EVALUATION OF CONTROL AND APPROACHES TO THE TREATMENT OF PATIENTS WITH BRONCHIAL ASTHMA COMBINED WITH GASTROESOPHAGEAL REFLUX DISEASE
Objective. Тo monitor the effectiveness of an integrated approach to the treatment of patients with BA, combined with GERD, using an M-anticholinergic agent (ipratropium bromide as part of the combined drug Berodual) and a selective non-benzodiazepine anxiolytic (Afobazol). Materials and methods. The study involved 34 patients with a combined course of BA and GERD. As part of the complex diagnostics, indicators of the function of external respiration (spirometry, body plethysmography), peak expiratory flow (PEF) and daily variability of PSV, and the level of nitric oxide in the exhaled air (NOex) were studied. The parameters of lipid peroxidation (LPO) and antioxidant protection (AOP) in blood serum were also studied. As part of complex therapy, patients with a combined course of BA and GERD received an M-cholinoblocker (ipratropium bromide) as part of the combined drug Berodual and a selective non-benzodiazepine anxiolytic fabomotizol (Afobazol) - to correct the identified anxiety and depressive disorders. GERD therapy was enhanced by an antacid - Phosphalugel. Treatment efficacy was monitored after 1 month after the start of complex therapy. Results. At the initial assessment of the level of BA control using the ACT questionnaire, 8 comorbid patients were found to have partially controlled course of BA, and 26 patients had uncontrolled course of BA. When studying the parameters of respiratory function at the beginning of the study in patients with a combined course of BA and GERD, pronounced obstructive disorders were identified with a significant increase in airway resistance. At the control spirometric study conducted after 1 month after the start of therapy, there was a significant increase in the parameters of respiratory function compared with initial values. According to the control body plethysmography, there was a slight increase in VCmax, a statistically significant decrease in RV, ITGV and Rtot. Peak flowmetry indicators also significantly improved: the average value of PSV increased, and the daily variability of PSV decreased. In addition, due to the ongoing therapy, a significant decrease in the level of serum indicators of the state of the lipid peroxidation system and a tendency to an increase in the level of catalase, the AOD enzyme, were recorded. A statistically significant improvement in the quality of life according to the results of the questionnaire using the SF-36 questionnaire and a significant decrease in the levels of depressive and anxiety symptoms according to psychometric scales were achieved. Conclusions. The inclusion of an M-anticholinergic antagonist (ipratropium bromide as part of the combined drug fenoterol/ipratropium bromide) and the selective non-benzodiazepine anxiolytic Afobazol into the complex therapy contributes to a decrease in the severity of the respiratory syndrome in comorbid patients with a combination of BA and GERD and a significant improvement in pulmonary ventilation and bronchial patency. The proposed approach to treatment also has a positive effect on the state of the LPO-AOP system, contributes to a statistically significant increase in the quality of life and a significant decrease in the levels of depressive and anxiety symptoms.