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CNAA / Theses / 2008 / June /

Treatment of chronic obstructive pulmonary disease with bronchodilators


Author: Eudochia Ţernă
Degree:doctor of medicine
Speciality: 14.00.05 - Internal Diseases (with specification: Pulmonology, Gastroenterology, Hepatology, Nephrology, Functional Diagnostics and Endoscopy)
Year:2008
Scientific adviser: Sergiu Matcovschi
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:
Scientific council:

Status

The thesis was presented on the 25 June, 2008
Approved by NCAA on the 18 September, 2008

Abstract

Adobe PDF document – 0.35 Mb / in romanian

Thesis

CZU 616.233- 002- 08 + 615.234

Adobe PDF document 1.13 Mb / in romanian
106 pages

Keywords

cronic obstructive pulmonary disease, teofilin retard, salbutamol, ipratropium bromid, pulmonary ventilation, alveoli-capillary diffusion of gases, pulmonary haemodinamic

Summary

In this study which included 106 patients suffering from COPD we determined that disturbances in bronchial permeability (decreased FEV1, MEF25-75, PEF50, PEF75) influenced pulmonary ventilation by an increase of RV and V, this resulted in a reduction of the lung membrane diffusion capacity. The most relevant changes were assessed in patients with moderate-severe bronchial obstruction. The degree of impaired lung function correlated with changes of pulmonary haemodynamics parameters. Haemodynamic changes were more prominent in patients with severe bronchial obstruction and chronic hypoxia followed by hypercapnia.

While examining the effect of Teophyllin retard, Salbutamol and Ipratropium bromide on evolution of COPD, we revealed that all bronchodilators produced statistically significant changes in pulmonary ventilation (reduced RV and V), in pulmonary haemodynamics (decreased SPAP, MPAP, PVR), in the lung diffusion capacity (increased TLO2, TtisO2) and influenced parameters of arterial blood oxygenation (increased PaO2, CaO2, SaO2). There were some peculiarities between the bronchodilators studied. Thus, Salbutamol significantly reduced RV in comparison with Teophyllin retard and Ipratropium bromide. Salbutamol and Teophyllin retard had a greater influence on VC and MVR versus Ipratropium bromide. Therapy with all three bronchodilators led to decrease of PA pressure at end-of-cure test, but Teophyllin retard demonstrated a higher effect on PVR. Both Salbutamol and Teophyllin retard had a more prominent effect on P (A-a) O2 and Qs, we also assessed a more relevant improvement of parameters of arterial blood oxygenation in these patients versus those who administered Ipratropium bromide.