[Evaluation of therapy efficiency in patients with combined course of copd and osteoarthritis]

Chronic obstructive pulmonary disease (COPD) is a disease that is characterized by chronic airflow limitation, a variety of pathological changes in the lungs, significant extrapulmonary manifestations, and severe comorbidities which may further aggravate the course of COPD [GOLD, 2013]. Intensity of systemic manifestations increases with the progression of obstruction, therefore the abovementioned symptoms are often overlooked and become apparent in the later stages of the disease. Systemic manifestations impair the quality of life, lead to early disability and significantly contribute to mortality in patients with COPD. Diseases of cardiovascular and musculoskeletal systems are the most serious and socially significant systemic manifestations of chronic obstructive pulmonary disease. Currently, there is no doubt that the activation of non-specific and specific immune responses in patients with COPD is associated with the influence of a number of universal mediators, among which a special place belongs to the cytokine network that controls implementation processes of the immune and inflammatory reactivity. The aim of our work was to increase the effectiveness of treatment in patients with chronic obstructive pulmonary disease in combination with osteoarthritis based on the study of clinical course, assessment of patient's life quality and substantiation of pharmacological correction.

The work was conducted on the basis of Poltava Regional Clinical Hospital named after N.V. Sklifosovskiy. The study was carried out at Research Institute for Genetics and Immunological Grounds of Pathology and Pharmacogenetics of Higher State Educational Establishment of Ukraine "Ukrainian Medical Stomatological Academy" (HSEEU "UMUMCA"). The study involved 40 patients with an average age of 54.4 ± 3.1 years with acute exacerbation of COPD (clinical group B-C - GOLD II-III), in combination with OA. The duration of COPD was 16.2 ± 2.1 years. Among patients there were 28 (70%) men and 12 (30%) women. All patients were smokers; the smoking period was 32.4 ± 2.9 pack-years. OA in the phase of unstable remission was verified in all patients, large joints were involved - knee, shoulder, and ankle. Depending on the chosen option of treatment, patients were divided into two representative groups - I and II. Patients of group I received only standard treatment for COPD in accordance with existing protocols, and in group II fenspiride hydrochloride 80 mg 2 times a day was added to the basic therapy for 12 days. Full examination of patients was carried out at admission and after 3 months from the date of admission.

According to the study, on addition of fenspiride to basic therapy in patients with constellation of COPD and OA, the regression of disease (reduction in cough) was observed by 2.9 ± 0.4 days earlier, dyspnea by 2.3 ± 0.33 than in the comparison group (p < 0.05), quality of life improved, and exercise tolerance increased. FEV1 in patients of group I after 3 months amounted to 62.6 ± 4.2%, in group II - 68.1 ± 4.9%, recurrence of airflow obstruction in both groups increased: in group I - by 4.2 ± 1.1%, in group II - by 5.6 ± 1.5%. Adding fenspiride hydrochloride to the treatment significantly improved the life quality of patients with COPD combined with OA at all scales of SF-36 questionnaire, reflecting the patient's physical condition, namely, physical activity, the role of physical problems in vital functions, the intensity of pain, overall health status, vitality. After 3 months of follow-up, in patients with comorbidity influenced by fenspiride hydrochloride against the background of traditional pathogenic therapy, the indicators of VAS significantly decreased by 1.9 times (3.18 ± 0.24 cm versus 6.01 ± 0.59 cm, p <0, 05), Lequesne index - by 2.0 times (9.42 ± 1.81 points against 19.17 ± 4.15 points, p <0.05) and WOM AC by 1.6 times (38.7 ± 3.7 points against 63.8 ± 8.3 points, p <0.05), respectively. In patients of group II, a more pronounced positive dynamics of reducing inflammatory activity, confirmed by the decrease in TNF-α content by 1.9 times (61.8 ± 5.9 pg / ml versus 131.5 ± 6.9 pg / ml, p <0.001) was observed. The hospitalization period of patients in group I was 14.3 ± 0.4 days, in group II it was less and amounted to 12.9 ± 0.5 days.

Supplementary application of fenspiride hydrochloride in the treatment of COPD patients in combination with OA improves the outcomes of patients' treatment, quality of life and prolongation of remission, indicating a decrease in the severity of systemic inflammation.