Chronic obstructive pulmonary disease is a disease characterized by irreversible or partially reversible, progressive obstruction (obstruction) of the bronchi. These are diseases that block the airways (bronchi) or damage the small air sacs (alveoli) in the lungs, making breathing difficult. Two main diseases; included in this group are emphysema and chronic bronchitis; many people with chronic obstructive pulmonary disease have both of these diseases.

Chronical bronchitis - This is a constant inflammation of the bronchi, leading to a constant cough with large amounts of mucus. When the cells lining the airways are irritated beyond a certain degree, the tiny cilia (hair-like outgrowths) that normally catch and throw out foreign objects stop working properly. Increased irritation leads to an excessive production of mucus, which clogs the air passages and causes the severe cough that is characteristic of bronchitis. Bronchitis is considered chronic when a person coughs up phlegm for three months, and this is repeated for two years in a row.

Emphysema- This is a gradual damage to the lungs as a result of tissue destruction and loss of elasticity of the alveoli, in which oxygen enters the blood and carbon dioxide leaves it. If the lungs are damaged by chemicals in cigarette smoke or as a result of persistent inflammation or chronic bronchitis, the thin walls of the alveoli can gradually thicken, lose elasticity, and become much less functional. Loss of elasticity, often combined with narrowing of the small air passages in the lungs (sometimes completely blocking them), traps used air instead of allowing it to escape. Thus, the affected air sacs are unable to supply oxygen to the blood or remove carbon dioxide from it; this causes shortness of breath, characteristic of emphysema. The damage to the lung may progress until the difficulty in breathing becomes very severe; from this moment, the disease becomes potentially life-threatening. Low oxygen levels in the blood can lead to increased pressure in the pulmonary arteries (pulmonary hypertension), which in turn can prevent right side the heart to pump blood through the lungs properly.

Chronic airway obstruction usually develops gradually. Many years pass before symptoms appear, and by this time the disease has already reached significant development. The damage to the lungs is permanent, but in many cases it can be prevented by avoiding smoking. Chronic airway obstruction is two to three times more common in men than in women. COPD is considered a disease in the second half of life. Patients are usually over 40 years old. Men get sick more often. The disease is more common in socially prosperous countries.

Symptoms

COPD - very insidious diseasecharacterized by a slow progressive course. From the actual onset of the disease to its manifestations, it takes from 3 to 10 years. COPD symptoms begin to appear only in the second stage of the disease.

Persistent cough with mucus production, especially in the morning (symptom of chronic bronchitis).

Chronic dry cough (a sign of emphysema).

In severe cases, symptoms of chronic obstructive pulmonary disease can include coughing up blood, chest pain, and a purplish complexion.

Swollen legs and ankles from right heart failure (cor pulmonale).

Difficulty breathing out.

Causes

Smoking is the most common cause of chronic obstructive pulmonary disease.

Air pollution can also be a contributing factor.

Industrial emissions or vapors containing chemicals can damage the airways.

Recurrent viral or bacterial lung diseases can thicken the walls of the bronchi, narrow air passages, and stimulate excessive mucus production in the lungs.

Hereditary deficiency of the enzyme alpha-1-antitrypsin can damage the walls of the alveoli.

People who are more susceptible to emphysema are those who are constantly exposed to dust, chemicals or other lung irritants in their occupations, as well as those whose profession requires constant heavy use of the lungs, such as glassblowers or musicians who play wind instruments.

Young children living near smokers are more susceptible to chronic airway inflammation.

Diagnostics

Medical history and physical examination are required.

A saliva sample may be taken for analysis.

Blood tests from an artery and vein are needed (to measure oxygen and carbon dioxide levels).

Breast x-ray is required.

Spirometry and other lung function tests are needed, which measure respiratory capacity and lung capacity.

You can measure the strength and efficiency of the heart muscle.

Treatment

Do not smoke; avoid smoky rooms.

Drink plenty of fluids to loosen mucus.

Avoid drinking caffeine and alcohol, as they are diuretic and can lead to dehydration.

Humidify the indoor air.

Try not to go outside on cold days or when the air is dirty, and avoid cold, wet weather. If bronchitis is severe and incurable, you may want to consider moving to a warmer, drier climate.

Do not use cough suppressants. A cough is necessary to clear accumulated mucus from the lungs, and suppressing it can lead to serious complications.

Viral infection respiratory tract can exacerbate the disease; reduce the risk infectious diseaseTo minimize contact with people with contagious respiratory diseases, wash your hands often. Get flu and pneumonia shots annually.

A bronchodilator may be prescribed to widen the bronchial passages. In more severe cases, oxygen may be prescribed.

A doctor may prescribe antibiotics to treat or prevent bacterial infections of the lungs, as patients with chronic obstructive pulmonary disease are more susceptible to them. Antibiotics must be taken for the entire prescribed period.

Your doctor can instruct you on how to clear mucus from your lungs by taking different positions in which your head is below your torso.

Some benefits can be brought breathing exercises.

In very serious cases where there is severe damage to the lungs as a result of emphysema, a lung transplant may be performed (if the disease has weakened the heart, a heart and lung transplant is recommended).

1. Treatment of mild severity

At this stage, the disease, as a rule, does not have clinical manifestations and does not need constant drug therapy... We recommend seasonal influenza vaccination and mandatory vaccination against pneumococcal infection once every five years (for example, with the PNEUMO 23 vaccine).

In case of severe symptoms of dyspnea, short-acting inhaled bronchodilators may be used. Preparations Salbutamol, Terbutaline, Ventolin, Fenoterol, Berrotek. Contraindications: tachyarrhythmias, myocarditis, heart defects, aortic stenosis, decompensated diabetes, thyrotoxicosis, glaucoma. The drugs can be used no more than 4 times a day.

It is important to inhale correctly. If you have been prescribed a similar drug for the first time, it is better to make the first inhalation with your doctor so that he points out possible errors. The drug must be inhaled (injected into the mouth) exactly against the background of inhalation, so that it gets into the bronchi, and not just "into the throat." After inhalation, you must hold your breath at the height of inspiration for 5-10 seconds.

Separately in this group is the drug Berodual. Its distinctive features are the duration of action of at least 8 hours and the good severity of the therapeutic effect. The first two days of taking the drug can cause a reflex cough, which then goes away.

In the presence of a cough with sputum discharge, patients are prescribed Mucolytics (drugs that thin sputum).

Currently, there are a large number of drugs with this effect on the pharmaceutical market, but, in my opinion, drugs based on acetylcysteine \u200b\u200bshould be preferred.
For example, ACC (bags for the preparation of a solution for the purpose of ingestion, effervescent tablets of 100, 200 and 600 mg), Fluimucil effervescent tablets. The daily dose of drugs for an adult is 600 mg.

There is also dosage form (acetylcysteine \u200b\u200bsolution for inhalation 20%) for inhalation with a nebulizer. A nebulizer is a device for converting liquid medicinal substances into aerosol form. In this form, the drug enters the smallest bronchi and alveoli and its effectiveness is significantly increased. This method of drug administration is preferred for patients with chronic diseases upper respiratory tract.

2. Treatment of a moderate form

Long-acting bronchodilator drugs are added to the drugs used in the 1st (mild) stage of the disease.

Serevent (salmeterol). Available as a metered dose inhaler. The recommended daily dosage for adults is 50-100 mcg / 2 times a day. The inhalation technique must be closely monitored.

Formoterol (foradil). It is produced in capsules containing powder for inhalation using a special device (handhealer). The recommended daily dosage is 12 mcg / 2 times a day.

Alternatively, you can regularly use berodual. If the drug is used in the form of a dosed aerosol, then 2 inhalations (2 breaths) of the drug are carried out three times a day: in the morning, at lunchtime and in the evening. Also, the drug is available in the form of a solution for inhalation through a nebulizer. In this case, the recommended dosage for an adult is 30-40 drops through a nebulizer - 3 times a day.

A relatively new, but already well-established, drug from this Spiriva group (tiotropium bromide). Spiriva is prescribed once a day and is available in capsules for inhalation using a special device. One of the most effective remedies for cOPD treatment currently. Active use is limited only by a fairly high cost.

3. Severe treatment.

At this stage of the disease, constant anti-inflammatory treatment is required.

Medium to high doses of inhaled glucocorticosteroids are prescribed. Preparations: Beklazon, Becotide, Benacort, Pulmicort, Flixotide, etc. They are usually produced in the form of metered aerosols for inhalation or in the form of solutions (Pulmicort preparation) for inhalation through a nebulizer.

Also, with a given degree of severity of the disease, combined preparations containing both a long-acting bronchodilator and an inhaled corticosteroid can be used. Preparations: seretid, symbicort. Combination drugs are currently considered the most effective means COPD therapy of this severity.

If you have been prescribed a medication containing an inhaled corticosteroid, be sure to ask your doctor how to inhale correctly. Incorrect procedure significantly reduces the effectiveness of the drug, increases the risk side effects... After inhalation, be sure to rinse your mouth out.

4. Extremely severe

In addition to the drugs used for severe disease, oxygen therapy is added (regular inhalation of oxygen-enriched air). For this purpose in stores medical technology or in large pharmacies you can find both large enough devices for home use, and small cans that you can take with you for a walk and use when shortness of breath increases.

If the condition and age of the patient allows, surgery.
When extremely grave condition the patient may require mechanical ventilation.

When an infection is attached, they add to the therapy antibacterial agents... The use of derivatives of penicillin, cephalosporins, fluoroquinolones is recommended. Specific drugs and their dosages are determined by the attending physician depending on the patient's condition and the presence of concomitant diseases, for example, with liver and / or kidney pathology - the dosage is reduced.

Prevention

Don't smoke (smoking is the first cause of chronic obstructive pulmonary disease).

Don't spend a lot of time outdoors on days when the air is polluted.

See your doctor if your symptoms become severe, such as if your shortness of breath or chest pain gets worse, your cough gets worse, or you cough up blood, if you have a fever, vomiting, or if your legs and ankles are more swollen than usual.

Make an appointment with your doctor if you have had a persistent cough with phlegm over the past two years or if you have persistent shortness of breath.

Attention! Immediate health careif your lips or face are bluish or purplish.

Despite the rapid development of medicine and pharmacy, chronic obstructive pulmonary disease remains an unsolved problem in modern health care.

The term COPD is the product of many years of work by disease experts respiratory system person. Previously, diseases such as chronic obstructive bronchitis, chronic simple bronchitis and emphysema were considered in isolation.

According to WHO forecasts, by 2030 in the structure of mortality worldwide, COPD will take the third place. At the moment, at least 70 million people on the planet suffer from this disease. Until the proper level of measures to reduce active and passive smoking is achieved, the population will be at a significant risk of this disease.

History of the issue

Even half a century ago, significant differences were noted in the clinic and pathological anatomy in patients with bronchial obstruction. Then, in COPD, the classification looked conditional, more precisely, it was represented by only two types. The patients were divided into two groups: if the bronchitic component predominated in the clinic, then this type in COPD figuratively sounded like "blue edema" (type B), and type A was called "pink puffers" - a symbolism of the prevalence of emphysema. Figurative comparisons have survived in everyday life of doctors to this day, but the classification of COPD has undergone many changes.

Later, in order to rationalize preventive measures and therapy, a classification of COPD by severity was introduced, which was determined by the degree of restriction of the air flow rate according to spirometry indicators. But such a breakdown did not take into account the severity of the clinic at a given time, the rate of deterioration of spirometric data, the risk of exacerbations, intercurrent pathology and, as a result, could not allow managing the prevention of the disease and its therapy.

In 2011, experts from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) integrated COPD progression assessment with an individual approach to each patient. Now the risk and frequency of exacerbations of the disease, the severity of the course and the effect of concomitant pathology are taken into account.

Objective determination of the severity of the course, the type of disease are necessary for the choice of rational and adequate treatment, as well as the prevention of the disease in susceptible individuals and the progression of the disease. The following parameters are used to identify these characteristics:

• the degree of bronchial obstruction;
• the severity of clinical manifestations;
• risk of exacerbations.

In the modern classification, the term "stages of COPD" is replaced by "degrees", but operating with the concept of staging in medical practice is not considered a mistake.

Severity

Bronchial obstruction is a mandatory criterion for the diagnosis of COPD. To assess its degree, 2 methods are used: spirometry and peak flowmetry. When conducting spirometry, several parameters are determined, but 2 are important for making a decision: FEV1 / FVC and FEV1.

The best indicator for the degree of obstruction is FEV1, and the integrating indicator is FEV1 / FVC.

The study is carried out after inhalation of a bronchodilator drug. Results are compared with age, weight, height, race. The severity of the flow is determined on the basis of FEV1 - this parameter forms the basis of the GOLD classification. For ease of use of the classification, threshold criteria are defined.

The lower the FEV1 score, the higher the risk of exacerbation, hospitalization, and death. In the second degree, the obstruction becomes irreversible. During an exacerbation of the disease, respiratory symptoms worsen, requiring a change in treatment. The frequency of exacerbations is different for each patient.

Clinicians noted in the course of their observations that the results of spirometry do not reflect the severity of shortness of breath, a decrease in resistance to physical activity and, as a consequence, the quality of life. After treatment of an exacerbation, when the patient notes a significant improvement in well-being, the FEV1 index may practically not change.

This phenomenon is explained by the fact that the severity of the course of the disease and the severity of symptoms in each individual patient is determined not only by the degree of obstruction, but also by some other factors that reflect systemic disorders in COPD:

• amyotrophy;
• cachexia;
• decrease in body weight.

Therefore, GOLD experts proposed a combined classification of COPD, including, in addition to FEV1, an assessment of the risk of exacerbations of the disease, the severity of symptoms according to specially developed scales. The questionnaires (tests) are easy to execute and do not require much time. Testing is usually done before and after treatment. With their help, the severity of symptoms, general condition, and quality of life are assessed.

The severity of symptoms

For typing of COPD, specially developed, valid questionnaire methods MRC are used - "Scale of the Medical Research Council"; CAT, COPD Assessment Test, developed by the global GOLD initiative - "Test for COPD Assessment". Check the score from 0 to 4 that applies to you:

MRC
0	I feel shortness of breath only with significant physical. load
1	I feel short of breath when accelerating, walking on a level surface, or when climbing a hill
2	Due to the fact that I feel short of breath, walking on a flat surface, I begin to walk more slowly compared to people of the same age, and if I walk the usual step on a flat surface, I feel how breathing stops
3	When I cover a distance of about 100 m, I feel that I am suffocating, or after a few minutes of a calm step
4	I cannot leave my house due to shortness of breath or suffocate when dressing / undressing

SAT
Example: I am in a good mood	0 1 2 3 4 5		I am in a bad mood	Points
I don't cough at all	0 1 2 3 4 5		Persistent cough
I don't feel phlegm in my lungs at all	0 1 2 3 4 5		I feel like my lungs are filled with phlegm
I don't feel any compression in my chest	0 1 2 3 4 5		I feel very strong pressure in my chest
When I climb stairs one flight or walk up, I feel short of breath	0 1 2 3 4 5		When I go up or go up stairs one flight, I feel very short of breath
I calmly do housework	0 1 2 3 4 5		I find it very difficult to do housework
I feel confident leaving home despite my lung disease	0 1 2 3 4 5		Can't leave home with confidence due to lung disease
I have a restful and fulfilling sleep	0 1 2 3 4 5		I can't sleep well because of my lung disease
I am quite energetic	0 1 2 3 4 5		I am deprived of energy
TOTAL POINT
0 — 10		Influence is negligible
11 — 20		Moderate
21 — 30		Strong
31 — 40		Very strong

Test results: CAT≥10 or MRC≥2 scale indicate significant severity of symptoms and are critical values. One scale should be used to assess the severity of clinical manifestations, preferably CAT, since it allows the most complete assessment of the state of health. Unfortunately, Russian doctors rarely use questionnaires.

Risks and groups of COPD

When developing a risk classification for COPD, based on conditions and indicators collected from large-scale clinical research (TORCH, UPLIFT, ECLIPSE):

• a decrease in spirometric indicators is associated with the risk of death of the patient and the recurrence of exacerbations;
• hospital stay caused by an exacerbation is associated with poor prognosis and a high risk of death.

For varying degrees of severity, the prognosis of the frequency of exacerbations was calculated based on the previous medical history. Risks table:

There are 3 ways to assess the risks of exacerbation:

1. Population - according to the classification of the severity of COPD based on spirometry data: at grade 3 and 4, a high risk is determined.
2. Individual history data: if there are 2 or more exacerbations last year, then the risk of subsequent ones is considered high.
3. The patient's medical history at the time of hospitalization, which was caused by an exacerbation in the previous year.

Step-by-step rules for using the integral assessment method:

1. Assess symptoms on the CAT scale, or dyspnea on the MRC.
2. Look to which side of the square the result belongs: to the left - "less symptoms", "less shortness of breath", or to the right - "more symptoms", "more shortness of breath."
3. Evaluate which side of the square (top or bottom) the result of the risks of exacerbations according to spirometry belongs to. Levels 1 and 2 indicate low risk, and levels 3 and 4 indicate high risk.
4. Indicate how many exacerbations the patient had in the last year: if 0 and 1, then the risk is low, if 2 or more, it is high.
5. Define a group.

Initial data: 19 p. according to the SAT questionnaire, according to the parameters of spirometry FEV1 - 56%, three exacerbations over the past year. The patient belongs to the category of "more symptoms" and it is necessary to define him in group B or D. According to spirometry - "low risk", but since he had three exacerbations in the last year, this indicates a "high risk", therefore this patient belongs to group D. This is a group high risk hospitalizations, exacerbations and death.

Based on the above criteria, patients with COPD are divided into four groups according to the risk of exacerbations, hospitalizations and death.

Criteria	Groups
	AND "Low risk" "Fewer symptoms"	IN "Low risk" "More symptoms"	FROM "High risk" "Fewer symptoms"	D "High risk" "More symptoms"
The frequency of exacerbations per year	0-1	0-1	≥1-2	≥2
Hospitalizations	Not	Not	Yes	Yes
SAT	<10	≥10	<10	≥10
MRC	0-1	≥2	0-1	≥2
GOLD class	1 or 2	1 or 2	3 or 4	3 or 4

The result of this grouping provides for rational and individualized treatment. The disease proceeds most easily in patients from group A: the prognosis is favorable in all respects.

COPD phenotypes

Phenotypes in COPD are a combination of clinical, diagnostic, pathomorphological signs that have formed in the process of individual development of the disease.

Phenotype identification allows for maximum optimization of the treatment regimen.

Indicators	Emphysematous type of COPD	Bronchitic type of COPD
Disease manifestation	With shortness of breath in persons from 30-40 years old	With a productive cough in people over 50
Body type	Skinny	Tendency to gain weight
Cyanosis	Not typical	Expressed strongly
Dyspnea	Significantly expressed, constant	Moderate, intermittent (increased during exacerbation)
Sputum	Slight, slimy	Large volume, purulent
Cough	Comes after shortness of breath, dry	Appears before shortness of breath, productive
Respiratory failure	Last stages	Constant with progression
Changes in chest volume	Increases	Does not change
Wheezing in the lungs	Not	Yes
Weakened breathing	Yes	Not
Chest x-ray data	Increased airiness, small heart size, bullous changes	Heart as a "stretched sac", strengthening of the pattern of the lungs in the root areas
Lung capacity	Increasing	Does not change
Polycythemia	Minor	Strongly expressed
Pulmonary hypertension at rest	Minor	Moderate
Lung elasticity	Significantly reduced	Normal
Pulmonary heart	Terminal stage	Developing rapidly
Pat. anatomy	Panacinar emphysema	Bronchitis, sometimes centriacinar emphysema

The assessment of biochemical parameters is carried out in the stage of exacerbation by indicators of the state of the antioxidant system of the blood and is assessed by the activity of erythrocyte enzymes: catalase and superoxide dismutase.

Table "Determination of the phenotype by the level of deviation of enzymes of the antioxidant blood system":

The problem of the combination of COPD and bronchial asthma (BA) is considered a topical issue in respiratory medicine. The manifestation of the insidiousness of obstructive pulmonary diseases in the ability to mix the clinic of two diseases leads to economic losses, significant difficulties in treatment, prevention of exacerbations and prevention of mortality.

The mixed phenotype of COPD - BA in modern pulmonology does not have clear criteria for classification, diagnosis and is the subject of a thorough and comprehensive study. But some differences make it possible to suspect this type of disease in a patient.

If the disease exacerbates more than 2 times a year, then they talk about the COPD phenotype with frequent exacerbations. Typing, determining the degree of COPD, various types of classifications and their numerous modifications set themselves important goals: to correctly diagnose, adequately treat and slow down the process.

Differentiating the differences between patients with this disease is extremely important, since both the number of exacerbations, and the rate of progression or death, and the response to treatment are individual indicators. Experts do not stop there and continue to look for ways to improve the classification of COPD.

COPD (chronic obstructive pulmonary disease) - a chronic disease of the respiratory system, which is characterized by obstructive pulmonary syndrome.

This is a pathological irreversible state of the body, in which ventilation of the lungs is impaired due to the impossibility of normal air movement through the organs of the respiratory system.

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Classmates

COPD symptoms

Bronchial obstruction - This is a condition that manifests itself in their obstruction. Figuratively speaking, this disease can be called symbiosis with. This disease causes irreversible changes in the organs of the respiratory system, therefore it is not completely curable.

Such a diagnosis indicates that the patient has narrowed the lumen of the bronchi, and also the elasticity of the walls of the alveoli is impaired. The first factor makes it difficult for air to enter the lungs, and the second reduces the efficiency of gas exchange between the alveoli and blood.

Early (obstructive pulmonary disease) will allow early treatment. This will not lead to a complete recovery, but it will stop the progression of the pathology.

• Cough is the earliest sign of COPD. At the onset of the disease, it occurs in episodes, but with the development of the disease it begins to disturb constantly, even during sleep;
• - bronchial obstruction is accompanied by a productive cough. In some cases, the sputum contains purulent exudate;
• dyspnea - occurs in patients who have been suffering from COPD for a long time. This symptom is explained by the fact that the alveoli are not able to give the required amount of oxygen to the blood. A person feels this as a lack of air, which is essentially oxygen starvation;
• swelling - mostly on the legs. The reason for this is blood stasis;
• cyanosis - cyanosis of the skin due to hypertension in the pulmonary circulation.

Forecast

COPD- an incurable disease. in four stages of development of the pathological process. The last one is the indication for disability.

As the disease progresses, the symptoms become more severe. Asthma attacks occur more and more often, which leads to neuropsychiatric disorders in the patient. COPD patients often suffer from depression, anxiety and fears, which only aggravate the course of the disease.
Usually, the treatment prescribed by the doctor is carried out by patients at home because it is a lifelong process. In cases of serious exacerbations, to stop the attack, the patient is admitted to the hospital.

COPD - it is impossible to completely cure, but it is quite possible to prevent, because its main cause is smoking... That is why the number of patients in countries with a high standard of living, that is, with the financial ability to buy tobacco, is slightly higher than in low-income countries. At the same time, in countries with a low standard of living, the mortality rate among the sick is higher, due to insufficient medical support.

The first step in the treatment of chronic bronchial obstruction should be smoking cessation.

You should also consult a doctor as soon as possible, in this situation - to a pulmonologist. He will prescribe supportive medications and monitor the further condition of the patient and the development of pathology.

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One of the most common pathologies that cause permanent inflammation of the respiratory system is chronic obstructive pulmonary disease (COPD for short). Although the term itself began to be used relatively recently, the number of patients with this disease is quite impressive (approximately 5-10% of the population). Such disappointing statistics is primarily due to the huge mass of smokers - they make up the overwhelming number of patients.

Since the disease is often detected already in the last stages, mortality within 10 years after going to a doctor is 55% of all recorded cases. In addition, its complications often lead to loss of performance and disability. Therefore, it is imperative that a timely diagnosis and treatment of COPD be initiated.

COPD is a disease in its own right. It is characterized by a restriction of air passage through the respiratory tract, and in some cases this process is irreversible. This pathological condition is caused by inflammation of the lung tissue, in turn due to the nonspecific response of the patient's body to some pathogenic microparticles or gases.

COPD diagnosis is a collective term that includes:

• chronic obstructive bronchitis (including purulent);
• pneumosclerosis;
• pulmonary hypertension;
• emphysema resulting from a violation of the patency of the bronchial tree;
• chronic cor pulmonale.

All of these diseases reflect structural changes and dysfunction of key body systems that occur at different stages of COPD. Some have signs of several pathological conditions at once.

Causes

In most cases, chronic obstructive pulmonary disease develops in people after 40. The majority of patients are men. This selective effect is based on the specific etiology of the disease. There are the following reasons for its occurrence:

• Smoking. It is the main culprit of COPD (more than 80% of patients), and this is typical mainly for developed countries, since the percentage of smokers there is higher. They have dyspnea and respiratory obstruction much faster. A fairly high percentage of the risk of getting sick also exists among those who are regularly exposed to secondhand smoke. This is especially harmful for children.
• Professional factors... These include some areas of the industry, the by-product of which is the release of micro-dust particles with a high content of silicon and cadmium into the air. These are the mining and metallurgical industries, the cellulose industry, as well as work directly related to the production and use of cement.
• Hereditary pathologies... The genetic causes of the development of chronic obstructive pulmonary disease are still under study, but it is already reliably known that one of them is a lack of α1-antitrypsin. It controls the activity of elastase, which is involved in the breakdown of various protein structures. If production of this protein body is reduced by more than 30%, elastase begins to destroy lung tissue, causing emphysema.

There are several other factors that are believed to lead to this disease. These include underweight, air pollution, familial illness, and regular inhalation of biofuel combustion products during cooking (observed in people living in backward countries).

Prematurity and frequent acute respiratory infections in children can also lead to the development of the disease, although there is no statistics on the frequency of cases at this age. At the same time, COPD is recorded in adolescents as a consequence of bronchial asthma (according to some sources, the frequency is 4-10%).

Of course, the above risk factors, when present in isolation, are unlikely to cause chronic obstructive pulmonary disease. But since in the modern world with a developed industry, high air pollution and other consequences of human life, they act together with improper diet and bad habits. Therefore, the number of diseases is increasing every year, and the life expectancy of patients due to untimely detection in the general percentage decreases.

Development mechanism

The pathogenesis of the disease originates from the bronchial walls. Under the influence of external factors, the functioning of the exocrine apparatus is disrupted, which leads to increased secretion of mucus and a change in its composition. After a while, an infection occurs, which causes an inflammatory process that takes on a permanent form.

Since chronic obstructive pulmonary disease is progressive in nature, the pathogenic microflora gradually destroys the tissues of the bronchi, bronchioles and adjoining alveoli. This course of the disease leads to a decrease in the supply of oxygen to the body, which, in turn, has an extremely negative effect on the work of all its systems. At the same time, the heart experiences the greatest stress, as a result of which the functioning of the respiratory organs is greatly impaired.

Classification

The wording of the diagnosis is largely based on the severity of the disease. For this, the reduction in the flow rate of the inhaled air is determined and, on the basis of the data obtained, the so-called Tiffno index is calculated - an indicator of a possible decrease in the throughput of the patient's respiratory tract.

A special device is used for measurements - a spirometer. It will help you find out two main values, based on which the classification of COPD is made: forced expiratory volume (FEV) and forced vital capacity (FVC). Their percentage is the Tiffno index.

In addition, it is necessary to take into account the symptomatic manifestations and the frequency of exacerbations of the disease. In modern medicine, there are 4 degrees of severity of chronic obstructive pulmonary disease:

• It proceeds easily, manifests itself as a periodic wet cough. Dyspnea is not observed in most cases. FEV / FVC<70% от исходного значения. ОФВ>80% of the norm.

• Moderate course of the disease with noticeable dyspnea on exertion and persistent cough. Obstruction increases, possibly exacerbation of COPD. FEV / FVC<70%, ОФВ<80% от должного.

• The disease is characterized by severe symptoms. The patient has a constant wet cough, wheezing in the sternum, the slightest physical exertion causes severe shortness of breath. Periods of exacerbation occur regularly. FEV / FVC<70%, ОФВ<50% от исходного значения.

• The condition is extremely serious, in some cases even life-threatening. Obstruction of the bronchi is pronounced,. At this stage, destructive processes in the body lead to disability. FEV / FVC<70%, ОФВ<80% от нормы.

Starting from stage 3, COPD can be divided into two types depending on the clinical manifestations:

• Bronchodilator... Cough is the predominant symptom here. At the same time it is pronounced. Since cor pulmonale develops early, the skin acquires a bluish color over time. The concentration of erythrocytes in the blood, as well as its total volume, are constantly increased, which often leads to the formation of blood clots, hemorrhages, heart attack.
• Emphysematous. This type includes COPD with prevailing dyspnea. Patients are characterized by intense breathing that exceeds the need for oxygen. Patients often complain of weakness, depression, and weight loss. There is a strong depletion of the body.

Symptoms

Chronic obstructive pulmonary disease does not appear immediately. Usually, noticeable signs are observed only 3-10 years after its onset. But even in this situation, the patient does not always go to the doctor. This behavior is especially typical for smokers. They consider coughing to be quite normal, since they inhale nicotine smoke every day. Of course, they determine the reason correctly, but they are mistaken with their further actions.

Most often, the disease is recorded in people aged 40-45 years, when the patient already feels significant shortness of breath. Therefore, it is important to know the main symptoms of COPD, especially in the initial stages:

• Cough Of all the signs, it arises first of all, having an episodic character. Then it becomes daily. In the absence of exacerbation, sputum usually does not come out.
• Sputum. Appears some time after the development of a periodic cough into a permanent one. Initially observed mainly in the morning. If the sputum becomes purulent, this indicates the development of an exacerbation.
• Dyspnea. This symptom means the transition of the disease to stage 2. Usually it is of the mixed type, less often - only with difficulty in exhaling. In the initial stages, it manifests itself only with strong physical stress, intensifying during acute respiratory infections. As it progresses, shortness of breath increases, limiting the patient's activity. In severe pathology, it develops into respiratory failure.

• If you work in a production facility and started coughing from industrial dust, then most likely you are developing.
• There is such a disease in children -. This is a hereditary pathology. We advise you to familiarize yourself.
• Rapid breathing is a clear sign. This problem, like others, can be treated with folk remedies and medicines.

Exacerbation of COPD

If the patient's condition constantly worsens for 2 or more days, this phase is called an exacerbation. In this case, the main symptoms of the disease intensify, an elevated temperature is observed. Depending on the severity of the pathology, the frequency of repetition of such periods can vary widely. The intervals between them are called remission phases. Exacerbation of the disease has its own characteristics of the course:

• significant increase in shortness of breath and cough;
• an increase in the volume of sputum secreted;
• frequent shallow breathing;
• high temperature;
• tachycardia;
• various neurological pathologies (for example, unmotivated agitation or depression).

Complications

At various stages of the disease, many destructive changes occur in the body, most often irreversible. Therefore, in the overwhelming majority of cases, patients have the following syndromes:

• Bronchial obstruction... It develops from the first stages of chronic obstructive pulmonary disease and gradually progresses. This process usually begins in the small bronchi. This results in increased resistance in the lower airways. Due to the deformation of the alveoli, the lung tissue loses its elasticity, pulmonary fibrosis is formed.
• Pulmonary hypertension... The main complications of COPD affect the cardiovascular system. Hypertension provokes a narrowing of the circulatory system in the respiratory organs, aggravated by thickening of the walls of blood vessels. This increases the level of pressure required for blood to flow through the network of capillaries that feed the lung.
• Pulmonary heart e. For what reasons in some patients there is an increase in the right ventricle, is still not fully known.
• Lung hyperinflation... At the same time, the lungs are overfilled with air and when exhaled, they are not completely emptied. This gradually weakens the breathing muscles, changing the shape of the diaphragm. Especially this state is felt during physical exertion, not allowing to increase the depth of breathing.
• Emphysema. Since the connection of the small bronchi with the alveoli is broken, this negatively affects their patency.
• General intoxication of the body... In some patients, muscle weakness develops, and an inflammatory reaction syndrome is often present. All this leads to a decrease in physical activity, a general deterioration in well-being.

Diagnostics

For a correct diagnosis, it is initially necessary to determine whether a person is exposed to risk factors for developing chronic obstructive pulmonary disease. If the patient smokes, the level of possible danger caused by this habit should be calculated at all times. This will help the so-called smoker's index, calculated by the formula: (number of daily smoked cigarettes * total experience (years)) / 20. If the resulting number is more than 10, the danger of getting sick is very real. Diagnosis of COPD includes the following steps:

• Clinical and biochemical blood test... It is recommended to do it 2 times a year, as well as during periods of exacerbation.
• Sputum analysis. Determination of its macro- and microscopic properties. If necessary, conduct a study for bacteriology.
• Electrocardiogram... Since chronic obstructive pulmonary disease often causes heart complications, it is advisable to repeat this procedure 2 times a year.
• X-ray of the sternum. It must be done annually (this is at least).
• Spirometry. It allows you to determine how severe the condition of the pathologies of the respiratory system is. It is necessary to pass once a year or more often in order to adjust the course of treatment in time.
• Blood gas and pH analysis... Do at 3 and 4 degrees.
• Oxyhemometry. Evaluation of the degree of blood oxygen saturation by a non-invasive method. It is used in the exacerbation phase.
• Monitoring the ratio of fluid to salt in the body... The presence of a pathological shortage of certain microelements is determined. It is important in exacerbation.
• Differential diagnosis... Most often diff. diagnosed with lung cancer. In some cases, it is also required to exclude heart failure, tuberculosis, pneumonia.

The differential diagnosis of bronchial asthma and COPD is especially noteworthy. Although these are two separate diseases, they often occur in the same person (called overlap syndrome). The reasons and mechanisms of this are not fully understood, therefore it is necessary to know the differences in their clinical manifestations. So, starting from grade 2, patients experience shortness of breath. After the attachment of bronchial asthma, it increases, and as the pathologies progresses, asthma attacks become more frequent. This is a rather dangerous condition that can be fatal.

A full range of laboratory tests and a thorough study of the patient's history will allow to give the correct formulation of the diagnosis of the disease. This includes the degree and severity of COPD, the presence of an exacerbation, the type of clinical presentation, and complications that have occurred.

Chronic obstructive disease treatment

It is still impossible to completely cure chronic obstructive pulmonary disease with the help of drugs of modern medicine. Its main function is to improve the quality of life of patients and to prevent severe complications of the disease.

COPD can be treated at home. The exceptions are the following cases:

• therapy at home does not give any visible results or the patient's condition worsens;
• respiratory failure intensifies, developing into an attack of suffocation, heart rhythm is disturbed;
• 3 and 4 degrees in the elderly;
• complications in severe form.

In remission

To expand the bronchi, a complex of inhalations of bronchodilators is made (check the dosage with your doctor):

• M-cholinolytics: "Ipratropium bromide" ("Atrovent"), 0.4-0.6 mg or "Thiopropium bromide" ("Spiriva"), 1 capsule - effectively block M-cholinergic receptors in parasympathetic nerve endings;
• "Fenoterol" or "Salbutamol" 0.5-1 ml - drugs with pronounced bronchodilator activity.

Since the accumulation of mucus in the respiratory tract contributes to the addition of infections, mucolytic drugs are used to prevent these diseases:

• "Bromhexin", "Ambroxol" - reduce the secretory function of the respiratory system and change the composition of mucus, weakening its internal connections;
• "Trypsin", "Chymotrypsin" - medications of a protein nature, actively interacting with the accumulated secretion, reducing its viscosity and eventually leading to destruction.

With exacerbation

Treatment of chronic obstructive pulmonary disease in the acute phase involves taking glucocorticoids, more often it is "Prednisolone". With severe respiratory failure, the drug is administered intravenously. Since the systemic medicines of this group have many side effects, now in some cases they are replaced by drugs that inhibit the functions of pro-inflammatory mediators ("Fenspirid", "Erespal"). If treatment with these medications at home does not show positive results, the patient must be hospitalized.

In addition, in this phase, emphysema often progresses and mucus stagnation is formed. These conditions can lead to the development of complications, namely bronchitis or pneumonia. To prevent this from happening, antibacterial therapy is prescribed for the prevention of these diseases - penicillins, cephalosporins, fluoroquinolones.

In the elderly

For the elderly, an individual approach is required, since, due to some peculiarities, the course of the disease is most often severe. There are several factors to consider before treating them:

• age-related changes in the respiratory system;
• the presence of additional diseases associated with COPD, and their mutual influence;
• the need to take many medications;
• difficulties in diagnosis and adherence to treatment;
• psychosocial features.

Food

To maintain the body in the tone necessary to resist the disease, a balanced diet is necessary:

• eating a sufficient amount of proteins (slightly more than the norm) - meat and fish dishes, dairy products;
• with a reduced body weight, you need a high-calorie diet;
• multivitamin complexes;
• reduced salt content in case of complications (pulmonary hypertension, bronchial asthma, and others).

Prevention

COPD treatment will not show positive dynamics until the patient eliminates all the factors that provoke this disease. The main recommendations are smoking cessation and timely prevention of infections affecting the respiratory system.

Effective prevention of COPD includes learning all the information about the disease, as well as knowing how to use the medical devices required during treatment. The patient should know how to do inhalation correctly, measure the highest rate of air exit from the lungs using a peak flow meter. And, of course, you must follow all the recommendations of the doctors.

COPD is a slowly progressive disease that can worsen and even die over time. Therapy can only slow down these processes, and the adequacy of its application directly depends on how much more the patient will remain working. In some cases, periods of remission last up to several years, so such patients live for decades.

Chronic obstructive pulmonary disease (COPD) is an independent progressive disease, which is characterized not only by the inflammatory component, but also by structural changes in the vessels and lung tissue. In addition, it should be mentioned about serious violations of bronchial obstruction. Such obstruction is localized in the region of the distal bronchi. This disease is delimited from a number of typical chronic processes of an important respiratory system.

It has been proven that chronic obstructive pulmonary disease most often affects men over 40. She occupies a leading position among all causes of disability. Moreover, the risk of mortality is high even among the working-age population.

With an increase in the production of bronchial mucus and an increase in its viscosity, the most favorable conditions are created for the rapid growth of bacteria. In this case, the patency of the bronchi is disturbed, the lung tissue and alveoli change. The progression of the disease directly leads to edema of the bronchial mucosa, mucus secretion and spasms of smooth muscles. Often in COPD bacterial complications join and relapses of pulmonary infections occur.

It happens that the course of chronic obstructive pulmonary disease is greatly aggravated by serious disorders of gas exchange, which are manifested by a significant decrease in oxygen in the blood and an increase in blood pressure. Such conditions provoke circulatory failure, which leads to death in about 30% of patients with this diagnosis.

COPD Causes

The main reason is considered to be tobacco smoking. Among other factors that cause the development of chronic obstructive pulmonary disease, there are respiratory infections in childhood, industrial hazards, concomitant bronchopulmonary pathologies, as well as a depressing state of the environment. In a small number of patients, the disease is based on a genetic predisposition, which is expressed by a deficiency of the alpha-1-antitrypsin protein. It is he who is formed in the tissues of the liver, protecting the lungs from serious damage.

As a rule, chronic obstructive pulmonary disease is considered an occupational disease of many railway workers, miners, construction workers, as well as workers who come into contact with cement. Often, this disease occurs among specialists in the metallurgical and pulp and paper industries. Genetic predisposition and environmental factors cause chronic inflammatory processes of the inner lining of the bronchi, which significantly reduces local immunity.

COPD symptoms and stages

There are several classifications of chronic obstructive pulmonary disease. At stage zero, the disease is manifested by a strong secretion of sputum and a constant cough against the background of unchanged lung function. The first stage is characterized by chronic, sputum production and minor obstructive disorders. In moderate conditions, various clinical symptoms can be observed, which intensify with a certain load. In this case, pronounced obstructive disorders progress.

In the third stage of the disease, when you exhale, the airflow restriction increases. An increase in exacerbations and an increase in shortness of breath can be noted. In extremely serious conditions, severe forms of bronchial obstruction appear that can threaten a person's life. Cor pulmonale develops and dangerous respiratory failure is diagnosed.

It should be mentioned that in the very early stages, chronic obstructive pulmonary disease can be secretive. Often, the characteristic clinic of the disease manifests itself in moderate conditions. COPD is characterized by severe cough with shortness of breath and phlegm. Sometimes in the early stages there is an episodic cough, accompanied by the release of a large amount of mucous sputum. During this period, shortness of breath with intense exertion also worries. The cough becomes permanent only as the disease progresses.

With the onset of a particular infection, dyspnea at rest is observed, and the sputum becomes purulent. The course of chronic obstructive pulmonary disease develops either by emphysematous or bronchial type. Many patients with bronchial types of the disease complain of cough, profuse sputum production. Intoxication, cyanosis of the skin and dangerous purulent inflammation in the bronchi can also be noted, as well as a significant expression of obstruction with mild pulmonary emphysema.

Patients with emphysematous type of COPD are characterized by expiratory dyspnea, which is characterized by difficulty in exhaling. In this case, pulmonary emphysema strongly prevails over typical bronchial obstruction. The patient's skin is gray-pink, and the rib cage is barrel-shaped. It should be mentioned that with a favorable benign course, all patients survive to old age.

In most cases, the progressive development of the disease is complicated by acute respiratory failure and pneumonia. Sometimes spontaneous pneumothoraxes, secondary polycythemia, pneumosclerosis, and congestive heart failure are diagnosed. In very severe stages, some patients may develop cor pulmonale or pulmonary hypertension. In absolutely all cases, the disease leads to a decrease in the quality of life and activity.

COPD diagnosis

Timely diagnosis of chronic obstructive pulmonary disease can increase the life expectancy of patients and significantly improve the quality of their existence. When collecting anamnestic data, modern specialists always pay attention to production factors and the presence of bad habits. The main method of functional diagnostics is spirometry. She reveals the initial signs of the disease.

Also important is the measurement of volumetric and speed indicators. These include the vital capacity of the lungs, forced capacity, and the volume of one forced expiration per second. For diagnosis, the ratio and summation of the identified indicators is sufficient. To assess the severity and nature of bronchial inflammation, a cytological method is used to study the sputum of patients. In the exacerbation phase, sputum always has a viscous and at the same time purulent character.

Clinical blood tests help to identify polycetomy, which is possible due to the development of dangerous hypoxemia only with a bronchial type of ailment. The number of erythrocytes, hemoglobin, hematocrit and blood viscosity is determined. The main symptoms of respiratory failure are the gas composition of the shelter. To exclude other similar diseases, chest x-rays are shown. COPD is characterized by deformation of the bronchial walls, as well as changes in the lung tissue of an emphysematous nature.

The ECG can reveal the development of pulmonary hypertension, and diagnostic bronchoscopy is necessary to assess the condition of the mucous membranes of the bronchi and to collect the analysis of their secretions.

COPD treatment

The main goal of therapy for a disease is considered to slow down all progressive processes, remove obstructions and exclude respiratory failure. This is exactly what is needed to increase the duration and quality of life of patients. Eliminating the cause of the disease, such as smoking or industrial factors, is a necessary treatment in complex therapy. Treatment begins with teaching the patient to use spacers, inhalers and nebulizers, as well as self-assessment.

At the same time, mucolytics and bronchodilators are prescribed to dilute sputum and expand the lumen of the bronchi. Then, inhaled glucocorticosteroids are usually prescribed, and antibiotic therapy is administered during exacerbations. If necessary, pulmonary rehabilitation and oxygenation of the body are prescribed. A decrease in the rate of development of COPD is possible only with a methodical complex treatment, which is selected adequately for each individual patient.

As a rule, the prognosis is favorable relative to the complete recovery of patients. With the steady progression of the disease, they speak of disability. It should be noted that the main prognostic criteria include the exclusion of provoking factors, and most importantly, patient compliance with treatment measures and all recommendations.

Prevention of COPD

Preventing the further development of chronic obstructive pulmonary disease (COPD) is the most important preventive measure. Abstaining from smoking is the main requirement for disease progression. Secondhand smoke is also considered unacceptable. An integrated approach against the disease will guarantee an increase in life expectancy.

You should also pay special attention to other respiratory infections that can trigger COPD recurrence. For the prevention of exacerbations, long-term use of special mucolytics, which have antioxidant activity, is considered promising.

Since COPD is an incurable disease, it is necessary to lead a proper lifestyle, control symptoms, due to which it is possible to significantly slow down the development of the disease. The correct preventive criteria will allow the patient to return to quality living conditions.

Expert editor: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".