Clinical obstructive pulmonary disease. Symptoms and signs of COPD

Chronic obstructive pulmonary disease (COPD) - chronic pathology due to the damage to the distal respiratory tract and pulmonary parenchyma with the development of emphysema, manifested by partially reversible bronchial obstruction. The following factors are promoted by the development of COPD: genetic predisposition, respiratory infectious diseases, smoking, influence of inorganic and organic dust.

Cook inflammation causes partly reversible bronchial obstruction. The irreversible component of bronchial obstruction is due to the development of fibrosis in the bronchial wall. Against the background of this process, the emphysema of the lungs occurs, characterized by the destruction of alveolar walls and the formation of bulb (thin-walled cavities). An important role in the development of COPD plays infectious diseases of the respiratory tract.

When the COPD has a patient, shortness of breath appears, coughing with sputum, with auscultation in the lungs, dry wheels are listened. The expressed emphysema of the lungs is manifested by an increase in the front-rear volume of the chest (so-called "barrel-shaped" chest). Also, the study of the function of external respiration is used to diagnose the state, in which the COPD is determined by obstructive disorders.

For COPD, bronchial obstruction is characteristic, as a result of which there is an excessive air accumulation. On the radiograph of it is defined as little hypership. X-ray manifestations of the lungs of the lungs have the following signs (Figure 1):

• Seal and low diaphragm domes
• Increase area of \u200b\u200bretrosternal space
• "Drip" shape shape heart

Figure 1. Chronic obstructive pulmonary disease (COPD). On the radiograph, the signs of the lungs of the lungs are determined: the location of the diaphragm is noted at the level of the front segmentsVII-VIII ribs, the dome of the diaphragm is sealed; The increase in retrosternal space is determined (see arrows), "drip" shadow of the heart. There is an expansion of both pulmonary arteries and their root branches - a characteristic sign of pulmonary hypertension.

The low arrangement of the diaphragm can be assumed if the peak (highest) point of its dome is visualized at the level of the front segment of 7 edges and below (especially if the radiography was performed in the sitting position). For COPD, a double-sided low arrangement of the diaphragm is characterized. It should be noted that the assessment of the aperture arrangement must be carried out with caution, since athletes or people with high growth of asthenic physique are the low location of the diaphragm domes is considered the norm.

When the COPD on the radiograph made in the lateral projection is characterized by an increase in retrosternal space, due to the fact that the hypernate pulmonary fabric is pushing back the heart and vessels, while an increase in the front-rear volume of the chest ("barrel-shaped" chest) is noted. It is determined narrow, elongated in the vertical direction of the heart shadow ("drip" heart).

Basic sign emphysema Lungs - Bully (thin-walled cavities in the lungs, the size of more than 1 centimeter (Figure 2).

Figure 2. COPD. BUT B. - Radiograph in the right side projection. In the lower share of the right lung, a large bull is marked - a thin-walled cavity (see pointers). On the radiograph of B bes noted the displacement of the bull vessels of the lower line of the back, while on the background of the cavity, the pulmonary pattern is not determined. The picture shows the signs of the lungs of the lungs: the seal and the low arrangement of the diaphragm domes, an increase in the front-rear volume of the chest. The expansion of the roots caused by pulmonary hypertension is determined. In the tongue segments to the left there is a decrease in transparency due to pneumonia

The top lobties of the lungs are considered the characteristic place of development of the Bull. Bully can reach large sizes and occupy a significant volume of lungs. In some cases, the radiograph cannot determine the wall of the Bully and the presence of it can be suspected only if there is no significant depletion of the pulmonary pattern (see an article) on a limited section of the lung (Figure 3).

Figure 3. Emphysema of the lungs with a very difficult COPD current. BUT - radiograph in direct projection; B. - Radiograph in the right side projection. The signs of the lungs of the lungs are determined - the seal and the low arrangement of the diaphragm domes, a significant increase in the area of \u200b\u200bretrosternal space, combining the pulmonary pattern on the periphery of the lungs. In the upper part of the left lung, the zone is determined, devoid of pulmonary pattern (cm arrows), in the lower part of the left on the background of fibrous changes, a section is marked, devoid of pulmonary pattern (see pointers) - these changes are due to bully

The Bulla wall can be breaking down, resulting in pneumothorax. In the emphysema of the lungs, diffuse depletion of the pulmonary pattern may occur (especially on the periphery of the lungs), however, this feature is not reliable, since the pattern of the pulmonary pattern strongly depends on the technical conditions of the radiograph and the depth of the patient. To diagnose the bulk emphysema of the lungs by selecting diagnostics is X-ray computed tomography (RTC).

For chronic obstructive pulmonary disease, an increase in pressure in the pulmonary arterial system is characterized, resulting in evolving pulmonary hypertensioncharacterized by expanding the roots of the lungs due to the pulmonary arteries (while the structure of the roots is preserved, their contours are smooth and clear - cm Figure 1, 2). Also, the periphery decreases dramatically the caliber of the arteries, and the roasting pulmonary artery expands - symptom "Ranger Rank".

The xobl radiological picture may also include a change in the drawing in the root lungs and thickening of the bronchi walls. On the radiograph of bronchi in the longitudinal section are defined as parallel strips ( symptom of "Tramway Rails"). Bronchi in orthopréscia (in cross section) on radiographs are defined as small ring-shaped shadows. Note that in the normal radiograph, single parallel and ring shadows can be determined in the root zones, due to bronchins, while the thickness of their walls does not exceed 1 mm. In the case of the development of the inflammatory process, the thickness of the bronchi walls is 2-3 mm, the inner lumen of the bronchi is narrowed, the contours of the bronchi - fuzzy; The contours of the vessels also lose clarity. These changes are called peribronchovascular "couplings".

Thus, if the COPLE on the radiograph is determined by the strengthening and deformation of the pulmonary pattern with the formation of reticular (mesh) shadows and the formation of peribronchovascular "couplings" in the roasting departments, this may be a sign of both inflammatory changes in the exacerbation of the process and pneumosclerosis.

COPL (chronic obstructive pulmonary disease) is a disease that develops due to an inflammatory response to the effect of certain irritants of the external environment, with the damage to the distal bronchi and developing emphysema, and which is manifested by the progressive decrease in the air flow rate in the lungs, increasing, as well as the defeat of other organs.

COPL ranks second among chronic noncommunicable diseases and the fourth place among the causes of mortality, and this indicator is growing steadily. Due to the fact that this disease is inevitably progressive, it occupies one of the first places among the causes of disability, as it leads to a violation of the main function of our body - the respiratory function.

The problem of COPD is really global. In 1998, the initiative group of scientists has created a "Global Initiative For Chronic Obstructive Lung Disease - Gold" (Global Initiative for Chronic Observative Lung. The main tasks of GOLD are the widespread information about this disease, the systematization of experience, clarification of the causes and the corresponding prevention measures. The main idea that doctors want to convey to humanity: COPD can be prevented and treated, This postulate is even submitted to the modern working definition of COPD.

Causes of Hobl Development

COPD is developing with a combination of predisposing factors and provoking agents of the external environment.

Predisposing factors

1. Hereditary predisposition. It has already been proven that the congenital deficit of some enzymes predisposes to the development of COPD. This explains the family history of this disease, as well as the fact that not all smokers, even with great experience, are ill.
2. Paul and age. More than 40 years old have been suffering from COPD, but this can be explained by the aging of the body, and the length of the seniority of smoking. Data is given that now the incidence rate among men and women almost equal. The reason for this may be the spread of smoking among women, as well as the increased sensitivity of the female organism to passive smoking.
3. Any negative impacts which affect the development of the child's respiration organs in the intrauterine period and early childhood, increase the risk of COPD in the future. In itself, physical underdevelopment is also accompanied by a decrease in lung volume.
4. Infections. Frequent respiratory infections in childhood, as well as increased susceptibility to them at an older age.
5. Bronchi hyperreactivity. Although the hyperreactivity of the bronchi is the main development mechanism, this factor is also considered a risk factor of COPD.

Provoking factors

Pathogenesis Hobl

The effects of tobacco smoke and other irritating substances leads to predisposed persons to the emergence of chronic inflammation in the walls of the bronchi. The key is the defeat of the distal departments (that is, located closer to the pulmonary parenchyma and alveolum).

As a result of inflammation, there is a violation of the normal discharge and death of the mucus, the blockage of small bronchi, the infection is easily joined, the inflammation applies to the submembress and muscle layers, muscle cells are dying and replaced by a connecting tissue (the process of bronchial remodeling). At the same time, the destruction of the parenchyma of the pulmonary fabric, the jumpers between the alveoli - the emphysema develops, that is, the hypernity of the pulmonary fabric. Easy to swell air, their elasticity decreases.

Small bronchi in exhale are poorly spread - the air is hardly coming out of emphysematous fabric. Normal gas exchange is disturbed, since the volume of the inhale also decreases. As a result, it arises the main symptom of all patients with COPD - shortness of breath, especially increasing when driving, walking.

Chronic hypoxia becomes the result of respiratory failure. He suffers from this entire body. Long-term hypoxia leads to a narrowing of the lumen of pulmonary vessels - arises, which leads to the expansion of the right-hand heart departments (pulmonary heart) and the attachment of heart failure.

Why did COPL allocated in separate nosology?

Awareness about this term is so low that most patients already suffering from this disease do not know that they are sick. Even if such a diagnosis is set in medical records, in everyday life of both patients and doctors still prevail the familiar and emphysema.

The main components in the development of COPD are really chronic inflammation and emphysema of the lungs. So why then the COPD is highlighted in a separate diagnosis?

In the title of this nosology, we see the main pathological process - chronic obstruction, that is, the narrowing of the lumen of the respiratory tract. But the obstruction process is present in other diseases.

The difference between COPD from bronchial asthma is that when COPD obstruction is almost or completely irreversible. This is confirmed by spirometric measurements with the use of bronchoditics. With bronchial asthma, after the use of bronchoditics, there is an improvement in the indicators of the FEV1 and PSV more than 15%. Such obstruction is treated as reversible. When COPD, these numbers change slightly.

Chronic bronchitis can precede or accompany COPL, But he is an independent disease with clearly defined criteria (long cough and), and the term itself implies the defeat of only bronchi. With COPD, all structural elements of the lungs are affected - bronchi, alveoli, vessels, pleura. Not always chronic bronchitis accompany obstructive violations. On the other hand, not always at the COPD there is an increased wet wet branch. That is, in other words, there may be chronic bronchitis without a COPD, and COPL does not quite fall under the definition of bronchitis.

Chronic obstructive pulmonary disease

Thus, COPD is now a separate diagnosis, has its criteria, and in no case replaces other diagnoses.

Diagnostic criteria Hobl

Positive COPD in the presence of a combination of all or more signs, if they occur against persons over 40 years:

A reliable confirmation of COPL is a spirometric indicator of the ratio of the volume of the forced exhalation for 1 C to the forced lung life capacity (FEV1 / Fer), conducted 10-15 minutes after the use of bronchodiolitics (beta sympathomimetics of salbutamola, Berotek, or 35-40 minutes after short-acting cholinolithics -Ipratropium of bromide). The value of this indicator<0,7 подтверждает ограничение скорости воздушного потока и в сочетании с подтвержденными факторами риска является достоверным критерием диагноза ХОБЛ.

The remaining indicators of spirometry - the peak rate of exhalation, as well as the measurement of the FEV1 without a test with bronchodils can be carried out as a screening survey, but do not confirm the diagnosis of COPD.

From other methods appointed during COPD, in addition to the usual clinical minimum, can be noted by the radiography of the lungs, pulse oximetry (determining the saturation of blood oxygen), the study of blood gases (hypoxemia, hypercapnia), bronchoscopy, thoracic CT, wet survey.

Classification Cobl

There are several COPD classifications in stages, severity, clinical options.

The classification of stages takes into account the severity of symptoms and spirometry data:

• Stage 0. Risk group. The impact of adverse factors (smoking). No complaints, the function of the lungs is not broken.
• Stage 1. Light current COPD.
• Stage 2. The medium-free COPD flow.
• Stage 3. Heavy current.
• Stage 4. Extremely difficult current.

In the last report Gold (2011 d) proposed a classification for stages to exclude, remains classification in the degree of gravity based on the indicators of the FEV1:

In patients with FEV1 / Fire<0,70:

• GOLD 1: Easy FEV1 ≥80% of the proper
• GOLD 2: Middle severity 50% ≤ OFV1< 80%.
• GOLD 3: Heavy 30% ≤ OPV1< 50%.
• GOLD 4: Extremely heavy FEV1<30%.

It should be noted that the severity of symptoms does not always correlate with the degree of bronchial obstruction. Patients with an easy obstruction may disturb quite pronounced shortness, and, on the contrary, patients with Gold 3 and Gold 4 can feel quite satisfactory for a long time. To assess the severity of shortness of shortness of shortness of breath, special questionnaires are used, the severity of symptoms is determined in points. It is also necessary to assess the course of the disease orient to the frequency of exacerbations, on the risk of complications.

Therefore, this report proposes on the basis of the analysis of subjective symptoms, spirometric data and risk of exacerbations to divide patients on clinical groups- A, B, C, D.

Practical doctors highlight more clinical forms of COPD:

1. Emphysematous version of COPD. Of the complaints, such patients prevails shortness of breath. Cough is observed less often, wets may not be. Hypoxemia, pulmonary hypertension is late. Such patients tend to have a low mass of the body, the color of the skin pink gray. They are called "pink puffers."
2. Bronchtic option. Such patients complain mainly on cough with a mocroid, shortness of breath worries less, they have a pulmonary heart with a corresponding picture of heart failure, swelling, swelling. Such patients are called "blue swells".

The separation of emphysematous and bronchtic options are quite conditionally, mixed forms are more often observed.

During the disease, the phase of stable flow and the aggravation phase is released.

Exacerbation of Cobl

The exacerbation of the COPD is called acutely developing condition when the symptoms of the disease go beyond the usual flow of its flow. There is a strengthening of shortness of shortness of breath, cough and deterioration of the overall state of the patient. The usual therapy, which he used earlier, does not stop these symptoms to the usual state, a dose change or treatment regimen is required. Usually, the COPD is required when exacerbation, hospitalization is required.

Diagnosis of exacerbations is based exclusively on complaints, history, clinical manifestations, and can also be confirmed by additional studies (spirometry, general blood test, microscopy and bacteriological examination of sputum, pulse oximetry).

The reasons for exacerbation are most often respiratory viral and bacterial infections, less often - other factors (the impact of harmful factors in the surrounding air). The usual patient with a COPD is an event that significantly reduces the function of the lungs, and the return to the initial state may take a long time or stabilization will occur on a more severe degree of the disease.

The more often the exacerbations happen, the worse the forecast of the disease and the above risk of complications.

Complications Hobl

As a result, patients with COPD exist in a state of permanent hypoxia, they often develop the following complications:

COPL treatment

The basic principles of therapeutic and preventive activities at COPD:

1. To give up smoking. At first glance, a simple but most difficult moment.
2. Pharmacotherapy. The early start of basic drug treatment can significantly improve the quality of the patient's life, reduce the risk of exacerbations and increase the life expectancy.
3. The diagram of drug therapy should be selected individually taking into account the severity of the flow, the patient's commitment to long-term treatment, availability and cost of drugs for each particular patient.
4. It should be offered to patients with hyobl vaccination against influenza and pneumococcal infection.
5. Proved the positive effect of physical rehabilitation (training). This method is under development, while there are no effective therapeutic programs. The easiest way that can be offered to the patient is a daily walking for 20 minutes.
6. In the event of a severe course of the disease with severe respiratory failure, long-term inhalation of oxygen as a means of palliative care makes it possible to improve the patient's condition and extend life.

To give up smoking

It is proved that the refusal of smoking tobacco has a significant impact on the course and forecast of COPD. Despite the fact that the chronic inflammatory process is considered irreversible, the cessation of smoking slows its progression, especially in the early stages of the disease.

Tobacco addiction is a serious problem that requires large spending time and forces not only by the patient, but also physicians, as well as relatives. A special long study was conducted with a smoking group, which proposed various activities aimed at combating this dependence (conversations, beliefs, practical advice, psychological support, visual agitation). At such costs, attention and time managed to achieve a refusal of smoking in 25% of patients. And the longer there are conversations, the greater the likelihood of their effectiveness.

Anti-bacchanic programs become national objectives. There was no need not only to propaganda a healthy lifestyle, but also a legislative punishment for smoking in public places. This will help limit harm at least from passive smoking. Especially harmful tobacco smoke for pregnant women (both active and passive smoking) and children.

Part of patients has a tobacco dependence of akin to narcotic, and the conversations in this case will not be enough.

In addition to campaigning, there are also medication ways to combat smoking. These are nicotine-mixing pills, sprays, chewing gum, civic plasters. It was also proved effectiveness of some antidepressants (bupropione, northriptiline) in the formation of a long-lasting abandonment of smoking.

Pharmacotherapy hobl

COPD Drug Therapy is aimed at eliminating symptoms, preventing exacerbations and slowing the progression of chronic inflammation. Fully stop or cured destructive processes in the lungs existing for today drugs are impossible.

The main drugs that are used to treat COPD:

Broncholitiki

Broncholites used to treat COPDs relax the smooth muscles of the bronchi, thereby expanding their clearance and facilitate the passage of air in exhalation. It is proved that all the bronchophists increase the portability of physical exertion.

The bronchussessing drugs include:

1. Beta-stimulants short action ( salbutamol, Fenoterol).
2. Beta-stimulants of long-term action ( salmotelol, Formoterol).
3. Short-acting cholinolics ( hipratropy Bromide - Atrovant).
4. Long-term cholinolics ( tiotropia Bromide - Spiriva).
5. Xanthines ( eufillin, Teophyllin).

Almost all existing bronchopholics are used in inhalation form, which is a more preferable way than the reception inside. There are different varieties of inhalers (dosage aerosol, powder inhalers, inhalers activated by inhalation, liquid forms for nebulizer inhalations). In serious patients, as well as patients with intellectual inhalation disorders, it is better to spend through a nebulizer.

This group of drugs is the main in the treatment of COPD, is used at all stages of the disease as monotherapy or (more often) in combination with other means. For constant therapy, the use of long-acting bronchodes is preferable. If it is necessary to assign short-range bronchoditics, preference gives combinations fenoterol and Bromide Jiprathopia (Berodal).

Xanthines (Eufillin, Theophylline) are used in the form of tablets and injections, have many side effects, not recommended for long-term treatment.

Glucocorticosteroid hormones (GKS)

GCS are a powerful anti-inflammatory agent. Used in patients with severe and extremely serious degree, and are also appointed short courses in exacerbations in the average stage.

The best form of application is inhalation GKS ( beclometazone, Fluticazone, Budesonide). The use of such forms of GCS minimizes the risk of systemic side effects of this group of drugs, which inevitably occur when taking them inside.

The GCS monotherapy is not recommended for the COPD patient, more often they are prescribed in combination with beta-agonists of long-term action. Main combined drugs: formoterol + budesonide (symbicort), Slemoterol + Fluticazone (Soldide).

With severe flow, as well as during the period of exacerbation, systemic GKS can be assigned - prednisolone, dexamethasone, Kenalog. Long-term therapy with data with the development of heavy side effects is fraught with the development of heavy side effects (erosive-ulcerative lesions of the gastrointestinal tract, Izsenko-Cushing syndrome, steroid diabetes, osteoporosis and others).

Broncholitics and GKS (and more often their combination) are the main most affordable funds that are prescribed when COPD. The treatment regimen, dose and combination of the doctor selects individually for each patient. In the choice of treatment, not only the recommended Gold schemes for different clinical groups, but also the social status of the patient, the cost of drugs and the availability of it for a particular patient, the ability to learn, motivation.

Other drugs applied when COPD

Mukolitiki (diluting the wet tools) are prescribed if there is a viscous, difficult sputum.

Phosphodiesterase-4 inhibitor roflumilast (Daksas) - Relatively new drug. It has a prolonged anti-inflammatory effect, is a kind of alternative to GKS. It is used in tablets of 500 mg 1 time per day in patients with severe and extremely severe COPD. Its high efficiency is proven, but the use is limited due to the high cost of the drug, as well as a fairly high percentage of side effects (nausea, vomiting, diarrhea, headache).

There are research that the drug fenspirid (Erespal.) He has an anti-inflammatory effect similar to GCS, and can also be recommended in such a patient.

Of the physiotherapy treatment methods, the distribution is obtained by the method of intrapulmonal percussion ventilation of the lungs: the special machine generates small amounts of air, which are fed into the light quick jokes. From such a pneumatic massage there is a disappearance of the armored bronchi and improving the ventilation of the lungs.

Treatment of exacerbation hobl

The purpose of the treatment of exacerbations is the highest possible relocation of the current exacerbation and the prevention of their emergence in the future. Depending on gravity, the treatment of exacerbations can be carried out outpatient or in the hospital.

Basic principles of treatment of exacerbations:

• It is necessary to correctly assess the severity of the patient's condition, eliminate complications that can be masked under the exacerbations of COPD, and to send to hospitalization in time during life-degrading situations.
• When aggravating the disease, the use of short-range bronchodilies is preferable to durable. Doses and reception frequency are usually increasing compared to the usual. It is advisable to use spacers or nebulizers, especially in severe patients.
• With the insufficient effect of the bronchodilitics, intravenous administration of euphilline is added.
• If monotherapy was previously used, a combination of beta-stimulants with cholinolithics (also short action) is used.
• If there are symptoms of bacterial inflammation (the first sign of which is the appearance of purulent sputum), antibiotics of a wide range of action are prescribed.
• Connecting intravenous or oral administration of glucocorticosteroids. An alternative to the systemic use of GCS is the inhalation of bulvikorts through a nebulizer of 2 mg twice a day after Berodala inhalation.
• Dosage oxygen therapy in the treatment of patients in the hospital through nasal catheters or Venturi mask. The oxygen content in the inhaled mixture is 24-28%.
• Other events are the maintenance of water balance, anticoagulants, treatment of related diseases.

Care for patients with severe COPD

As already mentioned, COPD is a disease steadily progressive and inevitably leading to the development of respiratory failure. The speed of this process depends on a variety of: the patient's failure from smoking, commitment to the treatment, material abilities of the patient, its epispical abilities, the availability of medical care. Starting with a medium degree of COPD, patients are sent to MSEK to obtain a group of disability.

With the extremely severe degree of respiratory failure, the patient cannot even perform the usual household load, sometimes cannot do even several steps. Such patients need constant unauthorized care. Inhalation with heavy patients are carried out only with the help of a nebulizer. Significantly facilitates the state of many non-strength oxygen and therapy (more than 15 hours a day).

For these purposes, special portable oxygen concentrators have been developed. They do not require refueling with pure oxygen, and concentrate oxygen directly from the air. Oxygen therapy increases the life expectancy of such patients.

Prevention Hobl

COPD - preventable disease. It is important that the level of prophylaxis COPD depends very little on doctors. Basic measures should be taken or a person (refusal of smoking) or a state (anti-packed laws, improvement of ecology, propaganda and stimulating a healthy lifestyle). It has been proven that the prevention of COPD is economically beneficial by reducing the incidence and reduction of disability of the working-age population.

Video: COPD in the program "Live Great"

Video: What is COPL and how to detect

This is a progressive disease characterized by an inflammatory component, impaired bronchial patency at the level of distal bronchi and structural changes in the pulmonary fabric and vessels. The main clinical signs are cough with the release of mucous-purulent sputum, shortness of breath, changing the color of the skin (cyanosis or pinkish color). Diagnosis is based on spirometry data, bronchoscopy, blood gas research. Treatment includes inhalation therapy, bronchodulators

General

Chronic obstructive disease (COPD) today is isolated as an independent lung disease and is deducted from a number of chronic processes of the respiratory system flowing with obstructive syndrome (obstructive bronchitis, secondary emphysema of the lungs, bronchial asthma, etc.). According to epidemiological data, COPL is more often striking men after 40 years, occupies a leading position among the causes of disability and 4th place among the causes of the mortality of the active and able-bodied part of the population.

Causes of Cobl

Among the causes causing the development of chronic obstructive pulmonary disease, 90-95% are given to tobacco. Among other factors (about 5%) produce production hazards (inhalation of harmful gases and particles), respiratory infections of children's age, concomitant bronchopile pathology, state of ecology. In less than 1% of patients, the COPD is based on a genetic predisposition expressed in the alpha1-antitripxin deficiency generated in the tissues of the liver and protecting the lungs from damage to the enzyme elastase.

COPD is a professional disease of miners, railway workers, builders in contact with cement, workers of the pulp and paper and metallurgical industry, agricultural workers engaged in the processing of cotton and grain. Among the professional harm among the reasons for the development of COBL leading:

• contacts with cadmium and silicon
• metal processing
• the harmful role of products formed during the combustion of fuel.

Pathogenesis

Environmental factors and genetic predisposition cause chronic inflammatory damage to the inner shell of bronchi leading to a violation of local bronchial immunity. At the same time, the production of bronchial mucus increases, its viscosity increases, thereby creating favorable conditions for the reproduction of bacteria, impaired bronchi, changes in lung tissue and alveoli. The progression of COPD leads to the loss of a reversible component (edema of mucous membranes, spasm of smooth muscles, mucus secretion) and an increase in irreversible changes leading to the development of peribrous fibrosis and emphysema. The progressive respiratory failure during COPDs can join bacterial complications, resulting in relapses of pulmonary infections.

COPL flow is exacerbated by a gas exchange disorder manifested by a decrease in O2 and CO2 delay in arterial blood, an increase in pressure in the row of pulmonary artery and leading to the formation of a pulmonary heart. Chronic pulmonary heart causes blood circulation deficiency and fatal outcome in 30% of patients with COPD.

Classification

In international experts in the development of chronic obstructive pulmonary disease, 4 stages are allocated. Criterion based on COPD classification is a decrease in the relations of FEV (forced exhalation) to the freak (forced lung life capacity)

• Stage 0. (Presense). It is characterized by an increased risk of COPD development, but it is not always transformed into it. It is manifested by a constant cough and wetting secretion with unchanged lung function.
• Stage I. (Light current COPD). Minor obstructive disorders are identified (the volume of forced exhalation for 1 sec. - FEV1\u003e 80% of the norm), chronic cough and sputum products.
• Stage II. (COPD moderate current). Progress obstructive disorders (50%
• Stage III (severe COPD). Air flow restriction increases with exhalation (30%
• Stage IV (extremely severe COPD). It is manifested by a heavy form of bronchial obstruction threatening for life (FEV, respiratory failure, the development of a pulmonary heart.

Symptoms hobl

In the early stages, chronic obstructive pulmonary disease flows secretly and is not always detected on time. A characteristic clinic unfolds, starting with the medium stage of COPD.

COPL flow is characterized by a cough with a wet and breath. In the early stages there is an episodic cough with the release of sputum mucosa (up to 60 ml per day) and shortness of breath with intensive loads; As the severity of the disease, cough becomes constant, shortness of breath is felt alone. With the addition of infection, the COPD flow is sharpened, the nature of the sputum becomes purulent, its number increases. COPD current can develop for two types of clinical forms:

• Bronchitic type. In patients with bronchtic type, COPD prevailing manifestations are purulent inflammatory processes in bronchi, accompanied by intoxication, cough, abundant wet wet. Bronchial obstruction is expressed significantly, pulmonary emphysema is weak. This group of patients are conditionally referred to as "blue swells" due to the diffuse and blue cyanosis of the skin. The development of complications and terminal stage are in young age.
• Emphysematous type. When developing COPD on emphysematous type, expiratory shortness of breath (with a difficult exhalation) comes into the forehead in symptoms. Emphysema lungs prevails over bronchial obstruction. According to the characteristic appearance of patients (pink-gray skin of the skin, a barrel-shaped chest, cachexia) they are called "pink puffers." It has a more benign flow, patients tend to live to elderly.

Complications

The progressive course of chronic obstructive pulmonary disease can be complicated by pneumonia, acute or chronic respiratory failure spontaneous pneumothorax, pneumosclerosis, secondary polycythemia (erythrocytosis), stagnant heart failure, etc. In the severe and extremely serious degree of COPD in patients develop pulmonary hypertension and pulmonary heart. . The progressive course of COPD leads to changes in the household activity of patients and reduce the quality of their lives.

Diagnostics

The slow and progressive course of chronic obstructive lung disease raises the question of the timely diagnosis of the disease that contributes to improving the quality and increase in life expectancy. When collecting anamnestic data, it is necessary to pay attention to the presence of bad habits (tobacco) and industrial factors.

• Research FVD. The most important method of functional diagnostics serves spirometry, revealing the first signs of COPD. Mandatory is the measurement of high-speed and volumetric indicators: the life capacity of the lungs (jerking), the forced life tank of the lungs (freak), the volume of the forced exhalation for 1 sec. (FEV1) and others. In the postbrontative sample. The summation and ratio of these indicators allows you to diagnose the COPD.
• Wet analysis. A cytological study of sputum in patients with COPD allows you to assess the nature and severity of inflammation of the bronchi, eliminate onconavalation. Out of exacerbation, the nature of the sputum is mucous with the predominance of macrophages. In the aggravation phase, the hob of the wet becomes viscous, purulent.
• Blood analysis. A clinical study of blood at COPD identifies polycetemia (an increase in the number of erythrocytes, hematocrit, hemoglobin, blood viscosity) as a result of the development of hypoxemia in the bronchitic type of disease. In patients with pronounced phenomena of respiratory failure, the gas composition of blood is investigated.
• Radiography of the chest. When the lung radiography, other diseases are excluded with similar clinical manifestations. In patients with COPD on a radiograph, a seal and deformation of bronchial walls is determined, emphysematous changes in lung tissue.

The changes determined by the ECG are characterized by hypertrophy of the right-hand heart departments indicating the development of pulmonary hypertension. Diagnostic bronchoscopy for COPD is shown for differential diagnosis, inspection of the bronchial mucosa and the assessment of its condition, the fence on the analysis of the bronchial secret.

COPL treatment

The objectives of therapy of chronic obstructive pulmonary disease are the slowdown in the progression of the bronchorate and respiratory failure, a decrease in the periodicity and severity of exacerbations, improved quality and an increase in the life expectancy of patients. The necessary element of comprehensive therapy is to eliminate the cause of the disease (first of all smoking).

COPL treatment is carried out by a pulmonologist and consists of the following components:

• patient learning using inhalers, spacers, nebulizers, criteria for assessing their condition and self-assistance skills;
• the appointments of bronchotors (preparations that expand the lumen of the bronchi);
• the appointment of mucolyts (drugs that dilute sputum and facilitating its extinguishing);
• appointments of inhalation glucocorticosteroids;
• antibiotic therapy during exacerbations;
• oxygenation of the body and pulmonary rehabilitation.

In the case of complex, methodical and adequately selected COPD treatment, it is possible to reduce the rate of development of respiratory failure, reducing the number of exacerbations and the extension of life.

Prediction and prevention

Regarding complete recovery, the prognosis is unfavorable. The steady progression of COPD leads to disability. The prognostic criteria of COPD include: the possibility of excluding provoking factor, compliance with the patient of recommendations and therapeutic measures, social and economic status of the patient. The adverse course of COPD is observed in severe concomitant diseases, cardiac and respiratory failure, old age of patients, the bronchitic type of disease. A quarter of patients with severe exacerbations die during the year. COPL prevention measures are the elimination of harmful factors (refusal of tobacco and observance of labor protection requirements in the presence of virtuality), prevention of exacerbations and other bronchopal infections.

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

This is a pathological irreversible condition of the body, in which the ventilation of the lungs is disturbed due to the impossibility of normal air movement by the respiratory system.

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Symptoms hobl

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

This diagnosis indicates that the patient was narrowed by the lumen of the bronchi, and the elasticity of the walls of the alveoli was violated. The first factor makes it difficult to enter the lungs, and the second - reduces the effectiveness of gas exchange between alveoli and blood.

Early (obstructive lung disease) will begin to begin treatment at an early stage. This will not lead to complete recovery, but will suspend the progression of pathology.

• Cough - This is the earliest sign of COPD. At the beginning of the disease, he arises with episodes, but with the development of the disease begins to bother constantly, even during sleep;
• - Bronchopstructions are accompanied by a productive cough. In some cases, the sputum contains purulent exudate;
• dyspnea - It occurs in patients who have been suffering from COPD for a long time. This symptom is explained by the fact that the alveoli is not able to give the desired amount of oxygen into blood. A person feels like a shortage of air, which is essentially an oxygen starvation;
• eveny - Mostly on the legs. The reason for this is stagnation of blood;
• cyanosis - Skin sinusiness due to hypertension in a small circle circle.

Forecast

Cobl- incurable disease. In the four stages of the development of the pathological process. The last one is an indication of disability.

With the development of the disease, symptoms are becoming heavier. The attacks of suffocation occur more and more often, which leads to neuropsychiatric disorders in the patient. Sick Cobls often suffer from depressions, anxiety and fears, which only aggravates the course of the disease.
Usually the treatment appointed by the doctor, patients spend at home, because this is a lifetime process. In cases of serious exacerbations, to relieve the attack of the patient put in the hospital.

COPD - It is impossible to fully cure, but it is quite realistic, because its main reason - smoking. That is why the number of patients in countries with a high standard of living, that is, with the financial opportunity to buy tobacco, is slightly higher than in low-income countries. At the same time, in low-life countries, the percentage of mortality among the diseases above, due to insufficient medical support.

The first step in the therapy of chronic bronchorate should be the cessation of smoking.

Also, as early as possible to consult a doctor, in this situation - to the pulmonologist. It will prescribe supporting drugs will follow the further state of the patient and the development of pathology.

Chronic obstructive pulmonary disease (COPD) is an acute and progressive light disease. However, early diagnosis and suitable treatment can significantly improve the perspectives of patients.

Early signs of COPD include cough, overweight mucus, shortness of breath and fatigue.

COPD is a long-term medical condition that causes the obstruction of the respiratory tract and makes it difficult to breathe. It is a progressive disease, that is, it has a property with time to take more heavy forms. Without treatment, COPD can bear a threat to life.

According to the World Health Organization (WHO), in 2016, COPD touched about 251 million people across the planet. In 2015, COPL was the cause of 3.17 million deaths.

COPD is an incurable disease, but the right medical care makes it possible to weaken the symptoms, reduce the risk of death and improve the quality of life.

In the current article we describe the early signs of COPD. We also explain in which situations it is necessary to contact a doctor for a survey.

The content of the article:

Early signs and symptoms

In the early stages of COPD people can face chronic cough

At an early stage, the symptoms of COPDs are usually not manifested at all or manifest themselves to such a light degree that people can notice them immediately.

In addition, each person has symptoms have different character and different severity. But since COPD is a progressive disease, over time they begin to manifest everything sharper.

The next symptoms of the COPD include the following.

Chronic cough

Permanent or often becomes one of the first signs of COPD. People can observe the chest cough, which does not pass on their own. Usually doctors consider chronic cough if it lasts longer than two months.

Cough is a protective mechanism that is launched by the body as a response to stimuli, for example, on a cigarette smoke that enters the respiratory tracts and light. Cough also helps remove wet wet or mucus.

However, if a person is disturbed by a permanent cough, it may indicate serious problems with light, such as COPD.

Excess mucus production

Allocation of too large mucus volumes can be an early symptom of COPD. The mucus is important to maintain the humidity of the respiratory tract. In addition, it captures microorganisms and stimuli, which fall into the lungs.

When a person inhales stimuli, his body produces more mucus, and it can lead to cough. Smoking is a common cause of the production of too large mucus volumes and cough appearance.

The long-term impact of irritants to the body can damage the lungs and lead to the COPD. In addition to cigarette smoke, the following is among such stimuli:

• chemical couples, such as those that proceed from paints and cleaning products;
• dust;
• pollution in the air, including car exhaust gases;
• perfumery, hair varnishes and other aerosol cosmetics.

Shortness of breath and fatigue

The obstruction of the respiratory tract may impede their breath, because of what people have shortness of breath. Dyspnea - Another early symptom of COPD.

Initially, shortness of breath may appear only after physical activity, but over time this symptom is usually aggravated. Some people trying to avoid breathing problems, reduce the level of activity and quickly lose the physical form.

People with COPD requires more effort to carry out the respiratory process. This often leads to a decrease in the overall energy level and a constant feeling of fatigue.

Other symptoms hobl

Pain and trimming in the chest - potential symptoms of COPD

Since people with COPD are lungs do not function correctly, their body is more inclined to develop respiratory infections, including colds, influenza and pneumonia.

The following symptoms of COPD include the following:

• streking in the chest;
• unintentional weight loss;
• highway in the lower feet.

People with COPD can experience outbreaks, that is, periods of exacerbation of symptoms of the disease. The factors provoking outbreaks include breastfeeding and effect on cigarette smoke organism or other stimuli.

When should I seek a doctor?

If a person faces any of the symptoms designated above, he should see a doctor. It is likely that such symptoms have no relation to COPD, as they can be caused by other medical conditions.

The doctor is usually possible to quickly distinguish the COPD from other diseases. Early diagnosis of COPD allows people to expose therapy faster, which slows down the progression of the disease and prevents its transition to that form that may pose a threat to life.

Diagnostics

Initially, the doctor will ask questions regarding the observed symptoms and personal medical history. In addition, the specialist learns whether the patient smokes and how often his lungs are exposed to irritants.

In addition, the doctor can fulfill the physical examination and test the patient on signs of whistling breathing and other problems with light.

Special diagnostic procedures may be proposed to confirm the diagnosis of the patient. Below are the most common of them.

• Spirometry. As part of this procedure, the patient breathes into the tube, which is attached to the device having a name of spirometer. With the help of spirometer, the doctor assesses the quality of the work of the lungs. Before starting this test, the doctor may ask a person to breathe broncholitic. This type of drugs that open the respiratory tract.
• X-ray study and computed tomography (CT) of the chest. These are visualized diagnostic procedures that allow doctors to see the inner side of the chest and check it on the signs of COPD or other medical conditions.
• Blood tests. The doctor may offer blood test for checking the level of oxygen or eliminating other medical conditions whose symptoms copy the symptoms of the COPD.

What is COPL?

COPD is a medical term that is used to describe a group of diseases that have an property with time to take more heavy forms. Examples of such diseases are emphysema or chronic bronchitis.

Lights consist of numerous channels or respiratory tract that branched out even smaller channels. At the end of these minor channels there are tiny air bubbles that are inflated and blown during breathing.

When a person inhales, oxygen is directed into the respiratory tract and through air bubbles falls into the bloodstream. When a person exhales, carbon dioxide leaves blood flow and comes out of the body through air bubbles and respiratory tract.

People with COPD have chronic inflammation of the lungs blocks the respiratory tract, because of which the breath may find it difficult. COPD also causes cough and increased mucus allocation, which leads to further blockages.

As a result, the respiratory tract may be damaged and becomes less flexible.

The most common cause of COPD is smoking cigarettes or other tobacco products. According to the National Institute of Hearts, Light and Blood US, up to 75% of people with COPD or smoke, or smoked earlier. However, the long-term impact on the body of other stimuli or harmful vapors can also cause COPD.

Genetic factors can also increase the risk of COPD development. For example, people with a deficiency of a protein, which has the name of alpha-1-antitripsein, is more susceptible to the development of COPD, especially if they smoke or regularly enter the influence of other stimuli.

Signs and symptoms of COPD in most cases begin to manifest themselves in people after forty years.

Conclusion

COPD is a common medical condition. However, some people mistakenly take his symptoms for the signs of the natural process of aging the body, which is not subject to diagnosis and do not receive treatment. Without therapy, COPLs can quickly progress.

Sometimes COPD causes a significant limitation of legal capacity. People with sharp shapes of COPDs can face difficulties when performing everyday tasks, for example, during a staircase approach or with long standing behind the kitchen stove during cooking. Outbreaks of COPD and complications can also have a serious impact on human health and the quality of his life.

COPD is impossible to cure, but early diagnosis and treatment significantly improve the perspectives of patients. A suitable therapeutic plan and positive lifestyle changes make it possible to weaken the symptoms and slow down or hold back the progression of COPD.

Treatment methods include reception of drugs, oxygen therapy and meal rehabilitation. Changing the lifestyle provides for regular exercises, the use of a healthy diet and a refusal of smoking.