RU2609992C1 - Method for improvement of sputum expectoration - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to pulmonology, and can be applied for treatment of patients with bronchoobstructive diseases to improve sputum expectoration. Complex impact, which includes laser and ultrasonic therapy, carried out at the background of standard therapy, is realized. Ultrasonic therapy is realised on the same day with laser therapy. First, ultrasonic therapy is performed, influencing two paravertebral fields in chest area for two minutes for each. Frequency of vibrations is 880 kHz, intensity is 0.4 W/cm². Then, laser therapy is performed. Device "LASMIC" with matrix laser head ML01K (ML-904-80) is applied. Impact is realised in contact way on five fields: Krenig field on the right, Krenig field on the left, on medium line of area of medium third of sternum, projection of right adrenal gland and projection of left adrenal gland. Each field is exposed to impact for 100 seconds in the following mode: pulse power 50 W, pulse repetition rate: 1 procedure - 80 Hz, 2 procedure - 500 Hz, 3 - 1500 Hz, 4 - 3000 Hz, the remaining procedures - 10000 Hz, on projection of adrenal glands - maximal frequency 3000 Hz. Course of complex impact constitutes 8-10 procedures.

EFFECT: method ensures improvement of sputum expectoration and increase treatment efficiency of patients with bronchoobstructive diseases due to anti-inflammatory, anesthetic, antispasmodic, defibrosing effects, enhancement of microcirculation, achieved by combined application of ultrasonic therapy and laser irradiation.

6 tbl, 2 ex

Description

The invention relates to medicine, namely to pulmonology, and can be used in the treatment of patients with bronchial obstructive diseases (chronic obstructive pulmonary disease (COPD), bronchial asthma, chronic obstructive bronchitis) to improve sputum discharge and increase the effectiveness of treatment of this group of patients.

Known non-pharmacological method for the treatment of bronchial asthma, which also improves sputum discharge due to the use of laser radiation (Chikisheva I.V. Efficiency of low-intensity laser radiation in patients with an infectious-allergic form of bronchial asthma. Author's abstract ... candidate of medical sciences Kharkov, 1987. - prototype ) The course treatment was carried out with the LG-75 helium-neon laser according to the cutaneous technique using various reflexogenic points of the upper body. The exposure for one point is 15 s, the duration of one session is 10 min, the power flux density is 122 mW / s, the sessions are daily, for the course - 10-20 procedures. The laser was used in complex therapy, in particular in combination with glucocorticoid therapy. The results of treatment depended on the degree of the disease. Patients disappeared attacks, coughing, decreased need for bronchodilators, hormonal therapy, improved spirographic and laboratory parameters.

The known method has the following disadvantages.

1. The method was used only in complex anti-inflammatory therapy, which indicates its lack of effectiveness.

2. The criteria for the appointment of laser therapy are not developed.

2. The possibility of side effects associated with the use of glucocorticoid drugs is not ruled out.

4. A sufficiently high power and radiation dose are used, which does not exclude the possibility of side effects of laser exposure.

5. Irrational duration of exposure to one point. The determining time is the exposure time associated with a period of 100 s of propagation of waves of increased concentration of Ca2 + in the cytosol [S.V. Moskvin, “On some errors that impede the development of laser therapy”, M., 2012].

Modern devices manufactured using LASMIK® technology allow you to set the maximum frequency of 10,000 Hz, the most effective in this case. One of the consequences of setting such parameters is the suppression of excessive proliferation, which is sometimes necessary (St. Moskvin, “The effectiveness of laser therapy”, Volume 2, p. 335).

With an increase in the frequency of pulsed lasers, the average radiation power also increases proportionally, which allows affecting deeper areas (Laser therapy in treatment and rehabilitation programs, Clinical recommendations, Moscow, 2015).

In addition, it is known that the use of matrix heads solves the problem of optimizing and controlling the energy density (EP) in the right amount. If you use a single point source of light, then when propagating to a depth, the energy of the laser light is unpredictably scattered. And the deeper the area of influence, the less likely that light energy will reach it.

Ultrasound therapy (ultrasound therapy) is a method of local exposure to ultrasonic vibrations of ultrahigh frequency, carried out using an appropriate emitter, contacted through an ointment base to a specific area of the skin of the patient's body or through an aqueous medium.

Features of ultrasound therapy are associated with a combined effect on the body of mechanical, thermal and physico-chemical factors of exposure to ultrasound. The mechanical factor is caused by alternating acoustic pressure due to the alternation of the zones of compression and discharging of the substance and is manifested in vibrational “micromassage” at the subcellular and cellular levels. The thermal factor is associated with the effect of the transformation of the absorbed energy of ultrasonic vibrations into heat. The physicochemical influence factor is the electrodynamic and subsequent conformational changes in biological structures based on the manifestation of the piezoelectric effect.

The main clinical effects: anti-inflammatory, analgesic, antispasmodic, metabolic, defibrosing (V.E. Illarionov, "Modern methods of physiotherapy", Moscow, 2007).

The presence of these factors and effects in the action of ultrasound has a positive effect on liquefaction and elimination of sputum. Ultrasound also reduces signs of inflammation, fibrosis and overproduction of sputum in the bronchi. Signs of bronchial obstruction are reduced, which generally positively affects the course of bronchial obstructive pulmonary disease.

The combined use of ultrasound and laser radiation leads to a significant increase in the clinical effect. The exposure parameters of these factors correspond to those of traditional application, and at the beginning, a session of ultrasound therapy is carried out, which increases local microcirculation and potentiates the subsequent laser exposure (Nikitin A.V., Esaulenko I.E., Vasilieva L.V. "Laser therapy", Voronezh, 2014).

The problem solved in the present invention is the development of a method aimed at improving sputum discharge.

The technical result achieved is an improvement in sputum discharge and, as a result, an increase in the effectiveness of the treatment of patients with bronchial obstructive diseases, faster remission, lower dosages of the drugs used, minimization of the risk of side effects, and a reduction in the length of hospitalization for exacerbations of the diseases.

The method is as follows.

Patients undergo combination therapy, which includes standard drug therapy, according to modern recommendations, and the combined exposure to ultrasound and an infrared laser (USLT) in one day.

First, ultrasound therapy is performed (for example, using the UZT-101 apparatus) on the chest in two paravertebral fields on the left and right for 2 minutes each. The oscillation frequency of 880 kHz, the intensity of 0.4 W / cm ^{2 the} mode is continuous or pulsed. Patient position - sitting on a chair facing the back of the chair, arms bent at the elbow joints and laid on the back of the chair, chin rests on the hands, continuous or pulsed mode, labile technique, contact method.

A total of 8-10 procedures per day in combination with laser exposure to the infrared spectrum according to the following procedure.

Laser exposure is carried out by the apparatus from the new series of laser physiotherapeutic equipment "LAZMIK", which is able to operate in pulsed mode at a frequency of 10000 Hz.

The new line of laser physiotherapeutic equipment LAZMIK manufactured by the Matrix research center includes several devices (LAZMIK, LAZMIK-VLOK, LAZMIK-01, LAZMIK-02, LAZMIK-03, Agiur). Each of them is capable of operating at a frequency of 10,000 Hz. Differences between them in performance, number of channels.

The matrix laser head ML01K (ML-904-80) with a wavelength of 904 nm, a maximum pulse power of 80 W, and a power density (PM) of 10 W / cm ^{2, is used} . Calculations of energy, which is measured in joules [J or W⋅s], or energy density [J / cm ² or W⋅s / cm ² ] (GOST 8.417-2002) are not carried out, since this information is not necessary to ensure effective laser Therapies (Laser therapy in medical rehabilitation and prophylactic programs, Clinical recommendations, Moscow, 2015).

The impact is carried out in five fields:

1st point - Krenig field on the right,

2nd point - Krenig field on the left,

3rd point - along the midline in the region of the middle third of the sternum,

4th point - projection of the right adrenal gland,

The 5th point is the projection of the left adrenal gland.

Each field is affected for 100 seconds in the following mode: pulse power of 50 watts. Pulse repetition rate: 1st procedure - 80 Hz, 2nd procedure - 500 Hz, 3rd - 1500 Hz, 4th - 3000 Hz, other procedures - 10000 Hz. On the adrenal glands - the maximum frequency of 3000 Hz. The use of LILR on the adrenal gland can increase the production of endogenous glucocorticosteroids (cortisol). This allows you to reduce the signs of inflammation in the bronchi, hyperreactivity, swelling of the mucosa and, as a result, bronchial patency, which positively affects the elimination of sputum from the bronchi.

Procedures for the treatment course 8-10 together with ultrasound therapy according to the above proposed methodology and drug therapy according to modern recommendations.

Monitoring the effectiveness of this method was performed in patients with COPD. A group of patients consisting of 25 people was selected.

To assess the effectiveness of the treatment method, the following research methods were used (general clinical and special):

1. General clinical research (data of objective examination and examination of the patient);

2. Functional research (study of the function of external respiration (HF) with computer fluometry and the calculation of volumetric and velocity indicators; tests with a bronchodilator and measurement of the peak forced expiratory flow rate (PSV) using a peak flow meter) and a 6-CMT test;

3. Laboratory studies (general analysis of blood, urine, sputum examination with determination of its quantity);

4. Biochemical blood test (studies of the cytokine profile: IL-4, IL-8, TNF-α; determination of hormones: cortisol, aldosterone, DHEA-S);

5. The study of the quality of life of patients using the questionnaire SF-36.

We treated a group of 25 patients (main group). The treatment method we developed allowed us to achieve the maximum clinical effect, the amount of sputum to be separated increased both with an objective assessment (the amount of sputum being separated per day) and with a subjective assessment of cough and sputum using YOUR), improved respiratory function, and improved biochemical parameters (increased level cortisol, aldosterone, DHEA-C. There were no side effects.

A comparison of the indicators was carried out with a group of patients consisting of 25 people (control group) who underwent complex treatment according to the technique disclosed in the prototype.

For accurate comparison of the effectiveness of the applied treatment method, the groups of patients were homogeneous in all respects that could affect the outcome of the disease (D.T. Comball, 1968).

A comprehensive clinical and laboratory examination of patients was carried out upon admission to the hospital and on 10-12 days.

The severity of the main clinical symptoms of COPD (shortness of breath, cough, sputum, wheezing, weakness) was assessed using the visual analogue scale YOUR. We measured the distance from the end of the line corresponding to the mark "no symptom" to the mark made by the patient.

The severity of dyspnea was assessed according to the Borg scale and the MRC scale.

YOUR divisions: 10 - unbearably hard due to cough (sputum does not go away); 9 - cough is very strong (sputum practically does not go away); 8, 7, 6 - intense cough (sputum is very difficult to go away); 5, 4 - the cough is intense, but it can be tolerated (sputum is very difficult to leave, several coughing efforts are required); 3 - a pronounced cough, but of moderate severity (sputum goes away moderately, requires repeated coughing attempts); 2 - the cough worries slightly (sputum discharge requires 1-2 coughing efforts); 1 - cough barely bothers (sputum goes away easily); 0 - cough does not bother (no sputum).

Borg scale divisions: 10 - maximum shortness of breath; 9 - very, very severe shortness of breath; 8, 7 - very severe shortness of breath; 5, 6 - severe shortness of breath; 4 - somewhat severe shortness of breath; 3 - moderate shortness of breath; 2 - easy shortness of breath; 1 - very easy shortness of breath; 0.5 - very, very slight shortness of breath; 0 - shortness of breath does not bother.

The patient is invited to make a mark on this line, corresponding to the intensity of the severity of shortness of breath or coughing (explanations made along the line may help. The distance between the beginning of the line (0) and the mark made was measured in cm. The greater this distance, the subjectively harder the patient suffered shortness of breath and cough.

The effect of dyspnea on daily activity was also determined using the MRC scale. MRC scale divisions: 4 - extremely severe shortness of breath; 3 - severe shortness of breath; 2 - average shortness of breath; 1 - easy shortness of breath; 0 - shortness of breath does not bother.

Analysis of complaints showed that upon admission, all patients complained of coughing with difficult to separate viscous sputum, shortness of breath, chest tightness.

The dynamics of clinical status indicators

Having studied the dynamics of clinical indicators in patients with COPD as a result of treatment, a decrease in the frequency of clinical symptoms was observed in all groups: a decrease in the number of coughs, an improvement in sputum removal, and a decrease in shortness of breath. At the same time, in patients of the main group, the severity of the reduction in dyspnea was significantly and significantly greater (p = 0.0012) than in patients in the control group according to the Borg scale and the MRC scale. Shortness of breath decreased from 3.12 ± 0.56 to 1.43 ± 0.58 points (according to the Borg scale), from 2.3 ± 0.11 to 1.02 ± 0.05 points (according to the MRC scale). In the control group, from 3.0 ± 0.07 to 2.1 ± 0.07 points (according to the Borg scale, p = 0.0122), from 2.2 ± 0.07 to 1.9 ± 0.06 points ( according to the MRC scale, p = 0.0386). The decrease in cough was also significant and significantly greater in the main group (p = 0.00153), from 3.26 ± 0.7 to 1.24 ± 0.52 points, whereas in the control group from 2.98 ± 0.65 up to 2.66 ± 0.6 points (p = 0.0983).

Against the background of the therapy, in the main group sputum discharge improved from 2.77 ± 0.14 to 1.62 ± 0.07 points (p = 0.00045). At the same time, in the control group after treatment, the amount of sputum discharge was 2.04 ± 0.09 points (at admission, 2.56 ± 0.10 points), where p = 0.0192. The significance of differences between the main group and the control after treatment is p = 0.012.

When analyzing clinical symptoms in patients of the main group who received a course of ultrasound, there was an improvement in sleep and overall well-being after the 2-3rd procedure; there was also a decrease in shortness of breath, dry cough, liquefaction of sputum and an improvement in its discharge. After the 5-6th procedure, the physical activity of patients increased, sleep improved (p <0.05), relief of coughing attacks - by 2.8 ± 0.3 days (p <0.05); improvement in sputum discharge by 3.2 ± 0.22 days (p <0.05), increased physical activity by 5.2 ± 0.16 days (p <0.01), normalization of sleep by 5.2 ± 0 5 (p <0.05).

Against the background of drug treatment in patients of the control group, the severity of shortness of breath and cough also decreased, however, the time of regression of symptoms was delayed by 5-7 days. Physical activity increased by the end of the course of treatment, sleep did not normalize in more than half of patients.

So, the inclusion of UZLT in the standard complex of therapeutic measures in patients with COPD leads to a more pronounced regression of symptoms and earlier positive dynamics than traditional drug therapy.

The dynamics of laboratory parameters is presented in the table, from which it can be seen that a significant decrease in the number of leukocytes was observed in the group of patients who received ultrasound in complex treatment - by 5.4 × ^{10 9} / l (p <0.05), a decrease in ESR by 12.3 mm w / h (p <0.05).

The study of the amount of sputum released per day was performed upon admission of patients to the hospital and on the 5-6th day of treatment. The results of the study are presented in the table.

The following notation was used in the tables: p ₁ - reliability of the Student criterion between the parameters in patients of the main and control groups on days 4-5, p ₂ - reliability of the Student criterion between the indicators in patients of the main and control groups on 10-12 days; p * - the reliability of the student criterion between the initial and final indicators in each group.

Patients' quality of life was assessed using the SF-36 questionnaire and the CAT (COPD Assessment Test). The results of the study showed a significant decrease in physical (28.5 and 26.4) and social (25.4 and 23.8) activities, limitation of life by physical (31.2 and 33.8) and emotional problems (11.3 and 15, 8). Due to their physical condition, patients were limited in performing certain types of work, could not perform work for a long time. A very low mental component was noted in the group of patients (42.3 and 41.0).

Decreased tolerance of physical activity, constant fear associated with a difficult act of breathing, and dependence on drugs and living conditions reduced the quality of life and prevented spending time in a familiar environment and reduced vitality, general health (43.5 and 41.8).

The CAT (COPD Assessment Test) is an additional tool for QOL research, which allows you to evaluate the impact of COPD on the health status of patients. The simplicity of its filling, brevity and ease of use suggest that he will be able to identify those aspects of the manifestations of the disease that are poorly reflected by instrumental research. The CAT questionnaire consists of eight pairs of statements that are opposite relative to each other. Answers to 8 questions related to cough, sputum, chest compression, shortness of breath, daily activities, confidence outside the home, sleep, energy, as well as the total score were evaluated depending on the degree of influence on the quality of life.

Analysis of the CAT test data showed that before treatment no significant differences in the indices between patients were revealed. After treatment, an improvement in CAT values was revealed compared with the initial data in all the studied groups (p <0.05). The CAT test indices decreased from 23.55 ± 0.46 to 17.5 ± 0.67 in the main group, from 24.18 ± 0.47 to 20.34 ± 0.76 in the control group.

Thus, the most pronounced positive dynamics of the CAT test was in the main group. Therefore, the application of the proposed method leads to a more pronounced improvement in the quality of life in patients.

With the improvement of the condition of patients during treatment, the need for short-acting bronchodilators decreased, which allowed to reduce single and daily doses. Initially, almost 100% of patients received short-acting bronchodilators, by the end of the course of treatment, against the background of the application of the proposed method, the volume of drugs decreased by 67.2% (main group), by 52.4% in the control group.

Under the influence of laser therapy, a significant decrease in all systemic biomarkers IL-4, IL-8 and TNF-2 was observed and it was more pronounced than in the compared groups. The concentration of IL-4 decreased by 1.86 pg / ml (p * <0.05), whereas after drug therapy the decrease was 0.4 pg / ml (p *> 0.1) and 0.5 pg / ml

An analysis of the treatment results showed an increase in physical activity from 28.5 (20.3; 31.8) to 34.2 (31.3; 36.4) points (p * <0.05), a significant increase in overall health to 28.5 (26.3; 30.8) (p * <0.05) and viability up to 46.6 (43.8; 49.5) (p * <0.05) in the group of patients who received complex laser therapy treatment. At the same time, social activity and mental health remained practically unchanged.

The overall state of health also significantly improved in the compared groups of patients who received drug therapy and a “placebo” procedure, but it was significantly lower - up to 25.3 (24.7; 27.8) and 24.8 (23.1; 26, 5) (p * <0.05), respectively.

Example 1

Patient S., 58 years old, was admitted to the pulmonology department of City Clinical Hospital No. 20 on September 15, 2015 with a diagnosis of COPD - stage II, bronchitis type, exacerbation. NAM II.

Upon admission to the hospital, he complained of a persistent, persistent cough during the day, aggravating in the morning, with difficult to separate yellow phlegm about 10 ml per day, shortness of breath when walking, fever up to 38-39 ° С, general weakness, malaise, heart attacks. The patient suffers from COPD for 15 years with periodic exacerbations 3-4 times a year. Attacks of difficulty breathing relieves by inhalation. Deterioration 5 days ago after hypothermia. Smokes 36 years 15-20 cigarettes a day. For 26 years he worked as a molder in a hot shop. The father had bronchial asthma, the mother had chronic bronchitis.

Objectively: general state of moderate severity. Consciousness is clear. The physique is correct, hypersthenic. Height - 174 cm, weight - 86 kg, BMI - 28 kg / m, chest circumference - 97 cm. The skin is pale, moist, diffuse cyanosis. Pastosity of the feet and legs. The chest is symmetrical, cylindrical, painless on palpation, weakly involved in the act of breathing. Dry, buzzing and wheezing rattles are heard auscultatively over the lungs in all fields, in the posterior regions, wet small-bubbling wheezes, the exhalation is elongated. With percussion of the lungs - a pulmonary sound with a boxed tint. NPV - 24 per minute. Pulse - heart rate = 84 per minute, rhythmic, satisfactory qualities. Heart sounds are rhythmic, deaf. In case of percussion of the heart, the boundaries of relative cardiac dullness are: right - along the right edge of the sternum, upper - upper edge of the III rib, left - 1 cm outward from the left midclavicular line. HELL - 155/95 mm Hg The abdomen is enlarged due to ascites, palpation is intense, painless, the liver is not detected by palpation, percussion 1 cm below the edge of the costal arch. Stool and urination without features. Your cough self-assessment according to YOUR - 8 points, shortness of breath - 5 points.

FEV ₁ - 47.37% of the due; PSV - 36% of what is due.

Complete blood count: erythrocytes - 4.8 × 10 ¹² / l, hemoglobin - 151 g / l, color indicator - 0.9, hematocrit - 48%, white blood cells - 16.8 × 10 ⁹ / l, stab neutrophils - 11% , segmented neutrophils - 61%, eosinophils - 3%, monocytes - 6%, lymphocytes - 19%, platelets - 254 × 10 ⁹ / l, ESR - 21 mm / hour. Urinalysis - without pathology. Blood cytokines level: IL-4 - 3.2 pg / ml; IL - 8 - 20.8 pg / ml, α-TNF - 226 pg / ml.

Hormone content: cortisol 85.6 nMol / l, aldosterone 148.4 nMol / l,

DHEA-S - 4.2 μmol / L, SaO ₂ = 92%. Sputum analysis: color - yellow, consistency - purulent, the total number of leukocytes - 8.5 × 10 ⁶ / ml, neutrophils - 44.2%, eosinophils - 1%. Sputum culture gave rise to Streptococcus pneumonia. ECG: sinus rhythm, heart rate - 76 per minute, EOS is shifted to the right, moderate changes in the myocardium are moderate.

Chest x-ray. Conclusion: signs of moderate stagnation in the lungs, the pulmonary pattern is deformed, enriched, the roots are unstructured, the sinuses are free, pulmonosclerosis, the borders of the heart shadow are widened across.

Spirometry: VC of inspiration - 68.32% of the due, FVC - 64.28 of the due, FEV ₁ - 46.18 of the due, FEV ₁ / FVC - 58.41% of the due, PSV _vyd - 44.12% of the due MOS ₂₅ - 22.18% of the proper MOS ₅₀ - 18.48% of the proper MOS ₇₅ - 28.12% pred. FEV ₁ after inhalation of 400 μg of salbutamol - 48.26% of the due. Conclusion: sharp violations of bronchial patency; a test with a bronchodilator is negative, an increase in FEV ₁ is 100 ml.

The patient was prescribed treatment: ceftriaxone 2.0 g intramuscularly 1 time per day, acetylcysteine orally 200 mg 3 times a day, inhalation with lazolvan, tiotropium bromide 18 mcg 1 time per day inhalation, oxis 9 mcg 2 times a day, combined with ultrasound and laser therapy according to our developed technique.

On the 6th day of treatment, the patient's well-being improved: body temperature returned to normal, cough decreased (YOUR cough is 5 points), the amount of sputum being separated increased to 30-40 ml per day. YOUR shortness of breath 4 points. Objectively: Acrocyanosis of the skin, a decrease in the frequency of respiratory movements - 20 per minute, with auscultation of the lungs scattered, dry, wheezing and buzzing were heard. In peripheral blood, the level of leukocytes (10.0 × 10 ⁹ / L), neutrophils (57%) decreased, ESR decreased to 12 mm / h; the concentration of interleukins decreased: IL-4 to 3.0 pg / ml, IL-8 to 18.8 pg / ml, TNF-α to 125.4 pg / ml. SaO ₂ = 94%. Sputum of a mucous nature, the total number of leukocytes decreased to 6.8 × 10 ⁶ / ml, neutrophils to 32%. FVD indicators improved: VCI of inspiration - 76.8% of the due, FVC - 72% of the due, FEV ₁ - 52.4% of the due, FEV ₁ / FVC - 62% of the due, PSV _vyd - 52% of the due, MOS ₂₅ -24.64% of the due, MOS ₅₀ - 22.12% of the due, MOS ₇₅ - 40.64% of due. FEV ₁ after inhalation of 400 μg of salbutamol - 58.4% of the due.

Conclusion: sharp violations of bronchial patency; a test with a bronchodilator is negative, an increase in FEV ₁ is 160 ml. On the 12th day the patient was discharged.

Example 2

Patient K., 58 years old, was admitted to the City Clinical Hospital No. 20 on 05/10/09, with a diagnosis of Chronic obstructive pulmonary disease, art. II, exacerbation. Pulmosclerosis. DN 2.

Upon admission, she complained of shortness of breath, chest congestion, cough with sputum difficult to separate about 10 ml per day.

From the anamnesis it is known that over the past 2 years it has been using a long-acting bronchodilator formoterol 10 mg, as well as a short-acting anticholinergic drug - ipratropium bromide up to 5 times a day. Notes 4 exacerbations of the disease over the past year.

Objectively: The condition is satisfactory. Consciousness is clear. The position is active. Patient normosthenic physique. The skin and visible mucous membranes are clean, moist, pink in color. NPV-22 per minute. In the distance, wheezing is heard. The chest is emphysematous. Percussion determined a clear pulmonary sound with a boxed tint across all fields of the lungs. Auscultation-weakened vesicular breathing, dry wheezing is heard in all fields of the lungs, the exhalation is elongated. AD-135/80 mmHg Ps = heart rate = 92 per minute, satisfactory filling and voltage. Heart sounds are rhythmic, muffled. Laboratory data: General blood test at admission: Red blood cells - 3.5 × 10 ¹² , hemoglobin - 132 g / l, white blood cells - 13.8, lymphocytes - 18%, eosinophils - 8%, stab neutrophils - 5%, segmented neutrophils - 72%, monocytes - 6%, ESR - 18.0 mm / h. In the study of HPF: VC - 52.2%; FVC - 57.2%; FEV1 - 45.4%; FEV1 / VC - 65.8%; PEF - 38.2%; MEF ₂₅ - 37.4%; MEF ₅₀ - 36.4%; MEF ₇₅ - 45.2.

The patient was prescribed the combined drug formoterol / budesonide 160-320 mg, as well as a course of ultrasound and laser therapy according to the proposed technique.

As a result of treatment, they decreased on day 5: shortness of breath, cough, sputum discharge improved (up to 30 ml per day). Objectively: the general condition improved, NPV - 20 per minute, Ps = heart rate = 90 per minute, satisfactory filling and voltage, blood pressure = 130/90 mm Hg. Auscultatory-weakened vesicular, single dry rales in the upper parts of the lungs remain. In the general analysis of blood: red blood cells - 3.8 × 10, hemoglobin - 130 g / l, white blood cells - 7.8; lymphocytes - 18%, eosinophils - 7%, stab neutrophils - 5%; segmented neutrophils - 72%, monocytes - 6%, ESR - 12.0 mm / h. In the study of HPF: VC - 76.2%; FVC - 70.0%; FEV1 - 78.4%; FEV1 / VC - 72.8%; PEF - 64.6%; MEF ₂₅ - 52.7%; MEF ₅₀ - 64.1%; MEF ₇₅ - 59.2%. By the end of the course of treatment, by the 10th procedure (12th day of hospital stay), the general condition of the patient improved significantly: shortness of breath disturbed only during physical exertion, the feeling of congestion in the chest disappeared, coughing, headaches stopped. Objectively: NPV - 18 per minute, Ps = HR = 78 per minute, rhythmic, satisfactory filling and voltage, BP = 130/80 mm Hg With auscultation, vesicular breathing is weakened, there are no wheezing. Heart sounds are rhythmic, muffled. In the general analysis of blood: red blood cells - 3.5 × 10 ¹² , hemoglobin - 132 g / l, white blood cells - 7.0%; lymphocytes - 27%, eosinophils - 5%, ESR - 5.0 mm / h. In the study of HPF: VC - 86.4%; FVC - 84.0%; FEV1 - 85.4%; FEV1 / VC - 87.8%; PEF - 86.6%; MEF ₂₅ - 75.2%; MEF ₅₀ - 79.0%; MEF ₇₅ - 65.8%.

Claims (1)

A method for improving sputum discharge, including laser therapy with standard therapy, characterized in that ultrasound therapy is additionally carried out on the same day as laser therapy, and ultrasound therapy is first performed, affecting two paravertebral fields in the chest area for 2 minutes each, with an oscillation frequency of 880 kHz, an intensity of 0.4 W / cm ² , then carry out laser therapy using the apparatus "LAZMIK" with a matrix laser head ML01K (ML-904-80), the effect of contact in five fields: the Krenig field on the right, the Krenig field on the left, in the midline in the middle third of the sternum, the projection of the right adrenal gland and the projection of the left adrenal gland, each field is affected for 100 seconds in the following mode: pulse power 50 W, pulse repetition rate: 1st procedure - 80 Hz, 2nd procedure - 500 Hz, 3rd - 1500 Hz, 4th - 3000 Hz, other procedures - 10000 Hz, on the projection of the adrenal glands - maximum frequency 3000 Hz, the course of the complex effect is 8 -10 treatments.