Correction of the acid-alkaline state in patients with asthma

Abstract

Background. The acid-alkaline state (AAS) in physiological conditions is caused by a certain ratio of acids and alkalis in blood plasma as well as in organs and tissues. Imbalances of the above ratio are observed in patients with asthma (As).
 Objective. To study AAS in patients with an uncontrolled course of As.
 Materials and methods. The study involved 27 patients having a moderately severe course of As with metabolic acidosis and without any controls. Physical examinations were made; respiratory function and AAS were assessed. The patients were divided into two groups: 13 cases – group 1 and 14 cases – group 2. Their basic treatment included budesonide / formoterol fumarate dehydrate 160/4.5 µg, with use of control questionnaires for As (ACQ-5) and life quality (SF-36). Additionally to their therapy patients from group 1 received 250 ml of 4.2 % sodium bicarbonate intravenously by drop infusions thrice daily every other day.
 Results and discussion. All the patients had a reduced control over As from 3.5 to 5 points (4 [3.5; 4.5] in group 1 and 4.5 [4; 5] in group 2). According to spirography data, the level of rate values before treatment in cases from group 1 was as follows: forced expiratory volume in 1 sec (FEV1) = 54.00 % [47.00; 59.00], peak expiratory flow (PEF) 25 % = 52.00 % [49.00; 57.00], PEF 50 % = 51.40 % [41.00; 57.00], PEF 75 % = 50.00 % [43.00; 57.10]. In patients from group 2 their level of rate values before treatment was as follows: FEV1 = 57.00 % [52.00; 61.00], PEF 25 % = 56.10 % [52.00; 59.70], PEF 50 % = 54.40 % [47.00; 59.00], PEF 75 % = 54.00 % [47.30; 60.10]. AAS values in cases from group 1 were: рН = 7.32±0.05, РСО2 = 33.8±1.34 mm Hg, ВЕ = -4,8±0,01 mmol/l; in patients from group 2 these were: рН = 7.31±0.04, РСО2 = 32.3±1.13 mm Hg, ВЕ = -4.25±0.01 mmol/l. After the treatment, the following changes were registered: respiratory function indices improved in both groups, but reliable changes versus pre-treatment results were revealed in 1st group – FEV1, PEF 25 % and PEF 75 % (p<0.05), while in 2nd group it was only in PEF 25 %. Both groups demonstrated positive changes of all AAS indices, but reliable changes in all examined indices were found out in patients from group 1 (р<0,05), whose treatment effectiveness was assessed as good in 8 cases and satisfactory in 4. In patients from group 2 the result of treatment was satisfactory in 9 cases, whereas in 5 patients it was unsatisfactory.
 Conclusions. Inclusion of sodium bicarbonate into combination therapy for patients with As is not accompanied with development of any adverse events and is recommended for using in combination therapy for exacerbations of As, particularly if metabolic acidosis develops.