Method of treating moderate house atopic bronchial asthma in patients with immune deficiency suffering from frequent acute respiratory infections

FIELD: medicine.

SUBSTANCE: treating moderate house atopic bronchial asthma in the patients with immune deficiency suffering from frequent acute respiratory infections is ensured by administering Grippferon intranasally 5 days a week with a leech therapy accompanied by a subcutaneous allergen-specific immune therapy with causally relevant allergens. The leech therapy is performed by applying one medical leech on the skin in a projection of the thymus twice a day for the period of time with no ARI episodes recorded over the last 3 months. The allergens are administered endolymphatically in the proximal direction from a cuff applied on a forehand, and pressure is maintained at 40 mm Hg for 60 minutes with an underlying basic therapy with the Symbicort preparation.

EFFECT: using the method enables providing the higher clinical effectiveness in anti-recurrent therapy of the frequent ARI episodes in the patients suffering from the moderate form of bronchial asthma, reducing the number and length of the ARI episodes, preserving control over the asthmatic symptoms with reducing a dose and a frequency of the preparations of the bronchial asthma therapy.

1 ex

 

The invention relates to medicine, namely to clinical immunology and Allergology, and can be used in the treatment of partially-controlled and controlled moderate to severe forms of atopic bronchial asthma (BA) household etiology, occurring with frequent exacerbations in the background of the syndrome secondary immunodeficiency States (VIGS) in patients with frequent acute respiratory infections (ARI).

Currently, there is no doubt the fact that the most sensitive and integral indicator of health in humans, is the state of his immune system (is), because it provides both antigenic and structural stability, and regulation of the processes of proliferation and differentiation of immune cells. The status of IP is important in the formation reaction of the body to any external and internal effects, including frequent acute respiratory infections of the respiratory system.

There is a method of treatment of frequent acute respiratory infections in patients with VIDS, consisting of intranasal administration of the drug "Grapperon, nose drops (CJSC FIRN, M., Russia) (Gaponyuk P. J., E. Doroshenko M. Journal "Polyclinic №5 2008", pages 22-26).

The disadvantage of this method is its low efficiency due to the rapid elimination of the drug from the mucous membranes of the nose, and t is the train no effect on the system thymusdependent cell type of the immune response.

The closest achieved technical result is a method of treatment of atopic BA household etiology by conducting subcutaneous allergen specific immunotherapy (ASIT) cause significant allergens (FSUE "NPO "Microgen" the Ministry") in the period of remission or pharmacological control (Kolher P. C., 2010, 516 S.).

The disadvantage of this method is its low efficiency because of the dominating influence on the systemic immune response and the absence of direct stimulation of lymphoid formations associated with the mucous membranes of the upper respiratory tract.

The authors proposed an efficient method for the treatment of moderate atopic bronchial asthma household etiology in patients with immunodeficiency condition, suffering from frequent ARI, does not require expensive equipment and drugs, but to effectively arrest the frequent exacerbation of BA caused respiratory infections that are resistant to treatment with other topical and systemic immunotropic drugs.

The technical result of the proposed method is to increase the effectiveness of preventive therapy of recurrent episodes of acute respiratory infections in patients suffering from moderate form of BA, due to the step therapy scheme of the proposed method.

Technical re the query result is achieved by that is administered intranasally "Grapperon" for 5 days a week with the simultaneous holding of hirudotherapy in the form of imposing one medical leeches on the skin in the projection of the thymus gland, which is carried out 2 times a week, during the time when for the last 3 months not recorded episodes of acute respiratory infections, and allergens enter the endolymphatic proximal cuff placed on the forearm, and keep the pressure 40 mm RT. Art. for 60 minutes on the background of basic therapy drug "Symbicort".

The method is as follows.

Patients with atopic BA household etiology, under the control of the basic therapy, and partial loss due to frequent re-ORI associated with secondary immunodeficiency syndrome in the form of a reduction in the number of KIC and/or their effector functions, designate the following diagram.

"Grapperon" (CJSC FIRN, M., Russia) 3 nose drops 1 time per day, in the morning, 5 days a week with a simultaneous imposition on the projection area of the thymus gland for 1 (one) medical leech to inadvertent separation of 2 times per week. A bleeding wound is closed with a sterile swab. Treatment VIDS in this way shown to reduce the frequency of re-ORI to 1 times in 4 months (i.e. 3 or less times per year). At the same time carry out ASIT cause-and-meaningful/mi allergen/mi, BB is necessary(mi) hypodermic syringe with a gradual increase in the volume of injection distal to the cuff with supported within 60 min pressure 40 mm RT. Art. (endolymphatic) program recommended by the manufacturer allergens FSUE "NPO "Microgen": from 0.1 to 0.8 ml of the 10-5 dilution 1 time per day during the set dose, 0.5 ml of undiluted serum 1 time in 7-14 days. The course is carried out for 3-5 years.

By the present method treated 54 patients with good therapeutic effect in 48 people, which helped reduce the amount of basic therapy for GINA to step down within 1 year of treatment.

Clinical example

The treatment by the present method.

Nicholas P., 17, surveyed 20 November 2007. The patient is re-examined on 30 November 2010.

Clinical diagnosis: Bronchial asthma, atopic, moderate, partly controlled, domestic (house dust 4C, miracles house dust) etiology. Frequent acute respiratory infections. Secondary immune deficiency, cell type.

Complained of frequent episodes of acute respiratory infections - up to 10 times over the past year, lasting up to 2 weeks, accompanied by fever, General weakness and lethargy; recurrent sore throat.

Frequent respiratory infections marked the last 3 years since migrated lacunar angina.

With 10 years suffers from bronchial asthma controlled with inhaled corticosteroids and bronholitikami. At last the e 3, the state asthma control is not sustainable: episodes expiratory dyspnoea with distant whistling rales occur during each respiratory infections and continue for 3-5 days. In the last 3 years of monitoring of asthma symptoms was carried out by the drug "Symbicort" (ASTRAZENECA AB, Sweden) 4,5/160, - 1 dose × 1-2 times a day, and at exacerbation, SMART technology, up to 12 doses per day.

The General condition of the patient closer to satisfactory health does not suffer. The skin is clean. Zev calm, purulent overlay no. Symptoms Zack, Transfiguration, Koritskiy, Carnico - negative. Thorax slightly increased in the sagittal dimension, percussion sound over all lung fields has boxed shade, breathing slightly elongated and exhale single sibilant rales in the lower lung. NPV 21 in 1 min HR 91 in minutes From other internal organs and systems of pathological changes were noted. Immune status is set moderately expressed disorders of phagocytic and secretory functions of polymorphonuclear leukocytes with a reduced number of CD3+, CD4+, and CD8-positive lymphocytes and normal levels of major classes of immunoglobulins A, M and G. the Immunoglobulin E - 570 ME. In addition, it was noted saved spontaneous and reduced to phytohemagglutinin (PHA) proliferation of lymphocytes, as well as increased spontaneous and decreased stimulated production of tumor necrotizing factor alpha (TNFα) in cell culture. Performed during health skin-scarify which include samples verify itchy papules more than 15 mm pseudoprime to the allergen from the house dust 4 series and allergen Dermatofagoidus pteronissimus.

Was therapy according to the scheme of the proposed method.

"Grapperon" (CJSC FIRN, M., Russia) was administered to 3 drops in each nostril 1 time per day 5 days a week in the morning for 3 (6, 9, 12) months prior to the disappearance of episodes of ARI in the last 3 months. Subsequent emergence of ORI reception "Grapperon" (CJSC FIRN, M., Russia) was renewed and cancelled on the same criterion. At the same time, 2 times a week on the skin of the sternum in the area of projection of the thymus put 1 medical leech to inadvertent separation. Expose haemolymph ranged from 20 to 50 milliliters per day. Leeching was held for 3 (6, 9, 12) months to achieve a target frequency of episodes of ARI and reopened in their new appearance. At the same time held the allergen-specific therapy drugs from the house dust allergens 4C and Dermatofagoidus pteronissimus (FSUE "NPO "Microgen", Russia), mixed 1:1, according to the program recommended by the manufacturers, starting with the 0.1 ml of the 10-5 to 0.5 ml undiluted allergen entered endolymphatic distal imposed cuff saved 40 mm RT. Art. pressure for 60 minutes

In the first year of treatment, the patient underwent 4 episode ORI, accompanied by paroxysms expiratory dyspnoea with distant sibilant rale, which were cut short by Symbicort the (ASTRAZENECA AB, Sweden) 4,5/160 technology SMART to 12 inhalations per day for 2 days. No episodes of acute respiratory infection in last 3 months is allowed to cancel anti-relapse treatment "Gripperdon" (CJSC FIRN, M., Russia) with leeching. Over the next 6 months, the asthma control was carried out by Symbicort" (ASTRAZENECA AB, Sweden) and ASIT at a dose of 0.5 ml, administered endolymphatic 1 time in 2 weeks. Then the patient again underwent an episode of ARI, without exacerbation (out of control) asthma, and therefore treatment Gripperdon" (CJSC FIRN, M., Russia) and leeching was renewed for 3 months, during which episodes of ARI was not. Over the past year the patient has suffered 2 episodes of ARI, with retained control of asthma, and after the first episode was resumed treatment Gripperdon" (CJSC FIRN, M., Russia) and leech, within 3 months, during which episodes of ARI had not been registered and after which immunogenically therapy was cancelled. All this time I held ASIT household allergens with the frequency of the endolymphatic introduction 1 every 2 weeks.

In immune status with the re-examination installed: disorders of phagocytic and secretory functions of polymorphonuclear leukocytes no, the relative and absolute number of CD3+, CD4+, and CD8-positive lymphocytes are not changed. Normal levels of immunoglobulins main class is s - A, M and G. the patient was noted saved spontaneous and increased PHA proliferation of lymphocytes, as well as increased spontaneous and stimulated production of TNFα in cell culture. Performed during health skin scratch tests have registered the pimple less than 3 mm allergens from house dust 4 series and allergen Dermatofagoidus pteronissimus.

Thus, ongoing therapy led to a decrease in the number of acute respiratory infections, control of the symptoms of atopic bronchial asthma and restoration of immune status.

During 3 years of treatment with 7 episodes of acute respiratory infection (2 episodes in the last year - a marked reduction in the incidence of ARI), which lasts 3-4 days (decrease in the duration of exacerbations), full control of asthma symptoms and restore the settings of the immune system.

Claimed by the authors of the method for the treatment of moderate atopic bronchial asthma household etiology in patients with immunodeficiency condition, suffering from frequent acute respiratory infections, showed high efficiency, allowing you to reduce the number and duration of episodes of ARI, maintaining control of asthma symptoms, reducing the dose and frequency of use of drugs of basic therapy of bronchial asthma.

The advantage of the proposed method over the known is that the claimed ability is b can effectively reduce the frequency of exacerbations of asthma in patients with secondary immunodeficiency syndrome, which greatly increases the effectiveness of therapy of bronchial asthma.

A method for the treatment of moderate atopic bronchial asthma household etiology in patients with immunodeficiency condition, suffering from frequent acute respiratory infections through subcutaneous allergen specific immunotherapy cause significant allergens, characterized in that it further administered intranasally "Grapperon" for 5 days a week with the simultaneous holding of hirudotherapy in the form of imposing one medical leeches on the skin in the projection of the thymus gland, which is carried out 2 times a week, during the time when for the last 3 months not recorded episodes of acute respiratory infections, and allergens enter the endolymphatic proximal cuff placed on the forearm, and keep the pressure 40 mm RT. Art. for 60 minutes on the background of basic therapy drug "Symbicort".



 

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3 tbl

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2 cl, 1 ex, 1 tbl

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3 ex

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25 cl, 20 ex, 5 tbl, 4 dwg

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2 tbl

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