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COMORBIDITY IN RHINOSINUSITIS AND CHRONIC
OBSTRUCTIVE PULMONARY DISEASE: CLINIC AND
TREATMENT FEATURES
1 2 Saliahunova H.O.\ Shaikhova Kh.E.2
Email: Saliahunoval7162@scientifictext.ru
1Saliahunova Hurshida Odilovna - Assistant; DEPARTMENT OF OTORHINOLARYNGOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN; 2Shaikhova Kholida Erkinovna - Doctor of Medical Sciences, Professor, DEPARTMENT OF OTORHINOLARYNGOLOGY, TASHKENT MEDICAL ACADEMY, TASHKENT, REPUBLIC OF UZBEKISTAN
Abstract: in this article, special attention is paid to the clinic, diagnosis and treatment of comorbid processes in diseases of the nasal cavity and diseases of the bronchopulmonary system.
Thus, the prevalence of inflammatory pathology of the mucous membrane of the nasal cavity and paranasal sinuses in patients with COPD has not been practically studied; there is no information in the literature on X-ray screening of the paranasal sinuses in patients with exacerbation of COPD. This is surprising, given that the pathogenesis of chronic rhinosinusitis and COPD is based on the phenomenon of the so-called "vicious" circle - a chain of sequential, closely related structural changes in the mucous membrane of the respiratory tract, leading to the development of inflammation, disruption of mucociliary transport and colonization of the respiratory tract by microflora. Keywords: comorbid pathology, rhinosinusitis, chronic obstructive pulmonary disease.
КОМОРБИДНОСТЬ ПРИ РИНОСИНУСИТЕ И ХРОНИЧЕСКОЙ
ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЕГКИХ: КЛИНИКА И
ОСОБЕННОСТИ ЛЕЧЕНИЯ
1 2 Салиахунова Х.О. , Шайхова Х.Э.
1Салиахунова Хуршида Одиловна - ассистент, кафедра оториноларингологии, Андижанский государственный медицинский институт, , г. Андижан; 2Шайхова Холида Эркиновна - доктор медицинских наук, профессор, кафедра оториноларингологии, Ташкентская медицинская академия, г. Ташкент, Республика Узбекистан
Аннотация: в данной статье особое внимание уделяется клинике, диагностике и лечению коморбидных процессов при заболеваниях полости носа и бронхолегочной системы.
Распространенность воспалительной патологии слизистой оболочки полости носа и придаточных пазух носа у пациентов с ХОБЛ практически не изучена. В литературе отсутствуют сведения о рентгенологическом обследовании придаточных пазух носа у пациентов с обострением ХОБЛ. Это удивительно, учитывая, что в основе патогенеза хронического риносинусита и ХОБЛ лежит феномен так называемого «порочного» круга - цепи последовательных, тесно связанных структурных изменений слизистой оболочки дыхательных путей, приводящих к развитию воспаления, нарушения мукоцилиарного транспорта и заселения дыхательных путей микрофлорой.
Ключевые слова: коморбидная патология, риносинусит, хроническая обструктивная болезни легких.
UDC 616.155.194-053.9
Relevance. Despite the numerous reports on the relationship between the pathology of the upper respiratory tract and bronchial asthma, the coverage of the nuances of the combination of COPD and rhinosinusitis began in the medical literature relatively recently [6].
Thus, the prevalence of inflammatory pathology of the mucous membrane of the nasal cavity and paranasal sinuses in patients with COPD has not been practically studied; there is no information in the literature on X-ray screening of the paranasal sinuses in patients with exacerbation of COPD [1,7]. This is surprising, given that the pathogenesis of chronic rhinosinusitis and COPD is based on the phenomenon of the so-called "vicious" circle - a chain of sequential, closely related structural changes in the mucous membrane of the respiratory tract, leading to the development of inflammation, disruption of mucociliary transport and colonization of the respiratory tract by microflora [3].
It is known that one of the factors contributing to the development of COPD and, to a greater extent, its exacerbation is a bacterial infection [4, 8]. This circumstance dictates the need to obtain convincing evidence of the relationship between the nature of chronic bacterial upper respiratory tract infection and the severity, nature, and clinical features of COPD. It is the representatives of conditionally pathogenic microflora that are the most significant causative agents of exacerbation of chronic rhinosinusitis and COPD [5].
Thus, in the modern literature, the problem of the relationship between diseases of the nasal cavity, paranasal sinuses and COPD is practically not studied. Two pathological conditions occurring comorbidly, in fact, are a single disease [2].
Apparently, one of the reasons for the low efficiency of treatment of exacerbations of COPD is the lack of information about the concomitant pathology of the upper respiratory tract and about the features of the microbial landscape of this category of patients [2].
Therefore, the direct result of the developed management regimens for patients with combined pathology of the upper respiratory tract and COPD is the creation of effective and comprehensive treatment methods that take into account all the etiopathogenetic aspects of these diseases. All of the above emphasizes the relevance of the dissertation topic chosen by the author [4].
Purpose of the study. To study the prevalence of nasal cavity pathology in patients with COPD and determine the role of an integrated approach in the treatment of inflammatory pathology of the nasal cavity, paranasal sinuses and COPD.
Materials and research methods. To accomplish this task, we selected and studied 70 patients with comorbidities of rhinosinusitis and chronic obstructive pulmonary disease.
Results of the study: Symptoms of inflammatory diseases of the nasal cavity and paranasal sinuses are present in 64.9% of patients with COPD. According to an objective examination, chronic inflammatory changes in the paranasal sinuses are diagnosed in 32.9% of cases with exacerbation of COPD.
The microbial landscape of sputum and nasal secretions in COPD patients is almost identical. The main causative agent of exacerbation of chronic rhinosinusitis in patients with COPD (1st group) is Streptococcus pneumoniae (29%). Streptococcus pneumoniae in 11.1% (n-94) cases is determined in the nasal secretion in patients with COPD during remission or in the latent course of rhinosinusitis (2nd and 3rd groups), which indicates the colonization of the upper respiratory tract by opportunistic flora.
Atypical microflora (Chlamydiapneumonia) was diagnosed in scrapings from the nasal cavity in 5.3% of cases and is not dominant.
The severity of an exacerbation of chronic rhinosinusitis is determined by the stage of COPD. This relationship was expressed in the prevalence of patients with III (29%) and IV (38%) stages of COPD disease in the first group in patients with moderate rhinosinusitis compared with the second (III -26%; IV - 23.3%) and third group (III - 21.20%; IV - 15.5%, respectively).
Antibiotic therapy for exacerbation of chronic rhinosinusitis and COPD should be carried out taking into account the probable causative agents of diseases of the upper and
lower respiratory tract (cefixime, moxifloxacin), in combination with intranasal glucocorticosteroids (mometasonafuroate) and rinsing the nasal cavity with sea water.
As a result of a comprehensive examination of patients with COPD, it was determined that inflammatory pathology of the nasal cavity is diagnosed in 64.9% of cases in patients with exacerbation of COPD, i.e., the need to consult an otorhinolaryngologist in the complex of mandatory diagnostic and therapeutic measures in patients with COPD is shown.
An almost identical microbial landscape was revealed in nasal swabs and in sputum in patients with COPD, which may indicate the relationship between inflammation of the upper and lower respiratory tract.
The most • actual causative agents of chronic rhinosinusitis in patients with COPD and their sensitivity to modern antibacterial agents have been identified.
An algorithm has been created that helps the practitioner navigate in the choice of methods for the diagnosis and treatment of inflammatory diseases of the nasal cavity in patients with COPD.
Conclusions: Patients with COPD must be examined by an otorhinolaryngologist. Along with the standard otorhinolaryngological examination, these patients need computed tomography of the paranasal sinuses and microbiological examination of sputum and smear from the nasal mucosa. In case of exacerbation of moderately yellow chronic rhinosinusitis in patients with stage 1 and 2 COPD, cephalosporins of the last generations are adequate drugs. In case of exacerbation of moderate and severe chronic rhinosinusitis in a patient with comorbid COPD stage 3-4, respiratory fluoroquinolones are adequate drugs. The empirical choice of an antibacterial drug should be based on the optimal antibacterial spectrum of the drug, a convenient dosing regimen, application and stage of COPD.
References / Список литературы
1. Arefieva N.A., Medvedev Yu.A. Immunological aspects of otorhinolaryngology // News of otorhinolaryngology and logopathology, 1997. № 4. S. 3-10.
2. Zhukhovitsky V. G. Substantiation of rational antibacterial therapy in otorhinolaryngology from the standpoint of a bacteriologist // Consiliummedicum, 2001. T. 3. № 8. P. 25.
3. Ovchinnikov A.Yu., Kolbanova I.G., Ovcharenko S.I. Rhinobronchial symptom complex. Materials of the XVII Congress of Otorhinolaryngologists of Russia // Nizhny Novgorod, 2006.
4. Svistushkin V.M., Nikiforova G.N., Ovchinnikov A.Yu., Panyakina M.A. Possibilities of non-puncture treatment of purulent sinusitis // Russian otorhinolaryngology, 2004. № 3. S. 150-152.
5. Tarasov A.A., Kamanin E.I., Kryukov A.I., Strachunsky J.I.C. Acute bacterial rhinosinusitis: modern approaches to diagnosis and antibacterial therapy in an outpatient setting // Bulletin of otorhinolaryngology, 2003. № 3. S. 46-54.
6. Avadhanula V., Rodriguez C.A., Devincenzo J.P. Respiratory viruses augment the adhesion of bacterial pathogens to respiratory epithelium in a viral species- and cell type-dependent manner // Virology, 2006. Vol. 80. P. 1629-1636.
7. Ewig S., Torres A. Is Chlamydia pneumoniae an important pathogen in patients with community-acquired pneumonia? // EurRespir J., 2003. Vol. 21 (5). P. 741-2.
8. Rosell A., Monso E., Soler N. Microbiologic determinants of exacerbation in chronic obstructive pulmonary disease. // Arch Intern Med., 2005. Vol. 165. P. 891-897.
9. Zawisza E. Effectiveness and tolerance of fenspiride treatment in chronic sinusitis. Results of the Polish multicenter study. // Otolaryngol Pol., 2005. Vol. 59 (1). P. 141-145.
