Method for treating the cases of tobacco addiction

FIELD: medicine.

SUBSTANCE: method involves delivering nicotine to patient organism and administering medicament by smearing internal surface of superior and inferior nasal passage part. Treatment is carried out with cigarette consumption being retained. Smell receptor canal blocker like rapid sodium canal blocker lidocaine is used as the medicament. Its aerosol is introduced immediately before smoking action as single jet in each nasal passage. Medicament introduction is localized with epithelial smell receptor cells arrangement.

EFFECT: enhanced effectiveness of treatment.

2 cl, 2 tbl

 

The present invention relates to the field of medicine and healthcare and can be used in the treatment of nicotine addiction.

Known methods of treatment of nicotine addiction, is given in a review article Obviiii [1]. When nicotine replacement therapy the patient must completely abandon the area for the entire course of treatment. Nicotine replacement therapy is the introduction into the body of drugs, structurally or functionally similar to nicotine or directly nicotine. This replacement therapy relieves withdrawal symptoms arising due to cancellation of tobacco Smoking. Gradual reduction of the dose of a drug intended for substitution therapy, provides over time, the refusal of the patient from Smoking tobacco. One of the methods of administration of medications containing nicotine, is spray irrigation of the nasal cavity (see page 36 [1]). This way of introducing nicotine provides its rapid absorption through the mucous membrane of the nasopharynx and oral cavity, kopurua bouts of craving for cigarettes. The dosage of these drugs is directly proportional to the number of cigarettes smoked per day. For nasal spray daily dose of from 8 to 40 single doses up to a maximum of 5 doses per hour. The course of treatment is three to six months.

The lack of nicotine replacement therapy is AI is the need of a complete failure of the patient from the area for the entire course of treatment, that is a strong negative emotional factor for the patient. It affects the psyche and causes premature termination of treatment, therefore many patients do not complete treatment and return to Smoking. For those patients who undergo the full course of treatment and quit Smoking after him cannot be reliably assumed that the reason for Smoking cessation has been the use of drugs, and not long abstinence from addiction with the help of the emotional-volitional efforts. Nicotine replacement therapy has a number of contraindications, in particular, it is contraindicated in patients in the acute period of myocardial infarction, severe cardiac arrhythmias, unstable angina, as the nicotine, as vasoactive acting on the vessels of the drug will undoubtedly worsen the function of the circulatory system at all levels and can lead to irreversible consequences. Smoking patients with severe cardiovascular disease is contraindicated in any medical methods of treatment of tobacco dependence, since it is impossible to fully anticipate their possible effects on the body of the patient with decompensated activity of the circulatory system.

The closest analogue is a method of treatment of tobacco dependence by the conduct nikotinsoderzhaschie drugs aerosol into the nasal cavity, where the absorption of nicotine in the blood, using nicotine spray (see ibid, page 36 [1]) with subsequent reduction of the daily dose to a complete cessation. Route of administration of the drug through the nasopharynx due to intense vascularization of nasal mucosa, which speeds up the absorption of the drug, on the one hand, and the maximum absorption of the anatomical area where it occurs under normal conditions, i.e. when Smoking, on the other hand (the habit of the patient to the absorption of nicotine from the mouth and nose). The disadvantages of this method are all deficiencies noted above.

The present invention is to expand the Arsenal of methods and means of treatment of nicotine addiction for a wide range of patients, to facilitate patients psychologically the treatment process.

To solve this problem it is first necessary to thoroughly reveal the formation mechanism of nicotine addiction.

Tobacco addiction in humans causes contained in tobacco is nicotine. It is rapidly absorbed by the mucous and skin and spreads throughout the body, causing a momentary increase in the activity of brain neurons. Occurring in parallel with this short-term extension of the brain vessels and stimulating effect on him of ammonia create a sense of evocation, elevated mood and uspace the Oia (see [2]). While nicotine as a poison, causing somatic reactions - nausea, dizziness, bradycardia. Thus, the formation process of addiction to Smoking consists of multidirectional mental and somatic reactions. Over time, mental reactions grow, and somatic reduced because of the rapid adaptation of man to poisons [3]. The apparent surge of energy, improvement, complacency with smoked cigarette, gaining traction in the mind of the smoker becomes a conditioned reflex [2]. The key moment in the scheme of formation of tobacco dependence is, in the opinion of the author, the ever-present strong smell of burning tobacco, which is a conditional stimulus.

The structural basis of reflex activity is the reflex arc [4]. It consists of receptors that perceive the irritation of afferent pathways, which are the excitation from the periphery to the Central nervous system, the part of neurons, efferent nerve fibers of the Executive body. Because Smoking is the intake of nicotine in the body is perceived only by the chemoreceptor organs, those organs in which the body is able to feel the action of nicotine, simultaneous stimulation of olfactory and gustatory receptor forms an arc of a conditional reflex area. If you violate reflectornuu arc conditional reflex tobacco dependence, you can affect itself a conditioned reflex, and to heal the sick from tobacco dependence. Thus, the "decoding" of the conditioned reflex Smoking can occur by eliminating the constant stimulation of the limbic area of the brain responsible for emotions, comfort, pleasure, namely, with the exception of the conditioned stimulus - smell of burning tobacco. To eliminate the smell of tobacco during Smoking should act on the olfactory receptors, so they didn't react to the smell of burning tobacco or change your reaction. Then the Smoking man in the process area or just will not feel the smell of tobacco or would feel not the usual smell, as amended, which is unusual.

The author's research found that temporary or permanent loss of the smokers smell reduces the craving for Smoking, facilitates failure Smoking from Smoking. Without the support of basic stimulus - smell - reflex fades away. Smokers, bravely lost their sense of smell as a result of injuries, surgeries, quit Smoking on their own without any treatment in 90% of cases. This is established by the author by conducting a mail survey of patients of the Republican clinical hospital and national cancer centre of Tatarstan, lost sense of smell in connection with the surgical treatment. Raza is taty studies is presented in Table 1. On the reliability of the survey results shows a consistent distribution of smokers/non-smokers in the total number of respondents, the distribution of Smoking on sexual, social characteristics, the average data.

However, to treat patients from Smoking by a complete violation of their sense of smell, as was the case in the studies described, is unwise. Based on the results of Table 1, the author has developed a method of treatment for tobacco dependence. This method is based on the destruction of conditioned reflex arc Smoking by temporarily changing its olfactory sensitivity. The smell must be changed only at the moment of area. Longer changes the smell is not required. Accordingly, to achieve the result it is necessary to use the minimum dose of a short exposure can affect the olfactory receptors smoker and repeat introduction as necessary to achieve the end result.

Thus, the method of treatment for tobacco dependence, as in the prototype involves the submission of nicotine into the body of the patient, using medications, which are applied to the inner surface of the upper and middle part of the nasal passages. By contrast, the closest known method is that the nicotine is not in the form of copper is amantani funds and the usual way during the act of Smoking, i.e. the patient does not require Smoking cessation at the time of treatment. As medications used blocker ion channels in membranes of olfactory cells, in particular, the fast sodium channels, which temporarily reduces all kinds of sensitivity, including the olfactory, and the blocker is administered immediately prior to Smoking. Blocking fast sodium channels in preference to other ion channels, as they create the receptor potential actions, and that they start initiates the excitation wave signal received adequate irritation, extending to the sensory center in the Central nervous system [5]. Inactivation of the sodium channel contributes to the termination of the action potential and development time newsbucket - established. In addition, preparations for the siege developed long ago and approved for use as medicines. For the implementation of the obstacles to the generation and conduction of excitation is most appropriate use of anesthetics, because it is believed that they act on the inner surface of the membrane of nerve fibers, reducing membrane permeability to ions such as sodium, i.e. they are blockers of ion channels. There is an assumption that the decrease in ionic pron is zeemote membranes of nerve fibers associated with the what anesthetics increase the surface tension of the phospholipids of the membrane that closes ion channels [6]. Means blocking sodium channels, are used in cardiology and are referred to as membrane stabilizers (quinidine, procainamide, disopyramide, lidocaine, phenytoin, flecainide, propafenone), as they apply to the arrhythmias associated with impaired automaticity and conductivity. Thus, as blockers can be used with the following medications:

- lidocaine 10% spray anesthetic;

cocaine hydrochloride, 1-5% solution or fine powder;

- membranostabiliziruyuschee drugs - preventing the change of membrane potential of cells, and therefore, the propagation of a pulse: quinidine, disopyramide, procainamide, meksiletin, phenytoin, flecainide, enkainid, propafenone, and other such products.

All these drugs can be used to blockade the olfactory receptors, however, the dosage form of lidocaine spray makes it preferable and more accessible, and only he comes in aerosol cans.

Calcium channel blockers (fenigidin, felodipine, isradipine, verapamil, diltiazem) reduce automaticity, significantly reduce the conductivity and increases the effective refractory period, which makes them suitable is for use as a blockade of the olfactory receptors.

The preferred form of anesthetic - spray, but, in principle, to obtain the desired effect can be used drip solutions by drawing on the layout area of the olfactory epithelium by instillation into the nose or lubrication of the nasal cavity using a swab moistened with the drug. The use of powder form for inhalation is also possible, however, time off for powder forms is longer. Introduction drugs localize the location of the epithelial cells of the olfactory receptors, namely the inner surface of the upper and middle nasal Concha and the upper parts of the nasal septum.

Treatment duration is proportional to the experience of Smoking and daily dose of tobacco. The dose is calculated on the basis of what one inhalation modifies (reduces and alters at the same time) olfactory sensations from five minutes up to 1 hour depending on which drug is selected for treatment - rapid or short-acting. The choice of the drug should be implemented on the basis of anamnestic data about the presence of allergies to anesthetics, individual sensitivity to them and the individual average duration of the anesthetic. For any selected single drug application involves a single inhalation in the floor is the terrain of the nose just before Smoking. Daily dose equal to the number of cigarettes smoked per day: one cigarette is one inhalation, but should not exceed the maximum daily therapeutic dose. For example, the maximum lidocaine dose is 40 exposures (irrigation) per day.

When irrigating the nasal cavity anesthetic blockade of fast sodium channels temporarily paralyzes all kinds of sensitivity, including olfactory. Olfactory receptors do not respond to present when Smoking smell, and his patient does not feel. Due to exceptions basic stimulus - smell, termination standard stimulate the limbic region of the cerebral cortex while Smoking, inconsistencies sensations while Smoking stereotypical craving for Smoking decreases and reflex fades away. The reflex arc is broken. Somatic symptoms: dizziness, cough, nausea, persisting regardless of the degree of violation of smell, serve as an additional incentive to stop craving for tobacco.

The method was tested in the Tatar Republican cancer center during the course of treatment for tobacco dependence 20 people. Treatment consisted of 5 sessions. Each patient was conducted preliminary testing of olfactory function to external stimuli and placed in the oral cavity. We then conducted an injection of aerosol lidocaine 10% of the initial dose in each nostril. Five minutes after inhalation was re-tested the function of smell. All interventions were conducted with preliminary and current control of olfactory function using olfactory method published in [7]. Dose and number of doses of 1-10 per day was calculated individually for each patient depending on the form of tobacco dependence: dissociated, ideational, psychosomatic, the experience of Smoking, number of cigarettes smoked per day. The total number of input anesthetic was not more than 10% by weight of anesthetic, safe for the patient. A single injection provided a partial shutdown of smell within 1 hour. During the day the injection was carried out at the peak of tobacco use. Patients were allowed to smoke when there is desire to smoke only after injections of anesthetic. When the desire to smoke more than one hour after insufflation was performed repeated administration of the drug. Through 1-1,5 hours the sensitivity of the receptors were recovered that were controlled by the above method using olfactory test set. The results of the treatment are shown in Table 2. All patients received the insufflating anesthetic 1 time per day. All patients noted change the taste of the cigarette during Smoking and continued to feel it during 1 hour after insufflation. As can be seen from table 2 treatment outcomes, when the number of sessions is greater than two, all patients reduced the number of cigarettes smoked per day. Forecast the effectiveness of the treatment is positive.

None of the existing methods of treatment of tobacco dependence is not associated with a change in the quality or intensity of olfactory reception, i.e. suppression of arc pathological reflex.

The duration of treatment until full extinction of the conditioned reflex - pull to Smoking, according to forecasts ranges from 2-3 weeks up to 2 months.

Table 1
All respondents SmokersOf them have lost their sense of smellOf them quit SmokingIn %
373027 people90%

Table 2
No.Number of sessionsNumber of peopleDiseaseThe number of cigarettes smoked per day
Before the treatmentAfter the treatment
1.1 session7 people (5 male, 2 wives.)Dissociative the th - 4

Ideational - 2

Psychosomatic - 1
20Without changes
2.2 session5 people (2 male, 3 wives.)Dissociated - 2

Ideational - 2

Psychosomatic - 1
5-201 the patient has reduced the number of cigarettes 2 times, the other without changing
3.3 session1 person (1 wives.)Dissociated20Quit Smoking completely
4.4 session2 people (2 men)Dissociated - 220; 208; 6
5.5 sessions6 people (3 male, 3 wives.)Dissociated - 1

Ideational - 4

Psychosomatic - 1
20-40All reduced the number of cigarettes 3-4 times

Sources of information

1. Ovewiew. Modern medical methods of treatment of tobacco dependence (review of literature). Disease prevention and health promotion, 2002, No. 3, pages 35, 36 prototype.

2. Rudenko H. the Legacy of Jean nicot. M.: Medicine, 1983, page 32.

3. Vccmin. Clinic and treatment of tobacco dependence. M: Showinfomessage, 2000

4. Concise medical encyclopedia. M: Soviet encyclopedia, 1973 is., page 573.

5. The General course of human physiology and animals, book 1, M.: Higher school, Ed. by V. Nozdrachev A.D., pages 36-58, 373-382.

6. Daharki. Pharmacology. M.: Medicine, 1999

7. Bulletin of otorhinolaryngology, 1988, No. 3. Aeiar, Imipramin Clinical olfactometry".

1. A method for the treatment of tobacco dependence, including the supply of nicotine into the body of a patient using a medical tool that is applied on the inner surface of the upper and middle part of the nasal passage, characterized in that the treatment is carried out while maintaining the consumption of cigarettes by blocking or reducing the sensitivity of the olfactory receptors as drugs used blocker of ion channels in olfactory receptor blocker fast sodium channels in the form of the anesthetic lidocaine, his introduction localize the location of the epithelial cells of the olfactory receptors and enter it directly before the act of Smoking.

2. The method according to claim 1, characterized in that the injected spray of lidocaine as a single injection in each nostril.



 

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