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Clinical-pharmacological aspects of Fenspiride in the treatment of The Chronic Obstructive Pulmonary Disease


Author: Butorov Serghei
Degree:doctor of medicine
Speciality: 14.00.25 - Pharmacology, Clinical Pharmacology
Year:2010
Scientific adviser: Veaceslav Gonciar
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Ion Ţîbîrnă
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution: State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific council: DH 50-14.00.25
State University of Medicine and Pharmacy "Nicolae Testemitanu"

Status

The thesis was presented on the 2 December, 2009
Approved by NCAA on the 11 February, 2010

Abstract

Adobe PDF document0.38 Mb / in romanian
Adobe PDF document0.39 Mb / in russian

Keywords

chronic obstructive pulmonary disease, exacerbation, stable period, fenspiride, respiratory symptoms, cumulative index, functions of the external respiration

Summary

In 148 patients with COPD (average age 49,4 ± 1,4 years) was studied the clinical effectiveness of the long term treatment with fenspiride in the exacerbation and stable period of the disease. The use of fenspiride in the complex therapy of COPD exacerbation significantly increases efficiency of the basic therapy, which leads to lowering of the regression time of the respiratory symptoms (cough in 2,9 times; elimination of the sputum in 2,5 times; short breath in 2,4 times, night symptomatic in 11,2 times).

The therapy with fenspiride showed cosniderable decrease of the bronchial inflammation markers: the cytose index in induced sputum decreased 2,5 times, the concentration of the neutrophyles and lymphocytes decreased 1,8 times and 1,3 times, the alveolar macrophage quantity increased 1,7 times. By the end of the treatment the clinic index of gravity decreased from 3,429 ± 0,021 to 1,008 ± 0,021 points (p<0,001), laboratory index from 3,239 ± 0,24 to 1,429 ± 0,22 u.a (p<0,0001). The therapy with fenspiride contributed to a faster normalization and/or decrease in the systemic inflammation markers and the level of the anti-inflammatory cytokines (IL-1b, TNF-a şi IL-8). Although the systemic and bronchial inflammation markers dicreased, they still remained high compared to relatively healthy persons, that shows us that the inflammatory process is still active and long termed anti-inflammatory therapy is required.

As a result of the long treatment with fenspiride, in patients with COPD of medium gravity, the manifestation of the clinical symptoms decreased, which could be concluded by the decrease of the cumulative index from 5,43 ± 0,14 to 1,78 ± 0,12 points (p<0,001). The effectuated therapy secured a faster and greater decrease and/or normalization of the systemic inflammation markers, and also the cellular composition in the induced sputum. At the end of the 6 month therapy, the level of IL-1b decreased 2,5 times, the activation of TNF-a decreased 2,6 times, the concentration of IL-8 decreased 2,4 times in comparison to the data before the treatment. In patients who used fenspiride, it was noticed the increase of FEF1 at the 6th month – with 19,1% and the increase of the physical tolerance with 17,5% in comparison with the data received before the beginning of treatment. The medium number of exacerbations per 1 patient decreased from 2,63 ± 0,26 to 1,21 ± 0,40 or by 2,2 times.