RU2158614C2 - Method for treating the patients suffering from bronchial asthma - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying transcerebral stimulation with sinusoid modulated currents in alternating mode according to frontooccipital method with operation mode III. Pulse send duration to pause duration ratio is equal to 1:1.5, oscillation frequency is 10-50 Hz, modulation depth is equal to 50-75%, current is 2-2.5 mA until feeble vibration feeling under the electrodes is achieved. The first procedure lasts 5 min, the following procedures take 15 min daily. The total treatment course is 8-10 procedures long. EFFECT: prolonged remission period; usability in cases of concomitant thyroid gland diseases being available.

Description

 The invention relates to medicine, in particular pulmonology, and can be used in institutions of practical health care: hospital, clinic, sanatorium.

 The relevance and social significance of the treatment and rehabilitation of patients with asthma determine the high prevalence of the disease, the severity of the course, the possibility of early disability.

 At present, certain successes have been achieved in the drug therapy of patients with bronchial asthma. Medicines used to eliminate and prevent airway obstruction include anti-inflammatory drugs and bronchodilators. Anti-inflammatory drugs (corticosteroids, cromolyn sodium, nedocromil sodium) can prevent the development of inflammation in the bronchi, have a preventive and suppressive effect. The action of bronchodilating drugs (beta-agonists, methylxanthines, ipratropium bromide) is mainly aimed at dilating the airways by relaxing the smooth muscles of the bronchi.

 However, drug therapy has a number of significant drawbacks. The main disadvantages of this method of treating bronchial asthma include a pronounced side effect, tachyphylaxis, and the lack of the ability to provide controlled remission. In addition, the use of medicines in patients with bronchial asthma is significantly limited by the presence of concomitant diseases. So, recently, more and more attention has been paid to the combination of bronchial asthma and thyroid pathology, in particular about 50% of women with bronchial asthma have manifestations of autoimmune thyroiditis / Vinogradov D.L. Laser therapy and plasmapheresis in the treatment of patients with bronchial asthma. - M., 1995 /. In these cases, a group of patients is formed in which drug therapy cannot be fully applied due to the negative effect of many drugs on the functional activity of the thyroid gland. In addition, with the emerging endocrine dysfunction, it is possible to potentiate the toxic effects of adrenomimetics and methylxanthines on the cardiovascular system, which does not allow the use of these drugs in adequate dosages and reduces their effectiveness / J. Kapitola, D. Vilimovska "Influense of theophylline on the circulatory actions of thyroid hormones" - DDR, 1975 /.

 There is a method of treating patients with bronchial asthma using various physical factors, prescribed mainly during incomplete remission or decaying exacerbation (Klyachkin L.M. et al. Physical treatment methods in pulmonology. - S.-P., 1997). The applied methods can be conditionally divided into those associated with direct exposure to the bronchopulmonary apparatus (exposure to the UHF electric field, microwave electromagnetic field, ultraviolet irradiation, laser radiation, ultrasound, electrophoretic and phonophoresis of drugs, exposure to pulsed currents, aerosol therapy), methods general action (AUFOK-therapy, supravenous laser irradiation, reflex and halotherapy) and techniques related to the impact on neuroendocrine regulation (transcerebral effects of electro agnitnymi fields and low-frequency pulse currents, as well as the impact on the area of projection of the adrenal gland, spleen, thyroid and thymus). The disadvantages of the 1st group include relatively low efficiency, especially with signs of exacerbation of the disease, associated with the features of the anatomical structure of the bronchopulmonary apparatus and the distribution of absorbed energy of physical factors. The methods of the 2nd group are also not always effective enough and have a number of limitations for use, especially in patients with concomitant endocrine pathology; in some cases, they are associated with an invasive effect. When using the methods of the 3rd group as a whole, high efficiency is shown, however, they also have limitations in individuals with thyroid damage. In particular, in connection with the peculiarities of the distribution of electromagnetic waves, the thyroid gland can be in the irradiation zone, which in some cases can provoke an inadequate reaction on its part.

 The prototype of this invention is a method of treating patients with bronchial asthma associated with exposure to rectangular pulsed currents according to the method of electric sleep. Applied domestic apparatus "Electroson-3". We used a constant pulse current with a rectangular pulse shape: the location of the electrodes of the orbital-occipital. The current strength was selected according to the patient’s sensation; it amounted to about 1.6 mA in the amplitude value. The frequency of pulses was increased with each procedure from 5 to 30-40 Hz. A patient with severe autonomic disturbances was left with a pulse frequency of 5-10 Hz. The exposure was prescribed on the 7-8th day of hospital stay. On a course of treatment 12-15 procedures at the rate of 5 procedures per week (2 consecutive days with one day break) (Davydova OB Treatment of patients with bronchial asthma with physical factors (inductothermy and electro-sleep). - M., 1971).

The disadvantages of this method are:
1. The pronounced irritating effect of a rectangular current on brain structures due to persistent accumulation of ions on cell membranes, which manifested itself in the development of a negative reaction to the procedure, in particular in patients with severe and prolonged bronchial asthma.

 2. As a result of the damaging effect of the constant component of a rectangular pulse current, the presence of contraindications from a number of eye diseases.

 3. Insufficient penetrating ability of rectangular currents and, therefore, low efficiency (clinical improvement was achieved in 56.6% of patients, the rest - without effect).

 4. The ability to exert a positive effect on the course of bronchial asthma only in a limited group of patients having certain functional changes in the state of the central and autonomic nervous system.

 The technical result of the proposed method for the treatment of bronchial asthma is to increase the effectiveness of treatment, achieve a deeper and more stable remission of the disease, the possibility of use in patients with concomitant damage to the thyroid gland, including those associated with a significant reduction in the drug load on the gland, that is, with minimization of basic drug therapy.

 The essence of the invention is that the transcerebral action by sinusoidal modulated currents is carried out according to the fronto-occipital technique in an alternating mode, type III operation, with a duration of sending pulses to a pause in the ratio 1: 1.5, an oscillation frequency of 10-50 Hz, a modulation depth of 50- 75%, current strength - until the sensation of vibration under the electrodes is reached, on average, 2-2.5 mA in amplitude value. The exposure time of the first procedure is 5 minutes (trial), subsequent - 15 minutes, daily 8-15 procedures per treatment course.

 A distinctive feature of this method of treatment is the possibility of a deeper penetration of sinusoidal modulated currents into the brain tissue compared to pulsed rectangular currents, the absence of an irritating effect due to the lack of persistent accumulation of ions on cell membranes, which ensures its good tolerance. In addition, the physical characteristics of sinusoidal modulated currents correspond to the physiological excitability limit of organs and tissues. The impact is carried out according to the fronto-occipital technique, which, given the wide range of contraindications when applying electrodes to the eyes, significantly expands the capabilities of the method. Conducting exposure in alternating mode with alternating bursts of pulses and pauses in a ratio of 1 to 1.5, type III work is the most physiological for the body and optimal for the transcerebral technique. The parameters of the pulse frequency of 10-50 Hz and the modulation depth of 50-75% are adequate to provide a clear effect on the deep structures of the brain with the formation of a pronounced sedative effect, on the hormonal link in the regulation of various body functions (Orekhova E.M. Low-frequency pulsed electrotherapy of hypertension. - M., 1990), to eliminate autonomic dysfunction (I. Kutina et al. Features of the hypotensive effect of transcerebral pulsed electrotherapy of arterial hypertension. - M., 1997). The first procedure for 5 minutes is carried out to exclude the possible, although extremely rare individual intolerance to modulated sinusoidal currents. In order to achieve high efficiency, it is necessary to carry out at least 8 daily treatments.

DESCRIPTION OF THE METHOD OF TREATMENT
After preliminary clinical and laboratory studies, EEG and consultation with an ophthalmologist, in the absence of contraindications, they begin treatment. Treatment in this way is carried out against the background of basic drug therapy, therapeutic respiratory gymnastics.

 Transcerebral action with sinusoidal modulated currents is carried out from the Amplipuls-4 apparatus, which was developed as a portable transistor circuit. To bring current to the patient, a special mask with four metal sockets mounted on rubber bands (cuffs) is used. Treatment is carried out in the morning. The position of the patient - lying in a comfortable position. The method of exposure to the frontooccipital, is carried out in a variable mode, type III of work with the duration of sending pulses to a pause in the ratio of 1 to 1.5. The current strength gradually increases until the patient feels a slight tingling sensation, a pleasant, painless vibration under the electrodes, an average of about 2-2.5 mA in amplitude. The frequency of pulses is 10-50 Hz, the depth of modulations is 50-75% (penetration ability and, therefore, the effectiveness of the impact does not change significantly within these ranges). The exposure time of the first procedure is 5 minutes, the subsequent 15 minutes. During the procedure, the patient is in a state of falling asleep, drowsiness or sleep. Against the background of transcerebral exposure to sinusoidal modulated currents, in the first days it is advisable to reduce the dosage of beta-adrenergic agonists by 25-50%, and then completely cancel them. The course of treatment is 8-15 daily procedures, depending on the patient's response to the 1st procedure.

 Examples of the method.

 Example 1. Patient Aleshina ON, 46 years old, was admitted to the rehabilitation and physiotherapy department of patients with respiratory diseases with a diagnosis of bronchial asthma of mixed origin (infection-dependent, atopic, dishormonal) of moderate severity in the acute phase. Chronic obstructive bronchitis. Emphysema. Pneumosclerosis Polyvalent allergy. NAM II. Condition after resection of the left lobe of the thyroid gland due to a "cold" node.

 Complaints upon admission: asthma attacks 3-4 times a day, occurring spontaneously, when inhaling pungent odors, contact with significant allergens, physical and emotional stress, nightly, stopping by inhaler; paroxysmal cough with difficult to separate mucous sputum, shortness of breath with slight physical exertion, severe weakness, increased sweating, palpitations, emotional lability, poor sleep, small tremor of the hands.

 From the anamnesis it is known that for the first time asthma attacks appeared 5 years ago against the background of exacerbation of chronic bronchitis. In the future, the disease progressed steadily, despite taking anti-asthma drugs. In the last 2 years, exacerbations of bronchial asthma acquired a seasonal nature, an allergic reaction to home and library dust, plant pollen, citrus fruits, penicillin antibiotics, and diphenhydramine was revealed. Repeatedly treated in hospitals without a pronounced effect. Deterioration over the past 7 months.

 Objectively, upon admission, the patient's condition is moderate. Orthopnea position. The skin is dry and pale. BH 20 respiratory movements per minute. The chest is symmetrical, somewhat enlarged. Intercostal spaces and supraclavicular fossae are retracted. Percussion over the entire surface of the lungs is determined by the box sound. Weakened breathing, scattered dry low-tone rales are heard. Forced expiration is sharply shortened. Heart sounds are muffled, rhythmic. HELL 140 and 90 mm RT. Art., heart rate 96 beats per minute. The abdomen is soft, painless on palpation. The liver and spleen are not enlarged. No swelling, Pasternatsky’s symptom is negative on both sides. The patient is emotionally unstable, there is a small tremor of hands, a superficial, restless sleep. Positive symptom Gref. The thyroid gland is not palpable.

The department has appointed a course of treatment consisting of inhaled steroids, prolonged theophylline preparations, expectorants, as well as short-acting beta-agonists designed to stop asthma attacks. It should be noted that taking theophyllines and adrenergic agonists provoked or exacerbated the occurrence of palpitations, hand tremors. The examination revealed leukocytosis 9.0 • 10 ⁹ / l, eosinophilia 14%, increased ESR 22 mm / hour. An increase in the level of cerulloplasmin (513.4 mg / l), serotonin (0.96 μmol / l), seromucoid (0.490 U) was noted, CRP was detected (4). According to spirography data, the respiratory rate was 18 respiratory movements per minute, VC was reduced and amounted to 62% of the target, the flow-volume curve patency was also reduced: V _peak was 59% of the target, patency on the middle and small bronchi - 22% of due, which testified to the generalized nature of bronchial obstruction. Ultrasound of the thyroid gland revealed hyperplasia and nodular formation of the right lobe. An analysis of the hormonal profile showed an increase in thyroglobulin level (66.2 μg / L).

 On the 3rd day of admission, the patient was prescribed therapeutic breathing exercises and on the same day, on the basis of the absence of contraindications, according to the EEG and the ophthalmologist’s opinion, the first (trial) procedure of transcerebral exposure to sinusoidal modulated currents from the Amplipulse-4 apparatus was performed fronto-occipital superposition of electrodes, in alternating mode, III kind of work, with the duration of sending pulses to a pause in the ratio of 1 to 1.5. The oscillation frequency was 30 Hz; the modulation depth was 75%. The current strength gradually increased until the patient felt a pleasant, painless vibration under the electrodes. The effects were carried out in the morning, 2 hours after breakfast. The time of the first procedure was 5 minutes, and from the second exposure it was increased to 15 minutes, since tolerance was good. The course of treatment amounted to 10 daily procedures.

 The sedative effect was already observed from the 3rd procedure, when the patient had tremor in his hands, sweating, and improved sleep. After the 5th procedure, there was a tendency to reduce the frequency of asthma attacks, mainly related to attacks that occur in the daytime. This allowed to reduce the frequency of use of beta-agonists up to 2 times. Cough and the amount of sputum being separated gradually decreased, and exercise tolerance increased, as shortness of breath began to occur with significant physical exertion. By the 10th procedure, no seizures occurred, the patient refused inhalation of an adrenergic agonist. Against this background, the patient stopped complaining of heart attacks, hand tremor was not observed, sleep returned to normal.

Objectively in the lungs against the background of weakened breathing, single dry high-pitched wheezing was heard on exhalation in the lower parts of the lungs. HELL 125 and 85 mm Hg Heart rate of 80 beats per minute. An examination carried out after a course of treatment showed a normalization in the level of leukocytes (6.7 • 10 ⁹ / l), eosinophils (4%), and ESR was 17 mm / hour. A biochemical blood test revealed a decrease in CRP to 3, ceruloplasmin to 498.3 mg / L, and serotonin levels completely normalized (0.74 μmol / L). According to the FVD, the BH was 16 respiratory movements per minute; the initially reduced VC value increased by almost 30% and amounted to 89% of the proper value. The most pronounced changes affected bronchial patency, which was confirmed by a significant increase in V _peak , V ₅₀ and V ₇₅ , which amounted to 70, 43 and 41% of the corresponding value, respectively. Thyroglobulin levels normalized (15.9 mcg / L).

 Follow-up observations showed that the remission of the disease was observed for 1 year, increased tolerance to respiratory viral infections that did not cause exacerbation of asthma. The patient's condition worsened somewhat during the spring flowering period, but the exacerbation proceeded in a less severe form.

 Example 2. Patient Blokhina AD, 58 years old, was admitted to the rehabilitation and physiotherapy department of patients with respiratory diseases with a diagnosis of bronchial asthma of mixed origin (infection-dependent, atopic, dishormonal) of moderate severity in the acute phase. DN I-II. Diffuse changes in the thyroid gland.

 Upon admission, she complained of attacks of expiratory dyspnea up to 6 times a day, occurring at night, when inhaling cold air, pungent odors, contact with significant allergens, with physical and emotional stress, spontaneous, stopping by an inhaler; palpitations, tearfulness, poor sleep, irritability, weight loss.

 Sick for 11 years. Attacks of suffocation appeared for the first time after suffering pneumonia. Repeatedly treated stationary with a short effect. 2 years ago, the patient underwent a resection of the left lobe and part of the isthmus of the thyroid gland regarding mixed goiter III tbsp. Significant improvement after surgery did not occur. An increase in the dosage of adrenergic agonists and methylxanthines during an exacerbation of asthma clearly provoked a deterioration in the course of endocrine pathology. The patient has an allergic reaction in the form of urticaria to many medications (antibiotics, antihypertensives). Burdened by maternal heredity.

 Objectively, the condition is relatively satisfactory. Skin and mucous membranes of normal color. The chest is cylindrical in shape. Percussion above the lungs is determined by pulmonary percussion sound with a box-like shade. Breath with a hard tint, dry high-pitched rales are heard over the entire surface of the lungs. The forced expiration is elongated, dry high- and mid-tone rales in the interscapular region and in the lower sections are heard. Heart sounds are clear, rhythmic. Heart rate 84 beats per minute. The abdomen is soft, painless on palpation. The liver and spleen are not enlarged. Urination is not impaired. Mild exophthalmos, a positive symptom of Botkin. Thyroid gland: palpable right lobe, compacted, heterogeneous structure.

 Upon receipt as an anti-inflammatory drug, the patient was prescribed a course of inhaled steroids, as well as short-acting beta-agonists for stopping attacks. From the 2nd day, the patient began to engage in therapeutic respiratory gymnastics.

The department conducted a survey. In a biochemical blood test, CRP was detected (1) and an elevated level of serotonin (1.18 μmol / L). According to the FVD, there was a decrease in VC and FVC to 80 and 74% of the proper value, as well as signs of generalized obstruction based on an analysis of the flow-volume curve: V _peak was 64%, V ₅₀ - 38% and V ₇₅ - 26 % of due values. A radioimmune blood test revealed a low level of thyroid-stimulating hormone of the pituitary gland (0.44 mU / l) and an excess of normal cortisol level (1019 Nmol / l). Ultrasound of the thyroid gland showed changes in the gland of a diffuse nature.

 On the 3rd day of hospital stay, on the basis of the absence of contraindications, according to the EEG and the ophthalmologist’s opinion, the patient was prescribed transcerebral sinusoidal modulated currents during frontooccipital application of electrodes in alternating mode, type III of work, with the duration of sending pulses to a pause in the ratio 1 to 1.5. The current strength gradually increased until the patient felt a weak, pleasant vibration under the electrodes. The pulse frequency was 30 Hz, the modulation depth was 75%. The exposure was carried out daily in the morning. The duration of the first procedure was 5 minutes, the following, due to good tolerance, 15 minutes. The course of treatment included 8 effects.

 Already after the 2nd procedure, a positive tendency was observed in the patient’s well-being, confirmed by the data from the control study of the VFD conducted immediately after the exposure, and consisting in a decrease in the need for dosed adrenergic agonists. By the middle of the course of treatment, the number of attacks was halved, and after the course, their frequency decreased by 3 times, amounting to 2 attacks of labored breathing per day. Moreover, the nature of the attacks has changed in the direction of an easier course, which does not always require the use of an inhaler, and in some cases, stopping on its own. The patient became calmer, sleep improved, general mood background, spontaneous heartbeat stopped, possibly due to a decrease in the drug load on the thyroid gland due to a decrease in the dose of medication consumed. No wheezing in the lungs.

 Conducted control studies revealed the absence of CRP, a normal level of serotonin in a clinical blood test. The bronchial patency increased. Analysis of the hormonal profile demonstrated the normalized values of the thyroid-stimulating hormone of the pituitary gland and cortisol. Follow-up observations made it possible to conclude that the patient's resistance to viral infections was increased, and there were no exacerbations of the disease for 8 months.

 Thus, the proposed method for the treatment of bronchial asthma can extend the period of remission of the disease, increase the body's resistance to viral infection, and also, which seems to be the most significant, can be used in patients with concomitant thyroid damage, at least without causing a deterioration in the course of endocrine pathology .

 The proposed method of treatment was applied in the department of rehabilitation and physiotherapy of patients with respiratory diseases of the RSC of rehabilitation and physiotherapy in 85 patients with bronchial asthma from the age of 15 to 61 years. Severe bronchial asthma was observed in 4 patients (5%), moderate in 52 (61%), mild in 17 (20%) and intermittent in 12 people (14%). In 42 patients, which accounted for 49% of the total number of subjects, the clinical symptoms of thyroid damage were revealed. The control group consisted of 20 patients who received only drug therapy and therapeutic respiratory gymnastics.

 The portability of the procedures was good. By the end of the course of treatment, a pronounced positive dynamics of the main clinical symptoms was noted. There was a decrease in the average daily frequency of asthma attacks by an average of more than 3 times, which made it possible to significantly reduce the dose of bronchodilator drugs used. Paroxysmal cough disappeared or decreased in 60% of patients, a significant decrease in the severity of shortness of breath was achieved in 66%. Most of the subjects improved their psycho-emotional state, their heart rate returned to normal, and their sleep improved. In the comparison group, favorable shifts in clinical symptoms were less pronounced.

The clinical results obtained are confirmed by the FVD data. There was a clear positive dynamics of the most significant parameters for bronchial asthma, however, more significant changes were obtained in individuals with initially low values. So, increased VC (p = 0.03), FVC (p = 0.02), V _peak (p = 0.008), V ₅₀ (p = 0.02), V ₇₅ (p = 0.01). Favorable shifts in the HPF indices were also noted in the comparison group, however, they were less pronounced and unreliable.

 Changes in the parameters of the general blood test affected only the initially elevated level of eosinophilic leukocytes and lymphocytes (for eosinophils, p = 0.005, for lymphocytes, p = 0.002). There was a positive dynamics of biochemical parameters, indicating a decrease in the activity of the inflammatory process. Highly significant changes were found in individuals with initially high values. In the control group, no significantly significant results were obtained.

 The study of the state of cellular immunity made it possible to draw a conclusion about the normalizing effect of this method of treatment, since the initially high absolute number of T-lymphocytes significantly decreased (p = 0.006), and the initially low absolute number increased (p = 0.04). It should be noted that in patients with bronchial asthma with concomitant thyroid damage, an initially elevated level of CIC, which indirectly indicates the activity of autoimmune inflammation in the body, tended to normalize under the influence of the effect.

 No clear dynamics of the clinical and laboratory manifestations of thyroid dysfunction against the background of the studied method for the treatment of patients with bronchial asthma was noted, however, there were no cases of deterioration of the course of endocrine pathology under the influence of the effect.

 Follow-up observations carried out within 2 years after treatment indicate the resistance of the therapeutic effect and increase the body's resistance to infectious diseases.

 Thus, the proposed method for the treatment of patients with bronchial asthma makes it possible to reduce the frequency and severity of the course of exacerbations, extend the period of remission to 1 year, significantly reduce, and often completely cancel anti-asthma therapy and, therefore, reduce the drug load on the thyroid gland, increase the body's resistance to infectious diseases, increase physical activity and improve the social adaptation of patients.

Claims (1)

 A method of treating patients with bronchial asthma by transcerebral exposure with a physical factor, characterized in that the exposure is carried out by sinusoidal modulated currents according to the frontooccipital technique in an alternating mode, type III work, with a duration of sending pulses to a pause in the ratio of 1 to 1.5, current 2 - 2.5 mA until a slight pleasant vibration is felt under the electrodes, the pulse frequency is 10 - 50 Hz, the modulation depth is 50 - 75%, the duration of the first procedure is 5 minutes, the next 15 minutes, daily, for a course of 8 - 15 procedures.