IV Международная студенческая научная конференция Студенческий научный форум - 2012

Abstract. The article reports experimental data on the use of polyoxidonium in a complex therapy of bronchial asthma in children. Evalutions of clinico-instrumental studies have been made for 25 children treated according to a standard therapy of bronchial asthma and 25 children treated with the use of polyoxidonium in addition. The emphasis of aggravation symptoms, needs for β₂ - agonists of a short action, functional indices of respiration (peak exhalation rate, daily variability in the peak exhalation rate) and blood tests for the contents of cerruloplasmin and catalaza in 10 children with bronchial asthma have been analyzed. Most active triggering factors in both groups of the patients are contacts with allergens and acute respiratory infection.  The use of polyoxidonium in a complex therapy of bronchial asthma has been found to attain the control over clinical symptoms of illness most effectively and to considerably improve the indices of the external respiration function in comparison with the patients subject only to a standard therapy. As a result of the use of polyoxidonium, the patients with bronchial asthma, who are often subject to respiratory infections, show a reliable growth of activity of antioxidant protection.

Key words: bronchial asthma, therapy, polyoxidonium.

For the recent years, there has been observed a growth of allergic diseases, which is connected with changes in socio-economic conditions of life and with improvements in diagnostics, as well as with the influence of ecological environments nowadays [4].

Bronchial asthma is a chronical inflamatory illness of the respiratory system in a genesis of which many cells and cellular elements take part. It is the cronical inflammation that causes the respiratory system hypercorrection and results in relapse episodes of goose breathing, asthma and cough. Pharmacotherapy is an indispensable part of treating asthma in children. The main purpose of bronchial asthma  treatment for children is the acquisition of a stable remission and high quality life for all patients independently of a level of gravity [3].

Apart from respiratory  allergens, much attention has, recently, been given to factors triggering the development of bronchial asthma aggravation in children [5]. Other authors share the opinion that acute frequently - repeated respiratory infections promote the development of lung bronchial pathology and dispose the development of otolaryngologic organ diseases which can be grounds for a delay in phsicomotoric and physical development of children. Such children constitute a dispensary group of frequently unhealthy patients. The criteria of including children into this group are determined by the number of episodes of acute respiratory infection which are as follows: for babies of the age up to 1 year - 4 episodes and more often; for the age from 1 to 3 years - 6 episodes and more often; for the age from 4 to 5 years - 5 episodes and more often; for the age of 5 years and older - 4 episodes and more often. By the data of many European sources, the percentage of such children varies from 15% up to 75%, and no tendency to a decrease is observed.

In view of this, the use of immunomodulators in a complex therapy of bronchial asthma of frequently unhealthy children is of great importance.

The present paper describes the analysis of the efficacy of using polyoxidonium (bromide azoximer) in a complex therapy of children fraught with acute respiratory

diseases.

Methods of investigation.

A retrospective analysis of case histories of children fraught with heavy, medium and light forms of bronchial asthma has been made together with the evaluation of such clinico-instrumental studies as:

• - emphasis of aggravation symptoms;
• - necessity of β₂-agonists of short action
• - changes in laboratory indices (general blood analysis, proteinogramm, catalaza activity, cerruloplasmin content)
• - changes in functional respiratory indices (peak exhalation rate, daily variability in the peak exhalation rate).

Two groups of 50 children^,s case histories of bronchial asthma have been analysed: 25 children of the age from 5 to 15 years who have received a standard therapy of bronchial asthma (inhalation glucocorticosteroid, nebulizer therapy whith bronchodilatators) and polyoxidonium in a doze of 3-6 mg once a day (intravenously), 3-5 injections for the course of treatment, and 25 children who have received a standard therapy of bronchial asthma only (control group), the  stationary course of treatment being 15 days.

 Results of the study and discussions.

 The two groups of children having the diagnosis of bronchial asthma were  comparable in the age, degree and time-period of illness as well as in the emphasis of initial symptoms. The patients of a medium form of bronchial asthma gravity prevailed in both groups. It was established that most significant triggering factors in both groups of children with bronchial asthma are contacts with allergens and acute respiratory infection.

Prior to the  course of treatment the patients showed the following clinical symptoms: bouts of asphyxiation at day-time and nights, impediments in breathing at a physical load, coughing and use of broncho-dilators of short action in connection with these episodes during the past 4 weeks (see table 1

 Table 1. Clinical symptoms in children having bronchial asthma at the reception                         

Groups analysed	Bouts of asphyxiation		Impediment in breathing at a physical load	Coughing
	Day-time	Night-time		Dry	Moist
Group I	25 (100%)	18 (72%)	21 (84%)	15 (60%)	10 (40%)
Group II	25 (100%)	15 (60%)	16 (64%)	16 (64%)	9 (36%)

In asthma-test results in Group I, 84% of the children showed ineffectively controlled bronchial asthma at the entering to the hospital and 16% of the children showed effectively controlled asthma. In Group II the percentage of insufficiently effective control was 20%. In both groups the general blood analysis showed leukocytosis with an increased amount of lymphocytes and moderate aeosynophilia. The proteinogramm showed an increate in α₂-fraction proteins.

In Group I the daily exhale peak rate variability up to 20% was observed in 4 patients (16%), variability of 20% to 30% was observed in 18 patients (72%) and variability over 30% was observed in 3 patients (12%) (see table 2).

Table 2. Daily variability of exhale peak rate in bronchial asthma patients

Groups analysed	Daily variability of exhale peak rate (%)
	Up to 20%	20-30%	Over 30%
Group I	4 (16%)	18 (72%)	3 (12%)
Group II	5 (20%)	17 (68%)	3 (12%)

The analysis of clinical symptoms was made on the 15-th day of  the treatment, see Table 3. In Group I, the  bouts of asphyxiation at day-time were  observed in 1 patient, the absence of coughs was observed in all patients of this group. This made it possible to reduce the necessity of β₂ -agonists of short action for the relief of broncho-obstruction. Impediments at breathing at physical loads were showed only by 2 patients. In Group II, the  bouts of asphyxiation at day-time were  observed in 7 patients and only in 2 patients at night; bouts of breath impediment at a physical load were  observed in 7 patients; dry cough - 5 patients and moist cough - in one child only.

Table 3. Clinical symptoms on the 15-th day of  the treatment

Groups analysed	The  bouts of asphyxiation		Impediments at breathing at physical load	cough
	Day-time	Night-time		dry	moist
Group I	1* (4%)	0	2 (8%)*	2 (8%)	0
Group II	7 (28%)	2 (8%)	7 (28%)	5 (20%)	1 (4%)

 Note : ^* - indicies are reliably different from those in Group II (p<0,001)

The data of objective examination obtained after this therapy on the 15-th day of  the treatment are as follows: harsh breathing at lung auscultation was observed in 3 patients of Group I (13%), whereas in Group II, harsh breathing was observed in 7 patients (28%). The indicies of blood analysis on the 15-th day of  the treatment were opproaching the normal ones. Peak fluometry indicies of  the patients treated with the use of polyoxidonium increased and were close to the normal values. This is reliable with respect to the group of patients treated with a standard therapy.

In Group I the  exhale rate variability up to 20% was observed in 20 patients (80%), variability of 20 to 30% was observed in 5 patients (20%), no variability over 30% was observed. In Group II, the variability up to 20% was observed in 14 patients (56%), variability of 20% to 30% was observed in 9 patients (36%),  variability over 30% was observed in 2 patients (8%). See table 4.

Table 4. Daily exhale peak rate variability in patients on the 15-th day of  the treatment

Groups analysed	Daily variability of exhale peak rate (%)
	Up to 20%	20-30%	Over 30%
Group I	20 (80%)*	5  (20%)*	0
Group II	14 (56%)	9 (36%)	2 (8%)

Note : ^* - indicies are reliably different from those in Group II (p<0,05)

One of the aims of this work was the analysis of biochemical indicies of the antioxidant protection in patients with bronchial asthma before and after the treatment by a standard therapy with the use of polyoxidonium. For this purpose blood analysis for the content of cerruloplasmin and catalaza activity was made for 10 patients. See table 5.

Table 5. Content of cerruloplasmin and catalaza activity in blood serum in the patients

Indicies of the antioxidant system	Control: healthy children	Before treatment	After treatment
Cerruloplasmin, mg%; M±m	23.71±0.263	16.13±0.522*	22.46±0.228**
Catalaza activity, mkcat/l; M±m	0.909±0.031	0.658±0.043*	0.829±0.024**

Note : ^* - indicies are reliably different from those of the control group  (p<0.05)

**- indicies are reliably different from a previous period of observation at (p<0.05)

The analysis of the data obtained showed that in the period of bronchial asthma aggravation, the cerruloplasmin content in the blood serum reached 16.13±0.522 mg% (p<0.05), which is by 1.5 times lower than that in the  healthy children. The catalaza activity in the blood serum before the treatment was 0.658±0.043 mkcat/l

(p<0.05). This is by 1.4 times lower than that in the  healthy children.

After the treatment was over, the cerruloplasmin content and catalaza activity in the blood serum increased up to 22.46±0.228 mg% (p<0.05) and 0.829±0.024. The cerruloplasmin concentration and catalaza activity approached the normal values.

Conclusions.

• 1. Most triggering factors of bronchial asthma in patients of the groups analyzed are contacts with allergens and respiratory infections.
• 2. The use of polyoxidonium in a complex therapy of bronchial asthma makes it possible to attain more effectively the criteria to control clinical symptoms of illness, i.e. absence of asphyxiation bouts, absence of the necessity to use bronchodilators of short action, impediments in breathing at physical loads, in comparison with the patients treated only with a standard therapy.
• 3. The group of patients treated with a complex therapy, i.e. the use of polyoxidonium, showed better indicies of peakfluometry (exhale peak rate, exhale peak rate variability) and haemograms (quantity of lymphocytes, euosynophiles) as compared to the patients treated only with a standard therapy.
• 4. In the period of bronchial asthma aggravation the patients showed a decrease in the value of antioxidant protection indices, i.e. cerruloplasmin and catalaza. With the use of a standard therapy and polyoxidonium all patients showed a reliable increase in the content of cerruloplasmin and catalaza activity in the blood serum as compared to healthy children.

Literature

• 1. Albitsky V.I., Kamaev I.A., Ogneva M.L. Frequently unhealthy children. - Nizhniy Novgorod: Nizhegorodskiy State Academy of Medicine. - 2003. - 180 pp.
• 2. Balabolkin I.I., Surashkina M.V., Tumetseva E.S. Immunocorrective therapy in a complex treatment of allergic children // Medical doctor. - 2005. - №7 - pp. 40 - 43.
• 3. Baranov A.A., Balabolkin I.I. Children allergology - Media 2006, 685 pp.
• 4. Global Strategy of Treatment and Prophilaxics of Bronchial Asthma (GINA, revised 2007), M.: Atmosphere. - 2008, pp.108
• 5. Rational Pharmacotherapy of Frequently Unhealthy Children. St. Peterburg - 2006, pp. 96.

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