RU2622610C1 - Method for regenerative treatment of patients with bronchial asthma and obesity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: basic therapy is carried out and electric stimulation is performed transcranially by pulsed current with pulse width of 4-5 ms, frequency of 76 Hz, amperage from 0.5 mA to 2.75 mA. Procedure duration is 30 minutes. The course of treatment consists of 10 daily treatments in the morning. At that, starting from the second procedure, the current strength is increased by 0.25 mA and duration of each subsequent treatment is increased by 1 minute.

EFFECT: method allows to improve the rehabilitation treatment efficiency and to increase the remission period, which is achieved by the developed mode of transcranial electrostimulation.

4 cl, 3 tbl, 3 ex

Description

The invention relates to medicine, namely to pulmonology and physiotherapy, and is intended for the treatment of patients with bronchial asthma (BA) associated with obesity.

The Global Initiativefor Asthma - GINA (2011 revision) program considers obesity as a factor affecting the development and severity of AD symptoms.

Sanatorium-resort treatment has a significant positive effect in the rehabilitation of AD patients. However, when prescribing therapeutic measures for asthmatic patients in a sanatorium, as a rule, they do not take into account their obesity, which reduces the effectiveness of the procedures used and prevents the achievement of full control over asthma. The applied methods of reconstructive treatment of AD are insufficient when combined with obesity, which leads to an increase in the activity of systemic inflammation and impaired immune system [Mineev V.N., Lalaeva T.M. Bronchial asthma, obesity and adipokines // Doctor. 2011. No4. S. 53-56; Phenotype of bronchial asthma with obesity / V.N. Mineev [et al.].

The effect on the human body of transcranial electrical stimulation (TPP), which has analgesic, reparative, sedative effects, is known. In obesity under the influence of TPP, stimulation of the production of endogenous opioid peptides (endorphins, serotonin) occurs, the increase in the concentration of which contributes to the normalization of psychophysical status, increase resistance to stress, uncontrolled drives, reduce the need for food as in external "stimulation" [Lebedev V.P. Development and justification of the therapeutic use of transcranial electrical stimulation of the brain's defense mechanisms using the principles of evidence-based medicine / V.P. Lebedev, V.I. Sergienko //

Transcranial electrical stimulation: Sat. scientific labor. - St. Petersburg, 1998. - S. 11-68].

It was found that TPP in the mode of analgesia helps to reduce the allergic manifestations of the disease. The main link in the mechanism for implementing these effects is opioidergic (production of opioid peptides). The revealed immunotropic effects of TPPs made it possible to use this method to correct immune disorders in certain diseases, including AD, because the course of AD is associated with various allergic manifestations [Rubtsovenko A.V. Immunotropic effects of transcranial electrical stimulation. // Abstract. Cand. Diss., Krasnodar, 1996, 21 pp.].

However, existing publications regarding the use of TPP in AD are of a scientific and informational nature and do not regulate specific treatment conditions, duration and strength of exposure, and do not take into account the presence of concomitant diseases.

The objective of the invention is to create a new method of rehabilitation treatment of patients with bronchial asthma with obesity, which will improve the effectiveness of rehabilitation treatment and increase the period of remission by improving the function of external respiration, reducing inflammation of the bronchi, reducing body weight, normalizing immune status, lipid metabolism by applying transcranial electrical stimulation against the background of basic therapy with inhaled glucocorticosteroids (IHC).

To solve this problem, a method for the rehabilitation treatment of obese patients with obesity has been developed, including basic therapy, an electro-stimulating effect on the head area, in which, according to the invention, the effect is transcranially pulsed with a pulse duration of 4-5 ms, a frequency of 76 Hz, and a current of 0 , 5 mA, increasing it by 0.25 mA to 2.75 mA to the final procedure,

the duration of the procedure is 20-30 minutes, a course of 10 procedures daily in the morning. In this case, the transcranial effect is carried out at the position of the electrodes: the negative is located in the region of the superciliary arches, the positive - on the mastoid processes. The duration of each subsequent procedure is increased by 1 minute. For TES-therapy, the Transair apparatus is used.

The technical result of the invention lies in the fact that a method of reconstructive treatment of obese patients with asthma was created, which allows to increase the effectiveness of reconstructive treatment and increase the period of remission by improving the function of external respiration, reducing inflammation of the bronchi, reducing body weight, normalizing immune status, and lipid metabolism by applying transcranial electrical stimulation, which provides positive effects, against the background of basic therapy of IGCS. The method can be used in the conditions of spa treatment.

Since the entire set of essential features of the claimed invention is not identified from the prior art, then, according to the applicant, it meets the criteria of the invention of "novelty."

The claimed technical solution, according to the applicant, meets the criteria of the invention of "inventive step", because as a result of studies in relation to the prior art, no solutions have been identified that have features that match its distinctive features.

The claimed technical solution meets the criteria of the invention of "industrial applicability", since it can be used in health care for the specified purpose.

The study of the proposed method was carried out by the applicant in the sanatorium conditions of the Primorsky Territory (sanatorium "Ocean" of the RF Ministry of Defense). The study involved 39 obese patients with obesity aged 20 to 65 years.

All patients received basic therapy of IGCS, standard spa treatment for 21 days, including therapeutic hypoallergenic nutrition, dosed walking, therapeutic exercises, speleotherapy in a sylvinite speleotherapy clinic, local physiotherapy with concomitant pathology.

Patients of the main group (20 people) additionally received TES therapy. Patients in the control group (19 people) received only basic therapy of IGCS and standard spa treatment. Patients of both groups had asthma of mild to moderate severity of a controlled and partially controlled course associated with alimentary-constitutional obesity of the I-II degree.

The examination of patients included an assessment of clinical, laboratory and functional indicators before and after a course of spa treatment:

1) asthma control assessment based on the results of an asthma control test (Asthma ControlTest ™ - ACT ™);

2) assessment of the clinical symptoms of AD (shortness of breath, feeling of suffocation, chest tightness, cough with viscous sputum) using a 10-point visualized analogue scale;

3) a study of the function of external respiration (HFD) according to the generally accepted methodology with an assessment of the vital capacity of the lungs - VC, forced vital capacity of the lungs - FVC, volume of forced expiration for 1 second - FEV1, Tiffno index - FEV1 / VC, growth of FEV1 after bronchodilator samples

4) a study of biochemical laboratory parameters - lipid, carbohydrate and protein metabolism;

5) assessment of immunological parameters of cellular and phagocytic immunity.

The method is as follows

A patient receiving basic therapy of IGCS (Seretide) is prescribed TES therapy in the morning, since the procedure is most effective in the first half of the day. In sanatorium-resort conditions, TPP therapy is prescribed after a period of adaptation (2-3 days after admission to the sanatorium).

The patient is laid on the couch in a supine position. The negative electrode is located in the area of the superciliary arches, the positive - behind the ears on the mastoid processes. The impact is carried out by rectangular bipolar pulses with a duration of 4-5 ms, a frequency of 76 Hz, the value of the therapeutic current from 0.5 mA (apparatus "Transair"). Procedures lasting 20-30 minutes are carried out daily with an increase in current strength with each subsequent procedure by 0.25 mA. There are 10 procedures per course. The current strength in the last procedure is 2.75 mA.

The duration of the procedure for more than 30 minutes is impractical due to the achievement of the desired result (task), and less than 20 minutes is insufficient for adequate exposure.

The course of procedures begins with 20 minutes, increasing the duration of each subsequent procedure by 1 minute, which contributes to better compliance (adherence) to the procedure at the beginning of treatment and a more pronounced effect at the end of treatment.

The dynamics of the survey data of the control and main groups are shown in tables 1-3:

table 1 - the dynamics of the clinical and functional parameters of patients with AD with obesity;

table 2 - the dynamics of biochemical parameters of patients with AD with obesity;

table 3 - the dynamics of cellular immunity in patients with AD with obesity.

At the end of the course, the effectiveness of treatment in all patients was regarded as improvement. Nevertheless, in BA patients of the main group, the regression of clinical symptoms was more pronounced, as evidenced by the AST test data. The AST test indicators reached the maximum figures in patients receiving TPP. The positive effect of TPP was also noted when comparing the dynamics of the parameters of the function of external respiration. According to spirography data, patients with the main group increased FVC, FEV1 by 17% and 22%, respectively, in the control group by 9% and 7%. Peak flowmetry indicators in BA patients of the main group returned to normal in 100% of cases, in the control group - in 90%. The decrease in body weight, which was accompanied by a significant decrease in waist circumference, was more significant in patients of the main group and averaged 4.5 kg, and in the control group - 3.3 kg.

When studying the parameters of the blood lipid spectrum, the positive dynamics was characterized by a significant decrease in the level of total cholesterol (OX), the atherogenic coefficient (KAt). The lipid-correcting effect in the main and control groups did not have significant differences, which

due to diet and rational exercise. However, only in patients receiving TES-therapy did the cholesterol level of low density lipoproteins (CLLP) and triglycerides (TG) significantly decreased by 17% and 28%, respectively, p <0.05. The concentration of glucose in the blood also significantly decreased in patients of this group (by 28%, p <0.05).

A comparative analysis of cellular immunity indices in obese AD patients receiving TES revealed a significant increase in the level of T-lymphocytes by 13% due to an increase in the level of T-helper cells by 20%, an increase in the immunoregulatory index CD4 ⁺ / CD8 ⁺ , indicating the direction of the immunological process " activation-suppression "by 22%. A decrease in the level of CD-markers of B-lymphocytes was observed in all patients. which can be regarded as an indicator of a decrease in allergic manifestations.

When assessing long-term results in patients of the main group, the frequency of exacerbations significantly decreased, and the period of remission increased.

Example 1

Patient K., 52 years old, Diagnosis: Asthma, moderate, controlled. Alimentary-constitutional obesity 2 tbsp.

On admission, she complained of a dry nagging cough, daytime suffocation attacks more than 2 times a week, at night up to 2 attacks per month, shortness of breath in the interictal period, shortness of breath.

The patient received basic therapy: Seretide 50/500 at 1 dose 2 times a day, mode 2, diet 8, dosed walking, speleotherapy, TES-therapy were performed.

On admission: height - 156 cm, weight - 92 kg, IR 37, OT - 115 cm, OB - 130 cm, Blood pressure 130/80 mm RT. Art., pulse 76 beats. in minutes, there are symptoms of respiratory failure 1 tbsp.

Spirography indicators before treatment: VC 1.88 L (62% of the norm), FEV ₁ 1.33 L (55% of the norm). There are signs of ventilation failure.

Biochemical blood parameters before treatment: OH 6.2 mmol / L (normal up to 5.17 mmol / L), TG 2.1 mmol / L (normal up to 1.7 mmol / L), HLPVP 1.37 mmol / l (with a norm of more than 1.2 mmol / l in women), CLPNP 3.88 mmol / l (with a norm of up to 3.0 mmol / l), blood sugar 5 mmol / l, CRP 15 (with a norm of up to 5).

Indicators of cellular immunity: T-lymphocytes (CD3 ⁺ ) 66.63%; T-helpers (CD4 ⁺ ) 45.84%; T-suppressors (CD8 ⁺ ) 18.29%; immunoregulatory index (CD4 / CD8) 2.51; B-lymphocytes (CD 19 ⁺ ) 11.72%.

After the adaptation period, on the second day of the stay in the sanatorium, the patient was given TES therapy with the TRANSAIR-3 apparatus according to the indicated method. After the 4th session, cough decreased, shortness of breath, mood and sleep improved. After the 6th session, a "sense of flight" appeared, a decrease in body weight of 3 kg was noted. At the end of the course of procedures, the symptoms of dry coughing and shortness of breath stopped, daytime suffocation attacks and no attacks occurred at night. Body weight decreased by 5 kg. I did not use short-acting bronchodilators (inhaled ventolin). As a basic therapy, he continues to receive Seretide 25/250 at 1 dose 1 time per day. At discharge: height - 156 cm, weight - 87 kg, IR 35.8, OT - 109 cm, OB - 126 cm, Blood pressure 120/70 mm RT. Art., pulse 72 beats. in minutes, day 0 tbsp.

Spirography indicators after treatment: VC 2.08 L (73% of the norm), FEV ₁ 1.63 L (67% of the norm). No signs of ventilation failure.

At the same time, an improvement in lipid metabolism was observed: OH decreased to 5.9 mmol / L, TG to 1.8 mmol / L, HLPNP to 3.5 mmol / L.

From the side of cellular immunity indicators: the level of T-lymphocytes increased by 15% due to T-helpers (by 20%), immunoregulatory index by 22%. The number of b-lymphocytes decreased by 15%. According to the totality of clinical and paraclinical data, the effectiveness of treatment, including the claimed method, was rated as a significant improvement. During the year, exacerbations of the disease did not occur. AD was a stably controlled course.

Example 2

Patient G., 61 years old, Diagnosis: Bronchial asthma, persistent moderate severity, partially controlled. Alimentary-constitutional obesity 2 tbsp. Hypertension 2 tbsp.

Upon admission, she complained of day and night attacks of suffocation more than 2 times a week, dry coughing, difficulty breathing in the interictal period, shortness of breath with difficulty breathing. Increased blood pressure to 160/100 mm RT. Art. The patient received basic drug therapy: Seretide 50/500 at 1 dose 2 times a day, if necessary - 1-2 ventolin inhalations. Antihypertensive therapy - Prestarium 10 mg 1 time per day. Mode 2, diet 10, dosed walking, speleotherapy, TES-therapy were carried out.

On admission: height - 160 cm, weight - 92 kg, IR 35.9, OT - 110 cm, OB - 127 cm, there are symptoms of respiratory failure 1 tbsp. HELL 150/90 mm Hg In terms of spirography - VC 2.06 liters (58% of the norm); FEV ₁ 1.48 L (52% of the norm), there are signs of ventilation failure. Blood biochemical parameters: OH 7.1 mmol / L (with the norm up to 5.17 mmol / L), TG 2.9 mmol / L (with the norm up to 1.7 mmol / L), HLPVP 1.0 mmol / L ( with a norm of more than 1.2 mmol / l in women), CLLPP of 3.6 mmol / l (with a norm of up to 3.0 mmol / l), blood sugar 6.7 mmol / l (with a norm of 6.2 mmol / l) , CRP 10 (at a rate of up to 5).

Indicators of cellular immunity: T-lymphocytes (CD3 ⁺ ) 58.45%; T-helpers (CD4 ⁺ ) 41.66%; T-suppressors (CD8 ⁺ ) 18.15%; immunoregulatory index (CD4 / CD8) 2.30; B-lymphocytes (CD 19 ⁺ ) 13.71%.

After the period of adaptation on the third day of stay in the sanatorium, the patient received TES therapy with the TRANSAIR-3 apparatus according to the described procedure. After the third procedure, a headache appeared in the parietal region of a pressing nature. Control of blood pressure 130/85 mm RT. Art. Assigned sedative therapy (T. Validoli), after 15 minutes the pain stopped. In the following procedures, the patient did not show complaints, the blood pressure numbers stabilized in the range of 120-130 / 80 mm Hg. Art. Reduced weight. After treatment according to the claimed method, dry coughing and shortness of breath, daytime and

night attacks of suffocation did not occur. The body weight decreased by 5.5 kg. Blood pressure decreased, taking antihypertensive drugs decreased 2 times. Does not use bronchodilators of short action. As a basic therapy, he continues to receive Seretide 25/250 at 1 dose 1 time per day.

At discharge: height - 160 cm, weight - 86.5 kg, IR 33.8, OT - 105 cm, ABOUT - 124 cm, HELL 120/70 mm RT. Art., pulse 72 beats. in minutes, day 0 tbsp.

Spirography indices without signs of ventilation deficiency, an improvement in the blood lipid spectrum was observed due to a decrease in the level of OH, TG, and LDL. Significantly improved indicators of cellular immunity. Based on the totality of clinical and paraclinical data, treatment effectiveness was rated as improvement. Over the next year, BA was a steadily controlled course.

Example 3

Patient L., 53 years old, Diagnosis: Bronchial asthma, mixed form, mild persistent course. Alimentary-constitutional obesity 1 tbsp.

Upon admission, he complained of daily attacks of suffocation up to 2 times a week, dry coughing, difficulty breathing in the interictal period, mixed dyspnea. Berodual received 1 dose once a day as a basic therapy, regimen 3, diet 8, dosed walking, speleotherapy, TES-therapy were carried out.

On admission: height - 179 cm, weight - 100 kg. IK 32, OT - 112 cm, OB - 120 cm, there are symptoms of respiratory failure 1 tbsp. HELL 140/80 mm RT. Art. In terms of spirography before treatment, there are signs of obstruction at the level of small and medium bronchi. Blood biochemical parameters: OH 5.7 mmol / L, HLPNP 3.8 mmol / L, HLPVP 0.84 mmol / L, CA 5.8, CRP 5.

Indicators of cellular immunity: T-lymphocytes (CD3 ⁺ ) 61.43%; T-helpers (CD4 ⁺ ) 43.12%; T-suppressors (CD8 ⁺ ) 21.65%; immunoregulatory index (CD4 / CD8) 2.0; B-lymphocytes (CD 19 ⁺ ) 14.11%.

After the period of adaptation, on the third day of his stay in the sanatorium, the patient received TES therapy with the TRANSAIR-3 apparatus according to the described procedure. After the 6th procedure, with a current of 2 mA, lightness appeared, which manifested itself in a decrease in shortness of breath and cough. Body weight decreased by 2.5 kg. At the end of the course of treatment, the symptoms of dry coughing and shortness of breath stopped, and asthma attacks did not occur. She notes that the feeling of fullness comes faster, the eaten portions have decreased. I lost 4.5 kg. In terms of spirography, there are no signs of ventilation failure. Blood biochemical parameters: OH 5.0 mmol / L, HLPNP 3.1 mmol / L, HLPVP 0.9 mmol / L, KAT 4.6, CRP 0.

From the side of cellular immunity indicators: the level of T-lymphocytes increased by 15%, due to T-helpers (by 22%), the immunoregulatory index increased by 17%. The number of b-lymphocytes decreased by 20%. According to the totality of clinical and paraclinical data, the effectiveness of treatment, including the claimed method, was rated as a significant improvement. During the year, exacerbations of AD did not occur.

Thus, the developed method allows to increase the effectiveness of rehabilitation treatment and control over the course of bronchial asthma associated with obesity.

Claims (4)

1. The method of rehabilitation treatment of patients with obesity bronchial asthma, including basic therapy, an electrostimulating effect on the head region, characterized in that the electrostimulating effect is carried out by a pulsed current transcranially with a pulse duration of 4-5 ms, a frequency of 76 Hz, a current strength of 0.5 mA up to 2.75 mA, the duration of the procedure is 20-30 minutes, a course of 10 procedures daily in the morning, while starting from the second procedure, the current strength is increased by 0.25 mA. 2. The method according to p. 1, characterized in that the transcranial effect is carried out at the position of the electrodes: the negative is located in the region of the superciliary arches, the positive is on the mastoid processes. 3. The method according to p. 1, characterized in that the duration of each subsequent procedure is increased by 1 minute. 4. The method according to p. 1, characterized in that the transair apparatus is used for transcranial therapy.