RU2360698C1 - Bronchial asthma treatment mode - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: treatment of the patients suffering from bronchial asthma involves basic therapy combined with Rusam. Additionally, sodium nucleinate is prescribed in a dose 0.5 g daily twice a day within 20 days and capsulated Hypoxene dosed 0.1-0.2 g a day, daily within 7 days.

EFFECT: scheduled introduction of such drug combination allows improving clinical effectiveness, including due to selective effect on the certain links of immune system and desensitisation through induction of specific immune response on introduction of Rusam, its enchancement with sodium nucleinate and elimination of hypoxic conditions.

1 tbl, 1 ex

Description

The invention relates to medicine, namely to pulmonology, and can be used to treat patients with bronchial asthma.

Bronchial asthma is a disease with a complex genesis of development - inflammation, sensitization, immunological disorders, excessive activation of lipid peroxidation, decreased antioxidant defense, etc. (A.G. Chuchalin. Immunocorrection in pulmonology. - M .: Medicine, 1989 - 240 s. .).

The traditional treatment, including a set of anti-inflammatory, antihistamines, bronchodilators, in severe cases, corticosteroids and other drugs, has a mostly symptomatic effect on patients, preserving immunopathology, metabolic disorders, which leads to chronic disease and patient disability (G.F. Fedoseev et al. , 1998, A.G. Chuchalin et al., 1998, 2002).

For several years, studies have been carried out in which attempts have been made to correct these disorders in patients suffering from a mixed form of bronchial asthma due to the additional administration of immunotropic drugs (A.G. Chuchalin, 1989, 1999; AMZemskov et al., 1995, 1999 , 2003, 2005, 2007).

Among the studied pharmacological correctors, sodium nucleinate was used (V.M. Zemskov, A.M. Zemskov, A.V. Nikitin. Sodium nucleinate. Instructions for use. Approved by the Pharmacological Committee of the Ministry of Health of the USSR, 1988). This drug, when administered to patients by mouth at a dose of 1000 mcg for 10-21 days, was able to increase the effectiveness of the basic therapy of bronchial asthma, but not with an absolutely positive result (AMZemskov, V.M. Zemskov, Yu.V. Sergeev, V. A.Vornovsky, A.V. Karaulov. 1000 formulas of clinical immunology. - M.: Medicine for all. - 2003. - 336 p.).

Academician A.G. Chuchalin et al. (1998) recommended a ruza containing components of Staphylococcus aureus administered intramuscularly at a dose of 200 mg once a day with an interval of 4-5 days, 600-800 mg per course as a hyposensitizing agent in the treatment of bronchial asthma. It should be recognized that this treatment option still did not lead to a complete correction of immunological disorders.

For the treatment of bronchial asthma in order to increase the effectiveness of basic therapy, a combination of traditional treatment with sodium nucleinate and rusam was proposed according to the following scheme: first, ruse, which was administered intramuscularly at a dose of 200 mg once a day with an interval of 4-5 days, for a course of 600- 800 mg, and in parallel with it, sodium nucleinate orally in a dose of 0.5 g twice a day after meals 10 days in a row, without a sufficiently complete correction of metabolic disorders (V.I. Bolotskikh Clinical and laboratory justification for the use of differentiated immunocorrection ns in the complex treatment of bronchial asthma: Abstract dis.dokt.med Sciences - Kursk, 2007. - 48 c).....

These treatment options for bronchial asthma have the following disadvantages.

Firstly, in the treatment of patients with ruzam with sodium nucleinate, there is the possibility of developing allergic reactions, given that individual intolerance is a contraindication to the appointment of drugs.

Secondly, the combination of basic therapy of bronchial asthma with sodium nucleinate helps to eliminate secondary immune deficiency while maintaining sensitization and metabolic disorders (AMZemskov, V.M. Zemskov, A.V. Karaulov. Clinical Immunology: Textbook. - M .: GEOTAR- Media. - 2005. - 319 p.), Which is one of the significant disadvantages of this type of therapy.

Thirdly, the combination of basic therapy with Ruzam helps to achieve good desensitization with an insufficient effect of eliminating secondary immune deficiency and metabolic disorders in patients with bronchial asthma, which leads to a chronic process and an increase in the number of relapses of the disease (AMZemskov, V.M. Zemskov, Yu. V. Sergeev, V. A. Vornovsky, A. V. Karaulov. 1000 formulas of clinical immunology. - M .: Medicine for all. - 2003. - 336 p.).

Fourth, the composition of the basic therapy of bronchial asthma with sodium nucleinate and rusam contributed to desensitization and elimination of secondary immune deficiency while maintaining metabolic disturbances (V.I. Bolotskikh. Clinical and laboratory justification for the use of differential immunocorrection in the complex treatment of bronchial asthma: Author's abstract. Doctor of Medical Sciences - Kursk, 2007 .-- 48 p.).

As a tool for assessing immune disorders, a method for the diagnosis of secondary immunodeficiency was developed (A.M. Zemskov, V.I. Zoloedov, RF patent No. 2137129, 1996).

Due to the integration of Ruzam with modulators of a different mechanism of action - thymogen, hemodesis, levamisole (A.M. Zemskov et al., RF patents No. 2288715, 2288741, 2309755, 2005-2007) - a fairly complete normalization of the distorted function of the immune system was achieved. However, the imbalance of lipid peroxidation and antioxidant protection in patients was not eliminated.

On the other hand, in 1996, the hypoxene preparation with antihypoxic, antioxidant, anticoagulant and hypolipidemic properties with a satisfactory therapeutic effect in bronchial asthma and other diseases was synthesized at the Institute of High Molecular Compounds and the All-Union Research Institute for Highly Pure Preparations. In this case, hypoxene, used by mouth in capsules of 0.1-0.2 g per day for 7 days, contributed to the correction of metabolic, but not immunological status.

Thus, the situation has developed, on the one hand, the presence of complex pathogenesis of the disease in patients, and on the other, the lack of a treatment standard that eliminates at the same time violations of all parts of homeostasis - sensitization, secondary immunodeficiency, lipid peroxidation disorders and antioxidant systems.

To achieve the stated goal, asthma complex therapy was first implemented, including a basic set of drugs: aminophylline, magnesium sulfate, 0.9% NaCl solution, benacort, salbutamol, saltos, dexamethasone, mildronate and, in addition, to rusam, for hypersensitivity, sodium nucleinate to enhance the effect of ruzam and the correction of immunodeficiency, and hypoxene - to normalize metabolic status.

The technical result is achieved by the fact that in addition to the usual basic therapy, patients were injected intramuscularly with a dose of 200 mg once a day after 4-5 days, a course of treatment of 600-800 mg in combination with sodium nucleinate taken by mouth at 0, 5 g 2 times a day for 20 consecutive days, and hypoxene - also through the mouth in capsules of 0.1-0.2 g per day for 7 consecutive days. The combination of Ruzam, sodium nucleinate and hypoxene was included in the usual basic therapy of bronchial asthma for 3-5 days from the moment of hospitalization after examining the immune status, determining the degree and nature of secondary immune deficiency.

To prove the achievement of a new quantitative and qualitative effect when using three well-known drugs, a special methodical technique was used that evaluates the mobile, normalizing effect, the targets of the individual terms, and their combination of complex immunotherapy in ranks (AMZemskov, V.M. Zemskov, A.V. Karaulov Clinical Immunology. Textbook. - M.: GEOTAR-Media. - 2005. - 319 p.), See table.

In each randomized group there were 30 patients, their representativeness was proved mathematically, the choice of statistical criteria was determined by the normal distribution of indicators.

As follows from the table, the greatest total effect was achieved with combined basic therapy (BT) with ruzam (Ru), sodium nucleinate (NN) and hypoxene (Gi). In second place is the BT + LV combination, then BT + Ru, then BT + Gi and one BT.

Basic treatment led to a significant change from the initial level of 9 parameters and the normalization of 19 indicators. The additional appointment of Ruzam patients contributed to reliable dynamics, 9 and 23 tests, the same - sodium nucleinate, 13 and 24, respectively, hypoxene - 8 and 22, Ruzam, sodium nucleinate, hypoxene - 11 and 25.

The key points in the immune system, as judged by the composition of the immunocorrection target formula, with the introduction of BT + Ru + HH + Gi turned out to be T cells, T helper cells, anti-inflammatory interleukin-4; the same - BT + NN - T-lymphocytes, phagocytic indicator and number; the same - BT + Ru - T-lymphocytes, T-suppressors, eosinophils; the same - BT + Gi - absorption and metabolic activity of phagocytes, pro-inflammatory cytokine - IL-8. There is a phenomenon not only of combining the mechanisms of the individual components of the combination, but also the emergence of a new quality.

A comparative analysis of the differentiated complex treatment of bronchial asthma in a rank assessment is presented in the table

The effectiveness of the complex therapy of bronchial asthma with the inclusion of a combination of ruzam with sodium nucleinate and hypoxene can be illustrated by the following example.

Example. Extract from the medical history N 3677. Patient B., 42 years old, was hospitalized at City Clinical Hospital No. 20 of Voronezh from 10/14/2004 to 10/26/2004, diagnosis: Bronchial asthma, mixed form, moderate, stage exacerbations, DAYS. Emphysema. Pneumosclerosis From anamnesis morbi: suffers from bronchial asthma for 8 years. It is treated stationary once a year. Steroid hormones were taken occasionally intravenously during inpatient treatment to relieve exacerbation of bronchial asthma. Since 2000, she has been using inhaled steroids (becotide, pulmicort, up to 6-8 doses per day). Upon admission, she complained of asthma attacks up to 5-6 times a day, including up to 2-3 times at night, poorly stopping with salbutamol and berotek, shortness of breath when climbing to the 3rd floor, difficulty breathing out, chest tightness, dry cough, weakness. Objectively: the general condition is satisfactory. Proper physique, increased nutrition (BMI = 30). The distribution of subcutaneous fat is uniform. The skin is clean, dry, on the skin of the abdomen - stria whitish color. Peripheral lymph nodes are not enlarged. Musculoskeletal system without visible deformities. NPV = 20-22 per minute. The chest is barrel-shaped, both halves are equally involved in the act of breathing. With percussion - a pulmonary sound. In the lungs during auscultation: breathing is weakened, scattered dry wheezing in all pulmonary fields, expiration is elongated. The boundaries of relative cardiac dullness are extended 1 cm from the left mid-clavicular line. Pulse - 80 beats per minute, rhythmic, satisfactory filling and tension. HELL - 140/90 mm Hg Heart sounds are rhythmic, muffled, noises are not heard. The abdomen is soft, painless on palpation. The liver and spleen are not palpable. No peripheral edema.

Laboratory and instrumental data: general analysis of blood and urine - without pathology; ECG - sinus rhythm, EOS is not rejected, moderate changes in the left ventricular myocardium; FVD - severe obstructive ventilation disorders of the lungs. Chest x-ray - pneumosclerosis, pulmonary emphysema. An immunological examination revealed a second degree of immune deficiency in the patient. The treatment: aminophylline, magnesium sulfate, 0.9% sodium chloride solution, benacort, salbutamol, saltos, dexamethasone, mildronate. For the correction of immune deficiency, a combination of immunomodulators was prescribed, first intramuscularly at a dose of 200 mg once a day after 4-5 days was administered to ruses, 600-800 mg per treatment course and 0.5 g of sodium per os were taken in parallel with it 2 times per day 20 days in a row and hypoxene - also by mouth in capsules of 0.1-0.2 g per day for 7 days in a row. Treatment was started from 3 days from the moment of hospitalization. Five days after the start of immunomodulation, the patient's condition improved significantly, asthma attacks, coughing stopped, and wheezing disappeared. Discharged with improvement on the 12th day of hospital stay, sodium nucleinate therapy was continued on an outpatient basis for up to 20 days. In this case, the elimination of the main symptoms of the disease occurred at the beginning of the second week of inpatient treatment, which indicates a good effect of combination immunotherapy. The inclusion in the treatment of bronchial asthma of a combination of ruzam with sodium nucleinate and hypoxene increases the effectiveness of the usual basic therapy of a mixed form of bronchial asthma. The use of the composition of Ruzam with sodium nucleinate and hypoxene is accompanied by a faster than normal treatment, on average for 3-4 days, normalization of the main manifestations of bronchial asthma, which reduces the time of patients in the hospital by 3-4 days.

Claims (1)

A method for the comprehensive treatment of bronchial asthma, including basic therapy in combination with ruzam, characterized in that it is additionally prescribed sodium nucleate 0.5 g 2 times a day for 20 days in a row and hypoxene in capsules 0.1-0.2 g per day 7 consecutive days.