Abstract

Chronic bronchitis, estimated to affect more than 13 million adults in the United States, is characterized in part by retention of airway secretions, but no approved or effective therapy for airway mucus retention in patients with chronic bronchitis has been established. Surfactant reduces sputum adhesiveness, which contributes to difficulty in clearing secretions, but surfactant has not been tested in patients with chronic bronchitis. To examine the effects of exogenous surfactant on sputum clearance and pulmonary function in patients with stable chronic bronchitis. A prospective, multicenter, randomized, double-blind, parallel-group, placebo-controlled comparison of the effects of 2 weeks of treatment with 3 doses of aerosolized surfactant (palmitoylphosphadidylcholine [DPPC]) or saline (placebo). Four US teaching hospitals. A total of 87 adult patients with the diagnosis of stable chronic bronchitis. Pulmonary function, respiratory symptoms, and sputum properties before treatment (day 0), after 2 weeks of treatment (day 14), and 7 days after stopping treatment (day 21). A total of 66 patients were randomized to surfactant treatment and 21 to saline treatment. Patient demographic characteristics between groups were similar at baseline. In patients who received a DPPC dose of 607.5 mg/d for 2 weeks, prebronchodilator forced expiratory volume in 1 second (FEV1) increased from 1.22 L (SEM, 0.08 L) at day 0 to 1.33 L (SEM, 0.09 L) at day 21 (P=.05), an improvement of 11.4%; postbronchodilator FEV1 improved 10.4% by days 14 and 21 (P=.02); and the ratio of residual volume to total lung capacity, a measure of thoracic gas trapping, decreased 6.2% by day 21 (P=.009). In the surfactant groups, there was a dose-dependent increase in the ability of sputum to be transported by cilia in vitro. Aerosolized surfactant improved pulmonary function and resulted in a dose-related improvement in sputum transport by cilia in patients with stable chronic bronchitis.

Highlights

  • ОРДС давно известен врачам под такими назва ниями, как некардиогенный отек легких, шоковое лег кое, мокрое легкое и другие

  • According to American European Consensus Conference (AECC) recommendations, diagnosis acute respiratory distress syndrome (ARDS) is established on the basis of four criteria: acute onset of the main disease; severe hypoxemia, refractory to oxy gen therapy; bilateral infiltrates on chest radiography; Адрес для корреспонденции: Розенберг Олег Александрович E mail: rozenberg@biosurf.ru

  • We have shown earlier that surfactant efficacy could manifest itself when surfactant was administered for the first time on day 1 of respiratory insufficiency develop ment in ARDS, whereas start of the therapy on day 2 was not effective [11, 13]

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Summary

Introduction

ОРДС давно известен врачам под такими назва ниями, как некардиогенный отек легких, шоковое лег кое, мокрое легкое и другие. Результаты клинических испытаний подтвердили необходимость введения сурфактанта БЛ каждые 12 часов до достижения PaO2/FiO2 > 300 mmHg. В зависимости от тяжести больного сурфак тант БЛ вводят в течение 1—2 суток, однако при ОРДС на фоне гриппа A/H1N1 нередко сурфактант терапию проводили в течение 4—5 дней, и даже при введении препарата на 3 — 5 день развития дыхательной недоста точности он был эффективен [19,20,21]. Surfactant BL was administered at a dose of 6 mg/kg, every 12 hours till stable gas exchange improvement and the achievement of PaO2/FiO2 300 mm Hg. Early start of surfactant therapy (not longer than 24 hours from ARDS manifestation) resulted in significant improvement in gas exchange parameters and lung biochemistry, the reduction of frequency of hospital acquired pneumonia development, the decrease of CMV treatment period and time in ICU. Controversial results of MRCT performed in nega tively in different countries had a negative impact on acceptance of surfactant therapy by international commu nity of anesthesiologists and resuscitationists, positive results of surfactant therapy obtained in Russia and Belarus are promising

Surfactant therapy of other lung diseases
Сурфактант терапия других заболеваний легких
Findings
Conclusion
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