Treatment of bronchial asthma: etiological and pathogenetic

"Bronchial asthma is a chronic inflammatory disease of the respiratory tract, in which many cells are involved: obese, eosinophils, T-lymphocytes.

In predisposed individuals, this inflammation leads to repeated episodes of wheezing, shortness of breath, chest pain and coughing, especially at night and / or in the early morning. These symptoms are usually accompanied by a common but variable obstruction of the bronchial tree, which is at least partially reversible spontaneously or under the influence of treatment. Inflammation also causes a friendly increase in the respiratory response to various stimuli "(Global Strategy for the Treatment and Prevention of Asthma, WHO, National Heart, Lung and Blood Disease Institute, USA, 1993).

Thus, the current definition of bronchial asthma includes the main provisions reflecting the inflammatory nature of the disease, the main pathophysiological mechanism is the bronchial hyperreactivity, and the main clinical manifestations are the symptoms of airway obstruction.

The main criterion for prescribing antiasthmatic drugs in bronchial asthma is the degree of its severity. In determining the severity of the disease, the following are considered:

• clinical signs characterizing the frequency, severity, time of occurrence during the day of episodes of increased symptoms, including attacks of suffocation;
• results of peak expiratory flow (PEF), measured using an individual peak-flow meter (deviation of values from the required in percent and scatter of the indicators during the day).

The peak expiratory flow rate (l / min) is the maximum rate at which air can escape from the respiratory tract during the fastest and deepest exhalation after a full inspiration. The PSV values closely correlate with the values of FEV1 (the volume of forced expiration in liters in the first second).

• the nature and extent of the therapy used to establish and maintain disease control.

It is also advisable to take into account the phase of the course of the disease: exacerbation, unstable remission, remission and stable remission (more than 2 years).

Stepwise therapy of bronchial asthma

Step	Treatment
Light and non-mutating, episodic flow	Long-term therapy with anti-inflammatory drugs, as a rule, is not indicated Prophylactic inhalation of beta2-agonist or sodium cromoglycan before expected physical exertion or contact with an allergen Short-acting bronchodilators (inhaled beta2-agonists), if necessary, for symptom control, no more than once a week
Light persistent flow	Daily long-term prophylactic reception for asthma control: Inhaled corticosteroids and a daily dose of 200-500 μg or sodium cromoglycate, nedocromil or theophylline, prolonged action If necessary, increase the dose of inhaled corticosteroids. If it was 500 μg, it should be increased to 800 μg or prolonged bronchodilators (especially for nighttime asthma control): inhalation (beta-agonists, theophylline or prolonged oral beta-2-agonists (in tablets or syrup) For relief of asthma attacks - short-acting bronchodilators - inhaled beta2-agonists are not more often 3-4 times a day: it is possible to use inhaled anticholinergics
Asthma persistent, of moderate severity	Daily prophylactic intake of anti-inflammatory drugs for the establishment and maintenance of asthma control: inhaled corticosteroids in a daily dose of 800-2000 mcg (using an inhaler with a spencer) Extended-action bronchodilators, especially for relief of nocturnal asthma (beta2-agonists in the form of inhalations, tablets, scrolls or theophylline) For relief of asthma attacks - short-acting bronchodilators - inhaled beta2-agonists not more often 3-4 times a day, possibly using inhalation anticholinergics
Heavy persistent	Daily reception Inhaled corticosteroids in a daily dose of 800-2000 μg or more Prolonged bronchodilator, especially in the presence of nocturnal asthma attacks (beta2-agonists in the form of inhalations, tablets, syrup m / or theophylline) Glucocorticoids orally For relief or relief of an attack of asthma - bronchodilators short-acting inhaled beta2-agonists (no more than 3-4 times a day). Possible use of inhalation anticholinergics

Notes:

1. Patients should be prescribed treatment (appropriate stage), taking into account the initial severity of the condition.
2. If there is insufficient control of the symptoms of asthma, it is recommended to go to a higher stage. However, in the beginning it is necessary to check whether the patient is using the medicines correctly, whether the doctor's advice is being followed, whether contact with allergens and other factors that cause exacerbations is avoided.
3. If it is possible to control the course of bronchial asthma for the last 3 months, a gradual decrease in the volume of treatment and a transition to the previous stage is possible.
4. Short courses of oral glucocorticoid therapy, if necessary, are carried out at any stage.
5. Patients should avoid contact with the triggers or monitor their effects.
6. Therapy at any stage should include patient education.

In accordance with the severity of manifestations of bronchial asthma, a stepwise approach to its treatment is provided. The choice of drugs and methods for their use are determined by the severity of the disease, designated as the corresponding stage.

Close to the above-mentioned stepwise therapy of bronchial asthma was proposed in 1991 by Vermeire (Belgium). He distinguishes the following stages of anti-asthma therapy:

1. the establishment of provoking factors and the appointment of beta-adrenomimetics in inhalations for the  arresting an attack of bronchial asthma ;
2. addition of sodium cromoglicate or low doses of glucocorticoids in inhalations;
3. addition of high doses of glucocorticoids in inhalations;
4. addition of theophylline orally and / or cholinomimetics in inhalations and / or beta2-adrenomimetics inside and / or an increase in the dose of beta2-adrenomimetics in inhalations;
5. addition of glucocorticoids inside.

The curative program includes the following areas.

Etiological treatment:

1. Elimination therapy.
2. Non-allergenic chambers.
3. Isolation of the patient from the surrounding allergens.

Pathogenetic treatment:

1. Impact on the immunological phase of pathogenesis
   1. Specific and nonspecific hyposensitization.
      • unloading and dietary therapy - isolated and in combination with enterosorption;
      • treatment with histaglobulin, allergoglobulin;
      • treatment adaptogeneens.
   2. Treatment of glucocorticoids.
   3. Treatment with cytostatics.
   4. Immunomodulating therapy (immunomodulating agents, extracorporeal immunosorption, monoclonal anti-IgE immunosorption, plasmapheresis, lymphocytapheresis, thrombocytopheresis, laser and ultraviolet irradiation of blood).
2. Effects on the pathochemical stage
   1. Membranostabilizing therapy.
   2. Extracorporeal immunopharmacotherapy.
   3. Inhibition of mediators of inflammation, allergies, bronchospasm.
   4. Antioxidant therapy.
3. Effects on the pathophysiological stage, the use of asthma medications.
   1. Bronchodilators (bronchodilators).
   2. Expectorants.
   3. Conducting novocain to the points of Zakharyin-Ged.
   4. Physiotherapy.
   5. Naturotherapy (non-pharmacological treatment).
      • Chest massage and postural drainage.
      • Barotherapy (hapbararopia and hyperbarotherapy).
      • Normobaric hypoxic therapy.
      • Rational breathing exercises (breathing with resistance, breathing through the dosed respiratory dead space, strong-willed elimination of deep breathing, artificial regulation of breathing, stimulation of diaphragmatic breathing).
      • Iconreflexotherapy.
      • Su-jok therapy.
      • Mountain-climatic treatment.
      • Speleotherapy, gallotherapy.
      • Aerophytotherapy.
      • EHF-therapy.
      • Homeopathic therapy.
      • Thermotherapy.

In this treatment program, such sections as etiological treatment and such types of pathogenetic therapy as the effect on the immunological phase (with the exception of glucocorticoids), the pathochemical phase, as well as many therapeutic effects directed to the pathophysiological stage, are carried out in the phase of bronchial asthma remission (t after an arrest of an attack of suffocation).

Variants of intolerance of plant allergens, food products and herbs in hay fever

	Possible cross-allergic reactions to pollen
Etiological factor	Pollen, leaves, stems of plants	Vegetable foods	Medicinal Herbs
Birch	Woodland, alder, apple tree	Apples, pears, cherries, cherries, peaches, plums, apricots, carrots, celery, potatoes, eggplant, pepper	Birch leaf (bud, alder cones, belladonna preparations)
Wild weeds (timothy, oatmeal, hedgehog)	-	Cereals (oats, wheat, barley, rye), sorrel	-
Sagebrush	Georgona, chamomile, dandelion, sunflower	Citrus, sunflower oil, halva, sunflower seeds, honey	Yarrow, mother-and-stepmother, chamomile, elecampane, thyme, tansy, calendula, string
Swan, ambrosia	Sunflower, dandelion	Beets, spinach, melon, bananas, sunflower seeds. Sunflower oil	-

Etiological treatment

1. Elimination therapy is a complete and permanent cessation of the patient's contact with a causally significant allergen, i.e. An allergen or a group of allergens that cause an attack of bronchial asthma. This therapy is carried out after the detection of an allergen with the help of a special allergological diagnosis.

The complete cessation of contact with the allergen in the early stages of the disease, when there are no complications, can be very effective and often leads to recovery.

When hypersensitivity to pet hair, daphnia, professional factors, it is necessary to change the living conditions and rational employment (do not start pets, aquariums, leave work with occupational hazards).

In the presence of an allergy to horse dandruff, the patient should not be administered anti-tetanus, anti-staphylococcus serum, It is possible to develop cross-allergic reactions with horse serum, which is used in the preparation of these preparations. You can not wear clothes made from fur or wool of an animal that is allergic (for example, a sweater from Angora wool, mohair - for allergy to sheep's wool).

Cross-allergic properties of drugs

The drug that causes allergies	Drugs that can not be used in conjunction with cross-allergy
Aminophylline, diafillin, aminophylline	Derivatives of ethylendamine (suprastin, ethambutol)
Aminazin	Phenothiazine derivatives: antihistamines (pipolfen, diprazine); Neuroleptics (propazine, tizercin, ztaperazin, mazheptil, sonapaks, etc.); antiarrhythmic drugs (etmozin, etatsizin); antidepressants (fluocyclin)
Preparations of the penicillin group	Cephalosporin antibiotics
Novokain	Local anesthetics (anesthesin, lidocaine, trimecaine, and dicaine) and medicines containing them (menovazine, sulphocamphocaine) Sulfonamides Derivatives of sulfonylureas are hypoglycemic agents (glibenclamide, glycvidone, glipizide, glycazide - predyan, diabeton, xpropropamide, etc.) Diuretics - dichlorothiazide, cyclomethaide, furosemide, bufenox, clopamide, indalamide, diacarb, etc.)
Iodine	Radiopaque iodine-containing products Inorganic iodides (potassium iodide, Lugol's solution, sodium iodide) Thyroxine, triyodtironin

When hypersensitivity to pollen of plants, it is necessary to minimize possible contacts with pollen (during pollination of plants do not go to the forest, field, do not work in the garden, refrain from going out in dry windy weather, day and night, ie at that time , when the concentration of pollen in the air is greatest).

In many patients suffering from pollen bronchial asthma, it is possible intolerance of many phytopreparations and food products due to cross-reactions with pollen allergens. This must be taken into account when treating and excluding from the diet the relevant foods. With the use of these products may exacerbate pollen bronchial asthma and other symptoms of hay fever.

If hypersensitivity to household dust should be taken into account that the main allergens of house dust are mites or fungi. Optimal conditions for the growth of mites - relative humidity of air 80% and temperature 25 ° C. The number of mites increases in seasons with high humidity. The same conditions are favorable for the development of fungi.

The main place of accumulation of ticks - mattresses, upholstered furniture, carpets, nap cloth, stuffed animals, plush toys, books. Mattresses should be covered with a washable, impermeable plastic and wet cleaned once a week. It is recommended to remove carpets, plush toys, pile, woolen and cotton blankets from the apartment, place books on glass shelves, regularly change linens, wash wallpaper and clean with a vacuum cleaner, irradiate the room with ultraviolet rays: in summer - using direct sunlight, in winter - with the help of ultraviolet lamps.

In hospital wards, the number of mites is less than 2% of their number in apartments, so hospitalization improves the condition of patients.

With food bronchial asthma, it is necessary to eliminate allergen from food, causing an attack of bronchial asthma (elimination diet), as well as "obligate" food allergens.

With drug bronchial asthma, it is necessary to cancel the drug causing the disease or its aggravation, and also not to use drugs that cause cross-allergic reactions.

One of the most important factors in the development of bronchial asthma is air pollution. In this regard, in the complex treatment of patients with bronchial asthma, it is advisable to use highly effective air purification systems. Modern air cleaners evenly clean the air throughout the room (room, apartment) regardless of the installation site. With the help of special filters, they catch allergens, bacteria, viruses, pollen of plants, house dust and other air pollutants, which significantly reduces the severity of exacerbation of bronchial asthma, and sometimes allows you to completely get rid of this disease.

2. Non-allergic wards are used in the treatment of patients with inhalation allergy (usually with severe sensitization to pollen of plants). These rooms are equipped with a system of fine air purification from aerosol mixtures (dust, fog, pollen, etc.). The air is cleared of all allergenic impurities and enters the chamber. The multiplicity of the exchange is 5 times per hour. Polymeric fine-fiber filter materials made of perchlorovinyl are used for air purification.
3. Isolation of the patient from the surrounding allergens (permanent or temporary change of residence, for example, for the period of flowering plants, change of place and working conditions, etc.) is made in the event that it is impossible to eliminate the allergen with a pronounced polyvalent allergy.

[1], [2], [3]

Pathogenetic treatment

The therapeutic measures in this phase are aimed at suppressing or significantly reducing and preventing the formation of reactants (IgE) and combining them with antigens.

Treatment with histaglobulin and allergoglobulin

Histaglobulin and allergoglobulin are means of nonspecific desensitization. In one ampoule (3 ml) of histaglobulin (histaglobin) contains 0.1 μg of histamine and 6 mg of gamma globulin from human blood.

The mechanism of action is the development of antihistamine antibodies and an increase in the ability of the serum to inactivate histamine.

Method of treatment: histaglobin is administered subcutaneously - first 1 ml, then 2 ml after 3 days, and then do three more injections of 3 ml at intervals of 3 days, if necessary, after 1-2 months the course is repeated.

You can use another method of treatment with histaglobulin: the drug is administered subcutaneously twice a week, starting from 0.5 ml and increasing the dose to 1-2 ml, the course consists of 10-15 injections. Histaglobulin is effective in pollen and food sensitization, atonic bronchial asthma, urticaria, Quinck's edema, allergic rhinitis.

Contraindications to the use of gigaglobulin: menstruation, high body temperature, treatment with glucocorticoids, the period of exacerbation of bronchial asthma, myoma of the uterus.

Close to the mechanism of action and effectiveness to allergoglobulin is antiallergic immunoglobulin. It contains blocking antibodies - IgG. The drug is administered intramuscularly at 2 ml with an interval of 4 days, only 5 injections. Allergoglobulin is a placental γ-globulin in combination with gonadotropin. The drug has a high histamine-protective ability. Produced in 0.5 ml ampoules. Allergoglobulin is administered intramuscularly at a dose of 10 ml once every 15 days (total 4 injections) or intramuscularly - 2 ml every 2 days (4-5 injections).

Perhaps the combined use of allergoglobulin with its rapid antiallergic effect (blocking of free histamine) and histaglobulin (the development of "antihistamine immunity" is a long delayed action) according to the following scheme: once a week intramuscularly inject 5 ml of allergoglobulin and 3 ml of histaglobulin subcutaneously. Course - 3 such complexes for 3 weeks. Treatment with histaglobulin and allergoglobulin is carried out only in the period of remission, repeated courses are possible after 4-5 months. Since allergoglobulin and antiallergic immunoglobulin contain gonadotropic hormones, they are contraindicated in the puberty period, with uterine myoma, mastopathy.

Treatment of adaptogens

Treatment with adaptogens, as a method of nonspecific desensitization, leads to an improvement in the function of the local system of bronchopulmonary protection, the system of general immunity, desensitization.

In the phase of remission during the month, the following tools are usually used:

• extract eleutherococcus 30 drops 3 times a day;
• saparal (obtained from the aralia of the Manchu) by 0.05 g 3 times a day;
• tincture of Chinese magnolia vine in 30 drops 3 times a day;
• tincture of ginseng 30 drops 3 times a day;
• tincture of rhodiola rosea on 30 drops 3 times a day;
• Pantocrine 30 drops 3 times a day inwards or 1-2 ml intramuscularly once a day;
• Rantarin - an extract from the antlers of the males of the reindeer, is taken orally 2 tablets 30 minutes before meals 2-3 times a day.

Treatment of glucocorticoids

Glucocorticoid therapy with bronchial asthma is used in the following variants:

1. Treatment with inhalation forms of glucocorticoids ( local glucocorticoid therapy ).
2. Use of glucocorticoids inside or parenterally ( systemic glucocorticoid therapy ).

Treatment with cytostatics (immunosuppressants)

Treatment with cytostatics is currently rarely used.

The mechanism of action of cytostatics is to inhibit the production of reactants and anti-inflammatory effect. Unlike glucocorticoids, they do not inhibit the adrenal glands.

Indications:

• a severe form of atopic bronchial asthma, which is not amenable to treatment by conventional means, incl. Glucocorticoids;
• cortico-dependent corticore-resistant bronchial asthma - with the aim of decreasing cortico-dependence;
• autoimmune bronchial asthma.

Immunomodulatory therapy

Immunomodulatory therapy normalizes the immune system. It is prescribed for prolonged course of bronchial asthma, resistant to conventional therapy, especially when the atopic form is combined with infection in the bronchopulmonary system.

Treatment with thymamine

Timalin is a complex of polypeptide fractions obtained from the thymus of cattle. The drug regulates the number and function of B- and T-lymphocytes, stimulates phagocytosis, reparative processes, normalizes the activity of T-killers. Produced in vials (ampoules) of 10 mg, it dissolves in isotonic NaCl solution. Intramuscularly administered 10 mg once a day, for 5-7 days. Yu. I. Ziborov and BM Uslontsev showed that the therapeutic effect of thymalin is most pronounced in persons with a short duration of the disease (2-3 years) with normal or decreased activity of T-lymphocytes-suppressors. Immunogenetic marker of a positive effect is the presence of HLA-DR2.

Treatment with T-activated

T-activin is derived from the thymus of cattle and is a mixture of polypeptides with a molecular weight of 1500 to 6000 daltons. Has a normalizing effect on the function of T-lymphocytes. It is produced in ampoules of 1 ml 0.01% (i.e., 100 μg each). It is administered intramuscularly once a day at a dose of 100 mcg, the course of treatment is 5-7 days. An immunogenic marker of a positive effect is the presence of HLA-B27.

Treatment with timoltin

Timoptin is an immunomodulating thymus preparation containing a complex of immunoactive polypeptides, including a-thymosin. The drug normalizes the parameters of the T- and B-systems of lymphocytes, activates the phagocytic function of neutrophils. Produced in the form of lyophilized powder of 100 μg, before administration is dissolved in 1 ml of isotonic solution. Subcutaneously in a dose of 70 mcg / m2 (ie for adults, usually 100 mcg) once in 4 days, the course of treatment - 4-5 injections.

Sodium Nucleate Treatment

Sodium nucleate is obtained by hydrolysis of yeast, stimulates the function of T- and B-lymphocytes and the phagocytic function of leukocytes, is administered orally 0.1-0.2 g 3-4 times a day after meals for 2-3 weeks.

Alkimer is an immunomodulating drug, derived from the liver oil of the Greenland shark. There are reports of its effectiveness in bronchial asthma.

Antilymphocytic globulin

Antilymphocytic globulin is an immunoglobulin fraction isolated from blood serum from animals immunized with human T lymphocytes. In small doses, the drug stimulates T-suppressor activity of lymphocytes, which helps to reduce the production of IgE (reactin). This is why the drug is used to treat atonic bronchial asthma. BM Uslontsev (1985, 1990) recommends the use of antilymphocytic globulin in a dose of 0.4-0.8 μg per 1 kg of body weight of the patient intravenously drip, the course of treatment consists of 3-6 infusions. The clinical effect is observed 2-3 months after the end of treatment and most often occurs in persons carrying HLA-B35 antigen.

[4], [5], [6], [7], [8],

Laser irradiation and UV of blood

Laser irradiation and UV of blood have immunomodulatory effect and are used for bronchial asthma of moderate severity and severe course, especially in the presence of corticostependence. When laser irradiation of blood reduces the need for glucocorticoids.

Effects on the pathochemical phase of pathogenesis

[9], [10]

Inhibition of some mediators of inflammation, allergies, bronchospasm

Some mediators are isolated from mast cells when they degranulate (histamine, platelet activating factor, slow reacting substance, eosinophilic and neutrophil chemotactic factors, proteolytic enzymes), a number of mediators are formed outside the mast cells, but with the help of activators released from them (bradykinin, thromboxane, serotonin, etc.).

Of course, it is impossible to inactivate all mediators of bronchospasm and inflammation with a single drug or several groups of drugs.

It is possible to name only separate preparations inactivating certain mediators.

Antiserotonin agents

Antiserotonin agents block the effects of serotonin. The most famous drug of this group is peritol (cyproheptadine). It has a pronounced antiserotonin effect (reduces spasmogenic and other effects of serotonin), but simultaneously exhibits antihistamine (blocks H1 receptors) and anticholinergic action. The drug also has a pronounced sedative effect, increases appetite and reduces the manifestations of migraine.

It is used in tablets of 4 mg 3-4 times a day. Contraindicated in glaucoma, edema, pregnancy, urinary retention.

[11], [12], [13]

Antikininovye funds

Antikininovye funds block the action of quinine, reduce the permeability of capillaries and swelling of the bronchi.

Anginin {prodektin, parmidin, pyridinolcarbamate) - is prescribed by 0.25 g 4 times a day for a month. But the treatment with this drug has not been widely spread because of the small and questionable effect. The use of the drug is advisable in the combination of bronchial asthma with the defeat of the arteries of the lower extremities (obliterating endarteritis, atherosclerosis).

[14], [15],

Inhibition of leukotrienes and fatty acids

Inhibition of leukotrienes and FAT (inhibition of synthesis and blocking of their receptors) is a new direction in the treatment of bronchial asthma.

Leukotrienes play an important role in the obstruction of the airways. They are formed as a result of the action of enzymes of 5-lipoxygenases on arachidonic acid and are produced by mast cells, eosinophils and alveolar macrophages. Leukotrienes cause the development of inflammation in the bronchi and bronchospasm. Inhibitors of leukotriene synthesis reduce the bronchospasic response to exposure to allergens, cold air, physical stress and aspirin in patients with bronchial asthma.

Currently, the effectiveness of a three-month treatment of patients with bronchial asthma of the lung and moderate course with zileuton - an inhibitor of 5-lipoxygenases and leukotrienes synthesis has been studied. A pronounced bronchodilating effect of zileuton when ingested at a dose of 600 mg 4 times a day is established, as well as a significant reduction in the frequency of exacerbations of asthma and the frequency of use of inhaled beta2-agonists. At present, clinical trials of leukotriene receptor antagonists accolote, pranlukast, singulair are underway abroad.

The use of FAT antagonists leads to a decrease in the content of eosinophils in the bronchial wall and a decrease in the reactivity of the bronchi in response to contact with the allergen.

Antioxidant therapy

In the pathochemical stage of the pathogenesis of bronchial asthma, activation of lipid peroxidation and the formation of peroxides and free radicals supporting allergic inflammation of the bronchi also occur. In this regard, the use of antioxidant therapy is justified. The use of antioxidants is provided by the recommendations of the European Society for Diagnosis and Treatment of Obstructive Pulmonary Diseases, but it should be noted that this therapy did not solve the problem of bronchial asthma, it is prescribed in the inter-ritual period.

As an antioxidant, vitamin E (tocopherol acetate) is used in capsules of 0.2 ml of a 5% oily solution (ie 0.1 g) 2-3 times a day for a month. You can use tocopherol acetate for 1 ml of a 5% solution (50 mg) or 1 ml of a 10% solution (100 mg) or 1 ml of a 30% solution (300 mg) intramuscularly once a day. It is also recommended that Aevit in capsules (a combination of vitamins A and E) is prescribed 1 capsule 3 times a day for 30-40 days. Vitamin E also has an immunocorrecting action.

Vitamin C (ascorbic acid) also has an antioxidant effect. A considerable amount of it is present in the liquid located on the inner surface of the bronchi and alveoli. Vitamin C protects the cells of the bronchopulmonary system from oxidative damage, reduces the hyperreactivity of the bronchi, reduces the severity of bronchospasm. It is prescribed vitamin C at 0.5-1.0 g per day. Higher doses can stimulate lipid peroxidation by reducing the iron involved in the formation of hydroxyl radicals.

As an antioxidant, also used are the compounds of selenium, which is part of the enzyme glutathione peroxidase, inactivating peroxide. Patients with bronchial asthma have a deficiency of selenium, which contributes to a decrease in the activity of glutathione peroxidase, the key enzyme of the antioxidant system. Application of sodium selenide in a daily dose of 100 mcg for 14 weeks significantly reduces the clinical manifestations of bronchial asthma. SA Syrin (1995) recommends the combined use of sodium selenide (2-2.5 μg / kg sublingually), vitamin C (500 mg / day), vitamin E (50 mg / day), which significantly reduces lipid peroxidation.

The antioxidant is also acetylcysteine. It is an expectorant, capable of deacetylating with the formation of cysteine, which is involved in the synthesis of glutathione.

Ultraviolet irradiation of blood, reduces lipid peroxidation, normalizes the activity of the antioxidant system, improves the clinical course of bronchial asthma, reduces the severity of bronchial obstruction, and reduces the number of bronchodilators taken.

Indications for the appointment of antioxidants in bronchial asthma:

• insufficient activity of traditional medical treatment;
• treatment and prevention of acute respiratory infections;
• prevention of seasonal exacerbations of asthma (in winter, spring), when there is the greatest deficit of vitamins and trace elements;
• asthmatic triad (with the recommended UFO blood).

[16], [17], [18]

Extracorporeal immunopharmacotherapy

Extracorporeal immunopharmacotherapy consists in the treatment with drugs (prednisolone, vitamin B12, diucifon) of mononuclears isolated from the blood of patients, followed by reinfusion of the cells. As a result of this effect, the histamine-releasing activity of mononuclears decreases and the synthesis of interleukin-2 is stimulated.

Indications for extracorporeal immunopharmacotherapy:

• cortico-dependent atonic bronchial asthma;
• combination of atopic bronchial asthma with atonic dermatitis, allergic rhinoconjunctivitis.

[19]