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PUBLISHED DATE: - 30-09-2024
https://doi.org/10.37547/TAJMSPR/Volume06Issue09-07
PAGE NO.: - 41-44
FEATURES OF CENTRAL HEMODYNAMICS IN
PATIENTS WITH BRONCHIAL ASTHMA
Muminov D.K.
MD, PhD, DSc., Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
Kenjaev O.O
Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
INTRODUCTION
In the last decade, chronic nonspecific lung
diseases have taken third place in terms of
prevalence, morbidity and mortality among other
types of pathology. According to 2020
–
2023 World
Health Organization (WHO) estimates, nearly 262
million people worldwide suffered from bronchial
asthma, resulting in 455,000 deaths [1].
Bronchial asthma (BA) is a heterogeneous disease
characterized by chronic inflammation of the
airways, the presence of respiratory symptoms
such as wheezing, shortness of breath, chest
congestion and cough, which vary in time and
intensity, and occur together with variable airway
obstruction [1,2]. Based on the pathogenesis of
asthma, a number of cytokines and growth factors
relevant to the chronicity of airway inflammation
are produced by normal resident cells of the
bronchial tree (fibroblasts, myofibroblasts,
epithelial cells and smooth muscle cells).
Fibroblasts play a key role in airway remodeling
and inflammation. They produce collagen,
reticular and elastic fibers, proteoglycans and
glycoproteins. Myofibroblasts promote tissue
remodeling by releasing interstitial collagen,
fibronectin and laminin, and producing growth
factors for blood vessels, nerves and smooth
muscle [3]. In bronchial asthma, the number of
myofibroblasts increases and their number
correlates with the thickness of the reticular
basement membrane. Thus, as a result of the
pathological process in bronchial asthma, the
reversible component of bronchial obstruction
predominates, which consists of contraction of
smooth muscles, edema of the mucous membrane,
and obstruction of the bronchial lumen by mucus.
However, with long-term inflammation in the
bronchi, wall remodeling and proliferation of
connective tissue (fibrosis) occurs, which is an
irreversible part of bronchial obstruction. This in
RESEARCH ARTICLE
Open Access
Abstract
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turn will lead to multiple complications from the
cardiovascular system [3,4].
Frequent exacerbations of attacks in asthma are
most clearly demonstrated by the close anatomical
and functional connection between the heart and
lungs. As a result, the problem goes from
pulmonary to cardiopulmonary. In patients with
asthma, changes in the cardiovascular system are
often recorded with the development of
pulmonary hypertension, damage predominantly
to the right side with the formation of chronic
pulmonary heart disease, the development of
myocardial
ischemia
and
heart
rhythm
disturbances. The issues of the combined course of
cardiovascular diseases (CVD) and asthma are
actively discussed in the literature. [5]. Cardiac
remodeling, which occurs in response to damage,
leading to a change in its geometry and impaired
contractility, ultimately determines the prognosis
of life for patients with chronic obstructive
pulmonary pathology. Despite the fact that the
main function of the circulatory system is
transport, its participation in physiological and
pathological processes in the div is very diverse.
It should be noted that the clinical, functional and
morphological changes that occur in the
cardiovascular system during inflammation, as a
rule, represent a complex chain of cause-and-effect
and closely related manifestations of pathology
[6,7]. Therefore, pathological changes that can be
objectively assessed are usually the result of the
simultaneous influence of multiple factors such as
hypoxemia, hypercapnia, bronchial obstruction
and associated ventilation disorders, intoxication
with products of altered tissue metabolism,
pathological effects of biologically active
substances, and disturbances in the rheological
properties of blood [8]. The severity of changes in
the cardiovascular system and, accordingly, its
clinical manifestations depend on the prevalence
of bronchial lesions, as well as the phase of the
process. It is known that changes in the pulmonary
circulation in patients with bronchial asthma can
be associated with both disturbances of central
hemodynamics and disorders of pulmonary
microcirculation.
According to the observations of many authors, in
patients with mild impairments in the function of
external respiration, normal levels of oxygen
tension in the arterial blood, pressure in the
pulmonary artery and minute blood volume do not
exceed normal figures [3,9]. Against the
background of repeated exacerbations, with the
progression of respiratory dysfunction, changes in
hemodynamics also become more pronounced.
Increasing disturbances in bronchial obstruction,
diffusion capacity and lung volume parameters,
leading to chronic hypoxemia and hypercapnia,
can cause the development of moderate
pulmonary hypertension at rest and an increase in
right ventricular filling pressure [10]. Systolic and
diastolic function of the right ventricle in patients
with asthma. Previous studies have revealed that
the state of diastolic function of the right ventricle
in asthma depends on the severity of the
underlying disease, the formation of the level of
afterload, the values of pulmonary hypertension
and the severity of enlargement and hypertrophy
of the right ventricle. In various groups of patients
with asthma, pathological load against the
background of the lack of pharmacotherapeutic
control of asthma (increased resistance in the
pulmonary circulation, myocardial hypoxia) leads
to structural and functional changes in the
pancreas [11]. An increase in the severity of
bronchial asthma naturally leads to even more
pronounced remodeling of the right ventricle and
changes in regional contraction indices at the
inflow level. The dependence of progressive
changes in the diastolic function of the right
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ventricle on the severity of asthma has been
established. Pulmonary hypertension in patients
with moderate and severe asthma is associated
with the development of diastolic dysfunction in
the right ventricle and changes in the
morphometric parameters of the right ventricle
[4,12].
It should be noted that the appearance of
hypertrophy, dilatation and subsequent failure of
the right ventricle can be recorded at relatively low
pressure levels in the pulmonary artery, not
exceeding 35 mmHg. This may indicate that
pulmonary hypertension is not the only cause of
the formation of chronic cor pulmonale [13]. In the
diagnosis of asthma, correlation analysis data in
the group of asthmatics with moderate disease
showed an inverse relationship between the
degree of right ventricular hypertrophy (RVH) and
the FEV1/FVC value. Outside of exacerbation of the
disease, a negative relationship was revealed
between RVH and FEV1. In a cohort of patients
with severe asthma during an exacerbation, a
negative relationship between FEV1/FVC and the
diameter of the pulmonary trunk was also
recorded
[7].
Correlation
analysis
of
echocardiographic
data
with
div
plethysmography data in patients with moderate
asthma during exacerbations established a
negative relationship between residual lung
volume and maximum late filling rate. In patients
with severe asthma, a significant positive
relationship was found between the thickness of
the anterior wall of the right ventricle and the
residual lung volume (RLV), the RLV/RLV ratio, as
well as between the RLV and end-diastolic
pressure in the pulmonary artery. During the
period of remission of the disease in the group of
patients with moderate asthma, a positive
relationship was established between expiratory
air resistance and the value of MPAP. A
combination of changes in the shape of the right
ventricular cavity (an increase in the ratio of
transverse to longitudinal dimensions) with the
development of diastolic dysfunction of the right
ventricle was also identified. The identified
disorders are a reflection of the general process
associated with the structural and functional
remodeling of the right heart in patients with
bronchial asthma. Changes in the right ventricular
myocardium are closely associated with persistent
bronchial obstruction, impaired lung volumes, and
chronic inflammation present in the airways. It has
been established that disturbances in the diastolic
function of the right ventricle progress in parallel
with an increase in the severity of bronchial
asthma [13,14].
Thus, the risk of cardiovascular diseases is closely
related to asthma; disturbances in intracardiac
blood flow in patients with asthma are associated
with the appearance of an obstructive syndrome,
which periodically resolves in the form of changes
in the blood flow of the lungs and pulmonary
circulation. The study of circulatory disorders in
asthma can play an important role in their
treatment.
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THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH
(ISSN
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