlozhnoy i vosstanovitel′noy khirurgii, 2021,  vol. 6, no. 4,  pp. 73–80 (in Russ.).
22. Ignatenko G.A. Mechanisms of vaso- and cardioprotection in hypoxic therapy of arterial hypertension and coronary heart disease. Kompleksnyye problemy serdechno-sosudistykh zabolevaniy, 2024,  vol. 13, no. 1,  pp. 98–108 (in Russ.). DOI: 10.17802/2306-1278-2024-13-1-98-108
23. Ignatenko G.A., Kontovskiy E.A., Dubovik A.V. et al. Use of interval normobaric hypoxic therapy in patients with cardiopulmonary pathology. Vestnik gigiyeny i epidemiologii, 2018,  vol. 22, no. 4,  pp. 22–25 (in Russ.).
24. Ignatenko G.A. Modern possibilities of adaptive medicine. Klinicheskaya meditsina, 2008,  vol. 11, no. 1,  p. 56 (in Russ.).
25. Kundavaram R., Kumar P., Malik S. et al. Impact of asthma phenotypes on myocardial performance and pulmonary hypertension in children. Cureus, 2023,  vol. 15 (8), p. e44252. DOI: 10.7759/cureus.44252
26. Markova T.A., Kalinova V.S., Potolova K.N. et al. The state of the cardiovascular system in children with bronchial asthma. Rossiyskiy vestnik perinatologii i pediatrii, 2016,  no. 4,  pp. 174–175 (in Russ.).
27. Gerasimova E.V. Clinical, instrumental, and laboratory analysis of the state of the cardiovascular system in children with bronchial asthma. Sovremennyye problemy nauki i obrazovaniya, 2014,  no. 2 (in Russ.), available at: https://science-education.ru/ru/article/view?id=12823
28. Özde Ş., Kayapınar O., Doğru M. et al. Assessment of the early effects of childhood asthma on heart function. Pediatr. Cardiol, 2024,  vol. 45,  pp. 858–866.
29. Kundavaram R., Reddy S., Kumar V. Impact of asthma on myocardial performance and right ventricular function in children. Pediatr. Cardiol, 2023,  vol. 44,  pp. 1568–1576.
30. Lang R.M., Badano L.P., Mor-Avi V. et al. Recommendations for cardiac chamber quantification by echocardiography. Eur. Heart J. Cardiovasc. Imaging, 2015,  vol. 16,  pp. 233–270.
31. Amegadzie J.E., Gamble J.M., Farrell J., Gao Z. Association between initiation of inhaled β2-agonists and risk of serious cardiovascular events. Int. J. Chron. Obstruct. Pulmon. Dis, 2022,  vol. 17,  pp. 1205–1217.
32. Cazzola M., Page C.P., Hanania N.A. et al. Asthma and cardiovascular diseases: bridging pharmacological interactions. Drugs, 2024,  vol. 84,  pp. 1251–1273.
33. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention, 2024.
34. Bloom C.I., Yang F., Hubbard R. et al. Association of dose of inhaled corticosteroids and frequency of adverse events. Am. J. Respir. Crit. Care Med, 2025,  vol. 211,  pp. 54–63.
35. Ma L.H., Jia L., Bai L. Safety outcomes of salbutamol: a systematic review and meta-analysis. Clin. Respir. J, 2023,  vol. 17,  pp. 1254–1264.
36. Lev-Ari N., Oberman B., Kushnir S. et al. The effect on the cardiovascular system of inhalers with long-acting bronchodilators. Heart Lung, 2025,  vol. 70,  pp. 250–257.
37. Su D., Johnston S.L. A smarter use of β-agonists in asthma: mechanisms and rationale. Allergy Asthma Immunol. Res, 2024,  vol. 16,  pp. 217–234.
38. Wirtgen E., Quickert S., Weitzel J. et al. Safety of biologics for the treatment of asthma in children and adolescents: a systematic review. Eur. Resp. Rev.: an Official J. Eur. Resp. Soc, vol. 34 (176),  p. 38.          240269. DOI: 10.1183/16000617.0269-2024