RU2288715C2 - Method for treating the cases of bronchial asthma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves introducing Levamisol at a peroral dose of 50 mg twice a day during 3 days into traditional therapy after having studied patient immunity state. Rusam is concurrently intramuscularly introduced at a dose of 200 mg once a day with 4-5 days long pause. The course is 3-4 injections long.

EFFECT: selective treatment of immune system chains.

Description

The invention relates to medicine, namely to pulmonology

Bronchial asthma is often accompanied by the development of secondary immune deficiency, 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: questions of clinical immunology // Therapist, architect. - 1987. - No. 12. - S.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 p.).

In pharmacological immunocorrection, a method is known for treating a mixed form of bronchial asthma with levamisole, which consists of oral administration of the drug at a dose of 150 mg per day, in a row 3 times a week for 3-4 weeks (V.P. Silvestrov et al. Non-specific lung diseases : clinic, diagnosis, treatment. - Voronezh: Publishing house of the Voronezh State University, 1991. - P.157).

However, the main disadvantages of levamisole therapy are the possibility of developing granulocytopenia (up to agranulocytosis and panmyelophthosis), headache, nausea, vomiting, diarrhea, especially with prolonged use of the drug, the need for constant monitoring of the main parameters of the hemogram and, first of all, the number and composition of granulocytes. The likelihood of significant side effects increases, if necessary, to achieve the optimal course dose of levamisole - 900-1800 mg.

Secondly, the empirical use of individual immunomodulators, for example levamisole, often does not reduce or completely eliminate secondary immune deficiency (A.M. Zemskov, V.M. Zemskov, Yu.V. Sergeev, V.A. Vornovsky, A. V.Karaulov. 1000 formulas of clinical immunology. - M .: Medicine for everyone. - 2003. - 336 p.), Which is one of the serious drawbacks of this type of therapy.

Thirdly, a significant drawback of monotherapy with immunomodulators is that the persistence of secondary immune deficiency in patients with bronchial asthma leads to a chronic process and an increase in relapse, which significantly reduces the effectiveness of the usual basic treatment of mixed forms of bronchial asthma.

The technical result of the invention is to increase the effectiveness of the usual basic treatment of bronchial asthma.

The technical result is achieved by the fact that orally administered levamisole at a dose of 50 mg 2 times a day, the course of treatment is 3 days with the parallel administration of Ruzam intramuscularly at a dose of 200 mg 1 time per day after 4-5 days for a course of treatment - 3-4 injections.

The combination of drugs was included in the usual treatment of the disease 3-5 days after hospitalization, after studying the immune status and determining the degree of secondary immune deficiency (A.M. Zemskov, V.M. Zemskov, A.V. Karaulov, L.A. Novikova . Directory of operational information on clinical immunology and allergology. - Voronezh: Publishing house of Voronezh State University, 1997. - 161 p.).

The rationale for this scheme to eliminate secondary immune deficiency in a mixed form of 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. Lazareva, 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 different mechanisms of action in order to eliminate immunological disorders (A.M. Zemskov, V.M. Zemskov, A.V. Karaulov. Clinical immunology / Ed. A.V. .Karaulova. - M .: MIA. - 1999. - 604 p.).

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, protein loss by the kidneys, etc .; 3) unsuccessful immunocorrective therapy with a separate drug for a month; 4) a high degree of immune deficiency (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 (A.M. Zemskov, V.M. Zemskov, Yu.V. Sergeev, A.V. Karaulov. Non-drug immunocorrection. - M.: Acad. Mycology, 2002 .-- 264 p.).

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

Example. Extract from the medical history N 3050. Patient N., 57 years old, was hospitalized at City Clinical Hospital No. 20 of Voronezh from 08/23/2004 to 09/06/2004, diagnosis: Bronchial asthma, mixed form, severe course, cortical dependent , stage of exacerbation. Pneumosclerosis Emphysema, DN _II . Hypertension II stage, 2 degree, risk 3, H _I. From anamnesis morbi: suffers from bronchial asthma for 17 years. I received steroid hormones intravenously, orally (polcortolone 3 tablets per day), inhaled (becotide) earlier for 7 years, periodically. Currently taking polcortolone 2 tablets per day and inhaled corticosteroids (flixotide 2 doses 2 times a day). Upon admission, she complained of asthma attacks, up to 6 times a day, mainly at night, stopped by taking Berodual, shortness of breath at rest, difficulty breathing out, cough with sputum that was difficult to separate, chest tightness, weakness. Objectively: the general condition is satisfactory. NPV = 24-26 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 - 90 beats per minute, rhythmic, satisfactory filling and tension. HELL 160/100 mm Hg 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. Left ventricular myocardial hypertrophy; FVD - significant obstructive bronchial obstruction.

An immunological examination revealed a third degree of immune deficiency in the patient. The treatment: aminophylline + verapamil + 0.9% sodium chloride solution, polcortolone, flixotide, salgim through a nebulizer, mildronate, berodual. For the correction of immunological deficiency, a combination of immunomodulators was prescribed, first, oral administration of levamisole at a dose of 50 mg 2 times a day, the course of treatment - 3 days with the parallel administration of Ruzam intramuscularly at a dose of 200 mg 1 time per day after 4-5 days per treatment course - 3 4 injections. Treatment was started from 4 days from the moment of hospitalization. After a week from 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 being in the hospital. In this case, the elimination of the main symptoms of the disease occurred by the middle of the second week of inpatient treatment, which indicates a good effect of combined immunotherapy.

As a result of the inclusion of the combination of levamisole with ruzam in the treatment of bronchial asthma, it was found that the use of a combination of drugs increases the effectiveness of traditional therapy of mixed forms of bronchial asthma. The use of the composition of levamisole with Ruzam is accompanied by a faster normalization of the main manifestations of bronchial asthma compared with conventional treatment, on average by 2 to 3 days, which reduces the patient’s hospital stay by 1-2 days.

Claims (1)

A method of treating bronchial asthma with conventional therapy, including the administration of levamisole, characterized in that orally levamisole is administered at a dose of 50 mg 2 times a day, the course of treatment is 3 days with a parallel administration of ruzam intramuscularly at a dose of 200 mg 1 time per day after 4-5 days, for the course of treatment - 3-4 injections.