[Effective control of a severe exacerbation of bronchial asthma]. / Effektivnyi kontrol tiazhelogo obostreniia bronkhial'noi astmy.

AIM: To evaluate effectiveness and safety of nebulizer therapy (NT) with broncholytics and pulmicort suspension (PS) in patients with a severe exacerbation of bronchial asthma (BA). MATERIAL AND METHODS: 75 patients with a severe BA exacerbation received broncholytic NT with consideration of comorbid pathology and age. Nebulized PS was used as an alternative to systemic glucocorticosteroids (SGCS). NT efficacy was assessed by changes in clinical symptoms, in the peak expiration velocity (PEV) and spirometry parameters. Safety was controlled by 24-h ECG monitoring, pulsoximetry. PS was examined for effect on adrenal cortex, calcium metabolism, oral infection with Candida. Side effects were registered. RESULTS: Clinical improvement was recorded in all the patients. NT reduced the number of additional inhalations of short-acting beta2-agonists 4-5 times, on the average. In the end of NT there was a 4.66% increase in SaO2 vs the initial value (p = 0.04). PEV and FEV1 increased. Plasm levels of hydrocortisone and its urine excretion did not lower vs initial values. CONCLUSION: The results of the study point to efficacy and safety of combined NT with broncholytics and PS in a severe exacerbation of BA.

[Effect of high doses of broncholytics on the state of cardiovascular system during treatment of sever exacerbation of bronchial asthma]. / Vliianie bol'shikh doz bronkholiticheskikh preparatov na sostoianie serdechno-sosudistoi sistemy pri lechenii tiazhelogo obostreniia bronkhial'noi astmy.

UNLABELLED: The use of broncholytic drugs through nebulizer is a standard treatment for acute episodes of bronchial asthma. However doses of these drugs administered by nebulizer can be much higher than those applied when metered dose inhaler is used. These doses have a potential of cardiotoxic effects. MATERIAL: Patients (n=75) with severe exacerbation of bronchial asthma. METHODS: All patients received broncholytic drugs through nebulizer. Doses were adjusted according to age and concomitant pathology among which prevailed ischemic heart disease (21.3%) and hypertension (53.3%). Nebulized beclomethasone was an alternative to systemic corticosteroids. Safety of therapy was controlled with electrocardiography, 24-hour electrocardiography, measurements of serum potassium level, registration of subjective signs (palpitation, tremor) and objective data (heart rate, blood pressure). RESULTS: Clinical improvement occurred in all patients. By the end of nebulizer therapy arterial blood O(2) saturation increased 4.66% from initial level (p=0.04). Peak expiratory rate and forced expiratory volume in 1 sec also rose (p <0.05). Termination of nebulizer therapy was associated with decrease of number of both supraventricular and ventricular premature beats. Moderate widening of of QT interval above 460 ms was registered in 4 patients, 3 of whom had ischemic heart disease. There were no significant changes of serum potassium levels. CONCLUSION: Broncholytic drugs administered by nebulizer in therapeutic doses selected with consideration of age and concomitant diseases did not produce cardiotoxic effects.