The dissertation is devoted to finding ways to solve the actual problem of internal medicine – optimization and forecasting the effectiveness of treatment of patients with chronic obstructive pulmonary disease (COPD) in combination with bronchial asthma (BA) on the background of hypertension (H) based on the assessment of clinical, laboratory and functional status in the conditions of various schemes of therapy.
The relevance of the work is due to the high prevalence of asthma-COPD overlap (ACO) in combination with H, which is accompanied by significant deterioration of the clinical course, functional status and quality of life of patients with this comorbidity, so there is the necessity for further study of impact of complex treatment regimens with active physical rehabilitation (PR) on clinical condition, functional status and quality of life of patients, and the reasonable necessity to develop criteria for the effectiveness of treatment.
The aim of the study was to optimize treatment and predict its effectiveness in patient with cardiopulmonary comorbidity – ACO on the background of H, based on the assessment of the dynamics of clinical, laboratory and functional status in different treatment regimens and predictors of treatment effectiveness.
To reach the aim of the study, 242 female and male patients aged 45-65 years were examined, from these patients we carefully selected 100 patients with ACO on the background of H (intervention group), 30 patients with ACO without H (comparison group 1), 30 patients with COPD on the background of H (comparison group 2), 30 patients with H (comparison group 3). All patients with ACO received basic triple therapy, and patients with COPD received double therapy, in stable dosage. All patients with H received long-term individually selected therapeutic doses of a double combination of antihypertensive drugs for controlling blood pressure (BP). The examination was performed in remission, which was characterized by stable clinical symptoms, indicators of respiration function and BP levels.
According to the study design, patients from intervention group were divided into 2 groups, comparable by sex, age, body mass index (BMI), smoking index, which did not differ significantly in baseline respiratory function (RF) and BP levels. In the first stage of the study, patients in intervention group 1 received basic treatment in combination with a PR program for 16 weeks. Patients in intervention group 2 - received the same amount of basic treatment without physical rehabilitation. Patients in intervention group 1 were heterogeneous in the degree of response to complex treatment, predictors of less effective treatment were identified. To test the hypothesis of the prognostic value of predictors of less effective treatment, stage 2 of the study was conducted – from intervention group 2, which received only basic treatment without PR program, were selected 30 patients (intervention subgroup 2A) who received the same composition and duration of basic treatment in complex with the program of PR as patients of intervention group 1. The result of treatment of this group of patients was confirmation of the correctness of the hypothesis regarding the prognostic value of the selected predictors of treatment effectiveness.
Patients of all studied groups underwent a comprehensive clinical examination: general clinical (medical history collection, determination of anthropometric characteristics and objective status of patients), electrocardiography in 12 standard leads, chest X-ray, determination of RF, echocardiography, clinics biochemical blood tests, questionnaires to determine symptoms and quality of life, functional study with a six-minute walk test (6MWT).
In the dissertation the program of PR was proposed which has aided to improve a quality of life of patients, and the method of forecasting of efficiency of their treatment was offered.
The study found that the presence of H in patients with ACO had a significant negative contribution to the course of cardiopulmonary comorbidity – patients with ACO with H in contrast to patients without H have the greater activation of inflammatory processes, which was confirmed by higher concentrations in the blood of C-reactive protein (CRP), interleukin 6 (IL-6) and interleukin 8 (IL-8) (by 3.49%, 6.99%, 37, 10%, respectively, p <0.05 for all indicators), there was an absence of a probable difference between the indicators of the functional state of patients according to the results of 6MWT and RF (p> 0.05). Comparison of indicators of patients with ACO on the background of H with indicators of patients with isolated H showed that cardiopulmonary comorbidity significantly worse indicators of RF – the forced expiratory volume in 1 second (FEV1), the forced vital capacity (FVC), FEV1 / FVC , the forced expiratory flow related to 25-50-75% of the FVC curve (FEF 25, 50, 75) (p <0,01).
