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COMBINATION THERAPY OF THE BRONCHIAL HYPERRESPONSIVENESS
SOLIEVALISHER UROKOVICH
Bukhara State Medical Institute, assistant professor of the depatment of internal medicine and Endocrinology,
Bukhara. Uzbekistan
ABSTRACT
In a study was included 26 patients with bronchial hyperresponsiveness. They used some course of treatment before combination therapy, wich was inefficient. Patients had next complains: prolonged cough, sometimes nerve-racking cough, wheezing, shortness of breath, frequent inflammation of the upper respiratory ways. The patients' age was between 2 and 56 years, among them - 13 men, 13 women, including 18 children, 8 adults. Patients took singlon or brizezi age-appropriate doses, one in the evening once a day for 10 days. Sometimes, if it is necessary we recommended these drugs for a long time. In patients we use inhalation of 5 ml heparin, furosemide 2 ml, 0.1% -1 ml of atropine sulfate, every other day, in 5 procedure. In patients with chronic cough we used inhalation every day for 10 days. Inhalation was carried out using an ultrasonic nebulizer Albedo IN-7.
After 5 procedure 23 (88.5%) patients did not have a cough or they were very few and they are not affected to the quality of the life of patients. In 2 (7.7%) patients cough decreased to 95%, after 10 procedure. In 1 (3.8%) patient symptoms of bronchial hyperresponsiveness decreases only to 30%. After 5 procedure her night attacks continued, but they were
easier. in 96% patients the results of treatment of the cough was very effective.
In 12 (46%) patients were common dry wheezing in the lung. In patients with bronchial hyperresponsiveness may be a prolonged cough, but dry rales in the lungs had only some of them. In all patients, dry rales in the lungs were removed. 1 patient had a long coughing, night attacks of dyspnea, like a bronchial asthma. But she did not have dry wheezing.
The combined using of antileukotrienes and inhalation of heparin, furosemide, atropine sulfate is an effective and safety method of treatment of the bronchial hyperreactivity in children and adults.
Keywords: bronchial hyperreactivity; cough; anti-leukotrienes; heparin; furosemide; atropine sulfate; Ultrasonic Nebulizer.
КОМБИНИРОВАННАЯ ТЕРАПИЯ ГИПЕРРЕАКТИВНОСТИ
БРОНХОВ
СОЛИЕВ АЛИШЕР УРОКОВИЧ
Бухарский государственный медицинский институт, ассистент кафедры внутренних болезней и эндокринологии.
г.Бухара.Республика Узбекистан АННОТАЦИЯ
В исследовние были включены 26 больных с гиперреактивностью бронхов, раньше принимавших неоднократное лечение, от которого улучшение не наблюдалось. Больные жаловались на длительный кашель, иногда мучительный кашель, свистящие дыхание, одышка, частое простудное состояние. Возраст больных было от 2 до 56 лет, среди них - 13 мужчин, 13 женщин, из них 18 детей, 8 взрослых. Больные принимали синглон или бризези в дозах соответствующих возрасту, вечером 1 раз в день, в течение 10 дней, при необходимости принимали длительно. Больные принимали ингаляцию, в составе которой были 5 мл
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гепарина, 2 мл фуросемида, 0,1%-1 мл атропин сульфата, через день, в 5 сеансов. Больные с затяжным и хроническим кашлем ингаляции принимали каждый день, в течение 10 дней. Ингаляция проводили с помощью ультразвукового ингалятора Альбедо ИН-7.
После 5 сеанса у 23 (88,5%) больных кашля не было почти или были единичными, которые на качество жизни больных не влиял. У 2 (7,7%) больных исчезновение кашля на 95%, наблюдался только после 10 сеанса. У 1 (3,8%) больного уменьшение симптомов гиперреактивности бронхов было достигнуто всего лишь на 30%. После 5 сеанса у нее продолжались ночные приступы, которые были легче по тяжести. 96% больные эффективно избавились от кашля.
У 12 (46%) больных в легких были сухие, распространенные хрипы. У больных с гиперреактивностью бронхов может наблюдаться длительный кашель, но сухие хрипы в легких определяется не у всех. У всех больных были устранены сухие хрипы в легких. У 1 больного был длительный кашель, приступы ночной одышки напоминающие бронхиальной астмы. Но у нее не было сухих хрипов в легких.
Комплексное применение антилейкотриенов и ингаляция гепарина, фуросемида, атропина сульфата является эффективным и безопасным методом лечения гиперреактивности бронхов и у детей, и у взрослых.
Ключевые слова: гиперреактивность бронхов; кашель; антилейкотриены; гепарин; фуросемид; атропин сульфат; ультразвуковой ингалятор.
БРОНХЛАР ГИПЕРРЕАКТИВЛИГИНИ КОМБИНИРЛАНГАН
УСУЛДА ДАВОЛАШ
СОЛИЕВ АЛИШЕР УРОКОВИЧ
Бухоро давлат тиббиёт институти, ички касалликлар ва эндокринология кафедраси ассистенти. Бухоро. Узбекистон.
АННОТАЦИЯ
Бронлар гиперреактивлиги булган 26 та бемор текширишда ;атнашди. Улар олдин бир неча марта даволанган ва ундан самара кузатилмаган. Беморларни узо; давом этувчи йутал, баъзан азоб берувчи йутал, цуштаксимон нафас, цансираш, тез-тез шамоллаш безовта ;илади. Беморлар 2 ёшдан 56 ёшгача эди. Уларнинг 13 тасини аёл, 13 тасини эркак, 18 тасини болалар, 8 тасини катталар ташкил ;илди. Беморлар синглон ёки бризези кеч;урун 1 ма^ал, 10 кун ёки зарур булганда узо; ва;т ;абул ;илишди. Дозаси ёшига мос цолда танланди. Бундан таш;ари беморлар таркибида 5 мл гепарин, 2 мл фуросемид, 0.1%- 1 мл атропин сульфат ингаляция усулида 10 кун давомида ;абул ;илишди. Ингаляция Альбедо ИН-7 аппарати ёрдамида утказилди.
5 ингаляциядан сунг 23 (88.5%) та беморда йутал умуман йу;олди ёки 1-2 та ;олиб, у беморнинг цаёт сифатига таъсир ;илмади. 2 та (7.7%) беморда 10 муолажадан сунггина йутал 95% га камайди. 1 (3.8%) та беморда йуталнинг камайиши фа;атгина 30% га кузатилиди. Ушбу беморда 5 муолажадан сунг цам кеч;урунги хуружлар давом этди. Беморларнинг 96% йуталда йутал самарали бартараф ;илинди. 12 (46%) беморнинг упкасида ;уру; хириллалар ани;ланди. Бронхларнинг гиперреактивлиги булган беморларда йутал кузатилиши мумкин, аммо уларнинг цаммасида цам ;уру; хириллашлар булмаслиги мумкин. 1 та беморда узо; йутал, кеч;урунги цансирашлар булиб, астмага ухшаб
ТЕРАПИЯ
61
кетарди. Аммо унинг упкасида цуштаксимон хириллашлар кузатиламади.
Болалар ва катталарда антилейкотриенлар ва гепарин, фуросемид, атропин сульфатни комбинирланган усулда кууллаш самарали ва хавфсиз усул булиб цисобланади.
Калит сузлар: бронхлар гиперреактивлиги, йутал, анти-лейкотриенлар, гепарин, фуросемид, атропин сульфат, ультра-товушли ингалятор.
In development of bronchial obstruction, the role of the epithelium of the respiratory tract is important. In patients with bronchial asthma, a decrease of the production of bronchodilating factors is detected, due to damage, desquamation of the epithelium, including against the background of a viral infection. Desquamation of the epithelium leads to the exposure of nerve endings, and the influence of inflammatory mediators on them leads to bronchial hyperreactivity and reflex bronchospasm [2].
Cough is the most common symptom of acute respiratory infections (ARI) in children. Of course, coughing is a protective reflex aimed at restoring airway patency. Hyper secretion of viscous mucus, edema and bronchospasm lead to the development of bronchial obstructive syndrome, which worsens the course and prognosis of the disease [4].
In treatment of inflammatory diseases of the upper respiratory tract, local use of medications is great important. The fact is that the drugs, firstly, act directly on the inflammation center; secondly, an optimal concentration of the necessary drug is created in the inflammatory focus and, thirdly, there is no systemic damage.
The effectiveness of inhalation therapy is beyond any doubt. It has a direct effect of drugs on the mucosa of the upper respiratory tract. When
absorbed by the mucous membrane of medicinal substances during inhalation, the whole organism is affected [5].
An important link in the pathogenesis of bronchial obstruction is an increase in the sensitivity and reactivity of the receptor apparatus. Various diseases of the respiratory tract are characterized by different frequency and degree of disturbance of sensitivity and reactivity of the bronchi - [6,3].
In bronchial asthma, bronchoobstructive syndrome (BOS) is the leading symptom complex determining the course and prognosis of the disease [1].
Materials and methods. The study included 26 patients with hyperreactivity of the bronchi who had previously taken repeated treatment, from which no improvement was observed. Patients complained of a prolonged cough, sometimes a painful cough, wheezing, shortness of breath, frequent catarrhal condition. The age of the patients was from 2 to 56 years, among them 13 men, 13 women, 18 of them children, 8 adults. Patients took singlon or breezezi at doses corresponding to age (up to 6 years of 4 mg, 6-12 years at 5 mg, over 12 years at 10 mg), in the evening 1 times a day for 10 days, if necessary, taken for a long time. The patients took inhalation, which included 5 ml of heparin, 2 ml of furosemide, 0.1% -1 ml of atropine sulfate, every other day, in 5 procedures. Patients with a protracted and chronic cough inhalation were taken every day, for 10 days. Inhalation was performed using an ultrasound inhaler Albedo IN-7. In children dose of heparin an furosemide was 1 ml. Atropine sulfate we used in small dose (0,5 ml) too.
Results of the study and discussion.
The duration of coughing is of particular importance with bronchial hyperreactivity. Since, a prolonged cough affects the quality of life of patients. The duration of cough in patients is shown in Table 1.
Table №1. Duration of cough before treatment.
Number of patients Duration of cough% %
12 1 year and more 46
14 to 1 year old 54
3 1 month 11,5
4 2 month 15,4
1 4 month 3,8
2 5 month 7,7
1 10 month 3,8
3 2 weeks 11,5
The data in Table 1 show that almost half of the patients have had a cough for more than a year. This requires the development of effective methods for treating bronchial hyperreactivity.
With auscultation of the lungs, widespread, dry, wheezing rales were observed in 14 (54%) patients. Of these, 9 (64%) were children, 5 (36%) were adults. Sixteen (61.5%) patients had nocturnal coughs. Suffocation was only in 2 (7.7%) patients.
The severity of clinical manifestations of bronchial hyperreactivity, especially cough, in patients after treatment was less. Table 2 shows data showing a decrease of cough dudring the treatment.
Table № 2. Reduction of coughing dudring the treatment.
after 1 after 2 after 3 after 4 after 5 after 10
procedur procedur procedur procedur procedur procedur
es es es es es es
Numbe
r of patient s 6 (23%) 7 (27%) 4 (15,4) 5 (19,2%) 1 (3,8%) 2 (7,7%)
ТЕРАПИЯ 64
%
reducti on of 81,6% 91,4% 85% 91% 95% 95%
cough
After 1 procedures in 6 patient reduction of coughing was 81.6%. After 5 procedures, 23 (88.5%) patients had not a cough or were 1 or two cough, which did not affect the quality of life of patients. In 2 (7.7%) patients, the disappearance of cough by 95%, was observed only after 10 procedures. Patients suffering from cough averaged 3.5 years. In 1 (3.8%) patients, the decrease in the symptoms of bronchial hyperreactivity was achieved only to 30%. The patient suffered from night attacks of asthma for 4 months. Before, she had not had any coughing or suffocation. After 5 procedures, she continued to have night attacks, which were easier in severity. The table 2 shows that, this method was efficient in 96% of patients.
Twelve (46%) patients in the lungs had dry, common wheezing. Patients with bronchial hyperreactivity may had a prolonged cough, but dry wheezing in the lungs is not determined by everyone.
Table №3. Disappearance of dry wheezing in the lungs after inhalation.
after 2 after 3 after 4 after 5 after 8
procedure procedure procedure procedure procedure
s s s s s
Numbe
r of patient 2 (16,7%) 5 (41,6%) 9 (75%) 11 (91,6%) 12 (100%)
s
This table shows dry wheezes were eliminated in 100% patients. One patient had a prolonged cough, attacks of nocturnal dyspnoea resembling bronchial asthma. But she did not have dry wheezing in lungs.
Weakness and tachycardia were observed in 2 (7.7%) patients during the treatment. Weakness was associated with hypokalemia, as a result of side effects of furosemide, and tachycardia was the result of the side effect of atropine.
Conclusion
Complex using of antileukotrienes and inhalation of heparin, furosemide, atropine sulfate is an effective and safe method for treating bronchial hyperreactivity in both children and adults. When weakness and tachycardia appear, furosemide and atropine sulfate is not used. Already after the first procedure, cough decreases, dry wheezing in the lungs disappears, the quality of life of patients improves.
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ТЕРАПИЯ
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