OPPORTUNITIES TO REHABILITATION OF MULTIMORBID PATIENTS WITH ASTHMA AND OBESITY

Abstract The problems of rehabilitation and achieving asthma control in patients with multimorbid conditions remain relevant despite modern advances in the treatment of asthma. Improving therapeutic approaches requires not only the development of new drugs, but also the creation of comprehensive, personalized rehabilitation programs that take into account individual symptoms and multimorbid pathology.

Aim. To create complex rehabilitation programs for patients with asthma and multimorbid diseases (obesity, osteoarthritis) and their impact assessment on asthma and comorbid diseases

Materials and methods. 70 patients with asthma and obesity were divided into 2 groups of 35 patients each (main group with the rehabilitation and control group) 2 times evaluated: FEV₁, quality of life (QoL) by AQLQ , asthma control by ACQ-5, multimorbid pathology by CIRS scale, Lequesne index, exercise capacity by 6-minute walk test (6MWT), physical activity (PA) by ODA23+, interleukin IL-6, IL-4, TNF-α, leptin levels. Statistical analysis: MS Excel 2013, Statistica 12.0 and Statgraphics Centurion XVIII. 

Results. Patients were comparable in all parameters assessed. Patients with moderate and severe asthma mainly prevailed in the research groups. The level of physical activity by ODA-23+ was low to moderate. The CIRS index was 10.0±1.1 in the 1st group and 9.2±1.1 points in the 2nd group (p>0.05). Lequesne index was 9.70±1.47 in the 1st group and 8.80±1.41 in the 2nd group (p=0.3900). After rehabilitation program in the 1st group, Lequesne index decreased by 2.37±0.60 (p<0.0001), which increased total PA by ODA-23+ by 6.57±2.00 points (p<0.05) and asthma control (ACQ-5 decreased by 0.74±0.20 points (p<0.05)). QoL increased by AQLQ from 3.8±0.4 to 4.5±0.3 (p<0.05)); tolerance to physical activity increased according to 6MWT, the distance covered increased by 18.2±6.8 m. In the 2nd group, the total Lequesne index increased by 0.16±0.41 (p>0.05), the level of total PA, asthma control, and QoL did not change significantly (p>0.05). A level of pro-inflammatory cytokines was reduced, IL-6 level in the main group decreased from 18.75±2.33 to 15.16±1.38 (p=0.011497), TNFα from 10.66±2.28 to 8.99±1.25 (p=0.211292), leptin from 29.53±5.48 to 27.16±4.97 (p=0.532037), while in the control group there were no significant changes in these parameters.

Conclusion. For patient with multimorbid pathology, it is necessary to offer multicomponent rehabilitation programs, based on individual treatable features of asthma, which improve the course of asthma and comorbidities. Rehabilitation programs significantly improved asthma control, patients' QoL, exercise tolerance, reduced pain, increased PA, and had positive effects on pro-inflammatory cytokines and leptin levels.