Method of treating angioedemas

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to allergology, and can be used for treating angioedemas. For this purpose introduced are antihistamine preparations, membrane-stabilisers, as well as pulmicort as glucocorticosteroid preparation. Pulmicort is introduced in amount 10 drops per 2 ml of physiological solution by inhalations through nebuliser during 3 minutes. Introduction of pulmicort is carried out daily during 1-3 days.

EFFECT: invention allows fast reduction of gullet and pharynx angioedemas due to direct impact on mucous membranes by said glucocorticosteroid in dose and mode of introduction specially designed for this purpose.

2 ex

 

The invention relates to medicine and Allergology and can be used for the treatment of patients angioedema pharynx and larynx.

Closest to the invention is mild angioedema using a short course of glucocorticoids (GCS) intravenous: dexamethasone at a dose of 8-12 mg / day or prednisone 40-60-90 mg per day for 1-3 days (Rational pharmacotherapy of allergic diseases: a guide for practitioners / Rmitv, Neelin, Tvetydig, Lowloss and others - M.: Letter, 2007. S; Clinical guidelines. Allergology. Edited Rmitv, Nieling. - M.: GEOTAR-Media, 2008. S).

The described method is applied in patients with acute angioedema not associated with disorders of the complement system. The method consists in intravenous drip (60 drops per minute) the introduction of corticosteroids in 200 ml of saline daily for 1-3 days. The effectiveness of the treatment is estimated by the relief of objective and subjective data angiotech. As a result of the treatment eliminates swelling of the oropharynx, hoarseness, trouble breathing.

The described method has a rapid clinical effect, however, the use of systemic corticosteroids, even short-term increases in blood pressure, headache, dyspeptic disorders.

It is known that about ilovesbilly the effect of SCS is mainly due to the stabilization of cell membranes (including fat and lysosomes), by suppressing the activity of phospholipase A2and hyaluronidase, release of arachidonic acid from the phospholipids of cell membranes (reduction products of its metabolism, prostaglandins, thromboxane and leukotrienes), and inhibition of the degranulation of mast cells release histamine, serotonin and bradykinin), synthesis of platelet activating factor and proliferation of connective tissue (Medmaravis, 2005).

The objective of the invention is to improve the efficiency and reduction of terms of treatment of patients angioedema with minimal side effects. This object is achieved by conducting a nebulizer therapy with pulmicort for 3 minutes daily for 1-3 days (10 drops pulmicort in 2 ml of physiological solution) using the apparatus "XVIII inqua NEB" (Germany).

Pulmicort (Budesonide) - corticosteroids for inhalation with a strong local anti-inflammatory action is rapidly absorbed after inhalation. In adults, systemic bioavailability of budesonide after inhalation of Pulmicort via nebulizer, approximately 15% of the total prescribed dose and about 40-70% of the delivered. Withmaxin the blood plasma is reached after 30 min after the start of inhalation.

To evaluate the effectiveness of nepaliterature before and after treatment were analyzed clinical SIM is Toms angiotech pharynx and larynx. Clinical testing of the method was performed in 18 patients angioedema pharynx and/or larynx. The control group consisted of 23 patients who received only traditional treatment (SCS/, antihistamines, memresistor). In the experimental group traditional treatment antihistamines, membranostabilizatora was supplemented three-minute sessions nebulizer therapy with pulmicort daily for 1-3 days. In the course of therapy was assessed clinical symptoms of the disease.

The results of the study revealed a clear positive dynamics of the disease. In 17 patients (94,4%) improvement was noted immediately after the 1st treatment: a significant decrease in edema when viewed from an ENT specialist, as well as the relief demanded complaint (hoarseness, difficulty swallowing, breathing, swelling of the oropharynx). After the 2nd session nebulizer therapy in 18 patients (100%) was stopped up all the symptoms.

To illustrate the effectiveness of nebulizer therapy with pulmicort, the following clinical observations.

Example 1

Patient L., 56 years old, no history of the disease 20093/785, went to the Allergy Department in April 2008 with complaints of shortness of breath, swelling of the tongue. These symptoms appeared about 2 hours ago after taking enalapril for about increase blood what about the pressure. Delivered by ambulance to KOKB admitted to the Allergy Department. History of arterial hypertension, chronic gastroduodenitis, pancreatitis. History of viral hepatitis a in childhood. The negative risk factors. When applying the General state of moderate severity. The skin is a normal color. The breath in the lungs vesicular, no wheezing. Respiratory rate 18 in 1 minute. Muffled heart sounds, rhythmic. Heart rate 86 in 1 minute. Blood pressure 150 and 90 mm Hg white furred Tongue, enlarged in size. The abdomen is soft, painless. The liver is not enlarged. In the General analysis of blood leukocytes of 7.8×109/l, p - 10, p - 67, e - 3, l - 13, m - 7, ESR - 5 mm/h, total animacy - d - 1013, acid, b - 0, epic. flat - 2-3 p/SP, l - 1-2 p/SP. ECG - signs of hypertrophy of the left ventricle. R-gram of the chest - lung fields clear, the structural roots, not expanded. The ENT examination: swelling of the tongue and oropharynx pale bluish color. The performance of immunolo status - Tabs - 56%, TX - 30%, Cu - 26%, VL - 22%, IgA - 1.8 g/l, IgM - 1.2 g/l, IgG - 14.2 g/l was assigned therapy: ketotifen 1 t×2 R, clarida 1 t×1 R, famotidine 40 mg×1R, nebulizer therapy with pulmicort. Improvement was noted immediately after the 1st treatment, manifested by a significant decrease swelling of the throat and tongue, but what melisaria breathing. On the 2nd day the symptoms were stopped completely.

Example # 2

Patient D., 42 years old, no history of the disease 31941/735 entered the Allergy Department in may 2008 with complaints of hoarseness, difficulty swallowing. Considers himself ill for about a week, when for the first time for no apparent reason caused swelling periorbital areas. Medical help is not sought, the swelling was controlled independently intramuscular antihistamines (suprastin). Recent deterioration few hours ago, when there were stroganoe swallowing, and then hoarseness. Suffering from chronic gastritis. About 10 years ago - appendectomy. Risk factors: urticaria drug Genesis. When applying the General state of moderate severity. The skin is a normal color. The breath in the lungs vesicular, wheezing netcd-17 1'. Heart sounds are clear, regular rhythm. HR - 80 1'. AD - 120/70 mm Hg Abdomen is soft, painless. The liver is not enlarged. In General, the analysis of blood - er - 4,4×1012/l, Hb - 140 g/l, the CPU is 0.9, l - 5,6×109/l, p - 2, p - 70, e - 2, l - 21, m - 5 ESR - 3 mm/hour, IgA - 2,04 g/l, IgM - 1,33 g/l, IgG - 16,22 g/l, IgE - 3,9 IU/ml, Tobs - 55%, TX - 38%, Cu - 17%, VL - 13%, phagocytosis - 59%, γ-IFN and 16.2 PG/ml, IL-4 to 6.5 PG/ml ECG - rhythm regular sinus. ENT doctor: pale bluish swelling of the soft palate, tongue, arms, throat. He was appointed therapy - ketotifen 1 t×2 R, clarida 1 t×1 R, n is belisama therapy with pulmicort. When the receipt was held the session nebulizer therapy with pulmicort. After the session noted improvement in breathing, swallowing, when viewed from the observed decrease swelling of the soft palate, tongue, arms. After the 2nd session nebulizer therapy was stopped swelling disappeared hoarseness.

Thus, the use of nebulizer therapy with pulmicort in patients with acute angioedema pharynx and larynx, not associated with the pathology of the complement system, which provides rapid elimination of symptoms.

This allows us to recommend this treatment in clinical practice for rapid relief of acute angioedema with minimal side effects.

A method of treating angioedema, including the introduction of antihistamine drugs, membrane stabilizers and glucocorticosteroid preparations, characterized in that as a glucocorticosteroid drug use pulmicort in 10 drops in 2 ml of physiological solution, which is administered by inhalation through a nebulizer for 3 min daily for 1-3 days.



 

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1 ex, 4 tbl

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8 tbl, 2 ex

FIELD: medicine.

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27 cl, 9 dwg

FIELD: medicine.

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5 dwg

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