RU2271233C1 - Method for treating patients for bronchial asthma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves administering therapeutic exercises, thoracic massage, mineral water inhalation, peat applications, and treatment with low frequency traveling magnetic field. Peat applications are given in the morning in a way that posterior chest surface is treated at 38-40°C one day and epigastrium, the right and the left hypochondrium region at 35-36°C the next day, in turn. Exposure time is equal to 20-30 min with 7-8 procedures per course upon each zone. Low frequency traveling magnetic field treatment is applied every day twice a day under intensity of 30 mTesla units, epigastrium and hypochondrium zone is treated in the morning during 14-15 min; collar and subscapular zones are treated during 5-7 min per each zone. The total treatment course is 12-14 days long.

EFFECT: enhanced effectiveness in treating respiratory and digestive apparatus without medicament load being increased.

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Description

The invention relates to medicine, namely to physiotherapy and balneology.

It is known that with bronchial asthma, not only the lower respiratory tract, but also the upper, skin, digestive organs are involved in the pathological process. The latter, according to various authors [1, 2, 3, 4], are affected in 60-100% of cases, complicating the treatment of asthma, contributing to chronic inflammation and often triggering asthma attacks [5]. The above requires in the treatment of bronchial asthma to simultaneously treat the organs of the gastrointestinal tract [6]. To this end, it is proposed the appointment of various medications: proton pump inhibitors, gastroprotectors [7], drugs that correct the motor function of the gastrointestinal tract [8]. The disadvantage of the proposed approach is a significant increase in the drug load on the patient (by 2-3 drugs), since most modern drugs have a highly specialized effect. In addition, the high cost of treating these patients is also significantly increasing.

A known method of treating lesions of the gastroduodenal zone in patients with bronchial asthma by administering to patients for 14 days oral systemic glucocorticosteroids at a dose of 10-15 mg / day after a 7-day course of anti-Helicobacter eradication therapy: clarithromycin, omez, metronidazole and while taking antisecretory drugs [9].

The disadvantages of the method

1. The increase in drug load.

2. The use of systemic corticosteroids, the "departure" from which was the goal of developing inhaled corticosteroids. Even in small doses, as suggested in the specified method, they can have a systemic negative effect on the patient. In addition, there are indications [10] on the possibility of enhancing the phenomena of gastroesophageal reflux when patients with bronchial asthma take oral corticosteroids and methylxanthines.

Also known is a method of using physical factors in the treatment of combined pathology of the respiratory and digestive organs. Moreover, in a sanatorium, patients received speleotherapy, mud applications on the chest, monitor bowel cleansing (5 procedures), bowel lavage with mineral water (5 procedures) against the background of basic drug therapy [11].

The disadvantages of the method

1. Inadequate clinical effect in the form of maintaining large fluctuations in peak expiratory flow during the day.

2. The possibility of implementation only in spa conditions, since bowel lavage requires the presence of a large volume of mineral water.

3. Endoecological repeated cleansing of the intestine, fashionable in recent years, promotes leaching of not only pathogenic, but normal microflora, which can lead to dysbiosis or aggravate existing ones, as well as disrupt the processes of parietal absorption.

The objective of the invention is to increase the clinical effect, availability, elimination of side effects.

The task is achieved by the appointment of physical therapy, chest massage, inhalation of mineral water, peat applications and exposure to a low-frequency traveling magnetic field, and peat applications are carried out in the morning in turn: one day on the back surface of the chest at a temperature of + 38 + 40 ° С, the second day - on the epigastric region, the right and left hypochondria at a temperature of + 35 + 36 ° C, the exposure time is 20-30 minutes, on the course of 7-8 effects on each zone, the effects of a low-frequency traveling magnet a field with an intensity of 30 mT is carried out daily, twice a day, in the morning - to the epigastric region and hypochondrium for 14-15 minutes, in the afternoon - to the collar and subscapular region for 5-7 minutes to each region, the treatment course is 12- 14 days.

Individualization of the exposure of the magnetic procedure is carried out according to the adaptation reactions of L.Kh. Garkavi, supporting a calm activation reaction in patients throughout the entire treatment course. For this, after 1, 5 and 10 magnetic procedures, the percentage in the peripheral blood of lymphocytes is determined. If it corresponds to 29-34%, then the duration of the procedures does not change, if less than 29%, then the exposure time is multiplied by a factor of 1.2, if more than 35% is divided by the same coefficient.

As an example, we provide extracts from case histories of two patients treated in accordance with the claimed method.

Clinical examples

Example 1

Patient N.V. I.V., 37 years old, and.b. No. 248, the duration of treatment January 27, 2004 - February 16, 2004.

Diagnosis: Bronchial asthma, atopic, mild course, BH ₁ , CA ₀ .

There were no asthma attacks upon arrival, however, there was a mild respiratory difficulty of the expiratory type, especially in the cold, a slight cough, shortness of breath with severe physical exertion, the patient was also disturbed by epigastric pain after eating, frequent heartburn, flatulence. I used salbutamol 1-2 times a day. Diagnosed with allergies to house dust and animal hair. Exacerbations of the disease 1-2 times a year. Sick for about 5 years.

The prescribed treatment: respiratory gymnastics daily, manual chest massage every other day, inhalation of mineral water daily, peat applications with a temperature of + 40 ° C on the back and + 36 ° C on the epigastrium and hypochondrium, alternating daily with an exposure of 20-30 minutes per course 8 applications of each localization, a running low-frequency magnetic field from the Almag apparatus, 30 mT, in the first half of the day - to the epigastric and hypochondrium, in the second - to the collar and subscapular regions for 8 minutes each, total No. 14. The patient tolerated the prescribed treatment well. By 4-5 days of treatment, the patient noted an improvement in overall health, a decrease in shortness of breath and coughing. During this period, the patient was less likely to be bothered by heartburn and flatulence. Judging by the content of lymphocytes in the blood (43%), the reaction of increased activation was diagnosed and the duration of the magnetic effect was adjusted: 12.5 minutes for the epigastrium and 6.5 minutes for the collar and subscapular region.

At the end of treatment, shortness of breath and cough are very minor, the need for salbutamol has disappeared. Peak expiratory flow rate increased by 8.3%, daily variability of this indicator - 3%. Spirographic data indicated normalization of bronchial obstruction.

Spirography data

Indicators Before treatment After treatment JELL,% 108 124 FVC,% one hundred 114 FEV ₁ ,% 80 105 PSV,% 70 98 MOS ₂₅ ,% 45 63 MOC ₅₀ % 44 58 SOS _25-75 % 43 59 VN I 0

Clinical and biochemical parameters before and after treatment indicated the absence of signs of active inflammation.

From the digestive tract after treatment: flatulence and heartburn did not bother, pain in the epigastrium was much less frequent and less pronounced.

Endoscopy data

Indicators Before treatment After treatment Esophagus: swelling, points 2 one hyperemia, points - - Stomach: swelling, points 2 one hyperemia, points 2 one slime ++ + LDPK: puffiness 2 one hyperemia 2 one parietal bile ++ +

Based on the totality of clinical and paraclinical data, the treatment outcome was rated as “improvement” (2.2 points).

Example 2

Patient L-va N.P., 53 years old, and.b. No. 749, the term of treatment is March 24, 2004-14 April 2004. Diagnosis: Bronchial asthma, mixed form, severe course, hormone-dependent, BH _I , CA _I.

Upon receipt of deployed attacks of suffocation no. However, a moderately pronounced respiratory depression is of concern. However, with physical exertion, a slight cough. He receives 1 tablet / day of polcortolone, 2 ing. / Day of Symbicort, 3-4 ing. / Day. beroteka. Sick for over 30 years. The last 5-6 years receives systemic corticosteroids. Against this background, exacerbations 1-2 times a year, during which the dosage of hormones increases.

On the part of digestion, constant heartburn after eating, a tendency to diarrhea, worry.

The prescribed treatment: therapeutic gymnastics, manual massage of the chest, inhalation of 6.8% sodium chloride, peat applications T + 38 ° C 20-30 minutes on the back and + 35 ° C 20-30 minutes on the epigastrium and hypochondria (alternating every day) , 7 treatments per zone. BeMP (apparatus "Almag") 2 times a day: in the morning - to the epigastric region, 15 minutes after lunch - to the collar region and a subscap of 7 for each region. The magnetic field strength is 30 mT. Course duration - 15 procedures.

The patient tolerated the prescribed treatment well. In accordance with the reaction of increased adaptation that arose after the 5th procedure, the magnetic exposure exposure was reduced to 12.5 and 5 minutes per zone.

By the time the treatment is completed, suffocation is completely stopped, there is no need for short-acting bronchodilators (starting from the 6th procedure), the cough does not bother, shortness of breath has decreased. On the part of the digestive system, the disappearance of heartburn was noted.

During treatment, the daily dose of polcortolone was reduced in the middle of the course to ¾ tablets, by the end - to ½ tablets.

The dynamics of spirography

Indicators Before treatment After treatment JELL,% 81 94 FVC,% 78 88 FEV ₁ ,% 69 94 PSV,% 70 96 MOS ₂₅ ,% 28 40 MOS ₅₀ ,% 31 41 SOS _25-75 % 29th 45 Daily fluctuations in PSV,% 25 12 VN II 0

The dynamics of clinical and biochemical blood parameters

Indicators Before treatment After treatment ESR, mm / hour 10 9 Eosinophils,% four 3 Sialic acids 2.64 2,53 Seromucoids 256 200 Ceruloplasmin 421 398 Lysozyme,% 37 32

The dynamics of fibrogastroduodenoscopy data

Indicators Before treatment After treatment Esophagus: swelling, points 2 0.5 hyperemia, points 0 0 Stomach: swelling, points 2 one hyperemia, points 2 0 slime +++ + LDPK: puffiness 2 one hyperemia 2 one

Based on the totality of clinical and paraclinical data, the treatment outcome was evaluated as “improvement” (2.8 points), a controlled course of asthma was achieved with parallel positive dynamics from the digestive organs.

A clinical study was performed on 27 patients with bronchial asthma (atopic, infection-dependent, mixed), mainly of moderate severity. The average age of patients was 40.8 ± 1.7 years, the duration of the disease ranged from 2 to 20 years. Evaluation of the treatment results was carried out on the basis of the analysis of the dynamics of clinical manifestations, spirography and peak flowmetry, clinical, biochemical and immunological blood tests, fibrogastroduodenoscopic studies.

Before treatment, asthma attacks (day and night) bothered 29.6% of the examined. In 96.3%, expiratory difficulty in breathing was observed, in 74.1% - cough, 92% used bronchodilators, more often - short-acting. Peak expiratory flow (peak flowmetry) averaged 355.7 ml / s in the group of patients, and daily fluctuations in 30% of cases exceeded 20%, ranging from 24 to 40%. In this case, complaints about the digestive system (heartburn, belching) were only in 1 / 5-1 / 6 of the patients. However, an endoscopic examination of the upper digestive tract revealed the presence of significant irregularities. So, almost all patients had swelling of the mucosa: the esophagus in 93.7% of cases, the stomach in 100%, the duodenum in 83.9%. Hyperemia occurred in the esophagus in 12.9%, the stomach - 67.7% and the duodenum - in 54.8% of cases. In addition, gastroesophageal diagnosis was diagnosed in 3.2% of the examined, and duodenogastric reflux in 25.8%. Stomach erosion was observed in 3.2% of cases, duodenum - in 6.4%. Bulbostasis occurred in 12.9% of cases. Thus, the examined patients had signs of inflammation, impaired motor skills and, less often, trophism in the upper digestive system.

The treatment carried out in accordance with the claimed method corresponded to a significant reduction in the clinical manifestations of asthma. So, the frequency of asthma attacks decreased by 8 times (from 29.6 to 3.7%). Shortness of breath was detected 22.2% less often (in 74.1% of patients versus 96.3% before treatment), cough - by 33.4% less often (in 40.7% versus 74.1%). In those patients in whom the symptoms persisted, a significant decrease in its severity was noted (table 1).

Table 1
The dynamics of the severity of the main clinical manifestations of asthma during treatment by the present method in points (n = 27) Clinical sign Before treatment (M ₁ + m ₁ ) After treatment (M ₂ + m ₂ ) R The average number of asthma attacks per day in the group 0.72 ± 0.19 0.04 ± 0.06 <0.01 Severe difficulty breathing 2.0 ± 0.14 0.94 ± 0.03 <0.01 Severity of cough 1.13 ± 0.14 0.48 ± 0.09 <0.01 The need for bronchodilators (in points) 3.44 ± 0.5 0.76 ± 2 <0.01 Peak expiratory flow rate (in ml / sec) 355.7 ± 21.2 434.1 ± 22.2 <0.05 Daily fluctuations in peak flow metrics (in%) 14.2 ± 2.8 4.2 ± 1.03 <0.01

where the severity of asthma symptoms was evaluated on a three-point scale;

taking bronchodilators: 1 breath of salbutamol, ventolin - 1 point; Berotek, Berodual, table bronchodilators - 2 points; daily fluctuations of peak flowmetry - the difference (in%) between the morning and evening measurements.

After the treatment, there was not a single case of maintaining the daily fluctuation of peak flow data of more than 20%, which indicated the transition of asthma to a new level - a controlled course. The number of patients with a need for short-acting bronchodilators decreased by 56% (from 92% to 36%, 2.6 times), and the average number of their use per patient in the group was 4.5 times.

Complaints about the digestive organs in all patients were either stopped or their severity was significantly reduced.

The treatment according to the claimed method had a rather pronounced anti-inflammatory effect, as evidenced by the favorable dynamics of blood counts, reflecting the activity of inflammation (table 2).

table 2
The dynamics of the initially altered blood parameters during treatment by the present method (n = 27) Indicators Baseline Before treatment (M ₁ + m ₁ ) After treatment (M ₂ + m ₂ ) Eosinophils (%) Elevated 9.0 ± 0.8 7.3 ± 1.4 Lymphocytes (%) Elevated 44.0 ± 1.9 35.8 ± 1.5 * Seromucoids Elevated 241.0 ± 6.06 181.0 ± 32.1 Sialic acids Elevated 2.67 ± 0.04 2.43 ± 0.1 * Catalase Elevated 45.3 ± 2.6 33.3 ± 2.7 * Ceruloplasmin Elevated 422.2 ± 3.8 399.1 ± 13.0 HCT-spontaneous (%) Elevated 31.9 ± 1.4 32.3 ± 4.2 T lymphocytes (%) Reduced 34.3 ± 2.1 37.5 ± 2.1 B lymphocytes (%) Elevated 36.7 ± 1.3 24.1 ± 2.4 * Lysozyme (%) Elevated 35.3 ± 0.7 31.9 ± 0.89 * CEC (c.u.) Elevated 106.2 ± 6.2 86.8 ± 6.7 * Jg A (g / l) Reduced 1.41 ± 0.2 1.7 ± 0.5 Jg A (g / l) Elevated 3.4 ± 0.2 2.8 ± 0.3 * Jg M (g / l) Elevated 2.44 ± 0.1 2.55 ± 0.4 Jg G (g / l) Elevated 18.2 ± 0.5 17.6 ± 2.6 where: * - P <0.05.

In the whole group, the number of patients without signs of active inflammation increased after treatment according to the claimed method 2.6 times (from 18.5% to 48.1%), and the number of patients with pronounced activity decreased 2 times (from 22.3 % to 11.2%).

Evidence of improved bronchial patency as a result of using the inventive method was the growth of spirographic indicators reflecting this process (table 3).

Table 3
The dynamics of the initially changed indicators of the high pressure for the treatment of the claimed method (n = 27) Indicators Before treatment (M ₁ + m ₁ ) After treatment (M ₂ + m ₂ ) YELLOW (%) 67.9 ± 5.73 87.0 ± 8.8 FVC (%) 59.6 ± 5.8 82.4 ± 10.2 * FEV ₁ (%) 60.3 ± 4.0 75.4 ± 7.0 * PSV (%) 59.9 ± 4.2 7b, 4 ± 4.9 * MOS-25 (%) 29.2 ± 3.4 40.5 ± 5.6 * MOS-50 (%) 30.5 ± 3.4 38.4 ± 4.3 SOS _25-75 (%) 30.3 ± 3, b 37.6 ± 4.3 where: * - P <0.05.

After treatment according to the claimed method, the number of patients without ventilation disorders increased by 22.3% (from 37% to 59.3%), and the number of patients with severe and severe disorders decreased 2.7 times (from 40.8% to 14, 8%).

An endoscopic examination of the gastrointestinal tract revealed a 1.8-fold decrease in the frequency of detection of swelling of the esophagus mucosa (47.4% versus 83.9%), and hyperemia - 12-fold (0% versus 12.9% before treatment). Relief of gastroesophageal reflux and a decrease in the frequency of duodenogastric reflux by 15.3% (from 25.8% to 10.5%). In all patients, erosion was "closed" both in the stomach and in the duodenum (before treatment in 3.2% and 6.5% of patients, respectively).

Evaluation of endoscopic disorders in points indicated the presence of significant positive dynamics in the severity of existing violations (table 4).

Table 4
The dynamics of endoscopic indicators of the gastrointestinal tract, characterizing the severity of the inflammatory process (in points) during treatment by the present method Sign Localization Esophagus Stomach Duodenal bulb Swelling d / l 1.39 ± 0.128 1.87 ± 0.0086 1.55 ± 0.085 s / l 0.47 ± 0.124 *** 1.08 ± 0.0093 * 1.1 ± 0.124 * Hyperemia d / l 0.26 ± 0.128 1.16 ± 0.085 0.94 ± 0.085 s / l 0 ** 0.63 ± 0.124 * 0.63 ± 0.124 ** where * - P <0.05; ** - P <0.02; *** - P <0.01; data before treatment M ± m ₁ ; data after treatment M ₂ ± m ₂

Judging by the data of endoscopy, the claimed method had an anti-inflammatory, trophic effect on the mucosa of the digestive tract, and contributed to the improvement of the motor function of the gastrointestinal tract.

A comprehensive assessment of the dynamics of clinical, spirographic, biochemical, immunological and endoscopic data made it possible to speak of positive treatment results according to the claimed method in 92.6% of cases with an average efficiency score of 2.12 ± 0.10. however, 3 patients (11.1%) completed treatment with significant improvement; 12 (44.4%) - with improvement; 10 (37.1%) - a slight improvement, 2 (7.4%) - no change.

Table 5
Comparative effects of the proposed method and prototype Indicators The inventive method Prototype Relieving Asthma Attacks + + Cough reduction, choking + + Increase in peak expiratory flow 27.5% thirty% Daily variability of peak expiratory flow rate of more than 20% no saved The possibility of implementing the method in non-resort conditions + - The likelihood of a violation of intestinal microbiocinosis and parietal absorption - +

Thus, the claimed method allows for the first time to achieve the transfer of the disease to a controlled course, can be used not only in the spa, but also in hospitals and outpatient clinics, cannot cause a negative side effect from the intestine.

The inventive method is proposed to improve the quality of rehabilitation treatment of patients with bronchial asthma due to the parallel effect on the respiratory and digestive organs without increasing the drug load on the patient. The method is carried out against the background of inhalation of mineral waters, manual massage of the chest, physiotherapy exercises and previously prescribed basic drug therapy.

When developing the proposed method, the choice of temperature parameters for mud therapy was due to:

on the back - + 38 + 40 ° С - the pronounced anti-inflammatory and immunocorrecting effect we have proved with respect to the respiratory system of such a temperature regime;

on epigastrium and hypochondria - + 35 + 36 ° С - the revealed possibility of enhancing reflux when assigned to this zone of application with a higher temperature, the presence of a beneficial effect on the immune inflammation of cool mud.

The choice of a traveling magnetic field was due to the improvement under its influence of bronchial patency in patients with obstructive bronchitis, as well as the therapeutic effects of magnetotherapy: anti-inflammatory, decongestant.

Bibliography

1. Chernyavskaya G.M., Beloborodova E.I., Pozdnyakov R.A., Plekhanova E.V., Vasilyeva S.A. The frequency of lesions of the gastroduodenal zone in bronchial asthma / Mater. 11 national congress on diseases org. breathing. M., 2001 .-- 148. - p. 60.

2. Chernyavskaya G.M. The defeat of the gastroduodenal system in bronchial asthma (clinical and pathomorphological aspects) / Abstract. Doct. dis. - Tomsk, 2004 .-- 57 p.

3. Chamsutdinov N.U., Abusuev A.A., Ataev M.-R.G. The condition of the mucous membrane of the gastrointestinal tract in patients with bronchial asthma / Mater. 12 nat. Congress on respiratory diseases. - M., 2002 .-- V.33. - p. 32.

4. Danilyak I.G., Naimann Yu.I., Kolosova K.Yu. Gastroesophageal reflux and pathology of the respiratory system / Clinical Gerontology, 2004. - 4. - p.27-31.

5. Mayev I.V., Busarova G.A., Samsonov A.A., Nikushkina I.N., Agapova N.R. The role of pH-metry in the diagnosis of gastroesophageal reflux in bronchial asthma / Mater. 11 nat. Congress on respiratory diseases. - M., 2001 .-- V.74. - C. 42.

6. Zagidullin Sh.Z., Galimov OV, Dmitriev D.M., Galimova B.C., Nurtdinov M.A. Ways to improve the treatment of patients with lung diseases / Mat. 11 nat. Congress on respiratory diseases. - M., 2001 .-- V.36. - p. 32.

7. Chamsutdinov N.U., Abusuev A.A., Ataev M.-R.G. Treatment of erosive and ulcerative lesions of the esophagus, stomach and duodenum in patients with bronchial asthma / Mater. 12 nat. Congress on respiratory diseases. - M, 2002 .-- IV.34. - p.32.

8. Kucherenko A.D., Petrov V.P., Kostyuk I.P. Impedansometry and 24-hour pH-metry of the upper digestive tract in patients with chronic respiratory diseases / Mat. 12 nat. Congress on respiratory diseases. - M., 2002 .-- IV.15. - p.27.

9. A method for the treatment of erosive lesions of the gastroduodenal zone resistant to conventional therapy in patients with bronchial asthma / Patent for invention RU No. 2215530 C1. publ. 11/10/03 Bull. No. 31.

10. Kireeva T.V., Telnov V.L. Night asthma and reflux / Mat. 11 nat. Congress on respiratory diseases. - M., 2001.- V.43. - p. 34.

11. Talapov I.V., Karaulov A.O., Kokarev Yu.S., Ivanova N.V., Semenova I.V., Zhigunova E.K. Physical methods of treatment for combined pathology of the respiratory and digestive organs / Mat. III scientific and practical. conf. “Problems and prospects of sanatorium-resort treatment and rehabilitation in Russian health resorts. - Sochi, Dagomys, 2002. - p. 61-62.

Claims (1)

A method of treating patients with bronchial asthma by prescribing physical therapy, chest massage, inhalation of mineral waters, peat applications and exposure to a low-frequency traveling magnetic field, characterized in that peat applications are carried out in the morning in the morning: one day - on the back surface of the chest at a temperature of + 38 + 40 ° С, the second day - on the epigastric region, the right and left hypochondria at a temperature of + 35 + 36 ° С, the exposure time is 20-30 minutes, the course of 7-8 effects on each zone, the impact is low a total traveling magnetic field with an intensity of 30 mT is carried out daily, twice a day, in the morning - to the epigastric region and hypochondrium for 14-15 minutes, in the afternoon - to the collar and subscapular region for 5-7 minutes to each region, the course of treatment is 12-14 days.