The role of comorbidity in the course of broncho-obstructive diseases in military personnel, participants in combat operations

Abstract

The article presents the features of comorbid pathology, the main indicators of functional disorders of the cardiovascular and respiratory systems, indicators of systemic immune inflammation in military personnel, participants in combat operations, patients with chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA). The purpose of the research is to study the clinical, functional and immunological features of the course of BA and COPD in military personnel, participants in combat operations. Materials and methods. 69 military personnel, participants in combat operations who sought consultative help from a pulmonologist were examined, all patients gave voluntary informed consent to participate in the study. The patients were divided into two groups: 1 group — 34 patients with COPD, group B, GOLD 2, without signs of exacerbation; Group 2 — 35 patients with BA, persistent course, moderate degree of severity, controlled. The average age of the patients was 44.5±3.6 years. Analysis of comorbid pathology was carried out by studying the inpatient medical record and the outpatient medical record. All COPD patients underwent the COPD Assessment Test. Results and discussion. In both groups of patients, in a high percentage of cases, concomitant pathology was represented by cardiovascular diseases: in 1 group of patients, in a probably higher percentage of cases, signs of heart failure I-II stage were detected and coronary heart disease. Stage II of arterial hypertension was detected in both groups of patients, however, patients in group 2 had more individuals with stage I hypertension (p<0.05). The analysis of the obtained data established that a frequent comorbid pathology in patients with BA was pathology of the gastrointestinal tract, especially gastroesophageal reflux disease. In this group of patients, a probably higher percentage of people with GERD was found, which indicates the provoking effect of regurgitation of acidic stomach contents on the development of broncho-obstructive syndrome. It should be noted that the number of concomitant diseases in servicemen with COPD ranged from 1 to 5, while more than 50% of patients had three or more diseases at the same time. in patients of group 1, signs of dyslipidemia with an increased level of triglycerides (TG) and a reduced content of HDL cholesterol and carbohydrate metabolism disorders with a HOMA index probably higher than the normative value were found. Conclusions. In patients with COPD, the main comorbid pathology is represented by the pathology of the cardiovascular system: arterial hypertension, coronary heart disease, and stage I-II of heart failure. In military personnel with BA, a pathology of the digestive organs — gastroesophageal reflux disease — is detected in a probably higher percentage of cases. In patients with COPD, disorders of lipid metabolism and signs of insulin resistance were found. A high level of pro-inflammatory cytokines was detected in the blood serum of both groups of patients, at the same time, a high concentration of TGF-β, which is a marker of bronchial remodeling, and IL-6 was detected in patients with COPD. In patients with BA, an increased content of IL-4, which is a marker of bronchial hyperreactivity, was found.