Features of the course of diseases of the bronchopulmonary system in a hot climate

It has been established that the pathological effect of ozone is primarily due to the activation and/or development of the inflammatory process in the bronchi in patients with bronchial asthma and healthy individuals)[11,4,23]. Studies of sputum and bronchoalveolar lavage in patients with bronchial asthma and healthy individuals after exposure to ozone revealed a statistically significant increase in their content of polymorphonuclear neutrophils, as well as some cytokines (interleukin-6, interleukin-8.

The authors who studied the state of the upper respiratory tract after exposure to ozone also showed an increase in the number of leukocytes, the level of leukotriene B4, platelets of activating factor (FAT), interleukin-8 (IL-8) in nasal lavage fluid, and in patients with bronchial asthma these changes were more significant compared to healthy subjects. A significant correlation was found between the level of IL-8 and the number of leukocytes in the nasal lavage fluid of BA patients after exposure to ozone [16,19,22].

Interestingly, inflammation in the respiratory tract as a result of exposure to ozone in the examined individuals persisted even after the respiratory function indicators returned to normal. It is known that in some patients with bronchial asthma, physical activity can cause attacks of suffocation [1,5,10,19]. As it turned out, there is not only a spasm of the smooth muscles of the bronchi, but also stimulation of mucus production, stagnation in small vessels and an increase in their permeability, as well as damage to the bronchial epithelium.

At the same time, an early reaction is isolated (5-15 minutes after physical exertion), the development of which is mainly associated with:

• a)    the direct influence of physical exertion;

• b)    with increased vagal reflexes, due to irritation of sensitive bronchial receptors;

• c)    with the release of primary mediators (histamine).

A late reaction to physical activity (after 4-10 hours) may be due to repeated release of histamine, as well as other (secondary) mediators that contribute to the development of inflammation and damage to the epithelium.

It is assumed that microcirculation disorders play an important role in the development of the inflammatory process under the influence of physical activity in patients with bronchial asthma [2,7,14.20]. Thus, it has been shown that in patients with asthma of physical effort, physical exertion causes vasodilation and increased blood flow in the bronchi, which are accompanied by an increase in osmolarity in the bronchial submucosa [6,12,17,21].

Thus, an increase in blood flow in the bronchi directly or indirectly leads to the release of inflammatory and bronchoconstrictor mediators. Such mediators involved in the pathogenesis of physical effort asthma include prostaglandin D2 (PGD2), which exerts its effect by stimulating thromboxane receptors.

In the development of exacerbations of bronchial asthma, various environmental factors are given importance: pollutants, ozone, chemical agents, as well as meteorological factors such as temperature, humidity, atmospheric pressure, precipitation. However, according to a number of authors, only temperature was clearly correlated with exacerbations of bronchial asthma[9,18,26].

Moreover, as it was shown, prolonged exposure to cold led to morphological changes in the bronchi, such as an increase in the number of goblet cells and mucous glands, hypertrophy of the smooth muscles of the bronchi and terminal arteries and arterioles [3,6]. These changes can play an important role in the development of chronic obstructive pulmonary disease and bronchial asthma, as they contribute to increased pressure in the pulmonary artery and inflammatory edema.

Interestingly, in countries with a hot climate, high ambient temperature (more than 25 ° C) can also be a risk factor for the activation of the inflammatory process in the bronchi and exacerbation of bronchial asthma.

The combination of unfavorable factors: temperature (cold air) and physical exertion can significantly aggravate their negative effect on the bronchi in patients with hypersensitivity to these factors and contribute to the activation of the inflammatory process and increased bronchial obstruction [5,13,19,22].

Currently, assessment of the impact of risk factors for chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA) and disease monitoring are significant components of patient care [3,24]. At the same time, the possible trigger role of meteorological factors is not taken into account, although the causes of 1/3 of exacerbations of diseases remain unknown. Meanwhile, there is evidence of increased weather sensitivity in patients with COPD and BA with features inherent in different climatic regions [10,11,15,18]. However, the issues of meteorological pathology of COPD and BA in mountainous conditions have not found proper coverage in the literature. In this connection, the identification of bioclimatic features of the low mountains of Northern Kyrgyzstan, synoptic and meteorological conditions of the formation and recurrence of meteopathic effects of the atmosphere, their influence on the course of COPD and BA is an important problem of balneology and pulmonology, especially if we take into account that in the Kyrgyz Republic respiratory diseases occupy the first place in the structure of the overall morbidity of children and adults, leading - with temporary and persistent disability [17].

According to modern concepts, unfavorable weather conditions can cause physiological compensatory reactions of the body that preserve homeostasis, or with a violation of adaptive mechanisms, the development of meteopathic reactions, which, in particular, in patients with COPD and BA can occur with increased symptoms of the disease and ventilation disorders [4,15,26]. However, the causes of such disorders have not been sufficiently studied in relation, for example, to the role of the autonomic nervous, oxidant-antioxidant and pulmonary surfactant systems, which in chronic inflammation of the respiratory tract are important in the formation and progression of bronchoobstructive and bronchohyperreactive syndromes [6,23,28]. The literature does not sufficiently cover the issues of meteotropic reactions in patients with COPD and BA (adults and children) with different degrees of meteosensitivity (meteostable and meteolable) under different types of weather in comparison with healthy people.

Complex medical rehabilitation with the use of medications, natural and preformed factors allows to achieve a high effect [9,14,27]. Meteolability reduces the effectiveness of restorative therapy of pulmonological patients, which is mainly studied by the results of sanatorium treatment [4]. Insufficient attention is paid to the issues of rehabilitation of COPD and BA patients, especially meteorolabile ones, in the conditions of rehabilitation centers, although specialized rehabilitation centers are recognized as the main form of its organization for such patients [20,25]. Therefore, maintaining a register of B A and COPD and monitoring the synoptic and meteorological situation are important problems designed to improve the effectiveness of medical rehabilitation of patients.

The issues of meteorological prophylaxis of pulmonological patients with physiotherapeutic methods that increase nonspecific resistance and adaptive capabilities of the body have not received adequate coverage in the literature to date. For this purpose, the study of low-intensity electromagnetic radiation of the EHF band with anti-stress, antioxidant, regulating properties [8,9,16,23,26] remains unexplored, and the literature information on the possibility of EHF therapy in the rehabilitation of patients with COPD and BA is extremely scarce. In this regard, the development of sanogenetically oriented methods of meteorological prophylaxis and rehabilitation is very important.

Scientists from Uzbekistan in the course of experiments proved that when carrying out preventive measures and planning epidemiological studies in relation to "chronically urgent" diseases, including AML, it is necessary to pay special attention to climatometeorological factors and the results of biometeorological studies.

The development of this scientific direction, especially in pulmonology, allows us to develop priority tasks that have medical, state and national economic significance. It is very important that modern science is moving towards expanding the nonspecific prevention of NCDs. This formulation of the question is, of course, based on data from clinical and climatobiorhythmological studies and is associated with predicted natural disasters, especially the expected global warming of the average temperature of the globe (Kyoto Protocol, 2017).

So, H. I. Yanbayeva (2013), based on long-term observations, concluded that "... the study of climatic factors, their possible impact on the human body, its adaptive mechanisms and the development of standards of practical measures for improving working and living conditions are one of the priority aspects of medicine....." [22]. According to E. Ballester et al. (2017) and L. M. Shedani et al. (2012), "... in conditions of changing meteorological factors, biological rhythms contribute to maintaining homeostasis, cause significant fluctuations in hemodynamic and bronchopulmonary parameters. Under their influence, the course of cardiorespiratory pathologies changes ..." [26]. Major studies by F. Fachini et al. (2011), L. B. Lecha Estela (2018) and N. Tanaka et al. (2010) lay the scientific basis for modern clinical and meteorological research and emphasize that "....the main pathogenic meteorological elements include: radiant energy, atmospheric pressure, air temperature, relative humidity, wind direction and speed. The aggravation of diseases occurs under the simultaneous influence of many weather and climatic causes: solar radiation, atmospheric circulation and a number of local climate features...." [27].

Meteorological factors (MF) are also reflected in the clinical manifestations of cardiorespiratory pathology. In some cases, dysadaptation in patients is detected in the form of undesirable clinical manifestations (thermal cramps, thermal exhaustion, thermal fainting and heat stroke) [28]. With an increase in the duration of the effects or fluctuations of meteorological factors, according to L. J. Folinsby (2010), there is an increase in cutaneous blood flow, cardiac output, heart rate, systolic volume, venous elasticity, internal temperature and sweating [18]. Researchers from far abroad Z. B. Rowell et al. (1986), S. M. Bernard et al. (2011) and M. Jaatelf (1999) report fundamental scientific results that various complications of cardiorespiratory diseases develop in response to meteostress, up to thermal, ischemic or radiation apoptosis and necrosis [25].

In bronchopulmonary and other diseases, under the influence of meteorological factors, there is a decrease in the blood flow of internal organs, renal blood flow, urine production, volume and total fluid content, there is a weighting of various syndromes – bronchoobstructive hypoxic, tonic, spastic, hypotensive, clinical, etc. In addition, under the influence of the MF of a sharply continental climate, according to B. I. Geltzer (2011) and G. A. Danilenko (2010), cardiorespiratory pathologies often occur with a less distinct clinical picture, but with a heavier degree of pathological processes and impaired functioning of various systems [6].

The presented results to a certain extent, of course, convince that by now there have already been scientific ideas about the climatobiorhythmopathogenetic mechanisms of the development and course of cardiorespiratory diseases, including community-acquired pneumonia (VP). Meteorological and climatic factors themselves, independently of other FRS, are associated with the frequency of therapeutic pathologies. However, the available works mainly studied the climatopathological features of chronic respiratory pathologies. We consider it necessary to express our point of view in this area, especially in matters of ecological pulmonology, on the problems of INDP and VP in various climatogeographic zones. We are interested in the works devoted to the climatopathogenetic mechanisms of development, course and prevention of the noted diseases among the population.