Nasalotherapy for treatment asthma and – Breathing chronic inflammatory diseases

1. Purposes
2. Introduction
4. Treatment
5. Local anesthetics
6. Mechanism of action of local anesthetics
7. Theory on the mechanism of action of the local anesthetics in the relief of bronchial asthma and chronic diseases of the respiratory tract
8. Scheme of treatment and procedures
9. Materiales y métodos
10. Referencias bibliográficas

PURPOSES

This document has for aim to propose and to explain the nasalotherapy as a therapeutic procedure for some chronic illnesses of the breathing apparatus that have an important inflammatory process.

To contribute with new elements for understanding the physiopathogenesys of human asthma and to propose a new treatment that involves a great part of the morbid processes that contribute to its pathogenesis.

To postulate a theory that explains the possible mechanisms of action of the nasalotherapy with local anesthetics in the relief of patient with bronchial asthma and chronic inflammatory processes of the respiratory tract.

INTRODUCTION

The respiratory diseases are the most common cause of consultation and hospitalization.

Among the wide range of pathologies that affect the respiratory tract, the bronchial asthma, the acute bronchitis, and the chronic bronchitis, the chronic

Tonsillitis, the chronic sinusitis, and the chronic rhinitis stand out for its high frequency of consultation, and also for its high prevalence in the general population.

The pathologies up mentioned have their own physiopathogenesys, but all of them present a common denominator: the acute or chronic inflammatory process.

Regardless of the physiopathogenesys of each one of these pathologies, the inflammatory process not resolved leads to their long standing, chronicity and new episodes beacuse of the damages of the epithelia produced by the presence of a great amount of inflammatory mediators such as histamine, neurotoxins, prostaglandins, tromboxanes, cytokines , leukotrienes, etc.

The high number of consultation for the same cause in a high group of these patients leads us to the conclusion that the antinflamatory therapies in the conventional protocols for this group of pathologies don't satisfy the expectations of the practitioner dealer neither of the patients.

The nasalotherapy, proposal therapeutics that uses the membranes stabilizing and antinflamatory properties of the local anesthetics (lidocaine chloridrate or procaine chloridrate) which provides an antinflamatory effect, and a stabilization of the epithelia more long standing than that of the aines and the steroids, with less remodeling and less epithelial damage.

The nasalotherapy is a non invasive procedure, of easy application that uses the mucosa of the air ways (nasal mucosa) to induce an antinflammatory effect and a stabilization of the breathing epithelia in patient with chronic breathing illnesses with a high inflammatory process.

The nasalotherapy is therapeutic method developed by the author of this document, who has used it in a large number of patients, obtaining good results in a large amount of cases.

PHYSIOPATHOGENESIS

Obstruction of the airways in asthma is due to a combination of factors, which includes smooth muscle spasm, bronchial constriction, and edema of the mucosa, increase of the mucus secretion, and infiltration especially by eosinophyls in the walls of the airways, with important injury, and remodeling of epithelium (2).

Within the multiple causes of bronchial constriction we found the iatrogenic liberation of allergenic and no allergenic mediators, autonomic disturb, inflammation by viral, environmental and idiopathic contamination, adrenoreceptor blockade, inhibition of the synthesis of prostaglandin, psychological factors and physic exercise (8).

The activity of elements such as the autonomous nervous system, the bronchial smooth muscle, and the complement system, the calcium ions (Ca++), the epithelium and the epithelial cell membranes of respiratory tract, the inflammatory mediators released by cells membranes (mast cells, eosinophils and T lymphocytes), and the liposolubility of certain substances are important in order to understand the pathogenesis of the bronchial asthma and its answer to the treatment proposed in this document.

Mast cells, eosinophils and T lymphocytes

They are the main cells in the development of the inflammation in asthma. The evidence of the central role of the mast cells and eosinophils in the intermittent inflammation has been accumulated from a great amount of studies using the technique of the nasal biopsy and the fybrooptic bronchoscope on the mucous tissue obtained from the lower airway (13).

Epithelium

Airway epithelium is something more than a simple physical barrier for protecting the underlying tissue against the environmental aggressions.

Epithelial cells play an important role in the initiation of allergic disease of the airways and in the maintenance of the chronic inflammation in the long lasting disease (4).

Epithelial cells release cytokines and proinflammatory mediators, which attract the eosinophils settling a cycle of events that perpetuate the inflammation (4).

Concentration of mast cells in nasal epithelium is 200-400 per mm3. (In rhinitis episodes the concentration is more than 2.000 mast cells per mm3.

Leukotrienes

The products derived from the metabolism of the araquidónico acid, the Leukotrienes, are powerful bronchoconstrictor agents, and they increase mucus production and micro vascular dilatation, and play a very important role in the inflammation and airway obstruction (4).

Autonomic nervous system

Adrenergic fibers and cholinergic fibers both innervate the bronchial smooth muscle. In the lung, the cholinergic stimulus produces muscular contraction, and the adrenergic stimulus produces relaxation (BETA-receptors). The Cholinergic action causes stimulation on the bronchial glands increasing the secretion (1).

Bronchial smooth muscle

The main autonomic effectors are the smooth muscle; it is characterized by the instability of its membrane potential and for showing continuous and irregular contractions.

Smooth muscle contains actina and myosin and its contraction process supposes ATP hydrolysis, and an interaction between actina and myosin initiated by calcium ions (Ca++) (1).

Calcium

Free calcium ions (Ca++) regulate the permeability of the cellular membrane, the excitability of the autonomic nervous system, the muscular contractility, and its presence is necessary for complement system activation (2).

Cellular membrane

The cell membrane structure of the respiratory tract epithelium and that of the inflammatory cells with their lipid components constitute an important part within the pathogenesis of the asthma and in the treatment proposed in this document.

The factors that determine the penetration of the cellular membrane by some substance are the pores of the membrane, the lipid solubility, the electrical charge and the molecular size of the substance.

Complement system

The complement system activation by the classic pathway or by the alternating pathway finishes in the conformation of the membrane attack complex (MAC), whose action on the membrane of the inflammatory cells depends on the lipid component of the membrane, and on the lipophylic properties of the MAC.

Biological activities associated with the complement which contribute to the asthma pathogenesis are the cell rupture (liberation of inflammatory mediators), and the activation of the membrane receptors, and the anaphiylotoxinic activity (C3C5) that increases the vascular permeability, the smooth muscle contraction and the mast cells degranulation (histamine liberation) (2).

The complement system also contributes to the chemiotaxis and to the increase of cellular adhesion (phagocytosis).