Role and treatment status of lymphocyte surface phenotype in chronic obstructive pulmonary disease and bronchial asthma
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https://www.eduzhai.net American Journal of Medicine and Medical Sciences 2021, 11(8): 572-574 DOI: 10.5923/j.ajmms.20211108.05 Current Views on the Role of the Surface Phenotype of Lymphocytes in Chronic Obstructive Pulmonary Disease and Bronchial Asthma and Their Treatment Nasirova Aziza Akbarovna*, Mansurov Dilmurod Norimovich Samarkand State Medical Institute, Samarkand, Uzbekistan Abstract Today, bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) is a global medical problem. Having an idea of the features of the course of the combination of BA and COPD, using specific diagnostic criteria, based on recommendations for the management of this category of patients, it is possible to achieve control over the disease, improve the quality of life, and reduce mortality. For this, it is necessary to determine the features of the diagnosis of COPD, BA and their combination. Keywords Bronchial asthma, Chronic obstructive pulmonary disease, The syndrome of intersection of bronchial asthma, Bronchodilation Today, bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) is a global medical problem. Patients with these pathologies have "their face", their own special phenotype. The term "phenotype" is proposed by one of the founders of modern genetics, the Danish biologist V. Johansen in 1909. Phenotype - visible characteristics of the body due to the interaction of its genetic component and external environmental factors. Phenotyping in medicine is the optimization of diagnosis, treatment and prevention . Both COPD and BA are inherent in different phenotypes that can be modified as the duration of the disease increases. In many patients, BA is characterized by a low level of control of the course of the disease, a higher frequency of exacerbations, a reduced response to the inhalation GK, greater need for emergency preparations. In this case, irreversible bronchial obstruction arises, associated with a long-term inflammation and associated with structural changes of the bronchopulmonary system, on the basis of which the phenotype of a heavy BA (neutrophilic, smokers, resistant to the GC) [11,12]. Hobs phenotyping also has its own history. For a long time, this disease was called chronic obstructive bronchitis or emphysema lungs - depending on the predominance of certain symptoms. In recent decades of the 20th century, scientists all decided to call it everywhere equally - COPD . In 2001, a global diagnostic, treatment and prevention strategy program was developed (Gold - from English. * Corresponding author: firstname.lastname@example.org (Nasirova Aziza Akbarovna) Received: Jul. 17, 2021; Accepted: Aug. 6, 2021; Published: Aug. 15, 2021 Published online at https://www.eduzhai.net Global Initiative for Chronic Obstructive Lung Disease). This document was revised in 2006, 2011, 2013 and 2014. [7,8]. Already in the first edition of the Gold, three main COPD phenotype were allocated: bronchitis, emphysematous, mixed. Subsequently, other phenotypes of this disease, characterized by the severity and character of inflammation, the presence of concomitant diseases, respond to therapy, variability of bronchial obstruction. In 2014, the phenotype of the combination of BA and COPD was isolated, the presence of a number of general features was determined under various mechanisms for the development of diseases of diseases . According to the definition given in GINA, BA is a heterogeneous disease, which is characterized by the presence of chronic inflammation of the respiratory tract. It is determined by the presence of a history of such symptoms as whistling wheezing, shortness of breath, a variable limitation of the air flow rate on exhalation . To increase the efficiency of the differential diagnosis between chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA), it was necessary to identify new biological markers. In 2014, there was a study of surface markers of peripheral blood lymphocytes in the peripheral blood lymphocytes, expressing antigens CD3, CD4, CD8, CD16, CD20, CD23, CD25, CD54, CD71, CD72, HLA-DR, CD95, and MIGM membrane immunoglobulins and Migg in patients with chronic obstructive pulmonary disease (COPD) and atopic bronchial asthma in the stages of exacerbation. There are significant differences in changes in the surface phenotype of lymphocytes in these diseases . Also, when COPD, it was revealed to increase the content of cytotoxic American Journal of Medicine and Medical Sciences 2021, 11(8): 572-574 573 lymphocytes (CD 4+, CD8 + up to 34%, CD16 + NK cells by more than 33% of the norm) in the blood regardless of the stage of the disease. It was proposed that the high cytotoxic potential of the immune system is the cause of the development of greater damage to the pulmonary tissue, which causes in the future pneumosclerosis, lung emphysema and system damage during the COPD. In patients with ABA during remission period, the activity of cytotoxic cells is reduced, and the predominance of the processes of activation apoptosis of lymphocytes (CD95) were observed over their readiness for differentiation and the acquisition of the late differentiation antigen (HLA-DR). The obtained multi-directional changes in the immune response in patients with Aba and COPD allow you to better understand the peculiarities of chronic inflammation in these nosological forms. In this study, changes in the immune system, developing during COPD and with Ba, have a number of significant differences. It was proposed that it was the high cytotoxic potential of the immune system of patients of COPD causes damage to the pulmonary tissue, causing the development of pneumosclerosis and lung emphysema. The high activity of cytotoxic lymphocytes and MK cells, apparently, is one of the factors of the hereditary predisposition to the development of COPD. In turn, the high "survival" of cytotoxic lymphocytes in patients with COPD can be explained by a decrease in their apoptosis due to the low expression of the Ligand . First of all, bronchodilators or their combination with inhalation GK are considered to be the first line drugs. The GC is not used in the form of monotherapy, since inflammation at the COPD refractory to the GC . An important place in the therapy of both diseases is occupied by inhalation broutons for long-acting (β2-agonists) and long-acting anticholinergic drugs. There are two main pharmacological strategies of broutine: direct, carried out by stimulating β2-adrenoreceptors, and indirect - due to inhibiting the effect of acetylcholine on muscarinic receptors . It is necessary to understand the rationality, validity, principles of the appointment of bronchodiolics of various groups separately and in combination with the spares. Before choosing a bronchological agent, you need to pay attention to well and take into account the distribution of receptors to this drug in the bronchial trees. The density of β2-adrenoreceptors is the same in large and small respiratory tract. M-cholinoreceptors have high density in large respiratory tract and low in small. It should be borne in mind that the vagus innervation of small respiratory tract is absent, but M-cholinoreceptors are localized throughout the tracheobronchial tree and activated by an extrareronal acetylcholine. This causes the bright effect of anticholinergic preparations at the level of proximal and distal airways. It has been proven that with heavy BA and COPD, the effectiveness of β2 agonists may decline due to the reduction of the number of active β2-adrenoreceptors and reduce their sensitivity (especially in elderly patients). An important feature of M-cholinoreceptors is the fact that their sensitivity does not change with age. When COBL, the reversible component of the bronchial obstruction is controlled by the parasympathetic department of the vegetative nervous system. The use of a combination of β2-agonist and M-cholinolite has advantages in terms of pharmacodynamics and pharmacokinetics. β2-agonists enhance the relaxation of bronchi caused by M-cholinoblocators. M Holinbleators, in turn, reduce the bronchokonstricative effect of acetylcholine, enhancing the effect of β2 agonists Brodskaya O.N. is a universal drug for the treatment of aggravation of bronchial asthma and COPD. The use of β2 agonist in conjunction with the cholinoblocator improves the permeability of the bronchi to a greater extent than the monotherapy. Until recently, there was no alternative to β2-agonists in combination with inhalation GK. The fixed combination of β2-agonists of long-acting and inhalation GK is rational in the treatment of Ba. However, it is necessary not to forget that control of the disease, especially with heavy BA, is achieved in less than half of the cases [1,2]. In one European study, it was shown that against the background of adequate therapy, partial control of the disease was achieved by 40.6%, the uncontrolled flow was noted in 17.8% of cases. In many recent studies, there is an important role of cholinergic mechanisms in the pathogenesis of Ba. It has been proven that the tone of the parasympathetic nervous system can increase due to the effects of tobacco smoke, inflammation, infections. In addition, it is also proved that the β2 receptor polymorphism may be the cause of the ineffectiveness of therapy by adrenomimetics. With a neutrophil phenotype of inflammation, the addition to therapy of cholinolics allows to reduce the severity of bronchial obstruction and prevent the development of heavy exacerbations. A total of 40.6%, uncontrolled flow was noted in 17.8% of cases. Thus, it can be concluded that the rational starting therapy of the spa includes drugs acting on the pathogenetic mechanisms of BA and COPD, and is a combination of inhalation GK with combined bronchial therapy β2-agonists of long-acting and prolonged anticholinergic preparations . Determining the dose of drugs, it is necessary to take into account the principles of drug therapy: the more signs of BA - the greater the dose of inhalation GK should be. Based on this, in the presence of uncertainty about the diagnosis, you can choose the safest treatment option and continue diagnostic research . In addition to pharmacological treatment, it is necessary to use other types of therapy, conduct preventive measures that will contribute to improving the control of symptoms, prevent the progression of the disease, improving the quality of life, decrease in mortality: smoking, easy rehabilitation, vaccination, treatment of concomitant diseases. Having ideas about the features of the flow of BA and COPD, using specific diagnostic criteria, based on the recommendations on the maintenance of the patient, you can achieve control over the disease, improve the quality of life, reduce mortality. To do this, it is necessary to determine the features of the diagnosis of COPD, BA and their combination. 574 Nasirova Aziza Akbarovna and Mansurov Dilmurod Norimovich: Current Views on the Role of the Surface Phenotype of Lymphocytes in Chronic Obstructive Pulmonary Disease and Bronchial Asthma and Their Treatment from English Ed. A.S. Belevsky. M.: Russian respiratory society. 2014; 92 S. 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Published by Scientific & Academic Publishing This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/
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