Overview of the research
GENERAL CHARACTERISTICS OF THE WORK. Relevance of the problem. Bronchial asthma (BA) is one of the most common allergic diseases in children. The increase in the number of allergic diseases is caused by environmental pollution from industrial waste, the introduction of chemicals in the production of agricultural products and in everyday life, and frequent illnesses. In these conditions, it is extremely important to increase the child’s resistance to unfavorable environmental factors (Abdirov Ch.F., Agadzhanyan NF., 1993). One of the methods that increases the functional reserves of the body is adaptation to hypoxia, which develops when breathing hypoxic mixtures (Strelkov RB 1983.
Anokhin MI., 1989, Geppe N.A. et al. 2000, Agadzhanyan N.A. 1994, Chizhov A.Ya., 1996). The results of many children’s scientific studies of the effects of hypoxia on the body underlie the use of the method of interval hypoxic training (IHT) in medical practice (Geppe N.A. et al., 1995, Dairova R.A., 1995, Kolchinskaya A 3., 1994, Karash Yu.M. et al., 1988) In the children’s clinic of the I.M. MMA. Sechenov IGT has been used since 1983. The Russian national program “Bronchial asthma in children Strategy for treatment and prevention” sets the main goal of treatment of bronchial asthma to improve the health of children by controlling the symptoms of the disease, maintaining external respiratory function at an optimal level, as well as improving the quality of life (QoL) due to the elimination of social maladaptation inherent in a significant number of patients as a result physical and physiological disorders. psychological and sonia-economic functions Frequent and prolonged hospitalizations, respiratory liscomforg, anticipation of an attack. various restrictions, medical interventions, and uncertainty about the future reduce the quality of life of children with asthma and their family members (French R, Christie MJ. 1991).
Assessment of quality of life encourages health workers to look beyond the disease and helps determine. how the disease affects a person. and also identify optimal methods of intervention and evaluate their effectiveness (Osman L, Silverman NG, Rees P.J., 1996).
When treating patients with asthma, improving their quality of life is one of the priorities. One of the possible ways is to use the IHT method, which normalizes the oxygen metabolism of tissues {Kolchinskaya A 3.. 1994. Pogievskaya VI. 1992) ‘Experimental studies have established. that adaptation to hypoxia increases the body’s resistance not only to lack of oxygen, but also increases the resistance of the central nervous system to stress. stimulates the pituitary-adrenal system. normalizes autonomic and adrenergic regulation, reduces the level of biogenic amines, increases the power of antioxidant systems (Strelkov RB et al., 1985.
Agadzhanyan NA et al. 1987. Kara YuM wap, 1988) and has an immunocorrective effect.
Considering the multifaceted impact of IHT. Quality of life in this paGore is considered as one of the criteria for assessing the effectiveness of this method in B\+ children. Purpose of the work: To study the quality of life of children with mild and moderate bronchial asthma who received IHT as part of complex therapy. Main objectives of the study. 1. Conduct a comparative analysis of the results of IHT courses of different durations on the course of the disease, the incidence of acute respiratory viral infections and quality of life in children with asthma in comparison with the placebo group 2.
Assess the dynamics of quality of life during long-term observation (2 years) and repeated ones. IGT courses. 3.
Compare QOL data with respiratory function indicators (spirography, bronchophonography) 4 Assess breathing pattern data during a hypoxic test and a course of IHT in children with asthma. 5. To study the indicators of NO metabolites in exhaled air condensate (ECC) in children with asthma before and after a hypoxic test and a course of IHT. Scientific novelty. Nervous, using a large clinical material, the quality of life of children 6-16 years old with bronchial asthma who received IHT as part of complex therapy was assessed. The data were compared with objective and functional (spirography, bronchophonography) examination methods.
Defined. that to reduce the frequency of attacks and increase periods of remission in children with asthma, at least 6 courses of IHT are necessary. consisting of 14 sessions. A significant decrease in the incidence of acute respiratory viral infections was revealed. Analysis of the quality of life of children with asthma showed that indicators of distress. subjective feeling of the severity of the disease, reactivity directly depend on the severity of asthma. In most children, after 1 course of IHT, a temporary increase in emotional anxiety was revealed in the form of increased distress, a feeling of severity of asthma, with subsequent normalization as they adapted to hypoxia during repeated courses.
IHT does not affect the quality of active life (QOL), adolescent life (QL), and passive life (QL). The tendency to increase these indicators in all groups was rather a consequence of children growing up. expanding their horizons. The positive effect of interval hypoxia on the breathing pattern in children with asthma has been shown. When the number of IHT courses and their duration are reduced, the effect is insignificant. Indicators of respiratory function according to spirography in children during the period of BA remission against the background of IHT did not change significantly and remained within the age norm.
A direct correlation was revealed between spirography and bronchophonography (BFG) indicators in children with asthma and high information content of acoustic work of breathing (ARB) indicators in the high-frequency (more than 5 kHz) part of the spectrum.
First noted. that adaptation to hypoxia as a result of IHT is accompanied by a decrease in APP. those by improving bronchial conductivity, but exceeding these indicators in healthy children. This allows the BFG method to be used as an informative additional test. It was shown for the first time that the stable NO metabolites nitrates and nitrites are excreted in KBB. decreases after 10 minutes of hypoxia (hypoxic test) and increases during the adaptation process after 1 course of IHT. Scientific and practical significance of the work. . The indications for IHT in children with BA, the method of implementation have been clarified, and long-term effectiveness has also been established.
It has been shown that to obtain a stable training effect of interval hypoxia, at least 6 courses of IHT are necessary. consisting of 14 sessions The positive effect of IHT in complex therapy is accompanied by improved treatment results, in form of reduction in the frequency of asthma symptoms. incidence of ARVI. .
Quality of life indicators are an important parameter for assessing the effectiveness of therapy. It has been shown that IHT is recommended for children with mild and moderate asthma, including children with increased anxiety. A temporary decrease in QoL was revealed in the form of an increase in distress and a subjective feeling of asthma severity in the process of adaptation to hypoxia, followed by stabilization of QoL parameters. It has been shown that the bronchophonography method is sensitive in assessing bronchial conduction in children with asthma. The integrated use of spirography and bronchophonography mutually complements information about the function of external respiration in children with asthma.
Indicators of NO metabolites in KBB can be used as one of the criteria for monitoring the effectiveness of the IHT method. In accordance with the results obtained, the IHT methodology was optimized in the clinic of childhood diseases of the I.M. Moscow Medical Academy. Sechenov. The results of the study were presented at seminars for practitioners. scientific conferences. included in the materials of practical and elective classes with students at the Department of Childhood Diseases of the Sechenov Moscow Medical Academy. The materials and results of the study were used in writing a manual for doctors “Intermittent normobaric hypoxic therapy in gynecology and obstetrics.
Pediatrics” M. 1998, co-author.
Strelkov RB. Chizhov AYA (17 pages). Provisions submitted for defense: 1. Inclusion of IHT in complex therapy for children. patients with asthma. contributes to an increase in the quality of life” indicators of distress and severity of asthma have significantly decreased, indicators of CVL, QL and QOL have increased in different age categories and in all groups. Reactivity, reflecting self-limitation due to the disease, has slightly increased compared to the initial indicators 2. Based on the results of bronchophonography, it can be assumed that a decrease in the quantitative characteristics of acoustic phenomena during treatment with dosed hypoxia may be associated with an improvement in bronchial conductivity. 3.
In children with asthma, there is an increased content of NO metabolites in the KBB. Short-term inhalations of hypoxia lead to a decrease in the excretion of stable metabolites of nitrates/nitrites in the KBB. In the process of adaptation to hypoxia, an increase in these indicators is possible. Approbation of work. The results of the study were reported at a meeting of the Department of Childhood Diseases of the Moscow Medical Academy named after IM. Sechenov September 29, 2003. The dissertation materials were presented at the scientific conference “Problems of childhood pulmonology” (MMA named after IM Sechenov, Moscow, June 2000). at the 11th National Congress on Respiratory Diseases (Moscow, November 2001), at the 3rd All-Russian Scientific and Practical Conference on Prenatal Education “Medical and Psychological Aspects of Modern Perinatology” (Moscow, November 2001), at the meeting of the Pulmonology Section of the Moscow Society of Pediatric Doctors (Moscow, March 2002), at the 2nd All-Russian Congress on Children’s Allergology (December 2003), HyGancaunn.
Study materials and methods
8 printed works have been published on the topic of the dissertation. Scope and structure of work. The dissertation is written according to a generally accepted plan and consists of an introduction, a literature review, a chapter devoted to materials and research methods, and two chapters of personal observations. conclusions, conclusions. practical recommendations and bibliography. including 200 domestic and 52 foreign sources. The dissertation is presented on 185 pages, illustrated with 1 diagram, 44 drawings and 38 tables. CONTENTS OF THE WORK. Materials and methods. The work was carried out on the basis of the Clinic of Children’s Diseases of the Moscow Medical Academy named after IM.
Sechenov (Director – Academician of the Russian Academy of Medical Sciences Baranov AA) In accordance with the objectives of the study, 150 children aged 5-16 years were examined, observed in the clinic from 1998 to 2003. 120 children were examined in remission of the disease, with a disease duration of 2.5 to 8 years. Of these, mild asthma was diagnosed in 43%. moderate – in 56% of children. Children were randomized upon admission into 3 groups. In the 1st group (N=60), the children received a course of IHT consisting of 14 sessions. In the 2nd group (N=30) – a short course of IHT of 6-7 sessions; in the 3rd group (N=30) – placebo.
That is, a similar training was carried out with atmospheric air instead of a typoxic mixture. The control group consisted of 30 apparently healthy children. with symptoms of bronchial obstruction and any manifestations of allergies. The age of the examined patients ranged from 5.2 to 16.3 (10.5 ± 1.1 years).
The main group consisted of school-age children (87%), 8 children (13%) were under the age of 7 years. Boys predominated among children with asthma (66%) In the control group, the number of boys was 50%. On average, the follow-up period was 2 years. All children were examined over time. Before starting the course of IHT, all patients underwent a hypoxic test (HT) for 10 minutes. Using a stationary membrane installation – a “hypoxicator” from Hypoxia Medical Academy, the child inhales the generated mixture. containing 12% oxygen (FiO₂). Arterial blood oxygen saturation (SaO₂) and heart rate were recorded every minute using a photoplethysmographic pulse oximeter from Hypoxia Medical LTD (Russia-Switzerland), and during the recovery process after the end of the test for 3 minutes.
When the saturation (SaO₂) in the blood decreased below 85%, the heart rate by more than 15-20%, the appearance of unpleasant sensations. headache. dizziness, difficulty breathing – the oxygen content in the inhaled mixture increased to 14%. In case of severe manifestations, the test was stopped. and such children were excluded from the study (N=12). IHT was also carried out on the “Hypoxicator”.
The session lasted 35-40 minutes with alternating inhalation for 5 minutes through a mask of a hypoxic mixture (hypoxia) containing from 12% to 14% oxygen, or atmospheric air (reoxygenation). The concentration of oxygen in the inhaled mixture was selected for each patient taking into account the results of the hypoxic test. If SaO₂ levels were below 85%, a mixture with 14% O₂ content was selected During the session controlled heart rate. SaO₂. From session to session, the duration of hypoxic exposure increased by increasing the number of “hypoxia-reoxygenation” cycles from 3 to 7-8 times. Of the 60 children in group 1: 24 patients received 7-8 courses of IHT, 17 children – 6 courses, 19 – 4-5 courses with a frequency of 3-3.5 months.
The number of IHT courses depended on the condition and the patient’s well-being, as well as from relationships with patients and their parents. discipline. remoteness of residence.
In the 2nd (CIGT) and 3rd (placebo) number of hypoxic trainings we carried out according to the same criteria. that 11 received full courses of 7-8 courses of IHT, 16 received 6 courses, 3 children received 4-5 courses. In the placebo group, 14 received 7-8 courses, 6 courses — #6 children. To assess the effectiveness of IHT, we analyzed data on the course of asthma. frequency of symptoms. duration of remission. the need to take short-acting B2-agonists, respiratory function indicators. The incidence of ARVI was also assessed. dynamics of quality of life (QOL) indicators and nitric oxide (NO) metabolites in exhaled air condensate (ECC) before and after a course of IHH Repeated studies were carried out on all patients with mild and moderate asthma with an interval of 3 months To assess the quality of life (QOL), adapted quality of life questionnaires for children with bronchial asthma were used (DJ French, MJ Chnstie Childhood Asthma Questionnaires, 1994 Russian version: VI Petrov.
And in Smolenov. 1995) The analysis was carried out among children of the first three troupes. Questioning of healthy children was not carried out. since this questionnaire was developed only for psychological testing of children with asthma. The assessment of QOL was carried out according to the following parameters: “quality of active life (QOL) – the patient’s participation in active games, sports; quality of passive life (QPL) – reading, drawing; severity of asthma (SA) – the child’s opinion about the severity of his asthma, missed school days, night awakenings; distress – the child’s emotional assessment of asthma symptoms, quality of adolescent life “QOLL” – determining the degree involving young people in social activities typical of adolescence – going to a disco, parties: reactivity is a concept reflecting the self-limitation of children in connection with the disease.
All children were divided according to age into two half-groups: “B” – for children 6-12 years old. “C” – for children 13-16 years old QOL parameters were assessed from minimum to maximum values in points In subgroup “B” the following QOL criteria were determined: QOL (7-35), QOL (4-22), distress (6-30), TA (6-23) In subgroup “C” QOL (8-36), QOLL (5-23), distress (12-60), TA (9-34), reactivity (5-24) The results were determined by the sum of answers using the “NEWS” computer program in Microsoft Access, developed by Smolenov I. V. et al in 2000. External respiration function was assessed using the Spirosift Fucuda 3000 apparatus.
Forced vital capacity (FVC), forced expulsion volume in the first second, peak velocity were recorded expiratory flow (PEF), minimum volumetric flow rate at the level of 25%, 50%, 75% VC Efficiency of IHT, along with routine methods (spirogram). we assessed using the bronchophonography (BFG) method.
BFG is a method for assessing respiratory noise, based on registration and analysis of the frequency-amplitude characteristics of respiratory sounds. The diagnostic complex “Patter” for determining BOT includes: a sensor with a special mouthpiece, a built-in board in a personal computer, a program for processing and analyzing data. The procedure for recording the pattern of respiratory sounds is carried out in the “sitting” position with quiet breathing for a short period of time (4-10 sec). In this case, the sensitive element of the sensor must be directed to the throat of the larynx. The resulting acoustic signal is transformed using an analog-to-digital converter, processed by a processor, and the processing results are displayed on the monitor screen of a personal computer in the form of a family of curves.
The graphical display of the phonorespirogram obtained in this way was called “breathing patterns.” Overview bronchophonograms in a three-dimensional display are divided along the axis of frequencies by a cursor, which is the boundary of the diagnostic zones. The frequency of oscillations of respiratory sounds was determined in the range from 0.1 to 12.6 kGy. The zone of low-frequency oscillations includes a frequency of 0.1-5 kGy, high frequencies – 5-12.6 K) and In order to identify Differences between BPG indicators in different periods of asthma and in healthy children. To confirm the correlation between the spirogram and bronchophonogram indicators, a group of children (N=10) with BA in the period of exacerbation with severe broncho-obstructive syndrome in the form of auscultatory wheezing in the lungs and the phenomenon of broncho-obstruction according to the spirogram data was examined.
We studied the effect of dosed hypoxia therapy on the daily excretion of stable NO metabolites nitrates/nitrites in the exhaled air condensate of children with asthma. To indirectly assess the content of nitric oxide in EBC, the determination of the total concentration of nitrates and nitrites was used as direct. Nitric oxide metabolites Nitrates were reduced to nitrites with the original cadmium reducing agent and further determination was carried out by the spectrophotometric method with Griess reagent. To conduct clinical and statistical analysis, a database was created using the Epi Info software package for epidemiological research. as well as Statistica for Windows, Version 5, “Stat Tutonal” in the Microsoft EXEL shell.
Student’s parametric test was used. Fisher test, method x?
Study findings
Analysis of variance was used to assess the effectiveness of the methods and the prognosis of the disease. Own results. All patients with BA, at the beginning of the study, received basic therapy with inhaled steroidal anti-inflammatory drugs (cromoglycate and nelocromil sodium) in age-specific dosages of at least | months, lasting in the same doses for 3-4 months. 33% (N=40) of children used antihistamines as a preventive treatment for mild and moderate BA, 92% (N=111) of children with BA received simitomatic bronchodilator therapy in the form of inhaled bronchodilators from 4 to 8 times a month; 23% received prolonged bronchodilators in combination with cromons.
Intramuscular injections of bronchodilators and corticoid hormones to relieve episodes of bronchial obstruction were used in 2.5% (N=3) of children with moderate BA. The average frequency of bronchodilator use in children with mild BA was 4.9 ± 0.6 per month, with moderate BA – 9.2 ± 1.8 per month. 26% of children with mild asthma had 2-6 mild attacks per month, 30% of patients with moderate asthma had mild and moderate asthma attacks 2-3 times a week. The average frequency of occurrence of asthma symptoms within a month in the group of children with asthma was 5.9 ± 0.9 (in the IHT group.
CIGT and placebo, respectively 6.2 ± 1.1, 5.1 ± 0.7, 5.9 ± 1.0) Compounded heredity, in the form of the presence of allergic diseases in close relatives. 87% of patients had 83% of children already from the first months of life had allergic reactions to food in the form of atopic dermatitis. Many children suffering from asthma. concomitant allergic pathology was noted – atopic dermatitis in 19% (N = 23) of children, 74% (N = 89) of children had allergic rhinitis and sinusitis. 15% of children had a combination of allergic damage to the ENT organs and atopic dermatitis.
All children with asthma showed sensitization to household allergens.
38% had sensitization to plant pollen. 94 children (78%) were diagnosed with diseases of the gastrointestinal tract such as biliary dyskinesia. esophagitis, gastroesophageal and duodenogastric reflux. gastritis. duodenitis The average number of acute respiratory viral infections per year in the group of children with mild asthma was 4.08 ± 1.05. with moderate severity – 5.65 ± 0.93; in the control group (healthy) children, the incidence of ARVI was 2 times less” 2.48 ± 1.44 (p < 0.05) The distribution of the incidence of ARVI in the IHT groups CIGT, placebo was respectively 5.3 ± 1.8, 4.9 ± 1.1 and 4.2 ± 1.0 After 1 course of IHT did not change significantly” the number of attacks remained up to 6.2 ± 1.1 after a course of 6.1 ± 1.0 in Mec, the nature of the attacks did not change. the frequency of use of bronchodilators decreased slightly from 5.15 ± 0.75 to 4.9 ± 1.1 per month Already after 1 course of IHT, when examining these children after 3 months, it turned out. that only 8 (13%) children suffered from a respiratory viral infection 1-2 times, the remaining 52 children in this group (86%) did not suffer from ARVI After | short course (SIGT), as well as in the placebo group, the course of asthma and the frequency of acute respiratory viral infections remained virtually unchanged.
The dynamics during the course of asthma were clearly identified only after 3 courses of hypoxic training. Over the 9 months of the study, positive dynamics occurred in almost all three groups with asthma. More significant indicators were in the group. who received a full course of IHT of 14 sessions in the form of a reduction in attacks from 6.2 ± 1.1 to 4.1 ± 0.9 (p < 0.05), prolongation of the period of BA remission (before IHT 2.5 ± 0.6 months after 3.3 ± 0.8 months (p < 0.05)), the number of bronchodilators used decreased by 26% (with 5.15 ± 0.75 to 3.8 ± 1.02 per month (p < 0.05)), the number of viral infections tended to decrease according to compared to the initial data by 2 times (from 4.9 ± 1.1 to 2.4 ± 0.1 (p < 0.001)) Over 18 months of observation. using regular IHT courses. the frequency of attacks significantly decreased from 6.2 ± 1.1 to 3.0 ± 0.5 (p < 0.001) compared to baseline values.
The attacks became easier. The periods of BA remission significantly lengthened – before IHT 2.5 ± 0.6 months, after – 4.2 ± 0.5 months (p < 0.05)) The number of bronchodilators used decreased from 5.15 ± 0.75 to 3.3 ± 1.0 (p < 0.05) The number of acute respiratory viral infections decreased from 4.94 ± 1.10 before the course and 2.3 ± 1.03 (p < 0.001) after the course (see pite.1) In the group of children. those who received a short course of IHT, the effect was not significant; the indicators improved (by 13%). In the group of children who received atmospheric air inhalation instead of a hypoxic mixture, after six courses there was a positive trend not associated with IHT.
The indicators improved by an average of 8%, apparently due to the main treatment of asthma and reflected the dynamics of the severity of the disease (Figure 1)
Quality of life
Thus, a direct correlation was noted between the positive dynamics of the course of asthma and the number of IHT courses. The more courses the patient received and the longer the training. the greater the effect was. To determine the required number of courses to achieve the maximum result, we carried out mathematical calculations using the Mahalanobis distance and linear function and identified. which is the optimal amount. To achieve a stable effect, at least 6-7 courses of IHT are required. To assess the effect of IHT on the quality of life of patients, children were surveyed before and after a course of hypoxia, over time after 3 months with repeated courses of IHT.
The obtained indicators were compared with the original ones. as well as with the results of children with asthma who received a course of placebo instead of IHT. Dynamics of QOL indicators.
QL, D. TA in the younger age group (subgroup “B”) and indicators of QL and reactivity in the older age group (subgroup “C”) were identical, but in subgroup “C” anxiety was more pronounced (96% versus 68% in subgroup “B”), which was manifested by initially high distress and indicated a higher subjective awareness of limitations. associated with the disease. The second most important psychological point was the initially high indicators of the severity of asthma in CPJ in subgroup “C” compared to TA and CPJ in subgroup “B”. The patient’s subjective assessment of the severity of his disease. apparently, it affects the self-sufficiency of the adolescent and is reflected in the QOL After the 1st course, the maximum values of distress and subjective sensation of HA were noted only in the groups of children receiving inhalations of the hypoxic mixture TA was reversed proportional to distress in these groups and directly proportional to distress in the placebo group.
In both age categories after 18 months of study. (six courses of IHT) the indicators of distress decreased significantly compared to the initial ones. TA. The indicators of CVL and QAF increased. The CPI remained virtually unchanged, as it was initially quite high. Reactivity increased significantly compared to baseline values (Figure 2). In the CIHT group, there was also a positive trend in the form of a decrease in distress, TA decreased slowly, and QL tended to slightly increase. indicators of reactivity and QOL practically did not change. In the placebo group there were no wave-like changes in indicators, as in the IHT groups.
The severity of asthma tended to decrease both after the 3rd course and after the 6th course. Reactivity increased slightly, distress increased, but not significantly. QOL, QOL and QOL tended to increase, which, rather, was a consequence of the growing up of children, the expansion of their horizons “ITH children remained “anxious”, and the subjective assessment of the severity of asthma increased compared to the initial data. Which can be explained by dissatisfaction with oneself and one’s illness. Thus, the increase in distress after the first course of IHT can be regarded as a normal physiological reaction of “triggered” adaptation mechanisms in response to dosed hypoxia, and, as a consequence, the development of the first phase in the form of a stress reaction according to Selye. the body finds itself in an environment with a low oxygen content, various defense mechanisms are activated.
They are based on a stress reaction, which enhances the production of adaptation hormones, increases the ability of cells to absorb available oxygen at the biochemical level and increases the energy of cells; the body “considers” hypoxia as. stress factor The reaction to the action of a stress factor (hypoxia) stimulates the body’s defenses and adaptive capabilities. Subsequently, the formation of a “structural trace” (Golikov MA, 2002) This is confirmed by a decrease in our patients. and then the normalization of stress factors (distress). improving criteria for assessing the quality of the disease (severity of asthma, reactivity), increasing adaptive reactions.
Respiratory function and adaptation
IHT causes significant changes in the psychophysiological status, which consist of switching the implementation of anxiety from the somatic and emotional level to the behavioral level (Akopov GP 1997, Bailina MI. 1998). Improvement in quality of life is also determined by the optimization of autonomic functions, a decrease in the manifestations of psycho-emotional tension, and a more economical autonomic provision of physical activity (Glazychev O S., 1994) To obtain an optimal clinical effect, the number of IHT sessions, according to our data, should be at least 14. This is consistent with the data of Ehrenburg I.V. 1996, who showed. that there should be at least 10 sessions.
The works of Strelkov R.B., 1997 say that incomplete (short) courses of IHT also give a positive result in the treatment of diseases. However, according to our data, a comparative study of the effectiveness of the effects of IHT courses of different durations on the course of asthma, the frequency of acute respiratory viral infections and the quality of life of children with asthma in comparison with the placebo group has not been carried out. It has been shown that only full courses of IHT have a significant effect on the course of asthma in children.
We assessed physical function in children who received IHT as part of complex therapy. using spirography and bronchophonography before and after inhalation of a bronchodilator. We assessed the dynamics of BPG indicators against the background of a course of IHT by “acoustic” work in the high-frequency zone, since it is this spectrum that is the criterion of a broncho-obstructive acoustic phenomenon (Method of suppression of respiratory noises caused by bronchopulmonary pathology in children, RF patent M 5062396, bull.
M 181995. Malyshev V S. Kaganov S 10, Medvedev V T. Ardashnikova SN. 1993) According to our data. the appearance of oscillations in the high-frequency spectrum correlates with the auscultatory characteristic of the severity of wheezing, which makes it possible to objectively reflect the work of breathing in nJ using a computer program in the breathing pattern (Geppe N.A. Malyshev VS. Lisitsya M.V., 2002). Analysis of the BFG showed that in healthy children, the indicators of “acoustic” work of breathing in the high-frequency range (5-12.6 kGy) are within the range of 0.30 ± 0.06 nJ.
In patients with BA in the period of exacerbation from 5.9 ± 1.9 nJ.
These indicators are directly proportional to the severity of asthma. In children in the period of remission of BA, the indicators of “acoustic” work were higher than in healthy children (0.3 nJ). and amounted to 1.2 ± 0.3 nJ. In 82% of children with bronchial obstruction, according to a spirogram, after a brocholytic drug there was a significant increase in FEV indicators, (17%) after inhalation of B›-agonists, APJ indicators decreased by 15%, and there was an inverse correlation between FEV indicators. APJ] indicators in the high-frequency spectrum after a bronchodilator significantly decreased from 5.9 ± 1.9 nJ to 0.9 ± 0.2 iJ (p < 0.001).
This indicates the presence of severe reversible obstruction in these children and correlates with spirography data (Table 1). Tabliya | According to BFG data, fluctuations in the high-frequency spectrum and the clear dependence of the presence of these fluctuations on the period of the disease and the severity of bronchial obstruction allow them to be used as criteria for assessing the state of bronchial conduction. In the group of children without clinical manifestations, i.e. regarded as remission of BA, all initial spirographic parameters were within normal limits. A 2–4% decrease in spirographic parameters against the background of a bronchodilator was insignificant.
After 6 courses of IHT, there was a slight increase in FVC and PEF. In these patients, there was a significant decrease in BPG levels during the bronchodilator treatment, which did not reach the level of healthy children. A decrease in BPG levels by 20% (according to ARD) was revealed during treatment with IHT (Table 2). In healthy children, during the hypoxic test, no significant dynamics of EF parameters were observed. Spirographic indices remained stable, BFG indices did not change in 96%, and in 4% the ARD in the low-frequency part of the spectrum changed chaotically and insignificantly.
The total concentration of nitrates and nitrites (more than MOUL\O;) in exhaled air condensate (ECC) in the experimental groups was measured before and after GG (n=20) or IHT (n=20) before and after 1 course.
In the control group of healthy children, KBB was collected twice according to the timing in the main groups. In the control group, the average value of ΣNO₃⁻/NO₂⁻ was 3.4 ± 0.9 µm. A decrease in ΣNO₃⁻/NO₂⁻ KBB was determined during the HGS 10.1 +/-2.0 µm to 7.4 +/-2.4 µm (p < 0.05) compared to the baseline. After one course of IHT (14 sessions), an increase in the average level of total concentration of nitrates and nitrites ΣNO₃⁻/NO₂⁻ in the EBC was detected from 7.9 ± 0.9 µm to 18.9 ± 5.7 µm (p < 0.001).
Excess of the measured parameter in the same patients before and after IHT compared with the control group. An increase in the total concentration of nitrates/nitrites indicates an increased synthesis of nitric oxide, which may be associated with changes in NO metabolites in the process of adaptation to hypoxia. These children require IHT against the background of basic anti-inflammatory therapy.
Conclusions and practical recommendations
CONCLUSIONS: 1 Interval hypoxic training has a significant positive effect on the course of asthma when conducting at least six courses (14 sessions each) in the form of a reduction in attacks by 48%, prolongation of periods of remission by 68%, a decrease in the number of short-acting bronchodilators used by 64%, a reduction in the incidence of ARVI by 46%. Short courses of IHT (6-7 sessions) do not significantly affect the course of asthma in children. 2 Indicators of quality of life in children with asthma (QOL, QL, D, TA) as in younger age groups (6-12 years). and in the older age group (13-16 years) are similar. indicators of distress, a subjective sense of the severity of the disease, and reactivity directly depend on the severity of asthma.
In the older age group {13-16 years old), a greater number of children showed increased anxiety (96% versus 68% in the group 6-12 years old). in the form of high distress and higher asthma severity scores 3 IHT did not affect the quality of active (QOL). adolescent (Adolescent). passive life (PL) Initial adaptation to hypoxia (1 course) was accompanied by an increase in distress and TA, followed by training. stabilization and a significant decrease compared to the initial indicators of distress and severity of asthma 4 Indicators of respiratory function according to spirography in children during the period of remission of asthma against the background of IHT did not change significantly, remained within the age norm.
A direct correlation was revealed between indicators of spirography and bronchophonography (BFG) in children with asthma and high information content of indicators of acoustic work of breathing in high frequency (more than 5 kHz) parts of the spectrum. 5 The positive effect of interval hypoxia on the breathing pattern in children with asthma has been shown. Adaptation to hypoxia. as a result of IHT. is accompanied by a decrease in ABP and an improvement in bronchial conductivity, but these indicators remain in excess compared to healthy children. When the number of IHT courses and their duration are reduced, the effect is insignificant 6 The BFG method based on an acoustic assessment of the amplitude-frequency characteristics of the breathing pattern is an informative additional test for assessing respiratory function in children with asthma. 7 Excretion of stable NO metabolites nitrates and nitrites in EBC. decreases after 10 minutes of hypoxia (hypoxic test) and increases during the adaptation process after 1 course of IHT, which requires training against the background of basic anti-inflammatory therapy.
PRACTICAL RECOMMENDATIONS. 1. Interval hypoxic training in complex therapy of BA in children with mild and moderate BA. including those with increased anxiety, has a positive effect on the course of asthma. significantly reduces the incidence of ARVI To obtain a positive training effect of IHT, it is necessary to use at least 6 courses, with an interval of 3 months. 14 sessions each. 2 For more complete control over the dynamics of asthma and the individual characteristics of the impact of the IHT method on each patient, a study of the quality of life is recommended. 3 Methods of spirography and bronchophonography. are mutually complementary methods for assessing external respiration function. allowing to identify and control the state of bronchial patency in children with asthma. 4 Determination of NO metabolites in exhaled air condensate. can be used as an additional criterion for assessing the effectiveness of interval hypoxia. 5.
In the process of adaptation to hypoxia in children with asthma, the synthesis of nitric oxide increases. Therefore, IHT is recommended against the background of basic anti-inflammatory therapy. .
References
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Bogdanova T A., Geppe МА . Saadaeva S.K , Kurchacova Т V., Klimanov LA , Belousova EG Nitric oxide in the condensate of exhaled air of children with asthma after hypoxic test 5” International Conference “Hypoxia т Medicine“ Innsbruck, Austria. Journal «Hypoxia Medical» 2003, р 47
Т.А. Богданова. Влияние интервальной гипоксической тренировки на качество жизни детей с бронхиальной астмой. Автореферат диссертации на соискание ученой степени кандидата медицинских наук. Москва, 2004.
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