Enterosorption therapy of chronic obstructive pulmonary disease against the background of endogenous intoxication

Aim: improve the effectiveness of treatment for patients with COPD in the acute phase with clinical and laboratory manifestations of endogenous intoxication by including carbon or organosilicon sorbents in complex therapy.

Materials and Methods: To evaluate the effectiveness of enterosorption therapy in the complex treatment of patients with COPD in the acute phase with clinical and laboratory manifestations of endogenous intoxication, patients were divided into three groups according to severity. The first group consisted of 34 patients (21.9%) with mild bronchial obstruction (GOLD 1), the second group included 64 patients (41.3%) with moderate bronchial obstruction (GOLD 2), and the third group included 57 patients (36.8%) with severe bronchial obstruction (GOLD 3). The control group consisted of 20 healthy people aged 40 to 78 years. The following exclusion criteria were used: the presence of diabetes mellitus, acute coronary syndrome, previous myocardial infarction, rheumatological pathology, oncological and infectious diseases, acute inflammatory processes of any localization in patients.

Results: COPD in the exacerbation phase is accompanied by clinical and laboratory manifestations of endotoxicosis, more pronounced in patients with severe broncho-obstruction. This is manifested by an increase in the content of endogenous intoxication indicators in blood serum (molecules of medium weight by 84% and 126% (p<0.001) and erythrocyte intoxication index by 86% (p<0.001)). There is a direct correlation of mean strength between the severity of the disease and the level of MSM254 and MSM280 (r=0.496 and r=0.557, p<0.01) and weak strength - with an erythrocyte index of intoxication (r=0.253, p<0.01). COPD in the exacerbation phase is accompanied by the activation of free radical processes, most pronounced in patients with severe broncho-obstruction, manifested by a probable increase in malondialdehyde - by 116% (p<0.001) and a decrease in the activity of superoxide dismutase - by 59% (p<0.01) compared to the control. There is a direct mean strength correlation between severity and malondialdehyde levels (r=0.486, p<0.01) and inverse with serum superoxide dismutase (r=-0.500, p<0.01). MDA content in blood serum increases, SOD activity decreases with increasing age of patients.

Conclusions: COPD exacerbation accompanied by clinical and laboratory manifestations of endogenous intoxication, namely increasing concentrations of malondialdehyde and superoxide dismutase activity decrease depending on the severity and age of bronchial patients. With the progression of the disease also increases the content of interleukin 1β and 10, tumor necrosis factor α, circulating immune complexes, immunoglobulin E and reduced lysozyme activity in serum, in proportion to the increase in the severity of the disease. The use in treatment of 10-day course enterosorbtsiynoyi therapy using carbon (karbolaynu) or silicone (enterosgel) enterosorbent in treatment of patients with COPD exacerbation is accompanied by a decrease in clinical and laboratory manifestations of endotoxemia, such as cough, shortness of breath, discharge of phlegm, weakness and significant reduction of the average molecular weight and erythrocyte intoxication index, malondialdehyde, interleukins, immunoglobulin E and circulating immune complexes and increased activity of SOD and content of lysozyme in serum.