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Not all problems are solved by drug therapy
Russian scientists have developed a new non-drug method for the treatment of chronic obstructive pulmonary disease (COPD). In Russia, COPD and bronchial asthma occupy a leading place in the structure of mortality and are classified as socially significant diseases, patients require lifelong use of drugs, but it is not enough to be limited only to drug treatment, doctors say.
Tatiana Kunafina. Photo: from personal archive /
Russian scientists have developed a new non-drug method for the treatment of chronic obstructive pulmonary disease (COPD). Despite the fact that respiratory diseases have been known for a long time and, it would seem, are well studied, they still occupy a leading place in the overall structure of mortality. In Russia, COPD and bronchial asthma are classified as socially significant diseases, patients with such diseases require lifelong regular use of drugs, but limiting only to this is not enough, doctors say.
On the importance of non-drug methods of treating COPD and the new development of scientists from the Russian National Research Medical University. N.I. Pirogova told the assistant of the department of hospital therapy of the pediatric faculty Tatyana Kunafina
What is the danger of COPD?
- COPD ranks fourth among the causes of death in Russians. Unfortunately, many of our compatriots - both men and women - continue to smoke, and this is the main factor causing this disease. Physically, COPD is manifested by coughing and feeling short of breath - shortness of breath, which progresses, leading to disability. In the later stages of the disease, patients can no longer do without oxygen therapy.
COPD drug therapy is aimed at improving the ventilation capacity of the lungs - increasing airway patency and oxygen delivery to the alveoli, which are involved in gas exchange. But the fact is that COPD is not only a disease of the lungs, as it would seem from its name. This disease is characterized by systemic manifestations - from depression to muscle dysfunction (muscle weakness), due to which people become immobilized.
In addition, a large group of muscles (diaphragm, intercostal muscles, muscles of the shoulder girdle, anterior abdominal wall) is involved in the breathing process itself, the dysfunction of which leads to a violation of the breathing mechanism itself. Unfortunately, these problems cannot be solved by drug therapy. Therefore, the question arises about other methods - not medication.
What are these methods?
- First of all, this is pulmonary rehabilitation - a complex of programs aimed at improving the quality of life of patients with breathing problems. And first of all, this is working with a psychologist, improving the patient's emotional background and adherence to therapy. In addition, breathing simulators are used to improve the breathing pattern (the ratio of the components of the respiratory act - the duration of the phases, the depth of breathing, the dynamics of pressure and flows in the airways), as well as a set of physical exercises aimed at improving muscle work. Moreover, unlike traditional physiotherapy exercises, which can be carried out in a group, pulmonary rehabilitation requires an individual approach, since everyone has their own degree of respiratory failure.
What component of pulmonary rehabilitation does your new development concern?
- We are talking about the use of the method of electromyostimulation - a restorative treatment, which is based on electrical stimulation of nerves and muscles. This method can be called a bridge to pulmonary rehabilitation for patients who are physically unable to perform standard pulmonary rehabilitation programs. Either they are not committed to this, that is, they cannot bring themselves to engage with sports equipment. And if such patients are not helped, they develop weakness and atrophy, especially of large muscles, which leads to a worsening prognosis.
There are a number of articles by foreign authors in which it is estimated how soon the weakness and atrophy of the main muscle of the thigh leads to the death of this group of patients. Therefore, we use electromyostimulation of the quadriceps femoris muscle to improve motor activity. And once patients begin to move, they can transition to standard pulmonary rehabilitation programs.
In the study of the method, which was carried out on the basis of the city clinical hospital. Pletnev, together with two departments (hospital therapy and pulmonology of the pediatric faculty), extremely difficult patients participated. We evaluated the improvement in their quality of life against the background of electromyostimulation - a subjective feeling of shortness of breath, as well as morphological and functional changes in the muscle structure itself. An improvement was noted in all these parameters: it became easier for people to breathe, the indicators of electromyography (studies of the bioelectrical activity of muscles) increased, the number of steps they could safely walk, and in general, their motor activity expanded.
Only patients with COPD were directly included in this study. But we also worked with other groups of patients - with other respiratory failure, with pulmonary fibrosis. And they also showed good results after applying electromyostimulation. This method turned out to be very effective for patients after lung transplantation - the period of their rehabilitation was reduced in comparison with standard programs.
Is the electromyostimulation method itself something new?
- Not. This method has been known for a long time; neurologists are very fond of using it for various polyneuropathies in patients with any muscle lesions. In pulmonology, we started with electrical myostimulation of the respiratory muscles, with the diaphragm, but later moved on to the idea of general rehabilitation of such patients, their faster recovery during exacerbations and an improvement in the quality of life between exacerbations.
In 2018, we spoke with this topic at the congress of the European Respiratory Society (ERS), where materials on the use of electromyostimulation of the main thigh muscle were presented in the West. In Europe, this method is also not yet in the Clinical Guidelines, and it is used in the framework of scientific research. But since they pay more attention to rehabilitation, in principle, patients receive the method of electromyostimulation in long courses - up to 4-6 weeks. We do not have the opportunity to keep patients for such a long time. Therefore, electromyostimulation is carried out in short-term courses of 10-12 days with electromyography assessment. And if the parameters have increased, and the patient can already engage in standard pulmonary rehabilitation programs, we transfer him to these programs.
The main thing is to activate COPD patients in the acute stage as early as possible, even the most severe patients with respiratory failure should not constantly be in a horizontal position. Dystrophy and atrophy of the muscles, including the one that participates in the act of breathing, should not be allowed. This must be fought in all possible ways. And electromyostimulation in this regard is a very good find.
And to what extent is the equipment available for electromyostimulation, the patient cannot continue the exercises on their own after being discharged home?
- We borrowed this apparatus from athletes. Its minimum price starts from 30 thousand rubles. It is quite accessible for the general medical system, but we do not recommend this method for self-study, because it is better to use it in conditions of exacerbation in order to help the patient return to standard pulmonary rehabilitation programs. And do it in a hospital setting. In addition, you cannot assign electromyostimulation to everyone. Among the contraindications - atherosclerosis of the lower extremities, which occurs in many smokers, inguinal hernia, the presence of a pacemaker.
How difficult will it be to replicate this technique? After all, it is no secret that recently, healthcare leaders are very skeptical about physiotherapy, departments and rates are being reduced
- Unfortunately, this is so, today non-drug therapy somehow fades into the background, but this is completely wrong. Rehabilitation without physical therapy is impossible, drug therapy alone cannot remove all manifestations of COPD, a person still has muscle dysfunction and depression. And if patients are not dealt with from this point of view, then they simply will not have adherence to drug therapy. This is the peculiarity of this disease. Patients understand that after a while the drugs stop working and go into depression, believing that nothing else will help them.