Informed written consent taken from all patients included in the study. Also study and record presence of wheezing or not. As spirometry remains an essential diagnostic tool in assessment of asthmatic patient But we will limit ourselves to study Peak Expiratory Flow Rate PEFR because it is a simple method of measuring airway obstruction the device is available, accessible, and easy to use by the patient and it will detect moderate or severe disease.
The simplicity of the method is its main advantage. The needle must always be reset to zero before PEF is measured. The measurement of peak expiratory flow rate PEFR three to four times allows the diagnosis and assessment of the severity of asthma. It will be studied for all patients, and the stress and anxiety status of patients will determined for all patients included in the study by using Perceived Stress Scale.
Arabic version of the questions set prepared and used through the study. Patients evaluation performed at interval of the study and at least to attend the chest clinic 3 times during the study period. At each study visit the peak expiratory flow PEF will be performed, the best of three measurements will be recorded [ 27 ]. It measures both the adequacy of asthma control and change in asthma control, which occurs either spontaneously or as a result of treatment [ 28 ].
We have developed a schedule for each patient where the following questions is registered for all visits to facilitate consideration of the patient's condition fully [ 29 ]. In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home? During the past 4 weeks, how often did your asthma symptoms wheezing, coughing, and shortness of breath, chest tightness or pain wake you up at night or earlier than usual in the morning?
During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication such as salbutamol? The mean age was In this study 22 patients has been selected for the first group, 18 patients Their results are shown in Table 3. The average age of patients was There was significant clinical impact of ventolin, Symbicort and Seretide conventional in treatment of asthma. Then average of improvement after a month was 1.
These patients were given the same of traditional medicines which given to the first group, but was added Tianeptine to each patients in this group. The average patients age was The treatment lead to improvement of 1. In addition, PEFR increased from Combined rates of all data for patients of Conventional treatment with Tianeptine [group 2].
These patients were given Tianeptine The improvement after a month was 1. Furthermore, average of Rate of peak expiratory flow at onset of study was In this group, 17 patients continued until the end of the study, including 8 patients were male and 9 were female.
The patients were given the same of traditional medicines given to the first group, but was added Tianeptine The average of improvement after a month was 2. In addition, PEFR was increased to All patients in the four groups have made improvement with lightly varying degrees in the first month, with the exception of the third group. However, the percentage of improvement in patients of this group in the first month was relatively low, but after two months the improvement became well.
Although the severity of asthma was more in group 4, the increase change was more prominent in this group as compared to other 3 groups. Table 6.
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Change: Mean the difference between the rate of peak expiratory flow between the beginning and end of the study. The present study demonstrated non significant differences in proportion of decreasing between the 4 groups. Table 7. Individuals with asthma have twice the risk of developing mood and anxiety disorders as individuals without asthma and these psychological factors are associated with worse outcomes and greater need for medical intervention.
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Similarly, asthma symptom onset and exacerbation often occur during times of increased psychological stress. Remission from depression, on the other hand, is associated with improvement in asthma symptoms and decreased usage of asthma medication. Yet research aimed at understanding the biological underpinnings of asthma has focused almost exclusively on the periphery.
An extensive literature documents the relationship between emotion and asthma, but little work has explored the function of affective neural circuitry in asthma symptom expression. However, using ANOVA analysis, the differences in percentage change in daily "as —needed'' between the four groups were not statistically significant. Furthermore, the percentage of change was highly significant for the four groups of treatment. PEFR was improved significantly in the four groups, however, there was a significant differences in changes between the four ngroups of treatment.
The rate of improvement was highest in group 4 and lowest in group 3 after one month of treatment course and the there was a highly significant differences between the 4 groups in their rate of improvement. However, after 2 months of treatment there was no significant differences between the groups in their rate of improvement.
This could be explasined on the basis that fexofenadine may exert antiinflammatory action that may influence the clinical improvement [ 31 - 38 ]. In this study the impact of Tianeptine was clear through the big improvement in patients who receice this medicine, as demonstrated in reduction of daily use and percent reduction of salbutamol, percent changes in PEFR and rate of improvement in group 2,3 and 4. However, the above parameters changes were lower in group of patients group 3 receiving singulair with Tianeptine. This could be due to that singulair acts as antiinflammatory, it does prevent bronchoconstriction, but not relieve the present bronchoconstriction.
In addition, it takes 3 -4 to reach high peak blood mean Tmax [ 39 ]. Serotonin induces bronchoconstriction via peripheral and central pathways resulting in increasing colinergic activity and histamine release[ 42 ]. These changes may explain why tianeptine has proven to be a powerful therapeutic tool in controlling asthma as this study indicated of better improvement in groups groups 2,3,and 4 receiving tinaneptine. During asthma attack, catacholamines and free serotonin fHT , only fHT levels correlated positively with pulmonary function clinical severity [ 43 , 44 ].
Pulmonary endocrine cells located at the parasympathetic terminals taken up fHT. Bronchial smooth muscle contracted due to effect of serotonin through potententiation of acetylcholine [ 39 ]. However, postsynaptic receptors 5-HT3 and 5-HT4 that located at the bronchial muscle mediated serotonin effects. A reported studies [ 45 , 46 ] suggested that tinaneptine therapy reduce plasma fHT, clinical rating and increase in pulmonary function.
While, asthma attach triggered by drugs that increase f-5HT such as buspirone and serotonin-uptake inhibitors like sertraline, paroxetine, etc. However, the side effects of buspirone and serotonin inhibitors may be controlled by atropine [ 51 ]. Dupon et al.
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In addition, Tianeptine greatlly annulated pulmonary vasoconstriction and bronchoconstriction that induced by drugs through their ability to increase f-5HT serum levels [ 53 - 59 ]. Neuroepithelial autocrine serotonergic cells located at the bronchopulmonary system release 5-HT under the effect of acetylcholine stimulation, while, serotonin triggers acetylcholine release from the parasympathetic terminals [ 60 ].
Mood disordera are more common in individuals with atopy [ 13 ]. Through our study, we can say Tianeptine definitely seems to improve the asthma as it reduced the severity of symptoms and improved the daily functioning of a asthmatic patient and reduced absences from school or work, with increase PEFR, whether that it was added to traditional medicines budesonide and formoterol inhalation or Salmeterol, fluticasone propionate or Singulair or fexofenadine.
But Group who took the traditional medicines for asthma with the addition of tianeptine and fexofenadine was better and their symptoms responded to treatment better than others.
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This finding may be due to synergistic antiinflamatory effects that induced by combination of Tianeptine and fexofenadine. Tianeptine led to a clinical improvement of asthmatic symptoms in the second group, patients who were given the tianeptine in addition to traditional medicine has with better improvement as compared to the first group who took traditional medicines only.
This suggests the positive effect of this drug for patients with asthma, of course not as a single medicine, but certainly as adjuvant drug to the essential approved medicines. The mechanism by which this positive impact was induced may be due to its significant anxiolytic properties for patients with asthma who worry more than others or due to positive association between free serotonin in plasma and severity of asthma in symptomatic patients.
As tianeptine was the only agent known to both reduce free serotonin in plasma and enhance uptake in platelets,[ 45 , 46 ]. Previous studies have shown that antidepressants may be of therapeutic value in asthma [ 61 , 62 ] as there is increasing evidence that a biological linkage may exist between asthma and depression [ 61 , 63 , 64 ]. A defect in the function of the autonomic nervous system such as alpha-adrenergic and cholinergic hyperresponsiveness and beta-adrenergic hyporesponsiveness even distal from the airways has been demonstrated in asthmatic patients, as well as in depression [ 61 , 64 ].
Antidepressants may have a therapeutic role in asthma by supressing proinflammatory cytokines and preventing their brain effects [ 61 , 65 ]. They also interfere with cholinergic and serotoninergic pathways, both centrally and peripherally. Most antidepressants also induce adaptive changes in central monoaminergic neurotransmission, which itself might modulate immune reactivity [ 61 , 65 ]. Tianeptine is an antidepressant drug that has been recently used with success in the treatment of asthma.
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