COPD diagnosis: causes, symptoms, diagnosis and treatment. chronic obstructive pulmonary disease

(COPD) is a progressive disease characterized by irreversible changes in the lung tissue. The abbreviation COPD speaks perfectly for itself - you can't say it better.

Unfortunately, once lung obstruction has developed, there is no way back.

The term obstruction means: a decrease in the bronchial lumen, extremely unsatisfactory patency in the bronchi, due to their spasm, an increase in the size of the walls, “mechanical” blockage, with extensive sputum production. In other words, prolonged obstruction drastically impairs the “ventilatory” capacity of the lungs.

Over the years, monotonously, the disease slowly creeps up on a person, eventually leading to respiratory failure. Many people do not attach much importance to rare coughs, explaining them as completely external causes, for example, colds, smoking, cold air.

By the way, COPD is a very, indicative example of the likely consequences of an addiction to smoking. Initially, the inflammatory process affects only, but in the future, it gradually spreads its negative influence to all key elements of the lung tissue:

• pleura
• alveoli
• vascular bed
• respiratory muscles

The sadness of the situation lies in the fact that since the disease is chronic, with proper therapy it is only possible to significantly slow down the course of its course, to try to improve the quality of life.

Causes of COPD

In addition to the above-mentioned reason, smoking, the health of the lungs and bronchi is extremely strongly affected by a high degree of environmental pollution, as well as the harmfulness caused by the professional component of life.

Here is a list of jobs in which people often suffer from COPD:

• metallurgists (hot metal working)
• miners
• builders, especially those whose job duties include mixing cement
• office workers
• workers employed in the processing of grain, cotton

It is worth mentioning the hereditary factor. Inflamed bronchi lose their protective potential, become a place for the formation of thick, viscous mucus, which is an excellent breeding ground for numerous pathogenic microorganisms.

Risk factors for COPD are mainly limited to the surrounding life, human work, rather than allergens. Smoking can be considered a key cause of obstructive pulmonary disease. The risk of developing the disease in this case increases many times, up to 90%. Shortness of breath and airway obstruction, smokers develop much more rapidly.

Symptoms of the disease

Clinical symptoms have multiple similarities with signs of obstructive bronchitis:

• frequent occurrence of shortness of breath, and initially, only with any physical exertion, and later even at rest
• when exposed to allergens, dust, there is an intense increase in shortness of breath
• systematically dry cough, with extremely difficult sputum
• with forced breathing, prolonged exhalation

The insidiousness of COPD is that the disease does not rush anywhere, gradually increasing its influence. It happens that years, and possibly even decades, may pass from the moment of manifestation of primary symptoms to severe manifestations of respiratory failure.

Let's take a closer look at the main symptoms.

Let's start with cough - the primary symptom of the manifestation of the disease, which initially makes itself felt quite rarely, but in the future, it becomes a very serious problem. Outside the acute phase, sputum separation is usually not observed.

Sputum discharge at the start of the disease is insignificant, mainly of a mucous nature, most often in the morning. If the character is purulent, and sputum discharge is abundant, then this is a clear signal of an exacerbation of the disease.

emergence shortness of breath can be stated approximately ten years after the patient's body "makes friends" with cough. She is able to declare herself with intense physical exertion, infectious diseases.

In the later stages of the disease, there may not be enough air, even with an elementary climb up the stairs. Severe respiratory failure develops, which is expressed by breathing problems when eating or putting on clothes.

When there is a need to take antibiotics, there is a fairly simple bioindicator called C-reactive protein for the answer. When its indicator exceeds 15 mg / l, then their use is quite acceptable.

COPD prevention

To begin with, it is worthwhile to clearly understand what factors are provoking the disease and try to completely eliminate them.

Here are the most significant:

• say goodbye to the habit of smoking
• try to protect your lungs from passive smoking
• avoid overheating and hypothermia of the body

If, by the nature of your work activity, you have to deal with the inhalation of harmful substances, then it is strongly recommended that you strictly comply with all labor protection rules. It is advisable to use respirators or gauze bandages.

I would like to note right away that carrying out any preventive therapeutic exercises is possible only during the period of remission of the disease, and even then, in the complete absence of third-party contraindications. It should be done by a professional massage therapist, otherwise the situation can only get worse.

When the exacerbation subsides, then the whole range of physiotherapy procedures is connected to the therapeutic process:

• inductothermy
• chest ultraviolet
• ultrasound

High efficiency of treatment is observed with oxygen therapy, which is mainly used in severe COPD. This technique involves the inhalation of air enriched with oxygen.

Chronic obstructive pulmonary disease can cause great trouble to the human bronchopulmonary system. It is extremely important to recognize the disease in a timely manner at the earliest stages and prevent its further development, because since the disease is chronic, if you miss the moment, then there will be no turning back.

Take an interest in your health in time, goodbye.

So, “COPD is characterized by airflow limitation that is not completely reversible. Airflow limitation is usually progressive and is caused by an abnormal reaction of the lungs to exposure to various noxious particles and gases. Next are the key points. It means clinical picture : prolonged cough, sputum production, shortness of breath, increasing as the disease progresses; in the terminal stage - severe respiratory failure and decompensated cor pulmonale. Pathophysiological mechanisms we : obstructive type of violation of the ventilation function of the lungs, mucociliary dysfunction, deposition of neutrophils in the respiratory mucosa, bronchial remodeling and damage to the lung parenchyma. And finally morpho logical changes : chronic progressive inflammatory process of the airways and lung parenchyma (especially respiratory bronchioles), existing regardless of the severity of the disease.

The term "chronic obstructive bronchitis" did not satisfy the fact that this pathology was previously regarded as a process occurring mainly in the bronchi, which determined a somewhat frivolous attitude towards this disease. Despite the fact that the process primarily occurs in the bronchi, they are not the only springboard on which pathology develops.

Recall the definition chronic obstructive bronchitis is a disease characterized by chronic diffuse inflammation of the bronchi, leading to a progressive obstructive ventilation disorder and manifested by cough, shortness of breath and sputum production, not associated with damage to other systems and organs. COB is characterized by progressive airway obstruction and increased bronchoconstriction in response to nonspecific stimuli.

Given the above, the term "COPD" is preferable to "chronic obstructive bronchitis", because in case of a disease, not only the bronchi are involved in the pathological process, but all the functional and structural elements of the lung tissue without exception (alveolar tissue, vascular bed, pleura, respiratory muscles). ). Understanding and knowledge of the features of this pathology makes us consider "COPD" as a term that more fully and deeply describes this disease.

In this way, COPD is characterized a progressive increase in irreversible obstruction as a result of pollutant-induced chronic inflammation, which is based on gross morphological changes in all lung tissue structures involving the cardiovascular system and respiratory muscles. COPD leads to limited physical performance, disability of patients and in some cases death.

The term "COPD", taking into account all stages of the disease, includes chronic obstructive bronchitis, chronic purulent obstructive bronchitis, pulmonary emphysema, pneumosclerosis, pulmonary hypertension, chronic cor pulmonale. Each of the terms - "chronic bronchitis", "emphysema", "pneumosclerosis", "pulmonary hypertension", "cor pulmonale" - reflects only the peculiarity of the morphological and functional changes that occur in COPD.

The appearance in clinical practice of the term "COPD" is a reflection of the basic law of formal logic - "one phenomenon has one name."

According to the International Classification of Diseases and Causes of Death of the 10th revision, COPD is coded according to the code of the underlying disease that led to the development of COPD - chronic obstructive bronchitis (code 491) and sometimes bronchial asthma (code 493).

Epidemiology.

It has been established that the prevalence of COPD in the world among men and women in all age groups is 9.3 and 7.3 per 1000 population, respectively.

COPD is one of the most common diseases in which mortality continues to increase.

Etiology.

COPD is defined by the disease that caused it. COB is based on a genetic predisposition, which is realized as a result of prolonged exposure to the bronchial mucosa of factors that have a damaging (toxic) effect. In addition, several loci of mutated genes associated with the development of COPD have been discovered so far in the human genome. First of all, this is a deficiency of α1-antitrypsin - the basis of the antiprotease activity of the body and the main inhibitor of neutrophil elastase. In addition to congenital deficiency of α1-antitrypsin, hereditary defects in α1-antichymotrypsin, α2-macroglobulin, vitamin D-binding protein, and cytochrome P4501A1 may be involved in the development and progression of COPD.

Pathogenesis.

If we talk about chronic obstructive bronchitis, then the main consequence of the impact of etiological factors is the development of chronic inflammation. The localization of inflammation and the features of triggering factors determine the specifics of the pathological process in COB. Biomarkers of inflammation in COB are neutrophils. They are predominantly involved in the formation of local deficiency of antiproteases, the development of "oxidative stress", play a key role in the chain of processes characteristic of inflammation, ultimately leading to irreversible morphological changes.

An important role in the pathogenesis of the disease is played by impaired mucociliary clearance. The efficiency of mucociliary transport, the most important component of the normal functioning of the airways, depends on the coordination of the action of the ciliated apparatus of the ciliated epithelium, as well as the qualitative and quantitative characteristics of bronchial secretions. Under the influence of risk factors, the movement of cilia is disrupted up to a complete stop, metaplasia of the epithelium develops with the loss of cells of the ciliated epithelium and an increase in the number of goblet cells. The composition of the bronchial secretion changes, which disrupts the movement of significantly thinned cilia. This contributes to the occurrence of mucostasis, causing blockade of the small airways.

The change in the viscoelastic properties of the bronchial secretion is also accompanied by significant qualitative changes in the composition of the latter: the content of nonspecific components of local immunity in the secretion, which have antiviral and antimicrobial activity - interferon, lactoferin and lysozyme - decreases. Along with this, the content of secretory IgA decreases. Violations of mucociliary clearance and the phenomenon of local immunodeficiency create optimal conditions for the colonization of microorganisms. Thick and viscous bronchial mucus with reduced bactericidal potential is a good breeding ground for various microorganisms (viruses, bacteria, fungi).

The whole complex of the listed pathogenetic mechanisms leads to the formation of two main processes characteristic of COB: impaired bronchial patency and the development of centrilobular emphysema.

Bronchial obstruction in COB consists of irreversible and reversible components. The irreversible component is determined by the destruction of the elastic collagen base of the lungs and fibrosis, changes in the shape and obliteration of the bronchioles. The reversible component is formed due to inflammation, contraction of bronchial smooth muscles and mucus hypersecretion. Ventilation disorders in COB are mainly obstructive, which is manifested by expiratory dyspnea and a decrease in FEV1, an indicator that reflects the severity of bronchial obstruction. The progression of the disease as a mandatory sign of COB is manifested by an annual decrease in FEV1 by 50 ml or more.

Classification.

Experts of the international program "Global Initiative for Chronic Obstructive Lung Disease" (GOLD - Global Strategy for Chronic Obstructive Lung Disease) distinguish the following stages of COPD (see table).

Note. Stage zero COPD, which is listed in the GOLD classification, is considered as a group.

The course of the disease.

When assessing the nature of the course of the disease, it is important not only to change the clinical picture, but also to determine the dynamics of the fall in bronchial patency. In this case, the determination of the FEV1 parameter, the forced expiratory volume in the first second, is of particular importance. Normally, with age, non-smokers experience a drop in FEV1 by 30 ml per year. In smokers, the decrease in this parameter reaches 45 ml per year. A prognostically unfavorable sign is an annual decrease in FEV1 by 50 ml, which indicates a progressive course of the disease.

Clinic.

The main complaint in the relatively early stages of the development of chronic obstructive bronchitis is a productive cough, mainly in the morning. With the progression of the disease and the addition of an obstructive syndrome, more or less constant shortness of breath appears, the cough becomes less productive, paroxysmal, hacking.

Auscultation reveals a wide variety of phenomena: weakened or hard breathing, dry whistling and various wet rales, in the presence of pleural adhesions, a persistent pleural "crack" is heard. Patients with severe disease usually present with clinical symptoms of emphysema; dry rales, especially on forced exhalation; in the later stages of the disease, weight loss is possible; cyanosis (in its absence, there may be a slight hypoxemia); there is a presence of peripheral edema; swelling of the cervical veins, an increase in the right heart.

Auscultation determines the splitting of the first tone in the pulmonary artery. The appearance of noise in the projection area of ​​the tricuspid valve indicates pulmonary hypertension, although auscultatory symptoms may be masked by severe emphysema.

Signs of an exacerbation of the disease: the appearance of purulent sputum; increase in the amount of sputum; increased shortness of breath; increased wheezing in the lungs; the appearance of heaviness in the chest; fluid retention.

Acute phase reactions of blood are weakly expressed. Erythrocytosis and an associated decrease in ESR may develop. In sputum, causative agents of exacerbation of COB are detected. Chest radiographs may show increased and deformed bronchovascular pattern and signs of pulmonary emphysema. The function of external respiration is disturbed according to the obstructive type or mixed with a predominance of obstructive.

Diagnostics.

The diagnosis of COPD should be considered in every person who has a cough, excessive sputum production, and/or shortness of breath. It is necessary to take into account the risk factors for the development of the disease in each patient. In the presence of any of these symptoms, it is necessary to conduct a study of the function of external respiration. These signs are not diagnostically significant in isolation, but the presence of several of them increases the likelihood of the disease. Chronic cough and excessive sputum production often long precede ventilation problems leading to dyspnoea.

It is necessary to talk about chronic obstructive bronchitis with the exclusion of other causes of the development of bronchial obstruction syndrome. Diagnosis criteria - risk factors + productive cough + + bronchial obstruction. Establishing a formal diagnosis of COB entails the next step - determining the degree of obstruction, its reversibility, as well as the severity of respiratory failure.

COB should be suspected in chronic productive cough or exertional dyspnoea, the origin of which is unclear, as well as signs of forced expiratory slowing. The basis for the final diagnosis are:

detection of functional signs of airway obstruction that persists despite intensive treatment using all possible means;

exclusion of a specific pathology (for example, silicosis, tuberculosis, or tumors of the upper respiratory tract) as the cause of these functional disorders.

So, the key symptoms for staging diagnosis of COPD.

Chronic cough: disturbs the patient constantly or periodically; more often observed during the day, less often at night. Cough is one of the leading symptoms of the disease; its disappearance in COPD may indicate a decrease in the cough reflex, which should be considered as an unfavorable sign.

Chronic sputum production: at the beginning of the disease, the amount of sputum is small. The sputum is mucous in nature and is excreted mainly in the morning. However, with an exacerbation of the disease, its amount may increase, it becomes more viscous, the color of sputum changes.

Shortness of breath: progressive (increases with time), persistent (daily). Increases with exercise and during respiratory infections.

The action of risk factors in history: smoking and tobacco smoke; industrial dust and chemicals; smoke from household heating appliances and fumes from cooking.

During a clinical examination, an elongated expiratory phase in the respiratory cycle is determined, over the lungs - with percussion a pulmonary sound with a box shade, with auscultation of the lungs - weakened vesicular breathing, scattered dry rales.

The diagnosis is confirmed by a study of the function of external respiration.

Determination of forced vital capacity (FVC), forced expiratory volume in the first second (FEV) and calculation of the FEV/FVC index.

Spirometry shows a characteristic decrease in expiratory respiratory flow with a slowdown in forced expiratory flow (decrease in FEV1). Forced expiratory slowing is also clearly seen in the flow-volume curves. VC and FVC are somewhat reduced in patients with severe COB, but closer to normal than the exhalation parameters. FEV1 is much lower than normal; the FEV1/VC ratio in clinically severe COPD is usually below 70%. The diagnosis can be considered confirmed only if these disorders persist, despite long-term, maximally intensive treatment.

An increase in FEV1 of more than 12% after inhalation of bronchodilators indicates a significant reversibility of airway obstruction. It is often noted in patients with COB, but is not pathognomonic for the latter. The absence of such reversibility, when judged by a single test, does not always indicate a fixed obstruction. Quite often reversibility of obstruction comes to light only after long, most intensive medical treatment.

Establishment of a reversible component of bronchial obstruction and its more detailed characterization are carried out during inhalation tests with bronchodilators (anticholinergics and β2-agonists). The test with berodual allows you to objectively assess both the adrenergic and cholinergic components of the reversibility of bronchial obstruction. In most patients, there is an increase in FEV1 after inhalation of anticholinergic drugs or sympathomimetics. Bronchial obstruction is considered reversible with an increase in FEV1 by 12% or more after inhalation of pharmaceuticals. It is recommended to conduct a pharmacological test before prescribing bronchodilatory therapy. At home, for monitoring lung function, it is recommended to determine the peak expiratory flow rate (PEF) using peak flow meters.

The steady progression of the disease is the most important sign of COPD. The severity of clinical signs in patients with COPD is constantly increasing. To determine the progression of the disease, a repeated determination of FEV1 is used. A decrease in FEV1 by more than 50 ml per year indicates the progression of the disease.

In COPD, disturbances in the distribution of ventilation and perfusion occur and manifest themselves in various ways. Excessive ventilation of the physiological dead space indicates the presence in the lungs of areas where it is very high in comparison with the blood flow, i.e., it goes “idle”. Physiological shunting, in contrast, indicates the presence of poorly ventilated but well-perfused alveoli. In this case, part of the blood coming from the pulmonary arteries to the left heart is not fully oxygenated, which leads to hypoxemia. In the later stages, general alveolar hypoventilation occurs with hypercapnia exacerbating the hypoxemia caused by physiological shunting. Chronic hypercapnia is usually well compensated and blood pH is close to normal, except for periods of sharp exacerbation of the disease.

X-ray of the chest organs. Examination of the patient should begin with the production of images in two mutually perpendicular projections, preferably on a film measuring 35 x 43 cm with an X-ray image intensifier. Polyprojection radiography makes it possible to judge the localization and extent of the inflammatory process in the lungs, the condition of the lungs as a whole, the roots of the lungs, the pleura, mediastinum and diaphragm. A picture only in a direct projection is allowed for patients who are in a very serious condition.

CT scan. Structural changes in the lung tissue are significantly ahead of irreversible airway obstruction, detected in the study of the function of external respiration and estimated by average indicators of less than 80% of the proper values. In the zero stage of COPD, using CT, gross changes in the lung tissue are detected. This raises the question of starting the treatment of the disease as early as possible. In addition, CT makes it possible to exclude the presence of lung tumors, the likelihood of which in chronic smokers is much higher than in healthy people. CT can detect widespread congenital malformations in adults: cystic lung, pulmonary hypoplasia, congenital lobar emphysema, bronchogenic cysts, bronchiectasis, as well as structural changes in the lung tissue associated with other past lung diseases that can significantly affect the course of COPD.

In COPD, CT allows examining the anatomical characteristics of the affected bronchi, determining the extent of these lesions in the proximal or distal part of the bronchus; using these methods, bronchiectasis is better diagnosed, their localization is clearly established.

By using electrocardiography evaluate the state of the myocardium and the presence of signs of hypertrophy and overload of the right ventricle and atrium.

At laboratory research erythrocyte count may reveal erythrocytosis in patients with chronic hypoxemia. When determining the leukocyte formula, eosinophilia is sometimes detected, which, as a rule, indicates COB of the asthmatic type.

Sputum examination useful for determining the cellular composition of bronchial secretions, although the value of this method is relative. Bacteriological examination of sputum is necessary to identify the pathogen with signs of a purulent process in the bronchial tree, as well as its sensitivity to antibiotics.

Assessment of symptoms.

The rate of progression and the severity of COPD symptoms depend on the intensity of exposure to etiological factors and their combined effect. In typical cases, the disease makes itself felt over the age of 40 years.

Cough is the earliest symptom, appearing by 40-50 years of age. By the same time, in the cold seasons, episodes of a respiratory infection begin to occur, which are not initially associated with one disease. Subsequently, the cough takes on a daily character, rarely aggravated at night. Cough is usually unproductive; can be paroxysmal in nature and provoked by inhalation of tobacco smoke, weather changes, inhalation of dry cold air and a number of other environmental factors.

Sputum is secreted in a small amount, more often in the morning, and has a mucous character. Exacerbations of an infectious nature are manifested by the aggravation of all signs of the disease, the appearance of purulent sputum and an increase in its amount, and sometimes a delay in its release. Sputum has a viscous consistency, often "lumps" of secretion are found in it. With an exacerbation of the disease, sputum becomes greenish in color, an unpleasant odor may appear.

The diagnostic value of an objective examination in COPD is negligible. Physical changes depend on the degree of airway obstruction, the severity of emphysema. The classic signs of COPD are wheezing with a single breath or with forced expiration, indicating a narrowing of the airways. However, these signs do not reflect the severity of the disease, and their absence does not exclude the presence of COPD in a patient. Other signs, such as weakened breathing, limited chest expansion, participation of additional muscles in the act of breathing, central cyanosis, also do not indicate the degree of airway obstruction.

Bronchopulmonary infection - although frequent, but not the only cause of exacerbation. Along with this, it is possible to develop an exacerbation of the disease due to the increased action of exogenous damaging factors or with inadequate physical activity. In these cases, signs of damage to the respiratory system are less pronounced. As the disease progresses, the intervals between exacerbations become shorter.

Shortness of breath as the disease progresses can vary from a feeling of lack of air during habitual physical exertion to pronounced manifestations at rest.

Dyspnea felt on exertion occurs on average 10 years after the onset of cough. It is the reason for most patients to see a doctor and the main cause of disability and anxiety associated with the disease. As lung function decreases, shortness of breath becomes more pronounced. With emphysema, the onset of the disease is possible from it. This occurs in situations where a person comes into contact with finely dispersed (less than 5 microns) pollutants at work, as well as in hereditary a1-antitrypsin deficiency, leading to the early development of panlobular emphysema.

At wording diagnosis COPD is indicated

severity of the course of the disease: mild course (stage I), moderate course (stage II), severe course (III stage) and extremely severe (stage IV),

exacerbation or remission of the disease, exacerbation of purulent bronchitis (if any);

the presence of complications (cor pulmonale, respiratory failure, circulatory failure),

indicate risk factors, the index of a smoking person.

Chronic obstructive pulmonary disease (COPD) is one of the most common pathologies that causes permanent inflammation of the respiratory organs. Although the term itself began to be used not so long ago, the number of patients with this disease is quite large (approximately 7-12% of the population). First of all, these disappointing statistics are explained by the large number of smokers, who make up the vast majority of patients.

What is COPD?

Chronic obstructive pulmonary disease is independent disease, which is expressed in the limited permeability of air through the respiratory system, and in certain cases this process is irreversible. This condition is caused by inflammation of the lung tissues.

The diagnosis of lung obstruction is a collective term that includes:

• pneumosclerosis;
• obstructive chronic bronchitis;
• chronic cor pulmonale;
• emphysema;
• pulmonary hypertension.

All these diseases reflect structural breach and changes in the work of the main body systems, and occur at different stages of chronic obstructive pulmonary disease. Some have signs of several pathological processes at the same time.

COPD most often occurs in people over the age of 35. Moreover, the majority of patients are men. This selective action is explained by the specific etiology of the disease. There are such reasons for its development:

There are a number of other factors that presumably lead to chronic obstructive pulmonary disease. This includes familial nature of the disease, air pollution, underweight.

COPD: Classification of the disease

To a greater extent, the formulation of the diagnosis of "chronic obstructive pulmonary disease" is based on the severity of this pathology. Why are the reductions in the speed of the passage of inhaled air determined and, taking into account these data, the so-called Tiffno coefficient is determined - an indicator of the probable decrease in the throughput of the respiratory organs in the patient.

In addition, it is necessary to take into account the frequency of exacerbations of the disease and symptomatic manifestations. Today they distinguish 4 severity levels of COPD:

From the third stage, COPD divided into two types based on clinical symptoms:

• emphysematous. This type includes chronic obstructive pulmonary disease with prevailing shortness of breath. The patient is characterized by rapid breathing, which exceeds the need for oxygen. Patients often complain of depression, weakness, weight loss. Significant depletion of the body is noted.
• Bronchodilator. In this case, the predominant symptom is cough. And the bronchial obstruction is strongly expressed. Since the cor pulmonale develops early, the skin after a certain time gets a bluish color. The content of erythrocytes in the blood is constantly increased, which often leads to a heart attack, hemorrhages, and the appearance of blood clots.

COPD: symptoms of the disease

COPD does not appear immediately. As a rule, noticeable symptoms appear only 4-9 years after the start of development. But even in this case, a person does not always go to the hospital. This behavior is especially characteristic of smokers, who consider coughing to be a completely natural condition, since they inhale nicotine every day. Naturally, they correctly determine the cause, but they are mistaken with subsequent actions.

As a rule, the disease is noted when a person already feels significant shortness of breath. Therefore, it is necessary to know the basic symptoms of chronic obstructive disease lungs, especially in the early stages:

Diagnosis of the disease

For a correct diagnosis, you first need to identify whether a person has been exposed to risk factors for developing COPD. When a person smokes, it is necessary calculate the level of probable danger, which is caused for all time by this habit. The so-called smoker coefficient, which is calculated by the formula: (number of cigarettes smoked per day * number of years) / 20, can help with this. When the coefficient is above 10, then the danger of getting sick is quite real. Diagnosis of chronic obstructive pulmonary disease includes the following activities:

A thorough study of the patient's history and a full range of laboratory examinations help determine the correct formulation of the diagnosis of the disease. This includes exacerbations, severity and degree of COPD, the complications that have arisen and the type of clinical manifestation.

COPD: treatment of the disease

With the help of modern medicines, it is not yet possible to cure COPD completely. The main goal of treatment is to increase life expectancy and quality of life for patients with COPD, as well as to prevent subsequent complications of the disease.

COPD can be treated at home. In this case, the following situations have an exception:

• the heart rhythm is disturbed, respiratory failure increases, which turns into an asthma attack;
• home treatment does not show any visible results or the patient's condition worsens;
• severe complications;
• Stages 3 and 4 in the elderly.

At the stage of remission

To dilate the bronchi perform a set of inhalations with the help of bronchodilators (the dose is prescribed by a doctor):

Since the accumulation of mucus in the respiratory tract contributes to the connection of infections, they are used to prevent these diseases. mucolytic agents:

• "Chymotrypsin", "Trypsin" - preparations of protein origin that actively interact with the accumulated secret, reducing its viscosity and resulting in destruction;
• "Ambroxol", "Bromhexine" - lower the secretory function of the respiratory system and, by weakening the internal bonds of mucus, change its composition.

During an exacerbation

Treatment of COPD at the stage of exacerbation involves the use of glucocorticoids, as a rule, this is Prednisolone. With significant respiratory failure, the drug is used intravenously. Since systemic medications of this group have many side effects, today in some situations they are replaced by drugs that inhibit the functions of pro-inflammatory mediators ( "Erespal", "Fenspiride"). When treatment with these medicines at home does not give a positive effect, then the person needs to be hospitalized.

In addition, at this stage, mucus stagnation often forms and emphysema progresses. These conditions can lead to complications such as pneumonia or bronchitis. To prevent this from happening, antibacterial treatment is recommended for the prevention of these diseases - fluoroquinolones, cephalosporins, penicillins.

In elderly people

For the elderly, an individual approach is required, since, due to certain characteristics, the passage of the disease, as a rule, is severe. Before starting treatment, some factors need to be taken into account:

• the presence of additional diseases that are associated with COPD and their interaction;
• age-related changes in the respiratory system;
• difficulties in diagnosing and following the course of therapy;
• the need for multiple medications.

Diet

To maintain the body in the required tone to resist the disease you need a balanced diet:

• with a small body weight, a high-calorie diet is required;
• consumption of a sufficient amount of proteins (slightly above the norm) - sour-milk products, fish and meat dishes;
• minimum salt in case of complications (bronchial asthma, pulmonary hypertension, etc.);
• multivitamin complexes.

COPD treatment will not have a positive effect until the person eliminates all the factors that provoke this disease. The main prevention is the rejection of cigarettes and the timely treatment of infections that affect the respiratory organs.

Effective prevention disease includes the study of all information about this pathology, as well as the ability to use the medical devices that are required during treatment. The patient must know how to correctly measure the maximum speed of air exit from the lungs using a peak flowmeter, and perform inhalations. And, of course, you need to follow all the prescriptions of doctors.

COPD is a slowly progressive pathology that eventually leads to a deterioration in the general condition and even death. Treatment can only slow down these processes, and the adequacy of its use directly determines how much more a person can keep working. Sometimes periods of remission last up to several years, so these patients live for decades.

» , most of us will not be told anything at all- unlike, for example, the other four letters that form "AIDS". However, this acronym hides one of the deadliest diseases in the world: chronic obstructive pulmonary disease, a disease that has already affected more than 200 million people around the globe. According to the World Health Organization (WHO), this disease is gradually reaching the third place in terms of mortality in many countries, including Russia. Unfortunately, attention to COPD in our society seems to be insufficient. Everyone is talking about HIV, tuberculosis and pneumonia, oncology of all stripes, but the mortality rate from all these diseases is much lower.

Statistics

Over the past 20 years, the number of people dying from COPD has increased by more than 10%. Officially, the diagnosis was registered in approximately 1.5% of citizens of the Russian Federation. And this indicator significantly reduces the scale of the COPD problem, which is given by an assessment from international experts (conducted on the initiative of the World Health Association together with the Russian Research Institute of Pulmonology). Extrapolation of recent data from an epidemiological study GARD (Global Alliance against Chronic Respiratory Diseases, Global Alliance to Combat Chronic Respiratory Diseases) made it possible to declare that as many as 15% of the total population of our country suffers from COPD. That is, more than 20 million patients in total, and every fifth Russian is in the main group of patients (from 40 to 60 years old). Many of them are unaware of the existence of such a disease and therefore do not take the initiative to undergo a diagnosis. But even among those who have undergone it, approximately 90% of Russian patients do not end up receiving the treatment recommended GOLD (Global initiative for Obstructive Lung Disease, Global COPD Initiative). Thus, it can be emphasized that although the accompanying threat is hidden, including by dry statistics, it exists and has a very devastating effect on the life of the population.

That is why COPD is listed by the World Health Organization as an epidemic of non-communicable diseases. And now every year, on November 17, at the initiative of this organization, World COPD Day is held. During its implementation, spirometry is done for everyone for free - a study of the functions of external respiration, implemented using a special device-spirometer.

Typical medical history

This disease is formed due to the inhalation of harmful particles or gases. Subsequently, the patient's airways gradually narrow due to inflammation of the lung tissues. Most importantly, this narrowing cannot be completely reversed.

COPD usually begins to develop at a young age. The process of development sometimes stretches for decades. All this time, a person may not consider himself sick. Potential victims of COPD most often do not pay attention to symptoms such as shortness of breath, cough, sputum. If they still decide to be treated, then they are treated later, as a rule, for cough, and not for COPD.

The problem is also that COPD, due to systematic respiratory disorders in a patient, provokes the development of many other diseases, for example, cardiovascular pathologies. The latter then often indicate the main cause of death, while COPD was the true cause.

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Diagnostics and therapy

At the same time, experts call the differential (separating) diagnosis of COPD and bronchial asthma both important and difficult.

A syndrome of overlap or combination of COPD with asthma is known. However, if the occurrence of asthma is usually associated with allergic reactions, then for COPD the main (80-90% of cases) risk factor is smoking, and in the second and subsequent stages - the systematic inhalation of harmful particles or gases.

As with asthma, bronchodilators are considered the main pharmacological drugs for the treatment of COPD - special bronchodilators, usually produced in inhalers or tablets. They are used as needed (for example, with shortness of breath) or for prevention. Moreover, if the body of an asthmatic usually reacts very positively to treatment with bronchodilators, then this cannot be said in the case of COPD. How can not be called a drug that can completely and completely cure the disease. Experts indicate that the most effective means of combating the disease is only a complete and timely cessation of smoking.

Methods for classifying patients with COPD into groups, as well as methods for their further treatment, vary from country to country.

Some (for example, this is customary in Spain, the Czech Republic and a number of other countries) more often use a phenotypic approach with grouping patients according to COPD phenotypes. The key phenotypes here are COPD itself “in its purest form” and its various combinations with other pulmonary diseases (asthma, bronchitis, emphysema, and others).

Other countries, notably the United States of America, prefer the outdated spirometry approach based on pulmonary function analysis. It is the attitude FEV1 (the volume of air exhaled by the patient in the first second with the most rapid and strong, or "forced" exhalation) to FZhEL (total volume of air in such an exhalation) determines the presence of COPD (characterized by the ratio FEV1/FVC below 70% of normal) along with the degree (from mild to extremely severe), according to which patients are classified.

The most modern is considered to be an integrated approach that takes into account the number of exacerbations, as well as symptoms and spirometry. It has already been fixed both in the latest GOLD recommendations and in our country. Now Russian Respiratory Society prepares a new version of the recommendations, which for the most part coincide with the recommendations of world experts.

Perspective: a universal algorithm?

Not so long ago International j external of COPD (the main special publication on COPD in the world) noted as a particularly promising work of domestic researchers (in particular, the teams of the Moscow State Medical University named after I.M. Sechenov and the Moscow State Medical University named after A.I. Evdokimov). They proposed a universal and rather simple scheme of COPD therapy, calculated simultaneously for two areas of medical practice: general practitioners and narrow-profile pulmonary specialists - pulmonologists.

Own clinical algorithm of drug therapy was formed by the authors in a long-term work with patients with stable COPD. According to the proposed scheme, patients are treated with long-acting bronchodilators and short-acting drugs on demand. If a FEV1 when spirometry is at least 50% of the proper value (it is considered individually from the ratio of height, weight and age of the patient), then the patient is offered treatment with one long-acting drug. Symptoms are addressed by a specific COPD Patient Assessment that includes eight questions about symptoms (specifically, cough, sputum, shortness of breath, and anxiety and other psychological disturbances). If the patient scored more than ten points on the test, or his FEV1 was less than 50% of the norm, then the patient is recommended combined bronchodilators.

And in cases where the above treatment did not give any significant result in three months, the therapist is recommended to redirect the patient to a pulmonologist for a detailed examination of the lungs by endotyping (analysis of endotypes - internal signs of pathological inflammatory processes in the body). The latter, according to the plan of our specialists, implies special attention of the pulmonologist to three key endotypes (each of which, in turn, corresponds to a certain type of inflammation - neutrophilic, eosimophilic and small cell).

The authors themselves reveal their vision of the method in a positive way: “Since there are too few pulmonologists in Russia to successfully fight the scale of the COPD epidemic on their own, we decided to take on the very mechanism of prescribing therapy. Our main goal was to obtain a scheme that would be easy for doctors to apply in daily practice. Moreover, we tried to choose the simplest markers, like a blood test or sputum. Thus, everything that we now offer for research is practically feasible if the simplest laboratory procedures are followed. And now it remains only to continue to monitor the medical application of our algorithm. Even before the official publication ofInternational Journal of COPD we have received a lot of feedback on the successful application of the approach in a number of countries, for example in Bulgaria and Serbia. It looks very comfortable. After all, it is easy to draw a complex scheme, but a simple, but effective one is just as difficult. And we hope that the algorithm will also become useful for doctors in our country.”

Title illustration: Maria Frolova

Airway obstruction is a specific clinical syndrome resulting from impaired patency of the bronchial tree. As a result, the flow of air into the lungs is limited and the main symptom develops - shortness of breath.

Characteristics of the syndrome

Obstruction, in addition to the main symptom - shortness of breath, has other clinical characteristics:

• stridor breathing - heavy, noisy;
• suprasternal retractions - due to retraction, the volume of the neck decreases;
• retraction (reduction) of the chest;
• hoarse cry;
• croupy cough.

If the upper airway obstruction is progressive, blueness (cyanosis) develops, leading to bradycardia (changes in heart rate) and threatening to stop breathing.

Broncho-obstructive syndrome can accompany a number of diseases that are not necessarily associated with pathologies of the respiratory system:

• bronchiolitis;
• pneumonia;
• obstructive bronchitis (acute or);
• heart failure;
• organophosphate poisoning;
• tumors of the tracheobronchial tree.

In bronchial asthma and in the clinical picture, violations of bronchial patency predominate. With pneumonia, these symptoms are hidden, which does not prevent them from negatively affecting the development of the underlying disease of various complications.

Types of airway obstruction

The etiology of this disease can be varied. Airway obstruction mechanisms include:

• violation of the secretory function of the bronchi, leading to increased accumulation of mucus (hypersecretion);
• bronchial dyskinesia (disturbance of work);
• blockage of the lumen of the bronchi with purulent crusts;
• swelling or thickening of the walls of the bronchi and bronchioles (hyperplasia), their infiltration, swelling of the glands;

• fibrosis of the walls of bronchioles (connective tissue grows, scars appear);
• intraluminal polyposis;
• spasm or thickening of the muscular membrane of the bronchi;
• inhalation of foreign bodies and other causes.

Broncho-obstructive syndrome, as a rule, develops as a result of degenerative and dystrophic changes in the bronchi or inflammatory processes.

Obstruction is often caused by the ingestion of blood, meconium (the first feces of the fetus), mucus, and milk into the respiratory tract. Foreign fluids are removed by suction (aspiration).

Although rare, the cause of bronchial obstruction in children after childbirth may be the prolapse of the vocal fold, when it protrudes, is not covered by tissues. Its cause is traumatic delivery or unsuccessful intubation. The listed variants of obstruction are called intraluminal (intraluminal).

Another type of aspiration obstruction is intramural obstruction. It may be due to:

• papilloma;
• subglottic stenosis;
• hematoma (accumulation of blood);
• laryngeal membrane.

The cause of the obstruction may also be external - compression (estradural obstruction) as a result of cystic hygroma (fluid accumulation), goiter (enlargement of the thyroid gland) or vascular goiter.

A disease such as obstructive syndrome is often diagnosed in children under 3 years of age, for which there are several objective reasons. Firstly, the anatomical features of the respiratory system of children of this age are such that the lumen of the bronchi in children is quite narrow, and therefore they are at risk of blockage. Secondly, the child's immune system is still at the stage of formation, and therefore the inflammatory processes of the respiratory system are more severe than in adults.

Infectious causes of obstructive syndrome and risk factors

In most cases, bronchial obstruction occurs and develops against the background of acute respiratory diseases caused by infections, and also as a complication after influenza, parainfluenza, adenovirus.

Also, the cause of the disease is infectious-inflammatory or allergic diseases - asthma, pneumonia. Occasionally, blockage of the bronchi is a sign of more dangerous diseases, such as cystic fibrosis or pulmonary tuberculosis.

External causes that can lead to the development of obstructive syndrome should also include smoking. Tobacco smoke, regularly entering the bronchi, carries with it a large number of chemical compounds that disrupt the synthesis of antibodies, which, in turn, leads to suppression of the immune system. After inhalation of cigarette smoke, the respiratory system is subjected to constant stress and irritation, and this is fraught with serious complications in the case of inflammatory diseases of the respiratory system.

Among the negative factors affecting the bronchi and lungs is the unfavorable environmental situation. Dust and gas contamination of the air with phosgene, ammonia, acid fumes, sulfur dioxide, chlorine also contribute to the development of inflammatory processes in the bronchi.

Bronchiolitis and obstructive bronchitis

The most common cause of both bronchiolitis and obstructive bronchitis is a viral infection combined with an allergic component. It can be parainfluenza, a respiratory virus or rhinoviruses, as well as chlamydia and mycoplasma. In bronchiolitis, bronchioles and small bronchi are affected, which is not observed in obstructive bronchitis. The air permeability is disturbed, it happens abruptly, as in the case of an attack of bronchial asthma.

Obstructive bronchitis is more common in children aged 3-6 years, while bronchiolitis is mainly diagnosed in children from the first months of life.

Symptoms and clinical signs:

• sudden and abrupt onset;
• hyperthermia;
• anxiety;
• breathing in children is carried out with the help of auxiliary muscles;
• tapping the lungs gives a "box" sound;
• wet, finely bubbling rales are heard;

Choking, acutely and progressively developing, is a clear symptom of an acute attack of bronchial asthma. The patient appears:

• dyspnea;
• difficult, in some cases wheezing breathing;
• spasmodic cough;
• the attack is characterized by a decrease in the rate of exhalation.

If the cause of suffocation is foreign bodies

When a foreign body enters the trachea, a cough suddenly occurs, breathing becomes frequent and difficult, individual sections of the chest are drawn in, and acrocyanosis is also pronounced. The patient tries to ease breathing by taking a comfortable position. When listening, a “box sound” is heard over the entire surface of the lungs, breathing is equally weakened on both sides.

Especially dangerous are foreign bodies stuck in the part of the trachea division: when inhaling or exhaling, they can move and block the entrance to the bronchi. The patient's condition worsens, shortness of breath increases, cyanosis increases.

Asphyxiation as a result of airway obstruction is especially dangerous in children in all cases where the coughing mechanism is impaired: with anesthesia, poisoning, CNS depression. Aspiration ("sucking") of food occurs mainly in 2-3-month-old children. After food enters the respiratory tract, mucosal edema develops in them, and when gastric juice is aspirated, toxic edema joins it. It manifests itself in a rapidly increasing suffocation, pronounced and bronchospasm and laryngospasm, turning blue, lowering blood pressure.

In the case of mechanical asphyxia of this kind, a person needs to be given emergency assistance - quickly remove the foreign body and eliminate the bronchioles. If the child is less than 1 year old, they put him on his arm down with his stomach so that his head is lower than the body, after which they turn over and make several pushes into the chest area (about 1 finger below the nipples, in the lower third of the chest). In the case when a foreign body can be seen, it is pulled out with tweezers, kartsang, Magill's forceps. Liquid vomit and food debris are removed from the oropharynx by suction.

In no case should a foreign body be examined and removed from a child with a blind finger - it can be pushed even further, which threatens with complete bronchial obstruction.

Extraction of a foreign body is best done in a hospital setting, while transporting a patient with an obstruction must be categorically in a sitting position.

Obstruction in pulmonary edema

Pulmonary edema develops as a result of a pathological increase in the volume of extravascular fluid in them. Distinguish between cardiogenic and non-cardiogenic edema. Cardiogenic occurs in the case of left ventricular failure due to arrhythmias, mitral valve defects, myocarditis.