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INVENTION
Russian Federation Patent RU2286795

METHOD treatment of chronic bronchitis

METHOD treatment of chronic bronchitis

Name of the inventor: Sungorkin Eugene P. (RU); Sungorkin Tatyana (RU); Karzakova Louise M. (RU); Leonid Kovalchuk (RU); Gankovskaya Ludmila (RU); Sappers Vladimir (RU); Averin Nadezhda (RU); Vladimirova Olga Vitalevna (RU)
The name of the patentee: Federal state educational institution of higher education. "Chuvash State University named after Ulyanov" (RU)
Address for correspondence: 428015, Cheboksary, Moscow Avenue, 15, CSU, OIC, NB. Shalunova
Starting date of the patent: 2005.09.16

The invention relates to medicine, namely to pulmonology, and can be used in the treatment, particularly chronic bronchitis. To do this, carry out implementation of a comprehensive therapy including antibacterial, bronchodilators, mucolytics, systemic immunomodulators, and endobronchial and physiotherapy and rehabilitation. In addition, immediately after endobronchial readjustment above the level of the tracheal bifurcation administered drug Superlymph. Administration is in a dose of 40-50 micrograms in 2.3 ml of 0.9% sodium chloride solution. The course of treatment is 1-3 treatments at intervals of 1-3 days. The method allows to normalize the physiological parameters and reduce the broncho-obstructive symptoms due to the potentiation of action Superlymph complex therapy.

DESCRIPTION OF THE INVENTION

The invention relates to medicine, namely to methods for treating chronic bronchitis.

According to the SSC Pulmonology the Ministry of Health the prevalence of chronic bronchitis in the adult population of Russia is 16%, and the total number of such patients reached 3.5 million, while labor losses from disease obstructive form of chronic bronchitis account for about 2/3 of all labor losses from chronic non-specific lung diseases.

Currently, a comprehensive method for the treatment of chronic bronchitis drug therapy, including antibacterial, bronchodilators, mucolytic agents and systemic immunomodulators, and endobronchial and sanitation, and physical therapy. However, known methods do not allow treatment to achieve rapid remission.

The claimed invention solves the problem of increasing the effectiveness of the treatment of chronic bronchitis by reducing the time to achieve remission of chronic bronchitis.

The technical result is to speed up the normalization of physiological parameters, reduction of obstructive disorders.

The problem is solved by the fact that in the complex method of treatment, which includes anti-bacterial medication, bronchodilators, mucolytic agents and systemic immunomodulators, and endobronchial and sanitation, and physical therapy, additionally prescribe Superlymph endobronchial. Thus Superlymph administered immediately after endobronchial readjustment above the bifurcation of the trachea in a dose of 40-50 micrograms in 2.3 ml of 0.9% sodium chloride solution course 1-3 through 1-3 day treatments.

Superlymph dosage form is a complex natural cytokines, including growth factors, pro-and anti-inflammatory cytokines (IL-1, IL-6, TNF, TGF, MIF), and represents a lyophilizate for local and external application. The proposed method of treatment used Superlymph (ampoules 0.1 mg), made OOO "Center for Immunotherapy" Immunohelp "Russia, registration certificate №RM002447 / 01-2003 issued by the Ministry of Health on 12.05.2003.

example 1

Patient A., 67 years old, case history # 725/253, was treated at the pulmonology department GOOSE RCH №1 from 15.03.05 on 05.04.05. Sick of chronic obstructive pulmonary disease, chronic purulent bronchitis for many years. Smoking experience was 50 years old in 1/2 pack of cigarettes a day, last 2 years did not smoke. He worked as a mechanic at a chemical plant. For a long time pointed cough in the morning. About 30 years ago it began to appear dyspnea on moderate exertion. Over the past two years marked deterioration: dyspnea occurred within the self-service, reduced exercise tolerance. Disturbed cough with scanty muco-purulent sputum, sweating, weight loss in recent months by 10 kg. An objective examination revealed lung auscultation diminished breath with a lot of wet medium and fine bubble, dry whistling, buzzing wheezing. When endoscopy diagnosed with bilateral diffuse purulent endobronchitis. The general analysis of blood leukocytes at admission 4,3 × 10 9 / L, erythrocyte sedimentation rate - 23 mm / h. According to the immunological blood tests revealed depression of T-cell immune response and decrease in the phagocytic activity of neutrophils. Treatment was carried out in the normal way with the connection Superlymph. Superlymph endobronchial administered at a dose of 50 mg in 3 ml 0.9% sodium chloride solution three times a day. On the day of the 2nd endobronchial rehabilitation was an increase in temperature to 37.1 ° C, on the other days the temperature was in the normal range. Tolerated treatment well. The dynamics of the reduction in the number of wheezing, shortness of breath decreased subjectively. Indicators spirogram - forced expiratory volume in the first minute (FEV1) and the index Tiffno (IT) have improved significantly: from 26 to 61%, from 40.1 to 64.2%, respectively. By the end of the treatment of T-cell immune response and neutrophil phagocytic activity improved: the number of T-lymphocytes increased from 43 to 54% phagocytic index increased from 47 to 61% (normal 52-69%). The number of circulating immune complexes decreased from 12 to 5 u.ed. Duration of treatment was 21 days.

example 2

Patient B., 21, medical history №1057 / 362, with 13.04.05 on 28.04.05 was hospitalized for acute exacerbation of chronic suppurative obstructive bronchitis. In early childhood, she suffered pneumonia, and then began to notice the appearance of cough with muco-purulent expectoration in cold and wet time of the year with the simultaneous addition of dyspnea during moderate exercise (walking up to 500 meters). On receipt of the time complained of cough with muco-purulent sputum to 20 ml / day, shortness of breath on exertion, recurrent pain in the leg muscles. Auscultation of the lungs listened scattered dry wheezing breathing hard in the background. On radiographs of the chest and noted increase in strain lung pattern. Right revealed pleuro-diaphragmatic adhesions. The roots of several tyazhistye. The general analysis of blood: white blood cells 7.7 × 10 9 / L, observed shift to the left (the number of band neutrophils - 18%), monocytes - 15%. Among the indicators immunogram drawn the attention of reducing the number of T-lymphocytes to 44%. The patient was treated with an additional appointment Superlymph. Superlymph endobronchial administered at a dose of 50 mg in 3 ml 0.9% sodium chloride solution three times a day. During treatment the body temperature remained within normal limits. At discharge, the lungs breathing was hard, wheezing not listened. In blood there was a decrease of stab neutrophils forms 6%, the number of monocytes was reduced to 10%. The number of T cells increased to 54%. Grew phagocytic activity of neutrophils: phagocytic index increased from 52 to 56%, phagocytic number - from 3.1 to 4.1 mic. tel. The number of days of hospitalization was 15 days.

example 3

Patient B., 23, medical history # 532/190, was treated in pulmonology GOOSE RCH №1 department with 22.02.05 on 15.03.05. She grew up a sickly child. From early childhood, he suffers from chronic purulent obstructive bronchitis. In grudnichkovom period underwent bilateral pneumonia. At the age of 13 years he was operated on the secondary bronchiectasis. Resection of S4 - S10 of the left lung. After surgery, I felt much better. Cough worried less sputum wore a slimy character, its amount reduced. Headaches that bothered before surgery, disappeared. At the time of this admission condition worsened again. Disturbed paroxysmal cough, especially in the morning, with the discharge of muco-purulent sputum up to 100 ml / day, the pain in his right side stabbing character, recurrent headaches, general weakness. Auscultation of the lungs auscultated hard breathing with lots of humming wheezing. Endoscopy revealed bilateral diffuse purulent endobronchitis. In the blood of the receivables they were found stab neutrophils - 9%, ESR - 10 mm / h. The precipitate bronchoalveolar wash consisted almost entirely of neutrophils. Receptor overexpression set activation of apoptosis (Fas) on peripheral blood mononuclear cells (0,55 × 10% of the cells had Fas-antigen) (reference values in a group of healthy - 0,31 - 0,45 × 10 9 / l). The patient was treated with an additional appointment Superlymph. Superlymph endobronchial administered at a dose of 50 mg in 3 ml 0.9% sodium chloride solution three times a day. During hospitalization fever phenomena were not. Clinically marked improvement status: sputum acquired slimy character, decreased cough, chest pain stopped bothering. Changed auscultatory picture in lungs listened unit humming wheezing in the interscapular region against the backdrop of the hard breathing. The general analysis of blood the number of band neutrophils decreased to 5%. Grown indicators neutrophil phagocytosis: phagocytic index - from 49 to 55%, phagocytic number - from 3.7 to 4.6%. The number of cells expressing the apoptosis receptor (CD95 +), was reduced to 0,24 × 10 9 / l. It reduces the degree of obstructive pulmonary disorders: FEV1 increased from 58 to 64%, CT from 72.9 to 82.1%. In bronchi endotsitogramme flush with decreased number of neutrophils in 2 times (before treatment - 98.2%, after - 47%). Hospitalization lasted 21 days.

example 4

Patient G., 19 years old, medical history №3370 / 1147 from 17.12.05 on 31.12.05 was hospitalized due to exacerbation of chronic purulent bronchitis. Disease duration is 4 years. The first symptoms appeared in the summer of 2001, after hypothermia. I began to worry paroxysmal cough with discharge of a small amount of muco-purulent sputum. In March 2004, she suffered a bilateral focal pneumonia. At the time of admission complained of paroxysmal cough with muco-purulent sputum to 50 ml / day, shortness of breath on mild exertion, periods subfebrile, wheezing sensation in the chest. Smoking Experience - 2.5 years for half a pack a day. When a state of moderate severity. Auscultation lung listened in a little buzzing rattles against the backdrop of the hard breathing. On the chest radiograph lung fields without focal and infiltrative shadows. When endoscopy revealed bilateral diffuse purulent endobronchitis. The general analysis of blood: leucocytes 4,7 × 10 9 / L, erythrocyte sedimentation rate - 4 mm / h. It showed a reduction in neutrophil phagocytic function. The proliferative activity of T-lymphocytes was reduced: the stimulation index of PHA-induced lymphoproliferation was 5.61 (normal 9,40-28,48). The patient was treated with an additional appointment Superlymph. Superlymph endobronchial administered at a dose of 50 mg in 3 ml 0.9% sodium chloride solution three times a day. During treatment the body temperature remained within normal limits. At discharge, wheezing in the lungs are not listened to. Grew phagocytic activity of neutrophils: phagocytic index - 52 to 59%, phagocytic number - from 2.8 to 3.2 mic. tel. stimultsii index of proliferative activity of T-lymphocytes was 22.17. Fewer lymphocyte apoptosis receptor bearing, with 0,32 to 0,23 × 10 9 / L. spirogram indicators remained within normal limits. The number of days of hospitalization was 14.

Example 5 (control group without Superlymph)

Patient D., 50 years old, medical history №244 / 90 from 25.01.05 on 18.02.05 was hospitalized due to exacerbation of chronic purulent bronchitis. He entered with complaints of cough, mostly in the morning with the office of viscous mucous-purulent sputum, shortness of breath on slight exertion. I had a long smoking history. The first cough began to disturb 10-15 years ago. Their appearance is connected with hypothermia. Shortness of breath is now 7 years after the first symptoms. Exacerbations of the disease occurred 2-3 times a year, lasted for 2-3 weeks. At the time of the inspection condition was moderately severe. It identifies lung auscultation in hard breathing in large quantities humming wheezing. The boundaries of cardiac dullness have been reduced. On the chest radiograph showed signs of emphysema. When bronchus endoscopy to define bilateral diffuse purulent endobronchitis. The general analysis of blood: white blood cells - 5,4 × 10 9 / L, the number of band neutrophils - 7%, ESR - 24 mm / h. Patients received standard therapy and endobronchial rehabilitation. Body temperature within one day after endoscopy increased to 37,4-38,0 ° C. Hospitalization lasted 24 days. The positive dynamics in leukogram not mentioned: the number of band neutrophils - 9%, ESR - 22 mm / h. In the immunological number of CD3 + lymphocytes remained practically unchanged (46% - before treatment, 48% - after). It maintains a low proliferative activity of T-lymphocytes (lymphocyte stimulation index to PHA 4.85 - before treatment, 2.79 - after treatment). The number of mononuclear cells expressing Fas-apoptotic receptor on the background of the therapy has not reached the values of healthy individuals (before treatment - 0,68 × 10 9 / L after - 0,53 × 10 9 / L). FEV1 and IT have not changed (43% at admission and 70.7% respectively and 70.7% and 66% at discharge). The number of days of hospitalization was 24 bed-days.

Example 6 (control group without Superlymph)

The patient E., 22 years old, medical history, 485/174, was treated in pulmonology GOOSE RCH №1 department with 02.17.05 on 10.03.05. Received state of moderate severity. According to his mother, the patient was sick in early childhood. Often pneumonia occurred. With the volume and purulence of sputum increased over time. Deterioration occurred 2 times a year, accompanied by a fever 37-38 ° C. On admission: auscultation lung listens hard breathing with a lot of buzzing and wheezing. Against the background of antibacterial therapy, endobronchial lavage aggravation docked for 21 days. After readjustment of the bronchi of the 3rd temperature rose to 37.4 ° C. In leukogram significant dynamics have been identified, the ESR was maintained at 23 mm / h. Decreased neutrophil phagocytic number from 4.4 to 2.7 mikr.tel. The number of cells expressing receptors apoptosis increased from 0,18 to 0,64 × 10 9 / l. Indicators of respiratory function remained virtually unchanged (FEV1 - 43-43% of IT - 66.2 - 63.8%).

The proposed method has been tested in the treatment of 30 people - a core group. The control group included 30 patients treated by a known method. Both groups were homogeneous in gender, age, ethnic composition, comorbidities, the presence of harmful habits. Both groups of patients were presented obstructive, nonobstructive, purulent, catarrhal forms hpronicheskogo bronchitis.

In the treatment of patients receiving Superlymph endobronchial revealed reduction in the number of cells expressing the apoptotic receptors with 0.45 ± 0,06 × 10 9 / L to 0.3 and 0,06 × 10 9 / L (p <0, 05), whereas in the control group, significant changes in the level of these cells have been identified. PHA-induced lymphocyte proliferative activity against treatment Superlymph increased significantly. PHA stimulation index increased from 8,92 ± 2,91 to 17,58 ± 5,86 (p <0.05), whereas no significant change in the control group (before treatment - 14,5 ± 1,61; after treatment - 9,02 ± 2,62) (p> 0.05). The group, which was used Superlymph overwhelming influence of antibiotics (ampicillin, ceftriaxone, ciprofloxacin, erythromycin) in vitro lymphocyte proliferation was significantly lower (p <0.05). Individuals receiving Superlymph, stimulation index of lymphocytes to PHA in medium with ampicillin increased from 7,24 ± 2,02 to 18,18 ± 7,93; with ceftriaxone - from 7,73 ± 2,43 to 13,82 ± 4,97; erythromycin - from 8,76 ± 2,49 to 18,54 ± 7,45; ciprofloxacin - from 7,78 ± 2,13 to 17,96 ± 5,69. The control group showed an increase in the overwhelming influence of the above mentioned antibiotics on the proliferative activity of T-lymphocytes: in a medium with ampicillin stimulation index decreased from 10.48 ± 1.67 to 5.88 ± 1.55; with ceftriaxone - from 9,77 ± 1,76 to 4,66 ± 1,16; erythromycin - from 10,34 ± 2,46 to 4,14 ± 0,98; ciprofloxacin - from 8,29 ± 3,07 to 4,09 ± 1,59. The treatment took place Superlymph improvement of respiratory function: Tiffno index increased from 70,82 ± 3,32 to 74,56 ± 3,25 (p <0.05), FEV1 increased from 56,35 ± 4,90 to 64, 81 ± 5,15 (p <0.001), due to a decrease in obstructive disorders during treatment Superlymph compared with the control group. The number of days of hospitalization in patients treated Superlymph was significantly lower (p <0,05) (16,30 ± 1,20 bed days against 19,78 ± 0,79 bed-days in the control group). Temperature response in individuals receiving Superlymph, predominantly occurred only after the first and second bronchoscopy whereas in the control group, it was approximately the same rate after each readjustment.

The data show that the appointment Superlymph endobronchial immediately after endobronchial readjustment above the bifurcation of the trachea in a dose of 40-50 mg in 2-3 ml of 0.9% sodium chloride solution rate of 1-3 procedures through 1-3 days potentiates the action of antibiotics and thus accelerating the achievement of remission.

Thus, the present process significantly enhances the effectiveness of treatment of chronic bronchitis.

USED ​​BOOKS

1. Butler LI Infection and chronic obstructive pulmonary disease. Consilium medicum, 2001; 3 (12) (/media/consilium/01_12/587.shtml).

2. Clinical guidelines. Chronic obstructive pulmonary disease / Ed. Chuchalina AG - M .: "Atmosphere" Publishing House, 2003. - 168 with silt..

3. AN Kokosov Chronic bronchitis and obstructive pulmonary disease: an analytical essay. Ter. Archive 2000, №3; 75-77.

4. Rational pharmacotherapy of respiratory diseases. Guidance for practitioners / Ed. Chuchalina AG - 2004. - 874 p.

5. Chuchalin AG, Arion VY, Evseev, NG et al. Immunotherapy in pulmonology. M., Medicine, 1989. S.20-143.

CLAIM

A method of treating chronic bronchitis, comprising antibacterial drug therapy, bronchodilators, mucolytic agents and immunomodulators system, and a sanitation endobronchial physiotherapy, characterized in that directly after endobronchial readjustment Superlymph introduced above the bifurcation of the trachea in a dose of 40-50 micrograms in 2.3 ml 0.9% sodium chloride solution course 1-3 through 1-3 day treatments.

print version
Publication date 06.01.2007gg