Certification work aerosol therapy. Aerosol therapy. Phytotherapy. Artificial ultraviolet irradiation. I. Inhalation therapy

Nuclear chromatin is a complex of deoxyribonucleic acids with proteins, where DNA is in varying degrees of condensation.

Under light microscopy, chromatin is irregularly shaped clumps that do not have clear boundaries, stained with basic dyes. Weakly and strongly condensed zones of chromatin smoothly pass into each other. Electron-dense, brightly colored heterochromatin and less colored, less electron-dense euchromatin are distinguished by electron and light-optical density.

Heterochromatin is a zone of highly condensed DNA associated with histone proteins. Electron microscopy shows dark lumps of irregular shape.

Heterochromatin is a densely packed collection of nucleosomes. Heterochromatin, depending on the localization, is divided into parietal, matrix and perinuclear.

Parietal heterochromatin is adjacent to the inner surface of the nuclear envelope, matrix heterochromatin is distributed in the karyoplasm matrix, and perinuclear heterochromatin is adjacent to the nucleolus.

Euchromatin is a region of weakly condensed DNA. Euchromatin corresponds to regions of chromosomes that have passed into a diffuse state, but there is no clear boundary between condensed and decondensed chromatin. Nucleic acids in euchromatin are mainly associated with non-histone proteins, but there are also histones that form nucleosomes, which are loosely distributed between regions of non-condensed DNA. Non-histone proteins exhibit less pronounced basic properties, are more diverse in chemical composition, and are much more variable in terms of resolution. They are involved in transcription and regulate this process. At the level of transmission electron microscopy, euchromatin is a structure of low electron density, consisting of fine-grained and fine-fibrillar structures.

Nucleosomes are complex deoxyribonucleoprotein complexes containing DNA and proteins with a diameter of about 10 nm. Nucleosomes consist of 8 proteins - histones H2a, H2b, H3 and H4, located in 2 rows.

Around the protein macromolecular complex, the DNA fragment forms 2.5 helical coils and covers 140 nucleotide pairs. Such a DNA region is called core and is designated as core-DNA (nDNA). The region of DNA between nucleosomes is sometimes referred to as a linker. Linker sites occupy about 60 base pairs and are referred to as iDNA.

Histones are low molecular weight, evolutionarily conserved proteins with pronounced basic properties. They control the reading of genetic information. In the region of the nucleosome, the transcription process is blocked, but if necessary, the DNA helix can “unwind”, and nuclear polymerization is activated around it. Thus, histones are significant as proteins that control the implementation of the genetic program and the functional specific activity of the cell.

The nucleosomal level of organization has both euchromatin and heterochromatin. However, if histone H1 is attached to the linker region, then the nucleosomes unite with each other, and further condensation (densification) of DNA occurs with the formation of coarse conglomerates - heterochromatin. In euchromatin, significant DNA condensation does not occur.

DNA condensation can occur in the form of superbeads or solenoid. In this case, eight nucleosomes are compactly adjacent to each other and form a superbead. In both the solenoid model and the superbead, the nucleosomes most likely lie in the form of a helix.

DNA can become even more compact, forming chromomeres. In the chromomere, deoxyribonucleoprotein fibrils are combined into loops held together by non-histone proteins. Chromomeres can be arranged more or less compactly. Chromomeres become even more condensed during mitosis, forming a chromonema (filamentous structure). Chromonemes are visible under a light microscope, are formed in the prophase of mitosis and participate in the formation of chromosomes, arranged in a spiral stacking.

It is more convenient to study the morphology of chromosomes at their greatest condensation in metaphase and at the beginning of anaphase. In this state, the chromosomes are shaped like sticks of varying lengths, but with a fairly constant thickness. They have a clearly visible zone of primary constriction, which divides the chromosome into two arms.

Some of the chromosomes contain a secondary constriction. The secondary constriction is a nucleolar organizer, since it is in these areas that the formation of nucleoli occurs during interphase.

In the region of the primary constriction, centromeres, or kinetochores, are attached. The kinetochore is a discoidal plate. Kinetochores are joined by microgrubs, which are associated with centrioles. Microtubules "pull apart" chromosomes in mitosis.

Chromosomes can differ significantly in size and arm ratio. If the shoulders are equal or almost equal, then they are metacentric. If one of the arms is very short (almost imperceptible), then such a chromosome is acrocentric. An intermediate position is occupied by a submetacentric chromosome. Chromosomes that have secondary constrictions are sometimes called satellite chromosomes.

Barr bodies (sex chromatin) are special chromatin structures that are more common in female cells. In neurons, these bodies are located near the nucleolus. In the epithelium, they lie parietal and have an oval shape, in neutrophils they protrude into the cytoplasm in the form of a “drumstick”, and in neurons they have a rounded shape. They are found in 90% of female and only 10% of male cells. The Barr body corresponds to one of the X sex chromosomes, which is believed to be in a condensed state. Identification of Barr bodies is important for determining the sex of the animal.

Perichromatin and interchromatin fibrils are found in the karyoplasm matrix and lie either close to chromatin (perichromatin) or scattered (interchromatin). It is assumed that these fibrils are weakly condensed ribonucleic acids caught in an oblique or longitudinal section.

Perichromatin granules are particles with a size of 30…50 nm, high electron density. They lie on the periphery of heterochromatin and contain DNA and proteins; it is a local area with densely packed nucleosomes.

Interchromatin granules have a high electron density, a diameter of 20...25 nm, and are an accumulation of ribonucleic acids and enzymes. These may be subunits of ribosomes transported to the nuclear envelope.

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It is in the composition of chromatin that the implementation of genetic information, as well as DNA replication and repair, takes place.

The bulk of chromatin is made up of histone proteins. Histones are a component of nucleosomes, the supramolecular structures involved in chromosome packing. Nucleosomes are arranged quite regularly, so that the resulting structure resembles beads. The nucleosome is made up of four types of proteins: H2A, H2B, H3, and H4. One nucleosome contains two proteins of each type - a total of eight proteins. Histone H1, which is larger than the other histones, binds to DNA at its entry into the nucleosome.

A strand of DNA with nucleosomes forms an irregular solenoid-like structure about 30 nanometers thick, the so-called 30 nm fibril. Further packing of this fibril may have different densities. If chromatin is tightly packed it is called condensed or heterochromatin It is clearly visible under a microscope. DNA located in heterochromatin is not transcribed, usually this state is characteristic of insignificant or silent regions. In interphase, heterochromatin is usually located on the periphery of the nucleus (parietal heterochromatin). Complete condensation of chromosomes occurs before cell division.

If chromatin is loosely packed, it is called eu- or interchromatin. This kind of chromatin is much less dense when observed under a microscope and is usually characterized by the presence of transcriptional activity. The packing density of chromatin is largely determined by histone modifications - acetylation and phosphorylation.

It is believed that in the nucleus there are so-called functional chromatin domains(The DNA of one domain contains approximately 30 thousand base pairs), that is, each region of the chromosome has its own "territory". The question of the spatial distribution of chromatin in the nucleus has not yet been sufficiently studied. It is known that telomeric (terminal) and centromeric (responsible for the binding of sister chromatids in mitosis) regions of chromosomes are fixed on nuclear lamina proteins.

Scheme of chromatin condensation

Notes

What is inhalation

The word "inhalation" came into our speech from the Latin language, in translation from which it means "to inhale". This translation very accurately reflects the essence of the entire procedure. It consists in inhaling medicinal substances with the help of special devices (both for therapeutic and prophylactic purposes). However, you need to make a reservation right away: inhalation therapy can be carried out not only through devices, but also in a natural, natural way - by inhaling, for example, sea air.

When receiving inhalations through devices, medicinal substances that enter the body are absorbed faster and better than if this happened in any other way. This is considered, in addition, the safest for all categories of the population. However, we will return to this issue later, but for now it is worth discussing the types of inhalation therapy - there are also many of them.

Types of inhalations

There are only five types of inhalation. These are steam - the most common inhalations, as well as dry, heat-moist, aerosol and oil. Let's talk a little more about each of these types.

Steam inhalation

This type of inhalation is considered the most common. Many have known him since childhood, because he is the easiest to use. It does not require special devices, you can breathe in this way not only with the help of inhalers, but also with folk methods - for example, over potatoes or over a kettle. The bottom line is to inhale hot steam, in which, if the procedure is performed using the device, special medicines are also added. The steam warms up our nasal passages, throat, trachea - in general, the organs of the respiratory system, thinning the phlegm in them. This type of inhalation is good for all kinds of colds such as rhinitis, pharyngitis and the like.

Medications are not required for steam inhalations, but it is still possible and even recommended to add something to the steam: leaves of eucalyptus, hops, chamomile, St. John's wort. Some people add soda, but then it is important that the steam is not too hot - otherwise it will leave a burn.

Dry inhalations

Dry inhalation also belongs to the types of inhalation therapy. This is the inhalation of medicines in the form of a powder through special nebulizers. It is this type of inhalation that is used, including for bronchial asthma.

Heat-moist inhalations

This type of inhalation is mainly done not at home, but in the clinic, since a compressor is needed to carry it out - this is the inhalation of moist air with a temperature of approximately forty degrees. However, there are special portable devices for inhalation therapy, with their help it is possible to carry out this procedure independently. Wet inhalations are usually done with a simple mineral water and are aimed at eliminating sputum.

Aerosol inhalations

The methods of inhalation therapy also include aerosol inhalations. This is the spraying of medicine in the form of an aerosol using a nebulizer or a special spray can. This method allows the particles of the medicinal substance to penetrate as deeply as possible to the more "remote" respiratory organs.

Oil inhalations

For this procedure, an inhaler is required. Hot vegetable oil is poured into it, which is then sent to the damaged respiratory organs of the patient. It relieves inflammation and, forming a protective film on the mucosa, prevents its irritation. An important point: oil cannot interact with dust, such synthesis will only aggravate the situation. Therefore, it is worth considering this for those people who work in very polluted rooms.

Indications and contraindications for inhalation therapy

Any treatment must be prescribed by a doctor. Each procedure has its own indications and contraindications. Inhalation therapy is no exception. About all cases when the procedure is allowed or prohibited, you need to know everyone who has ever thought about it. Let's start studying these things, perhaps, with contraindications.

First and foremost: in no case should such therapy be carried out at elevated temperatures. This is considered a mark of 37.5 - and above. It does not matter which type of inhalation and which way the patient wants to use. Any type of inhalation therapy is also prohibited when:

myocardial infarction and various heart diseases;
with bleeding from the nose;
pulmonary insufficiency and bleeding;
stroke
allergies.
steam inhalation is not possible with pleurisy;
oil can not be done with an allergy to oils, hypertension of the second and third stages, atherosclerosis (in the latter case, the dry method of inhalation therapy is also prohibited);
with weak vessels;
heat-moist inhalation should not be done in the presence of arrhythmia or heart failure, as well as in the event that a stroke or heart attack has been suffered (and less than eight months have passed since then);
finally, the aerosol type of inhalation is not allowed for people with heart problems, pulmonary insufficiency, or suffering from a hypertensive crisis.

As you can see, there are a lot of contraindications. However, there are still more indications for inhalation therapy:

All viral colds (such as SARS, influenza, rhinitis, and the like, including their complications).
Bronchitis (both acute and chronic).
Pneumonia.
Bronchial asthma.
Cystic fibrosis.
Tuberculosis.
Respiratory fungus.
HIV infections.
Also, inhalation therapy is indicated for the prevention of postoperative conditions.

And these are not all situations when inhalations will be useful to the body!

Features of the procedure

The goal of inhalation therapy is the effect on the mucous membrane. It has a positive result for several reasons. So, with the help of inhalations, swelling and inflammation are removed in a similar way, sputum and mucus go away. In the case of a cough, spasms disappear, and the mucous membrane is moistened without fail - regardless of which disease is eliminated. In addition, inhalations are a topical therapy; some call them "grandmother's remedy". Such features of inhalation therapy allow it to be successfully used for the treatment of the respiratory system both at home and in hospital conditions for many years.

Rules for the procedure

There are special rules for conducting inhalation therapy - regardless of which methods or methods and methods of inhalation will be carried out. These rules must be followed strictly in order to obtain the most effective result.

It is also possible that the attending physician will have additional requirements for the implementation of the procedure. In this case, of course, it is necessary to fully obey his instructions.

So, the first and most important requirement is to carry out inhalation therapy not earlier than one and a half, or even two hours after a meal. At the same time, after the procedure itself, neither eat nor drink for another hour. Also, for this period, you should refrain from smoking, singing and going out into the cold air.

Another rule that should also be followed is the selection of comfortable clothes and a comfortable posture. During the procedure, nothing should interfere and constrain - no movement, no throat, no arms, no chest. Sitting should also be comfortable.

As a rule, the standard course of treatment should be at least five days - and preferably all ten. Then the effect will be maximum. If the patient is an adult, he needs to do two or three procedures a day, if it is a child, one is enough for him. Inhalation therapy in children is carried out for three to four minutes. Adults should spend it a little longer - five to seven. If the treatment is carried out to eliminate rhinitis or any other disease of the nose and / or paranasal sinuses (no matter what method of inhalation therapy is used), inhale through the nose and exhale through the mouth. If a sore throat and / or cough is treated, then everything happens exactly the opposite. By the way, this is logical, but still it should be clarified: any inhalation is carried out either through the nose or through the mouth, depending on which disease needs to be eliminated. Inhalations and exhalations should be light, without tension. Inhalation is a simple procedure, but it requires utmost care and maximum concentration, and therefore one should not be distracted by any extraneous things, including conversations.

Methods of inhalation

There are several ways to carry out this procedure. We will not recall here about folk methods such as potatoes, a kettle and everything else, we will talk exclusively about devices for inhalation therapy. This is, firstly, a compressor - used in hospital conditions. Secondly, the nebulizer; in addition, special aerosols and inhalers, as well as a ventilator. Also, some consider smoking incense as a way of inhalation therapy.

The nebulizer is the most popular device, and therefore we will consider it in a little more detail.

Nebulizer

What is a nebulizer? What is so special about it that distinguishes it from a regular inhaler?

The word "nebulizer" has roots in Latin and is translated from it into our language as "cloud". This is the whole point of the nebulizer device - it is an inhalation device that converts medicine in liquid form into a cloud. This is the same inhaler, but with one single difference - it has a narrower action, that is, it allows the medicine to get exactly to the area that is needed, while the spray spectrum of a conventional inhaler is wider. Nevertheless, by and large, a nebulizer is not much different from an inhaler (which is translated from Latin as "inhale"), and therefore many manufacturers and sellers even write on packages / labels that this product is an "inhaler / nebulizer". Only a steam inhaler cannot be attributed to nebulizers, all the rest have the right to be called at least that way, at least that way.

Nebulizers are static, they are located in hospitals, but, in addition, there are portable devices for inhalation therapy. Asthmatics use these, because it is the nebulizer that helps them out when attacks begin. Thus, this device is used for inhalation as well as for the treatment of respiratory viral diseases and cystic fibrosis.

There are two ways to spray the medicine from the nebulizer to the patient - either through a mask or through a breathing tube. The latter is more commonly used.

When inhalation therapy with a nebulizer has its own specific requirements for how this procedure should occur. They are as follows:

The procedure is done only while sitting, you can not lean forward.
Before her, you can not drink expectorants.
It is necessary to ensure that the medicine does not get into the eyes.
You can not carry out the procedure for more than fifteen minutes.
The mask (if it is used) should fit snugly to the face.
You can dissolve the medicine only in saline.
Hold your breath for a couple of seconds before exhaling.
At the end of the procedure, the chamber of the device must be thoroughly washed in clean water and dried.

Inhalations for various diseases

As has been repeatedly mentioned, the spectrum of action of inhalation drugs and inhalation devices themselves is very wide, they can be used to eliminate a variety of diseases of the respiratory system. Below we will talk about the features of treatment for some ailments.

Inhalation for asthma

For those who are not in the know, let us explain: asthma - or bronchial asthma - is such a severe disease in which the bronchi are in the stage of chronic inflammation. And any contact with allergic substances or the slightest stressful situation can cause an asthma attack. If it is not immediately stopped, it can even lead to the death of the patient. That is why it is so important for every person suffering from this ailment to have some kind of pocket inhaler with them. Above, we have already found out that with asthma, you can use a nebulizer. But what else can be used for inhalation therapy with inhalers? First, the spacer. This device is equipped with special valves that allow you to regulate the flow of drugs into the patient's body - this happens only when you inhale. Such a device is very convenient for the treatment of small children, but its compactness leaves much to be desired: it is quite voluminous. Therefore, the spacer is not always convenient to carry.

Another type is an aerosol with a dispenser, due to which the medicine enters the body in certain doses. Its advantages are reliability in operation and a relatively low price. There are also metered-dose inhalers that spray powder instead of liquid medicine. They are also quite reliable and efficient, but they cost much more.

The next type of inhaler is an auto-inhaler that automatically delivers medication. Thus, the choice of devices for asthmatics is quite wide, and everyone can find a device that would suit him in all respects - despite the fact that experts generally recommend using a nebulizer.

Now let us briefly dwell on the advantages of inhalation therapy in the treatment of bronchial asthma. They are obvious, but they are still worth mentioning. First of all, the indisputable advantage of inhalation is the fact that the medicine enters the affected organ as quickly as possible - that is, into the bronchi, and at the same time all the necessary substances are concentrated just in the right area, and do not spread throughout the body. The third advantage of inhalation is that with such exposure, the drug has a therapeutic effect on the body for the longest time.

Above, we were talking exclusively about inhalation therapy with the help of special devices, but this procedure can also be carried out using folk methods, including in bronchial asthma. However, here it is worth paying attention to some important aspects: for example, steam “folk” inhalations cannot be used at the very beginning of an attack - they will not be able to stop suffocation, but will only lead to a worsening of the condition. In addition, steam inhalation with folk remedies is prohibited for children under the age of seven.

By the way, about the prohibitions: with bronchial asthma there are also contraindications, when it is strictly forbidden to carry out inhalation procedures. These are the situations:

when asthma worsens, attacks are repeated twice a week and more often;
when there are neoplasms and / or purulent processes;
when there are neoplasms in the brain;
when the work of the heart is disturbed;
when pulmonary and / or nosebleeds are frequent.

Inhalations for COPD

The strange abbreviation above is the name of a serious illness. Chronic obstructive pulmonary disease is a disease in which, due to the fact that the lungs are in a constant state of inflammation and therefore react sharply and very sensitively to everything that enters them, the flow of air into the organ is partially limited. In other words, it is a regular lack of oxygen. This process is irreversible, moreover, it is also progressive. Therefore, treatment should be ongoing, and inhalation therapy for COPD is one of the integral parts of this very treatment.

Usually, with COPD, it is recommended to use metered-dose inhalers, but during the period when an exacerbation of the disease occurs and a person, due to his condition, cannot control the dose of the drug, you should pay attention to nebulizers. The latter, by the way, in the treatment of COPD also have a beneficial effect on the heart failure that often accompanies this disease.

Inhalation for pneumonia

Pneumonia is pneumonia, and if it is also bilateral, it is also not a pleasant disease. Inhalations are also an excellent means of combating infection here. The rules of the procedure are standard and correspond to all described above.

Pneumonia also has a number of contraindications to the use of inhalation therapy. Firstly, it is impossible to carry out such procedures for people with cardiovascular diseases. Secondly, they are also prohibited in severe pneumonia, as well as in the presence of shortness of breath. Also, inhalations should be refrained from in all of the following cases: in the presence of pus and / or blood in the sputum, nosebleeds, tuberculosis. Lung tumors, allergies.

As for the devices used for inhalation in case of pneumonia, here too the preference is given to the nebulizer. Although, of course, it is not forbidden to use other methods - for example, steam inhalations are very common, including folk remedies - over potatoes, for example.

Interesting facts about inhalation therapy

For the first time, the healing effect of sea air, or rather, particles of salt in it, was described back in ancient Rome.
The first inhaler was invented in France, and it happened in the middle of the nineteenth century. That inhaler was pressurized, controlled by a hand pump. The steam inhaler originated first in Germany, and people suffering from various forms of tuberculosis were treated in this way.
The electric atomizer was invented almost a century later - only in the thirties of the twentieth century, and in the middle of the century ultrasonic atomizers appeared.
Using a nebulizer, you can also spray herbal infusions and decoctions, but they must first be carefully filtered.
The inhaler is a personal hygiene product, and therefore it is not recommended to use it with the whole family or, even worse, lend it to friends. There is a risk of catching other people's sores.
There are inhalers whose appearance is designed to interest the child. They are bright, colorful and look more like a toy than a medical device. With such a device, children are treated more willingly and more cheerfully.
The term "inhaler" itself was introduced into medicine and into speech in general by a British therapist at the end of the eighteenth century. This Briton came up with his own device for inhaling opium - he modernized a mug with a hole. It was this thing that he called an inhaler.
Even before our era, ancient people knew about the possibility of inhalation treatment: for example, they inhaled the fumes of henbane to cure the respiratory system.

Inhalations are a really effective procedure, and therefore are actively used in physiotherapy. Inhalation therapy, as a rule, does not carry any side effects and does not harm health - of course, if everything is done correctly and the recommendations are followed. So it's not for nothing that this "grandmother's remedy" lives for years!