The dissertation work is devoted to solving the actual problem of internal medicine - improving the functional state and quality of life and determining the prognostic predictors of their positive dynamics in obese patients with bronchial asthma in complex treatment and different treatment regimens.
In recent decades, there has been a significant increase in the number of patients with bronchial asthma (BA), with a significant increase in the number of patients who are overweight or obese. There is an increase in morbidity among all age groups, including young people, which is an important medical, social and economic problem. Both pathological processes are chronic and are multifactorial in nature.
The presence of obesity increases the risk of developing asthma by 4 times, worsens the control and course of asthma, reduces the response to standard therapy with inhaled corticosteroids (ICS). Overweight and obesity determine the more severe course and worse prognosis of asthma: patients with this comorbidity are more likely to be hospitalized , require increased drug therapy, and have lower quality of life rates than patients with normal body weight.
It is known that weight loss has a positive effect on indicators of respiratory function, reduces the severity of symptoms and the level of disease control. The use of physical rehabilitation in the complex treatment of asthma and obesity is a necessary component in comprehensive treatment of this comorbidity.
However, to date, there are almost no clinical data on the assessment of the impact and criteria for the effectiveness of comprehensive treatment on the indicators of clinical and functional statuses and quality of life in patients with asthma and overweight or obesity. The actuality of this issue led to our study.
The aim of the study was to improve the functional state and quality of life and to determine the prognostic predictors of their positive dynamics in patients with bronchial asthma and obesity on the background of complex treatment.
To achieve this goal, the following tasks were formed and defined:
1. Conduct a comparative study of clinical and laboratory, functional status and quality of life of patients with moderate asthma depending on body weight and determine the impact of weight gain in the course of bronchial asthma.
2. Assess the dynamics of clinical and functional status and quality of life in patients with asthma and overweight after 6 months of complex therapy, which is represented by drug treatment, diet and rehabilitation, and conduct a comparative analysis of the dynamics of indicators in patients, who did not receive a physical rehabilitation program.
3. To study the dynamics of clinical and functional status and quality of life in patients with bronchial asthma and overweight after 6 months of drug therapy, diet and physical rehabilitation depending on the level of weight gain.
4. To study the relationship between baseline clinical, laboratory and functional parameters of patients with moderate asthma and overweight with the level of dynamics of asthma symptoms control and the degree of BMI dynamics after 6 months of complex treatment with rehabilitation activities and predict the effectiveness of this complex therapy in relation to its influence on the state of asthma symptoms control and the value of the body mass index.
5. Based on the determinants of the effectiveness of complex treatment for 6 months of patients with moderate asthma and overweight relative to changes in the control of asthma symptoms and BMI to develop ways to individually predict the impact of therapy on integrated indicators of comorbidity "BA-Obesity" - control of asthma symptoms and BMI.
To achieve this goal, a comprehensive study of 102 patients, men and women aged 35-60 years with asthma with increased body weight (BMI ≥25 <40 kg / m2) and 30 patients with asthma and normal body weight (BMI from 18.5 up to 24.9 kg / m2). Both groups statistically did not differ in age. The mean age in the group of patients with normal BMI was 51.43 ± 6.92 years, in the group with high BMI - 51.44 ± 6.83 (p> 0.05). There were also no significant differences in the sex composition of groups with normal and high BMI. All patients with asthma received long-term basic therapy, which consisted of inhalation of a fixed combination of ICS (budesonide at a dose of 160 mcg) and long-acting beta-2 agonist (LABA) (4.5 mcg of formoterol), and the same combination in a single inhaler requirement (MART mode).
Weight gain in patients with moderate asthma was associated with significant reductions in the level of asthma symptoms control (r = 0.3; p = 0.005), exercise tolerance, β-coefficients of logistic regression analysis on the Borg Scale before and after WT6m - (-1.40) and (1.46) (p <0.01 for both coefficients) and quality of life (in comparing the scores on the SGRQ questionnaire, the activity rate was 11.9% (p <0.05), and SGRQ effect - by 17.4% (p <0.05)).
