The Potential of Repeated Application of β-Glucans in Patients with Chronic Obstructive Pulmonary Disease and the Comparative Effectiveness of Subsequent Treatment Courses

Abstract

Objective — to assess the effectiveness and safety of repeated courses of the β-glucans in patients with chronic obstructive pulmonary disease (COPD). Materials and methods. A total of 58 COPD patients with 2 to 4 clinical exacerbations in the previous year were examined and randomized into two groups. The severity of the course, the frequency of exacerbations, the stratification of symptoms and the measurement of external breathing parameters were carried out following the GOLD (Global Initiative for Chronic Obstructive Lung Disease) recommen­dations. Also, all patients recorded the need for antibiotics during the calendar year. Indicators of cellular immunity were determined by differentiation clusters on venous blood cells using a Beckman-Coulter flow cytometry.Patients of the 1st group (22 patients) received tiotropium and standard treatment for exacerbations, according to the COPD treatment protocol. At the beginning of the observation, 20 people in the 2nd group also received Imunsil D3 (Nutrimed, Ukraine) 1 capsule 2 times a day for 1 month. 16 patients from the 2nd group were reapplied beta-glucans for 1 month after a 1 year gap. These patients entered the 3rd group. Results and discussion. In contrast, the appointment of β-glucan ensured an increase in the number of cells with natural killer activity (p < 0.05) and cells of the monocyte-macrophage series (CD14+, p < 0.05), and also contributed to the restoration of the immunoregulatory index (p < 0.05). In the case of repeated use of the drug β-glucan for 1 month, the increase in the number of cells with the activity of natural killers (p < 0.05) and cells of the monocyte-macrophage series (CD14+, p < 0.05), as well as the CD4+/CD8+ index was more pronounced than even in patients of the 2nd group (p < 0.05).According to the CAT (COPD Assessment Test) questionnaire, in the 1st (control) group, there was also a tendency to aggravation — worsening of the severity indicator in 5 patients. At the same time, in patients treated with β-glucans, the CAT index worsened in only 1 patient. In the case of repeated use of β-glucans after 1-year gap (group 3), the CAT index did not deteriorate in any of the patients.The most important result of using immunostimulating therapy was a decrease in the frequency of exacerbations from 2.6 ± 0.5 during the previous year to 1.8 ± 0.4 after a one-month course of treatment with the drug β-glucan (p > 0.05). Repeated use of beta-glucan significantly reduced the number of exacerbations — up to 1.2 ± 0.2 times during the year (p < 0.05).The need to use antibiotics in patients treated with β-glucan decreased from 2.3 ± 0.3 to 1.1 ± 0.2 (p < 0.05) courses of antibiotic therapy per year. With repeated use of β-glucan after 1-year gap, the need for antibiotics decreased to 0.8 ± 0.2 courses per year. Conclusions. The appointment of β-glucan ensured an increase in the number of cells with the activity of natural killers and cells of the monocyte-macrophage pool. Also, it contributed to the restoration of the CD4+/CD8+ index. The use of β-glucans for 1 month was accompanied by a decrease in the number of exacerbations of COPD and significantly reduced the need for antibiotics in patients with COPD. At the same time, repeated administration of β-glucan was clinically and immunologically more effective.