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Региональные проблемы. 2018. Т. 21, № 3(1). С. 22-25. DOI: 10.31433/1605-220X-2018-21-3(1)-22-25.
UDK 616.24(571.63)
WEATHER DEPENDENCE OF PATIENTS WITH RESPIRATORY PATHOLOGY AT THE SOUTH OF PRIMORSKY KRAI
Tatiyana I. Vitkina1*, Lyudmila V. Veremchuk1, Elena A. Grigorieva2, Tatiyana A. Gvozdenko1 'Vladivostok Branch of Federal State Budgetary Science Institution «Far Eastern Scientific Centre of Physiology and Pathology of Respiration» - Institute of Medical Climatology and Rehabilitation Treatment (Vladivostok branch of FESCPPR - IMCRT), Vladivostok, Russia 2Institute for Complex Analysis of Regional Problems Far Eastern Branch Russian Academy of Sciences (ICARP FEB RAS), Birobidzhan, Russia Email: [email protected] (*corresponding author)
Climato-physiological reactions can be considered as favorable or adequate one, when irregular reactions of functional systems initiate autoregulatory processes returning the system to optimal functioning. The weather dependence is an ability of an organism to respond to changes in particular weather parameter and a complex of weather factors (atmospheric pressure, temperature, wind, etc.). The climatic factors mainly exposure to the skin and the mucous membranes of the upper respiratory tract; the respiratory system changes induced by the contrasting climate can be the result of meteophysiological processes and meteopathic reactions. Disadaptation in patients with respiratory diseases occurs more often and is more severe than in healthy people. The aim of the current study is to define the weather dependence degree of external respiration function of patients with bronchopulmonary pathology in the south of Primorsky Krai, characterized by the monsoon climate with negative effect on human health.
Keywords: weather dependence, external respiration function, bronchopulmonary pathology.
Introduction
Chronic respiratory diseases are among the leading causes of morbidity and mortality worldwide [4]. The etiology of respiratory diseases is largely determined by the influence of weather conditions. Normally, physiological processes in human body as a whole adapt to weather changes. But the course of respiratory diseases is determined largely by weather: directly through an impact on the respiratory tract or indirectly through a change in the intensity and nature of immunometabolic processes [2, 3, 9, 11, 13, 14]. However, the mechanisms of weather influence have not been sufficiently studied. Literature review shows conflicting results related to both different research approaches and regional characteristics of heterogeneous weather conditions influencing human body. Therefore, the study of the nature of the response of patients with a respiratory disease to weather conditions is important problem.
The weather factors influence on external respiration function (ERF) by a direct action on the mucous membranes of the respiratory tract; the study of ERF is essential for the diagnosis of violations in lung ventilation as a response to the external stress [12].
Oxidative stress plays a key role in the patho-genesis of chronic lung diseases. Reactive oxygen
species can serve as triggers of inflammation process both directly and through the formation of lipid peroxidation (LPO) products. Oxidative stress has important consequences for the respiratory system and the body as a whole [1, 7, 10]. However, nowadays there is practically no information about the impact of weather on the parameters of lipid peroxidation and antioxidant protection in patients with respiratory pathology.
The aim of the current study is to identify the mechanism of formation of meteopathic reaction in patients with respiratory diseases under the influence of the monsoon climate at the Russian Far East, characterized by contrasting changes in meteorological parameters with specific response in patient with respiratory pathology.
Materials and Methods
The subjects examined during period from 2012 to 2017 were 146 residents of Vladivostok: chronic catarrhal non-obstructive bronchitis (CCNOB) was diagnosed in 29 subjects, controlled asthma - in 51 subjects, and uncontrolled asthma - in 39 subjects. The control group included 27 healthy volunteers.
The study of ERF was carried out by spirog-raphy (12 parameters), characterizing the type of lung ventilation disorder, degree and reversibility of
bronchial obstruction; and by body plethismography (8 parameters), describing static lung volumes and bronchial resistance.
The system "lipid peroxidation-antioxidant defense" (the LPO-AOD system) is analyzed to understand the process of cell energy provision, that acts as a key trigger mechanism in chemical modification of cell membranes. The LPO system includes two parameters (malonic dialdehyde - MDA, malonic dialdehyde / antioxidant activity - MDA/AOA); the AOD system integrates five parameters (antioxidant activity - AOA, superoxide dismutase - SOD, glutathione peroxidase - GP, glutathione reductase - GR and reduced glutathione - GSH).
The study involves weather data (2012-2017) provided by Primorsky Office for Hydrometeorolo-gy and Environmental Monitoring [8, 15]. Standard meteorological parameters: air temperature and humidity, dew point temperature, atmospheric pressure, wind speed and direction, precipitation, atmospheric phenomena, apparent temperature, are used. The concept of "weather complex" is introduced, showing simultaneous influence of 9 weather parameters.
To estimate how respiratory system depends on weather changes, analysis was carried out for: a) the ERF response on the examination day (actual weather complex) and weather complex on 1 and 2 days after the examination; b) the LPO-AOD response on weather complex 1 and 2 days before the examination. The meteopathic reaction of a human body to climate is estimated in two stages: 1) direct influence on ERF; 2) indirect effect on the LPO-AOD system. Methods of the study at the first and second stages were different.
The study how weather conditions affect ERF was conducted based on the assessment of inter-systemic (P ) and intra-systemic relations (P ). P.
v inter ^ v intra inter
described the intensity of response of the ERF system to the influence of weather complex by 3 points (on the examination day, 1 and 2 days after the examination). These data determine the respiratory organs sensitivity to changes in weather conditions at different level of respiratory diseases severity. The calculation of direct influence of weather conditions on ERF was conducted in two ways: 1) estimation of P e %
inter
according to diagnostic system of ERF (spirography, body plethismography) and depending on the severity of respiratory disease; 2) the assessment of Pinter% characterizing compensatory reaction of ERF to the influence of weather complex on the examination day, 1 and 2 days after the examination.
To calculate inter-systemic and intra-systemic relations, the module "Multiple correlation" (STA-
TISTICA8) is used. The pair correlations (r) with statistical significance p<0.05 are summed and divided by the expected maximum sum of the correlation relations R=1.0 to select percent of active relations from total sum of correlation relations.
Thus, the sum of rinter evaluates the activity of
inter
the respiratory response (Pinter) of ERF on the effect of weather complex, and the sum of r. t indicates
r ' intra
the degree of functional strain (Pjntra) of the particular ERF systems depending on severity of respiratory diseases and weather.
The response of the biochemical blood parameters to the weather impact is estimated by the indirect influence of weather conditions on the LPO-AOD system with time lag 1 and 2 days. The module "Multiple regression" in the program STATISTICA8 is used for calculating the "response" of subsystems and particular indicators of the LPO-AOD system (R ).
i j v regres'
Results and Discussion
Differences of Pintra% represent changes in ventilatory lung capacity depending on the disease severity. Patients with CCNOB have minimal changes in ERF (Pntra=26-28%) compared to control group (P.n tra=23-25%). A significant increment of Pinra (1.5-2 times) indicates the most marked violations of venti-latory lung capacity in asthma (Pmtra=39-43%).
The activity of ERF response (P.nfer%, p<0.05) under the direct influence of weather complex differed depending on the severity of respiratory diseases. For instance, the total indices LP intr (Body + Spir) in healthy subjects were 7.8% (on the examination day), 8.9% (on 1 day after the examination) and 9.5% (on 2 days after the examination). These data demonstrate high compensatory capacity of a healthy body. However, the weather on the examination day (LP ,nfer=7,8%) reduces the adaptive potential of the respiratory system even in healthy subjects, indicating negative influence of the monsoon climate.
The analysis of the total LPinter in pathologies showed a clear dependence of the decrease in adaptive capabilities of ERF, depending on the severity of the respiratory diseases (LP.nier=1.1-5.7%). We assume that the influence of the monsoon climate causes a sharp decrease in the compensatory reaction (Pinter) in respiratory diseases characterized by a high intrasystem tension of ERF (P . t in asthma).
v intra '
The ERF in patients with respiratory diseases actively react to changes in weather 1 day after the examination, expressed mostly in patients with asthma (EPner=1.1%). Slight increase in weather sensitivity (EPner=5.5%) was observed in patients with CCNOB compared to the examination day (EP. . =5.8%).
The analysis of EP.t values 2 days after the
J inter J
examination shows that weather sensitivity in patients with CCNOB increases (EP.nter=3.8%) compared to data of 1 day after the examination (XP.t =5.5%).
inter
Perhaps it is due to the continuous and active reaction of the respiratory organs to the external environment in this pathology. However, a completely different reaction is observed in patients with asthma, when total parameter (Body + Spir) XP.ntrr is low enough (XP t =1.1%) one day after the examination, and ris-
inter
es to 2.7% two days after the examination, that can be explained by inertial character of respiratory system to weather change in asthma.
The indirect effect of weather on human body was analyzed by the response of the parameters of the LPO-AOD system (R ). This system is involved
J v regres/ J
in the process of providing energy for cells and is the most important trigger for the chemical modification of cell membranes [16]. The dependent variable «y» was the component of the LPO-AOD system (proo-xidant system - MDA, MDA/AOA; antioxidant system - AOA, SOD, GSH, GP, GR). The independent variable «x» was the weather parameter.
The study shows there is no pronounced response of peroxidation parameters to weather in healthy subjects and, accordingly, there is no need to induce compensatory antioxidant processes in them. The LPO-AOD system of patients with respiratory pathologies responded quite actively to changes in weather complex in 1 and 2 days before the examination (R =0.42-0.50) compared to the actual weath-
v regres ' A
er complex (Rregres=0.31-0.38) (Figure). The high reaction causes peroxidative process and induces a fairly rapid response of the system to weather within 1 or 2 days. The integral criterion characterizing
the LPO-AOD balance (MDA/AOA) is the best to demonstrate the reaction of the human body to weather factors. The enzymes of the AOD system (GSH, GP and CO), which are involved to remove lipid hydroperoxides, hydrogen peroxide, and to reduce oxidized glutathione, have a significant importance for the response of this system. GP and GR as key factors of the maintaining the oxidative cell balance, play the most important role in the formation of the compensatory response to weather. The activation of the glutathione unit in AOD system is aimed at interrupting the chain reaction of lipid oxidation to inhibit stress-induced accumulation of LPO products.
The respiratory pathology is accompanied by the development of the systemic oxidative stress. One of the reasons is the disregulation of the AOD system as the result of polymorphism of gene encoding the AOD enzymes. The intensification of oxidative stress has important implications for the course of the respiratory diseases. They include increased neutrophil sequestration into the lungs, oxidative inactivation of antiproteases and surface-active agents, mucus hypersecretion, destruction / remodeling of extracellular matrix and apoptosis. The oxidative stress leads to direct or indirect damage of key cellular components, such as lipids, proteins and nucleic acids, and also inhibits DNA repair [5, 6, 17].
Conclusion
The impact of the monsoon climate on patients with the respiratory diseases induces the complex mechanism of the response of the human body and leads to the formation of meteopathic reactions that actively influence the most open ERF system and indirectly - LPO-AOD system.
Figure. Response of the LPO-AOD system to the influence of weather complex (Rre re)
The strain of the ERF system of patients living in the monsoon climate is intensified depending on the disease severity. At the same time the adaptive-compensatory reaction of ERF to the influence of weather complex decreases depending on the disease severity and, as a result, the pathogenic process of weather dependence and weather sensitivity is formed. The effect of climate on the metabolic parameters of blood makes a relatively equal contribution to the meteopathic reaction of LPO-AOD system of glutathione-dependent antioxidant enzymes (actual weather complex, weather complex before 1 and 2 days). This process can be regarded as an increase in physiological strain by a change of the adaptive mechanisms at all stages of the development of weather dependence. The impact of the weather complex on human body acts on ERF primarily, while the response of metabolic parameters is manifested with a time lag of 1-2 days. Finally, the monsoon climate creates an additional load on both respiratory system and systems that ensure the perox-idation balance forming prerequisites for worsening of respiratory pathology.
REFERENCES:
1. Bargaglia E, Olivieria C, Bennetta D, Prasseb A, Muller-Quernheimb J, Rottolia P (2009) Oxidative stress in the pathogenesis of diffuse lung diseases: A review. Respir Med 103(9): 1245-1256. https://doi.org/10.1016/j.rmed.2009.04.014.
2. D'Amato G, Cecchi L, D'Amato M, Annesi-Mae-sano I (2014) Climate change and respiratory diseases. Eur Respir Rev 23: 161-169. Doi: 10.1183/09059180.00001714.
3. de Freitas CR, Grigorieva EA (2014) The impact of acclimatization on thermophysiological strain for contrasting regional climates. Int J Biomete-orol 58(10): 2129-2137. Doi: 10.1007/s00484-014-0813-9.
4. GBD 2015 Chronic Respiratory Disease Collaborators (2017) Global, regional and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 19902015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med 5(9): 691-706. https://doi.org/10.1016/S2213-2600(17)30293-X.
5. Gelpi RJ, Boveris A, Poderoso JJ (2016) Biochemistry of Oxidative Stress. Physiopathology and Clinical Aspects. Springer Int Publishing, 454. Doi: 10.1007/978-3-319-45865-6.
6. Gor'kavaya AYu, Vitkina TI, Antonyuk MV, Yan'kova VI (2014) Lipid peroxidation in exhaled breath condensate patient's chronic obstructive pulmonary disease. Health Med Ecol Sci 56(2): 53-55 (in Russian).
7. Kytikova OY, Gvozdenko TA, Vitkina TI (2016) Oxidative DNA damage in the pathogenesis of chronic obstructive pulmonary disease in older patients. Advances Gerontol 7(2): 163-165.
8. Regional Internet resource. http://vestiregion.ru (in Russian).
9. Rusanov VI (1987) Climate and Man's Health. Proceedings of the WMO; WHO, UNEP-Sympo-sium on Climate and Human Health in Leningrad 1986, WMO-WCP, Geneva 2: 101-107.
10. Van Eeden SF, Sin DD (2013) Oxidative stress in chronic obstructive pulmonary disease: A lung and systemic process. Can Respir J 20(1): 27-29.
11. Veremchuk LV, Gvozdenko TA (2013) Risk of spread of respiratory diseases in Primorsky Region. Modern Medicine Actual Issues 20: 50-57 (in Russian).
12. Veremchuk LV, Ivanov EM, Kiku PF (2008) The habitat and morbidity of respiratory organs in the Primorsky Region. Dal'nauka, Vladivostok. 217 p. (in Russian).
13. Veremchuk LV, Yankova VI, Vitkina TI, Nazaren-ko AV, Golokhvast KS (2016) Urban air pollution, climate and its impact on asthma morbidity. Asian Pacific J Tropical Biomed 6(1): 76-79.
14. Voronin NM (1981) Fundamentals of medical and biological climatology. Meditsina, Moscow. 352 p. (in Russian).
15. Weather and climate. http//www.pogodaiklimat. ru (in Russian).
16. Yan'kova VI, Veremchuk LV, Vitkina TI, Gvozdenko TA, Golokhvast KS (2016) Response of lipid peroxidation and antioxidant protection system to the combined effects of environmental factors in diseases of the respiratory system. Siberian Sci Med J 36(3): 94-102 (in Russian).
17. Wu NC, Liao FT, Cheng HM, Sung SH, Yang YC, Wang JJ (2017) Intravenous superoxide dis-mutase as a protective agent to prevent impairment of lung function induced by high tidal volume ventilation. BMC Pulm Med 17: 105. Doi: 10.1186/s12890-017-0448-9.
