Modern immunotherapy for chronic obstructive pulmonary disease
Ishchenko O.V., Novikov D.K., Sukalo A.V.
Vitebsk State Medical University, Vitebsk, Belarus
National Academy of Sciences of Belarus, Belarusian State Medical University, Minsk, Belarus
Introduction. The World Health Organization has included COPD in the group of diseases that are a priority for public health, for which pharmaceutical treatment is inadequate.
Objective. Aim was analysis of various ways of modern COPD immunotherapy and comparing them with the results of their own research.
Material and methods. The literature review was conducted in PubMed, Cochrane, Medline, Google Scholar, Elibrary. The analysis of the clinical and immunological efficacy of immunomodulators leyargunal, immunogenin and immunophysiocorrection was carried out on the basis of data from phase 1,2 clinical trials and blind randomized controlled clinical prospective comparative study of three physiotherapy methods (ultrasound on the thymus area, EHF and laser-therapy).
Results. The International Union of Basic and Clinical Pharmacology (IUPHAR) and the British Pharmacological Society (BPS) classify COPD as an immune disease. The GtoPdb database includes 42 immune ligands associated with COPD. The main directions are related to the anti-inflammatory mechanism: MAPp38 inhibitors; chemokine receptors CXCR2, CXCR1, CCR2; MMP-9 and MMP-12 blockers; leukotriene B4 receptor antagonist (BLT1), direct or indirect inhibitors of PI3K; pan-JAK inhibitors; neutrophil elastase blockers, etc. The controversial results of studies on the effectiveness of monoclonal antibodies against TNFα, IL-1β, IL-5, IL-8, IL-13 have been published. The immunocorrection by immunogenin normalized both cellular and humoral immunity, which clinically leded to a decrease exacerbations and increase the time interval between exacerbations. The leargunal treatment increased the of remission (p = 0.021) and reduced the number of exacerbations (p = 0.042). The therapeutic effect of Layargunal allowed to prevent further progression of COPD associated with the occurrence of exacerbations. The combination of immunophysiocorrection with basic therapy of patients resulted in increased control over asthma, reduced the exacerbations, reduced the progression of fixed bronchial obstruction, improved the quality of life of patients and improved the prognosis.
Conclusion. Modern therapy for COPD should include various methods of immunotherapy aimed at correcting immunological disorders in COPD. The criteria for the use of Layargunal and Imugenin in patients with COPD are the presence of frequent exacerbations in patients with the clinic of recurrent respiratory infections, recurrent bronchitis, pneumonia. Clinical and immunological indications for the use of immunophysiocorrection in patients with both asthma and COPD is an uncontrolled or partially controlled course of bronchial asthma, frequent exacerbations, progression of persistent obstruction of the bronchi, a strong influence of the disease on the quality of life of patients.