Efficacy of Plasmapheresis in the Treatment of Bronchial Asthma Combined with Cardiovascular Pathology

Purpose of the study

To substantiate the policy of applying complex drug therapy with the inclusion of therapeutic plasmapheresis in bronchial asthma of varying severity combined with cardiovascular pathology.

Tasks of the study

1. To study the features of intracardiac hemodynamics, hemorheology and hemostasis in patients with bronchial asthma of varying severity, both combined and not combined with cardiovascular diseases (arterial hypertension, ischemic heart disease - angina pectoris of functional classes I–III) during the exacerbation period – before the initiation of treatment programs.
2. To evaluate the efficacy of standard drug therapy for bronchial asthma, both combined and not combined with cardiovascular pathology
3. To investigate the clinical, functional, hemodynamic and hemostasiological status of patients with bronchial asthma, not combined and combined with cardiovascular pathology, during the application of sessions of therapeutic plasmapheresis in combination with standard drug therapy.
4. To compare the magnitude of the effect of standard drug therapy and combined therapy (with the inclusion of plasmapheresis) in groups of patients with bronchial asthma that are homogeneous in terms of severity and presence of cardiovascular pathology.

Scientific novelty of the work

An analysis was performed of the clinical, bronchodilator and functional efficacy of therapeutic plasmapheresis in the complex treatment of bronchial asthma of varying severity combined with cardiovascular pathology (arterial hypertension, ischemic heart disease, angina pectoris of functional classes I–III). For the first time, a comprehensive evaluation of the efficacy of therapeutic plasmapheresis in the treatment of bronchial asthma of varying severity combined with arterial hypertension and ischemic heart disease was carried out, taking into account the state of intracardiac hemodynamics, the hemostasis system and the rheological properties of blood. The expediency of including therapeutic plasmapheresis in complex treatment programs for patients with bronchial asthma suffering from cardiovascular pathology (arterial hypertension, ischemic heart disease - angina pectoris of functional classes I–III) has been substantiated.

Practical significance of the work

Criteria for the efficacy of plasmapheresis within drug treatment programs for bronchial asthma combined with arterial hypertension and ischemic heart disease, angina pectoris of functional classes I – II, have been developed. The results obtained made it possible to substantiate the expediency of including therapeutic plasmapheresis in the complex treatment of patients with bronchial asthma of varying severity combined with arterial hypertension and ischemic heart disease, on the basis of studying the comparative efficacy of standard drug and combined treatment programs. The indications, expediency, timing and policy for the application of therapeutic plasmapheresis in patients with bronchial asthma have been refined, taking into account the presence of concomitant cardiovascular pathology (arterial hypertension, angina pectoris of functional classes I–III) and the effect achieved.

Positions submitted for defense:

1. The course of bronchial asthma is characterized by disturbances of diastolic myocardial function, rheological properties of blood and hemostasis, depending on the severity of the disease, the degree of broncho-obstructive syndrome, the intensity of drug treatment and the presence of concomitant cardiovascular diseases (arterial hypertension, ischemic heart disease - angina pectoris of functional classes I–III);
2. The application of drug treatment is accompanied by control of bronchial asthma exacerbations and, as a rule, has a positive effect on the state of diastolic myocardial function, blood rheology and the hemostasis system, to a greater extent in patients with mild and moderate course of bronchial asthma not combined with cardiovascular diseases. In hormone-dependent patients, especially in combination with arterial hypertension and ischemic heart disease, the dynamics of the parameters of the systems studied, particularly the rheological properties of blood and hemostasis, are more rigid.
3. The inclusion of sessions of therapeutic plasmapheresis in drug therapy for bronchial asthma exacerbations, including in patients with combined cardiovascular pathology, is characterized by a clearer positive dynamics of clinical, functional and cardiodynamic parameters than with conventional treatment, particularly of the indicators of blood rheology and hemostasis.

Implementation of the results of the work

The results of the studies conducted have been implemented in clinical practice at the pulmonology departments of the Municipal Medical Institution "City Hospital No. 8" and in the educational process of the Department of Internal Medicine of the Pediatric and Dental Faculties of V.I. Razumovsky Saratov State Medical University (Ministry of Health of Russia).

Approval of the dissertation materials

The main positions of the dissertation were presented and discussed at the Scientific-Practical Conference for Northwestern Russia, Petrozavodsk (2000); at the XI (Moscow, 2001) and XII (Moscow, 2002) National Congresses on Respiratory Organ Diseases; at the XVII (Kazan, 2007) and XVIII (Yekaterinburg, 2008) National Congresses on Respiratory Organ Diseases; and at the I (Moscow, 2006), III (Moscow, 2008) and IV (Moscow, 2009) National Congresses of Therapists. The work was approved at a joint meeting of the Departments of Internal Medicine of the Pediatric and Dental Faculties, Hospital Therapy of the Clinical Faculty and Outpatient Therapy of V.I. Razumovsky Saratov State Medical University (Ministry of Health of Russia); and the Department of Internal Medicine (Continuing Education for Physicians) of the Military Medical Institute in Saratov.

Based on the materials of the dissertation, 16 printed works have been published, including 2 articles in leading peer-reviewed journals recommended by the Higher Attestation Commission of the Ministry of Education and Science of the Russian Federation.

Structure and volume of the work

The dissertation consists of an introduction, a literature review, a chapter devoted to the description of the materials and methods of the study, four chapters of original research, a conclusion, the main findings, practical recommendations and a reference list. The work is written in 247 pages of typescript, illustrated with 64 tables and 4 clinical examples. The reference list contains 380 sources, of which 217 are domestic and 163 - foreign.