Kisyova, K.

Peneva, M.

Zlatanov, Z.

English

Varna Medical University Press: Journals

COMBINED TREATMENT OF BRONCHOOBSTRUCTIVE DISEASES K. Kisyova, M. Peneva,Z. Zlatanov Key-words: bronchial obstruction - therapeutic schedules - spirography - clinics The difficulties of therapeutic choice in patients with broncho-obstructive states are due to complex pathogenesis of disease as well as to prevalence of one or another pathogenetic mecha­nism during single stages of its evolution (atopia, infectious-allergic component, dysbalance of bronchial autonomic regulation, glucocorticosteroid deficit, etc.). Recently, no new in principle discoveries in the field of bronchial obstruction treatment have occurred, indeed. However, pre­vious solutions are optimized to a considerable extent ( 1 , 2, 5). Indications and schedules for application of bronchoselective β2-adrenergic agonists for inhalatory, peroral and parenteral use, anticholinergic medicaments, inhibitors of mediator release, corticosteroids for local appli­cation are already specified. Medicamentous forms of theophyllin derivatives are improved. Des­pite of undoubted successes achieved in mastering of reversible bronchial obstruction it pres­ents a serious therapeutic problem in single cases and at different stages till now. Besides mod-dern bronchorelaxing means are not free of side effects. That is why renewal of our therapeutic possibilities has a definite practical importance (3 ,4 , 8, 9). The purpose of the present communication is to evaluate comparatively the clinical effecti­veness of some contemporary therapeutic schemes of bronchoobstructive diseases. Material and Methods During the period 1980-1986 a total of 195 bronchial obstruction patients (i.e. with in­fectious-allergic form of bronchial asthma and chronic obstructive bronchoobstructive disease) were followed-up in the Clinic of Pulmology and ambulatorily (in the allergological and poly-clinical consulting rooms of Hospital, Varna). Varna). Patients with approximately equally ex­pressed bronchial obstruction evaluated according to physical and spirographs examination were selected. Patients were divided into 7 groups as followed: 1st _ 30 patients treated with prolonged xanthine preparations (Phyllocontin or Bulgarian ̂ preparation "Theotard") at dosage of 300 mg twice daily; 2nd _ 30 patients treated withNovphyllin at dosages 200 mg thrice dai­ly-3rd _ 30 patients treated with selective fc2 -agonists; Salbutamol or Partusisten (Fenoterol); 4th _ 30 patients treated with cholinoly tic preparation — Atrovent for inhalatory use at dosage of 0.2 mg thrice daily; 5th - 30 patients treated with inhalatory corticosteroid preparation -Beclomethasondipropionat (Beclomet) at dosage of 100 mg 4 times daily; 6th - 15 patients treated with calcium agonist — Isoptin in an acute experiment used in patients with contra­indications to xanthine preparations and fc-agonists, and 7th _ 30 patients treated with soidum chromoglycate (Intal) at dosage of 20 mg four times daily or with Ketodiphen (Zaditen) at dosage of 1 mg twice daily. Patients were followed-up for three months. At the beginning of treatment as well as at the end of every month a functional examination of respiration was car­ried out by using of 'Tneumoscreen" apparatus and alveolo-diffusion test of the firm "Jaeger". Therapeutic effect was evaluated according to clinical and spirographs criteria. Presence of fa­vourable effect was considered when paroxysmal bronchial obstruction disappeared or at least reduced, accompanying cough arid physically manifested bronchial spasm decreased and spiro-Combined treatment of. 51 graphic parameters, especially F E V ! , increased by more than 15 per cent. Data obtained were processed by the methods of non-parametric and variation analyses. Results and Discussion The results from our study are shown on table 1.. Monotherapy with xanthine derivatives - a rapidly acting and prolonged theophyllin prepa­rations influences favourably upon more than the half of the patients. However, patients with good therapeutic effect prevail. Significant side unfavourable phenomena during the therapeutic T a b l e 1 Clinical effectiveness of different therapeutic methods Group No Therapy applied i Patient No Favourable effect n % p t Und I I I r d I V t h V th V l t h V l l t h prolonged xanthine preparation Novphyllin selective fi2-agonist cholinolytic (Atrovent) inhalatory corticosteroid preparation (Bcclomet) calcium antagonist ( I sop tin) prophylactic means ( Inta l , Zaditen) 30 30 30 30 30 15 30 17 20 18 19 7 12 24 56.7 66.7 60.0 *63.3 33.3 80.0 80.0 course are not observed. However, patients' majority (53.3 per cent) showed an exacerbation (bronchial spasm) during the 3-month long follow-up. The relative share of favourably influen-ed patients after Salbutamol therapy is approximately equal to that of patients after theophyl­lin preparation therapy when the group of selective fi2-agonists is concerned. However, side unfavourable effects are noted in 24.3 per cent of the cases predominantly of the cardiovascular system. Partusisten (Fenoterol) eliminates bronchospasm still on the 3 0 ш min. This favourable effect as well as the increase of spirograpliic values retain for hours. Sinus tachycardia is observ­ed and electrocardiographically registered in 14 of all the 15 patients causing therapy cessation in 5 of them. Headache is found in two patients but tremor accompanying tachycardia in three ones. The relative share of favourably influenced patients after Atrovent therapy is high (63.3 per cent) although spirographs indexes do not undergo such a favourable dynamics, too, when compared with those of patients from the other groups. Immediately after AtrovenJ inhalation, tachycardia is registered with 5 patients. It disappeared spontaneously one hour after the pro­cedure. In patients of the 6 Ш group Isoptin therapy results in favourable influence and spirographs value increase 30 min after application of the drug. Rhythmic disorders preceding therapy are removed. Headache is established only in two patients with accompanying ischemic heart di­sease. The lowest relative share of favourably influenced patients is in the group of inhalatory corticosteroid treatment. Probably, it is determined by the circumstance that the majority of these patients are corticosteroid-dependent and with considerably manifested durable bronchial obstruction, Corticosteroid dependence is eliminated n̂ 7 of the patients of this group. Patients treated with Intal or Zaditen are also favourably influenced. Most frequently, Intal induces a very good therapeutic effect while Zaditen results in a goodt>ne. Ten patients of this group be-52 К. Kisyova, М. Peneva, Z . Zlatanov. come spastic during the 3-month follow-up. This circumstance can be due to the fact that des­pite of phosphodiesterase inhibitory effect of th*se preparations they do not possess a strong direct bronchorelaxation effect similarly to classic phosphodiesterase inhibitors such as theo-phyllin preparations (6, 7). Clinical effectiveness of their "prophylactic" usage increases by com­bination with specific hyp ©sensibilization started in remittent periods when bronchial obstruc­tion is neutralized. The dynamic follow-up reveals differences in clinical effectiveness and spirographs paramet­ers. While theophyllin preparations and fi-agonists influence on diffuse bronchial obstruction (of smaller respiratory tracts, inclusive) objectified by means of capacity measurements with smoUer pulmonary volumes cholinolytic medicaments, calcium antagonists and corticosteroids for local use influence predominantly on large respiratory tract obstruction (pulmonary resist­ance). We can conclude that as result from our investigations of many years it can be accepted that modern combined treatment of bronchoobstructive diseases should comprise as "basic therapy" some bronchodilatators - theophyllin preparation (recommended is that one with least side effects), Б-mimetics or cholinolytics. When there are cardiovascular contraindications a calcium antagonist is preferred but when corticosteroid dependent and hardly influenced patients are concerned a corticosteroid preparation for local application should be administered. In the re­mittent period, combination of bronchodilatators and specific hyposensibilization together with prophylactic medicaments — Intal or Zaditen - results in maximally good therapeutic effect. R E F E R E N C E S 1. 3 л a T a H о в, 3. , К. К и с ь о в а, М . П е н е в а . Съвр. мед., 1981, № 4, 10-12. - 2. 3 л а т а-н о в, 3 . , К. К и с ь о в а , М . П е н е в а . Пневмол. и фтизиатр., 1983, № 2, 65-68. - 3. К о м а р о в , Ф. И., И. Г. Д а н и л я к. Клин, мед., 1981, № 4, 10-12. - 4. С и л ь в е с т р о в , В. П. Тер. арх., №982, № 4, 3 -9 . - 5 . С т а н е в а - С т о я н о в а , М., Г. К о с т у р к о в . Съвременно лечение на бронхиал­ната астма. Науч. обзор . София, ЦНИМЗ, 1981. - 6. Ш м е л е в, Е. В., Тер. арх., 1983, № 3, 25-27. -7, B e r n s t e i n , J . , et aL / . Allergy Clin. Immunol, 68, 1981, No 4, 247-254. - 8. V a 1 v е г d. E . , et aL Ann. Allergy, 48, 1982, No 1, 32-35 . - 9. W a g n е г, С., et al. Ann. Allergy, 50, 1983, No 1, 19-22 . КОМБИНИРОВАННОЕ ЛЕЧЕНИЕ БРОНХООБСТРУКТИВНЫХ ЗАБОЛЕВАНИЙ К. Кисеаа, М. Пенева, 3. Златанов Р Е З Ю М Е Проведено сравнительное исследование клинической эффективности некоторых современных схем лечения бронхообструктивных заболеваний. Больные были распределены на семь групп. В каждой группе проводилось лечение с применением одного из препаратов: новфилин, филоконтин (теотард), сальбутамол (паргосистен), атровент, бекломед, изоптин, интал (задитен). У всех боль­ных прослеживались показатели внешнего дыхания и физикального синдрома до и после лечения соответствующими препаратами. В результате исследований, проводимых в течение долгих лет, авторы делают заключение, что современное комбинированное лечение бронхообструктивных за­болеваний должно включать в качестве „базисной терапии" препарат теофилина, бетамиметик или холинолитик, а при кортизонзависимых больных - бекломед. Наилучший эффект дает сочетание бронходилататоркого лечения со специфической гигюсенсибилизацией, которое применяется одно­временно с медикаментами, имеющими профилактическс е действие - инталом или задитеном. 

COMBINED TREATMENT OF BRONCHOOBSTRUCTIVE DISEASES

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COMBINED TREATMENT OF BRONCHOOBSTRUCTIVE DISEASES

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