RU2062104C1 - Method for removing immunodefficiency in infection- dependent bronchial asthma - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves administering intramuscularly thymogen at a dose of 100 mg in evening time during 5 days one after another, then myelopid is administered intramuscularly at a dose of 3 mg three times with 24 h pause or the preparations are administered alternatively first thymalin 100 mg at the 1,3,5,7 and 8 day of treatment, then myelopid at a dose of 1.5 mg at the 2,4,6 day of treatment. EFFECT: enhanced effectiveness of treatment.

Description

 The invention relates to medicine, namely to pulmonology.

 Part of bronchial asthma is accompanied by the development of secondary immunodeficiency, which is manifested primarily by insufficiency of the T-link of immunity (M. P. Bakulin, V. P. Silvestrov, A. V. Karaulov, V. Yu. Martsinovsky. Predastma and bronchial asthma: issues of clinical immunology // Ter.arch. - 1987. N 12. P.33 39).

 Within the framework of modern immunocorrection, there are three main directions for eliminating secondary immunological deficiency: correction by hormones and mediators of the immune system, immune engineering (transplantation of organs and tissues of the immune system, sorption methods), pharmacological correction (levamisole, thymalin, hemodes, etc.) (A.G. Chuchalin (eds.) Immunocorrection in pulmonology.-M. Medicine, 1989. 256 pp.).

 In pharmacological immunocorrection, a method is known for eliminating secondary immunodeficiency in bronchial asthma using thymalin, which was administered intramuscularly 1 time per day, 10 mg, in two courses lasting 3 days with an interval of 7 days (Yu.I. Ziborov, B.M. Uslontsev. Clinical and immunological indications for the treatment of thymalin patients with bronchial asthma // Ter. Arch. 1990. N 1. P.70 73).

 In addition to thimalin, in the treatment of the disease, a myelopid B-immunity stimulator is used, which is administered 3 mg subcutaneously 1 time per day, every other day (R.V. Petrov, A.M. Borisova, A.V. Borisova, A .V. Glazko, A.V. Simonova, R.N. Stepanenko Effectiveness of the action of myelopid in immunodeficiency states // Ter. Arch. 1990. N 12. P.81 87).

 However, the empirical use of individual immunomodulators often does not completely eliminate secondary immunodeficiency (V.G. Perederiy, A.M. Zemskov, V.M. Zemskov et al. Some principles of differentiated administration of immunocorrections (method. Recommendations) Kiev, 1991. 48 p. .), which is one of the serious disadvantages of this treatment.

 The second disadvantage of monotherapy with immunomodulators is that the persistence of secondary immunological deficiency in patients with bronchial asthma leads to a chronic process and an increase in relapse, which significantly reduces the effectiveness of the symptomatic treatment of infectious-dependent bronchial asthma.

 The aim of the invention is to increase the effectiveness of traditional treatment and reduce the frequency of relapse of the disease. This goal is achieved due to a more complete correction of secondary immunological deficiency, which is carried out either by sequential administration of synthetic thymalin (thymogen) at a dose of 100 μg intramuscularly for 5 consecutive days, in the evening, once a day, after the end of the course of thymogen, myelopid is connected to treatment at a dose of 3 mg, intramuscularly, 3 times a day after 24 hours, or by alternating administration of drugs, first thymogen at a dose of 100 μg intramuscularly for 1, 3, 5, 7 and 8 days, in the evening, once a day, the course is 500 mcg mielopid m is 2, 4, 6 days, 1.5 mg, intramuscular injection, total dose - 4.5 mg.

 The combination of drugs was included in the usual treatment of the disease on day 3 5 from the moment of hospitalization, after examining the immune status and determining the degree of immunodeficiency (A.M. Zemskov. Promising approaches to assessing the human immune status // Lab.delo.1986. N 9. C .544 546).

 The rationale for this scheme for eliminating secondary immunodeficiency in infectious-dependent bronchial asthma is the need to study a specific drug to predict its effect in the face of many diverse breakdowns of the immune system (D.N. Lazarev, E.K. Alekhin. Immunity stimulants. M. Medicine, 1985. 256 s.).

 Combined immunocorrective therapy is understood to mean the sequential or simultaneous use of several immunomodulators with a different mechanism of action in order to eliminate immunological disorders (A.M. Zemskov, V.M. Zemskov, A.V. Karaulov, etc. The principles of differentiated administration of immunocorrections for non-specific inflammatory lung diseases // Pulmonology. 1992. N 2. P.75 - 83).

 Indications for combined immunocorrection are as follows: 1) Chronic course (more than three months) of the main pathological process, its frequent relapses, concomitant complications, secondary diseases; 2) severe intoxication syndrome, metabolic disorders, loss of protein by the kidneys, etc. 3) unsuccessful immunocorrective therapy with a single drug for a month; 4) a high degree of immunodeficiency (third) or a combined lesion of the T- and B-links of the immune system, T- and B-lymphocytes and macrophages, multidirectional disorders of the immune system, stimulation of some and a decrease in other indicators from the normal level. The basis for the selection of the terms of combined modulation are the features of violations of the immune status and combined action (V.G. Perederiy, A.M. Zemskov, V.M. Zemskov, etc. Some principles of differentiated assignment of immunocorrectors (method. Recommendations). Kiev, 1991. 48 s.).

 For thymus peptides and myelopeptides, it was found that their combined use has the most pronounced effect on antibody genesis (A.A. Mikhailova, L.A. Zakharova, S.V. Sorokin. Myelopeptides are a new class of endogenous immunoregulators (Scientific review). M. VNIMI, 1987.67 p.). The experiment showed that the introduction of thymic peptides into the inductive phase of the immune response, and myelopeptides into the productive one, leads to the summation of their effects (R.V. Petrov, A. A. Mikhailova, L. A. Zakharova. Multifunctionality of bone marrow peptides // Patol. physiology and exp. therapy. 1986. N 1. S. 7 - 12).

 The effectiveness of complex therapy of bronchial asthma with the inclusion of a combination of thymogen with myelopid can be illustrated by the following examples.

Example 1. An extract from the medical history N 14402. Patient Z. 59 years old, was hospitalized at the HCCHPS from 06/07/91 to 06/18/91, the diagnosis of bronchial asthma, infection-dependent, I period, with frequent attacks of suffocation moderate, hormone-dependent, stage of exacerbation. Chronic obstructive bronchitis, art. exacerbations. Pulmosclerosis. Emphysema, DN _II . From anamnesis morbi: suffers from bronchial asthma for 20 years. Hormones intravenously, orally (polcortolone 3 tablets per day), inhaled (becotide) received earlier for 7 years, periodically. On admission, he complained of asthma attacks, shortness of breath at rest, difficulty breathing out, cough with sputum that could hardly be separated, weakness. Objectively: general state of moderate severity. NPV 26 28 per minute. The chest cage is barrel-shaped, the auxiliary muscles of the neck are involved in the act of breathing. With percussion, a pulmonary sound, with a boxy tint. In the lungs during auscultation: weakened breathing, scattered dry wheezing in all pulmonary fields, expiration is elongated. Pulse 100 beats per minute, rhythmic, satisfactory filling and tension. HELL 120/80 mm RT. Art. The abdomen is soft, painless on palpation. The liver is not palpable. No peripheral edema.

 An immunological examination revealed a third degree of immunological deficiency in the patient. The treatment was carried out: glucose + insulin + potassium chloride + aminophylline + dexon, theopec, Vinogradov powders, papaverine, platifillin, sodium thiosulfate, physiotherapy. To correct immunological deficiency, a combination of immunomodulators was prescribed, first thymogen, a dose of 500 μg, and then, 9 mg myelopid. Treatment was started from 3 days from the moment of hospitalization. A week after the start of immunomodulation, the patient's condition improved significantly, asthma attacks, coughing stopped, and wheezing disappeared. Discharged with improvement on the 14th day of hospitalization. In this case, the elimination of the main symptoms of the disease occurred by the middle of the second week, which indicates a good effect of combination immunotherapy.

Example 2. Extract from the medical history N 5816. Patient L. 51 years old, was treated at the HCCHPS from 03.03.92 to 03.19.92, diagnosis: Bronchial asthma, infection-dependent, I period, with frequent attacks of moderate suffocation severity, stage of exacerbation. Chronic obstructive bronchitis, stage of exacerbation. Pulmosclerosis. Emphysema, DN _I. From anamnesis morbi: suffers from asthma for 2 years. I received hormones only intravenously. On admission, he complained of asthma attacks, cough with sparse white sputum that was difficult to separate, shortness of breath, weakness. Objectively: General state of moderate severity, NPV 26 28 per minute. The chest is of the correct form, both halves of it are evenly involved in the act of breathing. Percussion-pulmonary sound, boxed in the lower chest. Auscultatory: hard breathing, scattered dry wheezing in all pulmonary fields, exhalation is prolonged, pulse is 100 beats per minute, rhythmic, satisfactory filling and tension. HELL 120/70 mm RT. Art. The abdomen is soft, painless on palpation, the liver is not palpable, no edema.

 In the study of immunological status, a second degree of immunological deficiency was identified. The treatment was carried out: polarizing mixture + aminophylline + dexon, theopec, dimebon, Vinogradov powders, papaverine, platifillin, sodium thiosulfate, physiotherapy. Thymogen and myelopid were prescribed in half dose from the 5th day from the moment of admission to the hospital. The drugs were administered intramuscularly alternately on days 1, 3, 5, 7 and 8 of thymogen, 100 mcg, course 500 mcg, on days 2, 4, 6 myelopid, 1.5 mg, course 4.5 mg. Three days after the start of immunotherapy, the patient's condition improved, asthma attacks, coughing, shortness of breath, weakness disappeared. Discharged home with improvement on day 13 of inpatient treatment. This example characterizes the high efficiency of the combination of thymogen with myelopid. The main signs of the disease were eliminated by the middle of the second week of treatment of bronchial asthma.

 As a result of the use of a combination of thymogen with myelopid in the treatment of AD, it was found that the use of a combination of drugs increases the effectiveness of traditional therapy for infectious-dependent bronchial asthma by an average of 20 22 percent and increases the duration of remission of the disease by 6 9 months compared with conventional treatment. The combination of thymogen and myelopid in the complex treatment of bronchial asthma significantly led to an earlier reduction or disappearance of any wheezing compared to the control. The combination of drugs allowed to reduce the time of stopping asthma attacks by 2.2 ± 0.2 days, the time to eliminate the elongated output by 1.2 ± 0.6 days, cough by 1.0 ± 0.6, wheezing by 2.5 ± 0, 4 days and contributed to the onset of improvement in overall well-being earlier in comparison with the control by 1.0 ± 0.3 days.

As can be seen from these data, the use of the composition of thymogen with myelopid was accompanied by a faster, compared with conventional treatment, an average of 2
4 days, normalization of the main manifestations of bronchial asthma, which reduced the time spent by patients in the hospital by 1 2 days.

Claims (1)

 A method of eliminating immunodeficiency in infectious-dependent bronchial asthma by traditional therapy, including the administration of thymogen, characterized in that the thymogen is administered at a dose of 100 μg intramuscularly 1 time per day in the evening hours for 5 consecutive days, then an additional 3 mg intramuscular myelolid is administered 3 times at intervals of 24 hours, or the drugs are administered alternately at first with thymogen of 100 μg on the 1st, 3rd, 5th, 7th and 8th days of treatment, then myelolide at 1.5 mg on the 2nd, 4th, 6th days of treatment.