The steady increase in the number of fatal outcomes in relatively young patients with severe bronchial asthma largely depends on unsatisfactory drug therapy using sympathomimetics, glucocorticoid hormones and other modern medications [4, 6]. The use of therapeutic fasting (RDT) and a number of other non-traditional non-medication therapy methods [2, 3] provides a rehabilitative effect in a significant proportion of asthma patients [4].

As compensated (controlled) acidosis develops during therapeutic fasting (RDT), maximum fixation of blood-soluble carbon dioxide occurs in tissue cells, forming the basis for improving biosynthetic processes. As a result, the carboxylation of nucleic acids, nucleoproteins and other biologically active substances that improve the body’s immunosuppressive function progress and reach their apogee at the acidotic peak (day 5-7 of fasting). Published studies [4, 5] indicate the normalization of immunogenesis in asthma patients during therapeutic fasting (RDT). Simultaneously, the diencephalic region of the brain is activated and its regulatory function is subsequently normalized, which also contributes to the restoration of the functioning of the immunogenetic apparatus and efferent cell membranes. The criteria for the selection of patients for therapeutic fasting (RDT) were cases of asthma where the patient’s subjective condition and well-being depended on the use of direct-acting sympathomimetics (usually in the form of inhalers) and glucocorticoid hormones.

Between 1978 to 1985, therapeutic fasting (RDT) was carried out both on an inpatient and outpatient basis with 126 asthma patients using the fractional method developed by G.A. Voitovich et al (invention certificate #843987 dated March 6, 1979). 1 The group of patients included 61 men and 65 women. The distribution of patients by age structure was as follows: under 19 – 8 patients; 20-49 – 88; 50 years and older – 30 patients. Infection-dependent bronchial asthma was diagnosed in 118, atopic bronchial asthma – in 8 patients.

The disease was already present for up to 5 years in 31 patients; up to 10 years – in 56, over 10 years – in 39 patients. An average severity of the disease was noted in 38, while in 88 patients it took a severe course. 120 patients (95.2%) either suffered from asthma in the past or during admission to treatment. Moreover, asthmatic status was noted in the first 3 years of using sympathomimetics (in individual inhalers) in 64 patients (50.8%).

Prior to therapeutic fasting (RDT), the patients underwent clinical and X-ray examination. Concomitant diseases were present in 115 patients (91.2%), including cardiovascular diseases in 72 patients, other lung diseases in 70 patients, gastrointestinal tract lesions in 63 patients, and in other organs and systems – in 89 patients.

Immunity parameters were studied in 40 patients: lymphocytes (L), total T-lymphocytes (T-total) and active T-lymphocytes (T-act), B-lymphocytes (B-l), immunoglobulins (IgA, IgM, IgG), heterophile agglutinin titer (HTA). T- and B-lymphocyte counts were determined using the rosetting method in leukocytic suspension of ram or mouse erythrocytes (Novikov D.K. et al., 1979).

The research was carried out under two programs. Under program I, research was performed prior to each of the therapeutic fasting courses (RDT), and after the third course. They included studies in 36 patients before the first and second therapeutic fasting courses (RDT), in 29 patients – prior to the third course and in 21 patients – 53+5 days after the third course. Under program II, studies were carried on days 6-8 in 22 patients during the first course. Of these 22 patients, 18 patients were also tested during the second course and 14 patients – during the third course. During the first and second weeks of therapeutic fasting (RDT), most of the indicators (except Ig) tended to increase compared with the initial figures. Immunological parameters remained low in the patients who continued drug intake. If therapeutic fasting proceeded smoothly, these indicators increased or remained high. In comparison with the donors, the T-total value were slightly reduced prior to RDT. Indicators that exceeded the ‘norm± σ’, and which could be verified by subsequent tests (see table) were selected among all weekly blood tests carried out during the three RDT courses. As the table demonstrates, extreme deviations from the norm tend to normalize during RDT, that is, immunocorrection occurs.

For the purposes of evaluating the fractional therapeutic fasting method (RDT) results, the patients were divided into 3 groups: group 1 of asthma patients comprised 81 people (64.3%) who stopped using sympathomimetics, glucocorticoids and other drugs, that is, patients with persistent remission of the disease. Preventive therapeutic fasting courses (RDT), breathing exercises with mid-expiratory breath holding, autogenous training and other types of natural therapy were sufficient to maintain a normal state for this group of patients.

Group 2 comprised 34 patients (27.0%) without a stable remission of the disease, but with rare, short-term asthma attacks that were easily relieved by theophedrine or theophylline in combination with natural therapeutic methods (mild asthma). In both groups 1 and 2 therapeutic fasting (RDT) started with a complete termination of sympathomimetics and glucocorticoid hormone intake. Group 3 comprised 11 patients (8.7%), who went back to intake of sympathomimetics (in individual inhalers) or glucocorticoid hormones due to the short-lasting effect of therapeutic fasting. Contrary to our recommendations, four patients used inhalation of sympathomimetics (pocket inhalers) in the first 3-8 days of fasting. In the first days of fasting, five patients received hydrocortisone (up to 6-8 days). Four other patients used inhalers with sympathomimetics to relieve the asthma attacks that resumed shortly after fasting therapy (RDT); they and three patients (in this group) during the period of remission of the disease suffered a viral infection that activated the inflammatory process in the bronchi and lungs. In stationary conditions, they were again prescribed glucocorticoid hormones. In 6 out of 11 patients in this group, asthmatic state was noted again in the long-term. 3.5 years after fractional therapeutic fasting (RDT), one of the patients died with symptoms of cardiac decompensation due to the combination of mitral-aortic heart disease with a dominant stenosis of the left venous opening.

Along with a significant clinical improvement (in 91.3% of patients with asthma), protein, ionic and lipid metabolism normalized during fractional therapeutic fasting course (RDT), along with the coagulogram and other blood indicators. The synthesis of essential amino acids and (enzymes) proteins during the period of switching to full-fledged endogenous nutrition (after 5-7 days of fasting) is described in the work of M.F. Gulyi et al. (1966). After the first therapeutic fasting course (RDT), an unstable normalization of carbohydrate metabolism was noted in patients with concomitant diabetes mellitus. After the second 20-day course, which was normally carried out one month after the first course, there was a more stable normalization of blood and urine glucose levels in these patients. In two women, reverse development of uterine fibroids was noted. One man demonstrated a clinical recovery from prostate adenoma. A positive trend was also noted in the course of other concomitant diseases. It can be explained by the positive effect of therapeutic fasting (RDT) on the mechanisms of chronic disease emergence, dysregulation of adaptation processes and a decreased barrier function of cells of various organs and systems. These processes are closely interrelated. The simultaneous restoration of adaptation processes using therapeutic fasting (RDT) is important, as is the positive effect on the cells (including efferent cells) of the bronchial tree, which ensures the reversal of immunopathological processes in asthma and various concomitant diseases.

Conclusions
1. When using the fractional therapeutic fasting method (RDT), asthma patients demonstrated an improvement of immune function.
2. All patients who underwent three courses of therapeutic fasting (RDT) experienced a clinical improvement in the course of the disease.
3. The fractional method relieves patients from glucocorticoid dependence in 91.3% of cases.
4. Patients with asthma who are dependent on isoprenaline and other direct-acting sympathomimetics are the least prone to the fractional method treatment.
5. The use of direct-acting sympathomimetics in the first days of fasting therapy (RDT) is not justified.

BIBLIOGRAPHY

1. Voitovich G.A. Frakcionnyj metod lechebnogo golodaniya u bol’nyh sarkoidozom organov dyhaniya [Fractional therapeutic fasting method in patients with sarcoidosis of the respiratory organs]. In Regulatory and adaptive mechanisms in normal and pathological states, pp 151-153. Leningrad, 1982.

2. Kokosov A.N. Metodika razgruzochno-dieticheskoj terapii i ee osobennosti u bol’nyh bronhial’noj astmoj [Therapeutic fasting method and its specifics in bronchial asthma patients]. In Therapeutic fasting in treatment of bronchial asthma, pp. 17-26. Leningrad, 1978.

3. Kokosov A.N., Streltsova E.V. Lechebnaya fizicheskaya kul’tura v reabilitacii bol’nyh zabolevaniyami legkih i serdca [Remedial gymnastics in rehabilitation of patients with heart and lung diseases]. Medicine: Leningrad, 1981

4. Kokosov A.N., Osinin S.G. Razgruzochno-dieticheskaya terapiya bol’nyh bronhial’noj astmoj [Therapeutic fasting in bronchial asthma patients]. Medicine of UzSSR: Tashkent, 1984. Translated into English in 2020.

5. Nemtsov V.I. O vliyanii razgruzochno-dieticheskoj terapii na immunnopatologicheskij komponent patogeneza bronhial’noj astmy [On the effect of therapeutic fasting on the immunopathological component of the pathogenesis of bronchial asthma]. In Therapeutic fasting treatment of bronchial asthma, pp. 45-47. Leningrad, 1978

6. Chuchalin A.G. Bronhial’naya astma [Bronchial Asthma]. Medicine: Moscow, 1986.