MIL-therapy / Method of treatment / 7.9. Inflammatory diseases in the bronchi and lungs.
7.9. Inflammatory diseases in the bronchi and lungs.
MIL-therapy is indicated to patients with chronic bronchitis at the exacerbation period in combination with conventional medicamentous therapy and for the prophylactics of possible exacerbation. MIL-therapy increases effectiveness of the complex treatment in chronic bronchitis considerably activating positive processes in the bronchial tree, improving cell content in the broncho-alveolar lavage liquid (namely, increasing a number of alveolar macrophages and their vitality). There is a tendency: the longer is the disease duration and the more pronounced are its complications (emphysema, pneumosclerosis), the more resistant are obstructive processes to the treatment.
For achieving a positive clinical effect the individual biophotometric control of MIL-therapy is necessary. A gradual elevation of the reflection coefficient indexes in the diagnostically important points is thought to be a positive sign. For details see Article 8.
Chronic obstructive bronchitis in the exacerbation phase
MIL-therapy (6-7 daily procedures) is performed in combination with conventional medicamentous therapy. Impulse frequency is 50 Hz, LED radiation power is 80 mWt, exposure on one zone is 2 min. Irradiation is applied contactly to 4 zones with a slight compression of soft tissues (Fig. 22): the projection of main bronchi at Th3-Th6 level (zones 1) and over shoulders area (Krenigue fields, zones 2). The day after that (additionally to these zones) MIL-irradiation is done to the cubital vascular bundle (zones 3) for 2 min on each point ( 3-4 irradiations for the course).
After the 3rd procedure practically all patients have positive dynamics of subjective parameters. By the end of the treatment one can see normalization of temperature, improvement of bronchial patency, reduction of cough and amount of the discharged sputum, reduction of inflammatory process of the bronchi. After the 7th procedure some patients reveal signs of catarrhal inflammation in the upper respiratory tract. By the 7th procedure the induced NST-test reveals the reduction of microbicidic activity of neutrophils especially, in patients with the initial elevated metabolic indexes. These data may indicate some possible connections between the secondary infection in the organism and loss of potential capability of neutrophils to respond with respiratory explosion to an additional irritator. Studies of oxygen exchange with spontaneous and inducted NST-testing during the treatment may be recommended as a criterion for prognosing LT coure duration and for defining a risk group for secondary infection.
Fig. 23. Zones for MIL-irradiation in treating chronic obstructive bronchitis at its exacerbation phaseAcute and chronic bronchitis
The terminal is on the skin (Fig. 23) on the thymus projection (zone 1), exposure 1 min. Then the irradiation is transferred parasternally at the level of III-IV intercostal space (zone 2) and paravertebrally to the right and to the left at ThIII-ThV level (zones 3) with exposure time 2 min on each zone. Frequency is 80 Hz, LED radiation power is 80 mWt. The course consists of 10-12 daily procedures.
MIL-therapy results in the improvement of respiratory tract patency at the level of media and large bronchi because of the increased bronchi adrenoreceptors sensitivity to sympatomimetics, improved blood oxygenation, less coughing and easier sputum discharge.
Fig. 24. Zones for MIL-irradiation in treating acute and chronic bronchitisAsthma
In the bronchial walls of a patient with asthma there exists a chronic inflammatory process which, in the course of time, leads to irreversible sclerotic processes in the respiratory tract. Walls of the bronchi and bronchioles are sensibilized to allergic factors. Preservation of residual sensibilization after the treatment defines remission periods in patients. Presence of long lasting infective allergic process, application of corticosteroid drugs lead to the decrease of phagocytic activity. Unadequate MIL-stimulation of the immune system may cause the emaciation of cellular functional activities and, in a number of cases, disease exacerbation.
p>Athmatic patients are divided into 3 groups depending of the severity of the disease: with a mild course (I), with a moderate course (II) and with a severe course (III).
Patients from the first group take inhalations with ?2- sympatomimetics of short duration; from the second group - inhalations with ?2- sympatomimetics and/or corticosteroids; from the third group - inhalations with corticosteroids, oral ?2- sympatomimetics, teophillin of prolonged action and/or corticosteroids. Additionally, patients from the third group may be prescribed stabilizers of mast cell membranes, bronchospasmolitics and mucolitic expectorants.
Combined treatment is the most effective in the first and second groups: hemosorption + MIL-therapy (phagocytosis activity gets significantly increased, endotoxicosis level gets decreased, patients’ sensitivity to medicamentous therapy gets better). MIL-therapy is done after hemosorption ( hemosorption is performed with 3-day interval) (Fig. 24) on the area of left subclavicular (zone 8) and inguinal (zones 6) vascular bundles (for 2 min on each zone at LED radiation power 60 mWt in a day three times a week); MILtherapy course consists of 6 - 8 procedures and hemosoprbtion course has 3 procedures.
In the third group transcutaneous MIL-irradiation (Fig. 24) is performed paravertebrally at the level of upper angles of scapulas (zones 2)along the medial axillary lines (zone 4), supraclavicular areas ( zones 1), at the I and II intercostal spaces along the medclavicular lines (zone 10 on both sides) with 0,5 min exposure on each zone; on the areas of fossa jugular (zone 7) and thymus (zone 9) - for 1 min. Every other day the irradiation is applied to the area of cubital fossa (zones 5) for 2 minutes and to the projection of adrenal glands (zone 3) - for 1 min. One course includes 8 - 15 procedures every other day with respect to the hemoglobin content in patients’ blood. MIL-therapy has been noted to bring general improvement in patient’s state, larger amount of the discharged sputum , decreaseing of symptoms which require ?2- sympatomimetics and corticosteroids inhalations.
The best clinical effect is achieved in patients with a mild course of disease who have never used corticosteroids preparations.
Fig. 25. Zones for MIL-irradiation in treating asthmaAcute and chronic pneumonia
The terminal is put onto the skin in the areas corresponding to the projection of the diseased lung lobe ( revealed by X-ray and auscultation) and to the projection of main bronchi (frequency 80 Hz, LED radiation power 80 mWt). The illustrated example demonstrates MIL-therapy application in patients with the lesion in the upper lobe of the right lung.
RIGHT LUNG (Fig. 25) When upper lobe is injured: 1. – the IIIrd intercostal space along the medclavicular line (zone 2), exposure 2 min. 2. - the IVth intercostal space along the medial axillary line (zone 4), exposure 2 min. 3. - the IVth intercostal space along the paravertebral line (zone 3), exposure 2 min. 4. Krenigue field (zone 1), 1 min. When the medial lobe is injured: 1. - the Vth intercostal space along the medclavicular line (exposure 1 min). 2. - the Vth intercostal space along the back axillary line (exposure 1 min). 3. - the Vth intercostal space along the paravertebral line (exposure 1 min). When the lower lobe is injured: 1. - the VIth intercostal space along the front axillary line (exposure 1 min). 2. - the VIth intercostal space along the back axillary line (exposure 2 min). 3. - the VIth intercostal space along the paravertebral line (exposure 1 min).
LEFT LUNG. When the lesion is in the upper lobe: 1. – the IInd intercostal space along the medclavicular line (exposure 1 min). 2. - the IIIrd intercostal space along the medial axillary line (exposure 1 min). 3. - the IIIrd intercostal space along the paravertebral line (exposure 1 min). When the lesion is in the lower lobe: 1. -the VIIth intercostal space along the front axillary line (exposure 1 min). 2. - the VIth intercostal space along the back axillary line (exposure 2 min). 3. - the VIth intercostal space along the paravertebral line (exposure 2 min).
The terminal is put on the thorax on the area of lung infiltrate projection. The course of treatment has 7-8 sessions. In case of necessity it may be repeated in two weeks ( by the same scheme).
MIL-therapy in the complex treatment has been found out to reduce the duration of the disease by 5-7 days.
Fig. 26. Zones for MIL-irradation in treating acute and chronic pneumonia ( with the lesion in the upper lobe of the right lung)Acute pneumonias in children
Acute pathology of the lungs and pleura in children (aged 1-12 years) is accompanied by a constant and rapidly progressive acute respiratory insufficiency. Basic values of the external respiration function and gas exchange in children suffering of the complicated forms of acute pneumonia ( a pre-destruction phase) - lobitis, pleuropneumonia, infiltrative form- demonstrate some tension in the compensatory mechanisms with the reduction of lung diffuse capability . It indicates a marked deterioration in the alveolar-capillary membrane. Impairments in the ventilation and diffusion are accompanied by changes in blood gas content (1st-2nd stages of the respiratory insufficiency).
MIL-therapy is performed on the 3 day after the beginning of antibioticotherapy (Fig. 26). The application is done in the contact way: along the medioclavicular (zone 2), medial axillary (zone 3) and medial scapular (zone 4) lines on the area of inflammatory infiltration, paravertebrally and symmetrically in the area of ThII-VI (zones 5, 6). After that the thymus projection (zone 1) is irradiated. Impulse frequency is 50 Hz, LED radiation power is 30 mWt, exposure is 0,5 min on each zone. The course of treatment consists of 7-8 procedures every other day.
After MIL-therapy session in addition to the reduction of blood oxygen capacity indexes and anaemia one can see a statistically significant elevation of blood saturation and common oxygen concentration with stable values of hemoglobin content. Common clinical, X-ray and biochemical indexes improve more rapidly (3-4 days on the average).
In case of acute destructive pneumonia in children MIL-therapy increases compensatory processes of distributive-diffuse and ventilation mechanisms in respiratory insufficiency due to the elevation of respiration space-efficiency, balanced oxygen consumption, improved alveolar-capillary membrane function and oxygen-transport function of blood. Average day-time is reduced by 15-20% on the average, the incidence of destructive complications decreases up to 20-25%.
If infiltrative forms of the acute destructive pneumonia are transferred into different variants of lung and lung-pleural destruction, MIL-therapy sessions are to be cancelled before the acute phase of the disease is over.
Fig. 27. Zones of MIL-irradiation for treating acute pneumonias in children