The method of therapy of bronchial asthma in children

 

(57) Abstract:

The invention relates to medicine, in particular to Pediatrics (pediatric Allergology). The aim of the invention is the reduction of terms of treatment of bronchial asthma and prolongation of the remission period by assigning in complex therapy of domestic nucleoside - Riboxin. The proposed method of treatment is as follows. Children with bronchial asthma exacerbation in comprehensive basic therapy (Hypo-allergenic diet, Allergy-free environment2agonists, methylxanthines, Intal, tiled, membrane stabilizers, according to testimony - corticosteroids) is assigned Riboxin for 14 to 15 days. Children up to 3 years of 0.05 g per reception; from 3 to 7 years - 0.1 g; from 7 to 15 years - 0.2 g 3 times a day. The inclusion of Riboxin in the complex therapy of bronchial asthma in children can significantly improve the effectiveness of therapy, which is manifested in the reduction of attack period 3.5 times the elongation of remission 2.1 times, and reduction sensitization and the normalization of immunological parameters. In General, asthma in this group of children has become more smooth, long interictal periods and short acute illness the community respiration. Given the high clinical and immunological efficacy of Riboxin in bronchial asthma in children, the drug can be widely applied in the treatment of this pathology.

The invention relates to medicine, in particular to Pediatrics (pediatric Allergology).

The purpose of the invention is the shortening of the treatment of bronchial asthma and prolongation of the remission period by assigning in complex therapy of domestic nucleoside - Riboxin.

The increase in severe forms of asthma in children, resistance to therapy requires the search for new effective methods of treatment. Pathogenetically justified in this pathology the purpose of medicines, correcting metabolic processes in the body. These drugs include purine nucleoside Riboxin, which is a natural metabolite. It stimulates the oxidation-reduction processes in the cell due to the activation of hydrolytic enzymes pentoses cycle, increases the energy formation in the tissues, reduces hypoxia cells [2], which is especially important in the context of respiratory failure. The use of Riboxin is all the more justified that children with this pathology occurs on uchitelnoj as contributing to the processes of hypersensitivity, allergic inflammation, lysis and catabolism antigen [1], which requires metabolic correction. It was established experimentally that the introduction of Riboxin also leads to a decrease of the strength of anaphylactic reactions in animals that received strong sensitization to allergens [3]. In the literature there are only few reports about the use of this drug [4, 5].

We first conducted research on the application of Riboxin in complex therapy of bronchial asthma in children in the period of exacerbation. Riboxin was prescribed course within 14-15 days for children under 3 years of 0.05 g per reception, from 3 to 7 years - 0.1 g, from 7 to 15 years - 0.2 g 3 times a day. Criteria of clinical effectiveness were serving terms of reducing the duration of the period of exacerbation and prolongation of remission, as well as indicators of hemogram and immunological indexes and functions of external respiration.

The method is tested in the Allergy Department, 2nd pediatric clinical hospital, Kazan.

Under supervision there were 145 children with asthma aged from 10 months to 15 years. Of them boys of 71.7%, girls - 28,3%. Was dominated by moderate and severe over - 69,3%, while light was noted in 20.7 percent. Polyvalent sensitization otmecheni by age, sex, clinical structure and course were not statistically significant, 1 group consisted of 107 children with bronchial asthma treated in the complex basis of drug therapy Riboxin. The control group consisted of 38 children with asthma who received only basic therapy. Basic therapy did not differ in both groups were prescribed depending on the condition of the patient and includes: hypoallergenic diet, Allergy-free environment2agonists, methylxanthines, anti-inflammatory drugs (Intal, tiled), membrane stabilizers (ketotifen, zaditen), in severe cases, according to testimony - corticosteroids.

Clinical observation showed that combination therapy of bronchial asthma with the inclusion of Riboxin allows to achieve clinical efficacy in 74,7% of cases. This is reflected in the reduction in the duration of the period of exacerbation and prolongation of remission. Installed shortening attack period 3.5 times, the duration of which was on average 6.6 hours (before treatment - 23.4 hours). In the control group of children not receiving Riboxin, the duration of the attack period decreased by only 1.5 times and amounted to 18.0 hours (before treatment - 27,4 hour).

In the group of children, pvil of 5.8 months (whereas before treatment - 2.7 months), p < 0,05. In the control group, the duration of remission increased only 1.3 times and amounted to 3.7 months (whereas before treatment is 2.8 months).

Decrease exacerbations of asthma in children receiving in complex therapy of Riboxin, was accompanied by significant improvement of respiratory function. So, in this group noted the increase of PEF on 20 - 35%, while in the control group at 9-15%.

Thus, the inclusion of Riboxin in the complex therapy of bronchial asthma in children can significantly improve the effectiveness of therapy, which is manifested in the reduction of attack period 3.5 times the elongation of remission 2.1 times. In General, asthma in this group of children has become more smooth with long interictal periods and short exacerbations of the disease. Ischemia acute illness results in a significant improvement of respiratory function.

Analysis of hemogram showed that in the group of children receiving Riboxin, compared with the control group significant increase in the number of leukocytes and is to ensure 5,8109/l, while after treatment - 6,5109/l and in controlflow in the peripheral blood in all groups of patients - 4.3% before treatment was 7.9%, after treatment - 3.6%, while in the control group eosinophils are reduced only by 1.9%, respectively - of 6.3% and 4.4%.

A study of the effect of Riboxin on the complex immunological parameters in children with bronchial asthma. Comparison of changes in immunological parameters in the period of exacerbation and remission in the group of children receiving Riboxin in adjuvant therapy and in the control group showed a significant (p < 0.001) change CD8+- T-lymphocytes, IRI, total lgE and HCT-test-driven. So, the average change in the target group CD8+- T-lymphocytes was evident in their increasing by 4.8%, whereas in the control - only 1.5%, IRI increased by 1.2 units in the target group and by 0.38 units in the control, the content of total lgE decreased by 259,4 KE and 180,0 KE, respectively, and the values of HCT-test stimulated increased by 15.8% and 3.4%, respectively.

The data obtained show that Riboxin has immunocorrective action in bronchial asthma in children, which is manifested in the reduction of CD8+- T-lymphocytes and normalization of immunoregulatory index, as well as the inhibition of the production of common lgE. Kricheskii cell activity by increasing the reserve capacity of various systems of the body.

The advantage and novelty of this method is that the purpose of shortening the treatment of acute exacerbations of asthma in children and prolong remission in comprehensive basic therapy included domestic nucleoside Riboxin.

Example 1. Patient A., age 12. The history N 359. Hospitalized in the 1st division of the 2nd children's hospital 2/02-98 g with a diagnosis of Bronchial asthma. Atopic asthma. Exacerbation. Medium severity. Polyvalent Allergy. Reactive pancreatitis. Giardiasis intestinal.

Complaints at admission for asthma, wheezing, coughing fits. Worsening at night, after exercise. The attacks are repeated 1 time in 10-14 days and last for about 3 hours, the duration of remission for 2 months. Ill just 6 years old.

History of life - a child from the third pregnancy, III birth. Pregnancy proceeded with the toxicity of the first half, the threat of miscarriage. Birth weight 3300 g, born in asphyxia. On breastfed to 4 months, then artificial. The burdened heredity - the mother of atopic dermatitis. Living conditions are satisfactory.

When applying the General state of moderate severity due to dejatelnosti forced - with the fixation of shoulder girdle. BH - 28 per minute. The skin is clean. Lymph nodes are not enlarged. Zev - hyperemia not. In the lungs breathing hard, in all lung fields listened dry whistling and mixed moist rales. Percutere above the light box the color of the sound. Heart sounds are clear, rhythmic. Ps - 94 strike in minutes , rhythmic. The abdomen is soft, painless. Liver at the edge of the costal arch. Chair decorated. Diuresis is not broken.

The hemogram from 3.02.98 g: L - 4,3109/l, n - 1, C - 49, e - 7, m - 3, l 40%.

The function of external respiration: PEF was $ 255 l/min (reduced by 69%).

The immunological: CD3+- 60%, CD4+- 41%, CD8+- 15%, IRI - 2,7, CD19+- 25%, IgI - 2.1 g/l, AGg - 17.1 g/l, IgM - 1,9 g/l, CEC - 0,017 ed, CH50- 58%, HCTSP- 27%, HCTarticle- 30%, F. I.lat- 12%, Hlat- 1,4, IgE - 560 KE.

In the complex basic therapy (Hypo-allergenic diet, Allergy-free life, aminophylline, Intal) was included drug Riboxin 0.2 g 3 times daily for 14 days. The attack was stopped after 40 minutes On the background of treatment, the frequency of attacks decreased to 1 time per 3 months. On the 15-day treatment the leukocyte count increased to 5.3 109/l and eosinophils decreased to 2%. Figure PEF increased and UB>+- 12%, IgA - 2.3 g/l, IgG - 15.2 g/l, IgM - 2.0 g/l, CEC - 0,020 ed, CH50- 63%, HCTSP- 12%, HCTarticle- 45%, F. I.lat- 30%, F. Hlat- 1,2, IgE - 220 KE. Dynamic observation of patients showed that the duration of remission in the patient increased to 6 months.

Example 2. Patient P., aged 6. The history N 3493. Hospitalized in the 1st division of the 2nd children's hospital 17/12-98 g with a diagnosis of Bronchial asthma. Atopic asthma. Exacerbation. Medium severity. Polyvalent Allergy.

Complaints upon receipt by recurrent attacks of breathlessness, wheezing, coughing fits. Worsening at night, after contact with Pets. The attacks are repeated 2 times per month, the duration of the remission period - 2 months. Asthma attacks are marked with 3 and last approximately 2 hours.

The history of life:child 1 pregnancy, 1 birth. Pregnancy proceeded with the toxicity of the 1st half. Weight at rojdenni 3500, breastfed up to 2 months, then artificial. Heredity is not burdened. Living conditions are satisfactory.

When applying the General state of moderate severity due to respiratory failure. Shortness of breath expertrender shoulder girdle. BH 30 minutes the Skin is clean. Lymph nodes are not enlarged. Zev - hyperemia not. In the lungs breathing hard, in all lung fields listened dry whistling and moist rales. Percutere above the light box the color of the sound. Heart sounds are clear, rhythmic. Ps - 100 beats per min, rhythmic. The abdomen is soft, painless. Liver at the edge of the costal arch. Chair decorated. Diuresis is not broken.

The hemogram from 18.12.98 g: L - 4,6109/l, n - 2, p 43, e - 5, m - 3, l - 47%.

The function of external respiration: PEF was 48 l/min (reduced by 62%).

The immunological: CD3+- 48%, CD4+- 49%, CD8+- 27%, IRI - 1,8, CD19+- 28%, IgA - 0.8 g/l, IgG with 15.4 g/l, IgM - 3.8 g/l, CEC - 0,041 ed, CH50- 48%, HCTSP- 17%, HCTarticle- 51%, F. I.lat- 50%, F. Hlat- 5, IgE - 350 KE.

The patient received a comprehensive basic therapy (Hypo-allergenic diet, Allergy-free life, aminophylline, Intal). Riboxin in the combined therapy was not included. The attack was stopped after 2.5 hours. On the background of treatment, the frequency of attacks decreased only up to 1 times per month. On the 15-day treatment the leukocyte count increased to 5,0109/l and eosinophils decreased to 3%. Figure PEF has not increased and amounted 48-50 l/min In the immunological: CD3+50- 59%, HCTSP- 11%, HCTarticle- 60%, F. I.lat- 49%, F. Hlat- 5, IgE - 270 KE. Dynamic observation of patients showed that the duration of remission in the patient increased only up to 3 months.

Thus, the above examples show the positive clinical effect of Riboxin in comprehensive basic therapy for bronchial asthma in children, which contributes to the reduction of exacerbation and prolongation of remission, reduction sensitization and the normalization of immunologicheskikh indicators.

SOURCES OF INFORMATION

1. Bakanov W. I., Balabolkin I. I., Gordeev, F. and et al. Materials of all-Russian scientific-practical conference: "Allergic diseases in children", Moscow, 1996. - C. 10.

2. Kukes C. T., Fedorova N. M. et al. - Owls. the honey. - 1983. - N 2. - S. 84-86.

3. Levi E. C., Shchukin So I. In the book: Abstracts of the national scientific conference, L., 1980. - S. 40.

4. Malanichev.G., A. Shamov,, Shamov B. A. - KAZ. the honey. journal, 1998, No. 5, S. 370-372.

5. Yakovlev A. A., Conde L. A. journal of ophthalmology., The 1982 - N 5 104 C.

The method of therapy of bronchial asthma in children, including complex drug therapy, characterized in that as Lech

 

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