RU2202326C2 - Method for treating the infantine cases of bronchial asthma - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves administering dry carbon dioxide baths possessing 30-32% of carbon dioxide and gas supply time equal to 4 min at a rate of 8 revolutions per minute at 30-32 C treatment temperature. A procedure is 15-17 min long for 5-8 years old children and 20-22 min for long for 9-14 years old children. 4 baths per week is administered. The whole treatment course is 10- 12 procedures long. EFFECT: enhanced effectiveness of treatment; prolonged remission period; reduced frequency of attacks.

Description

 The invention relates to medicine, in particular pediatrics, namely to the treatment of bronchial asthma in children, and can be used in outpatient facilities, hospitals and resorts.

 The relevance and significance of the invention determines the high prevalence of bronchial asthma in children (up to 10-15%) with a tendency to increase in recent years, the early onset of the disease, the development of severe forms, an increase in the number of hospitalizations in this regard in reducing the quality of life of sick children.

Treatment programs for bronchial asthma are constantly being improved. Modern treatment concepts for this disease include basic anti-inflammatory therapy, which includes membrane-stabilizing drugs (Intal, Tiled, etc.), used to reduce seizures and a milder course of the disease, inhaled glucocorticosteroids prescribed for severe forms, antileukotriene drugs (acolate, singular). In order to stop the attacks of bronchospasm, bronchospasmolytic drugs have been successfully and successfully used for a long time - sympathomimetics, in particular β ₂ agonists (salbutamol, phenterol, clenbuterol, etc.), theophyllines (aminophylline), anticholinergics (atrovent). The prolonged forms of these drugs were created (I. Balabolkin, “Allergy Problems in Pediatrics,” Russian Medical Doctor Zh., 1998, 2, M., p. 49-52, A. Chuchalin, “Russian National Program for Combating Bronchial asthma ". Bulletin for doctors and pharmacists, 1998, 2, volume 18, M., p.3-7, VA Revyakina" Treatment of bronchial asthma in children ", J. Children's Doctor, 1999, 4, M., p. 15-18). Thus, modern complex treatment is aimed at controlling the course of bronchial asthma, achieving stable remission and preventing exacerbations. However, the main disadvantage of drug treatment is a side effect on other organs and systems (cardiovascular, nervous, endocrine, osteoarticular and gastrointestinal tract), which can lead to their pronounced dysfunction and further to aggravate the course of bronchial asthma. In addition, the complexity of many drug delivery systems, the need for cooperation of the child himself, and, as a consequence, the failure to comply with doctor's prescriptions, are important.

 Known physiotherapeutic methods of treating chronic non-specific lung diseases (COPD) in children. These include the use of pulsed infrared low-intensity laser radiation (Khan M.A., Rachinsky S.V., Sereda E.V., Chernyshova L.A., patent 2131752 from 1999, Russia), interference currents (Bogolyubov V.M. ., Khan M.A., Balabolkin I.I., Dovganyuk A.P., Shiryaeva I.S., Reutova BC, Bykova M.V., patent 2128526 from 1999, Russia), the combined effect of sinusoidal modulated currents and ultrasound (Razumov A. N, Khan M.A., Sereda E.V., Volkov I.K., Lukina O.F., Radetskaya L.I., application for invention 2000103398/14 from 02.14.00. ) The disadvantages of these methods are: intolerance to electric current that occurs in a group of children, or high laser radiation power, not suitable for young children or weakened children, the impossibility of a clear effect on bronchial obstruction, a pronounced exciting effect on the nervous system, and a decrease in the activity of medications under the influence electrotherapy.

The prototype of this invention is a method of treating bronchial asthma in children by exposure to carbon dioxide baths. The method is as follows. A sick child sits in the bath freely. Pre-cold water in a special apparatus is saturated with carbon dioxide under a pressure of 1.5-2 atm and mixed with hot water already poured into the bath. The level in the bath reaches the nipple line of the baby’s chest. The finished bath is transparent, contains carbon dioxide in a concentration of 0.7 to 1.4 g per liter of water, the water temperature is 37-36 ^o C, the duration of the bath for children 8-11 years is: for 1-2 baths for 5 minutes, for 3 -4 baths for 6 minutes each, for the 5th-7th procedure for 7 minutes, for 8-9 baths - for 8 minutes, for a course of 8-9 baths according to the procedure after 2 days for the third; for children 12-14 years old: the 1st-2nd bath is carried out for 8 minutes, 3-4 baths last for 9 minutes, 5-7 procedures for 10 minutes, 8 baths for 12 minutes, 9th bath - for 14 minutes, the 10th procedure lasts 15 minutes, according to the technique of 10 baths after 2 days on the third. Water carbonic baths were used to treat children with mild or moderate severe course of atopic bronchial asthma in the period of remission (Danielyan L.G. "The effectiveness of carbonic baths in the complex of sanatorium-resort treatment of children with bronchial asthma". In the book: Climatic and preformed physical factors in the prevention and rehabilitation of patients with bronchopulmonary and cardiovascular diseases (Yalta, 1989, pp. 177-179).

The disadvantages of this method are:
1. A pronounced hydrostatic stress effect on the heart, resulting from a decrease in total peripheral resistance, increased venous return to the heart, redistribution of circulating blood and manifested in an increase in cardiac output and increased oxygen consumption.

 2. Strong stimulating effect on tone n. vagus when in the aquatic environment, which causes a significant decrease in blood pressure and a decrease in heart rate and does not allow to achieve a training effect in relation to physical activity.

 3. Unwanted inhalation component of the water treatment.

4. A pronounced thermal effect and the associated increase in the intake of carbon dioxide and an increase in the concentration of carbon dioxide in the body (when the bath temperature rises by 5 ^° C, the concentration of carbon dioxide increases by 2 times), which can cause a negative effect on the cardiovascular system and blood circulation, as well as on the vasomotor and respiratory centers in young children who are in a state of unstable remission or having a severe course of the disease and a long history.

 5. In addition, it can be said that water procedures are not indicated for skin processes that often accompany atopic bronchial asthma, as a manifestation of dermo-respiratory syndrome in children.

 The technical result of the proposed method for the treatment of bronchial asthma in children is to increase the effectiveness of treatment, increase the period of remission of the disease, reduce the number of seizures and reduce their severity, as well as increase tolerance to physical activity.

The specified technical result is achieved by the use of "dry" carbon dioxide baths with a carbon dioxide concentration of 30-32%, a gas supply time of 4 minutes with a feed speed of 8 rpm, at a gas mixture temperature of 30-32 ^o C, the duration of one procedure is 15-17 minutes for children 5-8 years and 20-22 min for children 9-14 years old, 4 baths per week for a course of 10-12 procedures.

 A feature of the proposed method is that a carbon dioxide concentration of 30-32%, supplied in 4 min at a speed of 8 rpm, allows you to achieve the necessary effects on the respiratory, cardiovascular system, vasomotor and respiratory centers and skin apparatus, avoiding possible side reactions manifested in severe hypotension, bradycardia and an increase in heart load.

In this method, a temperature of 30-32 ^o C is used, which does not give a large thermal load on the child's body and allows to achieve the concentration of carbon dioxide necessary for the therapeutic effect.

 The use of a 15-22 minute exposure (depending on age) with carbon dioxide allows its maximum penetration into the skin and its fixation with further preservation for 4 hours and gradual release into the blood. The proposed course of treatment is optimal for children aged 5-14 years and in order to prevent overdose of carbon dioxide, the number of baths should not exceed 10-12 procedures.

Description of the treatment method
After a preliminary clinical and laboratory examination during remission, unstable remission or exacerbation (on the 3rd - 5th day after an attack of bronchospasm), a course of treatment begins. Dry carbon dioxide baths are carried out using a special Reabox device manufactured by Prima XXI with a capacity of 660 l for carrying out dry carbon dioxide baths with dosed carbon dioxide supply, a heating system, automatic maintenance of the set temperature in the bath and a carbon dioxide humidifier. A sick child sits in a bath in a position convenient for him, the patient's head, due to a neck neckline, is outside the action of carbon dioxide. The exclusion of carbon dioxide through the upper respiratory tract of the patient is achieved by using a seal. The bath is preheated to a predetermined temperature of 30-32 ^o C, the necessary parameters are set (carbon dioxide supply rate of 8 rpm (constant), supply time of 4 minutes to achieve an optimal therapeutic concentration of 30-32%, the duration of the procedure is 15-17 minutes for children 5-8 years and 20-22 min for children 9-14 years old, the humidity is unchanged and is set in the "Rebox" installation). The procedure begins with the supply of carbon dioxide, then for the appointed time the patient is in a moistened gas mixture, feeling a pleasant warmth, and ends with the inclusion of a 3-minute extract, after which the child monitors blood pressure, heart rate and respiration. The course of treatment consists of 10-12 procedures carried out daily in the mode of 4 procedures per week.

Examples of the method
Example 1. A 13-year-old patient was admitted to the allergological dispensary department of the Research Institute of Pediatrics NCHS RAMS with a diagnosis of bronchial asthma, atopic form, severe course, exacerbation. Respiratory failure II degree. Pollinosis: allergic rhinitis, remission.

From the anamnesis it is known that the girl is from the 1st normal pregnancy, timely delivery. Heredity is burdened (father has bronchial asthma). In early childhood, manifestations of food allergies in the form of atopic dermatitis with localization on the cheeks, stopped completely by 1.5 years. At the age of 7, for the first time a severe attack of bronchospasm in the spring against the background of flowering, which was stopped only with the help of glucocorticosteroid drugs. Then for 2 years she received intal with a relative effect - a constant cough syndrome persisted, but breathing difficulties were not noted. At 9 years old she was hospitalized with a severe attack, diagnosed with atopic bronchial asthma, severe course. From this moment on, frequent weekly attacks provoked by acute respiratory viral infections, stress, and physical exertion. Last year he receives inhaled corticosteroids (IKS) - flixotide with effect. Received in a state of exacerbation. Upon receipt, a moderate condition. Complaints of dry cough, shortness of breath with little physical exertion, difficulty in nasal breathing. On examination: the skin is dry, auscultation in the lungs listens to hard breathing, dry wheezing in the lower sections. The boundaries of the heart within the age norm, rhythmic tones, muffled, tachycardia up to 96 beats per minute, blood pressure = 102/66 mm RT. Art. The abdomen is soft, painless, the liver and spleen are not enlarged. The examination revealed: in the general analysis of blood, eosinophilia is 7%, an increase in total immunoglobulin E to 303 IU / ml and an increase in total immunoglobulin G to 1051 mg /% in an immunological blood test, pronounced generalized disturbances in bronchial obstruction with a decrease in FEV ₁ were noted on the function of external respiration up to 61%, MOC ₂₅ - 54%, MOC ₅₀ - 45%, MOC ₇₅ - 43%. After the examination, the girl was prescribed drug therapy: antihistamines (clarithin), a short course of prolonged bronchospasmolytic (theopec). From the 5th day of hospitalization, against the background of stabilization of the patient’s condition, “dry” carbon dioxide baths from the Reabox unit with an exposure temperature of 30 ^° C, therapeutic concentration of carbon dioxide of 32% were prescribed, the duration of the procedure was 20 minutes. There are 10 baths per course, 4 baths per week. The procedures were carried out daily 2-3 hours after taking the medication.

After 2-3 procedures, an improvement in general condition, a decrease in cough and wheezing in the lungs, and normalization of sleep were noted. By the middle of the course, according to the external respiration function (VFD), moderate bronchial obstruction was observed at the level of the peripheral departments with an increase in OFB data of ₁ to 89%, MOC ₂₅ - 74%, MOC ₅₀ - 70%, MOC ₇₅ - 59% and a decrease in the total number peripheral blood eosinophils up to 5%. After a course of treatment with “dry” carbon dioxide baths, a girl who had an auscultation observed a complete disappearance of wheezing, the absence of cough, and improvement of exercise tolerance amid theopec withdrawal and the absence of other groups of drugs. When studying the function of external respiration, normalization of previously decreased FEV values of ₁ to 92%, MOS ₂₅ - 77%, MOS ₅₀ - 73%, MOS ₇₅ - 69% was revealed. When analyzing the hemogram, a decrease in the number of eosinophils to 4% was noted, which fits into the boundaries of the age norm. Immunological parameters also tended to normalize with a decrease in total immunoglobulin E to 112 IU / ml and total immunoglobulin G to 842 mg /%, which is the result of the immunocorrective effect of "dry" carbon dioxide baths.

 Follow-up observations over a period of 10 months showed that the girl was able to refuse to take inhaled corticosteroids and, against the background of anti-inflammatory membrane-stabilizing drugs (tiled), there was a reduction in seizures and their milder course. Nasal breathing improved, thereby achieving a stable remission of allergic rhinitis.

 Example 2. A 6-year-old patient was admitted to the allergological dispensary department of the Research Institute of Pediatrics NCHS RAMS with a diagnosis of bronchial asthma, atopic form, mild course, remission. Atopic dermatitis, a common form, moderate to severe course, subacute period.

A boy from 3 pregnancies, 1 birth (previous pregnancies - interruption). From 4 months of manifestation of food allergies in the form of a dry form of atopic dermatitis with localization on the cheeks, extremities of a continuously recurrent course. From the age of 4, against the background of acute respiratory viral infections, bronchospasm attacks, stopped by euphyllinus. A single course of anti-inflammatory drugs (tiled) was performed with effect. Last exacerbation 6 months before admission. Upon examination, the condition is satisfactory, the skin is dry, hyperemia on the hands, infiltration, cracks. Complaints of skin itching. Auscultation in the lungs breathing with a harsh tinge, no wheezing. Heart sounds are clear, rhythmic, tachycardia up to 104 beats per minute, blood pressure = 102/5 8 mm RT. Art. The abdomen is painful in the epigastrium. During the examination: in the general analysis of blood, eosinophilia was not noted, in the immunological analysis of blood - an increase in total immunoglobulin E to 737 IU / ml and total immunoglobulin G to 900 mg /%, in the study of external respiration function revealed moderate generalized bronchial obstruction with a decrease in OFB ₁ up to 74%, MOC ₂₅ - 55%, MOC ₅₀ - 57%, MOC ₇₅ - 40%. As a prophylactic drug therapy, the boy received an anti-inflammatory membrane-stabilizing drug (intal). The exposure to "dry" carbon dioxide baths was carried out from the Reabox installation with an exposure temperature of 30 ^o C, a therapeutic concentration of carbon dioxide of 30%, the duration of the procedure was 15 minutes, the procedures were carried out daily 2-3 hours after taking the medication. In the course of 10 baths daily, 4 baths per week. Therapy began on the 3rd day of hospitalization.

By the middle of the course, the boy's condition remained stable, hyperemia disappeared, dryness, and skin infiltration decreased. According to the hemogram, eosinophilia was not observed. When studying the function of external respiration, normalization of all indicators was revealed with the FEV figures of ₁ to 94%, MOC ₂₅ - 71%, MOC ₅₀ - 71%, MOC ₇₅ - 66%. By the end of treatment, the boy had increased physical activity, tolerance of physical exertion was good, concomitant skin lesions completely stopped, sleep was normal. The examination revealed a decrease in the numbers of total immunoglobulins E and G to 340 IU / ml and 631 mg /%, respectively, according to the external respiration function, normal OFB values of ₁ - 96%, MOS ₂₅ - 79%, MOC ₅₀ - 77%, MOC ₇₅ - 68%.

 A follow-up observation showed persistent clinical and laboratory remission for 12 months, reducing the need for medication.

 The proposed method of treatment was applied in the allergology - dispensary department of the Research Institute of Pediatrics NCHZ RAMS in 88 patients with atopic bronchial asthma aged 5 to 14 years. With a mild course of the disease, 40% (35 children) were observed, with an average degree of severity also 40% (35 children), with severe bronchial asthma - 20% (18 children). Including in the period of remission there were 55% (48 children), in the period of unstable remission 26% (23 children) and in the period of exacerbation - 19% (17 children).

 All children tolerated treatment with the proposed method, no adverse reactions were noted. Already by the middle of the course, there was a positive dynamics of the main clinical symptoms, in 12% of 18% of children who had pronounced generalized disorders of bronchial obstruction according to the function of external respiration, there were only moderate violations of indicators at the level of peripheral departments. By the end of the course, cough disappeared in 78.8% of children, and wheezing disappeared in 83.8% of patients. The general condition of the children improved significantly, sleep was normalized, irritability, headaches, poor performance in educational institutions, meteopathic reactions in the form of fluctuations in blood pressure, heart rate and breathing decreased, skin lesions associated with bronchial asthma disappeared, and it was possible to reduce the drug load while maintaining all positive shifts.

Under the influence of treatment by the proposed method, there was an increase and in many cases a normalization of initially reduced indicators of external respiration function (FVC, FEV ₁ , MOS ₂₅ , MOS ₅₀ , MOS ₇₅ , etc.), improvement of clinical symptoms, which was accompanied by positive dynamics of hemogram indices - in 81 , 4% of children the number of eosinophils decreased to normal, and also in 76.7% of patients showed an immunocorrecting effect with a decrease in the level of total immunoglobulin E to normal or normal limits. These changes correlated with a decrease in the level of total immunoglobulin G and an increase in initially reduced immunoglobulin A.

 Follow-up observations conducted within 10-12 months after the course of treatment noted the persistence of the therapeutic effect. The period of remission was clearly observed during this time in most treated patients. The need for medicines and the amount of their consumption in patients with all degrees of severity of bronchial asthma decreased.

 Thus, the proposed method for the treatment of bronchial asthma in children can increase the effectiveness of the treatment of the disease, extend the duration and achieve complete clinical and laboratory remission, reduce the severity of bronchial asthma, the frequency of bronchospasm attacks and the hospitalization rate for this disease, increase resistance to physical activity and improve quality of life for sick children.

Claims (1)

A method of treating bronchial asthma in children by administering carbon dioxide baths, characterized in that the exposure is carried out by “dry” carbon dioxide baths with a carbon dioxide concentration of 30-32% with a gas supply time of 4 minutes at a speed of 8 rpm, the procedure time is 15-17 minutes for children 5-8 years and 20-22 min for children 9-14 years old, at an exposure temperature of 30-32 ^o C, 4 baths per week, for a course of 10-12 procedures.