Chronic obstructive respiratory diseases. Treatment of bronchial obstruction in children and adults
(COPD) is a progressive disease characterized by irreversible changes lung tissue. The abbreviation COPD speaks for itself perfectly - you couldn’t say it better.
Unfortunately, if pulmonary obstruction develops, there is no way back.
The term obstruction means: a decrease in the bronchial lumen, extremely unsatisfactory patency in the bronchi due to their spasm, an increase in the size of the walls, “mechanical” blockage, with extensive sputum production. In other words, prolonged obstruction radically impairs the “ventilatory” ability of the lungs.
Over the years, monotonously, the disease slowly creeps up on a person, ultimately leading to respiratory failure. Many don't give special significance rare coughs, explaining them completely third party reasons, for example, colds, smoking, cold air.
By the way, COPD is a very illustrative example of the likely consequences of an addiction to smoking. Initially, the inflammatory process only affects, but later it gradually spreads its Negative influence on all key elements of lung tissue:
- pleura
- alveolus
- vascular bed
- respiratory muscles
The sadness of the situation is that since the disease is chronic, with proper therapy it is only possible to significantly slow down its progression and try to improve the quality of life.
Causes of COPD
In addition to the above-mentioned reason, smoking, the health of the lungs and bronchi is extremely strongly influenced by the high degree of pollution of the surrounding air, as well as the harmfulness caused by the professional component of life.
Here is a list of occupations in which people often suffer from COPD:
- metallurgists (hot metal processing)
- miners
- construction workers, especially those whose job duties include mixing cement
- office workers
- workers involved in grain and cotton processing
It is also worth mentioning hereditary factor. Inflamed bronchi lose their protective potential and become the site of the formation of thick, viscous mucus, which is an excellent breeding ground for numerous pathogenic microorganisms.
Risk factors for COPD are mainly limited to the environment and work activities of a person, rather than to allergens. Smoking can be considered a key cause of obstructive pulmonary disease. The risk of developing the disease in this case increases many times, up to 90%. Dyspnea and obstruction respiratory tract, develops much more rapidly in smokers.
Symptoms of the disease
Clinical symptoms have many similarities with signs of obstructive bronchitis:
- frequent occurrence of shortness of breath, initially only during any physical activity, and later even at rest
- when exposed to allergens, dust, there is an intense increase in shortness of breath
- systematically dry cough, with sputum that is extremely difficult to separate
- during forced breathing, prolonged exhalation
The insidiousness of COPD is that the disease is in no hurry, gradually increasing its influence. It happens that years, and possibly decades, may pass from the moment the primary symptoms appear to severe manifestations of respiratory failure.
Let us dwell in a little more detail on the main symptoms.
Let's start with a cough - primary characteristic manifestations of the disease, which initially makes itself felt quite rarely, but later becomes a very serious problem. Outside the acute phase, sputum production is usually not observed.
Sputum discharge at the start of the disease is insignificant, mainly having slimy character, most often in the morning. If the character is purulent, and sputum discharge is abundant, then this is a clear signal of an exacerbation of the disease.
Emergence shortness of breath can be stated approximately ten years after the patient’s body “becomes friends” with cough. She is capable of expressing herself under intense physical activity, infectious diseases.
In the later stages of the disease, there may not be enough air, even with a basic climb up the stairs. Severe respiratory failure develops, manifested by problems with breathing when eating or putting on clothes.
When there is a need to take antibiotics, there is a fairly simple bioindicator called C-reactive protein for the answer. When its value exceeds 15 mg/l, then their use is quite acceptable.
Prevention of COPD
To begin with, you should clearly understand what factors provoke the disease and try to completely eliminate them.
Here are the most significant:
- say goodbye to the smoking habit forever
- try to protect your lungs from second-hand smoke
- avoid overheating and hypothermia of the body
If according to your kind labor activity If you have to deal with the inhalation of harmful substances, strict adherence to all labor safety rules is strongly recommended. It is advisable to use respirators or gauze bandages.
I would like to immediately note that carrying out any preventive therapeutic exercises possible only during the period of remission of the disease, and then, with complete absence third-party contraindications. It should be done by a professional massage therapist, otherwise the situation can only get worse.
When the exacerbation subsides, the entire range of physiotherapeutic procedures is included in the therapeutic process:
- inductothermy
- Ural Federal District chest
- ultrasound
High treatment effectiveness is observed with oxygen therapy, which is mainly used for severe COPD. This technique involves inhaling air enriched with oxygen.
Chronic obstructive pulmonary disease capable of delivering big trouble human bronchopulmonary system. It is extremely important to promptly recognize the disease at the earliest early stages and prevent its further development, because since the disease is chronic, if you miss the moment, there will be no turning back.
Take an interest in your health in time, goodbye.
What is chronic obstructive pulmonary disease? We will discuss the causes, diagnosis and treatment methods in the article by Dr. Nikitin I.L., an ultrasound doctor with 24 years of experience.
Definition of disease. Causes of the disease
Chronic obstructive pulmonary disease (COPD) is a disease that is gaining momentum, moving up in the ranking of causes of death for people over 45 years of age. Today, the disease ranks 6th among the leading causes of death in the world; according to WHO forecasts, in 2020 COPD will already take 3rd place.
This disease is insidious in that the main symptoms of the disease, in particular when 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 progresses imperceptibly, which becomes irreversible and leads to early disability and a reduction in life expectancy in general. Therefore, the topic of COPD seems especially relevant these days.
It is important to know that COPD is primary chronic illness, in which it is important early diagnosis on 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 should I change in my lifestyle, what is the prognosis for the course of the disease?
So, chronic obstructive pulmonary disease or COPD- it's chronic inflammatory disease with damage to the small bronchi (airways), which leads to breathing problems due to narrowing of the lumen of the bronchi. 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 compress and expand during breathing. At the same time, the lungs are constantly in a state of inhalation; there is always a lot of air left in them, even during exhalation, which disrupts normal gas exchange and leads to the development of respiratory failure.
Causes of COPD are:
- impact harmful factors environment;
- smoking;
- factors occupational hazard(dust containing cadmium, silicon);
- general environmental pollution (car exhaust gases, SO 2, NO 2);
- frequent respiratory tract infections;
- heredity;
- α 1-antitrypsin deficiency.
Symptoms of chronic obstructive pulmonary disease
COPD- a disease of the second half of life, most often develops after 40 years. The development of the disease is a gradual long-term process, often invisible to the patient.
They force you to see a doctor if you experience dyspnea And cough- the most common symptoms of the disease (shortness of breath is almost constant; cough is frequent and daily, with sputum discharge in the morning).
The typical patient with COPD is a 45-50 year old smoker who complains of frequent shortness of breath during exercise.
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 relatively early symptom diseases. In the first stages, it is released in small quantities, mainly in the morning. Slimy character. Purulent profuse sputum appears during an exacerbation of the disease.
Dyspnea occurs on more late stages disease and is observed initially only with significant and intense physical activity, intensifies with respiratory diseases. Subsequently, shortness of breath is modified: the feeling of lack of oxygen during normal physical activity is replaced by severe respiratory failure and intensifies over time. It is shortness of breath that becomes common cause in order to see a doctor.
When can you suspect COPD?
Here are a few questions about the algorithm for early diagnosis of COPD:
- Do you cough several times every day? Does this bother you?
- Do you produce phlegm or mucus when you cough (often/daily)?
- Do you experience shortness of breath faster/more often than your peers?
- Are you over 40 years old?
- Do you smoke or have you ever smoked before?
If the answer to more than 2 questions is positive, spirometry with a bronchodilator test is necessary. If the FEV 1/FVC test value is ≤ 70, COPD is suspected.
Pathogenesis of chronic obstructive pulmonary disease
In COPD, both the airways and the tissue of the lung itself, the pulmonary parenchyma, are affected.
The disease begins in the small airways with blockage of mucus, accompanied by inflammation with the formation of peribronchial fibrosis (thickening of connective tissue) and obliteration (overgrowth of the cavity).
When the pathology has developed, the bronchitis component includes:
- hyperplasia of the mucous glands (excessive cell formation);
- mucous inflammation and swelling;
- bronchospasm and blockage of the airways with secretions, which leads to narrowing of the airways and increased resistance.
The following illustration clearly shows the process of hyperplasia of the mucous glands of the bronchi with an increase in their thickness:
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 frame of the respiratory tract leads to their narrowing due to the tendency to dynamic collapse during exhalation, which causes expiratory collapse of the bronchi.
In addition, the destruction of the alveolar-capillary membrane affects gas exchange processes in the lungs, reducing their diffusion capacity. As a result, there is a decrease in oxygenation (oxygen saturation of the blood) and alveolar ventilation. Excessive ventilation of insufficiently perfused areas occurs, leading to an increase in dead space ventilation and impaired excretion carbon dioxide CO2. The alveolar-capillary surface area is reduced, but may be sufficient for gas exchange at rest, when these abnormalities may not be evident. 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.
Hypoxemia that appears over a long period of time in patients with COPD includes a number of adaptive reactions. Damage to the alveolar-capillary units causes an increase in pressure in the pulmonary artery. Since the right ventricle of the heart in such conditions should develop more pressure to overcome the increased pressure in the pulmonary artery, it hypertrophies and expands (with the development of heart failure of the right ventricle). In addition, chronic hypoxemia can cause an increase in erythropoiesis, which subsequently increases blood viscosity and worsens right ventricular failure.
Classification and stages of development of chronic obstructive pulmonary disease
Complications of chronic obstructive pulmonary disease
Complications of COPD include infections, respiratory failure, and chronic cor pulmonale. Bronchogenic carcinoma (lung cancer) is also more common in patients with COPD, although it is not immediate complication diseases.
Respiratory failure- device condition external respiration, in which either the O 2 and CO 2 tension in the arterial blood is not maintained at normal level, or it is achieved due to increased work external respiration systems. It manifests itself mainly as shortness of breath.
Chronic cor pulmonale- enlargement and expansion of the right parts of the heart, which occurs with an increase in blood pressure in the pulmonary circulation, which, in turn, developed as a result 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 the development of chronic obstructive pulmonary disease have been identified, then they should all be diagnosed with COPD.
In order to establish a diagnosis, data is taken into account clinical examination (complaints, anamnesis, physical examination).
A physical examination may reveal symptoms characteristic of long-term bronchitis: “watch glasses” and/or “ drumsticks"(deformation of fingers), tachypnea ( rapid breathing) and shortness of breath, a change in the shape of the chest (emphysema is characterized by a barrel-shaped shape), its low mobility during breathing, retraction of the intercostal spaces with the development of respiratory failure, drooping of the borders of the lungs, a change in percussion sound to a boxy sound, weakened vesicular breathing or dry wheezing, which intensify with forced exhalation (that is, rapid exhalation after a deep inhalation). Heart sounds may be difficult to hear. In 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 mixed forms of the disease are more common.
Most important stage diagnosis of COPD - external respiration function (RPF) analysis. 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. Establishment percentage FEV 1/FVC is most often used in medical practice. A decrease in the volume of forced expiration in the first second to the forced vital capacity of the lungs FEV 1 /FVC to 70% is the initial sign of airflow limitation even with preserved FEV 1 >80% of the proper value. Low peak speed expiratory air flow, which changes slightly when using bronchodilators, also speaks in favor of COPD. For newly diagnosed complaints and changes FVD indicators spirometry is repeated throughout the year. Obstruction is defined as chronic if it occurs at least 3 times per year (despite treatment), and COPD is diagnosed.
FEV monitoring 1 - important method confirmation of the diagnosis. Spireometric measurement of FEV 1 is carried out repeatedly over several years. Normal annual decline in FEV 1 for humans 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, during which the maximum FEV 1 is determined, the stage and severity of COPD are established, and bronchial asthma is excluded (if positive result), 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 diagnosis is the reversibility of bronchial obstruction, which is a characteristic feature of bronchial asthma. It has been established that people diagnosed with CO BL after taking a bronchodilator 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 important, since changes appear only in the later stages of the disease.
ECG can detect changes that are characteristic of cor pulmonale.
EchoCG necessary to identify symptoms pulmonary hypertension and changes in the right side of the heart.
General blood analysis- with its help you can estimate hemoglobin and hematocrit (may be increased due to erythrocytosis).
Blood Oxygen Level Determination(SpO 2) - pulse oximetry, a non-invasive study to clarify the severity of respiratory failure, usually in patients with severe bronchial obstruction. Blood oxygen saturation less than 88%, determined at rest, indicates severe hypoxemia and the need for oxygen therapy.
Treatment of chronic obstructive pulmonary disease
COPD treatment promotes:
- 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;
- reducing mortality.
The main areas of treatment include:
- weakening the degree of influence of risk factors;
- educational programs;
- drug treatment.
Reducing the influence of risk factors
Quitting smoking is mandatory. This is what is most effective way, which reduces the risk of developing COPD.
Occupational hazards should also be controlled and reduced by using adequate ventilation and air purifiers.
Educational programs
Educational programs for COPD include:
- basic knowledge about the disease and common approaches to treatment to encourage patients to quit smoking;
- training on how to properly use individual inhalers, spacers, nebulizers;
- practicing self-monitoring using peak flow meters, studying emergency self-help measures.
Patient education is important in patient care and influences subsequent prognosis (Evidence Level A).
The peak flowmetry method allows the patient to independently monitor 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 to increase exercise tolerance.
Drug 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 for relieving an attack and for preventing the development of an attack. Preference is given inhalation forms drugs.
To relieve rare bronchospasm attacks, inhaled short-acting β-adrenergic stimulants are prescribed: salbutamol, fenoterol.
Drugs to prevent seizures:
- formoterol;
- tiotropium bromide;
- combination drugs (Berotec, Berovent).
If the use of inhalation is impossible or their effectiveness is insufficient, then theophylline may be necessary.
In case of bacterial exacerbation of COPD, antibiotics are required. The following can be used: amoxicillin 0.5-1 g 3 times a day, azithromycin 500 mg for three days, clarithromycin SR 1000 mg once a day, clarithromycin 500 mg 2 times a day, amoxicillin + clavulanic acid 625 mg 2 times a day, cefuroxime 750 mg 2 times a day.
Withdrawal COPD symptoms Glucocorticosteroids also help, which are also administered by inhalation (beclomethasone dipropionate, fluticasone propionate). If COPD is stable, then the administration of systemic glucocorticosteroids is not indicated.
Traditional expectorants and mucolytics give a weak positive effect in patients with COPD.
In severe patients with a partial pressure of oxygen (pO 2) of 55 mm Hg. Art. and less oxygen therapy is indicated at rest.
Forecast. Prevention
The prognosis of the disease is influenced by the stage of COPD and the number of repeated exacerbations. Moreover, any exacerbation negatively affects the overall course of the process, therefore, the earliest possible diagnosis of COPD is extremely desirable. Treatment of any exacerbation of COPD should begin as early as possible. It is also important to fully treat an exacerbation; in no case is it permissible to endure it “on your feet.”
Often people decide to see a doctor for medical care, starting from the II moderate stage. At Stage III the disease begins to have a fairly strong impact on the patient, symptoms become more pronounced (increasing 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, and the development of cor pulmonale is possible.
The prognosis of the disease is influenced by the patient's compliance medical recommendations, adherence to treatment and a healthy lifestyle. Continued smoking contributes to the progression of the disease. Quitting smoking leads to a slower progression of the disease and a slower decline in FEV 1 . Due to the fact that the disease has a progressive course, many patients are forced to take medicines lifelong, many require gradually increasing doses and additional funds during exacerbations.
The best means of preventing COPD are: healthy image life, including good nutrition, hardening the body, reasonable physical activity, and eliminating exposure to harmful factors. To give up smoking - absolute condition prevention of exacerbation of COPD. Existing occupational hazards, when diagnosed with COPD, are a sufficient reason to change jobs. Preventive measures Avoiding hypothermia and limiting contact with people with ARVI are also important.
To prevent exacerbations, patients with COPD are recommended to receive annual influenza vaccination. People with COPD aged 65 years and older and patients with FEV 1< 40% показана вакцинация поливалентной пневмококковой вакциной.
Bibliography
- 1. General medical practice. National leadership in 2 volumes. T.1 / ed. Academician RAMS I. N. Denisova, prof. O. M. Lesnyak. – M.: GEOTAR-Media, 2013. - 976 p.
- 2. Chronic obstructive pulmonary disease: Moography / Ed. A.G. Chuchalina. – M.:Atmosfera, 2008. – 367 p.
- 3. Leshchenko I.V. New directions in the diagnosis and treatment of chronic obstructive pulmonary disease // Ter. Arch. – 2004. - No. 3. – p. 77-80.
- 4. Grippi M.A. Pathophysiology of the lungs. M.: Binom, 2014. – 304 p.
- 5. Therapy: trans. from English additional//chief editor A.G. Chuchalin. – M.: GEOTAR. - With. 1024
Pulmonary obstruction is dangerous condition, which limits the supply of inhaled oxygen and can lead to irreversible consequences throughout the body.
Normally, during inhalation, the lungs expand, and during exhalation, contraction occurs. Oxygen enters the lungs during inhalation, but due to obstruction during exhalation, it does not leave completely. As a result, a person may develop emphysema. Also, in this case, there is insufficient oxygen supply to the lungs, which leads to necrosis of the organ tissue: it decreases in volume, which will inevitably lead to human disability and death.
The course of obstructive syndrome is aggravated by gas exchange disorders, manifested by a decrease in oxygen and retention of carbon dioxide in the bloodstream, an increase in pressure in the bloodstream pulmonary artery and leading to the formation pulmonary heart.
Nowadays, the incidence is increasing every year. Pulmonary obstruction is diagnosed in approximately 5% of the population. Patients with such diseases practically lose the ability to live and work normally.
Obstructive syndrome has stages of development:
- I. Stage or pre-disease. It manifests itself as a cough with sputum production, but without functional disorders in the lungs.
- II. The stage has a mild course with prolonged cough with sputum separation. The volume of formed exhalation is 20% below normal.
- III. This stage of obstructive syndrome is characterized by a moderate course with shortness of breath and all the characteristic clinical manifestations. Forced expiratory volume is 30-50% below normal.
- IV. The stage has a severe course with increasing air restriction when exhaling, severe shortness of breath. Forced expiratory volume is 50-70% below normal.
- V. The course at this stage is extremely severe. It is characterized by severe bronchial obstruction with a high risk of complications (cor pulmonale, respiratory failure) and death. Forced expiratory volume is 30 percent or less below normal.
Pathological changes in pulmonary obstruction:
- excessive mucus production;
- dysfunction of the ciliated epithelium;
- bronchial obstruction;
- destruction of parenchyma and emphysema;
- violation of gas exchange;
- hypertension in the lungs;
- development of cor pulmonale over a long period of time;
- systemic disorders with a long course.
The causes of bronchial obstruction, against which pulmonary obstruction occurs, are varied. Under the influence of these reasons, the mucous membrane (and the villi on it) lose the ability to retain viruses and pathological microorganisms. The causes of pulmonary obstruction may be the following:
- genetic predisposition;
- compression and injury of the bronchi;
- dystonia;
- decreased immunity;
- hernia in the diaphragm;
- fistulas in the trachea and esophagus;
- diseases of the cardiovascular system;
- burn;
- poisoning;
- breathing problems due to a deviated nasal septum.
- smoking.
In children, the causes of bronchial obstruction may be the following:
- pregnancy complication;
- premature birth;
- complications during childbirth;
- passive smoking of parents;
- pathology of bronchial tubes development;
- foreign bodies in the bronchi.
Pulmonary obstruction can occur due to respiratory diseases:
- acute respiratory diseases;
- allergic respiratory diseases (asthma);
- infectious and inflammatory diseases (bronchitis, pneumonia);
- pulmonary tuberculosis;
- cystic fibrosis;
- tumor diseases;
- obstructive bronchitis;
- bronchiectasis;
- cystic pulmonary hypoplasia;
- pulmonary edema.
Predisposing factors for the occurrence of this disease:
- polluted air;
- unfavorable habitat;
- unfavorable working conditions;
- occupational hazards;
- low economic status;
- blood group a(11).
The first symptoms of pulmonary obstruction may be limited to coughing, but then characteristic signs of obstruction appear:
- cough may be nonproductive;
- shortness of breath, over time it can appear even with slight physical exertion (walking, for example);
- discharge of purulent sputum,
- bubbling breath
- hoarse voice and wheezing with whistling in the chest area, which can be heard even without a phonendoscope;
- swelling of the limbs;
- weakness;
- fatigue;
- sleep disturbance.
In children, pulmonary obstruction is manifested by the following symptoms:
- expiratory shortness of breath;
- percussion box sound;
- emphysematous chest swelling;
- scattered wheezing (in infants - wet, in older children - whistling and dry);
- weakened breathing;
- sleep disturbance;
- cough (wet or dry);
- anxiety.
Possible complications of pulmonary obstruction:
- transition to a chronic course;
- pneumonia;
- acute or chronic respiratory failure;
- pneumothorax;
- pneumosclerosis;
- heart failure;
- secondary polycythemia;
- pulmonary hypertension;
- pulmonary heart;
- myocardial infarction;
- stroke;
- renal disorders;
- emphysema;
- bronchiectasis;
- death.
This disease can be diagnosed in the following ways:
- examination by a doctor using auscultation and percussion techniques;
- X-ray examination of the lungs;
- CT scan;
- laboratory diagnostics (analysis of sputum, blood, urine);
- functional diagnostics of the lungs (spirometry);
- electrocardiography of the heart and other studies.
Treatment of bronchial obstruction in children of the first year of life is carried out only in a hospital.
Parents should not self-medicate, because many groups of drugs at this age are strictly prohibited, for example, expectorants, antihistamines, bronchodilators and others.
I. Elimination of the cause of the disease.
If the cause of the disease is smoking, you should immediately stop smoking. bad habit using nicotine patches, electronic cigarettes and other methods quick fight with smoking.
If the reason is accompanying illnesses, against the background of which bronchial obstruction has arisen, then treatment should be aimed at eliminating these diseases in order to reduce the risk of developing pathological processes in the lungs. If obstructive disorders are provoked by diseases of infectious origin, then antibiotic therapy is used in treatment to eliminate bacteria from the body.
II. Drug treatment.
In addition to antibiotics, the following are used for bronchial obstruction:
- antispasmodics to relieve spasm and dilation of the bronchi (aminophylline, etimizol, sympathomimetics);
- corticosteroid drugs for severe respiratory failure (prednisolone);
- expectorants (ambroxol, ascoril, omnipus and others);
- sputum-thinning drugs (acc, lazolvan and others);
- inhibitors of anti-inflammatory mediators (erespal and others).
Drug treatment in the first stages of the disease involves the use of tablets, syrups, and intramuscular administration of drugs. In severe cases, a course of inhalation therapy with hormonal agents is carried out.
III. Alveolar massage.
This instrumental method treatment of pulmonary obstruction, which affects all tissues of the organ. As a result of this massage, point impact Total bronchial tree and uniform distribution of air, which begins to intensively nourish the damaged lungs. The procedure is painless. It is carried out by inhaling air through a special tube, which is supplied using pulses.
IV. Oxygen therapy.
The use of artificial oxygen injection into the lungs reduces the severity of shortness of breath and improves general state sick.
V. Therapeutic and therapeutic breathing exercises promotes the evacuation of sputum from the bronchi and improves hemodynamics in the pulmonary circulation.
VI. Surgery. First way surgical intervention consists in completely opening the chest, and the second method is characterized by the use of the endoscopic method.
VII. Spa treatment.
Prevention of pathology
Prevention involves the following actions:
- To prevent relapses, it is recommended to perform chest massage;
- rejection of bad habits;
- promptly examine and treat concomitant diseases;
- proper nutrition;
- physical activity;
- vitamin prophylaxis in the off-season;
- hardening of the body;
- do not contact with chemicals;
- ventilate the room;
- Use a humidifier and air filter.
And remember that you need to alternate between work and rest, while getting adequate sleep.
Chronic obstructive pulmonary disease (COPD) is fatal dangerous disease. Quantity deaths per year worldwide reaches 6% of all deaths.
This disease, which occurs as a result of long-term damage to the lungs, is currently considered incurable; therapy can only reduce the frequency and severity of exacerbations and reduce the level of deaths.
COPD (chronic obstructive pulmonary disease) is a disease in which air flow in the airways is limited, partially reversible. This obstruction continually progresses, reducing lung function and leading to chronic respiratory failure.
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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 rate is in countries with low level life.
Origin of the disease
With many years of irritation of the lungs by harmful gases and microorganisms, it gradually develops chronic inflammation. As a result, narrowing of the bronchi occurs and destruction of the alveoli of the lungs. Subsequently, all respiratory tracts, tissues and blood vessels of the lungs are affected, leading to irreversible pathologies, causing deficiency oxygen in the body. COPD (chronic obstructive pulmonary disease) develops slowly, progressing steadily over many years.
With absence COPD treatment leads to human disability, then death.
Main causes of the disease
- Smoking is the main cause, causing up to 90% of cases of the disease;
- occupational factors - work in hazardous industries, 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 α1-antitrypsin deficiency.
- Cough– the earliest and often underestimated symptom. At first the cough is periodic, then it becomes daily, in rare cases appears only at night;
- – appears in the early stages of the disease in the form of a small amount of mucus, usually in the morning. As the disease progresses, the sputum becomes purulent and increasingly abundant;
- dyspnea– is detected only 10 years after the onset of the disease. At first it appears only during severe physical exertion. Further, a feeling of lack of air develops with minor body movements, and later severe progressive respiratory failure appears.
The disease is classified according to severity:
Mild – with slightly pronounced impairment of lung function. A slight cough appears. At this stage the disease is very rarely diagnosed.
Moderate severity - obstructive disorders in the lungs increase. Shortness of breath appears during exercise. loads The disease is diagnosed when patients present due to exacerbations and shortness of breath.
Severe - there is a significant restriction of air flow. Frequent exacerbations begin, shortness of breath increases.
Extremely severe - with severe bronchial obstruction. The state of health deteriorates greatly, exacerbations become threatening, and disability develops.
Diagnostic methods
Anamnesis collection - with analysis of risk factors. For smokers, the smoker's index (SI) is assessed: the number of cigarettes smoked daily is multiplied by the number of years of smoking and divided by 20. An SI of more than 10 indicates the development of COPD.
Spirometry – to assess 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 bronchial narrowing.
X-ray examination - determines the severity of pulmonary changes. The same is carried out.
Sputum analysis - to identify microbes during exacerbation and select antibiotics.
Differential diagnosis
X-ray findings are also used to differentiate from tuberculosis, as well as sputum analysis and bronchoscopy.How to treat the disease
General rules
- Smoking must be stopped forever. If you continue to smoke, no treatment for COPD will be effective;
- application individual funds protection respiratory system, reducing, if possible, the number of harmful factors in the work area;
- rational, nutritious nutrition;
- reduction to normal body weight;
- regular physical exercise(breathing exercises, swimming, walking).
Treatment with drugs
Its goal is to reduce the frequency of exacerbations and severity of symptoms, and prevent the development of complications. As the disease progresses, the scope of treatment only increases. Main drugs in the treatment of COPD:
- Bronchodilators are the main drugs that stimulate bronchodilation (atrovent, salmeterol, salbutamol, formoterol). Administered preferably in the form of inhalations. Short-acting drugs are used as needed, long-term drugs are used constantly;
- glucocorticoids in the form of inhalations - used for severe degrees illness, during exacerbations (prednisolone). In case of severe respiratory failure, attacks are stopped with glucocorticoids in the form of tablets and injections;
- vaccines – vaccination against influenza can reduce mortality in half of cases. It is carried out once in October - early November;
- mucolytics – thin mucus and facilitate its removal (carbocysteine, ambroxol, trypsin, chymotrypsin). Used only in patients with viscous sputum;
- antibiotics - used only during exacerbation of the disease (penicillins, cephalosporins, fluoroquinolones may be used). Tablets, injections, inhalations are used;
- antioxidants – capable of reducing the frequency and duration of exacerbations, used in courses of up to six months (N-acetylcysteine).
Surgery
- Bullectomy – removal can reduce shortness of breath and improve lung function;
- Reducing lung volume through surgery is currently under study. The operation improves physical state patient and reduce the mortality rate;
- Lung transplantation – effectively improves quality of life, lung function and physical performance sick. Application is hampered by the problem of donor selection and high cost operations.
Oxygen therapy
Oxygen therapy is carried out to correct respiratory failure: short-term - for exacerbations, long-term - for the fourth degree of COPD. If the course is stable, continuous 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 each chamomile and mallow;
√ 1 part flaxseeds, 2 parts each of eucalyptus, linden flowers, chamomile;
√ 1 part each of chamomile, mallow, sweet clover, anise berries, licorice and marshmallow roots, 3 parts flaxseed.
- Radish infusion. Grate black radish and medium-sized beets, mix and pour cooled boiling water over them. Leave for 3 hours. Drink 50 ml three times a day for a month.
- Nettle. Grind the nettle roots into a paste and mix with sugar in a ratio of 2:3, leave for 6 hours. The syrup removes mucus, relieves inflammation and relieves cough.
- Milk:
√ Brew a spoonful of cetraria (Icelandic moss) with a glass of milk and drink throughout the day;
√ Boil 6 chopped onions and a head of garlic in a liter of milk for 10 minutes. Drink half a glass after meals.
Frequent pneumonia in a child can subsequently provoke the development of COPD. Therefore, every mother should definitely know!
Are coughing attacks keeping you up at night? You may have tracheitis. You can learn more about this disease
Secondary
- physical activity, regular and dosed, aimed at the respiratory muscles;
- annual vaccination with influenza and pneumococcal vaccines;
- constant intake of prescribed medications and regular examinations with a pulmonologist;
- correct use of inhalers.
Forecast
COPD has a conditionally unfavorable prognosis. The disease progresses slowly but constantly, 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 constantly increasing doses of medication.
With continued smoking, obstruction progresses much faster, significantly reducing life expectancy.
Incurable and deadly, COPD simply encourages people to quit smoking for good. And for people at risk, there is only one piece of advice - if you notice signs of the disease, immediately contact a pulmonologist. After all, the earlier the disease is detected, the lower the likelihood of premature death.
» , most of us won't be told anything at all- unlike, for example, the other four letters that make up “AIDS.” However, behind this abbreviation lies one of the deadliest diseases in the world: chronic obstructive pulmonary disease, a diagnosis that has already affected more than 200 million people around the globe. According to the World Health Organization (WHO), this disease is gradually becoming the third leading cause of death in many countries, including Russia. Unfortunately, attention to COPD in our society seems to be insufficient. Everyone hears about HIV, tuberculosis and pneumonia, oncology of all kinds, and yet the mortality rate from all these diseases is much lower.
Statistics
Over the past 20 years, the number of people dying from COPD has increased by more than 10%. Officially, the diagnosis is registered in approximately 1.5% of citizens of the Russian Federation. And this indicator significantly reduces the scale of the COPD problem, which is assessed by international experts (carried out on the initiative of the World Health Association together with the domestic Research Institute of Pulmonology). Extrapolation of recent data obtained from epidemiological studies GARD (Global Alliance against Chronic Respiratory Diseases, Global Alliance to Combat Chronic Respiratory Diseases), made it possible to state that as much as 15% of the total population of our country suffers from COPD. That is, more than 20 million patients in total, and every fifth Russian is in the main group of patients (from 40 to 60 years old). Many of them are unaware of the existence of such a disease and, therefore, do not take the initiative to undergo diagnostics. But even among those who have undergone it, approximately 90% of Russian patients ultimately do not receive the recommended treatment GOLD (Global initiative for Obstructive Lung Disease, Global COPD Initiative). Thus, it can be emphasized: although the accompanying threat is hidden, including by dry statistics, it is there and has a very destructive impact on the life of the population.
That is why COPD is considered World Organization health care to epidemics non-communicable diseases. And now every year, on November 17, on the initiative of this organization, World COPD Day is celebrated. During its implementation, spirometry is performed for everyone completely free of charge - a study of external respiration functions, carried out using a special spirometer device.
Typical medical history
This disease is formed due to inhalation of harmful particles or gases. Subsequently, the patient's airways gradually narrow due to inflammation of the lung tissue. The most important thing is that this narrowing cannot be completely reversed.
COPD usually begins to develop in youth. The development process sometimes stretches for decades. All this time a person may not consider himself sick. Potential victims of COPD most often do not pay attention to symptoms such as shortness of breath, cough, and sputum. If they do decide to undergo treatment, then they are treated later, as a rule, for cough, and not for COPD.
The problem is that COPD, due to systematic breathing problems in the patient, provokes the development of many other diseases, for example, cardiovascular pathologies. The latter then often indicate main reason death, while the true cause was COPD.
Diagnostics and therapy
At the same time important and complex specialists called differential (separating) diagnosis of COPD and bronchial asthma.
There is a known syndrome of overlap or combination of COPD with asthma. However, if the occurrence of asthma is usually associated with allergic reactions, then for COPD the main (80-90% of cases) risk factor is smoking, and in the second and subsequent order is the systematic inhalation of harmful particles or gases.
As with asthma, the main pharmacological drugs For the treatment of COPD, bronchodilators are considered - special bronchodilators, usually produced in inhalers or tablets. They are used as needed (for example, for shortness of breath) or for prevention. Moreover, if the asthmatic’s body usually reacts to treatment with bronchodilators very positively, then in the case of COPD this cannot be said. It is also impossible to name a drug that can completely and completely cure a disease. Experts indicate that the most effective means of combating the disease is complete and timely cessation of smoking.
Methods for classifying COPD patients into groups, as well as methods for their further treatment, vary from country to country.
Some (for example, this is common in Spain, the Czech Republic and a number of other countries) more often use a phenotypic approach with grouping patients according to COPD phenotypes. The key phenotypes here are COPD itself “in pure form"and its various combinations with others pulmonary diseases(asthma, bronchitis, emphysema and others).
Other countries, particularly the United States of America, prefer the older spirometric approach based on pulmonary function testing. It is the attitude FEV1 (the volume of air exhaled by the patient in the first second with the fastest and most powerful, or “forced” exhalation) to FVC (the total volume of air in such an exhalation) determines the presence of COPD (characterized by the ratio FEV1/FVC below 70% of the norm) along with the degree (from mild to extremely severe), according to which patients are classified.
The most modern is considered A complex approach, which takes into account the number of exacerbations, as well as symptoms and spirometry. It has already gained a foothold in the latest GOLD recommendations and in our country. Now Russian Respiratory Society is preparing a new version of the recommendations, which for the most part coincide with the recommendations of world experts.
Perspective: a universal algorithm?
Not so long ago International j ournal of COPD (the main special publication on COPD in the world) noted as a particularly promising work of domestic researchers (in particular, the teams of the I.M. Sechenov Moscow State Medical University and the A.I. Evdokimov Moscow State Medical University). They offered a universal and quite simple diagram therapy for COPD, designed simultaneously for two areas of medical practice: general practitioners and highly specialized pulmonary specialists - pulmonologists.
Own clinical algorithm drug therapy was formed by the authors in long-term work with patients with stable COPD. According to the proposed scheme, patients are treated with long-acting bronchodilators and short-acting drugs as required. If FEV1 if spirometry is at least 50% of the proper value (calculated individually from the ratio of the patient’s height, weight and age), then the patient is offered treatment with one long-acting drug. Symptoms are addressed by a patient-specific COPD Assessment Test, which includes eight questions about symptoms (specifically, cough, sputum, shortness of breath, as well as anxiety and other psychological disturbances). If the patient scored more than ten points on the test or FEV1 turned out to be less than 50% of the norm, then the patient is recommended to use combined bronchodilators.
And in cases where the above-described treatment did not produce any significant results within three months, the therapist is recommended to redirect the patient to a pulmonologist for a detailed examination of the lungs by endotyping (endotype analysis - internal signs pathological inflammatory processes in the body). The latter, according to our specialists, assumes Special attention pulmonologist to three key endotypes (each of which, in turn, corresponds to a specific type of inflammation - neutrophilic, eosymophilic and small cell).
The authors themselves reveal their vision of the method in a positive way: “Since there are too few pulmonologists in Russia to successfully combat the scale of the COPD epidemic on our own, we decided to tackle the very mechanism of prescribing therapy. Our main goal was to obtain a scheme that would be easy for doctors to use in daily practice. Moreover, we tried to select the simplest markers, such as blood or sputum tests. Thus, everything that we now offer for research is practically feasible if the simplest laboratory techniques are followed. And now all that remains is to continue monitoring the medical application of our algorithm. Even before the official publication inInternational Journal of COPD We have received a lot of feedback about the successful application of the approach in a number of countries, for example, in Bulgaria and Serbia. It looks very comfortable. After all complex circuit It’s easy to draw, but a simple but effective one is quite difficult. And we hope that the algorithm will also become useful for doctors in our country.”
Title illustration: Maria Frolova
