The approaches to prevention and therapy of cardiovascular disorders in children with chronic bronchopulmonary pathology

Authors

  • G. O. Lezhenko Zaporizhzhia State Medical University, Ukraine,
  • О. Ye. Pashkova Zaporizhzhia State Medical University, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2018.3.130512

Keywords:

pulmonary disease, cystic fibrosis, asthma, child, ACE inhibitors, arginine, cardiovascular system

Abstract

The purpose of this study was to develop and evaluate the algorithm for cardiovascular disorders prevention and therapy effectiveness in children with chronic bronchopulmonary pathology.

Materials and methods. There was catamnestic examination of 57 patients with chronic bronchopulmonary pathology (29 children with severe, controlled or partially controlled persistent bronchial asthma and 28 children with cystic fibrosis and pancreatic insufficiency) who were analyzed the dynamics of left ventricular myocardial remodeling, depending on the administrated treatment. Catamnesis duration was 1 year. The average age of children in the observation group was 9.2 ± 0.6 years. The ultrasound examination of the heart was performed using the Medison SonoAce 8000 ultrasound machine (USA) according to the standard procedure. The mathematical analysis and statistical processing of data were performed on a PC using the licensed software package of Statistic for Windows 10.RU using variation, correlation, regression and nonparametric methods of statistical analysis. Variables were expressed as M  ±  m and P value <0.05 was considered to indicate statistical significance.

Results. It has been established that there is a structural and functional left ventricular myocardium rearrangement on the background of left ventricular diastolic dysfunction development, sympathetic branch of the autonomic nervous system functional impairment, myocardium electrical instability and endothelium-depended vasodilation disturbance in children with chronic bronchopulmonary diseases. The algorithm has been worked out for choosing tactics of cardiovascular disorders therapy based on the study results, which is a complex of non-medicamentous and medicamentous methods with drug modulators of "L-arginine – nitric oxide" system – ACE and L-arginine inhibitors inclusion in the therapy. The effectiveness of proposed algorithm was estimated in 27 children with chronic bronchopulmonary diseases. The other 30 patients, who were treated with traditional therapy, made up a comparison group. It has been found that proposed therapeutic method application in the complex treatment of children with chronic bronchopulmonary pathology contributed to left ventricular myocardium morphofunctional state improvement by slowing processes of left ventricular remodeling and increasing the number of patients who had normal left ventricular myocardium geometry. There was a progression of the left ventricle morphofunctional state changes in the comparison group, which was manifested by an increase in the left ventricular myocardium mass and structural-geometric myocardial restructuring by concentric type of cardiac remodeling.

Conclusions. The use of proposed algorithm can prevent cardiovascular disorders progression and provide more effective rehabilitation of children with chronic bronchopulmonary diseases.

 

References

Cazzola, M., Calzetta, L., Bettoncelli, G., Novelli, L., Cricelli, C., & Rogliani, P. (2011). Asthma and comorbid medical illness. Europ. Resp. J., 38(1), 42–49. doi: 10.1183/09031936.00140310.

Roy, R., & Couriel J. M. (2006). Secondary pulmonary hypertension. Paediatric Respiratory Reviews., 7(1), 36–44.

Nedel'skaya, S. N., Srebrodol'skaya E. V., & Bessikalo, T. G. (2010). Izmenenie gemodinamicheskikh pokazatelej u detej s bronkhial'noj astmoj [The change in hemodynamic parameters in children with bronchial asthma]. Zaporozhye medical journal, 12(2), 43–47. [in Russian].

Venkatesan, A., Spalding, C., Speedie, A., Sinha, G., & Rumbaugh, J. A. (2005). Pseudomonas aeruginosa infective endocarditis presenting as bacterial meningitis. J. Infect., 51(4), 199–202. doi: 10.1016/j.jinf.2005.02.019.

Nagra, A., Maddock, H., & Hussain, A. (2011). The bronchodilator salbutamol is associated with increased myocardial injury in a pre-clinical heart attack model. Heart., 97, e1–e2.

Manara, A., Hantson, Ph., Vanpee, D., & Thys, F. (2012). Lactic acidosis following intentional overdose by inhalation of salmeterol and fluticasone. Canadian Journal of Emergency Medicine., 14(6), 378–81.

Abaturov, A. E. (2009). Rol' monooksida azota v sisteme nespecificheskoj zaschity respiratornogo trakta [The role of nitrogen monoxide in the system of nonspecific protection of the respiratory tract]. Zdorov'e rebenka, 1, 130–137. [in Russian].

Papi, A., Nicolini, G., Baraldi, E., Boner, A. L., Cutrera, R., Rossi, G. A., & Fabbri, L. M. (2009). Regular vs prn nebulized treatment in wheeze preschool children. BEclomethasone and Salbutamol Treatment (BEST) for Children Study Group.Allergy., 64(10), 1463–71. doi: 10.1111/j.1398-9995.2009.02134.x.

Chaumais, M.-C., Macari, E. A., & Sitbon, O. (2013). Calcium-Channel Blockers in Pulmonary Arterial Hypertension. Pharmacotherapy of Pulmonary Hypertension., 218, 161–175. doi: 10.1007/978-3-642-38664-0_7.

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. (2004). National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics., 114(2), 555–576.

Devereux, R. B., Alonso, D. R., Lutas, E. M., Gottlieb, G. J., Campo, E., Sachs, I., & Reichek, N. (1986). Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol., 57, 450–458.

De Simone, G., Devereux, R. B., Daniels, S. R., Koren, M. J., Meyer, R. A., & Laragh, J. H. (1995). Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J. Amer. Coll. Cardiology., 25, 1056–1062. doi: 10.1016/0735-1097(94)00540-7.

Daniels, S. R., Kimball, T. R., Morrison, J. A., Khoury, P., & Meyer, R. A. (1995). Indexing left ventricular mass to account for differences in body size in children and adolescents without cardiovascular disease. Am. J. Cardiol., 76, 699–701. doi: https://doi.org/10.1016/S0002-9149(99)80200-8.

Golikov, P. P. & Nikolayeva, N. Yu. (2004). Metod opredeleniya nitrita/nitrata (NOx) v syvorotke krovi [Method of the measurement of nitrite/nitrate (NOx) in serum]. Biomedicinskaya khimiya, 50(1), 79–85. [in Russian].

Pashkova, O. E. (2011). Osoblyvosti morfofunktsionalnoho stanu miokarda livoho shlunochka u ditei z khronichnoiu bronkholehenevoiu patolohiieiu [The features of the morphofunctional state of the left ventricular myocardium in children with chronic bronchopulmonary pathology]. Current issues in pharmacy and medicine: science and practice, 2, 293–298. [in Ukrainian].

Lezhenko, G. A. & Pashkova, E. E. (2012). Stan neiroendokrynnoi rehuliatsii sertsevoho rytmu u ditei, khvorykh na bronkhialnu astmu ta retsydyvuiuchyi bronkhit [The state of the neuroendocrine regulation of heart rate in children with bronchial asthma and recurrent bronchitis]. Problemy endokrynnoi patolohii, 4, 79–84. [in Ukrainian].

Pashkova, O. E., & Lezhenko, G. O. (2012). Obgruntuvannia patohenetychnoi terapii sertsevo-sudynnykh porushen u ditei, khvorykh na mukovistsydoz [The substantiation of pathogenetic therapy of cardiovascular disorders in children suffering from cystic fibrosis]. Vestnik fizioterapii i kurortologii, 3, 64–67. [in Ukrainian].

Lezhenko, G., & Pashkova, E. (2014). Markery razvitiya serdechno-sosudistykh narushenij u detej s bronkholegochnoj patologiej [The markers of cardiovascular disorders formation in children with bronchopulmonary diseases]. Pediatriya. Vostochnaya Evropa, 1(5), 49–57. [in Russian].

Pashkova, O. E., & Lezhenko, G. O. (2017). Morfofunktsionalni osoblyvosti miokarda livoho shlunochka ta zahalnykh sonnykh arterii u ditei, khvorykh na mukovistsydoz [The morphofunctional features of the left ventricular myocardium and common carotid arteries in children with cystic fibrosis]. Zdorov'e rebenka, 5, 7–12. [in Ukrainian].

Melnikova, L. V. (2011). Znachenie gemodinamicheskikh faktorov v razvitii remodelirovaniya sosudov myshechno-e'lasticheskogo tipa pri arterial'noj gipertenzii [Importance of hemodynamic factors in vascular remodeling of muscular elastic type in arterial hypertension]. Saratovskij nauchno-medicinskij zhurnal, 7(1), 76–79. [in Russian].

Lezhenko, H. O., & Pashkova, O. Ye. (2013). Stan funktsii endoteliiu u ditei z khronichnymy ta retsydyvnymy zakhvoriuvanniamy bronkholehenevoi systemy [The state of the endothelial function in children with chronic and recurrent bronchopulmonary diseases of the bronchopulmonary system]. Bukovynskyi medychnyi visnyk, 17, 3(67), 2, 48–52. [in Ukrainian].

Nagornaya, N. V., & Parshin, S. A. (2010). Ingibitory APF. Vozmozhnost' primeneniya v pediatricheskoj praktike [The ACE inhibitors. Possibility of application in pediatric practice]. Zdorov'e rebenka, 3, 113–115. [in Russian].

Agapitov, L. I. (2012). Diagnostika i lechenie legochnogo serdca u detej [The diagnosis and treatment of pulmonary heart in children]. Lechaschij vrach, 8, 47–54. [in Russian].

Böger, R. H. (2007). The pharmacodynamics of L-arginine. The Journal of nutrition, 137(6), 1650S–1655S. doi: 10.1093/jn/137.6.1650S.

Downloads

How to Cite

1.
Lezhenko GO, Pashkova ОY. The approaches to prevention and therapy of cardiovascular disorders in children with chronic bronchopulmonary pathology. Zaporozhye Medical Journal [Internet]. 2018May30 [cited 2024Nov.2];(3). Available from: http://zmj.zsmu.edu.ua/article/view/130512

Issue

Section

Original research