Traditional medicine

Chronic obstructive pulmonary inflammation. COPD and obstructive pneumonia - a dangerous connection

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

Types of pathology

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

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

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

Causes and symptoms of the disease

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

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

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

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

What is COPD?

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

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

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

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

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

COPD has 4 stages:

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

Treatment of pneumonia

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

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

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

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

Terminology

Chronic pneumonia (CP)- the term most common in the 60-80s among doctors involved in pulmonology, by the end of the 90s it practically ceased to be used in the scientific literature. Along with this, after 1995, the term began to be used quite often in the domestic pulmonological literature “chronic obstructive pulmonary disease” (COPD), work has intensified to optimize the diagnosis and treatment of this group of patients, and finally, a Federal program on COPD has been created. At the 9th National Congress on Respiratory Diseases (Moscow, 1999), the question often arose whether there was a simple substitution of one term (CP) for another (COPD) and whether all this was a terminological balancing act and an attempt to comply with the standards of English-language literature, not whether there are “violations of the traditions of Russian medicine.”

In the early 60s, the term CP in the USSR united most respiratory diseases. This provision was legalized in 1964, when the HP classification was adopted in Minsk, and in 1972 in Tbilisi it was supplemented and detailed. At the same time, attempts were made to isolate chronic bronchitis from the concept of CP, but the scientific community of the congress of therapists did not support this initiative. However, a series of works soon appeared that substantiate the inappropriateness of using the term CP, which combines the main nosological forms of pulmonology. A number of diseases have been isolated from CP: chronic non-obstructive bronchitis, chronic obstructive bronchitis, emphysema, focal pneumosclerosis, bronchiectasis. Each nosological form has its own etiology, pathogenesis and clinical features, which requires the use of various prevention and treatment programs. By the 90s, the formulation of the concept of HP was presented as follows: “chronic pneumonia- limited chronic inflammation of the lungs of infectious etiology, prone to recurrence, resulting from unresolved acute pneumonia.”

Chronic obstructive pulmonary disease (COPD) is a term with dual content.
Firstly, COPD is a collective concept, which unites a group of chronic diseases of the respiratory system, characterized by progressive irreversible bronchial obstruction and an increase in chronic respiratory failure. This group includes chronic obstructive bronchitis (COB), pulmonary emphysema (PE), some forms bronchial asthma (BA) with an increase in irreversible bronchial obstruction (usually non-atopic BA).

Secondly, COPD as an independent disease(nosological form) is the final stage of the progressive course of COB, EL, BA, i.e. that stage at which, due to the progression of the disease, the reversible component of bronchial obstruction is lost, and the diseases that led to COPD lose their individuality.

This attitude to the problem also corresponds to the International Classification of Diseases, 10th revision (ICD-10), in which, under the heading J.44.8, chronic obstructive bronchitis without additional specifications is identified, which is part of the specified COPD.

Heading J.44.9 identifies chronic obstructive pulmonary disease, unspecified, which is considered as the terminal phase of diseases, in which all the individual characteristics of individual diseases that led to COPD are already erased.

Thus, patients with COPD have at least 2 main features that fundamentally distinguish them from CP - the diffuse nature of damage to the respiratory system and progressive respiratory failure of the obstructive type.

Therefore, it can be stated that COPD and CP are inherently different lesions of the respiratory system. As for the term “CP” itself, there is no such nosological form in ICD-10. At the 9th National Congress on Respiratory Diseases (Moscow, 1999), two opinions were expressed: to preserve this concept, used for limited forms of pulmonary pathology, or to name specific pathological conditions that form CP (focal pneumosclerosis, segmental bronchitis with bronchiectasis).

Epidemiology

Chronic obstructive pulmonary diseases (COPD) occupy a leading place among the causes of morbidity and mortality in the adult population.

Terminological uncertainty that has existed for many years makes it difficult to provide accurate data on the prevalence of COPD. Due to discrepancies regarding the definitions, diagnosis and treatment of COPD, in the 90s national and international standards began to be created on this problem (Canada, 1992; USA, 1995; European Respiratory Society, 1995; Russia, 1995; Great Britain, 1997). All of these documents emphasize that reliable and accurate epidemiological data on COPD are not yet available. Thus, in the USA in 1995, 14 million people suffered from COPD, of which 12.5 million were diagnosed with COPD. From 1982 to 1995 in the United States, the number of patients increased by 41.5%. About 6% of men and 3% of women have COPD, and among people over 55 years of age this figure reaches 10%.

In Russia , according to calculations using epidemiological markers, there must be about 11 million patients with COB. However, official medical statistics list about half a million patients with COB, i.e. There is a diagnosis in the late stages of the disease, when the most modern treatment programs are not able to slow down the steady progression of the disease. This is the main reason for the high mortality rate in patients with COPD. Although these approximate figures require clarification, there is no doubt about the socio-economic significance of this widespread disease.

Etiology and pathogenesis

COPD manifests itself as a chronic inflammatory process with predominant damage to the distal respiratory tract. This category of patients is characterized by a decrease in maximum expiratory flow and a slow gradual deterioration in gas exchange function of the lungs, which reflects the irreversible nature of airway obstruction. Biomarkers of chronic inflammation in COPD are participation of neutrophils with increased activity of myeloperoxidase, elastase; imbalance in the proteolysis-antiproteolysis and oxidant-antioxidant systems . The main clinical manifestations of COPD are cough of varying severity, sputum production and shortness of breath. COPD belongs to a group of multigenetic diseases.

External and internal etiological factors of COPD (risk factors) are divided depending on their significance (Table 1).

The main risk factor (in 80-70% of cases) of COPD is smoking . Smokers have the highest mortality rates, they quickly develop irreversible obstructive changes in respiratory function and all the known signs of COPD. The demographics of COPD are thought to reflect smoking prevalence.

The most common (about 70%) cause of COPD is COPD , about 1% is EL (due to deficiency of a 1 - antitrypsin), the remaining percentage is due to severe asthma. Isolation of COB into a separate nosological form is of fundamental importance from the standpoint of early diagnosis and treatment at the stage of a preserved reversible component of bronchial obstruction, i.e. when the disease has not yet lost its individuality and there is a real possibility of inhibiting the progression of the disease by influencing the reversible component of bronchial obstruction.

Chronic obstructive bronchitis- a disease characterized by chronic diffuse non-allergic inflammation of the bronchi, leading to progressive obstructive ventilation impairment and manifested by cough, shortness of breath and sputum production, not associated with damage to other systems and organs.

Due to the summation of environmental risk factors and genetic predisposition, a chronic inflammatory process develops, which involves all morphological structures of bronchi of different sizes, interstitial (peribronchial) tissue and alveoli. The main consequence of the action of etiological factors (risk factors) is chronic inflammation. The localization of inflammation and the characteristics of the triggering factors determine the specifics of the pathological process. The chain of events developing in patients with COB is presented in Fig. 1.

Clinical picture

The clinical picture of COPD depends on the stage of the disease, the rate of disease progression and the predominant level of damage to the bronchial tree. COPD, as the main component of COPD, develops slowly under the influence of risk factors and progresses gradually. Thus, the standards of the American Thoracic Society emphasize that the appearance of the first clinical symptoms in patients with COB is usually preceded by smoking at least 20 cigarettes per day for 20 years or more. The rate of progression and severity of COB symptoms depends on the intensity of the impact of etiological factors and their summation.

The first signs with which patients usually consult a doctor are cough and shortness of breath, sometimes accompanied by wheezing and sputum production. These symptoms are most pronounced in the morning. The earliest symptom, appearing by 40-50 years of age, is cough. By this time, during cold seasons, episodes of respiratory infection begin to occur, which at first are not associated with one disease. Dyspnea, felt initially during physical activity, occurs on average 10 years later than the onset of cough.

Sputum is secreted in small quantities (rarely more than 60 ml/day) in the morning, is mucous in nature and becomes purulent only during infectious episodes, which are usually regarded as exacerbations.

As COB progresses, the intervals between exacerbations become shorter.

The results of physical examination of patients with COB depend on the severity of bronchial obstruction, the severity of pulmonary hyperinflation and physique. As the disease progresses, the cough is accompanied by wheezing, which is most noticeable with rapid exhalation. Auscultation often reveals dry rales of different timbres. Shortness of breath can vary over a very wide range: from a feeling of shortness of breath during standard physical activity to severe respiratory failure. As bronchial obstruction progresses and hyperinflation of the lungs increases, the anteroposterior size of the chest increases. The mobility of the diaphragm is limited, the auscultatory picture changes: the severity of wheezing decreases, exhalation lengthens.

The sensitivity of physical methods for determining the severity of COPD is low. Classic signs include wheezing exhalation and prolonged expiratory time (>5 sec) which may indicate bronchial obstruction.

Thus, the development and progression of COPD occurs under the influence of risk factors and is characterized by a slow gradual onset. The first (earliest) sign of COPD is a cough. The remaining signs appear later as the disease progresses, and the progression of the disease gradually accelerates.

The severity of clinical signs and changes in the main functional indicators depending on the severity of COPD are presented in table. 2.

Diagnostics

Establishing a diagnosis of COPD is based on identifying the main clinical signs, taking into account the effect of risk factors and excluding lung diseases with similar symptoms. Most patients are heavy smokers with a history of frequent respiratory diseases, mainly in the cold season.

A physical examination for COPD is not enough to establish a diagnosis of the disease; it only provides guidelines for further direction of diagnostic research using instrumental and laboratory methods. Conventionally, all diagnostic methods can be divided into mandatory minimum methods, used in all patients (general blood count, urine, sputum, chest x-ray, pulmonary function test (PVR), ECG), and additional methods, used for special indications.

For everyday clinical work with patients with COB, in addition to general clinical tests, it is recommended FVD study(FEV 1, forced vital capacity or vital capacity), bronchodilator test(b 2 -agonists and anticholinergics), chest x-ray. Other research methods are recommended to be used for special indications, depending on the severity of the disease and the nature of its progression.

Of great importance in the diagnosis of COB and objective assessment of the severity of the disease is FVD study. Due to its good reproducibility and ease of measurement, FEV 1 is now a generally accepted indicator for assessing the degree of obstruction in COB. Based on this indicator, the severity of COB is determined. Mild severity - FEV 1 >70% of proper values, moderate - 50-69%; severe degree - less than 50%. This gradation is recommended by the European Respiratory Society and accepted as working in Russia.

In everyday practice in patients with COB they use tests with bronchodilators (β-agonists and/or anticholinergics), which to a certain extent characterize the ability for rapid regression of bronchial obstruction, in other words, the “reversible” component of obstruction. An increase in FEV 1 during the test by more than 15% from the initial values is conventionally characterized as reversible obstruction.

So, Diagnosis of COB is carried out in the presence of:

Clinical signs, the main ones being cough and expiratory shortness of breath;

Risk factors;

Impaired bronchial obstruction (decreased FEV 1) during the study of respiratory function. An important component of diagnosis is the progression of the disease. A prerequisite for diagnosis is the exclusion of other diseases that can lead to similar symptoms.

When an irreversible component of bronchial obstruction appears in patients with asthma, differential diagnosis between these diseases loses its meaning, since it can be stated that a second disease has joined - COPD and the final phase of the disease - COPD is approaching.

Treatment

The goals of treatment are: reducing the rate of progression of diffuse bronchial damage, leading to an increase in bronchial obstruction and respiratory failure, reducing the frequency and duration of exacerbations, increasing exercise tolerance and improving quality of life.

These strategic directions are the main guideline for individual work with the patient. When determining a treatment strategy for a particular patient, the treatment goal must be realistic and sufficient. Early and consistent therapy is necessary at all stages of COPD development. The implementation of strategic goals is usually carried out through a series of individualized organizational and therapeutic measures (treatment tactics):

1. Stop smoking and limit the effect of external risk factors.

2. Patient education.

3. Bronchodilator therapy.

4. Mucoregulatory therapy.

5. Anti-infective therapy.

6. Correction of respiratory failure.

7. Rehabilitation therapy.

When developing strategies and tactics for treating patients with COPD, it is fundamentally important to distinguish 2 treatment regimens: treatment outside of exacerbation (maintenance therapy) And treatment of exacerbation of COPD (Tables 3 and 4).

The vast majority of patients should be treated on an outpatient basis, according to an individual program developed by the attending physician.

Hospitalization of such patients is indicated only for exacerbation of COPD, which is not controlled in an outpatient setting, with increasing hypoxemia, the occurrence or increase of hypercapnia, decompensation of the pulmonary heart.

The hospital stay should be short-term, aimed at stopping the exacerbation and establishing a new outpatient treatment regimen.

Literature

1. Chronic obstructive pulmonary diseases. Federal program, M., 1999.

2. Chronic obstructive pulmonary disease /Ed. A.G. Chuchalina M., 1998.

3. Standards for the Diagnosis and Care of patients with chronic obstructive pulmonary disease. Resp. Crit. Care Med. 1995; 152 (5): 78-121.

4. Optimal assessment and management of chronic obstructive pulmonary disease. Siafakas N.M. et al., Eur. Resp. J. 1995; 8: 1398-420.

5. Fletcher C., Peto R. The natural history of chronic airflow obstruction. Br. Med. J. 1977; 1: 1645-8.

6. Vermiere P. Definition of COPD. in book: COPD: Diagnosis and treatment. ed by van Herwaarden C.L.A., et al., Exepta Med., 1996.

7. BTS Guidelines for the management of chronic obstructive pulmonary disease. Thorax 1997; 52 (Suppl. 5).

8. Saetta M. Central airways inflammation in the development of COPD. Eur. Resp. Rev. 1997; 7 (43): 109-10.

Rice. 1. Scheme of the pathogenesis of COB

Editor

Pulmonologist

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

Causes and provoking factors

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

In adults, risk factors for developing the disease are:

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

In childhood, provoking factors are as follows:

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

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

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

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

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

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

Diagnostics

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

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

With obstructive inflammation in the blood increases:

leukocyte count;
blood viscosity increases;
hemoglobin levels increase.

Symptoms of pneumonia

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

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

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

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

When ailments worsen, the following is observed:

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

In COPD, pneumonia can occur in two ways:

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

Treatment

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

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

Symptomatic treatment:

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

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

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

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Conclusion

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

Pulmonary obstruction is a progressive disease of the bronchopulmonary system, in which the air in the respiratory tract flows incorrectly. This is due to abnormal inflammation of the lung tissue in response to external stimuli.

This is a non-infectious disease, it is not associated with the activity of pneumococci. The disease is common; according to WHO, 600 million people worldwide suffer from pulmonary obstruction. Mortality statistics indicate that 3 million people die from the disease every year. With the development of megacities, this figure is constantly growing. Scientists believe that in 15-20 years the mortality rate will double.

The problem of the prevalence and incurability of the disease lies in the lack of early diagnosis. A person does not attach importance to the first signs of obstruction - cough in the morning and shortness of breath, which appears faster than in peers when performing the same physical activity. Therefore, patients seek medical help at a stage when it is impossible to stop the pathological destructive process.

Risk factors and mechanism of disease development

Who is at risk for pulmonary obstruction and what are the risk factors for the disease? Smoking comes first. Nicotine several times increases the likelihood of pulmonary obstruction.

Occupational risk factors play a major role in the development of the disease. Professions in which a person is constantly in contact with industrial dust (ore, cement, chemicals):

miners;
builders;
pulp processing industry workers;
railway workers;
metallurgists;
grain and cotton processing workers.

Atmospheric particles that can serve as a trigger for the development of the disease are exhaust gases, industrial emissions, and industrial waste.

Hereditary predisposition also plays a role in the occurrence of pulmonary obstruction. Internal risk factors include hypersensitivity of respiratory tract tissues and lung growth.

The lungs produce special enzymes - protease and antiprotease. They regulate the physiological balance of metabolic processes and maintain the tone of the respiratory organs. When there is systematic and prolonged exposure to air pollutants (harmful air particles), this balance is disrupted.

As a result, the skeletal function of the lungs is impaired. This means that the alveoli (cells of the lung) collapse and lose their anatomical structure. Numerous bullae (vesicle-like formations) form in the lungs. Thus, the number of alveoli gradually decreases and the rate of gas exchange in the organ decreases. People begin to feel severe shortness of breath.

The inflammatory process in the lungs is a reaction to pathogenic aerosol particles and progressive airflow limitation.

Stages of development of pulmonary obstruction:

tissue inflammation;
pathology of small bronchi;
destruction of parenchyma (lung tissue);
limitation of air flow speed.

Symptoms of pulmonary obstruction

Obstructive airway diseases are characterized by three main symptoms: shortness of breath, cough, and sputum production.

The first symptoms of the disease are associated with breathing problems. The person is short of air. It is difficult for him to climb several floors. Going to the store takes longer, a person constantly stops to catch his breath. It becomes difficult to leave the house.

System of development of progressive dyspnea:

initial signs of shortness of breath;
difficulty breathing during moderate physical activity;
gradual limitation of loads;
significant reduction in physical activity;
shortness of breath when walking slowly;
refusal of physical activity;
constant shortness of breath.

Patients with pulmonary obstruction develop a chronic cough. It is associated with partial obstruction of the bronchi. The cough can be constant, daily, or intermittent, with ups and downs. Typically, the symptom is worse in the morning and may occur throughout the day. At night, coughing does not bother a person.

Shortness of breath is progressive and persistent (daily) in nature and only gets worse over time. It also increases with physical activity and respiratory diseases.

With pulmonary obstruction, patients experience sputum discharge. Depending on the stage and advanced stage of the disease, the mucus can be scanty, transparent or abundant, purulent.

The disease leads to chronic respiratory failure - the inability of the pulmonary system to provide high-quality gas exchange. Saturation (oxygen saturation of arterial blood) does not exceed 88%, while the norm is 95-100%. This is a life-threatening condition. In the last stages of the disease, a person may experience apnea at night - suffocation, stopping pulmonary ventilation for more than 10 seconds, on average it lasts half a minute. In extremely severe cases, respiratory arrest lasts 2-3 minutes.

During the daytime, a person feels very tired, drowsiness, and instability of the heart.

Pulmonary obstruction leads to early loss of ability to work and a reduction in life expectancy; a person acquires disability status.

Obstructive changes in the lungs in children

Obstruction of the lungs in children develops as a result of respiratory diseases, malformations of the pulmonary system, chronic pathologies of the respiratory system. The hereditary factor is of no small importance. The risk of developing pathology increases in a family where parents constantly smoke.

Obstruction in children is fundamentally different from obstruction in adults. Blockage and destruction of the respiratory tract are a consequence of one of the nosological forms (a specific independent disease):

Chronic bronchitis. The child has a wet cough, wheezing of various sizes, and exacerbations up to 3 times a year. The disease is a consequence of an inflammatory process in the lungs. Initial obstruction occurs due to excess mucus and phlegm.
Bronchial asthma. Despite the fact that bronchial asthma and chronic pulmonary obstruction are different diseases, in children they are interrelated. Asthmatics are at risk of developing obstruction.
Bronchopulmonary dysplasia. This is a chronic pathology in children during the first two years of life. The risk group includes premature and low birth weight babies who have had acute respiratory viral infection immediately after birth. In such infants, the bronchioles and alveoli are affected, and the functionality of the lungs is impaired. Respiratory failure and oxygen dependence gradually appear. Gross tissue changes occur (fibrosis, cysts), and the bronchi become deformed.
Interstitial lung diseases. This is a chronic hypersensitivity of lung tissue to allergenic agents. Develops from inhalation of organic dust. It is expressed by diffuse damage to the parenchyma and alveoli. Symptoms: cough, wheezing, shortness of breath, poor ventilation.
Obliterating bronchiolitis. This is a disease of the small bronchi, which is characterized by narrowing or complete blockage of the bronchioles. Such obstruction in a child mainly manifests itself in the first year of life.. The cause is ARVI, adenoviral infection. Signs: non-productive, severe, recurrent cough, shortness of breath, weak breathing.

Diagnosis of pulmonary obstruction

When a person consults a doctor, an anamnesis (subjective data) is collected. Differential symptoms and markers of pulmonary obstruction:

chronic weakness, decreased quality of life;
unstable breathing during sleep, loud snoring;
weight gain;
increase in the circumference of the collar zone (neck);
blood pressure is higher than normal;
pulmonary hypertension (increased pulmonary vascular resistance).

The mandatory examination includes a general blood test to exclude a tumor, purulent bronchitis, pneumonia, and anemia.

A general urine test helps to exclude purulent bronchitis, which reveals amyloidosis, a disorder of protein metabolism.

A general sputum analysis is rarely done, as it is not informative.

Patients undergo peak flowmetry, a functional diagnostic method that evaluates expiratory flow. This is how the degree of airway obstruction is determined.

All patients undergo spirometry - a functional study of external respiration. Assess the speed and volume of breathing. Diagnosis is carried out using a special device - a spirometer.

During the examination, it is important to exclude bronchial asthma, tuberculosis, bronchiolitis obliterans, and bronchiectasis.

Treatment of the disease

The goals of treating pulmonary obstruction are multifaceted and include the following steps:

improvement of respiratory function of the lungs;
constant monitoring of symptoms;
increasing resistance to physical activity;
prevention and treatment of exacerbations and complications;
stopping the progression of the disease;
minimizing side effects of therapy;
improving quality of life;

The only way to stop the rapid destruction of your lungs is to completely stop smoking.

In medical practice, special programs have been developed to combat nicotine addiction in smokers. If a person smokes more than 10 cigarettes a day, then he is prescribed a course of drug therapy - short - up to 3 months, long - up to a year.

Nicotine replacement treatment is contraindicated in the following internal pathologies:

severe arrhythmia, angina pectoris, myocardial infarction;
circulatory disorders in the brain, stroke;
ulcers and erosions of the gastrointestinal tract.

Patients are prescribed bronchodilator therapy. Basic treatment includes bronchodilators to open up the airways. The drugs are prescribed both intravenously and inhalation. When inhaled, the medicine instantly penetrates the affected lung, has a rapid effect, and reduces the risk of developing negative consequences and side effects.

During inhalation you need to breathe calmly, the duration of the procedure is on average 20 minutes. When taking deep breaths, there is a risk of developing severe coughing and choking.

Effective bronchodilators:

methylxanthines – Theophylline, Caffeine;
anticholinergics - Atrovent, Berodual, Spiriva;
b2-agonists – Fenoterol, Salbutamol, Formoterol.

In order to increase survival, patients with respiratory failure are prescribed oxygen therapy (at least 15 hours per day).

To thin the mucus, enhance its removal from the walls of the respiratory tract and dilate the bronchi, a complex of drugs is prescribed:

Guaifenesin;
Bromhexine;
Salbutamol.

To consolidate treatment, obstructive pneumonia requires rehabilitation measures. The patient must do physical training every day to increase strength and endurance. Recommended sports are walking from 10 to 45 minutes daily, exercise bike, lifting dumbbells. Nutrition plays an important role. It should be rational, high-calorie, and contain a lot of protein. An integral part of the rehabilitation of patients is psychotherapy.