13.11.2017

Chronic obstructive pulmonary disease (COPD)

Description of chronic obstructive diseases

Chronic obstructive pulmonary disease (COPD) is a combination of two lung conditions: chronic bronchitis and emphysema (expansion of the chest). COPD severely restricts the flow of oxygen into the lungs as well as the removal of carbon dioxide from the lungs. Bronchitis causes inflammation and constriction of the airways, while emphysema damages the alveoli (tiny air sacs) in the lungs, making them less efficient at carrying oxygen from the lungs to the bloodstream.

Smoking tobacco products is the root cause of chronic obstructive pulmonary disease (COPD), and a huge number of people are affected by this disease. Since there are many people who use tobacco products, as well as former smokers. Inhaling other substances that irritate the lining of the lungs, such as dirt, dust or chemicals, over a long period of time can also cause or contribute to the development of COPD.

Development of COPD

The ducts branch out, resembling an upside-down tree, and at the end of each branch there are many small air sacs containing balloons called alveoli. In healthy people, every airway is clear and open. The alveoli are small and refined, and the airways with air sacs are elastic.

Difference between healthy bronchi and those with sputum

When a person inhales, each alveolus fills with oxygen, like a small balloon. When you exhale, the balloon contracts and gases escape. With COPD, the airways and alveoli become less elastic and flexible. Less oxygen gets in and less oxygen gets out because:

• air ducts and alveoli lose their elasticity (for example, an old rubber band);
• the walls between many alveoli become unusable;
• the walls of the respiratory tract become thick and inflamed (swollen);
• cells in the respiratory tract secrete more body fluid (phlegm), which leads to blockage of the respiratory tract.

COPD develops slowly and it may take many years before a person notices symptoms, such as feeling short of breath. Most of the time, COPD is diagnosed in people thirty years of age or older. The higher your age, the more likely you are to develop COPD.

COPD ranks fourth in the world in terms of the percentage of deaths from the disease. There is no cure for COPD. There are medications that can slow the progression of COPD, but the damage to the lungs will still occur. COPD is not contagious—it cannot be caught from another person.

What causes COPD?

The use of tobacco products is the main cause of COPD. A huge number of cases of COPD develop after repeated use of vapors and other substances that irritate and damage the lungs and airways. Smoking tobacco products is the main irritant that causes COPD. Pipe, cigarette, hookah and other types can also cause COPD.

Breathing other fumes and dusts over long periods of time can also contribute to the development of COPD. The lungs and airways are very sensitive to these irritants. They cause inflammation and narrowing of the airways, destroying the elastic fibers that allow the lung to stretch and then return to its resting form. This makes it difficult to breathe air in and out of the lungs.

People at risk need to quit smoking

Other things that can irritate the lungs and contribute to COPD include:

• working around certain types of chemicals and breathing gases for years;
• working in a dusty area for many years;
• severe exposure to air pollution;
• Secondhand smoke (smoke in the air from other people smoking cigarettes) also plays a role in an individual's development of COPD.

Genes—tiny bits of information in your body's cells passed on by your parents—may play a role in the development of COPD. In rare cases, COPD is caused by a genomic disorder called alpha-1 antitrypsin. Alpha-1 antitrypsin is a protein in human blood that inactivates destructive proteins. People with antitrypsin deficiency have low levels of alpha-1 antitrypsin; protein imbalance leads to lung destruction and COPD. If people with this disease smoke, the disease progresses faster.

Who is at risk for COPD?

Most people with COPD are smokers or have been smokers in the past. People with a family history of COPD are more likely to develop the disease if they smoke. The likelihood of developing COPD is also higher in people who have been exposed to mild irritants for many years, such as:

1. Air pollution. Chemical fumes, fumes and dust are commonly associated with certain workplaces.
2. A person who has frequent and severe lung infections, especially as children, may be more likely to develop lung damage, leading to COPD. Fortunately, this is much less common today with antibiotic treatment.
3. Most people with COPD are at least 40 years old, or around middle age when symptoms begin. This is unusual, but possible, for people under 40 who have COPD.

Signs and symptoms of COPD

COPD produces symptoms, disability, and decreased quality of life that may respond to medications and other treatments that affect the obstruction. Symptoms of COPD include:

• difficulty breathing or shortness of breath during exercise or at rest (in later stages);
• chest tightness during exercise or at rest;
• chronic cough with sputum production, a feature of chronic bronchitis;
• wheezing, especially when exhaling;
• weight loss and loss of appetite;
• swelling of the ankle.

A persistent cough and phlegm are a common sign of COPD. They often occur several years before the flow of air in and out of the lungs decreases. However, when COPD develops, not all symptoms occur.

The severity of the symptoms depends on which part of the lung was subject to “destruction”. If the patient continues to smoke, the destruction of the lungs occurs faster.

How is COPD diagnosed?

Doctors consider a diagnosis of COPD if a person has typical symptoms and a history of exposure to lung irritants, especially cigarette smoking. Medical history, physical examination and breathing tests are the most important tests to determine whether a patient has COPD.

The attending physician conducts an examination and “listens” to the lungs. The specialist will also ask questions about relatives and medical history, etc. If the patient worked in hazardous work or was exposed to other negative environmental influences, then the doctor should be told about this.

Treatment and prevention

Treatment for COPD is divided into medical and conservative approaches. The basis of conservative therapy is absolute abstinence from nicotine and elimination of other inhaled harmful substances. Teaching the patient breathing exercises in combination with training.

Vaccination against pneumococcal and influenza viruses is prescribed to prevent infection. Prevention of osteoporosis calcium and vitamin D3 are beneficial as produces glucocorticoid-induced osteoporosis. Existing sources of infection must exclude concomitant diseases and require treatment.

The most effective way of prevention is to avoid risk factors. It has been shown that middle-aged smokers who were able to quit experienced significant improvements in well-being and slowed the progression of the disease.

Complications

Acute and chronic respiratory failure are complications of COPD. Viral or bacterial infections can cause more severe problems that last for a long time. In addition, comorbidities such as cardiovascular disease and metabolic syndrome, lung cancer, muscle weakness and osteoporosis, and depression are complications of COPD.

Characterized by weight loss. Pulmonary hypertension can lead to right ventricular failure with hepatomegaly and ascites.

How to detect COPD in the program “About the Most Important Thing”

Chronic obstructive pulmonary disease (COPD) is a disease accompanied by impaired ventilation of the lungs, that is, the flow of air into them. In this case, the disruption of air supply is associated precisely with an obstructive decrease in bronchial patency. Bronchial obstruction in patients is only partially reversible; the lumen of the bronchi is not completely restored.

The pathology has a gradually progressive course. It is associated with an excessive inflammatory and obstructive response of the respiratory system to the presence of harmful impurities, gases, and dust in the air.

Chronic obstructive pulmonary disease - what is it?

Traditionally, the concept of COPD includes obstructive bronchitis and emphysema (bloating) of the lungs.

Chronic (obstructive) bronchitis is an inflammation of the bronchial tree, which is determined clinically. The patient has a cough with sputum. Over the past two years, a person must have coughed for a total of at least three months. If the duration of the cough is shorter, then the diagnosis of chronic bronchitis is not made. If you have, consult a doctor - early initiation of therapy can slow down the progression of the pathology.

Prevalence and significance of chronic obstructive pulmonary disease

Pathology is recognized as a global problem. In some countries, it affects up to 20% of the population (for example, in Chile). On average, among people over 40 years of age, chronic obstructive pulmonary disease occurs in approximately 11–14% of men and 8–11% of women. Among the rural population, pathology occurs approximately twice as often as among urban residents. With age, the incidence of COPD increases, and by the age of 70, every second male rural resident suffers from obstructive pulmonary disease.

Chronic obstructive pulmonary disease is the fourth leading cause of death in the world. Mortality from it is increasing, and there is a tendency towards an increase in mortality from this pathology among women.

The economic costs associated with COPD rank first, surpassing the costs of treating patients with asthma by half. The greatest losses occur in inpatient care for patients with an advanced stage, as well as in the treatment of exacerbations of the obstructive process. Taking into account temporary disability and reduced performance when returning to work, economic losses in Russia exceed 24 billion rubles per year.

Chronic obstructive pulmonary disease is an important social and economic problem. It significantly impairs the quality of life of an individual patient and places a heavy burden on the healthcare system. Therefore, prevention, timely diagnosis and treatment of this disease are very important.

Causes and development of COPD

In 80–90% of cases, the cause of chronic obstructive pulmonary disease is smoking. The group of smokers has the highest mortality rate from this pathology; they experience faster irreversible changes in pulmonary ventilation and more severe symptoms. However, pathology also occurs in non-smoking people.

An exacerbation can develop gradually, or it can occur suddenly, for example, against the background of a bacterial infection. A severe exacerbation may result in the development of acute heart failure.

Forms of COPD

The manifestations of chronic obstructive pulmonary disease largely depend on the so-called phenotype - the set of individual characteristics of each patient. Traditionally, all patients are divided into two phenotypes: bronchitis and emphysematous.

With the bronchitis obstructive type, the clinical manifestations of bronchitis predominate - cough with sputum. In the emphysematous type, shortness of breath predominates. However, “pure” phenotypes are rare, and there is usually a mixed picture of the disease.

Some clinical signs of phenotypes in COPD:

In addition to these forms, other phenotypes of obstructive disease are distinguished. So, recently a lot has been written about the overlap phenotype, that is, the combination of COPD and. This form develops in patients with asthma who smoke. It has been shown that about 25% of all patients with COPD have reversible COPD, and eosinophils are found in their sputum. In the treatment of such patients, the use is effective.

A form of the disease is distinguished that is accompanied by two or more exacerbations per year or the need for hospitalization more than once a year. This indicates a severe course of the obstructive disease. After each exacerbation, lung function worsens. Therefore, an individual approach to the treatment of such patients is necessary.

Chronic obstructive pulmonary disease causes the body to respond in the form of systemic inflammation. It primarily affects skeletal muscles, which increases weakness in patients with COPD. Inflammation also affects blood vessels: the development of atherosclerosis accelerates, the risk of coronary heart disease, myocardial infarction, and stroke increases, which increases mortality among patients with COPD.

Other manifestations of systemic inflammation in this disease are osteoporosis (decreased bone density and fractures) and anemia (decreased amount of hemoglobin in the blood). Neuropsychiatric disorders in COPD include difficulty falling asleep, nightmares, depression, and memory impairment.

Thus, the symptoms of the disease depend on many factors and change throughout the patient’s life.

Read about the diagnosis and treatment of obstructive disease.

One of the most common pathologies that cause permanent inflammation of the respiratory system is chronic obstructive pulmonary disease (COPD). Although this term itself began to be used relatively recently, the number of patients with this disease is quite impressive (approximately 5-10% of the population). Such disappointing statistics are primarily due to the huge mass of smokers - they make up the overwhelming number of patients.

Since the disease is often detected in its final stages, mortality within 10 years after seeing a doctor is 55% of all recorded cases. In addition, its complications often lead to loss of performance and disability. Therefore, it is extremely important to promptly diagnose and begin treatment for COPD.

COPD is an independent disease. It is characterized by a limitation in the passage of air through the respiratory tract, and in some cases this process is irreversible. This pathological condition is caused by inflammation of the lung tissue, which in turn is caused by a nonspecific reaction of the patient’s body to some pathogenic microparticles or gases.

The diagnosis of COPD is a collective term that includes:

• chronic obstructive bronchitis (including purulent);
• pneumosclerosis;
• pulmonary hypertension;
• emphysema resulting from obstruction of the bronchial tree;
• chronic pulmonary heart disease.

All of these diseases reflect structural changes and dysfunction of key body systems that occur at different stages of COPD. Some people show signs of several pathological conditions at once.

Reasons

In most cases, chronic obstructive pulmonary disease develops in people after 40. The majority of patients are men. This selective exposure is based on the specific etiology of the disease. The following reasons for its occurrence are identified:

• Smoking. It is the main culprit of COPD (more than 80% of patients), and this is typical mainly for developed countries, since the percentage of smokers is higher there. They develop shortness of breath and respiratory tract obstruction syndrome much faster. A fairly high risk of getting sick also exists among those who are regularly exposed to second-hand smoke. This is especially harmful for children.
• Professional factors. These include some areas of industry, the by-product of which is the release into the air of dust microparticles with a high content of silicon and cadmium. These are the mining and metallurgical industries, the pulp industry, as well as work directly related to the production and use of cement.
• Hereditary pathologies. The genetic causes of chronic obstructive pulmonary disease are still under study, but it is already reliably known that one of them is a lack of α1-antitrypsin. It controls the activity of elastase, which is involved in the breakdown of various protein structures. If the production of this protein body decreases by more than 30%, elastase begins to destroy lung tissue, causing emphysema.

There are several other factors that presumably lead to this disease. These include low body weight, air pollution, the family nature of the disease, as well as regular inhalation of biofuel combustion products during cooking (observed in people living in backward countries).

Prematurity and frequent acute respiratory infections in children can also lead to the development of the disease, although there are no statistics on the frequency of cases at this age. At the same time, COPD is recorded in adolescents as a consequence of bronchial asthma (according to some sources, the frequency is 4-10%).

Of course, the above risk factors, when present individually, have a negligible likelihood of causing chronic obstructive pulmonary disease. But since in the modern world with developed industry, high air pollution and other consequences of human activity, they act together with poor nutrition and bad habits. Therefore, the number of diseases is growing every year, and the life expectancy of patients due to late detection in general percentage is decreasing.

Development mechanism

The pathogenesis of the disease originates in the bronchial walls. Under the influence of external factors, the functioning of the exocrine apparatus is disrupted, which leads to increased secretion of mucus and a change in its composition. After some time, an infection occurs, which causes an inflammatory process that takes on a permanent form.

Since chronic obstructive pulmonary disease is progressive, pathogenic microflora gradually destroys the tissue of the bronchi, bronchioles and adjacent alveoli. This course of the disease leads to a decrease in the supply of oxygen to the body, which, in turn, has an extremely negative impact on the functioning of all its systems. In this case, the heart experiences the greatest load, as a result of which the functioning of the respiratory organs greatly deteriorates.

Classification

The formulation of the diagnosis is largely based on the severity of the disease. To do this, the reduction in the flow rate of inhaled air is determined and, based on the data obtained, the so-called Tiffno index is calculated - an indicator of a possible decrease in the patient’s respiratory tract capacity.

For measurements, a special device is used - a spirometer. It will help you find out the two main values ​​based on which COPD is classified: forced expiratory volume (FEV) and forced vital capacity (FVC). Their percentage ratio is the Tiffno index.

In addition, it is necessary to take into account the symptomatic manifestations and frequency of exacerbations of the disease. In modern medicine, there are 4 degrees of severity of chronic obstructive pulmonary disease:

• It occurs easily and is manifested by a periodic wet cough. In most cases, shortness of breath is not observed. FEV/FVC<70% от исходного значения. ОФВ>80% of normal.

• Moderate course of the disease with noticeable shortness of breath during physical exertion and persistent cough. Obstruction increases, and COPD may worsen. FEV/FVC<70%, ОФВ<80% от должного.

• The disease is characterized by severe symptoms. The patient has a constant wet cough, wheezing in the sternum, and the slightest physical exertion causes severe shortness of breath. Periods of exacerbation occur regularly. FEV/FVC<70%, ОФВ<50% от исходного значения.

• The condition is extremely serious, in some cases even life-threatening. Obstruction of the bronchi is clearly expressed. At this stage, destructive processes in the body lead to disability. FEV/FVC<70%, ОФВ<80% от нормы.

Starting from stage 3, COPD can be divided into two types depending on clinical manifestations:

• Bronchodilator. Here the predominant symptom is cough. At the same time, it is clearly expressed. Since cor pulmonale develops early, the skin becomes bluish after some time. The concentration of red blood cells in the blood, as well as its total volume, is constantly increased, which often leads to the formation of blood clots, hemorrhages, and heart attack.
• Emphysematous. This type includes COPD with prevailing shortness of breath. Patients are characterized by intense breathing, exceeding the need for oxygen. Patients often complain of weakness, depression, and weight loss. There is severe exhaustion of the body.

Symptoms

Chronic obstructive pulmonary disease does not appear immediately. Typically, noticeable signs are observed only 3-10 years after its onset. But even in this situation, the patient does not always consult a doctor. This behavior is especially typical for smokers. They consider coughing a completely normal condition, since they inhale nicotine smoke every day. Of course, they determine the reason correctly, but they make mistakes with their further actions.

Most often, the disease is diagnosed in people aged 40-45 years, when the patient already feels significant shortness of breath. Therefore, it is important to know the main symptoms of COPD, especially in the initial stages:

• Cough . Of all the symptoms, it occurs first and is episodic in nature. Then it becomes daily. In the absence of an exacerbation, sputum is usually not produced.
• Sputum. Appears some time after an intermittent cough develops into a permanent one. Initially, it is observed mainly in the mornings. If the sputum becomes purulent, this indicates the development of an exacerbation.
• Dyspnea. This symptom means the disease has entered stage 2. Usually it is of a mixed type, less often - only with difficulty in exhaling. In the initial stages, it manifests itself only under strong physical stress, intensifying during acute respiratory infections. As it progresses, shortness of breath intensifies, limiting the patient's activity. In severe cases of the pathology, it develops into respiratory failure.

• If you work in production and start coughing from industrial dust, then most likely you are developing.
• There is such a disease in children -. This is a hereditary pathology. We advise you to read it.
• Rapid breathing is a clear sign. This problem, like others, can be treated with folk remedies and medications.

Exacerbation of COPD

If the patient's condition constantly worsens over 2 or more days, this phase is called an exacerbation. At the same time, the main symptoms of the disease intensify, and an increased temperature is observed. Depending on the severity of the pathology, the frequency of recurrence of such periods can vary widely. The intervals between them are called remission phases. Exacerbation of the disease has its own characteristics:

• significant increase in shortness of breath and cough;
• an increase in the volume of sputum produced;
• frequent shallow breathing;
• elevated temperature;
• tachycardia;
• various neurological pathologies (for example, unmotivated agitation or depression).

Complications

At various stages of the disease, many destructive changes occur in the body, most often irreversible. Therefore, in the vast majority of cases, patients experience the following syndromes:

• Bronchial obstruction. It develops from the first stages of chronic obstructive pulmonary disease and gradually progresses. This process usually begins in the small bronchi. This results in increased resistance in the lower airway. Due to deformation of the alveoli, the lung tissue loses its elasticity, and pulmonary fibrosis forms.
• Pulmonary hypertension. The main complications of COPD affect the cardiovascular system. Hypertension is provoked by a narrowing of the circulatory system in the respiratory organs, aggravated by thickening of the walls of blood vessels. Due to this, the level of pressure required for blood to flow through the network of capillaries feeding the lung increases.
• Cor pulmonale e. For what reasons some patients experience enlargement of the right ventricle is not yet fully known.
• Hyperinflation of the lungs. In this case, the lungs are filled with air and are not completely emptied when exhaling. This gradually weakens the breathing muscles, changing the shape of the diaphragm. This condition is especially felt during physical exertion, preventing one from increasing the depth of breathing.
• Emphysema. Since the connection between the small bronchi and the alveoli is disrupted, this negatively affects their patency.
• General intoxication of the body. Some patients develop muscle weakness, and inflammatory response syndrome is often present. All this leads to a decrease in physical activity and a general deterioration in well-being.

Diagnostics

To make a correct diagnosis, it is first necessary to determine whether a person is exposed to risk factors for developing chronic obstructive pulmonary disease. If the patient smokes, the level of possible danger caused by this habit over the entire period should be calculated. The so-called smoker’s index, calculated using the formula: (number of cigarettes smoked daily * total experience (years))/20, will help with this. If the resulting number is greater than 10, the danger of getting sick is very real. Diagnosis of COPD includes the following:

• Clinical and biochemical blood test. It is recommended to do it 2 times a year, as well as during periods of exacerbation.
• Sputum analysis. Determination of its macro- and microscopic properties. If necessary, conduct a bacteriological study.
• Electrocardiogram. Since chronic obstructive pulmonary disease often causes heart complications, it is advisable to repeat this procedure 2 times a year.
• X-ray of the sternum. It needs to be done annually (at a minimum).
• Spirometry. Allows you to determine how severe the condition of respiratory system pathologies is. It is necessary to undergo once a year or more often in order to adjust the course of treatment in time.
• Blood gas and pH analysis. This is done for grades 3 and 4.
• Oxygemometry. Assessment of the degree of blood oxygen saturation using a non-invasive method. Used in the acute phase.
• Monitoring the ratio of fluid and salt in the body. The presence of a pathological deficiency of individual microelements is determined. It is important during exacerbation.
• Differential diagnosis. Most often, diff. diagnosis is made with lung cancer. In some cases, it is also necessary to exclude heart failure, tuberculosis, and pneumonia.

The differential diagnosis of bronchial asthma and COPD especially deserves attention. Although these are two independent diseases, they often appear in one person (the so-called overlap syndrome). The causes and mechanisms of this are not fully understood, so it is necessary to know the differences in their clinical manifestations. So, starting from grade 2, patients experience shortness of breath. After the addition of bronchial asthma, it intensifies, and as the pathologies progress, attacks of suffocation become more frequent. This is a rather dangerous condition that can be fatal.

A full range of laboratory tests and a thorough study of the patient’s medical history will allow us to give the correct diagnosis of the disease. This includes the degree and severity of COPD, the presence of an exacerbation, the type of clinical manifestation and complications encountered.

Treatment of chronic obstructive disease

It is still impossible to completely cure chronic obstructive pulmonary disease with the help of modern medicine. Its main function is to improve the quality of life of patients and prevent severe complications of the disease.

Treatment for COPD can be done at home. The following cases are exceptions:

• therapy at home does not produce any visible results or the patient’s condition worsens;
• respiratory failure intensifies, developing into an attack of suffocation, heart rhythm is disturbed;
• grades 3 and 4 in the elderly;
• severe complications.

In remission

To dilate the bronchi, a set of inhalations of bronchodilators is given (check the dosage with your doctor):

• M-anticholinergics: “Ipratropium bromide” (“Atrovent”) 0.4-0.6 mg or “Tiopropium bromide” (“Spiriva”) 1 capsule – effectively block M-cholinergic receptors in the parasympathetic nerve endings;
• "Fenoterol" or "Salbutamol" 0.5-1 ml - drugs with pronounced bronchodilator activity.

Since the accumulation of mucus in the respiratory tract contributes to the occurrence of infections, mucolytic drugs are used to prevent these diseases:

• “Bromhexine”, “Ambroxol” - reduce the secretory function of the respiratory organs and change the composition of mucus, weakening its internal connections;
• “Trypsin”, “Chymotrypsin” are proteins of a protein nature that actively interact with the accumulated secretion, reducing its viscosity and ultimately leading to destruction.

During exacerbation

Treatment of chronic obstructive pulmonary disease in the acute phase involves taking glucocorticoids, most often Prednisolone. In case of severe respiratory failure, the drug is administered intravenously. Since systemic medications of this group have many side effects, now in some cases they are replaced with drugs that delay the functions of pro-inflammatory mediators (Fenspiride, Erespal). If treatment with these medications at home does not show positive results, the patient must be hospitalized.

In addition, in this phase, emphysema often progresses and mucus stagnation forms. These conditions can lead to the development of complications, namely bronchitis or pneumonia. To prevent this from happening, antibacterial therapy is prescribed to prevent these diseases - penicillins, cephalosporins, fluoroquinolones.

In the elderly

For the elderly, an individual approach is necessary, since due to certain features the course of the disease is most often severe. Before treating them, you need to consider a number of factors:

• age-related changes in the respiratory system;
• the presence of additional diseases associated with COPD and their mutual influence;
• the need to take multiple medications;
• Difficulties in diagnosis and adherence to treatment;
• psychosocial features.

Nutrition

To maintain the body in the tone necessary to resist the disease, a balanced diet is necessary:

• eating enough proteins (a little more than normal) - meat and fish dishes, fermented milk products;
• with reduced body weight, you need a high-calorie diet;
• multivitamin complexes;
• reduced salt content for complications (pulmonary hypertension, bronchial asthma and others).

Prevention

Treatment of COPD will not show positive dynamics until the patient eliminates all factors that provoke this disease. The main recommendations are quitting smoking and timely prevention of infections affecting the respiratory system.

Effective prevention of COPD includes studying all the information about this disease, as well as the ability to use medical devices required during the treatment process. The patient must know how to do inhalations correctly and measure the highest speed of air leaving the lungs using a peak flow meter. And, of course, it is necessary to follow all the recommendations of doctors.

COPD is a slowly progressive disease, leading to worsening and even death over time. Therapy can only slow down these processes, and the adequacy of its use directly determines how long the patient will remain able to work. In some cases, periods of remission last up to several years, so such patients live for decades.

Chronic obstructive pulmonary disease (COPD) is a deadly disease. The number of deaths per year worldwide reaches 6% of the total number of deaths.

This disease, which occurs as a result of long-term damage to the lungs, is currently considered incurable; therapy can only reduce the frequency and severity of exacerbations and reduce the level of deaths.
COPD (chronic obstructive pulmonary disease) is a disease in which air flow in the airways is limited, partially reversible. This obstruction continually progresses, reducing lung function and leading to chronic respiratory failure.

Classmates

Who has COPD

COPD (chronic obstructive pulmonary disease) mainly develops in people with many years of smoking experience. The disease is widespread throughout the world, among men and women. The highest mortality rate is in countries with low living standards.

Origin of the disease

With many years of irritation of the lungs by harmful gases and microorganisms, chronic inflammation gradually develops. As a result, narrowing of the bronchi occurs and destruction of the alveoli of the lungs. Subsequently, all respiratory tracts, tissues and blood vessels of the lungs are affected, leading to irreversible pathologies that cause a lack of oxygen in the body. COPD (chronic obstructive pulmonary disease) develops slowly, progressing steadily over many years.

If left untreated, COPD leads to disability and then death.

Main causes of the disease

• Smoking is the main cause, causing up to 90% of cases of the disease;
• occupational factors - work in hazardous industries, inhalation of dust containing silicon and cadmium (miners, builders, railway workers, workers in metallurgical, pulp and paper, grain and cotton processing enterprises);
• hereditary factors - rare congenital α1-antitrypsin deficiency.

• Cough– the earliest and often underestimated symptom. At first, the cough is periodic, then it becomes daily, in rare cases it appears only at night;
• – appears in the early stages of the disease in the form of a small amount of mucus, usually in the morning. As the disease progresses, the sputum becomes purulent and increasingly abundant;
• dyspnea– is detected only 10 years after the onset of the disease. At first it appears only during severe physical exertion. Further, a feeling of lack of air develops with minor body movements, and later severe progressive respiratory failure appears.

The disease is classified according to severity:

Mild – with slightly pronounced impairment of lung function. A slight cough appears. At this stage the disease is very rarely diagnosed.

Moderate severity - obstructive disorders in the lungs increase. Shortness of breath appears during exercise. loads The disease is diagnosed when patients present due to exacerbations and shortness of breath.

Severe - there is a significant restriction of air flow. Frequent exacerbations begin, shortness of breath increases.

Extremely severe - with severe bronchial obstruction. The state of health deteriorates greatly, exacerbations become threatening, and disability develops.

Diagnostic methods

Anamnesis collection - with analysis of risk factors. For smokers, the smoker's index (SI) is assessed: the number of cigarettes smoked daily is multiplied by the number of years of smoking and divided by 20. An SI of more than 10 indicates the development of COPD.
Spirometry – to assess lung function. Shows the amount of air during inhalation and exhalation and the speed of entry and exit of air.

A test with a bronchodilator - shows the likelihood of reversibility of the process of bronchial narrowing.

X-ray examination - determines the severity of pulmonary changes. The same is carried out.

Sputum analysis - to identify microbes during exacerbation and select antibiotics.

Differential diagnosis

X-ray findings are also used to differentiate from tuberculosis, as well as sputum analysis and bronchoscopy.

How to treat the disease

General rules

• Smoking must be stopped forever. If you continue to smoke, no treatment for COPD will be effective;
• use of personal protective equipment for the respiratory system, reducing, if possible, the amount of harmful factors in the work area;
• rational, nutritious nutrition;
• reduction to normal body weight;
• regular physical exercise (breathing exercises, swimming, walking).

Treatment with drugs

Its goal is to reduce the frequency of exacerbations and severity of symptoms, and prevent the development of complications. As the disease progresses, the scope of treatment only increases. Main drugs in the treatment of COPD:

• Bronchodilators are the main drugs that stimulate bronchodilation (atrovent, salmeterol, salbutamol, formoterol). Administered preferably in the form of inhalations. Short-acting drugs are used as needed, long-term drugs are used constantly;
• glucocorticoids in the form of inhalations - used for severe degrees of the disease, for exacerbations (prednisolone). In case of severe respiratory failure, attacks are stopped with glucocorticoids in the form of tablets and injections;
• vaccines – vaccination against influenza can reduce mortality in half of cases. It is carried out once in October - early November;
• mucolytics – thin mucus and facilitate its removal (carbocysteine, ambroxol, trypsin, chymotrypsin). Used only in patients with viscous sputum;
• antibiotics - used only during exacerbation of the disease (penicillins, cephalosporins, fluoroquinolones may be used). Tablets, injections, inhalations are used;
• antioxidants – capable of reducing the frequency and duration of exacerbations, used in courses of up to six months (N-acetylcysteine).

Surgical treatment

• Bullectomy – removal can reduce shortness of breath and improve lung function;
• Reducing lung volume through surgery is currently under study. The operation improves the patient’s physical condition and reduces the mortality rate;
• Lung transplantation – effectively improves the quality of life, lung function and physical performance of the patient. Application is hampered by the problem of donor selection and the high cost of the operation.

Oxygen therapy

Oxygen therapy is carried out to correct respiratory failure: short-term - for exacerbations, long-term - for the fourth degree of COPD. If the course is stable, continuous long-term oxygen therapy is prescribed (at least 15 hours daily).

Oxygen therapy is never prescribed to patients who continue to smoke or suffer from alcoholism.

Treatment with folk remedies

Herbal infusions. They are prepared by brewing a spoonful of the collection with a glass of boiling water, and each is taken for 2 months:

√ 1 part sage, 2 parts each chamomile and mallow;

√ 1 part flax seeds, 2 parts each eucalyptus, linden flowers, chamomile;

√ 1 part each of chamomile, mallow, sweet clover, anise berries, licorice and marshmallow roots, 3 parts flaxseed.

• Radish infusion. Grate black radish and medium-sized beets, mix and pour cooled boiling water over them. Leave for 3 hours. Drink 50 ml three times a day for a month.
• Nettle. Grind the nettle roots into a paste and mix with sugar in a ratio of 2:3, leave for 6 hours. The syrup removes mucus, relieves inflammation and relieves cough.
• Milk:

√ Brew a spoonful of cetraria (Icelandic moss) with a glass of milk and drink throughout the day;

√ Boil 6 chopped onions and a head of garlic in a liter of milk for 10 minutes. Drink half a glass after meals. Every mother should know this!

Are coughing attacks keeping you up at night? You may have tracheitis. You can learn more about this disease

Secondary

• physical activity, regular and dosed, aimed at the respiratory muscles;
• annual vaccination with influenza and pneumococcal vaccines;
• constant intake of prescribed medications and regular examinations with a pulmonologist;
• correct use of inhalers.

Forecast

COPD has a conditionally unfavorable prognosis. The disease progresses slowly but constantly, leading to disability. Treatment, even the most active, can only slow down this process, but not eliminate the pathology. In most cases, treatment is lifelong, with constantly increasing doses of medication.

With continued smoking, obstruction progresses much faster, significantly reducing life expectancy.

Incurable and deadly, COPD simply encourages people to quit smoking for good. And for people at risk, there is only one piece of advice - if you notice signs of the disease, immediately contact a pulmonologist. After all, the earlier the disease is detected, the lower the likelihood of premature death.