JOURNAL OF HEPATO-GASTROENTEROLOGY RESEARCH | ЖУРНАЛ ГЕПАТО-ГАСТРОЭНТЕРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ
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Sanakulov Abdulatif Burxanovich,
Assistant of the Department of Hospital Pediatrics, Samarkand State Medical Institute, Uzbekistan
Mirzaeva Zubaydahon Ulugbekovna,
Assistant of the Department of Hospital Pediatrics
Andijan State Medical Institute.
Uzbekistan
COMPREHENSIVE TREATMENT OF BRONCHIAL ASTHMA IN CHILDREN USING RESISTOL
ANNOTATION
Studied 78 children with varying degrees of bronchial asthma severity at the clinic of Hospital, Outpatient and
Emergency Therapy Department of Andijan State Medical Institute in Andijan, aged 6-14 years. For prospective study
we have formed two groups of patients: the first group of patients who received standard baseline therapy and placebo
tablet (n = 35); the second group of patients (n = 43), who received along with baseline therapy, received the drug
"Resistol". Administration of this drug suppresses the metabolism of corticoid hormones in the div, and the duration
of their action increases. Our own studies have shown that in Group 1 we managed to reduce the dose of inhaled
glucocorticosteroids by 13.5 ± 3.1%. A particularly valuable effect of impaired β2-adrenoreceptor sensitivity due to
excessive use of salbutamol. The positive effect of the drug was a decrease in the number of daytime and nighttime
attacks, an increase in absolute PSV values and a decrease in pronounced variability. ICC values were normalized more
effectively in most patients. Thus, treatment with the drug "Resistola" not only contributed to more effective
rehabilitation of children with bronchial asthma, including increased parameters of external respiratory function, but
also had a favorable effect on the condition of the upper airways, contributing, apparently, to a decrease in the severity
of allergic inflammation.
Key words:
bronchial asthma in children, immunology, resistol
Санакулов Абдулатиф Бурханович,
Ассистент кафедры госпитальной педиатрии Самаркандского государственного медицинского
института, Узбекистан
Мирзаева Зубайдахон Улугбековна,
Ассистент кафедры госпитальной педиатрии
Андижанский государственный медицинский институт.
Узбекистан
КОМПЛЕКСНОЕ ЛЕЧЕНИЕ БРОНХИАЛЬНОЙ АСТМЫ У ДЕТЕЙ, С ПРИМЕНЕНИЕМ ПРЕПАРАТА
РЕЗИСТОЛ
АННОТАЦИЯ
Обследованы 78 детей с разной степенью тяжести бронхиальной астмы в поликлинике стационара,
отделениях поликлиники и неотложной терапии Андижанского государственного медицинского института в
возрасте 6-14 лет. Для проспективного исследования мы сформировали две группы пациентов: первая группа -
пациенты, получавшие стандартную базовую терапию и плацебо (n = 35); вторая группа пациентов (n = 43),
получавших наряду с базовой терапией препарат «Резистол». Прием этого препарата подавляет метаболизм
кортикоидных гормонов в организме и продолжительность их действия увеличивается. Собственные
исследования показали, что в 1-й группе нам удалось снизить дозу ингаляционных глюкокортикостероидов на
13,5 ± 3,1%, что особенно ценно при нарушении чувствительности β2-адренорецепторов в результате
чрезмерного употребления сальбутамола. Положительным эффектом препарата было уменьшение количества
дневных и ночных приступов, увеличение абсолютных значений ПСВ и уменьшение выраженной
вариабельности. Значения ICC нормализовались более эффективно у большинства пациентов. Таким образом,
лечение препаратом «Резистол» не только способствовало более эффективной реабилитации детей с
бронхиальной астмой, но и повышению параметров функции внешнего дыхания. Кроме того, благоприятно
JOURNAL OF HEPATO-GASTROENTEROLOGY RESEARCH | ЖУРНАЛ ГЕПАТО-ГАСТРОЭНТЕРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ
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сказалось на состоянии верхних дыхательных путей, способствуя, по всей видимости, уменьшению
выраженности аллергического воспаления.
Ключевые слова:
бронхиальная астма у детей, иммунология, резистол.
Introduction.
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 [1,2,3,8].
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 [7,8,9]. 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 [4.9]. 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 [5,6].
As an example, we chose the domestic drug
"Resistol", the drug Resistol contains an extract from the
seed-like Pelargonium sidoid (Pelargonium sidoides),
which is home to 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 [8]. 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
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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.
Table 1.
Dynamics of indicators of peak expiratory flow rate and daily dose of
IGCC in 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
<0,05
347,8±23,3
<0,05
229,9 ± 15,7
<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.
Table 2.
Dynamics of daily consumption requirements (β2-adrenomimetics per day for 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 <0,001
Note: P - reliability of differences in performance between groups.
In our work, we also studied the biological
markers of the severity of the inflammatory process in
allergic diseases [2]. The levels of low eosinophil (ESP)
and high density (EWP) were studied. As a result of the
combined anti-inflammatory therapy, a significant
decrease in the activity of allergic inflammation was
noted. Over the course of 3,4,5,6 months from the start of
treatment, a definite decrease in ENP was detected in
both groups. So, after 3 months from the start of therapy
in patients of group 1, the level of ENP was 79.4 ± 13.0,
whereas in group 2 it was 99.6 ± 13.8 per 1000 cells. 6
months after the combination therapy, the number of ENP
in group 1 was 54.7 ± 12.5, in group 2 - 883.3 ± 11.2. It
should be noted that if a significant difference in the
levels of ESP and EEC after treatment was P <0.001.
Regarding the absolute amount of EEC, it should be
noted that before treatment, their levels in both groups
were increased: in group 1 - 158.2 ± 17.1, in 2 - 163.3 ±
12.7. 3 months after the treatment, the number of EEC in
patients of group 1 decreased to 129.4 ± 11.9, 2 groups -
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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