Changes in hemodynamics during the course of surfactant therapy in patients with hormone-dependent asthma

Non-specific hyperresponsiveness of the respiratory tract mucosa makes one of the important pathophysiological mechanisms for asthma development; it is characterized by the increased active response of the efferent system to stimuli. When this occurs, it damages the alveoli surfactant which ensures the viability of local immunity of lung tissue. Chronic respiratory failure induces changes in the cardiovascular system. The course of inhalations with a native surfactant reduces the dependence on inhalation corticosteroid.

The objective of the study: to assess the effect of the course of inhalations with surfactant on the cardiovascular system in patients with hormone-dependent asthma.

Materials and methods: 15 patients with asthma underwent a 70-day course of inhalation with natural surfactant based on a certain regimen (25 mg per inhalation, 21 inhalations in total) in addition to the basic therapy (inhaled corticosteroids and bronchodilators). On the 1st and 70th days of the surfactant therapy course, oscillometry was performed in order to assess macrohemodynamic parameters.

Results. After the course of treatment, pulse pressure was found to increase by 26% compared to the initial level (p <0.05), the cardiac index increased by 16% (p <0.05) and the linear blood flow rate went up by 20% (p <0.05). At the same time, the pulse wave velocity decreased by 15% (p <0.05), while specific vascular resistance went down by 24% (p <0.01). This suggests that clinical remission during surfactant therapy in asthma patients is accompanied by changes in the functional state of the cardiovascular system.

1. Kuznik B.I. Fiziologiya i patologiya sistemy krovi. Rukovodstvo dlya vuzov. [Physiology and pathology of blood system. Handbook for universities]. 3rd ed., suppl. and amend., Moscow, Vuzovskaya Kniga Publ., 2004, 296 p.

2. Kosovskikh А А., Churlyaev Yu.А., Kan S.L., Lyzlov А.N., Kirsanov T.V., Vartanyan А.R. Central hemodynamics and microcirculatory flow in critical states. Obschaya Reanimatologiya, 2013, vol. 9, no. 1, pp. 18-22. (In Russ.) Available: https://doi.org/10.15360/1813-9779-2013-1-18.

3. Kompleks apparatno-programmny neinvazivnogo issledovaniya tsentralnoy gemodinamiki metodom obemnoy kompressionnoy ostsillometrii KАP TSG osm-Globus. Instruktsiya po primeneniyu.[Hardware and software for invasive examination of central hemodynamics by volume compression oscillometry of KAP CG osm-Globus. Users' guidelines]. Belgorod, Globus Publ., 2004, 51 p.

4. Moroz V.V., Tuchina L.M., Poroshenko G.G. On mechanisms of pulmonary protection. Obschaya Reanimatologiya, 2005, vol. 1, no. 5, pp. 69-77. (In Russ.) Available: https://doi.org/10.15360/1813-9779-2005-5-69-77

5. Bishot R., Bourke J.E., J-Hirst S., Meeuegen E., Kenneth J., Snibson J., Van Der Velden J. Measurement and Impact of remodeling in the lung. Airway neovascurilisation in asthma. Proceed. Am. Thoracic Society, 2014, vol. 6, pp. 673-677.

6. Devendra G., Spragg R.G. Lung surfactant in subacute pulmonary disease. Respir. Res., 2002, no. 3, 1930. Available: http://dx.doi.org/10.1186/rr168. PMID: 11980588].

7. Hohlfeld J., Fabel H., Hamm H. The role of pulmonary surfactant in obstructive airways disease. Eur. Respir. J., 1997, no. 10, pp. 482-491.

8. Rosenberg O., Seiliev A., Zhuikov A. Lung surfactant: correlation between biophysical characteristics, composition, and therapeutic efficacy. In: Gregoriadis G., editor. Liposome Technology. New York, Informa Healthcare, 2006, pp. 317-345.

9. Rosenberg O.A., Lebedeva E.S., Loshakova L.V., Shulga A.Ed., Seiliev A.A., Volchkov V.A. Influence of long-term inhaled glucocorticoids on the lung surfactant phospholipid levels in rats. Intern. J. Biomed., 2016, vol. 6, no. 3, pp. 167-169.

10. Stepanova O.V., Akulova E.A., Kochneva A.A., Seiliev A.A., Shulga A.Ed., Lovacheva O.V., Lukyanov S.A., Shapovalov K.G., Volchkov V.A., Rosenberg O.A. Influence of Natural Lung Surfactant Inhalations on Clinical Symptoms and Pulmonary Function Parameters in Patients with Bronchial Asthma. Communication 1. Intern. J. Biomed., 2016, vol. 6, no. 4, pp. 255-258.

11. van Iwaarden F.J., van Golde L.M.J. Pulmonary surfactant and lung defense. In: Robertson B., Taeusch H.W. eds., Surfactant therapy for lung disease. Lung biology in health and disease. vol. 84, New York, Marcel Dekker Inc, 1995, 75-84.