Chronic obstructive airways disease. Treatment of bronchial obstruction in children and adults
(COPD) is a progressive disease characterized by irreversible changes lung tissue. The abbreviation COPD speaks perfectly for itself - you can't say it better.
Unfortunately, once lung obstruction has developed, there is no way back.
The term obstruction means: a decrease in the bronchial lumen, extremely unsatisfactory patency in the bronchi, due to their spasm, an increase in the size of the walls, “mechanical” blockage, with extensive sputum production. In other words, prolonged obstruction drastically impairs the “ventilatory” capacity of the lungs.
Over the years, monotonously, the disease slowly creeps up on a person, eventually leading to respiratory failure. Many do not give special significance rare coughs, explaining them completely external reasons eg colds, smoking, cold air.
By the way, COPD is a very, indicative example of the likely consequences of an addiction to smoking. Initially, the inflammatory process affects only, but in the future, it gradually spreads its Negative influence on all key elements of lung tissue:
- pleura
- alveoli
- vascular bed
- respiratory muscles
The sadness of the situation lies in the fact that since the disease is chronic, with proper therapy it is only possible to significantly slow down the course of its course, to try to improve the quality of life.
Causes of COPD
In addition to the above-mentioned reason, smoking, the health of the lungs and bronchi is extremely strongly affected by a high degree of environmental pollution, as well as the harmfulness caused by the professional component of life.
Here is a list of jobs in which people often suffer from COPD:
- metallurgists (hot metal working)
- miners
- builders, especially those whose job duties include mixing cement
- office workers
- workers employed in the processing of grain, cotton
It is worth mentioning about hereditary factor. Inflamed bronchi lose their protective potential, become a place for the formation of thick, viscous mucus, which is an excellent breeding ground for numerous pathogenic microorganisms.
Risk factors for COPD are mainly limited to the surrounding life, human work, rather than allergens. Smoking can be considered a key cause of obstructive pulmonary disease. The risk of developing the disease in this case increases many times, up to 90%. Shortness of breath and obstruction respiratory tract, smokers develop much faster.
Symptoms of the disease
Clinical symptoms have multiple similarities with signs of obstructive bronchitis:
- frequent occurrence of shortness of breath, and initially, only with any physical exertion, and later even at rest
- when exposed to allergens, dust, there is an intense increase in shortness of breath
- systematically dry cough, with extremely difficult sputum
- with forced breathing, prolonged exhalation
The insidiousness of COPD is that the disease does not rush anywhere, gradually increasing its influence. It happens that years, and possibly even decades, may pass from the moment of manifestation of primary symptoms to severe manifestations of respiratory failure.
Let's take a closer look at the main symptoms.
Let's start with a cough - primary sign manifestations of the disease, which initially makes itself felt quite rarely, but in the future, it becomes a very serious problem. Outside the acute phase, sputum separation is usually not observed.
Sputum discharge at the start of the disease is insignificant, mostly 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 "makes friends" with cough. She is able to declare herself with intense physical activity, infectious diseases.
In the later stages of the disease, there may not be enough air, even with an elementary climb up the stairs. Severe respiratory failure develops, which is expressed by breathing problems when eating or putting on clothes.
When there is a need to take antibiotics, there is a fairly simple bioindicator called C-reactive protein for the answer. When its indicator exceeds 15 mg / l, then their use is quite acceptable.
COPD prevention
To begin with, it is worthwhile to clearly understand what factors are provoking the disease and try to completely eliminate them.
Here are the most significant:
- say goodbye to the habit of smoking
- try to protect your lungs from passive smoking
- avoid overheating and hypothermia of the body
If by its kind labor activity If you have to deal with the inhalation of harmful substances, strict adherence to all labor protection rules is strongly recommended. It is advisable to use respirators or gauze bandages.
I would like to note right away that any preventive therapeutic gymnastics possible only during the period of remission of the disease, and then, with total absence external contraindications. It should be done by a professional massage therapist, otherwise the situation can only get worse.
When the exacerbation subsides, then the whole range of physiotherapy procedures is connected to the therapeutic process:
- inductothermy
- UFO chest
- ultrasound
High efficiency of treatment is observed with oxygen therapy, which is mainly used in severe COPD. This technique means breathing air enriched with oxygen.
Chronic obstructive pulmonary disease able to deliver big trouble human bronchopulmonary system. It is extremely important to recognize the disease in a timely manner early stages and prevent its further development, because since the disease is chronic, if you miss the moment, then there will be no turning back.
Take an interest in your health in time, goodbye.
What is chronic obstructive pulmonary disease? We will analyze the causes of occurrence, diagnosis and methods of treatment in the article of Dr. Nikitin I. L., an ultrasound doctor with an experience of 24 years.
Definition of disease. Causes of the disease
Chronic obstructive pulmonary disease (COPD)- a disease that is gaining momentum, advancing in the ranking of causes of death for people over 45 years old. To date, the disease is in 6th place among the leading causes of death in the world, according to WHO forecasts in 2020, COPD will take the 3rd place.
This disease is insidious in that the main symptoms of the disease, in particular, with smoking, appear only 20 years after the start of smoking. It does not give clinical manifestations for a long time and can be asymptomatic, however, in the absence of treatment, airway obstruction imperceptibly progresses, which becomes irreversible and leads to early disability and a reduction in life expectancy in general. Therefore, the topic of COPD seems to be especially relevant today.
It is important to know that COPD is a primary chronic illness, at which it is important early diagnosis on initial stages because the disease tends to progress.
If the doctor has diagnosed Chronic Obstructive Pulmonary Disease (COPD), the patient has a number of questions: what does this mean, how dangerous is it, what to change in lifestyle, what is the prognosis for the course of the disease?
So, chronic obstructive pulmonary disease or COPD- is chronic inflammatory disease with damage to the small bronchi (airways), which leads to respiratory failure 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 contract and expand during breathing. At the same time, the lungs are constantly as if in a state of inhalation, there is always a lot of air in them, even during exhalation, which disrupts normal gas exchange and leads to the development of respiratory failure.
Causes of COPD are:
- 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;
- deficiency of α 1 -antitrypsin.
Symptoms of chronic obstructive pulmonary disease
COPD- a disease of the second half of life, often develops after 40 years. The development of the disease is a gradual long process, often imperceptible to the patient.
Appeared forced to consult a doctor dyspnea And cough- the most common symptoms of the disease (shortness of breath is almost constant; cough is frequent and daily, with sputum in the morning).
The typical COPD patient is a 45-50 year old smoker who complains of frequent shortness of breath on exertion.
Cough- one of the earliest symptoms of the disease. It is often underestimated by patients. In the initial stages of the disease, the cough is episodic, but later becomes daily.
Sputum also relatively early symptom diseases. In the first stages, it is released in small quantities, mainly in the morning. Slimy character. Purulent copious sputum appears during an exacerbation of the disease.
Dyspnea occurs over late stages diseases and is noted at first only with significant and intense physical exertion, it increases with respiratory diseases. In the future, shortness of breath is modified: the feeling of lack of oxygen during normal physical exertion is replaced by severe respiratory failure and intensifies over time. It is shortness of breath that becomes common cause in order to see a doctor.
When can COPD be suspected?
Here are a few questions of the COPD early diagnosis algorithm:
- Do you cough several times a day? Does it bother you?
- Does coughing produce phlegm or mucus (often/daily)?
- Do you get short of breath faster/more often than your peers?
- Are you over 40?
- Do you smoke or have you ever smoked before?
If more than 2 questions are answered positively, spirometry with a bronchodilator test is necessary. When the test indicator FEV 1 / FVC ≤ 70, COPD is suspected.
Pathogenesis of chronic obstructive pulmonary disease
In COPD, both the airways and the tissue of the lung itself, the lung parenchyma, are affected.
The disease begins in the small airways with blockage of their mucus, accompanied by inflammation with the formation of peribronchial fibrosis (densification of the connective tissue) and obliteration (overgrowth of the cavity).
With the formed pathology, the bronchitis component includes:
- hyperplasia of the mucous glands (excessive neoplasm of cells);
- mucous inflammation and edema;
- bronchospasm and blockage of the airways with secretion, which leads to narrowing of the airways and an increase in their 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 framework of the airways leads to their narrowing due to the tendency to dynamically collapse during exhalation, which causes expiratory bronchial collapse.
In addition, the destruction of the alveolar-capillary membrane affects the gas exchange processes in the lungs, reducing their diffuse capacity. As a result, there is a decrease in oxygenation (oxygen saturation of the blood) and alveolar ventilation. Excessive ventilation of underperfused areas occurs, leading to an increase in dead space ventilation and impaired excretion carbon dioxide CO2. The area of the alveolar-capillary surface is reduced, but may be sufficient for gas exchange at rest, when these anomalies may not appear. However, during physical activity, when the need for oxygen increases, if there are no additional reserves of gas exchange units, then hypoxemia occurs - a lack of oxygen in the blood.
The hypoxemia that appeared during long-term existence in patients with COPD includes a number of adaptive reactions. Damage to the alveolar-capillary units causes a rise in pressure in the pulmonary artery. Since the right ventricle of the heart in such conditions must 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 exacerbates right ventricular failure.
Classification and stages of development of chronic obstructive pulmonary disease
Complications of chronic obstructive pulmonary disease
Complications of COPD are infections, respiratory failure, and chronic cor pulmonale. Bronchogenic carcinoma (lung cancer) is also more common in patients with COPD, although it is not immediate complication illness.
Respiratory failure- device status external respiration, in which either the maintenance of the voltage of O 2 and CO 2 in arterial blood is not ensured at normal level, or it is achieved through increased work external respiratory systems. It manifests itself mainly as shortness of breath.
Chronic cor pulmonale- an increase and expansion of the right parts of the heart, which occurs with an increase in blood pressure in the pulmonary circulation, developed, in turn, as a result of lung diseases. The main complaint of patients is also shortness of breath.
Diagnosis of chronic obstructive pulmonary disease
If patients have cough, sputum production, shortness of breath, and risk factors for chronic obstructive pulmonary disease have been identified, then they should all be assumed to have a diagnosis of COPD.
In order to establish a diagnosis, data are taken into account clinical examination (complaints, anamnesis, physical examination).
Physical examination may reveal symptoms characteristic of long-term bronchitis: “watch glasses” and / or “ drumsticks» (deformity of the fingers), tachypnea ( rapid breathing) and shortness of breath, a change in the shape of the chest (a barrel-shaped form is characteristic of emphysema), its low mobility during breathing, retraction of the intercostal spaces with the development of respiratory failure, lowering of the boundaries of the lungs, a change in percussion sound to a box sound, weakened vesicular breathing or dry wheezing, which aggravated by forced expiration (that is, a quick exhalation after a deep breath). Heart sounds can be heard with difficulty. In the later stages, diffuse cyanosis, severe shortness of breath, and peripheral edema may occur. For convenience, the disease is divided into two clinical forms: emphysematous and bronchitis. Although in practical medicine cases of the mixed form of a disease meet more often.
Most milestone COPD diagnostics - analysis of respiratory function (RF). It is necessary not only to determine the diagnosis, but also to establish the severity of the disease, draw up an individual treatment plan, determine the effectiveness of therapy, clarify the prognosis of the course of the disease and assess the ability to work. Establishment percentage FEV 1 / FVC is most often used in medical practice. A decrease in forced expiratory volume in the first second to the forced vital capacity of the lungs FEV 1 / FVC up to 70% is the initial sign of airflow limitation even with a preserved FEV 1 > 80% of the proper value. Low peak speed expiratory air flow, which changes slightly with the use of bronchodilators, also speaks in favor of COPD. With newly diagnosed complaints and changes respiratory function indicators spirometry is repeated throughout the year. Obstruction is defined as chronic if it occurs at least 3 times per year (regardless of treatment), and COPD is diagnosed.
FEV monitoring 1 - important method confirmation of the diagnosis. Spireometric measurement of FEV 1 is carried out repeatedly over several years. The rate of annual fall in FEV 1 for people middle age is within 30 ml per year. For patients with COPD, a typical indicator of such a drop is 50 ml per year or more.
Bronchodilator test- primary examination, in which the maximum FEV 1 is determined, the stage and severity of COPD are established, and bronchial asthma is excluded (with a positive result), the tactics and volume of treatment are chosen, the effectiveness of therapy is evaluated and the course of the disease is predicted. It is very important to distinguish COPD from bronchial asthma, since these common diseases have the same clinical manifestation - broncho-obstructive syndrome. However, the approach to treating one disease is different from another. The main distinguishing feature in the diagnosis is the reversibility of bronchial obstruction, which is a characteristic feature of bronchial asthma. It has been found that people with a diagnosis of CO BL after taking a bronchodilator, the percentage increase in FEV 1 - less than 12% of the original (or ≤200 ml), and in patients with bronchial asthma, it usually exceeds 15%.
Chest x-rayhas an auxiliary value chenie, since changes appear only in the later stages of the disease.
ECG can detect changes that are characteristic of cor pulmonale.
echocardiography needed to detect symptoms pulmonary hypertension and changes in the right side of the heart.
General blood analysis- it can be used to evaluate hemoglobin and hematocrit (may be increased due to erythrocytosis).
Determining the level of oxygen in the blood(SpO 2) - pulse oximetry, a non-invasive study to clarify the severity of respiratory failure, as a rule, in patients with severe bronchial obstruction. Blood oxygen saturation of less than 88%, determined at rest, indicates severe hypoxemia and the need for oxygen therapy.
Treatment of chronic obstructive pulmonary disease
Treatment for COPD helps:
- reduction of clinical manifestations;
- increasing tolerance to physical activity;
- prevention of disease progression;
- prevention and treatment of complications and exacerbations;
- improving the quality of life;
- reduction in mortality.
The main areas of treatment include:
- weakening the degree of influence of risk factors;
- educational programs;
- medical treatment.
Weakening the degree of influence of risk factors
Smoking cessation is required. This is what is most effective way which reduces the risk of developing COPD.
Occupational hazards should also be controlled and reduced using adequate ventilation and air cleaners.
Educational programs
Educational programs for COPD include:
- basic knowledge about the disease and common approaches treatment to encourage patients to stop smoking;
- training on how to properly use individual inhalers, spacers, nebulizers;
- the practice of self-control using peak flow meters, the study of emergency self-help measures.
Patient education plays an important role in patient management and influences subsequent prognosis (Evidence A).
The method of peak flowmetry allows the patient to independently control the peak forced expiratory volume on a daily basis - an indicator that closely correlates with the FEV 1 value.
Patients with COPD at each stage are shown physical training programs in order to increase exercise tolerance.
Medical treatment
Pharmacotherapy for COPD depends on the stage of the disease, the severity of symptoms, the severity of bronchial obstruction, the presence of respiratory or right ventricular failure, and concomitant diseases. Drugs that fight COPD are divided into drugs to relieve an attack and to prevent the development of an attack. Preference is given inhalation forms drugs.
To stop rare attacks of bronchospasm, inhalations of short-acting β-agonists are prescribed: salbutamol, fenoterol.
Preparations for the prevention of seizures:
- formoterol;
- tiotropium bromide;
- combined preparations (berotek, berovent).
If the use of inhalation is not possible or their effectiveness is insufficient, then theophylline may be necessary.
With a bacterial exacerbation of COPD, antibiotics are required. Can be used: amoxicillin 0.5-1 g 3 times a day, azithromycin 500 mg for three days, clarithromycin SR 1000 mg 1 time per day, clarithromycin 500 mg 2 times a day, amoxicillin + clavulanic acid 625 mg 2 times a day, cefuroxime 750 mg twice a day.
Withdrawal COPD symptoms also help glucocorticosteroids, which are also administered by inhalation (beclomethasone dipropionate, fluticasone propionate). If COPD is stable, then the appointment 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 at rest, oxygen therapy is indicated.
Forecast. Prevention
The prognosis of the disease is affected by the stage of COPD and the number of recurrent exacerbations. At the same time, any exacerbation negatively affects the general course of the process, therefore, the earliest possible diagnosis of COPD is highly desirable. Treatment of any exacerbation of COPD should begin as early as possible. It is also important to fully treat the exacerbation, in no case is it permissible to carry it “on the legs”.
Often people decide to see a doctor for medical care, starting from the II moderate stage. At Stage III the disease begins to have a rather strong effect on the patient, the symptoms become more pronounced (increased shortness of breath and frequent exacerbations). At stage IV, there is a noticeable deterioration in the quality of life, each exacerbation becomes a threat to life. The course of the disease becomes disabling. This stage is accompanied by respiratory failure, the development of cor pulmonale is not excluded.
The prognosis of the disease is affected by patient compliance medical advice adherence to treatment and a healthy lifestyle. Continued smoking contributes to the progression of the disease. Smoking cessation leads to slower progression of the disease and slower decline in FEV 1 . Due to the fact that the disease has a progressive course, many patients are forced to take medicines for life, many require gradually increasing doses and additional funds during periods of exacerbation.
The best ways to prevent COPD are: healthy lifestyle life, including good nutrition, hardening of the body, reasonable physical activity, and the exclusion of exposure to harmful factors. To give up smoking - absolute condition prevention of exacerbation of COPD. Existing occupational hazards, when diagnosing COPD, are a sufficient reason to change jobs. Preventive measures avoiding hypothermia and limiting contact with those with acute respiratory viral infections are also.
In order to prevent exacerbations, patients with COPD are shown annual influenza vaccination. People with COPD aged 65 years or older and patients with an FEV1< 40% показана вакцинация поливалентной пневмококковой вакциной.
Bibliography
- 1. General medical practice. National leadership in 2 vols. Vol. 1 / ed. Acad. RAMS I. N. Denisova, prof. O. M. Lesnyak. - M.: GEOTAR-Media, 2013. - 976 p.
- 2. Chronic obstructive pulmonary disease: Moography / Ed. A.G. Chuchalin. - M.: Atmosfera, 2008. - 367 p.
- 3. Leshchenko I.V. New trends 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. add.//chief editor A.G. Chuchalin. – M.: GEOTAR. - With. 1024
Lung obstruction is dangerous state, in which the supply of inhaled oxygen is limited, and it can lead to irreversible consequences throughout the body.
Normally, when you inhale, the lungs expand, and when you exhale, they contract. Oxygen enters the lungs during inhalation, but when obstructed during exhalation, it does not completely exit. As a result, a person may develop emphysema. Also, at the same time, there is an insufficient supply of oxygen to the lungs, which leads to necrosis of the tissue of the organ: it decreases in volume, which will inevitably lead to disability and death.
The course of the obstructive syndrome is aggravated by gas exchange disorders, manifested by a decrease in oxygen and carbon dioxide retention in the bloodstream, an increase in pressure in the bloodstream. pulmonary artery and leading to the formation cor pulmonale.
Nowadays, the incidence is increasing every year. Pulmonary obstruction is diagnosed in about 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 predisease. Manifested by cough with sputum, but without functional disorders in the lungs.
- II. The stage has an easy course with prolonged cough with sputum. The volume of the formed exhalation is 20% below the norm.
- III. This stage of the obstructive syndrome is characterized by a course of moderate severity 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 an increase in air restriction during exhalation, severe shortness of breath. Forced expiratory volume is 50-70% below normal.
- V. The course at this stage is extremely difficult. 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 secretion of mucus;
- dysfunction of the ciliated epithelium;
- bronchial obstruction;
- destruction of the parenchyma and emphysema;
- violation of gas exchange;
- hypertension in the lungs;
- development of cor pulmonale with a long course;
- systemic disorders with a long course.
The causes of bronchial obstruction, against the background of which pulmonary obstruction occurs, are diverse. Under the influence of these reasons, the mucous membrane (and the villi on it) lose their ability to trap viruses and pathological microorganisms. Causes of lung obstruction may include:
- 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;
- respiratory failure with deviated nasal septum.
- smoking.
In children, the causes of bronchial obstruction may be the following:
- complication of pregnancy;
- premature birth;
- complications in childbirth;
- passive smoking of parents;
- pathology of the development of the bronchi;
- foreign bodies in the bronchi.
Pulmonary obstruction can occur against the background of 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 hypoplasia of the lungs;
- pulmonary edema.
Predisposing factors for this disease:
- polluted air;
- unfavorable habitat;
- unfavorable working conditions;
- professional hazards;
- low economic position;
- blood type a (11).
The first symptoms of lung obstruction may be limited to only cough, but then the characteristic signs of obstruction appear:
- cough, may be unproductive;
- shortness of breath, over time it can appear even with small physical exertion (walking, for example);
- secretion of purulent sputum,
- bubbling breath,
- a hoarse voice and wheezing with a whistle in the chest area, which can be heard even without a phonendoscope;
- swelling of the limbs;
- weakness;
- fatigue;
- sleep disturbance.
In children, lung obstruction is manifested by the following symptoms:
- expiratory shortness of breath;
- percussion box sound;
- swelling of the chest of an emphysematous nature;
- scattered wheezing (in infants - wet, in older children - whistling and dry);
- weakened breathing;
- sleep disturbance;
- cough (wet or dry);
- anxiety.
Possible complications of lung obstruction:
- transition to a chronic course;
- pneumonia;
- acute or chronic respiratory failure;
- pneumothorax;
- pneumosclerosis;
- heart failure;
- secondary polycythemia;
- pulmonary hypertension;
- cor pulmonale;
- myocardial infarction;
- stroke;
- renal disorders;
- emphysema;
- bronchiectasis;
- death.
This disease can be diagnosed in the following ways:
- examination by a doctor using auscultation, percussion;
- x-ray examination of the lungs;
- CT scan;
- laboratory diagnostics (analysis of separated 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, then you should immediately stop this bad habit using nicotine patches electronic cigarettes and other methods quick fight with smoking.
If the cause is accompanying illnesses, against which bronchial obstruction has arisen, then treatment should be directed to the elimination of these diseases in order to reduce the risk of developing pathological processes in the lungs. If obstructive disorders provoked diseases of an infectious origin, then antibiotic therapy is used in the treatment to eliminate bacteria from the body.
II. Medical treatment.
In addition to antibiotics for bronchial obstruction, the following are used:
- antispasmodic drugs to relieve spasm and expand the bronchi (eufillin, 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 is the use of tablets, syrups, intramuscular administration of drugs. In severe cases, a course inhalation therapy with hormonal agents is carried out.
III. Alveolar massage.
This instrumental method treatment of lung 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 with the help of pulses.
IV. Oxygen therapy.
The use of artificial introduction of oxygen 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 the complete opening of 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 recurrence, it is recommended to perform chest massage;
- rejection of bad habits;
- in time to examine and treat concomitant diseases;
- proper nutrition;
- physical activity;
- vitamin prophylaxis in the off-season;
- hardening of the body;
- do not come into contact with chemicals;
- ventilate the room;
- use a humidifier and air filter.
And remember that you need to alternate work and rest, while maintaining proper sleep.
Chronic obstructive pulmonary disease (COPD) is deadly dangerous disease. Quantity deaths per year worldwide reaches 6% of the total number of deaths.
This disease, which occurs with long-term damage to the lungs, is currently considered incurable, therapy can only reduce the frequency and severity of exacerbations, and achieve a decrease in the level of deaths.
COPD (Chronic Obstructive Pulmonary Disease) is a disease in which airflow is restricted in the airways, partially reversible. This obstruction is progressively progressive, reducing lung function and leading to chronic respiratory failure.
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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 is in countries with low level life.
Origin of the disease
With many years of irritation of the lungs with harmful gases and microorganisms, gradually develops chronic inflammation. The result is a narrowing of the bronchi and the destruction of the alveoli of the lungs. In the future, all respiratory tracts, tissues and vessels of the lungs are affected, leading to irreversible pathologies, deficient oxygen in the body. COPD (chronic obstructive pulmonary disease) develops slowly, progressing steadily over many years.
With absence COPD treatment leads to disability, then death.
The main causes of the disease
- Smoking is the main cause, causing up to 90% of cases of the disease;
- professional factors - work in hazardous production, inhalation of dust containing silicon and cadmium (miners, builders, railway workers, workers in metallurgical, pulp and paper, grain and cotton processing enterprises);
- hereditary factors - rare congenital deficiency of α1-antitrypsin.
- Cough is the earliest and often underestimated symptom. At first, the cough is intermittent, 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. With the development of the disease, the sputum becomes purulent and more and more abundant;
- dyspnea- is found only 10 years after the onset of the disease. At first, it manifests itself only with serious physical exertion. Further, the feeling of lack of air develops with minor body movements, later severe progressive respiratory failure appears.
The disease is classified according to severity:
Mild - with mild impairment of lung function. There is a slight cough. At this stage, the disease is very rarely diagnosed.
Moderate severity - obstructive disorders in the lungs increase. Appears shortness of breath with physical. loads. The disease is diagnosed at the address of patients in connection with exacerbations and shortness of breath.
Severe - there is a significant restriction of air intake. Frequent exacerbations begin, shortness of breath increases.
Extremely severe - with severe bronchial obstruction. The state of health deteriorates greatly, exacerbations become threatening, disability develops.
Diagnostic methods
Collection of anamnesis - with an analysis of risk factors. Smokers evaluate the smoker's index (SI): the number of cigarettes smoked daily is multiplied by the number of years of smoking and divided by 20. IC greater than 10 indicates the development of COPD.
Spirometry - to evaluate lung function. Shows the amount of air during inhalation and exhalation and the speed of entry and exit of air.
A test with a bronchodilator - shows the likelihood of reversibility of the process of narrowing of the bronchus.
X-ray examination - establishes the severity of pulmonary changes. The same is being done.
Sputum analysis - to determine the microbes during exacerbation and the selection of antibiotics.
Differential Diagnosis
X-ray data, as well as sputum analysis and bronchoscopy, are also used to differentiate from tuberculosis.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 working 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 the severity of symptoms, to prevent the development of complications. As the disease progresses, the amount of treatment only increases. Main drugs in the treatment of COPD:
- Bronchodilators are the main drugs that stimulate the expansion of the bronchi (atrovent, salmeterol, salbutamol, formoterol). It is preferably administered by inhalation. Short-acting drugs are used as needed, long-acting drugs are used constantly;
- glucocorticoids in the form of inhalation - used for severe degrees diseases, exacerbations (prednisolone). With severe respiratory failure, attacks are stopped by glucocorticoids in the form of tablets and injections;
- Vaccines – Influenza vaccination reduces mortality in half of cases. It is carried out once in October - early November;
- mucolytics - thin the mucus and facilitate its excretion (carbocysteine, ambroxol, trypsin, chymotrypsin). Used only in patients with viscous sputum;
- antibiotics - used only during exacerbation of the disease (penicillins, cephalosporins, it is possible to use fluoroquinolones). Tablets, injections, inhalations are used;
- antioxidants - able to reduce the frequency and duration of exacerbations, are used in courses of up to six months (N-acetylcysteine).
Surgery
- Bullectomy - removal can reduce shortness of breath and improve lung function;
- lung volume reduction with surgery is 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 - with exacerbations, long-term - with the fourth degree of COPD. With a stable course, constant long-term oxygen therapy is prescribed (at least 15 hours daily).
Oxygen therapy is never prescribed to patients who continue to smoke or suffer from alcoholism.
Treatment with folk remedies
Herbal infusions. They are prepared by brewing a spoonful of the collection with a glass of boiling water, and each is taken for 2 months:
√ 1 part sage, 2 parts chamomile and mallow;
√ 1 part flax seeds, 2 parts of eucalyptus, linden flowers, chamomile;
√ 1 part chamomile, mallow, sweet clover, anise berries, licorice roots and marshmallow, 3 parts flaxseed.
- Infusion of radish. Grate black radish and medium-sized beets, mix and pour with cooled boiling water. Leave for 3 hours. Use three times a day for a month, 50 ml.
- Nettle. Grind nettle roots into gruel and mix with sugar in a ratio of 2: 3, leave for 6 hours. The syrup removes phlegm, relieves inflammation and relieves cough.
- Milk:
√ Brew a spoonful of cetraria (Icelandic moss) with a glass of milk, drink during the day;
√ Boil 6 chopped onions and a head of garlic for 10 minutes in a liter of milk. Drink half a glass after meals.
Frequent pneumonia in a child can subsequently provoke the development of COPD in him. Therefore, every mother must know!
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Secondary
- physical activity, regular and dosed, aimed at the respiratory muscles;
- annual vaccination with influenza and pneumococcal vaccines;
- constant intake of prescribed drugs and regular examinations by a pulmonologist;
- correct use of inhalers.
Forecast
COPD has a conditionally poor prognosis. The disease slowly but constantly progresses, leading to disability. Treatment, even the most active, can only slow down this process, but not eliminate the pathology. In most cases, treatment is lifelong, with ever-increasing doses of medication.
With continued smoking, obstruction progresses much faster, significantly reducing life expectancy.
The incurable and deadly COPD simply urges people to stop smoking forever. And for people at risk, there is only one advice - if you find signs of a disease, immediately contact a pulmonologist. After all, the earlier the disease is detected, the less likely it is to die prematurely.
» , most of us will not be told anything at all- unlike, for example, the other four letters that form "AIDS". However, this acronym hides one of the deadliest diseases in the world: chronic obstructive pulmonary disease, a disease that has already affected more than 200 million people around the globe. According to the World Health Organization (WHO), this disease is gradually reaching the third place in terms of mortality in many countries, including Russia. Unfortunately, attention to COPD in our society seems to be insufficient. Everyone is talking about HIV, tuberculosis and pneumonia, oncology of all stripes, but the mortality rate from all these diseases is much lower.
Statistics
Over the past 20 years, the number of people dying from COPD has increased by more than 10%. Officially, the diagnosis was registered in approximately 1.5% of citizens of the Russian Federation. And this indicator significantly reduces the scale of the COPD problem, which is given by an assessment from international experts (conducted on the initiative of the World Health Association together with the Russian Research Institute of Pulmonology). Extrapolation of recent data from an epidemiological study GARD (Global Alliance against Chronic Respiratory Diseases, Global Alliance to Combat Chronic Respiratory Diseases) made it possible to declare that as many as 15% of the total population of our country suffers from COPD. That is, more than 20 million patients in total, and every fifth Russian is in the main group of patients (from 40 to 60 years old). Many of them are unaware of the existence of such a disease and therefore do not take the initiative to undergo a diagnosis. But even among those who have undergone it, approximately 90% of Russian patients do not end up receiving the treatment recommended GOLD (Global initiative for Obstructive Lung Disease, Global COPD Initiative). Thus, it can be emphasized that although the accompanying threat is hidden, including by dry statistics, it exists and has a very devastating effect on the life of the population.
That is why COPD is listed World Organization health care to epidemics noncommunicable diseases. And now every year, on November 17, at the initiative of this organization, World COPD Day is held. During its implementation, spirometry is done for everyone for free - a study of the functions of external respiration, implemented using a special device-spirometer.
Typical medical history
This disease is formed due to the inhalation of harmful particles or gases. Subsequently, the patient's airways gradually narrow due to inflammation of the lung tissues. Most importantly, this narrowing cannot be completely reversed.
COPD usually begins to develop at a young age. The process of development sometimes stretches for decades. All this time, a person may not consider himself sick. Potential victims of COPD most often do not pay attention to symptoms such as shortness of breath, cough, sputum. If they still decide to be treated, then they are treated later, as a rule, for cough, and not for COPD.
The problem is also that COPD, due to systematic respiratory disorders in a patient, provokes the development of many other diseases, for example, cardiovascular pathologies. The latter then often indicate main reason death, while COPD was the true cause.
Diagnostics and therapy
both important and complex specialists called differential (separating) diagnosis of COPD and bronchial asthma.
A syndrome of overlap or combination of COPD with asthma is known. However, if the occurrence of asthma is usually associated with allergic reactions, then for COPD the main (80-90% of cases) risk factor is smoking, and in the second and subsequent stages - the systematic inhalation of harmful particles or gases.
As with asthma, the main pharmacological preparations For the treatment of COPD, bronchodilators are considered - special bronchodilators, usually produced in inhalers or tablets. They are used as needed (for example, with shortness of breath) or for prevention. Moreover, if the body of an asthmatic usually reacts very positively to treatment with bronchodilators, then this cannot be said in the case of COPD. How can not be called a drug that can completely and completely cure the disease. Experts indicate that the most effective means of combating the disease is only a complete and timely cessation of smoking.
Methods for classifying patients with COPD into groups, as well as methods for their further treatment, vary from country to country.
Some (for example, this is customary in Spain, the Czech Republic and a number of other countries) more often use a phenotypic approach with grouping patients according to COPD phenotypes. The key phenotypes here are COPD itself "in pure form and its various combinations with other lung diseases(asthma, bronchitis, emphysema and others).
Other countries, notably the United States of America, prefer the outdated spirometry approach based on pulmonary function analysis. It is the attitude FEV1 (the volume of air exhaled by the patient in the first second with the most rapid and strong, or "forced" exhalation) to FZhEL (total volume of air in such an exhalation) determines the presence of COPD (characterized by the ratio FEV1/FVC below 70% of normal) along with the degree (from mild to extremely severe), according to which patients are classified.
The most modern is considered A complex approach, which takes into account the number of exacerbations, as well as symptoms and spirometry. It has already been fixed both in the latest GOLD recommendations and in our country. Now Russian Respiratory Society prepares a new version of the recommendations, which for the most part coincide with the recommendations of world experts.
Perspective: a universal algorithm?
Not so long ago International j external of COPD (the main special publication on COPD in the world) noted as a particularly promising work of domestic researchers (in particular, the teams of the Moscow State Medical University named after I.M. Sechenov and the Moscow State Medical University named after A.I. Evdokimov). Those offered universal and pretty a simple circuit therapy for COPD, calculated simultaneously for two areas of medical practice: general practitioners and narrow-profile pulmonary specialists - pulmonologists.
Proprietary clinical algorithm drug therapy was formed by the authors in a long-term work with patients with stable COPD. According to the proposed scheme, patients are treated with long-acting bronchodilators and short-acting drugs on demand. If FEV1 when spirometry is at least 50% of the proper value (it is considered individually from the ratio of height, weight and age of the patient), then the patient is offered treatment with one long-acting drug. Symptoms are addressed by a specific COPD Patient Assessment that includes eight questions about symptoms (specifically, cough, sputum, shortness of breath, and anxiety and other psychological disturbances). If the patient scored more than ten points on the test, or his FEV1 was less than 50% of the norm, then the patient is recommended combined bronchodilators.
And in cases where the above treatment did not give any significant result in three months, the therapist is recommended to redirect the patient to a pulmonologist for a detailed examination of the lungs by endotyping (endotype analysis - internal signs pathological inflammatory processes in the body). The latter, according to the idea of our specialists, involves Special attention pulmonologist to three key endotypes (each of which, in turn, corresponds to a certain type of inflammation - neutrophilic, eosimophilic and small cell).
The authors themselves reveal their vision of the method in a positive way: “Since there are too few pulmonologists in Russia to successfully fight the scale of the COPD epidemic on their own, we decided to take on the very mechanism of prescribing therapy. Our main goal was to obtain a scheme that would be easy for doctors to apply in daily practice. Moreover, we tried to choose the simplest markers, like a blood test or sputum. Thus, everything that we now offer for research is practically feasible if the simplest laboratory procedures are followed. And now it remains only to continue to monitor the medical application of our algorithm. Even before the official publication ofInternational Journal of COPD we have received a lot of feedback on the successful application of the approach in a number of countries, for example in Bulgaria and Serbia. It looks very comfortable. After all complex scheme drawing is simple, but simple, but effective - just the same difficult. And we hope that the algorithm will also become useful for doctors in our country.”
Title illustration: Maria Frolova
