ABSTRACT
INTRODUCTION: Treatment of co-morbidities, including bronchial asthma (BA) and coronary heart disease (CHD), is a relevant issue of modern therapy. The aim of the research is to study the impact of long-term intake of pioglitazone on the development of inflammation and ED in patients with BA concurrent with CHD. MATERIAL AND METHODS: The clinical study involved 50 people aged 40-75 who suffered from asthma concurrent with CHD. On the first day of the study, blood samples were collected and clinical examinations were performed, after which patients were randomized and divided into the control group who continued to receive only the standard therapy, and the study group, who received pioglitazone (Pioglar, Ranbaxy, India) 15 mg once a day along with comprehensive therapy. Re-examination was carried out in 6 months. RESULTS: It has been found that inclusion of pioglitazone in the course of standard therapy in patients with asthma concurrent with coronary heart within 6 months is a more efficient scheme than the course of standard therapies. According to the data obtained from the patients, there was a significant decrease in respiratory rate (p<0.01), levels of systolic blood pressure (p<0.001) and diastolic blood pressure (p<0.001). Administering pioglitazone contributed to the improvement of respiratory function and airflow obstruction, increased FEV1 performance (p<0.01) and Tiffeneau index (p<0.05). In patients of the study group, intake of pioglitazone helped to reduce angina. Intake of pioglitazone showed a significant decrease in the frequency of angina pectoris FC II (p<0.05) and a significant increase in the frequency of angina FC I (p<0.05), increase in the rate of threshold load power (p<0.05). In assessing endothelium-dependent vasodilation of the brachial artery, it has been noted that intake of pioglitazone by patients with asthma concurrent with coronary heart disease resulted in a statistically significant increase in the diameter of the brachial artery by an average of 4% (p<0.0001), the maximum blood flow velocity (TAMX) by an average of 40 % (p<0.0001), Δ% diameter increase in the brachial artery (p<0.0001), and achieved positive indicators of RI (p<0.0001). In assessing endothelium-dependent vasodilation of brachial artery in patients treated with pioglitazone, there was a significant increase in the diameter of brachial artery on average by 5% (p<0.0001) after taking nitroglycerin, an increase in ?% diameter of brachial artery (p<0.0001) and RI (p<0.0001). Inclusion of pioglitazone in the complex therapy for 6 months resulted in a significant decrease in the index of systemic inflammation hs-CRP (p<0.0001) and adhesion marker sVCAM-1 (p<0.0001), total cholesterol (p<0.001), triglycerides (p<0.001). CONCLUSION: Thus, these data demonstrate the anti-inflammatory and endothelium protective effects of pioglitazone against the background of standard therapy in patients with BA concurrent with CHD within 6 months, which may enhance the clinical efficacy in the treatment of these diseases.
