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УДК 616.248-07:616.21/233-099.812
Ганиев Абдурашид Ганиевич
доцент кафедры госпитальной
педиатрии Андижанского государственного
медицинского института. г. Андижан, Узбекистан
Назаров Комил Дадаевич
доцент кафедры госпитальной педиатрии
Ургенчского филиала Ташкентской
медицинской академии. г. Ургенч, Узбекистан
КОМПЛЕКСНОЕ ЛЕЧЕНИЕ БРОНХИАЛЬНОЙ АСТМЫ У ДЕТЕЙ С ИСПОЛЬЗОВАНИЕМ РЕЗИСТОЛА
For citation:
Ganiev A.G., Nazarov K.D. Сomprehensive treatment of bronchial asthma in Children using resistol. Journal of cardiorespiratory
research. 2020, vol.3, issue 1, pp.55-58
http://dx.doi.org/10.26739/2181-0974-2020-3-11
АННОТАЦИЯ
Нами обследовано, 78 детей с различной степенью тяжести бронхиальной астмы в возрасте от 6-14 лет. Первая группа больных,
получавшие стандартную базисную терапию и таблетку плацебо (n=35); вторая группа больных (n=43), получавшие наряду с
аналогичным спектром базисной терапии был назначен препарат «Резистол» по схеме. Комбинированное использование
противовоспалительных препаратов и Резистола дает выраженный эффект в плане улучшения клинического состояния детей,
нормализации иммунологических, лимфоцитарных показателей у больных бронхиальной астмой.
Ключевые слова:
бронхиальная астма у детей, иммунология, Резистол.
Ganiev Abdurashid Ganievich
Associate Professor, Department
of Hospital Pediatrics, Andijan State
Medical Institute. Andijan, Uzbekistan
Nazarov Komil Dadaevich
associate professor of the department
of hospital pediatrics, Urgench branch
of the Tashkent Medical Academy. Urgench, Uzbekistan
COMPREHENSIVE TREATMENT OF BRONCHIAL ASTHMA IN CHILDREN USING RESISTOL
ANNOTATION
We examined 78 children with varying degrees of severity of bronchial asthma at the age of 6-14 years. The first group of patients who received
standard basic therapy and a placebo pill (n = 35); the second group of patients (n = 43), who received along with a similar spectrum of basic
therapy, was prescribed the drug "Resistol" according to the scheme. The combined use of anti-inflammatory drugs and Resistol gives a
pronounced effect in terms of improving the clinical condition of children, normalizing immunological and lymphocytic parameters in patients
with bronchial asthma.
Keywords:
bronchial asthma in children, immunology, Resistol.
Ganiev Abdurashid Ganievich
Andijon davlat tibbiyot instituti gospital
pediatriya kafedrasi dotsenti.
Andijon, O'zbekiston
Nazarov Komil Dadaevich
Toshkent tibbiyot akademiyasining
Urganch filiali, gospital pediatriya
kafedrasi dotsenti. Urganch, O'zbekiston
BRONXIАL АSTMАNI KOPLEKS DАVOLАSHDА REZISTOL MODDАSINI QO’LLАSH USULI
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ANNOTATSIYA
Biz 6-14 yoshda bronxial astmaning og'irligi har xil bo'lgan 78 bolani tekshirdik. Standart terapiya asosida platsebo tabletkasini olgan
bemorlarning birinchi guruh deb atadik (n = 35); shunga o'xshash asosiy terapiya spektri bilan birga qabul qilingan bemorlarning ikkinchi
guruhiga (n = 43) sxema bo'yicha "Resistol" preparati buyurildi. Yallig'lanishga qarshi vositalar va Resistolni birgalikda qo'llash bolalarning
klinik holatini yaxshilash, bronxial astma bilan og'rigan bemorlarda immunologik, limfotsitik ko'rsatkichlarni normallashtirish nuqtai nazaridan
sezilarli ta'sir ko'rsatadi.
Kalit soʼzlar:
bolalarda bronxial astma, immunologiya, rezistol.
The problem of asthma continues to be relevant throughout the
world, despite numerous studies and a sufficient amount of treatment
and preventive measures. In childhood, bronchial asthma is one of the
most common chronic diseases [1, 2, 4, 9].
According to the results of a number of researchers, the
prevalence of asthma in the Republic of Uzbekistan varies from 3.1%
to 8.2%, which is due not only to the influence of external regional
factors, but also to the use of various diagnostic methods [1].
However, as shown by virtually all studies conducted under the
ISAAC (Intemacional Study of Astma and Allergy in Children)
program in all regions of the planet, the true incidence of asthma was
significantly higher than official statistics [8, 9, 10]. The
discrepancies between official statistics on recruitment and the results
of epidemiological studies are also associated with the underdiagnosis
of bronchial asthma in different age groups.
Analysis of epidemiological studies in the city of Andijan
showed that in the structure of the prevalence of allergic diseases,
bronchial asthma is in 2nd place (5.6 + 0.03%), yielding to allergic
rhinitis (12.7 + 0.19%) [1].
Despite the use of increasingly effective means for anti-
inflammatory therapy of respiratory allergies, up to a third of patients
continue to complain about the persistence of symptoms of the
disease even when it is carried out in an adequate age dosage.
Unfortunately, treatment with inhaled corticosteroids,
being the most effective one currently used, has a number of side
effects, including depression of the hypothalamus-pituitary-adrenal
cortex axis, the formation of local candidiasis, and others [5, 10]. In
this regard, one of the areas of pharmacotherapeutic research is the
search for approaches aimed at reducing the dose of steroids used to
achieve a sufficient clinical effect.
One of such approaches may be the joint appointment of
traditional anti-inflammatory drugs - local corticosteroids and
leukotriene receptor antagonist drugs, agents for systemic use in
obstructive respiratory diseases, which are also known from the
literature [6, 7].
As an example, we chose the drug Galichpharm OJSC
(Ukraine, Lviv) "Resistol" oral drops, the drug "Resistol" is permitted
in Uzbekistan (Order of the Minister of Health of the Republic of
Uzbekistan No. 3087 dated November 12, 2018). "Resistol" contains
an extract of the seed-like Pelargonium sidoides, which grows in
South Africa. It is known that with oral use of the extract, there was
a decrease in the signs of the disease (non-specific symptoms of the
disease that occur due to infection) and antioxidant properties were
manifested.
In the course of in vitro studies, the following drug actions
were confirmed:
- stimulation of non-specific protective mechanisms:
- stimulation of the oscillation frequency of the villi of the ciliary
epithelium;
- modulation of the synthesis of interferon and anti-inflammatory
cytokines;
- stimulation of the activity of NK cells;
- stimulation of phagocytosis, expression of adhesive molecules,
chemotaxis
This message is devoted to determining the feasibility of
using the drug "Resistol" against the background of standard therapy
of bronchial asthma in children.
Materials and methods:
Under our supervision in the
clinic of the department of hospital, polyclinic and emergency
treatment of the Andijan State Medical Institute based on ODMMTS
Andijan there were 78 children with varying degrees of severity of
bronchial asthma between the ages of 6-14 years.
For a prospective study, we formed two groups of patients: the
first group of patients who received standard basic therapy (n = 35);
the second group of patients (n = 43) who received, along with a
similar range of basic therapy, received the drug Resistol on a five-
day schedule (1-day 1.0 ml, 2-day 1.5 ml, 3-day 2.0 ml, 4-day 2.5 ml,
5-day 3.0 ml. Intramuscularly) with a break of 1 day, 3 times.
The duration of "Resistol" therapy was 15 days. The duration of
the observation of the patients of the studied groups lasted for a year.
In addition to age, the criteria for inclusion in the study group were
verification of the diagnosis of bronchial asthma, mild, moderate,
severe disease. The exclusion criteria from the study group were
severe for the disease using systemic glucocorticoids for more than 6
months.
All observed patients received hydrocortisone as a basic
therapy in the form of a metered-dose inhaler. Depending on the
severity of asthma, the daily dose of the drug averaged 25-50 mg. All
observed patients were given a short-acting β2-adrenomimetic -
(salbutamol). In all cases, undesirable drug reactions were recorded.
Against the background of the use of the drug "Resistol" we have not
registered the side effects of the drug.
The survey included monitoring peak expiratory flow rate
over the entire observation period, assessing the quality of life using
a specially designed questionnaire, studying mucociliary clearance
(MSC), β2-adrenoreceptor activity, and immune status parameters.
The diagnosis of bronchial asthma was set according to international
criteria on the basis of detecting reversible bronchial obstruction,
confirmed in functional tests. The presence of specific sensitization
to atopic allergens was detected by skin allergic testing methods.
To compare the peak expiratory flow rates in children of the
experimental groups with the control, we used the standards
developed earlier for the metropolitan area [9]. In terms of obtaining
standards of mucociliary clearance, 30 children of the same sex and
age were examined. Statistical processing of the obtained material
was performed using the t-criterion of reliability of differences
between the Student and Oyvin IA groups.
Results and discussion.
According to the literature it is known
that the effects of bronchodilation of the β-agonist and Resistol are
additive. Treatment with Resistol reduces both the early and late
phases of bronchoconstriction caused by antigens. It is known that in
adults and children aged 2 to 14 years, treatment with Resistol
significantly reduces the number of eosinophils in the respiratory tract
(as measured in sputum) and in peripheral blood, while improving the
clinical control of asthma.
With the appointment of this drug, the metabolism of corticoid
hormones in the div is suppressed, and the duration of their action
increases.
Own studies have shown that in group 1 it was possible to reduce
the dose of inhaled glucorticosteroids by 13.5 ± 3.1%.
The positive effect of the use of the drug was to reduce the
number of day and night attacks, the increase in the absolute values
of PSV and reduce the pronounced variability. The majority of the
most normalized indicators MCC.
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Table 1.
Dynamics of indicators of peak expiratory flow rate and daily dose of
IGCC in children during treatment
No
of patients treated Qty
children
Qty
children
(n)
Need to use
β2-adrenomimetics per/day
(п)
Before treatment олечения
After treatment
1 gr.
Children treated with basic therapy
(hydrocortisones)
35
2,45 ±0,1
2,07 ±0,1
2 gr.
Children who received basic therapy and
“Resistol”
43
2,52 ±0,1
1,38 ±0,1
P <0,001
Note: P - reliability of differences in performance between groups.
From the presented own data it is clear that in the group of children
who received, along with inhalation glucocorticosteroids, also
Resistol, the steroid dose was reduced from 299.5 to 229.9 mcg/day,
that is, by 24.7%.Ego difference was statistically significant (P
<0.001). One of the criteria for the effectiveness of the treatment of
bronchial asthma is to reduce the need for the use of inhaled β2-
adrenomimetics. Our studies have shown that in children who
received the combined treatment with hydrocortisone and Resistol,
the need for the use of salbutamol was reduced from 2.07 to 1.38 per
day. This difference was highly statistically significant (P <0.001).
The average peak expiratory flow rate in children who
received the drug Resistol, compared with children who received only
traditional therapy of asthma, was 29.7% higher even with the
statistical significance of these differences (P <0.05) .
If in children of the control group (group 3), the MCC
index was 8.8 ± 0.2 min, then in patients with bronchial asthma before
treatment it was 15.6 ± 0.4 min (P <0.001). During treatment with
hydrocortisone, the index decreased to 13.7 ± 0.3 min (P <0.001), thus
differing by 1.13 times compared with the initial parameter. However,
this figure was 1.15 times higher than that of children with bronchial
asthma, who received, along with hydrocortisone, propionate also
Resistol. In our work, we also studied biological markers of the
severity of the inflammatory process in allergic diseases [2]. The
levels of low and high density eosinophils have been studied
(According to modern concepts, eosinophils are non-dividing
granulocytes, which, like other polymorphonuclear leukocytes, are
continuously formed in the bone marrow from a single stem cell.
Eosinophilopoiesis and the differentiation of eosinophils from
precursor cells by regulating secretion of colony-stimulating factor
granulocytes and macrophages (GM-CSF), interleukin-3 (IL-3) and
interleukin-5 (IL-5). In addition, IL-5 and GM-CSF activate
eosinophils, inducing the
Table 2.
Dynamics of daily consumption requirements
(β2-adrenomimetics per day for children during treatment)
No
Of the group of treated
patients
Qty
children
Indicators of PSV
(l / min)
Average daily dose of IGS (mkg)
Before treatment
After treatment
Before treatment
After treatment
1 gr.
Children who received
basic therapy
(hydrocortisone)
35
190,0 ± 21,6
218,8±21,6
347,3± 23,6
299,5± 23,4
2 gr.
Children receiving basic
therapy and "Resistol"
43
199,3± 21,2
259,5 ± 24,4
p<0,05
347,8±23,3
p<0,05
229,9 ± 15,7
p<0,001
transition of cells from normal density to low) [3]. As a result of
combined anti-inflammatory therapy, a significant decrease in the
activity of allergic inflammation was noted. Within 3,4,5,6 months
from the beginning of treatment in both groups, a significant decrease
in EPS was revealed. So, after 3 months from the start of therapy in
patients of the 1st group, the level of ENP was 79.4 ± 13.0, while in
the 2nd group - 99.6 ± 13.8 per 1000 cells. 6 months after the
combination therapy, the number of ENPs in the 1st group was 54.7
± 12.5, in the 2nd group - 883.3 ± 11.2. It should be noted that with a
significant difference in ESP and EEC levels after treatment, P
<0.001. As for the absolute amount of EEC, it should be noted that
before treatment, their level in both groups was increased: in the 1st
group - 158.2 ± 17.1, in the 2nd - 163.3 ± 12.7. 3 months after
treatment, the number of EEC in patients of group 1 decreased to
129.4 ± 11.9, in group 2 - 145.8 ± 13.5.
Conclusion. Combined therapy of bronchial asthma with
the use of the drug "Resistol" to a greater extent contributed to the
reduction of allergic inflammation, which was manifested by a
decrease in the absolute number of eosinophils, especially low
density.
Thus, treatment with Resistol not only contributed to more
effective rehabilitation of children with bronchial asthma, including
an increase in the parameters of external respiratory function, but also
favorably influenced the upper respiratory tract, contributing,
apparently, to the reduction of allergic inflammation. The combined
use of anti-inflammatory drugs and Resistol gives a pronounced
effect in terms of improving the clinical condition of children, the
normalization of immunological parameters in patients with
bronchial asthma.
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