COPD - this is a common pathology of bronchopulmonary system, manifested by irreversible changes in the distal portions of the respiratory tract obstructive type, resulting from prolonged exposure etiopathogenetic factors of non-inflammatory nature.
COPD in medical practice is a complex of pulmonary pathologies, including chronic bronchitis and emphysema, obstructive type.Due to the deteriorating global environmental situation, annual statistical recording of incidence of COPD is increasing.The sad fact is that the mortality rate of this disease remains high, despite the rather good development of the pharmaceutical and diagnostic industries.
few years ago COPD longer met among men, but now the disease often suffer equally to both sexes, and is associated with an increase in the smoking population.
predominant risk for occurrence of COPD are persons who have the habit of smoking, and the severity of the disease depends on the length and number of "pack-years".Persons
Furthermore, modifiable risk factors are important in the pathogenesis of COPD.This category etiological factors include: reduced weight, frequent episodes of respiratory diseases in childhood, smoking, passive type, prolonged exposure to polluted atmosphere (professional group of pathologies of the respiratory system).
of COPD in non-smoker is possible only on condition that his genetic predisposition, namely alpha-trypsin deficiency, so that there is an imbalance between protease activity and antiproteaznoy lung tissue.Under normal conditions, as a result of exposure to the protease activity of neutrophil elastase, tissue metalloproteinase is the destruction of elastin, and connective tissue, and restoration of the structure of the lung parenchyma.Antiproteaznaya activity of alpha-antitrypsin and secretory proteinase inhibitor is aimed at the regulation of the destruction of elastin, and therefore, patients with COPD, there are always signs of a decline antiproteaznoy activity, resulting in destructive changes of the lung tissue.As a result of the activation of neutrophils appear signs of bronchoconstriction intrabronchial excessive production of mucus and mucosal edema of the respiratory tract.
Severe COPD is always accompanied by secondary infection of the respiratory tract caused by a pronounced decrease in the clearance of mucus in the projection of the distal respiratory tract.Exacerbation of COPD occurs when the re-infection of the bronchial tree, and exacerbates the underlying disease.
Thus, pathogenetic chain reactions that encourage the development of COPD in individuals with a predisposition, is the appearance of obstructive changes in the bronchial passages mainly in the distal due to a sharp increase in production of mucus and bronchoconstriction.
Symptoms of COPD
COPD is usually progressive, however, in most of the patients have developed clinical symptoms develop within a few years or even decades.
first specific symptom of COPD patient is the emergence of a cough.At the onset of the disease cough bothers the patient only in the morning and has a short duration, but over time there is deterioration in the patient's condition and the appearance of painful hacking cough with copious amounts of phlegm department mucous character.Isolation viscous sputum yellow indicates purulent secretion of inflammatory nature.
long period of COPD is inevitably accompanied by the development of emphysema bilateral localization, as evidenced by the appearance of dyspnea expiratory character, ie, difficulty in breathing in the phase of "exhalation".A characteristic feature of shortness of breath in COPD is its permanent nature with a tendency to progression in the absence of remedial measures.
appearance of the patient's chronic headaches with no clear localization, dizziness, drowsiness and reduce disability favor the development of hypoxic and hypercapnic destruction of brain structures.
objective examination of the patient with long-term course of the disease is accompanied by the discovery of the typical features that characterize the irreversible changes in the respiratory tract.For example, visual inspection indicated the formation hypersthenic type of chest and knotted limited tour of the lungs.The skin of the patient become cyanotic shade preferentially localized in the distal trunk and the upper half of the chest.
In conducting light percussion notes bandbox shade of pulmonary sound, symmetrical on both sides, and auscultation signs of COPD are scattered in multiple listening dry wheezing, do not disappear even after the expectoration of sputum.
degrees and stages of COPD
Given a set of clinical and instrumental parameters functioning of the respiratory system of the patient with COPD, the main task is to define the pulmonologist stage of disease progression and severity of the patient's health.To this end, we developed a unified classification of COPD worldwide, taking into account the most important nuances of clinical data and instrumental methods of diagnosis.Such an approach to the diagnosis of COPD allows to effectively develop individual basic therapy, which the patient must adhere to.
Thus, the first stage of COPD is characterized by clinical symptoms of mild manifestations in the form of periodic episodes of dry cough and sputum discharge of a small amount of mucous character.In carrying out functional studies of respiratory function (spirometry) at this stage COPD celebrated figure in forced expiratory volume more than 80%.
In a situation when COPD symptoms become more pronounced, namely the accession of breathlessness occurs during physical activity to patients, suspected to be the second stage of the disease.Spirometry moderate COPD is the reduction in forced expiratory volume to a value of 80% of predicted.
third stage of COPD is accompanied by significant changes in the health status of the patient, as the growing respiratory disorder interferes with the normal physical activity and periods of exacerbation of COPD with pulmonary infection in joining apparatus are becoming more frequent.The establishment of the third stage of the disease and its severe clinical manifestations should be confirmed by spirometry (forced expiratory volume does not exceed 50% of predicted).
fourth stage COPD is nothing more than an extremely severe pulmonary insufficiency, manifested severe hemodynamic and respiratory disorders.Diagnosis of COPD, located in this very severe, it is not difficult, given the expressed specific symptoms, but in most cases it is impossible to carry out spirometry in mind the serious condition of the patient.
COPD medical history
main document of the patient during his stay in the hospital day and night stay in a "case history", which is filled in the primary treatment of the patient.Typically, patients suffering from COPD, have a long outpatient observation period during which changes the state of health of the patient in an outpatient therapist reflects the patient's record.In this regard, in order to facilitate the registration of the patient in the emergency room medical institutions stationary type, the patient must present a medical receptionist direction of hospitalizations, the prescribed family doctor, an identity document of the patient and the patient's outpatient card.In the case where the patient is in serious condition, his delivery is carried out ambulances and patient registration takes place in a simplified mode.
Initial examination of the patient is a thorough collection of complaints, anamnesis of symptoms and the presence of comorbidities with compulsory registration data in the case history in the "initial examination", which carried out a therapist admissions.These physical examination should also be reflected in writing, as to further assess the dynamics of the disease is very important condition of the patient at the time of delivery to the hospital.
In a situation where the therapist is difficult to diagnose, it is expedient in the "additional methods of inspection" to indicate the amount of the recommended diagnostic measures, after that, be sure your doctor admissions should be written "preliminary diagnosis" or differential diagnostic range of diseases.After assessing the severity of the patient with COPD, your doctor decides that, in any branch of the patient should be hospitalized for further treatment, but the therapist is required to reflect the pre-ever recommendations for treatment of the patient.
further treatment of patients diagnosed with COPD should be engaged specialist pulmonal profile, the function of which lies in the dynamic observation of the state of health of the patient with daily filling the "diary of observation" in the history of the disease and correct medical treatment "piece of appointments."In a situation where a patient requires diagnostic actions or advice specialists narrow profile, the physician is only necessary to make a record in the history of the disease with justification appointed instrumental or laboratory testing (control spirography in order to select the minimum therapeutic dose of a bronchodilator).
length of service of patients with COPD can be determined only by the attending physician and at discharge from the hospital the patient is given "discharge summary" that reflects all the stages of a patient's stay in hospital and a further brief recommendations with regards to the treatment of the underlying disease.
Unfortunately, early diagnosis of COPD is extremely difficult, because this pathology is characterized by slow progression and long asymptomatic period.In a situation when developing the typical clinical presentation, indicating the patient has irreversible changes in bronchopulmonary apparatus, the diagnosis of COPD reduces to determining changes in respiratory function, the presence or absence of an inflammatory component, as well as carrying out stress tests.
In fact, even the appearance of a man of such symptoms as "cough", that he has a short-term nature, should be the basis for the pulmonologist thoroughly examine the patient.In such a situation, examination of the patient starts with a basic standard of blood and sputum.
presence of a patient with COPD is almost 80% of cases is accompanied by an inflammatory reaction of blood, indicating the occurrence of a period of exacerbation of the underlying disease.In the interictal period a blood test does not have any changes.The appearance of blood polycythemic syndrome in the form of increased red blood cells, hemoglobin, and low ESR evidence of severe hypoxemia, which is observed in a very severe COPD.
When examining a patient with suspected COPD, sputum specimen collection is of great diagnostic value, since the detection of inflammatory elements in it allows you to set the conclusion of "COPD exacerbation" and the definition of atypical cells eliminates the nature of existing oncology patient respiratory disorders.In a situation where the analysis of sputum there are signs of an inflammatory response, it is advisable to conduct microbiological culture studies with the definition of the type of pathogen and its sensitivity to antibiotics of a particular pharmacological group.
Assessment of indicators of the respiratory system in the form of spirometry and pikfluometrii takes place when it is necessary to assess the severity of COPD to determine the future tactics of the patient, as well as a control method of research, which allows to evaluate the effectiveness of the applied treatment.
bronchodilation test is a "marker" of possible reversible obstructive changes in the patient's bronchial apparatus of great importance in the differential diagnosis of asthma and COPD.To carry out the medical test used any drug group A beta-agonitsov short type of action (salbutamol at a dose of 400 mg), followed by the definition of spirometry no earlier than 15 minutes.In a situation where the drug after the patient has an increase in forced expiratory volume in more than 15%, there is every reason to believe reversible airflow obstruction, which is contrary to the diagnosis of "COPD".
significant role in the changes of the bronchial tree in patients with COPD have the instrumental methods of diagnostics based on the use of ionizing radiation.Thus, computed tomography, carried out in the initial stage of the disease, to determine the deformation of lung pattern due to enhanced proliferation of pulmonary interstitial.Severe COPD is associated with significant radiographic changes in the form of limited or widespread increase pnevmotizatsii lungs, diaphragm flattening and expansion of the boundaries of the ground floor of the mediastinum by increasing the parameters of the right atrium of the heart.
Determination of blood gases as part of the algorithm required diagnostic measures in patients with a long history of COPD.This technique allows us to estimate the degree of respiratory failure and concomitant hypoxemia, followed by the selection of an adequate oxygen therapy scheme.
In difficult situations, when the patient's complaints and physical examination data correspond to-severe COPD, and data spirographic figures do not coincide with the clinical symptoms, it is advisable to apply the test with physical activity.
extremely rare, as a diagnostic event in COPD using bronchoscopic study eliminates the presence of surround tumors in the lumen of the bronchi, present with similar clinical picture as COPD.
Treatment of COPD
After the definite diagnosis, confirmed by instrumental methods of visualization, pulmonologist must determine whether the amount of remedial measures, taking into account the basic principles of treatment of COPD.Therapy should be pathogenetically justified and aimed at improving not only the quality of life of the patient, but also to prevent possible complications of the underlying disease.
All applied conservative and surgical treatments should be divided into several categories: activities etiopathogenetic orientation, conservative treatment of the patient in stable condition, exacerbation of COPD therapy and rehabilitation activities.
etiopathogenetic treatment of patients with COPD should begin to eliminate the root causes of changes in the bronchial system, ie modification of the patient's lifestyle.The key to successful treatment of even severe COPD is a complete cessation of smoking.In a situation where COPD is the result of influence of the trade of hazardous conditions, the appearance of its symptoms in humans should be a cause for termination of employment in hazardous conditions, atmospheric pollutants.