Nebuliser therapy in complex treatment of chronic obstructive pulmonary disease

INTRODUCTION: Nebulizer therapy in the complex treatment of patients with bronchospostic syndrome has become firmly established in the practice of its use mainly in bronchial asthma. For chronic obstructive pulmonary disease (COPD) patients, this therapy has not been widely used. Little studied was the study of the dynamics of indicators of the function of external respiration (FER), bronchial patency, acid-base state, oxygen saturation of the blood and the temporary organization of FER, chronosensitivity to fenoterol (Beroteс®) during the day, week, half-week period in COPD.

AIM: To study the effectiveness of nebulizer therapy with Berotec® in the dynamics of treatment against the background of complex traditional therapy of COPD patients.

MATERIALS AND METHODS: To accomplish this task, in addition to the generally accepted clinical and laboratory, X-ray, instrumental studies, the study of FVD indicators, spirometry on the “Metatest” apparatus “Medapparatura” (Ukraine), peak flowmetry by the Ferraris Medical Limited apparatus (UK), computer spirometry with the analysis of the flow-volume curve, hemodynamic parameters using EchoCG, as well as blood pressure measurement by N.S. Korotkov, ECG. The acid-base balance and oxygen saturation of the blood were determined. These comprehensive studies were carried out before and after the end of therapy, as well as every 3 hours by peak flowmetry for a day, a week and half a week in 20 patients with COPD. The time-dependent effects of nebulizer therapy to determine chronosensitivity to Berotec® were studied using an acute clinical and pharmacological test. The whole complex of studies was carried out 2 times a day at 08.00 and 18.00. The information obtained was analyzed by methods of variational statistics using the χ² Pearson’s criterion and the difference method. Chronobiological information was analyzed by the method of kosinor analysis according to F. Halberg.

RESULTS: The results of the conducted studies indicate the effectiveness of nebulizer therapy with Berotec® in COPD patients. This was manifested in the improvement of clinical symptoms, positive dynamics of indicators of FER, bronchial patency, acid-base balance, blood saturation O₂ (SaO₂). However, this therapy did not restore the disturbed temporary organization of bronchial patency, BH, hemodynamic parameters. Only the circadian rhythmicity of the parameters of peak flowmetry, DAD, and ADsr was preserved. The average daily, average weekly, average weekly values (mesors) of BH, HR, SAD, DAD, ADsr, double product (DP) decreased and the values of peak flowmetry increased.

CONCLUSION: The results of the conducted studies suggest that 2-time use of nebulizer therapy in the morning and in the evening in the same patients leads to the fact that tachyphylaxis develops more often in the evening on the 8^th, 10^th, 14^th day. Based on the data obtained, it is recommended to use the Berotec® 2 times a day (morning and evening) during the week, and a single application of nebulizer therapy with Berotec® can be carried out in the morning for no more than 12 days.