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Home / Issues / № 2, 2011

THE PECULIARITIES OF MEDICAMENTAL MANAGEMENT OF THE PATIENTS OF ELDERLY AGE WITH COMBINED CARDIORESPIRATORY PATHOLOGY
Ganceva H.H., Nazifullin V.L., Iliasova T.M., Gabitova D.M.
The chronic obstructive illness of lungs (COIL), as the rule, develops of the persons older than 45 years, is slowly progressing, heavy and extremely heavy duration of illness falls on the age of 55-56 years. For this age population there is characteristic the polymorbidity and usually COIL is not the only one disease of the elderly man. The most often in the older age groups COIL is taking at the background of coronary artery disease, heart failure, the abnormalities of the rhythm, hypertonic disease, diabetes mellitus, thrombophlebitis etc.

Accordingly, except the therapy by the COIL, these patients receive coronary active agents, hypotensive, diuretic and antiarrhythmic preparations, heart glycosides. The considerable part of elderly people takes sedative and hypnotic preparations. Bronchodilators occupy the central place in the symptomatic therapy COIL, all categories of bronchodilators raise tolerance to the physical load, even while the absence of changes of the volume of forced exhalation in 1 second (VFE1). With the taking into consideration of this fact, that elderly patients have multiorgan pathology, tachycardia, hypoxemia, the lowering with the age sensitivity of receptors to sympathomimetics, while the curing of this group of patients there raises the role of anticholinergic preparations. Iprotropium bromide is prescribed as the monotherapy, and in comparison with b2 - agonists. More revealed and fast subjective improvement is reached while the use of unbulized solution Bedural (fixed combination of fenoteroland iprotropium bromide). While the combination of inhalation bronchodilation tools there occurs the improvement of bronchial patency in the more degree, then while the prescription of any of these preparations as monotherapy. The rather comfortable and less expensive are fixed combinations of preparations in one inhaler. The combination of bronchodilators with different mechanisms of action raise the effectiveness and lowers the risks of side effects in comparison with the raising of the doze of one preparation. One of these preparations is berodual. The frequency of side effects while the use of berodual is lower than while use of sympathomimetics, so it can be used while the accompanying cardiovascular diseases of the persons of elderly and senile age. It´s considered that the optimal inhalation technique of delivery of preparation while the intensification of COIL is dozed, aerosol inhalers in the combination with spacers or nebulizers. For people of elderly age, with regard to disfunction of respiratory muscular system, mental abnormalities, gravity of the condition there is preferably to use nebulizers. In connection with that patients of older groups can´t make adequate inhalation maneuver, it impedes the use by them of dozed aerosol inhalers. Besides, the use of nebulizers doesn´t require the cooperation of patient and constant control from the side of medical personnel of observance of the rules of inhalation.

The aim of our research is to assess the effectiveness and safety of nebulizing therapy with berodual of the elderly people with COIL in combination with coronary disease of heart and artery hypertension. We observed 37 sick people with COIL with the middle-heavy, heavy and extremely-heavy duration at the age from 59 till 75 years at the period of intensification. COIL of these patients was combined with stenocardia of loading FK P-H and Hypertonic disease of P and H stages. With taking into account that at the phase of intensification patients with COIL require intensive bronchodilator therapy with an adequate way of delivery of bronchodilators, patients was treated with the therapy of inhalation berodual through the nebulizer «Delphinus F1000» (Itali). The assessment of effectiveness of curing was carried out by the facts of clinically-functioned research, which included spirography, peak flow, ECG, there was assessed the frequency of heart beat, frequency of respiratory movements, arterial pressure, quality of sleep, tolerance to the physical load, satiety of blood with oxygen (SaO ) before and after inhalation course. The course of curing continued in average 18 days, with 2-3 inhalations a day through 6-8 hours. At the background of curing all patients have decreased the evidence of short breath, the number of dry wheezes in lungs, there was observed the trustworthiness increase of showings of bronchial patency (speed of space of exhalation increases in average to 32 %, VGE1 - to 9 %), there increased the tolerance to the physical load, there normalized the sleep, SaO2 increases in average to 3-5 %. Meanwhile there was noticed good portability of berodual, there were no considerable changes of ECG and abnormalities of heart rhythm revealed. Patients at the background of decrease of anoxemia have the decreased figures of frequency of heart beat and frequency of breath moving without rising of arterial pressure.

Thereby, the curing with inhalation berodual with the help of nebulizer is the high effective, safe method and guarantees the stabilization of condition of the sick people with COIL, without appearance of cardiotoxic effect. With the taking into consideration that patients of elderly ages COIL is often combined with coronary disease of heart and hypertonic disease, weakening of respiratory muscular system and mental abnormalities, nebulizer therapy of combined bronchodilators (including berodual) is the most adequate and effective way of bronchodilation therapy in conditions of hospital.


The work was submitted to the International Scientific Conference «Modern science intensive technologies», Spain (Tenerife island), 20-27 of November 2010, сame to the editorial office 05.10.2010.


Bibliographic reference

Ganceva H.H., Nazifullin V.L., Iliasova T.M., Gabitova D.M. THE PECULIARITIES OF MEDICAMENTAL MANAGEMENT OF THE PATIENTS OF ELDERLY AGE WITH COMBINED CARDIORESPIRATORY PATHOLOGY. International Journal Of Applied And Fundamental Research. – 2011. – № 2 –
URL: www.science-sd.com/389-23517 (04.12.2021).