Host disease. Chronic obstructive pulmonary disease (COPD) - symptoms and treatment. Why hobles is singled out as a separate nosology

Chronic obstructive pulmonary disease, or COPD, is one of the most common health problems in humans today. This is due to the deplorable state of our environment.

The quality of the air that a person inhales has noticeably deteriorated, which cannot but affect the health of the organs responsible for the process of air exchange.

What is COPD?

COPD - is a general term for many respiratory diseases, such as, and. May also include other respiratory diseases.

The most common causative factor is smoking.

Inflammatory processes in the lungs, provoked by the influence of exhaust, various impurities of atmospheric air, cigarette smoke (passive smoking is not excluded) are fundamental processes for the development of COPD.

According to the statistics of the World Health Organization (WHO) - Chronic obstructive pulmonary disease in adults, occupies the fourth position in the mortality rate.

People suffering from this disease die from developing complications such as:

• respiratory failure;
• cardiovascular disorders (which COPD provokes).

This disease, with proper diagnosis in the early stages of development, is fully treated, using a number of actions to prevent this disease, it is possible to prevent its development.

According to µb 10 are coded asJ44.0 - if COPD develops in conjunction with affecting the lower respiratory tract. Code for the International Classification of Diseases 10 helps to systematize and track statistics for each disease.

COPD microbial 10 with code J44.9 is reflected in case of undetermined genesis.

Signs of COPD

Symptoms and signs may include:

• fatigue;
• shortness of breath
• paroxysmal nocturnal dyspnea (PND);
• wheezing when breathing;
• cough with sputum (mucous and / or purulent);
• fever
• chest pain.

Risk factors

• For the most part, the most harmful and frequently encountered factor is smoking. Tobacco smoke and cigarette tar adversely affect all respiratory organs. Passive smoking is absolutely no less harmful, but on the contrary, even more dangerous. A person who is close to a smoker consumes a much higher amount of smoke than himself. The category of people who smoke endangers not only themselves, but also the people around them. Among the group of heavy smokers, approximately 15-20% of the clinical manifestations of COPD are diagnosed.
• genetic predisposition. An example of disorders leading to this disease is a condition such as:
  • alpha-antitrypsin deficiency (in people who have never smoked and increases the risk for the disease in smokers);
• bacteria. The exacerbation of the disease in question can be influenced by bacteria of such groups as Haemophilus influenza, Moraxella catarrhalis. Another type of bacteria that affects the development of the disease are streptococcus pneumoniae;
• Occupational hazard (dust, fumes of various acids and alkalis, harmful masses released from chemicals);
• Bronchial hyperreactivity.

Pathogenesis

With prolonged exposure to any risk factor on the human body, inflammation of the walls of the bronchi of a chronic nature develops. The most likely damage to the distal (located in maximum proximity to the alveoli and lung parenchyma).

The production and excretion of mucus is impaired. Small bronchi get clogged and various infections develop against this background. Muscle cells die and are replaced by connective tissue. As a result, emphysema develops - the lung tissue overflows with air because of this, their elasticity decreases markedly.

From bronchi damaged by emphysema, air is released with great difficulty. The volume of air is reduced as gas exchange is not in proper quality. As a result, one of the main symptoms manifests itself - shortness of breath. With exertion or just walking, shortness of breath creates an increasing effect.

As a result of respiratory failure, hypoxia develops. With prolonged exposure to hypoxia on the human body, the lumens of the pulmonary vessels decrease, which leads to (in the course of this disease, an increase and expansion of the right sections of the heart develops).

Classification

This disease is classified according to the severity of the course and the clinical picture.

• Latent, almost impossible to recognize, has no pronounced symptoms.
• Medium, manifested cough in the morning (with phlegm or dry). Shortness of breath more often with minor physical exertion.
• Severe course, occurs in a chronic course and is accompanied by bouts of severe coughing with sputum production, frequent shortness of breath.
• The fourth stage can be fatal, characterized by persistent cough, shortness of breath even at rest, a rapid decrease in body weight.

Aggravation

Let's take a look at what a COPD exacerbation is.

This is a condition in which the course of the disease is aggravated. The clinical picture worsens, shortness of breath increases, coughing attacks become more frequent and intensify. There is a general depression of the body. The treatment that was used earlier does not bring a positive effect. In most cases, the patient needs hospitalization, revision and adjustment of the previously prescribed treatment.

A state of exacerbation can develop against the background of a previous disease (ARI, bacterial infections). A common upper respiratory tract infection for a person with COPD is a condition in which the functionality of the lungs is greatly reduced. The normalization period is delayed for a longer time.

A condition such as an exacerbation of COPD is diagnosed based on symptomatic manifestations, patient complaints, hardware and laboratory studies).

How COPD affects the body

Any disease of a chronic nature has a negative impact on the body in general. So COPD leads to disorders that seem to have nothing to do with the physiological structure of the lungs.

• Violation of the functions of the intercostal muscles (participate in the act of breathing), muscle atrophy may occur;
• Decreased glomerular filtration of the kidneys;
• The risk rises;
• Decreased memory;
• Tendency to depression;
• Decreased protective functions of the body.

Diagnostics

• Blood analysis. This analysis is mandatory for diagnosing COPD. In the acute stage, an increased, neutrophilic leukocytosis can be traced. In patients with developing hypoxia, there is an increase in the number of red blood cells, a low ESR and increased hemoglobin.
• Sputum analysis, what it is - this is the most important procedure for patients who produce sputum. The results of such an analysis can provide answers to many questions. The nature of inflammation, the degree of its severity. You can also trace the presence of atypical cells, in such diseases it is necessary to make sure that there is no oncological disease.

Sputum in patients with COPD is mucous, and in the acute stage it can be purulent. The viscosity of sputum increases, as does its quantity, the color becomes greenish with streaks of yellow.

Sputum analysis is still necessary for such patients, because thanks to it it becomes possible to find out the causative agents of the infection and their resistance to a particular antibacterial drug.

• An X-ray diagnostic method is mandatory for the correct diagnosis and exclusion of other lung diseases (many diseases of the respiratory system can have a similar clinical picture). An x-ray is taken in two positions, frontal and lateral.

During periods of exacerbations, it allows you to exclude or.

• An ECG is used to exclude or confirm such a diagnosis of cor pulmonale (hypertrophy of the muscles of the right heart).

A step test, at the initial stage of the disease, is usually not pronounced and for diagnosis it is necessary to check whether it is present with a slight physical exertion.

Symptoms to look out for

Consider a number of symptoms that you should pay attention to and, if necessary, consult a doctor for a correct diagnosis.

• Often recurrent acute;
• Attacks of excruciating cough, their number gradually increases;
• Cough with constant expectoration;
• Increase in body temperature;
• Attacks of shortness of breath, which increases with the course of the disease.

Is it possible to be active with a disease such as COPD

The disease in question certainly reduces the quality of life, but it must be remembered that it is important not to forget - an active lifestyle will help in the treatment of the disease and improve the psycho-emotional state.

You need to start physical activity very carefully and gradually!

With particular caution, a group of people who, before the illness, did not lead a very active lifestyle, should start training.

Start with classes lasting no more than ten minutes, it is worth increasing the load slowly with several workouts per week.

Do your daily household chores, this way of physical impact on the body will be gentle options for patients with this disease. Walk up the stairs, take a walk in the fresh air, do household chores (wash the floor, windows, dishes), take on part of the duties of the yard (sweep, plant and care for plants).

Before performing the planned actions, do not forget about the warm-up.

Warming up promotes safe exercise, it slowly and gradually prepares the body for a more serious load. An important point will be considered that the warm-up will help increase the frequency of respiratory movements, moderate heart contractions, and normalize body temperature.

Treatment

There are several basic principles for the treatment of this disease.

• Complete rejection of addiction - smoking;
• Medicamentous method of treatment, with the help of drugs of various groups of orientation;
• Vaccination against infections caused by pneumococcus and;
• Moderate physical activity has a significant effect;
• Oxygen inhalation is used in severe respiratory failure as a way to prolong life.

Groups of drugs used in the treatment

• Bronchodilators (atrovent, salbutamol, aminofillin);
• Hormonal preparations from the group of corticosteroids (symbicort, seretide);
• Drugs that promote sputum discharge (ambrobene, codelac);
• Immunomodulating agents (immunal, Derinat);
• Phosphodiesterase 4 inhibitors (Daxas, Dalisp).

COPD treatment with folk remedies

Treatment of some symptoms of this disease can be carried out using traditional medicine recipes.

It is important to remember the need to consult with a specialist! Treatment with alternative medicine is an addition to the treatment that the doctor must prescribe.

Steam inhalation

This procedure is carried out at home with ease. You will need a container for the solution, a towel and a little time.

• For one liter of hot water (90-100 degrees), 5-6 drops of pine essential oil, eucalyptus oil and chamomile.
• Inhalations with the addition of sea salt (a liter of boiling water, 2-3 tablespoons of sea salt).
• Inhalations of the collection of mint, calendula and oregano herbs (2 tablespoons of the collection per liter of boiling water).

Also, when treating chronic pulmonary obstruction, you can do.

Breathing exercises

Breathing exercises, activities aimed at strengthening the muscles of the lungs and intercostal muscles have a very beneficial effect.

Gymnastics option. On inspiration, raise your hands up, and on exhalation, tilt the body and arms to the left, on the next breath, raise your hands up, and tilt the body and arms to the right.

Chronic obstructive pulmonary disease (COPD)- symptoms and treatment

What is chronic obstructive pulmonary disease (COPD)? We will analyze the causes of occurrence, diagnosis and methods of treatment in the article of Dr. Nikitin I. L., an ultrasound doctor with an experience of 25 years.

Definition of disease. Causes of the disease

Chronic obstructive pulmonary disease (COPD)- a disease that is gaining momentum, advancing in the ranking of causes of death for people over 45 years old. To date, the disease is in 6th place among the leading causes of death in the world, according to WHO forecasts in 2020, COPD will take the 3rd place.

This disease is insidious in that the main symptoms of the disease, in particular, with smoking, appear only 20 years after the start of smoking. It does not give clinical manifestations for a long time and can be asymptomatic, however, in the absence of treatment, airway obstruction imperceptibly progresses, which becomes irreversible and leads to early disability and a reduction in life expectancy in general. Therefore, the topic of COPD seems to be especially relevant today.

It is important to know that COPD is a primary chronic disease in which early diagnosis is important in the initial stages, since the disease tends to progress.

If the doctor has diagnosed Chronic Obstructive Pulmonary Disease (COPD), the patient has a number of questions: what does this mean, how dangerous is it, what to change in lifestyle, what is the prognosis for the course of the disease?

So, chronic obstructive pulmonary disease or COPD is a chronic inflammatory disease with damage to the small bronchi (airways), which leads to respiratory failure due to narrowing of the bronchial lumen. Over time, emphysema develops in the lungs. This is the name of a condition in which the elasticity of the lungs decreases, that is, their ability to contract and expand during breathing. At the same time, the lungs are constantly as if in a state of inhalation, there is always a lot of air in them, even during exhalation, which disrupts normal gas exchange and leads to the development of respiratory failure.

Causes of COPD are:

• exposure to harmful environmental factors;
• smoking;
• occupational hazard factors (dust containing cadmium, silicon);
• general environmental pollution (car exhaust gases, SO 2 , NO 2);
• frequent respiratory tract infections;
• heredity;
• deficiency of α 1 -antitrypsin.

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of chronic obstructive pulmonary disease

COPD- a disease of the second half of life, often develops after 40 years. The development of the disease is a gradual long process, often imperceptible to the patient.

Appeared forced to consult a doctor dyspnea and cough- the most common symptoms of the disease (shortness of breath is almost constant; cough is frequent and daily, with sputum in the morning).

The typical COPD patient is a 45-50 year old smoker who complains of frequent shortness of breath on exertion.

Cough- one of the earliest symptoms of the disease. It is often underestimated by patients. In the initial stages of the disease, the cough is episodic, but later becomes daily.

Sputum also a relatively early symptom of the disease. In the first stages, it is released in small quantities, mainly in the morning. Slimy character. Purulent copious sputum appears during an exacerbation of the disease.

Dyspnea occurs in the later stages of the disease and is noted at first only with significant and intense physical exertion, increases with respiratory diseases. In the future, shortness of breath is modified: the feeling of lack of oxygen during normal physical exertion is replaced by severe respiratory failure and intensifies over time. It is shortness of breath that becomes a common reason to see a doctor.

When can COPD be suspected?

Here are a few questions of the COPD early diagnosis algorithm:

• Do you cough several times a day? Does it bother you?
• Does coughing produce phlegm or mucus (often/daily)?
• Do you get short of breath faster/more often than your peers?
• Are you over 40?
• Do you smoke or have you ever smoked before?

If more than 2 questions are answered positively, spirometry with a bronchodilator test is necessary. When the test indicator FEV 1 / FVC ≤ 70, COPD is suspected.

Pathogenesis of chronic obstructive pulmonary disease

In COPD, both the airways and the tissue of the lung itself, the lung parenchyma, are affected.

The disease begins in the small airways with blockage of their mucus, accompanied by inflammation with the formation of peribronchial fibrosis (densification of the connective tissue) and obliteration (overgrowth of the cavity).

With the formed pathology, the bronchitis component includes:

The emphysematous component leads to the destruction of the final sections of the respiratory tract - the alveolar walls and supporting structures with the formation of significantly expanded air spaces. The absence of a tissue framework of the airways leads to their narrowing due to the tendency to dynamically collapse during expiration, which causes expiratory bronchial collapse.

In addition, the destruction of the alveolar-capillary membrane affects the gas exchange processes in the lungs, reducing their diffuse capacity. As a result, there is a decrease in oxygenation (oxygen saturation of the blood) and alveolar ventilation. Excessive ventilation of insufficiently perfused zones occurs, leading to an increase in the ventilation of the dead space and a violation of the removal of carbon dioxide CO 2 . The area of ​​the alveolar-capillary surface is reduced, but may be sufficient for gas exchange at rest, when these anomalies may not appear. However, during physical activity, when the need for oxygen increases, if there are no additional reserves of gas exchange units, then hypoxemia occurs - a lack of oxygen in the blood.

The hypoxemia that appeared during long-term existence in patients with COPD includes a number of adaptive reactions. Damage to the alveolar-capillary units causes a rise in pressure in the pulmonary artery. Since the right ventricle of the heart under such conditions must develop more pressure to overcome the increased pressure in the pulmonary artery, it hypertrophies and expands (with the development of right ventricular heart failure). In addition, chronic hypoxemia can cause an increase in erythropoiesis, which subsequently increases blood viscosity and exacerbates right ventricular failure.

Classification and stages of development of chronic obstructive pulmonary disease

Complications of chronic obstructive pulmonary disease

Complications of COPD are infections, respiratory failure, and chronic cor pulmonale. Bronchogenic carcinoma (lung cancer) is also more common in patients with COPD, although it is not a direct complication of the disease.

Respiratory failure- the state of the external respiration apparatus, in which either the maintenance of the O 2 and CO 2 tension in the arterial blood at a normal level is not ensured, or it is achieved due to the increased work of the external respiration system. It manifests itself mainly as shortness of breath.

Chronic cor pulmonale- an increase and expansion of the right parts of the heart, which occurs with an increase in blood pressure in the pulmonary circulation, which, in turn, has developed as a result of pulmonary diseases. The main complaint of patients is also shortness of breath.

Diagnosis of chronic obstructive pulmonary disease

If patients have cough, sputum production, shortness of breath, and risk factors for chronic obstructive pulmonary disease have been identified, then they should all be assumed to have a diagnosis of COPD.

In order to establish a diagnosis, data are taken into account clinical examination(complaints, anamnesis, physical examination).

Physical examination may reveal symptoms characteristic of long-term bronchitis: "watch glasses" and / or "drumsticks" (deformity of the fingers), tachypnea (rapid breathing) and shortness of breath, a change in the shape of the chest (a barrel-shaped form is characteristic of emphysema), small its mobility during breathing, the retraction of the intercostal spaces with the development of respiratory failure, the descent of the boundaries of the lungs, the change in percussion sound to a box sound, weakened vesicular breathing or dry wheezing, which increase with forced expiration (that is, a quick exhalation after a deep breath). Heart sounds can be heard with difficulty. In the later stages, diffuse cyanosis, severe shortness of breath, and peripheral edema may occur. For convenience, the disease is divided into two clinical forms: emphysematous and bronchitis. Although in practical medicine, cases of a mixed form of the disease are more common.

The most important step in diagnosing COPD is analysis of respiratory function (RF). It is necessary not only to determine the diagnosis, but also to establish the severity of the disease, draw up an individual treatment plan, determine the effectiveness of therapy, clarify the prognosis of the course of the disease and assess the ability to work. Establishing the percentage of FEV 1 / FVC is most often used in medical practice. A decrease in forced expiratory volume in the first second to the forced vital capacity of the lungs FEV 1 / FVC up to 70% is the initial sign of airflow limitation even with a preserved FEV 1 > 80% of the proper value. A low peak expiratory airflow rate that does not change significantly with bronchodilators also favors COPD. With newly diagnosed complaints and changes in respiratory function, spirometry is repeated throughout the year. Obstruction is defined as chronic if it occurs at least 3 times per year (regardless of treatment), and COPD is diagnosed.

FEV monitoring 1 is an important method for confirming the diagnosis. Spireometric measurement of FEV 1 is carried out repeatedly over several years. The norm of the annual fall in FEV 1 for people of mature age is within 30 ml per year. For patients with COPD, a typical indicator of such a drop is 50 ml per year or more.

Bronchodilator test- primary examination, in which the maximum FEV 1 is determined, the stage and severity of COPD are established, and bronchial asthma is excluded (if the result is positive), the tactics and volume of treatment are selected, the effectiveness of therapy is assessed and the course of the disease is predicted. It is very important to distinguish COPD from bronchial asthma, since these common diseases have the same clinical manifestation - broncho-obstructive syndrome. However, the approach to treating one disease is different from another. The main distinguishing feature in the diagnosis is the reversibility of bronchial obstruction, which is a characteristic feature of bronchial asthma. It has been found that people with a diagnosis of CO BL after taking a bronchodilator, the percentage increase in FEV 1 - less than 12% of the original (or ≤200 ml), and in patients with bronchial asthma, it usually exceeds 15%.

Chest x-rayhas an auxiliary sign chenie, since changes appear only in the later stages of the disease.

ECG can detect changes that are characteristic of cor pulmonale.

echocardiography necessary to detect symptoms of pulmonary hypertension and changes in the right heart.

General blood analysis- it can be used to evaluate hemoglobin and hematocrit (may be increased due to erythrocytosis).

Determining the level of oxygen in the blood(SpO 2) - pulse oximetry, a non-invasive study to clarify the severity of respiratory failure, as a rule, in patients with severe bronchial obstruction. Blood oxygen saturation of less than 88%, determined at rest, indicates severe hypoxemia and the need for oxygen therapy.

Treatment of chronic obstructive pulmonary disease

Treatment for COPD helps:

• reduction of clinical manifestations;
• increasing tolerance to physical activity;
• prevention of disease progression;
• prevention and treatment of complications and exacerbations;
• improving the quality of life;
• reduction in mortality.

The main areas of treatment include:

• weakening the degree of influence of risk factors;
• educational programs;
• medical treatment.

Weakening the degree of influence of risk factors

Smoking cessation is required. This is the most effective way to reduce the risk of developing COPD.

Occupational hazards should also be controlled and reduced using adequate ventilation and air cleaners.

Educational programs

Educational programs for COPD include:

• basic knowledge about the disease and general approaches to treatment with the encouragement of patients to stop smoking;
• training on how to properly use individual inhalers, spacers, nebulizers;
• the practice of self-control using peak flow meters, the study of emergency self-help measures.

Patient education plays an important role in patient management and influences subsequent prognosis (Evidence A).

The method of peak flowmetry enables the patient to independently control the peak forced expiratory volume on a daily basis - an indicator that closely correlates with the FEV 1 value.

Patients with COPD at each stage are shown physical training programs in order to increase exercise tolerance.

Medical treatment

Pharmacotherapy for COPD depends on the stage of the disease, the severity of symptoms, the severity of bronchial obstruction, the presence of respiratory or right ventricular failure, and concomitant diseases. Drugs that fight COPD are divided into drugs to relieve an attack and to prevent the development of an attack. Preference is given to inhaled forms of drugs.

To stop rare attacks of bronchospasm, inhalations of short-acting β-agonists are prescribed: salbutamol, fenoterol.

Preparations for the prevention of seizures:

• formoterol;
• tiotropium bromide;
• combined preparations (berotek, berovent).

If the use of inhalation is not possible or their effectiveness is insufficient, then theophylline may be necessary.

With a bacterial exacerbation of COPD, antibiotics are required. Can be used: amoxicillin 0.5-1 g 3 times a day, azithromycin 500 mg for three days, clarithromycin SR 1000 mg 1 time per day, clarithromycin 500 mg 2 times a day, amoxicillin + clavulanic acid 625 mg 2 times a day, cefuroxime 750 mg twice a day.

Glucocorticosteroids, which are also administered by inhalation (beclomethasone dipropionate, fluticasone propionate), also help relieve symptoms of COPD. If COPD is stable, then the appointment of systemic glucocorticosteroids is not indicated.

Traditional expectorants and mucolytics have little positive effect in patients with COPD.

In severe patients with a partial pressure of oxygen (pO 2) of 55 mm Hg. Art. and less at rest, oxygen therapy is indicated.

Forecast. Prevention

The prognosis of the disease is affected by the stage of COPD and the number of recurrent exacerbations. At the same time, any exacerbation negatively affects the general course of the process, therefore, the earliest possible diagnosis of COPD is highly desirable. Treatment of any exacerbation of COPD should begin as early as possible. It is also important to fully treat the exacerbation, in no case is it permissible to carry it “on the legs”.

Often people decide to see a doctor for medical help, starting from the II moderate stage. At stage III, the disease begins to have a rather strong effect on the patient, the symptoms become more pronounced (increased shortness of breath and frequent exacerbations). At stage IV, there is a noticeable deterioration in the quality of life, each exacerbation becomes a threat to life. The course of the disease becomes disabling. This stage is accompanied by respiratory failure, the development of cor pulmonale is not excluded.

The prognosis of the disease is affected by patient compliance with medical recommendations, adherence to treatment and a healthy lifestyle. Continued smoking contributes to the progression of the disease. Smoking cessation leads to slower progression of the disease and slower decline in FEV 1 . Due to the fact that the disease has a progressive course, many patients are forced to take drugs for life, many require gradually increasing doses and additional funds during exacerbations.

The best means of preventing COPD are: a healthy lifestyle, including good nutrition, hardening of the body, reasonable physical activity, and the exclusion of exposure to harmful factors. Smoking cessation is an absolute condition for the prevention of exacerbations of COPD. Existing occupational hazards, when diagnosing COPD, are a sufficient reason to change jobs. Preventive measures are also avoiding hypothermia and limiting contact with those with SARS.

In order to prevent exacerbations, patients with COPD are shown annual influenza vaccination. People with COPD aged 65 years or older and patients with an FEV1< 40% показана вакцинация поливалентной пневмококковой вакциной.

Among the pathologies that affect the organs of the respiratory system, obstructive lesions stand apart, due to the specificity of clinical manifestations. For this reason, these diseases are not well known, and patients are often frightened, and rightly so, when they are diagnosed with COPD. What is it and how is it treated, our experts will tell.

Under the obscure abbreviation COPD is chronic obstructive pulmonary disease - a progressive disease characterized by irreversible processes in the tissues of all parts of the respiratory system.

According to the standards of the World Health Organization, the COPD code set for ICD 10 means that according to the International Classification of Diseases of the tenth revision, the disease belongs to the category of respiratory organs.

Activities to reduce the number of factors that reduce the risk of developing COPD are considered a priority by WHO experts.

To understand how serious such lung damage is for health, it is not necessary to delve into the underlying processes that occur during the development of COPD. What kind of disease it is becomes clear from his prognosis - there is practically no chance of recovery.

Clinical picture

A characteristic feature of COPD is the modification of the structure of the bronchi, as well as lung tissues and blood vessels. As a result of exposure to irritating factors, inflammatory processes occur on the bronchial mucosa, which reduce local immunity.

Against the background of inflammation, the production of bronchial mucus becomes more intense, but its viscosity increases, making it difficult to remove the secretion naturally. For bacteria, such stagnation is the best stimulant for development and reproduction.

Due to bacterial activity, the patency of bronchial communications that connect the alveoli with air, the structure of the trachea and lung tissue is gradually disrupted.

Further progress of the disease leads to irreversible processes that cause the development of fibrosis and emphysema:

• swelling of the bronchial mucosa;
• spasms of smooth pulmonary muscles;
• increasing the viscosity of the secretion.

These pathologies are characterized by the proliferation of connective tissue and the abnormal expansion of the air-filled areas of the distal sections.

Provoking factors

Harmful factors are the basis for the occurrence of COPD. One of the main factors causing irreversible lung obstruction is smoking. In vain do smokers think that for many years of adherence to a bad habit, their health remains the same. The prerequisites for the development of the disease are formed more than one day, and not even a year - most often, a disappointing diagnosis is made to those who are over 40.

Passive smokers are also at risk.

Inhalation of tobacco smoke not only irritates the respiratory mucosa, but also gradually destroys their tissues. Loss of elasticity of the alveolar fibers is one of the first signs of developing obstruction. However, at this stage, the symptoms of the disease are not sufficiently pronounced for a sick person to turn to medicine for help.

Additional triggers for COPD:

• infectious lesions of the respiratory tract;
• inhalation of harmful substances or gases;
• pathogenic impact of the professional environment;
• genetic predisposition to lung tissue damage by elastase, due to a deficiency of the alpha-1-atrypsin protein.

The emergence and development of COPD is not associated with the course of other chronic processes in the organs of the respiratory system. But it refers to a number of occupational pathologies that affect metallurgists, builders, miners, railway workers, workers of pulp and processing enterprises, as well as agricultural workers involved in the processing of grain and cotton.

In terms of the number of deaths, COPD ranks fourth among the main pathologies of the working population.

Features of the classification

The classification of COPD provides for four stages in the development of pathology, determined by the level of complexity of its course. The main criteria for stratification are the presence of characteristic symptoms, as well as forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC), recorded after inhalation with a bronchodilator.

The main stages of the course of COPD:

• light. Functionality of external respiration corresponds to the norm. The ratio between FEV1 and FVC is less than 70% of the norm, which is regarded as a sign of early development of bronchial obstruction. Chronic symptoms may not be observed;
• average. Indicators of the functions of external respiration are less than 80%. The ratio between FEV1 and FVC is less than 70% of the norm, which confirms the progress of obstruction. The cough gets worse. There are other characteristic symptoms of the disease;
• heavy. OVF1 indicators are less than 50% of the norm. The ratio of FEV1 and FVC is less than 70% of the norm. Accompanied by a strong cough, copious sputum and significant shortness of breath. There are attacks of exacerbations;
• extremely heavy. The functionality of external respiration is provided by less than 30%. It is characterized by the appearance of respiratory failure and the development of cor pulmonale with an abnormal expansion of the right-sided heart.

The only thing that a sick person can do is to diligently follow all the recommendations of doctors in order to slow down the progress of the disease and improve overall well-being. The best thing a healthy person can and should do is to prevent the occurrence of disease by making efforts to ensure preventive measures.

Symptoms of chronic obstructive pulmonary disease

The characteristic signs of the development of COPD appear at the stage of moderate severity. Before the onset of the later stages, the disease proceeds in a latent form and may be accompanied by a small episodically appearing cough. As the pathology develops, the secretion of mucous sputum joins the cough.

Approximately ten years after the onset of early symptoms, shortness of breath develops - a feeling of lack of air accompanies physical activity. Over the years, the intensity of shortness of breath increases. In severe COPD, shortness of breath causes a person to stop every hundred meters. With an extremely severe form of the disease, the patient is not able not only to leave the house on his own, but also to change clothes.

Severe symptoms of COPD occur when the development of the pathology reaches a severe phase:

• coughing fits become long and regular;
• the volume of secreted mucous sputum increases significantly, with the onset of an extremely severe stage, pus appears in the sputum;
• shortness of breath occurs even at rest.

Pathological processes characteristic of the course of COPD lead to pathophysiological changes in all parts of the respiratory system and are accompanied by systemic manifestations in the form of skeletal muscle dysfunction and loss of muscle mass.

Clinical forms

Depending on the intensity of expression of the symptoms of the disease and their characteristics, there are two clinical forms of COPD - bronchial and emphysema.

The main criteria for determining the clinical form are applicable only in the last stages of the development of pathology:

• predominance of cough, shortness of breath;
• severity of bronchial obstruction;
• the severity of hyperventilation of the lungs - weak or strong;
• the color of cyanosis is blue or pinkish gray;
• the period of formation of the cor pulmonale;
• the presence of polycythemia;
• severity of cachexia;
• age at which death is possible.

Loss of physical performance, as well as disability, is an inevitable consequence of the progress of COPD.

Treatment of chronic obstructive disease:

Due to the fact that timely diagnosis is not possible, COPD treatment is most often started at the onset of the moderate or severe stage. The collection of anamnesis provides for the identification of individual risk factors - the determination of the smoker's index, the presence of infections.

For differential diagnosis with bronchial asthma, parameters characterizing shortness of breath when exposed to a provocative stimulus are studied.

To confirm the diagnosis, spirometry is performed - the measurement of volumetric and speed characteristics of breathing to determine its functionality.

As additional diagnostic measures apply:

• sputum cytology,
• a blood test to detect polycythemia;
• study of the gas composition of the blood;
• x-ray of the lungs;
• bronchoscopy.

Only after the diagnosis has been clarified and the stage and form of the disease determined, treatment is prescribed.

In remission

During periods of decline in acute manifestations of COPD, patients are recommended to use bronchodilators that increase the lumen of the bronchi, mucolytics that thin sputum, as well as inhaled glucocorticosteroids.

With exacerbations

The exacerbation phase of COPD is characterized by a sharp and significant deterioration in the patient's well-being and lasts about two days. To reduce the intensity of the manifestations of the disease, pulmonologists prescribe antibiotic therapy.

The choice of antibiotic preparations is carried out taking into account the type of bacterial flora inhabiting the lungs. Preference is given to drugs that combine penicillins and clavulanic acid, respiratory fluoroquinolones, and second-generation cephalosporins.

In the elderly

The treatment of COPD in the elderly is not only the use of drug therapy, but also the use of folk remedies, providing aerobic exercise and preventive measures, including quitting smoking and correcting respiratory failure.

Alternative methods and means of treating COPD

The application of the recommendations of traditional medicine in COPD has several goals:

• mitigation of symptoms;
• slow pathological progress;
• launch of regeneration mechanisms;
• restoration of vitality of the patient.

The most effective way to influence tissues affected by COPD are inhalations based on plant materials - oregano, mint, calendula, chamomile, as well as essential oils of pine and eucalyptus.

To enhance the therapeutic effect, infusions of anise seeds, pansies, marshmallow, lungwort, plantain, heather, Icelandic moss, thyme and sage are used.

Breathing exercises

Aerobic exercise and a set of breathing exercises form the basis for the rehabilitation of patients with COPD. Thanks to respiratory gymnastics, the weakened intercostal muscles are included in the breathing process, the smooth muscles of the lungs are strengthened, and at the same time, the psychological state of the patient improves.

One of the exercises: inhale through your nose and at the same time raise your arms up, arch your back and take your leg back. Then exhale through your mouth and return to the starting position. When repeating the exercise, then the left, then the right leg is taken alternately.

Exercise is allowed only during the remission period.

COPD prevention

Smoking cessation is considered the basis of COPD prevention, since it is tobacco smoke that provokes the appearance of destructive processes in the lungs.

In addition, the following measures will help eliminate the likelihood of developing COPD:

• compliance with labor protection requirements in hazardous work;
• respiratory protection from contact with substances hazardous to health;
• strengthening immunity - physical activity, hardening, adherence to the daily routine;
• healthy food.

In order to prevent COPD, the World Health Organization has developed a convention to combat the globalization of the distribution of tobacco products. The agreement was signed by representatives of 180 countries.

Update: October 2018

Chronic obstructive pulmonary disease (COPD) is an urgent problem of modern pulmonology, directly related to violations of the ecological well-being of mankind and, first of all, to the quality of inhaled air. This pulmonary pathology is characterized by a continuing violation of the speed of air movement in the lungs with a tendency to progress and involve other organs and systems in the pathological process in addition to the lungs.

COPD is based on inflammatory changes in the lungs, which are realized under the influence of tobacco smoke, exhaust gases and other harmful impurities in the atmospheric air.

The main feature of COPD is the ability to prevent its development and progression.

Today, according to WHO, this disease is the fourth most common cause of death. Patients die from respiratory failure, cardiovascular pathologies associated with COPD, lung cancer and tumors of other localizations.

In general, a person with this disease in terms of economic damage (absenteeism, less efficient work, the cost of hospitalizations and outpatient treatment) exceeds a patient with bronchial asthma by three times.

Who is at risk of getting sick

In Russia, approximately every third man over 70 has chronic obstructive pulmonary disease.

• Smoking is the number one risk for COPD.
• It is followed by hazardous industries (including those with a high dust content of the workplace) and life in industrial cities.
• Also at risk are people over 40 years old.

The predisposing factors for the development of pathology (especially in young people) are genetically determined disorders in the formation of the connective tissue of the lungs, as well as prematurity of infants, in which the lungs do not have enough surfactant to ensure their full expansion with the onset of breathing.

Of interest are epidemiological studies of differences in the development and course of COPD in urban and rural residents of the Russian Federation. For villagers, more severe forms of pathology, purulent and atrophic endobronchitis are more typical. They have chronic obstructive pulmonary disease often combined with other severe somatic diseases. The culprits for this are most likely the lack of access to qualified medical care in the Russian countryside and the lack of screening studies (spirometry) among a wide range of smokers over 40 years old. At the same time, the psychological status of rural residents with COPD does not differ from that of city dwellers, which demonstrates both chronic hypoxic changes in the central nervous system in patients with this pathology, regardless of place of residence, and the general level of depression in Russian cities and villages.

Variants of the disease, stages

There are two main types of chronic obstructive pulmonary disease: bronchitis and emphysematous. The first includes predominantly manifestations of chronic bronchitis. The second is emphysema. Sometimes a mixed variant of the disease is isolated.

1. With emphysematous variant there is an increase in the airiness of the lungs due to the destruction of the alveoli, more pronounced functional disorders that determine the fall in blood oxygen saturation, decreased performance and manifestations of cor pulmonale. When describing the appearance of such a patient, the phrase “pink puffer” is used. Most often, this is a smoking man aged about 60 years with a lack of weight, a pink face and cold hands, suffering from severe shortness of breath and a cough with scanty mucous sputum.
2. Chronical bronchitis manifests itself as a cough with sputum (for three months in the last 2 years). A patient with this pathology variant fits the “blue edema” phenotype. This is a woman or man about 50 years old with a tendency to be overweight, with diffuse cyanosis of the skin, cough with copious mucopurulent sputum, prone to frequent respiratory infections, often suffering from right ventricular heart failure (cor pulmonale).

At the same time, the pathology for a rather long period of time can proceed without manifestations recorded by the patient, developing and progressing slowly.

Pathology has phases of stability and exacerbation. In the first case, the manifestations are unchanged for weeks or even months, the dynamics is monitored only when observed during the year. An exacerbation is marked by a worsening of symptoms for at least 2 days. Frequent exacerbations (from 2 to 12 months or exacerbations resulting in hospitalization due to the severity of the condition), after which the patient leaves with reduced lung functionality, are considered clinically significant. In this case, the number of exacerbations affects the life expectancy of patients.

A separate variant that has been highlighted in recent years has been the association of bronchial asthma/COPD, which developed in smokers who had asthma previously (the so-called overlap syndrome or cross syndrome). At the same time, oxygen consumption by tissues and the adaptive capabilities of the body are further reduced.

The classification of the stages of this disease was canceled by the GOLD expert committee in 2011. The new assessment of severity combined not only the indicators of bronchial patency (according to spirometry, see Table 3), but also the clinical manifestations recorded in patients, as well as the frequency of exacerbations. See table 2

To assess risks, questionnaires are used, see Table 1

Diagnosis

The wording of the diagnosis of chronic obstructive pulmonary disease is as follows:

• chronic obstructive pulmonary disease
• (bronchitis or emphysematous variant),
• mild (moderate, severe, extremely severe) degree of COPD,
• severe clinical symptoms (risk on the questionnaire is greater than or equal to 10 points), unexpressed symptoms (<10),
• rare (0-1) or frequent (2 or more) exacerbations,
• associated pathologies.

Sex differences

In men, COPD is statistically more common (due to smoking habits). At the same time, the frequency of the occupational variant of the disease is the same for both sexes.

• In men, the disease is better compensated by breathing exercises or physical training, they are less likely to suffer from exacerbations and appreciate the quality of life during the illness.
• Women are characterized by increased bronchial reactivity, more pronounced shortness of breath, but better indicators of oxygen saturation of tissues with the same parameters of bronchial tree patency as men.

Symptoms of COPD

Early manifestations of the disease include complaints of cough and (or) shortness of breath.

• Cough often appears in the morning, while this or that amount of mucous sputum is separated. There is an association of coughing with periods of upper respiratory tract infections. Since the patient often associates cough with smoking or the influence of adverse air factors, he does not pay due attention to this manifestation and is rarely examined in more detail.
• The severity of dyspnea can be assessed using the British Medical Council (MRC) scale. It is normal to feel short of breath during strenuous exercise.
  1. Easy shortness of breath 1 degree- this is forced breathing when walking fast or climbing a gentle hill.
  2. Moderate severity and 2 degree- shortness of breath, forcing you to walk more slowly on level ground than a healthy person.
  3. Severe dyspnea grade 3 the state is recognized when the patient suffocates when passing a hundred meters or after a few minutes of walking on level ground.
  4. Very severe grade 4 dyspnea occurs during dressing or undressing, as well as when leaving the house.

The intensity of these manifestations varies from stability to exacerbation, in which the severity of shortness of breath increases, the volume of sputum and the intensity of cough increase, the viscosity and nature of the sputum discharge changes. The progression of the pathology is uneven, but gradually the patient's condition worsens, extrapulmonary symptoms and complications join.

Nonpulmonary manifestations

Like any chronic inflammation, chronic obstructive pulmonary disease has a systemic effect on the body and leads to a number of disorders that are not related to lung physiology.

• Dysfunction of the skeletal muscles involved in breathing (intercostal), muscle atrophy.
• Damage to the inner lining of blood vessels and the development of atherosclerotic lesions, an increase in the tendency to thrombosis.
• Damage to the cardiovascular system arising from the previous circumstance (arterial hypertension, coronary heart disease, including acute myocardial infarction). At the same time, hypertrophy of the left ventricle and its dysfunction are more typical for people with arterial hypertension against the background of COPD.
• Osteoporosis and associated spontaneous fractures of the spine and tubular bones.
• Renal dysfunction with a decrease in glomerular filtration rate, reversible decreases in the amount of urine separated.
• Emotional and mental disorders are expressed in disability disorders, a tendency to depression, a reduced emotional background, and anxiety. At the same time, the greater the severity of the underlying disease, the worse emotional disorders can be corrected. Sleep disturbances and sleep apnea are also recorded in patients. A patient with moderate to severe COPD often demonstrates cognitive impairment (memory, thinking, learning ability suffer).
• In the immune system, there is an increase in phagocytes, macrophages, in which, however, the activity and ability to absorb bacterial cells decreases.

Complications

• Pneumonia
• Pneumothorax
• Acute respiratory failure
• bronchiectasis
• Pulmonary bleeding
• Pulmonary hypertension complicates up to 25% of moderate cases of pulmonary obstruction and up to 50% of severe forms of the disease. Its figures are somewhat lower than in primary pulmonary hypertension and do not exceed 50 mm Hg. Often it is the increase in pressure in the pulmonary artery that becomes the culprit of hospitalization and death of patients.
• Cor pulmonale (including its decompensation with severe circulatory failure). The formation of cor pulmonale (right ventricular heart failure) is undoubtedly influenced by the experience and volume of smoking. In smokers with forty years of experience, cor pulmonale is almost a mandatory accompaniment of COPD. At the same time, the formation of this complication does not differ for bronchitis and emphysematous variants of COPD. It develops or progresses as the underlying pathology progresses. In about 10-13 percent of patients, cor pulmonale is decompensated. Almost always, pulmonary hypertension is associated with expansion of the right ventricle, only in rare patients the size of the right ventricle remains normal.

The quality of life

To assess this parameter, the SGRQ and HRQol Questionnaires, Pearson χ2 and Fisher tests are used. The age of onset of smoking, the number of packs smoked, the duration of symptoms, the stage of the disease, the degree of shortness of breath, the level of blood gases, the number of exacerbations and hospitalizations per year, the presence of concomitant chronic pathologies, the effectiveness of basic treatment, participation in rehabilitation programs,

• One of the factors that must be taken into account when assessing the quality of life of patients with COPD is the length of smoking and the number of cigarettes smoked. Research confirms. That with an increase in the smoking experience in COPD patients, social activity significantly decreases, and depressive manifestations increase, responsible for the decrease not only in working capacity, but also in the social adaptation and status of patients.
• The presence of concomitant chronic pathologies of other systems reduces the quality of life due to the syndrome of mutual burdening and increases the risk of death.
• Older patients have worse functional performance and ability to compensate.

Diagnostic methods for detecting COPD

• The screening method for detecting pathology is spirometry. The relative cheapness of the method and the ease of performing diagnostics allows it to cover a fairly wide mass of patients in the primary medical and diagnostic link. Difficulties with expiration become diagnostically significant signs of obstruction (a decrease in the ratio of forced expiratory volume to forced vital capacity is less than 0.7).
• In individuals without clinical manifestations of the disease, changes in the expiratory part of the flow-volume curve may be alarming.
• Additionally, if difficulties with expiration are detected, drug tests are performed using inhaled bronchodilators (Salbutamol, Ipratropium bromide). This makes it possible to separate patients with reversible bronchial obstruction (bronchial asthma) from those with COPD.
• Less often, daily monitoring of respiratory function is used to clarify the variability of disorders depending on the time of day, load, and the presence of harmful factors in the inhaled air.

Treatment

When choosing a strategy for managing patients with this pathology, improving the quality of life (primarily by reducing the manifestations of the disease, improving exercise tolerance) becomes an urgent task. In the long term, it is necessary to strive to limit the progression of bronchial obstruction, reduce possible complications, and ultimately limit the risks of death.

Primary tactical measures should be considered non-drug rehabilitation: reducing the effect of harmful factors in the inhaled air, educating patients and potential victims of COPD, familiarizing them with risk factors and methods for improving the quality of inhaled air. Also, patients with a mild course of pathology are shown physical activity, and in severe forms - pulmonary rehabilitation.

All patients with COPD should be vaccinated against influenza as well as against pneumococcal disease.

The volume of drug provision depends on the severity of clinical manifestations, the stage of pathology, and the presence of complications. Today, preference is given to inhaled forms of drugs received by patients both from individual metered dose inhalers and with the help of nebulizers. The inhalation route of administration not only increases the bioavailability of drugs, but also reduces the systemic exposure and side effects of many groups of drugs.

• At the same time, it should be remembered that the patient must be trained to use inhalers of various modifications, which is important when replacing one drug with another (especially with preferential drug provision, when pharmacies are often not able to supply patients with the same dosage forms all the time and a transfer is required from one drugs to others).
• Patients themselves should carefully read the instructions for spinhalers, turbuhalers and other dosing devices before starting therapy and do not hesitate to ask doctors or pharmacists about the correct use of the dosage form.
• Also, one should not forget about the phenomena of rebounds that are relevant for many bronchodilators, when, if the dosage regimen is exceeded, the drug ceases to effectively help.
• The same effect is not always achieved when replacing combined drugs with a combination of individual analogues. With a decrease in the effectiveness of treatment and the resumption of painful symptoms, it is worth informing the attending physician, and not trying to change the dosage regimen or frequency of administration.
• The use of inhaled corticosteroids requires constant prevention of fungal infections of the oral cavity, so one should not forget about hygienic rinses and limiting the use of topical antibacterial agents.

Medicines, preparations

1. Bronchodilators assigned either permanently or in demand mode. Long-acting inhalation forms are preferred.
   • Long-term beta-2 agonists: Formoterol (aerosol or powder inhaler), Indacaterol (powder inhaler), Olodaterol.
   • Short-acting agonists: Salbutamol or Fenoterol aerosols.
   • Short-acting anticholinergic dilators - Ipratropium bromide aerosol, long-term - powder inhalers Tiotropium bromide and Glycopyrronium bromide.
   • Combined bronchodilators: aerosols Fenoterol plus Ipratropium bromide (Berodual), Salbutamol plus Ipratropium bromide (Combivent).
2. Glucocorticosteroids in inhalers have a low systemic and side effect, well increase bronchial patency. They reduce the number of complications and improve the quality of life. Aerosols of Beclamethasone dipropionate and Fluticasone propionate, Budesonide powder.
3. Combinations of glucocorticoids and beta2-agonists reduces mortality, although it increases the risk of developing pneumonia in patients. Powder inhalers: Formoterol with Budesonide (Symbicort turbuhaller, Formisonide, Spiromax), Salmeterol, aerosols: Fluticasone and Formoterol with Beclomethasone dipropionate (Foster).
4. Methylxanthine Theophylline in low doses reduces the frequency of exacerbations.
5. Phosphodiesterase-4 inhibitor - Roflumilast reduces exacerbations of severe forms of bronchitis variant of the disease.

Schemes and dosing regimens

• For mild and moderate COPD with mild symptoms and rare exacerbations, Salbutamol, Fenoterol, Ipratropium bromide in the “on demand” mode are preferable. Alternative - Formoterol, Tiotropium bromide.
• With the same forms with vivid clinical manifestations, Foroterol, Indacaterol or Tiotropium bromide, or combinations thereof.
• Moderate and severe course with a significant decrease in forced expiratory volume with frequent exacerbations, but an unexpressed clinic, requires the appointment of Formoterol or Indacaterol in combination with Budesonide, Beclametoazone. That is, they often use inhaled combination drugs Symbicort, Foster. An isolated appointment of Tiotropium bromide is also possible. An alternative is to prescribe long-term beta-2 agonists and tiotropium bromide in combination or tiotropium bromide and roflumilast.
• Moderate and severe course with severe symptoms is Formoterol, Budesonide (Beclamethasone) and Tiotropium bromide or Roflumilast.

Exacerbation of COPD requires not only increasing the doses of the main drugs, but also connecting glucocorticosteroids (if they were not previously prescribed) and antibiotic therapy. Seriously ill patients often have to be transferred to oxygen therapy or mechanical ventilation.

Oxygen therapy

The increasing deterioration of the oxygen supply to tissues requires additional oxygen therapy on a continuous basis with a decrease in the partial pressure of oxygen from 55 mm Hg and a saturation of less than 88%. Relative indications are cor pulmonale, blood clotting, edema.

However, patients who continue to smoke, are not receiving medical treatment, or are not attuned to oxygen therapy, do not receive this type of care.

The duration of treatment takes about 15 hours a day with breaks no longer than 2 hours. The average rate of oxygen supply is from 1-2 to 4-5 liters per minute.

An alternative in patients with less severe ventilation disorders is long-term home ventilation. It involves the use of oxygen respirators at night and several hours during the day. Selection of ventilation modes is carried out in a hospital or respiratory center.

Contraindications to this type of therapy are low motivation, patient agitation, swallowing disorders, and the need for long-term (about 24 hours) oxygen therapy.

Other methods of respiratory therapy include percussion drainage of bronchial contents (small volumes of air are supplied to the bronchial tree at a certain frequency and under a certain pressure), as well as forced exhalation breathing exercises (inflating balloons, breathing through the mouth through a tube) or.

Pulmonary rehabilitation should be performed in all patients. starting with 2 severity. It includes training in breathing exercises and physical exercises, if necessary, oxygen therapy skills. Psychological assistance is also provided to patients, they are motivated to change their lifestyle, they are trained to recognize signs of deterioration of the disease and the skills to quickly seek medical help.

Thus, at the present stage of development of medicine, chronic obstructive pulmonary disease, the treatment of which has been worked out in sufficient detail, is a pathological process that can not only be corrected, but also prevented.

Chronic obstructive pulmonary disease (COPD) is a deadly disease. The number of deaths per year worldwide reaches 6% of the total number of deaths.

This disease, which occurs with long-term damage to the lungs, is currently considered incurable, therapy can only reduce the frequency and severity of exacerbations, and achieve a decrease in the level of deaths.
COPD (Chronic Obstructive Pulmonary Disease) is a disease in which airflow is restricted in the airways, partially reversible. This obstruction is progressively progressive, reducing lung function and leading to chronic respiratory failure.

In contact with

Classmates

Who has COPD

COPD (chronic obstructive pulmonary disease) mainly develops in people with many years of smoking experience. The disease is widespread throughout the world, among men and women. The highest mortality is in countries with a low standard of living.

Origin of the disease

With many years of irritation of the lungs with harmful gases and microorganisms, chronic inflammation gradually develops. The result is a narrowing of the bronchi and the destruction of the alveoli of the lungs. In the future, all respiratory tracts, tissues and vessels of the lungs are affected, leading to irreversible pathologies that cause a lack of oxygen in the body. COPD (chronic obstructive pulmonary disease) develops slowly, progressing steadily over many years.

If left untreated, COPD leads to a person's disability, then death.

The main causes of the disease

• Smoking is the main cause, causing up to 90% of cases of the disease;
• professional factors - work in hazardous production, inhalation of dust containing silicon and cadmium (miners, builders, railway workers, workers in metallurgical, pulp and paper, grain and cotton processing enterprises);
• hereditary factors - rare congenital deficiency of α1-antitrypsin.

• Cough is the earliest and often underestimated symptom. At first, the cough is periodic, then it becomes daily, in rare cases it manifests itself only at night;
• - appears in the early stages of the disease in the form of a small amount of mucus, usually in the morning. With the development of the disease, the sputum becomes purulent and more and more abundant;
• dyspnea- is found only 10 years after the onset of the disease. At first, it manifests itself only with serious physical exertion. Further, the feeling of lack of air develops with minor body movements, later severe progressive respiratory failure appears.

The disease is classified according to severity:

Mild - with mild impairment of lung function. There is a slight cough. At this stage, the disease is very rarely diagnosed.

Moderate severity - obstructive disorders in the lungs increase. Appears shortness of breath with physical. loads. The disease is diagnosed at the address of patients in connection with exacerbations and shortness of breath.

Severe - there is a significant restriction of air intake. Frequent exacerbations begin, shortness of breath increases.

Extremely severe - with severe bronchial obstruction. The state of health deteriorates greatly, exacerbations become threatening, disability develops.

Diagnostic methods

Collection of anamnesis - with an analysis of risk factors. Smokers evaluate the smoker's index (SI): the number of cigarettes smoked daily is multiplied by the number of years of smoking and divided by 20. IC more than 10 indicates the development of COPD.
Spirometry - to evaluate lung function. Shows the amount of air during inhalation and exhalation and the speed of entry and exit of air.

A test with a bronchodilator - shows the likelihood of reversibility of the process of narrowing of the bronchus.

X-ray examination - establishes the severity of pulmonary changes. The same is being done.

Sputum analysis - to determine the microbes during exacerbation and the selection of antibiotics.

Differential Diagnosis

How to treat the disease

General rules

• Smoking must be stopped forever. If you continue to smoke, no treatment for COPD will be effective;
• the use of personal protective equipment for the respiratory system, reducing, if possible, the number of harmful factors in the working area;
• rational, nutritious nutrition;
• reduction to normal body weight;
• regular physical exercises (breathing exercises, swimming, walking).

Treatment with drugs

Its goal is to reduce the frequency of exacerbations and the severity of symptoms, to prevent the development of complications. As the disease progresses, the amount of treatment only increases. Main drugs in the treatment of COPD:

• Bronchodilators are the main drugs that stimulate the expansion of the bronchi (atrovent, salmeterol, salbutamol, formoterol). It is preferably administered by inhalation. Short-acting drugs are used as needed, long-acting drugs are used constantly;
• glucocorticoids in the form of inhalations - used for severe degrees of the disease, with exacerbations (prednisolone). With severe respiratory failure, attacks are stopped by glucocorticoids in the form of tablets and injections;
• Vaccines – Influenza vaccination reduces mortality in half of cases. It is carried out once in October - early November;
• mucolytics - thin the mucus and facilitate its excretion (carbocysteine, ambroxol, trypsin, chymotrypsin). Used only in patients with viscous sputum;
• antibiotics - used only during exacerbation of the disease (penicillins, cephalosporins, it is possible to use fluoroquinolones). Tablets, injections, inhalations are used;
• antioxidants - able to reduce the frequency and duration of exacerbations, are used in courses of up to six months (N-acetylcysteine).

Surgery

• Bullectomy - removal can reduce shortness of breath and improve lung function;
• lung volume reduction by surgery is under study. The operation improves the physical condition of the patient and reduces the mortality rate;
• lung transplantation - effectively improves the quality of life, lung function and physical performance of the patient. Application is hampered by the problem of donor selection and the high cost of the operation.

Oxygen therapy

Oxygen therapy is carried out to correct respiratory failure: short-term - with exacerbations, long-term - with the fourth degree of COPD. With a stable course, constant long-term oxygen therapy is prescribed (at least 15 hours daily).

Oxygen therapy is never prescribed to patients who continue to smoke or suffer from alcoholism.

Treatment with folk remedies

Herbal infusions. They are prepared by brewing a spoonful of the collection with a glass of boiling water, and each is taken for 2 months:

√ 1 part sage, 2 parts chamomile and mallow;

√ 1 part linseeds, 2 parts eucalyptus, linden flowers, chamomile;

√ 1 part chamomile, mallow, sweet clover, anise berries, licorice roots and marshmallow, 3 parts flaxseed.

• Infusion of radish. Grate black radish and medium-sized beets, mix and pour with cooled boiling water. Leave for 3 hours. Use three times a day for a month, 50 ml.
• Nettle. Grind nettle roots into gruel and mix with sugar in a ratio of 2: 3, leave for 6 hours. The syrup removes phlegm, relieves inflammation and relieves cough.
• Milk:

√ Brew a spoonful of cetraria (Icelandic moss) with a glass of milk, drink during the day;

√ Boil 6 chopped onions and a head of garlic for 10 minutes in a liter of milk. Drink half a glass after meals. Every mom should know!

Coughing attacks keeping you awake at night? Perhaps you have tracheitis. You can learn more about this disease

• physical activity, regular and dosed, aimed at the respiratory muscles;
• annual vaccination with influenza and pneumococcal vaccines;
• constant intake of prescribed drugs and regular examinations by a pulmonologist;
• correct use of inhalers.

Forecast

COPD has a conditionally poor prognosis. The disease slowly but constantly progresses, leading to disability. Treatment, even the most active, can only slow down this process, but not eliminate the pathology. In most cases, treatment is lifelong, with ever-increasing doses of medication.

With continued smoking, obstruction progresses much faster, significantly reducing life expectancy.

The incurable and deadly COPD simply urges people to stop smoking forever. And for people at risk, there is only one advice - if you find signs of a disease, immediately contact a pulmonologist. After all, the earlier the disease is detected, the less likely it is to die prematurely.

In contact with