The treatment of patients with asthma and comorbidity.

G. V. Yeryomenko; T. V. Bezditko

doi:10.26641/2307-0404.2018.1(part1).127209

Authors

G. V. Yeryomenko
T. V. Bezditko

DOI:

https://doi.org/10.26641/2307-0404.2018.1(part1).127209

Keywords:

asthma, diabetes mellitus type 2, MCP-1, MMP-9, von Willebrand factor, L-arginine, Tiotropium bromide

Abstract

The increasing prevalence of asthma (A) and diabetes mellitus type 2 (DM2T) necessitates administration of the adequate antiasthmatic long-term basic therapy with consideration of comorbid states. The purpose consisted in revealing the therapeutic potential of Tiotropium bromide (TB) and L-arginine (Tivortine) in patients having uncontrolled moderately severe asthma in combination with DM2T (A+DM2T). Forty seven A+DM2T patients underwent an in-depth study before and after their treatment. They were divided into 2 groups: treatment (group 1, n=28) and comparison (group 2, n=19). Both groups received the standard 2-component therapy: budesonide/formoterol fumarate dihydrate – 160/4.5µg by 2 breaths twice a day and metformin at a dose of 500 mg twice a day. The complex of their basic therapy for group 1 additionally included TB (18 µg a day) and arginine hydrochloride preparation (Tivortine® aspartate, Yuriya-Farm) orally by 15 ml twice a day during 3 months (90 days). The patients were followed up 3 months and one year later. Their general condition demonstrated positive dynamics in both groups, the number of exacerbations in group 1 reducing by a factor of 4. The complex use of L-arginine and TB preparations against a background of the basic therapy in A+DM2T patients produced a better control over the disease, a more rapid elimination of obstruction manifestations, achievement and prolongation of the clinical spirographic remission, an improvement of the quality of life, correction of disturbances in haemocoagulation, fibrinolysis and the functional state of endothelium.

Author Biographies

G. V. Yeryomenko

Kharkiv National Medical University
Department of propaedeutics of internal medicine 2 and nursing
Nauki av., 4, Kharkov, 61022, Ukraine

T. V. Bezditko

Kharkiv National Medical University
Department of propaedeutics of internal medicine 2 and nursing
Nauki av., 4, Kharkov, 61022, Ukraine

References

Barkagan ZS, Mоmоt АP. [Diagnosis and Controlled Therapy of Homeostatic Disorders]. Moskva, Nʹiudiamed; 2008. Russian.

Vertkin AL, Hovasova NO. [Comorbidity is a new pathology. The technology of its prevention and treatment]. The Archives of Internal Medicine. 2013;4:68-72. Russian.

Katerenchuk IP. [Optimization of the correction of endothelial dysfunction in patients with metabolic syndrome in the practice of a family doctor]. Lіki Ukraїni. 2014;7/8:43-46. Ukrainian.

Koval'ovaOM, Gorbach TV, Demydenko GV. [Diagnosis of endothelial function, assessment of vasoactive nitrogen oxide pool]. Kyiv; 2009. Russian.

Kuriata AV, Syrenko OJu. [Insulin resistance and endothelial dysfunction in patients with arterial hypertension in combination with rheumatoid arthritis and their correction with L-arginine aspartate]. Therapy. Ukrainskiy meditsinskiy vestnik. 2015;5:57-58. Russian.

Pertseva TA. [Features of treatment of patients with bronchial obstructive diseases in combination with diabetes and obesity]. Ukraїns'kiy pul'monologіchniy zhurnal. 2017;2:59. Russian.

[Order of the Ministry of Health ofUkraineN 1118 of 21.12.2012 "On Approval and Implementation of Medical-Technological Documents for the Standardization of Medical Aid in Type 2 Diabetes"]. [Internet]. Ministry of Health ofUkraine; 2012. Available from: http://old.moz.gov.ua/ua/portal/dn_20121221_1118.html

[Order of the Ministry of Health ofUkraineN 868 of 10.08.2013 "On Approval and Implementation of Medical-Technical Documents on Standardization of Medical Aid in Bronchial Asthma"]. [Internet]. Ministry of Health ofUkraine; 2013. Available from: http://old.moz.gov.ua/ua/portal/dn_20131008_0868.html

Feshchenko JuI. [Asthma, chronic obstructive pulmonary disease: promising global strategy of management, advanced diagnostic techniques, modern approaches to therapy]. Astma ta alergіya. 2015;4:36-42. Ukranian.

Al-Shawwa B, Al-Huniti NH, DeMattia L, Gershan W. Asthma and insulin resistance in morbidly obese children and adolescents. J Asthma. 2007;44(6):469-73.

Pereira ED, Cavalcante AG, Pereira EN, Lucas P, Holanda MA. Asthma control and quality of life in patients with moderate or severe asthma. J Bras Pneumol. 2011;37(6):705-11.

Bousquet J, Jeffery PK, Busse WW, Johnson M, Vignola AM. Asthma: From bronchoconstriction to airways inflammation and remodeling. Am J RespirCritCareMed. 2000;161(5):1720-45.

Barnes PJ. Corticosteroid resistance in patients with asthma and chronic obstructive pulmonary disease. J Allergy Clin Immunol. 2013;131(3):636-45

Campbell-Scherer D. Multimorbidity: a challenge for evidence-based medicine. EvidBasedMed. 2010;15:165-6.

Global strategy for asthma management and prevention.Bethesda: National Institutes of Health National Heart & Lung and Blood Institute. 2017;159.

Thuesen BH, Husemoen LLN, Hersoug LG, Pisinger C, Linneberg A. Insulin resistance as a predictor of incident asthma-like symptoms in adults. ClinExp Allergy. 2009;39(5):700-7.

Juel CT-B, Ulrik CS. Obesity and asthma: impact on severity, asthma control, and response to therapy. Respir Care. 2013;58(5):867-73.

Rashid Q, Klein R. Tiotropium in the treatment of patients with asthma. South Med J. 2014;107(5):330-7.

Suissa S, Kezouh A, Ernst P. Inhaled corticosteroids and the risks of diabetes onset and progression. Am J Med. 2010;123(11):1001-6.

Tesse R, Schieck M, Kabesch M. Asthma and endocrine disorders: Shared mechanisms and genetic pleiotropy. MolCellEndocrinol. 2011;333(2):103-11.

Kerstjens HAM, Engel M, Dahl R, Paggiaro P, Beck E, Vandewalker M, et al. Tiotropium in Asthma Poorly Controlled with Standard Combination Therapy. N Engl J Med. 2012;367(13):1198-207.