Application of acetylcysteine in inhalation form in complex treatment of patients with bronchial asthma with neutrophilic type of inflammation
Authors: Ignatieva V.I. , Opimakh S.G. , Dobrianskyi D.V. , Gumeniuk G.L. , Ilnytskyi R.I. , Kuzmenko N.M. 
Published: October 2020

Background. Bronchial asthma (BA) is a heterogeneous chronic inflammatory disease of the airways. On the base of this heterogeneity, among other factors, a significant role is played by the type of inflammation (eosinophilic, neutrophilic or malogranulocytic). In this regard it is offered to allocate separate endotypes of the disease. BA with a neutrophilic type of inflammation is characterized by more severe course with the presence of obstruction at the level of small bronchi and fixed bronchoobstruction. In the presence of disorders at the level of small bronchi, it is advisable to prescribe anti-inflammatory drugs in delivery devices that can create a high concentration of drugs in the peripheral departments (eg, Respimat, inhaled inhalers, fine aerosols). Mucolytics disrupt the structure of the mucus gel, thereby reducing its viscosity and elasticity and, thus, improving the viscoelastic properties of sputum, which facilitate airway clearance and promote the targeted delivery of bronchodilators and anti-inflammatory drugs to the small bronchi.

Objective. To evaluate the effectiveness of the use of ultrafine-particle glucocorticoid tiotropium bromide through Respimat in standard therapeutic doses and inhalation of a10 % solution of acetylcysteine with a nebulizer once a day for 10 days as basic therapy.

Materials and methods. The diagnosis of BA with the neutrophilic type of inflammation was established in patients, whose results of the blood analysis by microscopy showed the level of neutrophils ≥4000 in 1 μl. The effectiveness of treatment of patients having BA with neutrophilic type of inflammation was studied in 30 patients. First (control) group consisted of 15 patients (5 men and 10 women, mean age – 53.2±4.9 years, FEV1 after test with a bronchodilator – 50.6±16.3 %, FEV1/FVC – 66.4±17,8), who received as a standard therapy a combined drug – 320 mcg of budesonide and 9 mcg of formoterol – twice a day in complex treatment. Second (main) group consisted of 15 patients (9 men and 6 women, mean age – 53.6±3.8 years, FEV1 – 51.5±4.7 %, FEV1/FVC – 67,2±3,5), who were administered the inhalation of 250 μg of ultrafine-particle beclomethasone dipropionate and 12 μg of formoterol twice a day, 5 mcg tiotropium bromide as inhalations through the delivery device respimat once a day for 3 months. In the complex treatment, the inhalation of acetylcysteine (3 ml of 10 % solution) with a nebulizer once a day in the morning (duration of an inhalation session – 10 min) for 10 days was additionally prescribed.

Results and discussion. After 3 months in patients of group 2, the effectiveness of treatment was 93.3 %. There was a statistically significant increase in the total score of the test for asthma control (ACT) from 14.3±1.3 to 20.3±0.8 points (p<0.05), a decrease in the total score evaluation of the questionnaire for the control of asthma symptoms (ACQ) from 2.3±0.2 to 1.1±0.1 points (p<0.05), which indicated an improvement in the control of asthma symptoms and a reduction in exacerbations; clinically significant decrease in the number of symptoms from 71.4±5.6 to 51.3±5.0 points (p<0.05) according to the results of the St. George’s Hospital quality of life questionnaire, which indicated an improvement in the quality of life of patients; an increase in MEF50 from 28.9±4.5 % to 41.6±4.2 %, MEF25 from 19.1±2.9 % to 27.6±2.6 % and FEV1/FVC from 67.2±3.5 % to 76.1±2.3 %, which indicated an improvement in bronchial patency at the level of small bronchi and a decrease in fixed bronchial obstruction; an increase in the number of passed meters 6MWT from 266.3±16.2 to 312.0±14.4 m, a decrease in shortness of breath on the Borg scale from 2.5±0.3 to 1.5±0.1 points before the test and from 4.1±0.3 to 3.1±0.3 points after the test, which testified to the increase of tolerance to physical activity. The complex therapy was well tolerated by patients and was not accompanied by the development of side effects. In patients of the control group, statistically significant dynamics of the studied indicators was not detected.

Conclusions. Prescription to patients with BA with the neutrophilic type of inflammation according to the severity of the disease as a basic therapy of ultrafine-particle inhaled glucocorticoid tiotropium bromide through a modern technical device Respimat in a standard therapeutic dose, and formoterol 12 μg twice a day for 10 days led to a positive dynamics of clinical symptoms of asthma, improved respiratory function, increased tolerance to physical activity, and improved the quality of life, thus, resulted in the effectiveness of treatment of patients with BA with the neutrophilic type of inflammation being 93.3 %.