Bronchial pneumonia - causes, symptoms and treatment. Infectious pneumonia of the lungs - symptoms and methods of treatment Causes and provoking factors

Bronchial pneumonia is a type of pneumonia. Harmful bacteria and viruses, along with the inhaled air, penetrate the lungs and infect the smallest branches of the bronchial tree.

What causes bronchopneumonia

Bronchial pneumonia can be caused by many viruses and bacteria. In most cases, inflammation is a consequence of an upper respiratory tract infection. For example, bronchitis or ARVI can lead to the development of the disease. The most common pathogens are bacteria such as streptococcus, pneumococcus, and many viruses.

Pneumonia can also be a consequence of food entering the respiratory tract, compression of the lungs by a tumor, inhalation of toxic gases, or a postoperative complication.

Who is at risk of getting sick

Absolutely anyone can get pneumonia. But there are groups of people who are especially vulnerable to this disease.

High-risk groups include:

Newborns and children under 3 years of age;
Children with congenital diseases of the respiratory system;
Children with congenital or hereditary defects of the immune system (immunodeficiencies);
Elderly over 65 years of age;
People who already have lung diseases (such as asthma and bronchitis);
HIV-infected;
Suffering from heart disease and diabetes;
Smokers.

The main signs of the disease are:

Fever. Increase in body temperature to 37.5 - 39 degrees within 1-3 days. Accompanied by severe weakness, loss of appetite or complete refusal of food, sweating and chills, insomnia, pain in the calf muscles. Fever is a manifestation of the body's fight against inflammation. Therefore, at temperatures up to 37.5-38C, it is not recommended to take antipyretic drugs.
Cough. At the beginning of the disease it is dry, frequent, irritating. As pneumonia progresses, sputum appears. The sputum has a characteristic greenish-yellow color, sometimes streaked with blood.
Dyspnea. In adults with severe disease, there is a feeling of lack of air and frequent shallow breathing. Sometimes shortness of breath persists even at rest.
Chest pain. Disturbs when coughing or taking a deep breath. With pneumonia, pain appears on the side of the affected lung, often stabbing or pulling, and goes away after coughing.

Features of symptoms in children

Due to the fact that children's airways are short and do not yet have protective immune barriers, inflammation is sometimes lightning fast. Bronchopneumonia is especially dangerous in newborns and infants.

Symptoms such as fever and cough may be mild or absent in children. Sometimes pneumonia can develop at normal or reduced body temperature. Loud wheezing and shortness of breath come to the fore.

To suspect pneumonia in children, parents should pay attention to prolonged bronchitis or ARVI, the child’s lethargy and lack of appetite, increased breathing, and shortness of breath.

What diagnostic examination should be performed?

If the above symptoms appear, you should consult a doctor. At your appointment, the doctor will conduct an initial examination, which includes:

Measuring body temperature.
Tapping (percussion) of the lungs. Using his fingers, the doctor taps on the surface of the lungs (above the collarbones, between the shoulder blades, in the lower parts of the chest). In the presence of pneumonia, a shortening of the sound over the affected area is characteristic.

At the moment, this method is considered uninformative and is almost not used in the diagnosis of pneumonia.

Listening (auscultation) of the lungs. It is carried out using a stethoscope or phonendoscope. The essence of the method is to listen to wheezing, weakened breathing, and pleural friction noise in the affected area. The appearance of these sound phenomena depends on the period of the disease (beginning, peak, recovery) and cannot always be heard.

Based on complaints, characteristic symptoms and examination, a diagnosis of pneumonia can be made.

To document the disease, a chest X-ray and a series of laboratory tests must be performed. In special cases, computed tomography, sputum analysis, pathogen identification tests, and bronchoscopy will be needed.

Chest X-ray is the gold standard for diagnosing pneumonia. This research method must be performed twice - when making a diagnosis and after treatment. This method makes it possible to evaluate the effectiveness of the treatment and determine the future prognosis.

Treatment includes measures on regimen, nutrition, as well as the prescription of medications and physical therapy.

Mode.

At the onset of the disease, bed rest is recommended. Be sure to ventilate and clean the room. When body temperature normalizes, walks in the fresh air are allowed. Resumption of hardening from 2-3 weeks after the end of pneumonia. Resumption of physical activity from the 6th week of recovery.

Diet.

There are no food restrictions. Nutrition should be balanced, high in proteins and vitamins. Small and frequent meals are recommended. It is mandatory to drink plenty of liquid in the form of warm fruit drinks, herbal teas, and warm mineral water.

Physiotherapeutic treatment.

It should be started after body temperature has normalized. Chest massages and inhalations with drugs that facilitate breathing and sputum discharge are useful.

Types of drugs used

The use of antibiotics is the main treatment for pneumonia. The choice of antibiotic is made individually for each patient. The type of pathogen, risk factors, and severity of the disease are taken into account.

Treatment involves prescribing antibiotics in the form of tablets or injections (intravenous or intramuscular).

Also in the treatment of bronchopneumonia, antipyretics, expectorants, antiallergic drugs, and vitamins are used. In some cases, oxygen is prescribed.

Therapy in childhood

Treatment of children is carried out only in a hospital. If necessary, the child may be placed in an intensive care unit.
When prescribing drugs, the dose is calculated based on the patient's weight. If pneumonia is caused by viruses, then in severe cases antiviral drugs may be prescribed.

Children are more at risk of dehydration. The threat is especially high against the background of elevated body temperature, so much attention is paid to maintaining water balance. Sometimes the missing fluid is administered using droppers. To prevent shortness of breath, oxygen inhalations are used.

Currently, due to the effective treatment of bronchitis and ARVI in the early stages, the number of children with severe forms of pneumonia is quite rare.

Consequences of inflammation and prevention

For most people, pneumonia goes away without leaving a trace. Residual manifestations of the disease (weakness, shortness of breath when walking quickly) disappear within 1 month.

To prevent relapse, you must follow simple rules:

Wash your hands regularly;
Avoid smoking;
Avoid contact with sick people;
Stick to a healthy diet;
Exercise;
Get enough sleep, rest regularly.

Editor

Pulmonologist

Pulmonary obstruction is a pathology in the bronchopulmonary system that leads to improper passage of air in the respiratory tract. As a rule, the disease occurs during an inflammatory process in the tissues of an organ, as a response to external stimuli.

Causes and provoking factors

In most cases, pneumonia develops as a result of a negative influence; in some cases, mycoplasma and viruses are the culprits of the inflammatory process.

In adults, risk factors for developing the disease are:

poor nutrition;
weak immunity;
frequent respiratory infections;
smoking;
the presence of chronic diseases - heart pathologies, pyelonephritis;
autoimmune diseases.

In childhood, provoking factors are as follows:

chronic infections in the ENT organs;
overheating or cooling;
incorrect daily routine;
lack of physical education;
violation in children's institutions.

The pathogenesis of COPD has not been fully studied, however, scientists have identified triggers factors that can give impetus to the development of pathology:

smoking;
working in hazardous production or living in an environmentally unfavorable environment;
cold and damp climatic conditions;
infectious lesion of mixed origin;
long-term bronchitis;
pathologies of the pulmonary system;
hereditary predisposition.

Obstructive pneumonia develops slowly over a long period of time and is often preceded by inflammation in the bronchi. Factors leading to the development of the disease:

It is important to understand that people with COPD are at risk of developing pneumonia increases significantly.

The simultaneous occurrence of pneumonia along with COPD leads to a vicious circle, that is, one disease affects the other, therefore, the clinical picture of the pathology becomes more severe. Moreover, COPD itself, and pneumonia itself, are often the causes of the development of respiratory failure, and when they act together, the complication becomes much more serious and dangerous.

Diagnostics

Diagnosis of diseases is based on various studies. Initially, the doctor collects anamnesis and learns about the presence of bad habits. He then listens to the bronchopulmonary system and refers the patient to determine damage to lung tissue and organ deformation. Spirometry or body plethysmography may also be prescribed to assess breathing volume, lung capacity and other indicators.

To find out the nature of the pathology, it is necessary to examine the sputum; in addition, this analysis is needed to prescribe the correct treatment - drugs are selected depending on the specific one and its resistance to a particular drug.

With obstructive inflammation in the blood increases:

leukocyte count;
blood viscosity increases;
hemoglobin levels increase.

Symptoms of pneumonia

The initial stages of pulmonary obstruction may not manifest themselves in any way; patients complain only of a chronic cough, which most often bothers them in the morning.

Shortness of breath first appears during physical activity, but then can occur even with minor exertion.

Advanced stages of COPD are difficult to distinguish from pneumonia because The clinical picture of these diseases is not much different:

cough with phlegm;
dyspnea;
wheezing;
breathing problems;
pneumonia may be supplemented by:
- high temperature;
- chills;
- pain in the sternum when breathing or coughing.

When ailments worsen, the following is observed:

loss of the ability to speak due to lack of air;
critical temperature indicators;
lack of positive effect when taking medications.

In COPD, pneumonia can occur in two ways:

. Onset of the disease:
- spicy;
- the temperature rises sharply;
- pulse quickens;
- cyanosis appears;
- there is severe night sweats;
- dyspnea;
- headache;
- pain in the chest;
- cough with mucous or purulent sputum.
Perifocal focal pneumonia. Development of pathology:
- gradual;
- at the initial stages the body temperature is subfebrile;
- subsequently, its increase to critical levels is observed;
- chest pain on the affected side;
- dyspnea;
- cough with purulent sputum.

Treatment

For severe and moderate disease patient needs hospitalization to the pulmonology or therapeutic department . For uncomplicated pneumonia, therapy can be carried out on an outpatient basis under the supervision of a physician.

The basis for treating the disease is etiotropic therapy, which is aimed at destroying the causative agent of the disease. Based on the fact that most often the pathology is bacterial in nature, antibacterial therapy is prescribed, but in case of a viral infection, antibiotics can also be prescribed - to prevent the addition of bacterial flora. The drug is selected individually depending on the resistance of the pathogen.

Symptomatic treatment:

means to reduce body temperature;
expectorants and mucolytics;
antihistamines (to block histamine receptors and relieve allergic symptoms);
bronchodilators;
detoxification agents;
vitamins;
corticosteroids that relieve inflammation.

As for COPD, this disease cannot be treated; all therapy is aimed at relieving negative symptoms and improving the quality of life. On average, exacerbations of COPD occur 1-2 times a year, but as the disease progresses, exacerbations may occur more often.

Important! Stabilization of the condition in COPD, that is, if it is possible to stop the progression of the disease, this is already a success. Unfortunately, in most cases, the disease actively progresses.

Useful video

What is COPD and how to detect it in time:

Reference materials (download)

To download, click on the desired document:

Conclusion

Chronic obstructive pulmonary disease leads to deterioration in the functionality of the airways and respiratory organs. This increases the risk of developing pneumonia. The disease can have a protracted course and lead to a number of complications, for example, pleurisy, bronchiectasis, pneumosclerosis, and so on. Without proper treatment, pneumonia due to COPD will be fatal.

Pulmonary obstruction is a disease that results in inflammation and narrowing of the bronchi and severe disruption of the structure and function of the lungs. The disease tends to progress and become chronic.

Are you having any problem? Enter “Symptom” or “Name of the disease” into the form, press Enter and you will find out all the treatment for this problem or disease.

The site provides reference information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor. Any drugs have contraindications. Consultation with a specialist is required, as well as detailed study of the instructions! .

The pathology is called COPD - chronic obstructive pulmonary disease.

What happens with pulmonary obstruction

The mucous membrane of the airways has villi that trap viruses and harmful substances that enter the body. As a result of long-term negative effects on the bronchi, provoked by various factors (tobacco smoke, dust, toxic substances), the protective functions of the bronchi are reduced, and inflammation develops in them.

The consequences of inflammation in the bronchi are swelling of the mucous membrane, as a result of which the bronchial passage narrows. During examination, the doctor hears hoarse, whistling sounds from the chest, characteristic of obstruction.

Normally, when you inhale, the lungs expand; when you exhale, they completely contract. With obstruction, air enters them when you inhale, but does not completely leave them when you exhale. Over time, as a result of improper functioning of the lungs, patients may develop emphysema.

The reverse side of the disease is insufficient oxygen supply to the lungs, as a result of which necrotization of the lung tissue occurs, the organ decreases in volume, which will inevitably lead to human disability and death.

Symptoms of the disease

In the first and second stages of the disease, the disease manifests itself only as a cough, to which rarely any patient pays due attention. More often people go to the hospital in the third and fourth stages of the disease, when serious changes develop in the lungs and bronchi, accompanied by pronounced negative symptoms.

Characteristic symptoms of pulmonary obstruction:

Dyspnea,
Discharge of purulent sputum,
bubbling breath
Hoarse voice,
Swelling of the limbs.

Causes of pulmonary obstruction

The most important cause of pulmonary obstruction is long-term tobacco smoking, against the background of which there is a gradual decrease in the protective function of the bronchi, they narrow and provoke changes in the lungs. The characteristic cough of this disease is called “smoker’s cough” - hoarse, frequent, disturbing a person in the morning or after physical exertion.

Every year it will become more and more difficult for a smoker; shortness of breath, weakness, and sallow skin will be added to a lingering cough. Habitual physical activity will be difficult, and when coughing up, purulent greenish sputum may appear, sometimes mixed with blood.

More than 80% of patients with chronic obstructive pulmonary disease are experienced smokers.

Obstruction may occur due to diseases:

Bronchiolitis. A severe disease accompanied by chronic inflammation of the bronchioles.
Pneumonia.
Poisoning with toxic substances.
Heart diseases.
Various formations arising in the area of the trachea and bronchi.
Bronchitis.

Against the background of the development of pneumonia, the symptoms are not very pronounced, but the most serious destruction occurs. To avoid the consequences of the disease, it is necessary to undergo a thorough examination during the period of illness and after it.

The cause of COPD is prolonged exposure to harmful and toxic substances.

The disease is diagnosed in people who, by the nature of their profession, are forced to work in “harmful” industries.

If a disease is detected, it will be necessary to refuse such work, and then undergo comprehensive recommended treatment.
More often, obstructive pulmonary disease affects adults, but the inexorable trend of early smoking may soon change the statistics.

There is no need to exclude a genetic predisposition to the disease, which can often be traced within the family.

Video

Emphysema as a consequence of obstruction

As a result of partial blockage of the lumen in the bronchi, formed against the background of inflammatory processes in the mucous membrane, obstructive changes occur in the lungs. With pathology, air does not leave the lungs when exhaled, but accumulates, stretching the lung tissue, resulting in a disease - emphysema.

The symptoms of the disease are similar to other respiratory diseases - obstructive bronchitis or bronchial asthma. A common cause of emphysema is long-term, chronic bronchitis, which occurs more often in men and women of mature age.

The disease can be triggered by various lung diseases, including tuberculosis.

Emphysema will be caused by:

Smoking,
Contaminated air,
Work in “harmful” production associated with inhalation of parts of silicon and asbestos

Sometimes emphysema can develop as a primary disease, causing severe lung failure.

Common symptoms of emphysema include:

Severe shortness of breath
Blueness of the skin, lips, tongue and nose area,
Noticeable swelling in the rib area,
Extension above the collarbone.

With emphysema or COPD, the first symptom is shortness of breath, which first appears with mild physical exertion. If the disease is not treated at this stage, the disease will progress rapidly.

The patient will begin to experience difficulty breathing with little physical exertion, at rest. The disease should be treated at the first appearance of bronchitis; subsequently, irreversible changes in organs may develop, which will lead to disability of the patient.

Diagnosis of obstructive syndrome

Patient examination begins with interviewing and examining the patient. Signs of obstructive disease are detected already at these stages.

Held:

Listening with a phonendoscope,
Tapping (percussion) in the chest area (with bronchial and pulmonary diseases there will be an “empty” sound),
X-ray of the lungs, with which you can find out about pathological changes in the lung tissue, learn about the condition of the diaphragm,
Computed tomography helps determine whether there are formations in the lungs, what shape they have,
Lung function tests that help determine how much air a person inhales and how much air they exhale.

After identifying the degree of the obstructive process, treatment measures begin.

Complex therapy of the disease

If lung disorders occur as a result of long-term smoking, it is necessary to get rid of the bad habit. You need to quit smoking not gradually, but completely, as quickly as possible. Due to constant smoking, even greater injury occurs to the lungs, which already function poorly as a result of pathological changes. In the beginning, you can use nicotine patches or e-cigarettes.

If the cause of obstruction is bronchitis or asthma, then these diseases must be treated to prevent the development of pathological changes in the lungs.

If the obstruction is caused by an infectious disease, then antibiotics are used as treatment to destroy bacteria in the body.

Treatment can be carried out instrumentally, using a special device that is used for alveolar massage. Using this device, you can influence the entire lungs, which is impossible when using medications that are fully received by the healthy part of the organ, and not the diseased one.

As a result of the use of such acupressure, oxygen is evenly distributed throughout the bronchial tree, which nourishes the damaged lung tissue. The procedure is painless and involves inhaling air through a special tube, which is supplied using pulses.

In the treatment of pulmonary obstruction, oxygen therapy is used, which can be performed in the hospital or at home. At the initial stage of the disease, therapeutic exercises are used as treatment.

At the last stage of the disease, the use of conservative methods will not bring results, so surgical removal of the overgrown lung tissue is used as treatment.

The operation can be performed in two ways. The first method involves a complete opening of the chest, and the second method is characterized by the use of an endoscopic method, in which several punctures are made in the chest area.

To prevent the disease, it is necessary to lead a healthy lifestyle, give up bad habits, treat emerging diseases in a timely manner, and at the first unpleasant symptoms go to the doctor for examination.

Surgical treatment of pathology

The surgical treatment of this disease is still being discussed. One of the methods of such treatment is to reduce lung volume and transplant new organs. Bullectomy for pulmonary obstruction is prescribed only to those patients who have bullous emphysema with enlarged bullae, which is manifested by hemoptysis, shortness of breath, chest pain and infection in the lungs.

Scientists have conducted a number of studies on the effect of reducing lung volume in the treatment of obstruction, which have shown that such surgical intervention has a positive effect on the patient’s condition. It is much more effective than drug treatment for the disease.

After such an operation, you can observe the following changes:

Restoration of physical activity;
Improving quality of life;
Reducing the chance of death.

This surgical treatment is in the experimental phase and is not yet available for widespread use.

Another type of surgical treatment is lung transplantation. With it you can:

Restore normal lung function;
Improve physical performance;
Improve the patient's quality of life.

Treating yourself at home using folk remedies

Treatment of such a disease with folk remedies is best combined with taking medications prescribed by the attending physician. This is much more effective than using home treatment alone.

Before using any herbs or infusions, you should consult a doctor so as not to aggravate the condition.

For pulmonary obstruction, the following folk recipes are used:

Grind and mix 2 parts nettle and one part sage. Add a glass of boiling water and leave for one hour. Then strain and drink every day for several months.
To remove phlegm from the lungs, you need to use an infusion of flax seeds 300 g, chamomile 100 g, the same amount of marshmallow, anise and licorice root. Pour boiling water over the mixture for one hour, strain and drink half a glass every day.
A decoction of spring primrose horse gives excellent results. To prepare, pour boiling water over a tablespoon of chopped root and place in a water bath for 20-30 minutes. Take a spoonful 1 hour before meals several times a day.
If a severe cough bothers you, adding 10-15 drops of propolis to a glass of warm milk will help to quickly remove it.
Pass half a kilogram of aloe leaves through a meat grinder, add half a liter jar of honey and 300 ml of Cahors to the resulting pulp, mix everything thoroughly and put it in a jar with a tight lid. You need to insist for 8-10 days in a cool place. Take a spoonful several times every day.
A decoction of elecampane will ease the patient’s well-being and help remove phlegm. Pour boiling water over a spoonful of herbs and drink as tea every day.
It is effective to take yarrow juice. Take 2 spoons several times a day.
Black radish with honey is an ancient way to treat all respiratory diseases. It helps remove phlegm and helps with expectoration. To prepare, you need to cut a small hole in the radish and pour honey. Wait a little until the juice is released, drink a teaspoon several times a day. You cannot drink it with water or tea.
Mix coltsfoot, nettle, St. John's wort, motherwort and eucalyptus in equal proportions. Pour a spoonful of the resulting mixture with a glass of boiling water and let it brew. Then strain and drink as tea every day for several months.
Onions and honey work well. First, boil the whole onions until softened, then pass them through a meat grinder, add a few tablespoons of honey, 2 tablespoons of sugar, 2 tablespoons of vinegar. Mix everything thoroughly and press down a little. Take a spoonful every day.
To relieve a strong cough, you need to use viburnum with honey. Pour 200 g of berries with a glass of water, add 3-4 tablespoons of honey, and cook over low heat until all the water has evaporated. Take the resulting mixture one teaspoon per hour for the first 2 days, then several spoons per day.
Mix half a teaspoon each of the following herbs: marshmallow, sage, coltsfoot, fennel, dill, and pour boiling water into a container with a tight lid. Leave for 1-2 hours. Drink 100 ml every day 3 times.

Possible consequences and complications

The disease has dire consequences if treatment is not started in time. Among the possible complications, the most dangerous are:

Pulmonary hypertension;
Respiratory failure;
Poor circulation.

Frequent consequences of the advanced initial form of the disease are:

Dyspnea;
hacking cough;
Increased fatigue;
Chronic weakness;
Heavy sweating;
Decreased performance.

Complications are dangerous for a child’s body. They can appear if you do not pay attention to the first symptoms of the disease in time. Among them is a regular cough.

Prevention of pathology and prognosis

Pulmonary obstruction is highly treatable. The process goes unnoticed and without complications if you notice the first symptoms in time, do not start the disease and get rid of the causes of its occurrence. Timely and effective treatment helps remove all unpleasant symptoms and delay the progression of the pathology.

There are several factors that can adversely affect the prognosis:

Bad habits, mainly smoking;
Frequent exacerbations;
Formation of the pulmonary heart;
Elderly age;
Negative reaction to therapy.

To avoid developing pulmonary obstruction, you need to carry out prevention:

To refuse from bad habits. Smoking is one of the main causes of this disease.
Increase your immunity level. Consume vitamins and microelements in sufficient quantities regularly.
Avoid junk and fatty foods and eat plenty of vegetables and fruits.
To maintain the protective function, do not forget about garlic and onions, which help protect the body from viruses.
Avoid all foods and items that cause an allergic reaction.
Combating occupational factors that cause this disease. This includes providing individual respiratory protection and reducing the concentration of harmful substances in the air.
Avoid infectious diseases and vaccinate on time.
Lead a healthy lifestyle and regularly strengthen the body, increasing its endurance.
Walk outdoors regularly.
Do physical exercise.

5 / 5 ( 8 votes)

Obstructive pneumonia is a serious lung disease in which the patient experiences difficulty breathing. The disease is a consequence of long-term destructive effects on the lungs. If you do not consult a doctor in time and do not carry out the proper course of treatment, the disease will become chronic and irreversible.

Types of pathology

Pneumonia is popularly called pneumonia. It is accompanied by a cough and copious sputum production. With the further development of the disease, the surface of the lungs shrinks, the patient begins to suffer from rapid breathing, and he experiences shortness of breath. It is considered very dangerous and at the same time one of the most common ailments in any age category.

Depending on the pathogen, there are bacterial, viral, fungal pneumonia, as well as those caused by helminths or protozoa. There is also a mixed type, most often it is a bacterial-viral effect on the patient’s body. There are mild, moderate, severe and extremely severe degrees of complexity of the disease.

The process of inflammation can be unilateral or bilateral, the localization of the disease is focal, segmental, lobar or total. The obstructive form is most often lobar, that is, it affects one or more lobes of the lung and its pleura.

Causes and symptoms of the disease

This disease of the lower respiratory system develops very slowly at first. Most often it is preceded by inflammation of the bronchi. The list of factors leading to the disease is very impressive:

If the first symptoms of obstructive pneumonia occur, it is necessary to urgently contact a pulmonologist in order to quickly restore the health of the respiratory system and avoid the development of COPD.

In 9 out of 10 cases, the cause of the disease is smoking. And only 1 out of 10 cases occurs due to the following factors:

bronchitis;
bronchial asthma;
fragile or weakened immune system (in childhood and adulthood, respectively);
hereditary predisposition;
hazardous production (contact with chemicals);
a combination of several factors.

What is COPD?

Chronic obstructive pulmonary disease is a concept that has come into use relatively recently. COPD is a collective term for a large number of chronic respiratory diseases that cause obstruction (blockage) and cause respiratory failure.

Signs of COPD are a constant cough with sputum (in the later stages of the disease, it bothers the patient even during sleep), shortness of breath (may occur 10 or more years after the onset of the disease).

Data from the World Health Organization states: chronic obstructive pulmonary disease occurs in 9 people for every 1 thousand male inhabitants of our planet, and in 7 women for every 1 thousand female inhabitants. According to official information, there are 1 million citizens in Russia who have this diagnosis.

Among all types of pneumonia, the obstructive form is characterized by a rapid, abrupt onset. Early signs of the disease:

chills and fever (may last 7-10 days);
temperature rise to 39 or more;
headache;
weakness;
increased sweating;
cough with phlegm;
dyspnea;
severe chest pain in the area of the affected part of the lung;
difficulty breathing.

COPD has 4 stages:

I - mild (except for periodic coughing, nothing bothers the patient; at this stage it is almost impossible to make a correct diagnosis);
II - moderate (a more intense cough is observed, shortness of breath occurs during physical exertion);
III - severe (significant difficulty breathing, shortness of breath even at rest);
IV - extremely severe (at this stage, a significant part of the bronchi is already blocked, the disease becomes life-threatening for the patient, and he is assigned a disability).

Treatment of pneumonia

It is strictly forbidden to try to diagnose yourself and subsequently treat this serious and dangerous disease at home. Only a qualified pulmonologist can make the correct diagnosis and prescribe an appropriate course of treatment. On your own, you will not be able to understand what ailment has struck you - an obstructive form of inflammation or any other. And in no case should you delay treatment, since advanced respiratory diseases can be fatal.

As for treatment, it is carried out with pharmacological agents. The main ones are antibiotics. Depending on the severity of the disease, they are used in the form of syrups, tablets or injections. The second important group of drugs used to combat the disease are bronchi dilators. It is necessary to take expectorants, and patients are prescribed a complex of vitamins. It is important to follow one strict rule - bed rest.

Only with this combination of measures and means is a speedy recovery guaranteed.

The main way to reduce your chances of developing COPD, as well as any other respiratory disease, is to stop smoking. Residents of large cities, whose ecology is very damaged, need to undergo regular medical examinations. In addition, it is important to eat well and properly, to follow a routine in order to avoid overwork and nervous exhaustion, as a result of which pneumonia also occurs. It is necessary to strengthen the immune system. Breathing exercises will be beneficial.

(1) Research Institute of Pulmonology of the First St. Petersburg State Medical University
(2) Vvedenskaya City Clinical Hospital, St. Petersburg

The article provides information about community-acquired pneumonia (CAP) in patients with chronic obstructive pulmonary disease (COPD): frequency, predisposing factors, distinctive features of etiology and pathogenesis, predictors of adverse treatment outcomes. The use of scales to assess the severity of CAP in patients with COPD is analyzed, allowing one to characterize the risk of an unfavorable outcome and determine the optimal place of treatment. Using a clinical case as an example, the features of treatment for such patients are discussed.

Keywords: community-acquired pneumonia, chronic obstructive pulmonary disease.

Information about authors:
Kuzubova Natalia Anatolyevna – Doctor of Medical Sciences, Deputy Director for Scientific Work, Research Institute of Pulmonology, State Budgetary Educational Institution of Higher Professional Education “PSPbSMU named after. I.P. Pavlova"
Olga Nikolaevna Titova – Doctor of Medical Sciences, Director, Research Institute of Pulmonology, State Budgetary Educational Institution of Higher Professional Education “PSPbSMU named after. I.P. Pavlova"
Volchkov Vladimir Anatolyevich – Doctor of Medical Sciences, Chief Physician, St. Petersburg State Budgetary Healthcare Institution “Vvedenskaya City Clinical Hospital”
Kozyrev Andrey Gennadievich – candidate of medical sciences, head. laboratory, Research Institute of Pulmonology, State Budgetary Educational Institution of Higher Professional Education "PSPbSMU named after. I.P. Pavlova"

The features of community-acquired pneumonia in patients with chronic obstructive pulmonary disease

N.A. Kuzubova (1), O.N. Titova (1), V.A. Volchkov (2), A.G. Kozyrev (1)

(1) Research Institute of Pulmonology, First Pavlov State Medical University of St. Petersburg
(2) Vvedenskaya City Clinical Hospital, St. Petersburg

The article provides data on community-acquired pneumonia (CAP) in patients with chronic obstructive pulmonary disease (COPD): frequency, predisposing factors, the distinctive features of etiology and pathogenesis, predictors of treatment failure. The authors analyze the use of severity assessment scores for SAD in patients with COPD, allowing to characterize the risk of treatment failure and to determine the optimal treatment site. By the example of a clinical case the distinctions in treatment of such patients are discussed.

Keywords: community-acquired pneumonia, chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability, a disease whose medical and social significance is difficult to overestimate. According to the results of prospective epidemiological studies, by 2020 COPD will take third place in the world among all causes of death from diseases. Community-acquired pneumonia (CAP) is a factor that has an additional impact on the prognosis of life and work ability of a COPD patient. As shown by the ARIC (Atherosclerosis Risk in Communities Study) and CHS (Cardiovascular Health Study), which analyzed the results of observation of 20,375 patients 45 years of age and older, the probability of hospitalization for CAP in people with normal respiratory function was 1.5 cases per 1000 person-years At the same time, in patients with COPD stages III–IV, this value already reached 22.7 cases. Observation of a group of COPD patients consisting of 40,414 patients 45 years of age and older showed that they had CAP with a frequency of 22.4 cases per 1000 person-years, which increased significantly in people over 65 years of age. Along with the severity of COPD and the patient’s age, independent risk factors for the development of CAP include previous hospitalizations for exacerbations of the disease, chronic hypoxemic respiratory failure requiring long-term oxygen therapy (LOT) at home, and concomitant diseases (Table 1).

CAP in patients with COPD is often characterized by unfavorable treatment outcomes. When analyzing mortality from CAP, the presence of COPD was significantly associated with death, especially with increasing hypoxemia and hypercapnia. Other predictors of mortality are severe disease, requiring referral of the patient to the intensive care unit (ICU), bilateral infiltration, development of shock, and the presence of indications for VCT due to severe chronic respiratory failure.

Of 596 patients followed over a 3-year period, 75 developed at least one pneumonia (55.1 cases per 1000 person-years). When assessed using the PORT (Pneumonia Outcomes Research Team) scale proposed by M.J. Fine et al., 1997, with the determination of the pneumonia severity index PSI (Pneumonia Severity Index), more than half of the cases of pneumonia (55.3%) were classified as prognostically unfavorable PSI classes IV and V. On the contrary, the group with PSI classes I–II, suggesting the possibility of outpatient treatment was only 14 patients (18.7%). In a study of 744 hospitalized patients with CAP, the PSI value in patients with COPD was significantly higher than in patients without this pathology, 105±32 and 87±34.

The development of CAP in a COPD patient is associated with a more severe prognosis compared to an infectious exacerbation (AI) of the disease without infiltrative changes in the lung tissue. An analysis of the results of treatment of 9338 hospitalized patients with COPD, 1505 of whom developed CAP, showed that in groups comparable in age, gender, comorbidities and a number of other parameters, the probability of in-hospital death was 19% higher. The two conditions, infectious exacerbation of COPD and CAP in a patient with COPD, also differ in pathogenetic features, which in some cases may have differential diagnostic significance. In particular, in patients with CAP and COPD, compared with IO disease, higher concentrations of C-reactive protein, procalcitonin, tumor necrosis factor-a (TNF-a), and interleukin-6 (IL-6) in the blood serum were observed. This is likely accompanied by different phenotypes of macrophage activation in the sputum of patients. In COPD patients with CAP, the M1 phenotype was observed, when the expression of receptors for TNF-a and IL-6 increased in macrophages. Such changes are associated with processes of inflammation, destruction of the extracellular matrix and bactericidal activity. On the contrary, in the case of IO COPD (without infiltration of lung tissue), an M2-like phenotype was observed (increased levels of expression of receptors for mannose, arginase), which promotes tissue regeneration, angiogenesis, cell proliferation and inhibition of the inflammatory response.

The prognosis of CAP in patients with COPD also worsens in the case of concomitant cardiovascular pathology. In turn, CAP against the background of COPD relatively often, in 12% of cases, leads to cardiovascular complications (arrhythmias, myocardial infarction, pulmonary edema).

The etiology of CAP in patients with COPD, in comparison with IO disease without the development of infiltration of lung tissue, is more often associated with S. pneumoniae, atypical pathogens, less often with gram-negative enterobacteria and is comparable with respect to H. influenzae. In patients with COPD with CAP, the probability of isolating P. aeruginosa is higher than in patients without COPD, in 5.6 and 1.3% of cases, respectively. This must be kept in mind when choosing an antibacterial pneumonia disease. An illustration of the problem of CAP in patients with COPD is the following clinical example.

Patient G., 62 years old, was admitted to the emergency department of the hospital with the assumption of VP in the left lung and complaints of shortness of breath at rest, suffocation with minimal physical exertion, cough with the release of a significant amount of mucopurulent sputum, pain in the left side, low-grade fever.

For 5 years before this hospitalization, the patient was observed with a diagnosis of COPD (retrospectively, symptoms of the disease were noted for at least 12 years). The intensity of shortness of breath gradually increased; in recent months, the patient could climb no more than one flight of stairs without stopping. The post-bronchodilator level of forced expiratory volume in the first second was 27% of the normal level. In the year preceding the events described, the patient was hospitalized three times due to IO COPD. I stopped smoking two years ago, smoking experience is 42 pack-years. Thus, the patient had stage IV COPD, group D.

The volume of therapy administered increased as the disease progressed. During the first one and a half to two years, only short-acting bronchodilators were used. In the last 8 months, I have inhaled (not quite regularly) tiotropium (18 mcg/day), budesonide/formoterol (160 mcg/4.5 mcg, 4 doses/day), fenoterol/ipratropium (50 mcg/20 mcg) on demand (in days preceding hospitalization - more than 10 r/day, with little effect).

Concomitant pathology was represented by stage II hypertension (achieved degree of hypertension - 1, risk of cardiovascular complications - 3), coronary artery disease, angina pectoris of functional class II, atherosclerotic cardiosclerosis, dyslipidemia, obliterating atherosclerosis of the vessels of the lower extremities.

The real deterioration of the respiratory disease began 5 days before admission to the hospital. For 3 days, on the recommendation of a local physician, the patient took amoxicillin/clavulanate (875 mcg/125 mcg, 2 tablets per day), without any significant effect.

Upon admission, the patient's serious condition was stated. Contact with the patient was difficult. Tachycardia (114 beats per minute), tachypnea (32 beats per minute), and decreased blood pressure (95/65 mmHg) were noted. Dullness of percussion sound was detected over the lower and middle parts of the left lung. On auscultation, against the background of weakened breathing and scattered dry rales, moist fine bubbling rales were heard in the indicated area. The arterial blood pO2 level was 48 mm Hg. Art., рСО2 – 46 mm Hg. Art., pH – 7.68, O2 saturation – 80%. X-ray confirmed infiltrative shading in the lower lobe and in the lingular segments of the upper lobe of the left lung. In the clinical blood test, attention was drawn to a decrease in the number of erythrocytes to 3.65 × 10 12, hemoglobin to 117 g/l, hematocrit to 32.7, and leukopenia (3.9 × 10 6). The urea level was 7.2 mmol/l.

The patient was sent to the ICU, where he was transferred to mechanical ventilation (ALV) in the IPPV mode, then an auxiliary ventilator mode (SIMV) was used. Antimicrobial chemotherapy was carried out parenterally and included ceftazidime 4 g/day and levofloxacin 0.5 g/day, its total duration was 12 days. The glucocorticosteroid dexamethasone was used at a dose of 16 mg/day, the fungistatic fluconazole 100 mg/day. Detoxification and bronchodilator therapy was also carried out in the required volume.

As a result of the treatment, positive clinical and radiological dynamics were achieved. Considering that by the time the patient was discharged for outpatient treatment, the blood saturation was about 89–90%, the patient was recommended for dynamic observation to determine the indications for VCT. Roflumilast was added to the treatment at a dose of 500 mcg/day. Recommendations were given on the need for influenza and pneumococcal vaccination.

Along with illustrating the severe course of the disease, which is relatively often characterized by CAP in patients with COPD, the above example raises the problem of using scales that assess the severity of the disease in such patients. The scales allow not only to characterize the risk of an unfavorable outcome of CAP, but also to determine the optimal place of treatment for the patient: in an outpatient or inpatient setting, incl. in the ICU. Recommendations for the diagnosis, treatment and prevention of CAP, adopted in our country in 2010, primarily guide the practitioner to use the CURB-65 scale (Confusion, Urea, Respiratory Rate, Blood pressure, Age >65: impaired consciousness, respiratory rate , blood pressure, patient age >65 years) (Table 2). Two points on the CURB-65 scale (confusion, serum urea - >7 mmol/l), awarded in the case of patient G., suggested only short-term hospitalization or even outpatient treatment and did not sufficiently reflect the severity of the disease in a patient with chronic respiratory pathology. To avoid underdiagnosis of severe CAP in the analyzed situation, it was advisable to use the IDSA/ATS scale, 2007, developed by the Infectious Diseases Society of America/American Thoracic Society, 2007 (Table 3) and allowing for a more accurate assessment of the need to refer a patient with CAP to the ICU . In the case of patient G., when assessed according to IDSA/ATS, 2007, one major criterion was determined (the need for invasive mechanical ventilation) and four minor ones (multilobar infiltration, confusion/disorientation, serum urea - >7 mmol/l, leukocytes -<4000 /мм3). Это является несомненным указанием на необходимость направления больного в ОРИТ, что и было сделано.

Considering the lack of success from the initial antibacterial treatment at the prehospital stage (amoxicillin/clavulanate), it was impossible to exclude the etiology of CAP caused by strains of S. pneumoniae, gram-negative enterobacteria, and P. aeruginosa resistant to the initial therapy. Therefore, in accordance with the recommendations for the treatment of CAP and taking into account the serious condition of the patient, a combination of a third generation cephalosporin and a respiratory fluoroquinolone, which had antipseudomonas activity: ceftazidime and levofloxacin, was prescribed.

It is worth noting a number of shortcomings in the outpatient management of the patient over several years. Frequent (more than 2 times a year) infectious exacerbations of an extremely severe disease, severe obstructive disorders (FEV1<50% от должного уровня), сопутствующая сердечно-сосудистая патология предполагают, наряду с обеспечением регулярности ингаляционного лечения ХОБЛ, усиление противовоспалительной терапии рофлумиластом . Кроме того, отсутствовал контроль состояния газообмена; между тем, на этапе выписки уровень сатурации кислородом был пограничным для назначения ДКТ, что делает необходимым уточнение показаний к такому лечению. Наконец, выявление анемии является поводом еще для одного дополнительного обследования и анализа анамнестических данных. Снижение числа эритроцитов у больного ХОБЛ, для которой более характерен симптоматический эритроцитоз, может отражать как дефицит или перераспределение железа, так и системные эффекты основного заболевания. Известно, что даже тенденция к анемии у больного с хронической дыхательной недостаточностью является неблагоприятным прогностическим признаком , поэтому уточнение генеза отклонений в анализе крови необходимо для определения дальнейшей тактики ведения пациента.

Thus, treatment of COPD, built in accordance with generally accepted protocols (GOLD, 2014), allows to slow down the progression of the disease and prevent the development of complications, incl. VP. Successful treatment of CAP in a patient with COPD is facilitated by assessing the risk of an unfavorable outcome of the disease using prognostic scales, choosing antibacterial treatment taking into account the likely pathogens, and timely correction of concomitant pathology.

Literature

1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet. 1997; 349(9064):1498–1504.
2. Mannino DM, Davis KJ, Kiri VA. Chronic obstructive pulmonary disease and hospitalizations for pneumonia in a US cohort. Respir Med. 2009 Feb;103(2):224-9.
3. Müllerova H, Chigbo C, Hagan GW, Woodhead MA, Miravitlles M, Davis KJ, Wedzicha JA. The natural history of community-acquired pneumonia in COPD patients: a population database analysis. Respir Med. 2012 Aug;106(8):1124-33.
4. Molinos L, Clemente MG, Miranda B, Alvarez C, del Busto B, Cocina BR, Alvarez F, Gorostidi J, Orejas C; ASTURPAR Group. Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease. J Infect. 2009 Jun;58(6):417-24.
5. Rello J, Rodriguez A, Torres A, Roig J, Sole-Violan J, Garnacho-Montero J, de la Torre MV, Sirvent JM, Bodi M. Implications of COPD in patients admitted to the intensive care unit by community-acquired pneumonia. Eur Respir J. 2006 Jun;27(6):1210-6.
6. Ruiz De Oña JM, Gómez Fernández M, Celdrán J, Puente-Maestu L. Pneumonia in the patient with chronic obstructive pulmonary disease. Levels of severity and risk classification. Arch Bronconeumol. 2003 Mar;39(3):101-5.
7. Merino-Sánchez M, Alfageme-Michavila I, Reyes-Núñez N, Lima-Alvarez J. Prognosis in patients with pneumonia and chronic obstructive pulmonary disease. Arch Bronconeumol. 2005 Nov;41(11):607-11.
8. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997 Jan 23;336(4):243-50.
9. Restrepo MI, Mortensen EM, Pugh JA, Anzueto A. COPD is associated with increased mortality in patients with community-acquired pneumonia. Eur Respir J. 2006 Aug;28(2):346-51.
10 Myint PK, Lowe D, Stone RA, Buckingham RJ, Roberts CM.U.K. National COPD Resources and Outcomes Project 2008: patients with chronic obstructive pulmonary disease exacerbations who present with radiological pneumonia have worse outcome compared to those with non-pneumonic chronic obstructive pulmonary disease exacerbations. Respiration. 2011;82(4):320-7.
11. Huerta A, Crisafulli E, Menéndez R, Martínez R, Soler N, Guerrero M, Montull B, Torres A. Pneumonic and nonpneumonic exacerbations of COPD: inflammatory response and clinical characteristics. Chest. 2013 Oct;144(4):1134-42.
12. Gutierrez P, Closa D, Piñer R, Bulbena O, Menéndez R, Torres A. Macrophage activation in exacerbated COPD with and without community-acquired pneumonia. Eur Respir J. 2010 Aug;36(2):285-91.
13. Sibila O, Mortensen EM, Anzueto A, Laserna E, Restrepo MI. Prior cardiovascular disease increases long-term mortality in COPD patients with pneumonia. Eur Respir J. 2014 Jan;43(1):36-42.
14. Griffin AT, Wiemken TL, Arnold FW. Risk factors for cardiovascular events in hospitalized patients with community-acquired pneumonia. Int J Infect Dis. 2013 Dec;17(12):e1125-9.
15. Li XJ, Li Q, Si LY, Yuan QY. Bacteriological differences between COPD exacerbation and community-acquired pneumonia. Respira Care. 2011 Nov;56(11):1818-24.
16. Reissig A, Mempel C, Schumacher U, Copetti R, Gross F, Aliberti S. Microbiological diagnosis and antibiotic therapy in patients with community-acquired pneumonia and acute COPD exacerbation in daily clinical practice: comparison to current guidelines. Lung. 2013 Jun;191(3):239-46.
17. Chuchalin A.G., Sinopalnikov A.I., Kozlov R.S., Tyurin I.E., Rachina S.A. Community-acquired pneumonia in adults: practical recommendations for diagnosis, treatment and prevention. A manual for doctors. M., 2010. 106 p.
18. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT. Determining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003 May;58(5):377-82.
19. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72.
20. http://www.goldcopd.org/uploads/users/files/GOLD_Report2014_Jan30.pdf.
21. Kollert F, Tippelt A, Müller C, Jörres RA, Porzelius C, Pfeifer M, Budweiser S. Hemoglobin levels above anemia thresholds are maximally predictive for long-term survival in COPD with chronic respiratory failure. Respira Care. 2013 Jul;58(7):1204-12.