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THE FUNCTIONS OF EXTERNAL RESPIRATION AND ZONAL LUNG VENTILATION IN CHILDREN WITH BRONCHIAL ASTHMA

E-mail
Akhmedova M.M.   
19.05.2010 .

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The Fergana Branch of the Tashkent Medical Academy, Tashkent

In last years along with a general growth of morbidity with the various allergic diseases observe growth of number of the patients with polyvalent sensitivity.  At widespread allergic diseases such as bronchial asthma, pollinosis, rhinitis the cases monosensibilization are seldom observed [E.N. Dolginaich, 1997]. The multiple increased sensitivity was observed more frequently simultaneously to several kinds of allergens related to one class and having one nature (especially to pollen of various kinds of plants), also to various classes with different allergen nature (to household and dust, to epidermal, to dust and food, to household and bacterial allergens. At same time increasing of the multiple increased sensitivity of organism to heterologic allergens changed pathogenesis of the basic disease, clinical current, character of an aggravation and increased their duration, the questions of specific hyposensitizing become considerably complicated.  Joining of other kind of sensibilization can cause heavy associated bronchial asthma form for the patients with atopic form of bronchial asthma, which accompanies with disturbances of external respiration’s functions and requires special methods of diagnostics and therapy. 
The purpose of research to define functions of external respiration (FER) and zonal lung ventilation at children with bronchial asthma.
In the present work the analysis 236 patients of children bronchial asthma is carried out.   The analysis showed that from general number of the surveyed patients have at 39 (16.0%) easy currents, at 107 (46%) average - heavy currents and at 90 (37.8%) heavy currents [.T.Ermekov, J.A. Satibildieva, 2000]
The function of external respiration was investigated by the methods of computer spirography and rheopneumography on the apparatuses Masterlab and Bronchoscreen (firm Erikh Eger). 
Results and their discussions
We know from the research of function of external breathing that changes of pulmonary ventilation depend on period of bronchial asthma.
The aggravation of disease was characterized by obstructive changes which consists of infringement of bronchial passableness, reduction of vital capacity (LVC) and forced vital capacity of lungs.  At the period of attack reduction of volumetric speed of the forced  exhalation was registered in all levels of respiratory tract (FEMV25-75), however, the clearest disturbances of ventilation were mainly registered in terminal parts that was expressed by reduction in FEMV75.
The local volumes of breathing (BV) of various zones of every lung were characterized by heterogeneity that resulted in irregular regional ventilation. 
The local ventilation grew because of the maximal increasing of volumes of breathing of both lungs’ lower departments. The minute volumes of ventilation (VMV) of lower lobes of lungs were also increased.  The changes of pulmonary ventilation depended on the severity of disease.  The least deviations of EBF were noted in the active period of bronchial asthma, when bronchial patency suffered insignificantly, resulting to reduction of FLVC (73.5±2.8%) and FEV1 (71.2±3.1%) at easy current of disease.  Even more expressed infringements of function of external breathing were marked in moderate severity of disease. 
Increase in minute volumes of ventilation at the expense of some rising of RV is mainly marked in the lower lobes of the lungs.   The aggravation of bronchial asthma moderate severity was accompanied by marked obstructive disturbances, which resulted in more significant decrease in LVC (75.4±2.3%), FLVC (62.6±3.1%), FEV1 (64.6±2.7%) plus essential infringement of bronchial patency in the peripheral parts of the bronchial tree (MOS75=74.6±4.2%). 
The result of bronchial obstruction was increase of maximal volume of ventilation middle (VMV=41.8±1.3 per min) and lower pulmonary fields (VMV=38.5±0.8 per min.) both on the right and left. It’s necessary to note that the increase in VMV at the aggravation of bronchial asthma occurred at the expense of increase of frequency of breathing and respiratory volumes.  The bronchial patency was decreased significantly at the active severe period of bronchial asthma.  This was expressed in reduction of (LVC=75.6±2.3%), (FLVC 60.4±2.3%), (FEV1 59.8±2.5%) showing development of generalized obstruction maximal expressed at the level of small bronchi (FEMV75 (66.4±3.5%). 

Table 1

Parameters of the external breathing function and zonal lung ventilation during the period of exacerbation of disease depending on severity degree of bronchial asthma

 

Parameters  

Healthy children (n=26)

Bronchial asthma severity degree

 Mild (n-39)

 Moderate (n=107)

Severe (n=90)

LVC%

 99.5 2.1

 80.1+2.4

 75.4+2.3*

 75.6+2.3*

 FLVC%

 89.3 2.4

 73.5+2.8*

 62.6+3.1*

 60.4+2.3*

 FEV1%

 95.6 3.1

 71.2+3.1*

 64.6+2.7*

 59.8+2.5*

 %

 91.2 3.2

 87.1+3.0

 91.5+4.2

 83.3+3.4

 FEMV25  %

 95.4+2.8

 78.8+3.3

 76.2+4.8

 78.5+3.6

 FEMV50 %

 92.1+2.6

 72.4+4.2

 81.5+4.8

 71.9+3.6

 FEMV75 %

 96.5+4.3

 78.3+5.5

 74.6+4.2

 66.4+3.5*

 RL

UZ

BV per min

 0.9+0.01

 1.3+0.09

 0.9+0.04

 1.5+0.09*  ***

VMV per min

 16.1+0.8

 26.3+0.8

 19.8+1.0

 38.2+0.6* ** ***

MZ

 BV per min

 1.2+0.03

 1.5+0.07

 1.9+0.06* **

 2.1+0.09 * **

 VMV per min

 22.0+0.8

 29.2+0.7

 41.8+1.3* **

 52.7+1.5* ** ***

LZ

BV per min

 1.5+0.06

 2.0+0.07*

 1.7+0.06

 1.8+0.08

VMV per min

 27.6+0.9

 38.8+0.6*

 38.5+0.8

 46.5+1.7*

 LL

 

UZ

 BV per min

 0.7+0.01

 1D+0.05

 1.0+0.07

 1.4+0.09*

 VMV per min

 13.3+0.5

 22.5+0.6

 22.4+0.5

 36.5+1.2* ** ***

MZ

BV per min

 1.1+0.04

 1.4+0.05

 1.8+0.04* **

 2.0+0.09* **

VMV per min

 20.0+0.8

 27.3+0.7

 40.4+1.2* **

 50.7+1.7* ** ***

LZ

UZ

 BV per min

 1.03+0.08

 2.0+0.07*

 1.6+0.08*

 1.9+0.08*

 VMV per min

 2.7+0.8

 38.7+0.9*

 36.9+0.6*

 48.8+1.8*

 

Notes: RL – right lung, LL – left lung, UZ – upper zone, MZ – middle zone, LZ – lower zone.

* - reliability of differences between group of patients and control, ** - reliability of differences with mild BA, ***- reliability differences with moderate severity BA P<0.05

 

 Table 2

Parameters of function of external breath and zone ventilation of lungs in the period of aggravation depending on prescription bronchial asthma

 

 Parameters

Middle heavy BA 

Heavy BA

 Less 5 years (n=49) 

 More 5 yrs (n=58)

 Less 5 years (n=25) 

 More 5 yrs (n=65)

 1

2

3

4

LVC%

 89.8+3.1

 85.4+3.1

 87.3+4.1

 74.3+3.9

 FLVC%

 75.4+3.4

 72.4+3.5

 70.5+2.8

 60.1+2.8**

 FEV1%

 84.1+3.3

 79.5+3.3

 73.7+4.8

 62.3+4.7**

 %

 89.2+6.6

 86.4+6.5

 78.5+2.4

 70.1+2.3

 FEMV25  %

 100.1+5.9

 102.3+5.9

 86.4+8.7

 79.8+8.5

 FEMV50 %

 98.9+5.8

 103.5+5.9

 74.1+9.1

 70.5+8.9

 FEMV75 %

 114.2+5.6

 122.6+5.6

 73.1+8.9

 71.5+9.1

 RL

UZ

BV per min

 1.3+0.02

 1.3+0.05

 1.5+0.1

 1.5+0.04

VMV per min

 26.1+0.6

 27.3+0.9

 29.4+2.4

 31.6+0.5

MZ

 BV per min

 2.0+0.07

 2.4+0.06

 2.1+0.1

 2.5+0.05**

 VMV per min

 41.2+1.0

 49.6+0.5

 41.1+1.1

 51.9+0.6**

LZ

BV per min

 1.9+0.09

 2.3+0.1*

 2.3+0.1

 2.2+0.03

VMV per min

 37.9+1.1

 48.1+0.6*

 45.3+0.7

 45.7+0.6

 LL

 

UZ

 BV per min

 1.5+0.06

 1.4+0.06

 1.3+0.06

 1.3+0.02

 VMV per min

 30.6+0.8

 29.2+0.8

 25.7+0.6

 26.9+0.6

MZ

BV per min

 1.9+0.07

 2.1+0.1

 1.8+0.1

 2.3+0.03**

VMV per min

 39.1+0.9

 41.3+0.9

 35.3+0.7

 46.2+0.7**

LZ

UZ

 BV per min

 2.0+0.07

 1.7+0.1*

 1.5+0.01

 1.6+0.03

 VMV per min

 41.7+1.0

 34.5+1.1*

 31.3+0.4

 29.7+0.4

 

·        * - Reliability of distinctions of parameters 1 and 2 of groups of the patients and control,  ** - Reliability of distinctions of parameters 1 and 2 of groups of the patients and control, P<0.05


Tachypnea in combination with diffusive increase of air permeability in pulmonary tissue reflected clinical picture of emphysema.  Thus, the local respiratory volumes are fixed at the level 36.5±38.2 per min. in the upper parts and 50.7±52.7 per min. in middle parts, which was a attribute of marked heterogeneity of zonal ventilation. 
Air hyperpeameability of the pulmonary tissue in the generalized bronchial obstruction at the patients with exacerbation of the severe asthma testified to development of the mechanism so-called "air trap» in the results of small bronchi collapsing.   Compensatory mechanism has a kind of air hyperpeameabilty syndrome.  The increase of air filling lungs’ provided distension of the pulmonary ways and, consequently, patency.  However, this compensation reduced efficiency of respiratory musculature working activity [N.E. Ilyina, R.M. Khaitov, 2001]  . 
The analysis of parameters of respiratory function depending on durability of disease (table 2) showed that in the patients, suffering from bronchial asthma for a long time of moderate severity in the period of exacerbation of parameters of FEV1 (79.5±3.3%) and FEMV50(103.5±5.9 %).  Long current of heavy bronchial asthma resulted in significant reduction of LVC (74.3±3.9 %) and patency at the level of large (FEMVS25=79.8±8.5 %) and middle (FEMV50=70.5±8.9 %) bronchi during disease exacerbation.  Except these, at the patients who have the duration of disease is more than five years, heterogeneity of zone ventilation was more expressed than the children who have the duration of disease less than five years.  The air filling of the middle parts of the lungs was significantly increased (VMV=56.9-55.8 per min). 
The analysis respiratory of infringements in the period reduction has shown, that the infringements of ventilation depend on weight of disease.  At easy bronchial asthma differed insignificant infringements of ventilation.  It has been registered the increased ventilation of average zones on the right (VMV=46.4±1.56 per min.) and reduced lower zones at the left (VMV=40.7±1.58 per min.).  Reduction heavy bronchial asthma was characterized by significant ventilating infringements, upper (VMV=45.4±1.12 and 40.2±1.01 per min.) and lower (VMV=43.5±1.14 and 38.1±1.10 per min.) zones.  Serious infringement of respiratory functions is registered in reduction heavy bronchial asthma.  Proof reduction of bronchial passableness (FMEV=63.5±1.62%, LVC =68.0±2.32 %) and non-uniform ventilation middle, lower zones of both lungs. 
These facts can testify that the relapses of disease for a long time rendered influence on the structure of the bronchial walls and pulmonary parenchyma.  Therefore, the aggravation of inflammatory process resulted in more expressed damages of bronchial patency and regional pulmonary ventilation. 
Thus, we establish significant damages of the function of external breathing and zonal pulmonary ventilation in children with bronchial asthma with heavy current more than five years that, naturally, complicates clinical course of disease and requires performance of urgent therapeutical measures. 
( 14.04.2011 . )
 

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