RU2294202C1 - Method for selection in individual treatment of patients with bronchial asthma - Google Patents

Abstract

FIELD: medicine, pulmonology.

SUBSTANCE: method involves sampling sputum after inhalation with sodium chloride hypertonic solution followed by cytological analysis of sputum. Inhalations with steroid are carried out in case of detection of candidas, eosinophilia in sputum, and degranulation and lysis of cells also. Pulse-therapy with steroids is carried out in case of detection of eosinophilia in sputum and degranulation of cells. Inhalations and pulse-therapy with steroids are carried out in case of detection of eosinophilia in sputum and degranulation and lysis of cells. In each case treatment is carried out in combination with broncholytics and secretolytics. Method provides enhancing the effectiveness of treatment of bronchial asthma based on individual selection of the selective schedule of therapy and depending on state of microflora and cytology indices of sputum. Invention cab used in complex treatment of patients with bronchial asthma.

EFFECT: improved method of treatment.

1 ex

Description

The invention relates to medicine, namely to pulmonology, and is intended for the selection of drugs for the complex treatment of patients with bronchial asthma according to the results of a cytological examination of sputum.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. In the European Union, COPD and bronchial asthma, along with pneumonia and cystic fibrosis, take third place among the causes of mortality. In Russia, COPD is in fourth place among all causes of mortality. At the same time, mortality and prevalence of COPD continue to increase.

The main characteristic feature of bronchial asthma is chronic bronchial obstruction, which slowly progresses over the years and is most often irreversible. Although at the time of the development of clinical manifestations of COPD morphological changes in most cases are already irreversible, there are treatment methods that can improve the quality, life expectancy and, possibly, functional activity of patients with COPD.

In recent years, several national and transnational consensus statements have been published on the optimal assessment and treatment of asthma. These agreed statements have contributed to the standardization of diagnosis and treatment at the international level, as well as improved patient care. They laid the foundation for clinical audits and identified areas for future research. However, few attempts have been made to develop coherent guidelines for asthma treatment. In particular, hypereosinophilia occurs in a large group of diseases that have different mechanisms of occurrence, a wide variety of clinical manifestations and differences in prognosis and outcome. In clinical practice, doctors of many specialties deal with patients who have an increased content of eosinophils in the blood. Most often, patients with hypereosinophilia are detected in the practice of pulmonologists and allergists. However, this diagnostic problem is not uncommon in diseases of the heart and blood vessels (systemic vasculitis), in patients with neoplastic processes. This syndrome occupies a special place in patients with asthma, pneumonia and cystic fibrosis. Genetic congenital forms of hypereosinophilia and an idiopathic variant of its occurrence are described (P. Weller, 2002, Up-To-Date, Vol. 10, No. 1). Each of these diseases needs an independent analysis, the search for specific morphological markers of eosinophilia.

Since cytological diagnosis of sputum, along with clinical manifestations, determines the tactics of treating bronchial asthma, the task of increasing the effectiveness of treatment appears to be very urgent.

Currently, the following methods are used to diagnose allergic conditions.

Electrodermal diagnosis, based on a change in skin resistance in contact with an allergen [Therapy of allergic diseases. G.I. Drynov. Ed. Moscow, 2004, p. 354-357].

The disadvantage of this method is that it does not have a rational physiological basis, the reliability of this test is not confirmed.

In clinical practice, the Shelle indirect reaction, a test of basophil degranulation [Davenase E., Beauvais F., Amara J. et al., Is used to test allergies. // Nature. - 1988. - Vol. 333, N 6176. - P.816-818]. The essence of this method is to calculate the percentage of destroyed basophils in the blood serum of patients who are expected to have antibodies to the allergen. A sample is considered positive if more than 30% of the basophils in the experimental reaction are degranulated or destroyed [Private allergology. / Ed. A.D. Ado. Ed. Moscow., 1976]. Comparison is made with a control study, where instead of an allergen an isotonic sodium chloride solution is used.

The disadvantages of this method are its invasiveness (venous blood sampling), the need for special reagents (drugs of the alleged allergens) and equipment (tablets, thermostat, centrifuge, Goryaev’s chamber). The results of this test should be considered only in conjunction with the data of other clinical and laboratory studies, and for the most reliability it is advisable to conduct a test during the period of remission of the disease [Use of a direct test of basophil degranulation to diagnose allergies. D.K. Novikov, E.A. Dotsenko, G.Ya. Zhakova. Department of Clinical Allergology FUV Vitebsk Medical Institute, 1990].

The closest analogue of the proposed method is the method of choosing an individual treatment for patients suffering from bronchial asthma, including daily monitoring of peak expiratory flow rate using a peak flow meter during therapeutic treatment and determination of peak expiratory flow rates, while women of the perimenopausal period are additionally determined with peak expiratory flow rate against the background of transdermal administration of estrogen in a dose of 25-100 mcg for 3-4 days, compare them with the original ones and if they have not decreased , then determine the indications for replacement therapy with estrogen-containing drugs with simultaneous treatment of bronchial asthma (RU 2161011, 12.27.2000).

However, the known method has several disadvantages. In particular, it is intended to assess the effect of the drug only in fertile women who should take estrogen-containing drugs as indicated.

These drugs have many side effects, the most significant of which is an oncological predisposition. In addition, using this method it is not possible to evaluate the effectiveness of the drug in men, and additional invasive examination is required to determine the level of estrogen in the blood.

The technical result of the proposed method is the selection of individual treatment for patients suffering from bronchial asthma according to the results of revealing the morphological features of hypereosinophilia in sputum, including with the absence of an increase in eosinophils in peripheral blood, in order to increase the effectiveness of treatment of patients with bronchial asthma due to selective therapy.

In particular, the technical result is achieved by choosing an individual treatment for patients suffering from bronchial asthma based on the study of sputum cytology (after staining according to Gram and Leishman). The first smear on the accompanying microflora was stained according to Gram, and for the study of eosinophils and their morphology - according to Leishman. In sputum smears, the percentage of eosinophils, their absolute number per 100 smear cells, was determined. Sputum smears were prepared using a special cytological brush. Fixation with Smear Fix ©, for 1-2 minutes, the samples are washed from the fixative with distilled water and dried.

Samples were placed in a container (3% acetic acid in 95% methanol) for 1 minute, the samples were washed from the fixative with distilled water and dried. The drugs on the rack were coated with 1ml Leishman's reagent for 20 seconds.

Added 2ml of buffer, changed the position of the drugs on the rack up and down to mix the reagents, coloring for 7 minutes. Rinsing in distilled water with pH-6.8 buffer - 2 minutes, drying with blotting paper without fiber. Fixation. Microscopy.

The proposed method is based on assessing the state of concomitant microflora, the absolute and relative number of eosinophils, as well as studying the morphology of the cells themselves: their lysis, apoptosis, and the number of granules.

Patients were divided into 3 groups of fifty people, depending on the type of treatment for bronchial asthma. All patients received bronchodilators, secretolitics. In addition to these drugs, the first group of patients was prescribed pulse therapy with steroids; the second group - inhaled steroids, the third group - inhaled steroids and pulse therapy with steroids. The age of patients is from 25 to 65 years.

All patients underwent a standard examination, including: identification of complaints, collection of medical history (predisposition to allergies and infectious diseases), physical examination, functional tests, diagnosis according to classification, preparation of a therapeutic treatment plan. All patients did not have hypereosinophilia of peripheral blood. Material sampling - 2 cytological studies of sputum in a row. Used the method of investigation of induced sputum. Sputum collection was carried out after inhalation of a hypertonic solution of sodium chloride. A similar method of obtaining sputum is more informative for revealing the morphological characteristics of cells.

In patients with bronchial asthma, sputum was mucous. The prevailing cellular elements were macrophages. If sputum was not collected correctly, and mucus was delivered to the laboratory from the oral cavity, then in such cases macrophages were not detected and the preparations were considered invalid. Macrophages were indicators of sputum. With an exacerbation of the disease, sputum acquired a purulent character, its viscosity increased. An increase in the amount of sputum, its high viscosity and a greenish-yellow color were regarded as signs of an exacerbation of the infectious inflammatory process of the respiratory tract. The most common pathogens were Candida albicans. A dependence of the state of microflora and sputum cytology on the type of treatment of bronchial asthma was revealed, which made it possible to make an individual choice of drug therapy.

In this study, it was proved that the detection of sputum contamination by candida, eosinophilia and the cytotoxic effect of degranulation and cell lysis is an indication for the use of inhaled steroids, bronchodilators, secretolytics. Identification of the cytotoxic effect - cell degranulation, eosinophilia - to the use of pulse therapy with steroids, bronchodilators, secretolitics. Identification of eosinophilia and high cytotoxic effect - degranulation and cell lysis, as well as their apoptosis - to the use of inhaled steroids, pulse therapy with steroids, bronchodilators, secretolitics.

Example 1

Patient G. 29 years old, outpatient card number 1389. Diagnosis: Bronchial asthma.

Before treatment: complaints of repeated wheezing, shortness of breath, feeling of lack of air, separation of viscous yellowish mucous sputum.

Staining of sputum smears according to Leishman: eosinophils up to 15%, cell degranulation. Lysis and apoptosis were not detected. The results obtained are an indication for the use of pulse therapy with steroids, bronchodilators and secretolitics.

Treatment: pulse therapy with steroids, bronchodilators and secretolytics.

After treatment: the frequency of seizures decreased. Cell degranulation, lysis, apoptosis were not detected. The data obtained indicate the absence of contamination by pathogenic microbes and the absence of a cytotoxic effect when using pulse therapy with steroids in combination with bronchodilators and secretolytics.

Examining smears by two methods, according to Gram and Leishman, we revealed morphological changes in eosinophils in response to treatment. The dependence of the cytological composition of sputum on the type of complex therapy of bronchial asthma was revealed.

Thus, the obtained data can be used when choosing individual treatment for patients with bronchial asthma. Apply a selective treatment regimen (specifically for each patient), depending on the cytological composition of sputum. Recommend specific therapy to patients depending on the results of sputum analysis.

Claims (1)

The method of choosing an individual treatment for patients with bronchial asthma, characterized in that they collect sputum after inhalation of a hypertonic sodium chloride solution and, when sputum contamination is detected by candida, eosinophilia, as well as cell degranulation and lysis, steroid inhalation is performed, and pulse is detected in the sputum when eosinophilia and cell degranulation -therapy with steroids, and if eosinophilia, degranulation and cell lysis, as well as their apoptosis are detected in the sputum, inhalations and pulse therapy with steroids are carried out, with e om in all cases, the treatment is carried out in combination with bronchodilators and Sekretolitiki.