RU2324511C1 - Method of complex treatment of polypous rhinosinusitis in patients with bronchial asthma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: low-intensity laser with wave 630 nm and power 50 mcW/cm² is applied daily with course of 15 days. For external application: the nose bridge is exposed for 1 min, central part of dorsum of nose - for 20 sec, in point of fossa canina on both sides - for 1 min. Intranasal application - the light guide is inserted 1 cm into both nasal meati alternately, exposure time - 15 sec. Blood is exposed transcutaneously by 15 min exposure of the area above the ulnar vena. Simultaneously with the laser therapy course, the patient is administered intranasally the combined inhaler Seretid, which contains Salmeterol (25 mcg) and Fluticazone propionate (125 mcg), during inspiration, into each nasal meatus, twice a day.

EFFECT: method increases therapeutic efficiency and provides rapid regression of polypous tissue.

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Description

The invention relates to medicine, namely to pulmonology and otolaryngology.

The pathogenesis of polypous rhinosinusitis is based on an inflammatory reaction, a certain role in which is the release of histamine and other mediators of inflammation from mast cells, eosinophilic infiltration and apoptosis of eosinophils in the mucous membrane, exudation and edema of the mucous membrane itself, impaired mucociliary transport and proliferation . S. Drug and surgical treatment of polyposis rhinosinusitis. Treatment of sinusitis associated with bronchial asthma. - Ros. Rhinology. - 1999, No. 1. - S.65-68). These components naturally irritate the β ₂ -adrenergic receptors of the nasal mucosa, leading to its proliferation. Currently, there is a known method for the treatment of polyposis rhinosinusitis in patients with bronchial asthma using new forms of intranasal corticosteroid preparations, in particular inhacort, using laser radiation (Pat. 2229317 Russian Federation, IPC A61N 5/067; A61K 37/24. Method for the treatment of polypous rhinosinusitis in patients with bronchial asthma./ Samsonov V.P., Lutsenko M.T., Zavarzina E.V .; patentee of the State Administration of the Scientific Center of the FPD SB RAMS. - No. 2002121207; filed August 5, 2002; published May 27, 2004, Bull. No. fifteen). If we consider the pharmacodynamics of corticosteroids in relation to the given scheme of the pathogenesis of polypous rhinosinusitis, we will see that these drugs affect most of the pathogenetic moments.

The known method has a significant drawback, namely, when using intranasal ingacort, there was no drug acting on β ₂ -adrenoreceptors of the nasal mucosa, and in complex treatment it did not allow to fully optimize the control and treatment results of bronchial asthma in those patients who use a single glucocorticosteroid was not efficient enough. These patients were additionally prescribed, inhaled through the oral cavity, β ₂ -adrenoreceptor agonists, which was more effective in controlling asthma symptoms and its positive treatment results than simply increasing the dose of an inhaled corticosteroid.

The purpose of the proposed method is to optimize the control and treatment results of polypous rhinosinusitis and bronchial asthma with a comprehensive conservative method of treatment of both diseases.

This goal is achieved in that the treatment of nasal polyps that are combined with bronchial asthma is carried out by applying low-intensity laser therapy, through the blood and through the nose, with intranasal inhalation treatment with a combined drug - sertide containing glucocorticosteroid - fluticasone propionate and β ₂ -adrenoreceptor agonist - salmeterol.

The method is as follows. Low-intensity laser irradiation is performed by a helium-neon laser (LA-2 installation).

The radiation wavelength is 630 nm, the radiation power from the distal end of the fiber is 50 mW / cm ² .

Irradiation of the nose is carried out: 1) external-cutaneous: nose bridge 1 minute, in the center of the back of the nose for 20 seconds, at the fossa canina point on both sides for 1 minute; 2) intranasal - the fiber is inserted alternately into both nasal passages to a depth of 1 cm, the exposure time is 15 seconds. Irradiation of blood is carried out by a transcutaneous infusion method in the region of the ulnar vein, exposure is 15 minutes. The course of treatment is 15 sessions. An additional 2 times a day, the patient intranasally inhals the combined drug - Seretide, in a single dose of 25/125 mcg, during inspiration in each nasal passage. We were the first to use a β ₂ -adrenoreceptor agonist - salmeterol, which is part of the combined drug Seretide for a new purpose, namely intranosally. Previously, this drug was used for inhalation through the oral cavity for the treatment of bronchial asthma. When studying the pharmacodynamics of drugs belonging to the group of selective long-acting (up to 12 hours) β ₂ -adrenoreceptor agonists, and in particular salmeterol, it was found that this drug inhibits the entry of calcium ions into cells, inhibits the release of allergy-activated allergy mediators (histamine, leukotrienes, etc.) from mast cells, has some anti-inflammatory effects, in particular, reducing vascular permeability, increases mucociliary transport, even once f introduction of salmeterol weakens the respiratory tract hyperreactivity (Rational pharmacotherapy of respiratory diseases, a guide for practicing physicians. / Ed. by A.G. Chuchalin. - M., Publishing House "Literra". - 2004. - P.34-41). The above pharmacological effects of this group of drugs allow you to influence many points in the pathogenesis of polypous rhinosinusitis. The drug interaction of β ₂ -adrenoreceptor agonists with glucocorticosteroids is synergistic: the sensitivity of β ₂ -adrenoreceptors increases, which improves control over the course of bronchial asthma and improves the quality of life of patients.

The above treatment was carried out against the background of the traditional treatment regimen for bronchial asthma: the appointment of a basic drug, bronchodilator, thinning and expectorant sputum drugs.

The proposed method treated 32 patients with polypous rhinosinusitis associated with bronchial asthma of an infectious-allergic form of moderate severity.

Comparative evaluation of treatment results for patients with polyposis rhinosinusitis associated with bronchial asthma, a low-intensity laser, and intranasal inhalation of serethide and ingacort.

Clinical, laboratory and instrumental data Treatment day The first Fifteenth Seretide Ingacort Seretide Ingacort 1. Nasal breathing - absent in 14 patients in 12 patients 0 0 - partial in 18 patients in 18 patients in 2 patients in 3 patients 2. Visual inspection of the nasal cavity In all patients, the mucous membrane, nasal concha are cyanotic, edematous, poorly reduced when lubricated with adrenaline. In the lumen of the nasal passages are visible polyps of gray color, shiny, mobile, which filled the middle and common nasal passages. In all patients, the mucous membrane, nasal concha are cyanotic, edematous, poorly reduced when lubricated with adrenaline. In the lumen of the nasal passages are visible polyps of gray color, shiny, mobile, which filled the middle and common nasal passages. In all patients, cyanosis of the nasal mucosa was decreased. No swelling of the nasal concha. Polypous tissue was reduced in 30 (93.8%) patients in the nasal passages, single polyps in the area of the ethmoid labyrinth were preserved in 2 (6.2%) patients, which were reduced in size compared to the initial state and did not interfere with free nasal breathing. In all patients, cyanosis of the mucous membrane of the turbinates decreased. Swelling of the nasal
no sinks. In the lumen of the nasal passages in 27 (90%) patients, polypous tissue disappeared, in 3 (10%) patients in the area of the ethmoid labyrinth, single polyps remained, reduced in size, not interfering with nasal breathing. 3. White blood cell count (× 10 ⁹ / l) 6.4 ± 0.5 5.9 ± 0.7 5.8 ± 0.2 5.6 ± 0.4 4. Molecules of medium weight (unit opt. Raft.) 0.382 ± 0.081 0.357 ± 0.081 0.321 ± 0.042 0.336 ± 0.052 5. Spirographic indicators of bronchial patency FEV ₁ 51 ± 1 52 ± 1, ^* 71 ± 2 64 ± 2, ^** JELL 96 ± 1 92 ± 2, ^* 110 ± 1 101 ± 1, ^*** MOS 25 24 ± 1 26 ± 1, ^* 39 ± 2 31 ± 2, ^*** MOS 50 31 ± 1 33 ± 1, ^* 52 ± 2 45 ± 2, ^** MOS 75 42 ± 1 41 ± 1, ^* 59 ± 2 53 ± 3, ^* 6. Attacks of suffocation more than 5 times a day in 20 patients in 17 patients 0 0 less than 5 times a day in 12 patients in 13 patients in 4 patients in 5 patients 7. Histological analysis of polypous tissue of the nose at the biopsy site. The mucous membrane is hyperplastic and polypous changed. Desquamation and squamous metaplasia of the epithelium are noted. In the stroma there are phenomena of edema, blood vessels are dilated. The mucous membrane is hyperplastic and politically changed. Desquamation and squamous metaplasia of the epithelium are noted. In the stroma there are phenomena of edema, blood vessels are dilated. In all patients in the epithelium of the nasal mucosa, there is a tendency to restore its normal plan of structure, in the stroma there is a significant decrease in edema. In all patients in the epithelium of the nasal mucosa, there is a tendency to restore its normal plan of structure, in the stroma there is a significant decrease in edema. Note: ^* - p>0.05; ^** - p <0.01; ^*** - p <0.001 compared with sertide.

As a control, a group of 30 patients with bronchial asthma of an infectious and allergic genesis of moderate severity, combined with polypous rhinosinusitis with intranasal inhalation inhalcort in a single dose of 250 μg, was inspected during inspiration into each nasal passage 2 times a day and the above laser therapy.

The age of the patients was from 27 to 62 years old, all of them were hospitalized in the pulmonology department. All patients underwent a thorough examination before and after the course of treatment: analysis of clinical, laboratory, functional and diagnostic data, as well as a diagnostic biopsy of polypous tissue, followed by histological examination of the material.

Comparative treatment results are presented in the table. It can be seen from the table that after treatment with serotide, polypous tissue was reduced in 30 (93.8%) patients, in 2 (6.2%) patients, single polyps decreased in size in the posterior-upper parts of the ethmoid labyrinth, which did not interfere with free nasal breathing , while in the group of patients receiving intranasally inhacort, polypous tissue was reduced in 27 (90%) patients, single polyps reduced in size and located in the posterior nasal cavity were preserved in 3 (10%) patients. In all patients, taking into account the use of a combined corticosteroid drug, Seretide, which, in addition to its glucocorticosteroid content and a selective, long-acting (up to 12 hours) β ₂ -adrenoreceptor agonist, there was a more rapid relief of asthma attacks and polypous tissue regression occurred 13-14 days from start of treatment than when used alone corticosteroid (e.g., ingakorta) and β ₂ -adrenoceptor agonist, which when applying a positive effect was observed an average of 15-16 days. In all patients who received a helium-neon laser irradiation with parallel use of intranasal sertide, an improvement in bronchial asthma was recorded, which is confirmed by a decrease in the frequency of asthma attacks per day, a significant increase in spirographic indicators of bronchial patency, and a decrease in endotoxicosis compared with intranasal inhacort, . In histological studies of biopsy specimens before and after the course of treatment, polyposis tissue regressed, up to its disappearance in both groups (see drawing).

Claims (1)

A method for the complex treatment of polyposis rhinosinusitis in patients with bronchial asthma, which consists in treating polyposis of rhinosinusitis in patients with bronchial asthma with intranasal use of a glucocorticosteroid drug and irradiation with a helium-neon laser with a wavelength of 630 nm and a radiation power from the distal end of the fiber - 50 mW / cm ² ; externally-cutaneous: nose bridge - 1 min, in the center of the back of the nose - 20 s, at the fossa canina point on both sides for 1 min; intranasally - the light guide is inserted alternately into both nasal passages to a depth of 1 cm, the exposure exposure is 15 s; blood irradiation is carried out by a transcutaneous infusion method, in the region of the ulnar vein, exposure is 15 minutes; the course of treatment is carried out daily for 15 days, characterized in that, simultaneously with the course of laser therapy, the patient receives intranasally inhalation of the combined drug seretide, which contains salmeterol (a selective, long-acting β ₂ -adrenoreceptor agonist) and fluticasone propionate (glucocorticosteroid) at a dose of 25 / 125 mcg, during inspiration, in each nasal passage, twice a day.

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