Chronic obstructive pulmonary disease, or COPD, is one of the most common health problems in humans today. This is due to the deplorable state of our environment.

The quality of the air that a person inhales has noticeably deteriorated, which cannot but affect the health of the organs responsible for the process of air exchange.

What is COPD?

COPD - is a general term for many respiratory diseases, such as, and. May also include other respiratory diseases.

The most common causative factor is smoking.

Inflammatory processes in the lungs provoked by exposure to exhaust gases, various atmospheric impurities, cigarette smoke (passive smoking is not excluded) are fundamental processes for the development of COPD.

According to the statistics of the World Health Organization (WHO) - Chronic obstructive pulmonary disease in adults occupies the fourth position in the mortality of the population.

People suffering from this disease die from developing complications such as:

• respiratory failure;
• cardiovascular disorders (which COPD provokes).

This disease, with proper diagnosis in the early stages of development, is fully treated, using a number of actions to prevent this disease, it is possible to prevent its development.

According to µb 10 are coded asJ44.0 - if COPD develops in conjunction with affecting the lower respiratory tract. Code for the International Classification of Diseases 10 helps to systematize and track statistics for each disease.

COPD microbial 10 with code J44.9 is reflected in case of undetermined genesis.

Signs of COPD

Symptoms and signs may include:

• fatigue;
• shortness of breath
• paroxysmal nocturnal dyspnea (PND);
• wheezing when breathing;
• cough with sputum (mucous and / or purulent);
• fever
• chest pain.

Risk factors

• For the most part, the most harmful and frequently encountered factor is smoking. Tobacco smoke and cigarette tar adversely affect all respiratory organs. Passive smoking is absolutely no less harmful, but on the contrary, even more dangerous. A person who is close to a smoker consumes a much higher amount of smoke than himself. The category of people who smoke endangers not only themselves, but also the people around them. Among the group of heavy smokers, approximately 15-20% are diagnosed clinical manifestations COPD
• genetic predisposition. An example of disorders leading to this disease is a condition such as:
  • alpha-antitrypsin deficiency (in people who have never smoked and increases the risk for the disease in smokers);
• bacteria. The exacerbation of the disease in question can be influenced by bacteria of such groups as Haemophilus influenza, Moraxella catarrhalis. Another type of bacteria that affects the development of the disease are streptococcus pneumoniae;
• Occupational hazard (dust, fumes of various acids and alkalis, harmful masses released from chemicals);
• Bronchial hyperreactivity.

Pathogenesis

With prolonged exposure to any risk factor on the human body, inflammation of the walls of the bronchi of a chronic nature develops. The most likely damage to the distal (located in maximum proximity to the alveoli and lung parenchyma).

The production and excretion of mucus is impaired. Small bronchi get clogged and various infections develop against this background. Muscle cells die and are replaced by connective tissue. As a result, emphysema develops - the lung tissue overflows with air because of this, their elasticity decreases markedly.

From bronchi damaged by emphysema, air is released with great difficulty. The volume of air is reduced as gas exchange is not in proper quality. As a result, one of the main symptoms manifests itself - shortness of breath. With exertion or just walking, shortness of breath creates an increasing effect.

As a result of respiratory failure, hypoxia develops. With prolonged exposure to hypoxia on the human body, the lumens of the pulmonary vessels decrease, which leads to (in the course of this disease, an increase and expansion of the right sections of the heart develops).

Classification

This disease is classified according to the severity of the course and the clinical picture.

• Latent, almost impossible to recognize, has no pronounced symptoms.
• Medium, manifested cough in the morning (with phlegm or dry). Shortness of breath more often with minor physical exertion.
• Severe course, occurs in a chronic course and is accompanied by bouts of severe coughing with sputum production, frequent shortness of breath.
• The fourth stage can be fatal, characterized by persistent cough, shortness of breath even at rest, a rapid decrease in body weight.

Aggravation

Let's take a look at what a COPD exacerbation is.

This is a condition in which the course of the disease is aggravated. The clinical picture worsens, shortness of breath increases, coughing attacks become more frequent and intensify. There is a general depression of the body. The treatment that was used earlier does not bring a positive effect. In most cases, the patient needs hospitalization, revision and adjustment of the previously prescribed treatment.

A state of exacerbation can develop against the background of a previous disease (ARI, bacterial infections). A common upper respiratory tract infection for a person with COPD is a condition in which the functionality of the lungs is greatly reduced. The normalization period is delayed for a longer time.

A condition such as an exacerbation of COPD is diagnosed based on symptomatic manifestations, patient complaints, hardware and laboratory studies).

How COPD affects the body

Any disease of a chronic nature has a negative impact on the body in general. So COPD leads to disorders that seem to have nothing to do with physiological structure lungs.

• Violation of the functions of the intercostal muscles (participate in the act of breathing), muscle atrophy may occur;
• Decreased glomerular filtration of the kidneys;
• The risk rises;
• Decreased memory;
• Tendency to depression;
• Decreased protective functions of the body.

Diagnostics

• Blood test. This analysis is mandatory for diagnosing COPD. In the acute stage, an increased, neutrophilic leukocytosis can be traced. In patients with developing hypoxia, there is an increase in the number of erythrocytes, low rate ESR and increased hemoglobin.
• Sputum analysis, what it is - this is the most important procedure for patients who produce sputum. The results of such an analysis can provide answers to many questions. The nature of inflammation, the degree of its severity. You can also trace the presence of atypical cells, in such diseases it is necessary to make sure that there is no oncological disease.

Sputum in patients with COPD is mucous, and in the acute stage it can be purulent. The viscosity of sputum increases, as does its quantity, the color becomes greenish with streaks of yellow.

Sputum analysis is still necessary for such patients, because thanks to it it becomes possible to find out the causative agents of the infection and their resistance to a particular antibacterial drug.

• An X-ray diagnostic method is required for the correct diagnosis and exclusion of other lung diseases (many diseases respiratory system may have a similar clinical picture). An x-ray is taken in two positions, frontal and lateral.

During periods of exacerbations, it allows you to exclude or.

• An ECG is used to exclude or confirm such a diagnosis of cor pulmonale (hypertrophy of the muscles of the right heart).

A step test, at the initial stage of the disease, is usually not pronounced and for diagnosis it is necessary to check whether it is present with a slight physical exertion.

Symptoms to look out for

Consider a number of symptoms that you should pay attention to and, if necessary, consult a doctor for a correct diagnosis.

• Often recurrent acute;
• Attacks of excruciating cough, their number gradually increases;
• Cough with constant expectoration;
• Increase in body temperature;
• Attacks of shortness of breath, which increases with the course of the disease.

Is it possible to be active with a disease such as COPD

The disease in question certainly reduces the quality of life, but it must be remembered that it is important not to forget - an active lifestyle will help in the treatment of the disease and improve the psycho-emotional state.

You need to start physical activity very carefully and gradually!

With particular caution, a group of people who, before the illness, did not lead a very active lifestyle, should start training.

Start with classes lasting no more than ten minutes, it is worth increasing the load slowly with several workouts per week.

Do your daily household chores, this way of physical impact on the body will be gentle options for patients with this disease. Walk up the stairs, take a walk in the fresh air, do household chores (wash the floor, windows, dishes), take on part of the duties of the yard (sweep, plant and care for plants).

Before performing the planned actions, do not forget about the warm-up.

Warming up promotes safe exercise, it slowly and gradually prepares the body for a more serious load. An important point will be considered that the warm-up will help increase the frequency of respiratory movements, moderate heart contractions, and normalize body temperature.

Treatment

There are several basic principles for the treatment this disease.

• Complete rejection of addiction - smoking;
• Medical method of treatment, with the help of medicines different target groups;
• Vaccination against infections caused by pneumococcus and;
• Moderate physical activity has a significant effect;
• Oxygen inhalation is used in severe respiratory failure as a way to prolong life.

Groups of drugs used in the treatment

• Bronchodilators (atrovent, salbutamol, aminofillin);
• Hormonal preparations from the group of corticosteroids (symbicort, seretide);
• Drugs that promote sputum discharge (ambrobene, codelac);
• Immunomodulating agents (immunal, Derinat);
• Phosphodiesterase 4 inhibitors (Daxas, Dalisp).

COPD treatment with folk remedies

Treatment of some symptoms of this disease can be carried out using traditional medicine recipes.

It is important to remember the need to consult with a specialist! Treatment with alternative medicine is an addition to the treatment that the doctor must prescribe.

Steam inhalation

This procedure is carried out at home with ease. You will need a container for the solution, a towel and a little time.

• For one liter hot water(90-100 degrees), 5-6 drops essential oil pines, Eucalyptus oil and chamomile.
• Inhalations with the addition of sea salt (a liter of boiling water, 2-3 tablespoons of sea salt).
• Inhalations of the collection of mint, calendula and oregano herbs (2 tablespoons of the collection per liter of boiling water).

Also, when treating chronic pulmonary obstruction, you can do.

Breathing exercises

Breathing exercises, activities aimed at strengthening the muscles of the lungs and intercostal muscles have a very beneficial effect.

Gymnastics option. On inspiration, raise your hands up, and on exhalation, tilt the body and arms to the left, on the next breath, raise your hands up, and tilt the body and arms to the right.

COPD is a well-known diagnosis among people over the age of 45. It affects the lives of 20% of the adult population of our planet. COPD is the 4th leading cause of death among middle-aged and elderly people. One of the most dangerous features of this disease is its subtle onset and gradual but steady development. The first ten years of the disease, as a rule, fall out of sight of both patients and doctors. Obvious symptoms of the development of a serious and dangerous disease for many years are mistaken for the natural consequences of colds, bad habits and age changes. Being in such delusions, a sick person avoids the issue of diagnosing and treating his illness for years. All this leads to almost irreversible progress of the disease. A person gradually loses his ability to work, and then completely the opportunity to live a full life. Disability is coming ... In this article, we will analyze in detail all the most necessary information that will allow us to suspect the disease in time and take effective measures to save health and life.

In this article:

• COPD - what does this diagnosis mean?
• How to distinguish COPD from asthma and other diseases?
• COPD Treatment - Options and Perspectives.
• What main reason steady progress of COPD?
• How to stop the disease?

Diagnosis of COPD - what is it?

COPD stands for Chronic Obstructive Pulmonary Disease. The disease is characterized by chronic inflammation in the lungs with a progressive decrease in airway patency. The provocateur of such inflammation is the regular inhalation of tobacco smoke, as well as household and industrial chemicals from the surrounding air.

Regularly inhaled irritants cause chronic inflammation in the airways and lung tissue. As a result of this inflammation simultaneously two pathological processes develop at once: permanent edema and narrowing of the airways ( Chronical bronchitis) and deformation of lung tissue with loss of its function (pulmonary emphysema). The totality of these processes occurring simultaneously and developing and their consequences - this is chronic obstructive pulmonary disease.

In turn, the leading provocateurs of COPD development are smoking, work in a hazardous industry with persistent inhalation of irritants and serious outdoor air pollution fuel combustion products (life in a metropolis).

How to recognize COPD? Onset and leading symptoms of the disease.

Chronic obstructive pulmonary disease develops gradually, starting with the smallest symptoms. For many years, a sick person considers himself "healthy". The main difference between the disease is its steady, poorly reversible progress. Therefore, often, the patient goes to the doctor already reaching disabling stage diseases. However, there are three main reasons to suspect COPD at almost any stage:

• APPEARANCE of cough / cough with sputum
• APPEARANCE of noticeable shortness of breath after exercise

COUGH

As a rule, the disease begins with the appearance cough. Most often this cough in the morning, with expectoration. The patient develops so-called "frequent colds". Most of all, such a cough worries in the cold season - autumn-winter period. Most often, in the early years of COPD formation, patients do not associate cough with an already developing disease. Cough is perceived as natural satellite smoking does not pose a health risk. While this particular cough may be first alarm during the development of a severe and almost irreversible process.

DYSPNEA

There is marked shortness of breath at first from climbing stairs and walking fast. Patients often accept this condition as a natural result of the loss of their former physical form - detraining. but dyspnea in COPD is steadily progressing. Over time, less and less physical activity causes a lack of air, a desire to catch your breath and stop. Up to the appearance of shortness of breath even at rest.

exacerbation of COPD

The most dangerous periodic complication of the course of the disease. In the vast majority of cases, exacerbation of COPD symptoms occurs against the background of bacterial and viral infections upper respiratory tract. This happens especially often in the autumn-winter period of the year, during a seasonal jump in the viral incidence of the population.

Exacerbation manifests itself a significant deterioration sick, ongoing more than a few days. There is a noticeable increased cough, change in the amount of sputum discharged with cough. Increasing shortness of breath. This significantly reduces the respiratory function of the lungs. Worsening of symptoms during COPD exacerbations is a potentially life-threatening condition. An exacerbation can lead to the development of severe respiratory failure and the need for hospitalization.

How to distinguish COPD from Asthma and other diseases?

There are several basic signs that allow you to distinguish between COPD and bronchial asthma even before the examination. So for COPD:

• CONSISTENCY of symptoms (cough and shortness of breath)
• PRESENCE of a regularly inhaled pathogen (smoking, manufacturing, etc.)
• AGE of the patient over 35 years

Thus, clinically, COPD differs from asthma primarily in the persistence of symptoms over a long period of time. Asthma, on the other hand, is characterized by a bright, undulating course - attacks of lack of air are replaced by periods of remission.

With COPD, you can almost always find a constant provoking inhaled factor: tobacco smoke, participation in hazardous production.

Finally, COPD is a disease of the adult population - middle-aged and elderly people. At the same time, the older the age, the more likely the diagnosis of COPD in the presence of characteristic symptoms.

Of course, there are a number of instrumental and laboratory research to ensure a definite diagnosis of COPD. Among them the most significant are: breath tests, blood and sputum examination, lung x-ray and ECG.

Why is COPD dangerous? What does this disease lead to?

The most dangerous feature of COPD is subtle and gradual development of the disease. Already a sick person, considering himself "practically healthy" for 10-15 years, does not pay the necessary attention to his condition. All the symptoms of the disease are attributed to the weather, fatigue, age. During all this time, COPD continues to progress steadily. Progress until it becomes impossible not to notice the disease.

Loss of ability to work. Patient with COPD gradually loses the ability to endure physical activity. Climbing stairs, fast walking - become a problem. After such loads, a person begins to suffocate - severe shortness of breath appears. But the disease continues to develop. So, gradually going to the store, minor physical activity - all this now causes respiratory arrest, severe shortness of breath. The final of a neglected disease is a complete loss of exercise tolerance, disability and disability. Severe dyspnea even at rest. It does not allow the patient to leave the house and fully serve himself.

Infectious exacerbations of COPD. - almost any infection of the upper respiratory tract (for example, influenza), especially in the cold season, can lead to a severe exacerbation of the symptoms of the disease, up to hospitalization in intensive care with severe respiratory failure and the need for mechanical ventilation.

Irreversible loss of heart function - "cor pulmonale". Chronic stagnation in the pulmonary circulation, excessive pressure in the pulmonary artery, increased load on the chambers of the heart - almost irreversibly change the shape and functionality of the heart.

Cardiovascular diseases acquire the most aggressive and life-threatening course against the background of COPD. The patient significantly increases the risk of developing coronary artery disease, hypertension and myocardial infarction. At the same time, concomitant cardiovascular diseases themselves acquire a severe, progressive and poorly treatable course.

vascular atherosclerosis lower extremities - Most common in COPD. It is a change in the wall of blood vessels with subsequent deposition of cholesterol plaques, impaired patency and the risk of pulmonary embolism (PE).

Osteoporosis - Increased bone fragility. Occurs in response to a chronic inflammatory process in the lungs.

progressive muscle weakness - gradual atrophy skeletal muscles almost always accompanies the progress of COPD.

Based on the above consequences of the progress of COPD, its features, as well as its accompanying conditions, follow the most dangerous for the life of the patient complications most often leading to death:

• Acute respiratory failure- the result of an exacerbation of the disease. Extremely low blood oxygen saturation, a life-threatening condition that requires immediate hospitalization.
• Lung cancer- the result of a lack of alertness in patients regarding their disease. The result of underestimation of the danger of constant exposure to risk factors and the lack of measures taken for timely diagnosis, treatment and lifestyle modification.
• myocardial infarction is a common complication of COPD-related coronary heart disease. Having COPD doubles the risk of a heart attack.

Treatment of COPD: main options and their prospects.

First of all, you need to understand: Neither medicine nor surgery cures the disease. They temporarily suppress her symptoms. Drug therapy for COPD is a lifelong inhalation of drugs that temporarily expand the bronchi. In the case of a diagnosis of the disease at an intermediate and severe stage, glucocorticosteroid hormones are added to the above drugs, designed to intensely restrain chronic inflammation in the airways and temporarily reduce their swelling. All these drugs, and in particular drugs based on glucocorticosteroid hormones, have a number of significant side effects, significantly limiting the possibility of their use in different categories of patients. Namely:

Bronchodilators (beta-agonists)- are the main group of drugs used to control the symptoms of COPD. It is important to know that data medicines can cause:

• cardiac arrhythmias, in connection with which their intake is contraindicated in patients with arrhythmias and is dangerous in old age.
• oxygen starvation of the heart muscle- as a possible side effect of beta-adrenergic agonists is dangerous for patients with coronary artery disease and angina pectoris
• increase in blood sugar- an important indicator that needs to be monitored in diabetes mellitus

Glucocorticosteroid hormones- are the basis for the containment of severe and moderate COPD in conjunction with bronchodilator drugs. It is generally accepted that the most terrible for health are the so-called systemic side effects of glucocorticosteroid hormones, the development of which they try to avoid with the help of inhalations. But what exactly are the side effects of glucocorticosteroids that patients and doctors are so afraid of? Let's break down the most important ones:

• Cause hormonal dependence and withdrawal syndrome.

Suppression of the function of the adrenal cortex. Against the background of the constant intake of glucocorticosteroids, a violation of the natural production of vital adrenal hormones is possible. In this case, the so-called adrenal insufficiency develops. At the same time, the higher the dosages of hormones and the longer the course of treatment taken, the longer the suppression of adrenal function can last. What then happens? There is a violation of all types of metabolism, especially water-salt and sugar metabolism. As a result, disturbances in the work of the heart occur - arrhythmias, jumps and increased blood pressure. And blood sugar changes. That is why this condition is especially dangerous for patients with diabetes and heart disease.

Immune suppression- Glucocorticosteroid hormones depress local immunity. That is why, as a result of regular inhalations, the patient may develop oral candidiasis. For the same reason, bacterial and viral infections of the respiratory tract can easily join COPD, which can cause a severe exacerbation of the disease.

Decreased bone density- occurs due to increased excretion of calcium from the body. Osteoporosis develops. As a result, compression fractures of the vertebrae and bones of the extremities.

• Increase in blood sugar- is of particular danger in concomitant diabetes mellitus.
• Muscle damage- there is weakness of the muscles mainly of the shoulder and pelvic girdle.
• Raise intraocular pressure - most dangerous for elderly patients.
• Violation of fat metabolism- can manifest itself in the form of subcutaneous fat deposits and an increase in blood lipid levels.

dying off bone tissue(osteonecrosis)- can manifest itself as the appearance of multiple small foci, mainly in the femoral head and humerus. The earliest disturbances can be tracked using MRI. Late disturbances are visible on x-rays.

Given the above, it becomes clear:

Crosstalk of side effects from the use of such drugs can itself result in a separate disease.

On the other hand, there are a number of restrictions on admission in the elderly - which just corresponds to the main group of COPD patients in need of treatment.

Finally, the vast majority of COPD sufferers already have comorbid cardiovascular diseases such as hypertension and coronary heart disease. Taking medications for COPD can lead to an aggravation of the course of these diseases: pressure rises, the appearance of arrhythmias. While taking medications for hypertension can exacerbate COPD symptoms: increase shortness of breath and provoke coughing.

In such a situation, it is absolutely necessary for patients to be aware of the possibility of treating COPD in a non-drug way, which will help significantly reduce the drug load on the body and avoid cross-effects of medications.

How to stop COPD without drugs?

The first thing that every COPD patient needs to understand is: Smoking cessation is essential. A treatment option for the disease without eliminating the inhaled irritant is impossible. If the cause of the development of the disease is harmful production, inhalation of chemicals, dust - in order to save health and life, it is necessary to change working conditions.

Back in 1952, the Soviet scientist Konstantin Pavlovich Buteyko developed a method that allows, without the use of drugs, to significantly alleviate the condition of patients with officially recognized "incurable" disease is COPD.

Dr. Buteyko's studies have shown that the depth of the patient's breathing makes a huge contribution to the development of bronchial obstruction processes, the formation of allergic and inflammatory responses.

Excessive depth of breathing is deadly for the body, it destroys the metabolism and the normal course of a number of vital processes.

Buteyko proved that the patient's body automatically protects itself from excessive breathing depth - natural defense reactions occur aimed at preventing leakage from the lungs carbon dioxide with exhalation. So there is swelling of the mucous membrane of the respiratory tract, the smooth muscles of the bronchi are compressed - all this is a natural defense against deep breathing.

It is these protective reactions that play a huge role in the course and development of lung diseases such as asthma, bronchitis and COPD. AND each patient is able to remove these protective reactions! Without the use of any medication.

is a universal way to normalize breathing, created to help patients with the most famous pathology. Help that does not require drugs or surgery. The method is based on the revolutionary Discovery of deep breathing diseases committed by Dr. Buteyko back in 1952. Konstantin Pavlovich Buteyko devoted more than thirty years to the creation and detailed practical development of this method. Over the years, the method has helped save the health and lives of thousands of patients. The result was the official recognition of the Buteyko method by the USSR Ministry of Health on April 30, 1985 and its inclusion in the standard of clinical therapy for bronchopulmonary diseases.

Chief Physician of the Center for Effective Training in the Buteyko Method,
Neurologist, manual therapist
Konstantin Sergeevich Altukhov

Chronic obstructive pulmonary disease (COPD) is an irreversible systemic disease that becomes the end stage for many lung diseases. Severely impairs the quality of life of the patient, can lead to death. At the same time, the treatment of COPD is impossible - all that medicine can do is to alleviate the symptoms and slow down the overall development.

The mechanism of occurrence and changes in the body

Chronic obstructive pulmonary disease develops as a result of an inflammatory process that affects the entire tissue, from the bronchi to the alveoli, and leads to irreversible degeneration:

• epithelial tissue, mobile and flexible, is replaced by connective tissue;
• cilia of the epithelium, which remove sputum from the lungs, die;
• glands that produce mucus, which serves as a lubricant, grow;
• smooth muscles grow in the walls of the respiratory tract.

• due to hypertrophy of the glands in the lungs, there is too much mucus - it clogs the alveoli, prevents air from passing through and is poorly excreted;
• due to the death of the cilia, viscous sputum, which is already in excess, ceases to be excreted;
• due to the fact that the lung loses its elasticity, and the small bronchi are clogged with sputum, the patency of the bronchial tree and the constant lack of oxygen are disturbed;
• due to the proliferation of connective tissue and an abundance of sputum, small bronchi gradually completely lose their patency and emphysema develops - a collapse of part of the lung, leading to a decrease in its volume.

At the last stage of chronic obstructive pulmonary disease, the patient develops the so-called "cor pulmonale" - the right ventricle of the heart increases pathologically, there are more muscles in the walls of large vessels throughout the body, and the number of blood clots increases. All this is an attempt by the body to speed up the flow of blood in order to satisfy the need of organs for oxygen. But it doesn't work, it only makes things worse.

Risk factors

All the causes of COPD development can be easily described in two words - the inflammatory process. Inflammation of the lung tissue leads to irreversible changes, and many diseases can cause it - from pneumonia to chronic bronchitis.

However, in a patient whose lungs are not deformed and were healthy before the disease, the likelihood of developing COPD is low - you need to refuse treatment for a long time so that they begin to degrade. A completely different picture is observed in people with a predisposition, which include:

• Smokers. According to statistics, they make up almost ninety percent of all cases and mortality from COPD among them is higher than among other groups. This is due to the fact that even before any inflammatory process, the smoker's lungs begin to degrade - the poisons contained in the smoke kill the cells of the ciliated epithelium and they are replaced by smooth muscles. As a result, debris, dust and dirt that enter the lungs settle, mix with mucus, but are almost not excreted. In such conditions, the onset of the inflammatory process and the development of complications is only a matter of time.
• People working in hazardous industries or living nearby. The dust of certain substances deposited in the lungs for many years has approximately the same effect as smoking - the ciliated epithelium dies and is replaced by smooth muscles, sputum is not excreted and accumulates.
• Heredity. Far from all people who smoke for many years or work twenty years in hazardous work develop COPD. The combination of certain genes makes the disease more likely.

Interestingly, the development of COPD can take many years - the symptoms do not appear immediately and may not even alert the patient in the early stages.

Symptoms

The symptomatic picture of COPD is not too extensive and actually has only three manifestations:

• Cough. It appears before all other symptoms and often goes unnoticed - or the patient writes it off as the consequences of smoking or working in hazardous industries. It is not accompanied by pain, the duration increases with time. Most often it comes at night, but it also happens that it is not connected with time.
• Sputum. Even the body of a healthy person secretes it, because patients simply do not notice that it has begun to separate more often. Usually plentiful, mucous, transparent. Has no smell. At the stage of exacerbation of the inflammatory process, it can be yellow or greenish, which indicates the reproduction of pathogens.
• Dyspnea. The main symptom of COPD is usually a visit to a pulmonologist with a complaint about it. It develops gradually, for the first time occurs ten years after the cough appears. The stage of the disease depends on the severity of shortness of breath. On the initial stages almost does not interfere with life and appears only under intense stress. Then there are difficulties with fast walking, then with walking in general. With dyspnea of ​​the 3rd degree, the patient stops to rest and catch his breath every hundred meters, and at the 4th stage it is difficult for the patient to perform any action at all - even when changing clothes, he begins to suffocate.

Constant oxygen deficiency and stress due to the inability to lead a full life often lead to the development of mental disorders: the patient withdraws into himself, he develops depression and lack of interest in life, and a high level of anxiety is constantly maintained. In the last stages, degradation of cognitive functions, a decrease in the ability to learn, and a lack of interest in learning are often added. Some people experience insomnia or, conversely, constant drowsiness. There are attacks of nocturnal apnea: breathing stops for ten or more seconds.

The diagnosis of COPD is very unpleasant to make and even more unpleasant to receive, but without treatment, the prognosis of the disease is extremely unfavorable.

Diagnostic measures

Diagnosis of COPD is usually straightforward and includes:

• Collection of anamnesis. The doctor asks the patient about the symptoms, about heredity, about the factors conducive to the disease and calculates the index of the smoker. To do this, the number of cigarettes that are smoked daily is multiplied by the length of smoking and divided by twenty. If you get a number greater than ten, it is likely that COPD has developed as a result of smoking.
• Visual inspection. In COPD, the patient has a purple skin tone, swollen veins in the neck, barrel rib cage, protrusion of the subclavian fossae and intercostal spaces.
• Auscultation in COPD. Whistling rales are heard in the lungs, the exhalation is lengthened.
• General blood and urine tests. Pathoanatomy of COPD has been sufficiently studied and decoding allows you to get a fairly accurate idea of ​​​​the state of the body.
• X-ray. The picture shows signs of emphysema.
• Spirography. Allows you to get an idea of ​​​​the general pattern of breathing.
• Medication test. To determine whether a patient has COPD or bronchial asthma, use drugs that narrow the lumen of the bronchi. The diagnostic criterion is simple - they have a strong effect in asthma, but noticeably less in COPD.

Based on the results, a diagnosis is made, it is determined how severe the symptoms are, and COPD treatment begins.

Treatment

Although there is no cure for COPD, there are tools in medicine that can slow down the course of the disease and improve the overall quality of life of the patient. But first of all, he will have to:

• Quit smoking. Smoking will only aggravate the course of COPD and significantly reduce life expectancy, so the first thing to do after learning the diagnosis is to give up cigarettes altogether. You can use nicotine patches, switch to lollipops, quit by force of will or go to training - but the result should be.
• Quit a hazardous job or change your place of residence. No matter how difficult it is, it must be done, otherwise the patient will live noticeably less than he could.
• Stop drinking. COPD and alcohol are incompatible for two reasons. First, alcohol is not compatible with certain medications and oxygen therapy. Secondly, it provides dehydration, which makes sputum more viscous, and vasoconstriction, which leads to even greater oxygen starvation.
• Lose weight. If it is above the norm, this is an additional burden on the body, which can be fatal in COPD. Therefore, you should start eating right and moderately engage in your physical form - at least walk once a day in the park.

After that, you can start using medications, including:

• Bronchodilators. They form the basis of therapy. They are needed to alleviate the course of COPD by constantly dilating the bronchi. Breathing becomes easier, shortness of breath does not disappear, but it becomes easier. They are used both constantly and during attacks of suffocation - the first are weaker, the second are stronger.
• Mucolytics. Viscous sputum is one of the main problems. Mucolytic drugs allow you to remove it from the lungs, at least partially.
• Antibiotics. They are used if the patient has caught inflammation and it is urgent to destroy the pathogens before complications begin.

In addition to drug therapy, breathing exercises are used in the early stages. It is easy to perform, it has little effect, but the signs of COPD in adults are so serious that even the slightest help cannot be refused. Exists different variants exercises. For instance:

• "Pump". Lean forward a little, lowering your head with your shoulders and drawing in the air - deeply, as if trying to absorb a pleasant smell. Hold for a couple of seconds, straighten up with a smooth exhalation.
• "Cat". Press your hands to your chest, bending your elbows, relax your hands. Exhale as much as possible and sit down, turning at the same time to the right. Hold for a couple of seconds, slowly straighten up with a smooth exhalation. Repeat on the other side.
• "Hands to the side." Clench your hands into fists, rest on your sides. On a powerful exhale, lower your arms and open your palms. Hold for a couple of seconds, on a smooth breath, raise your hands back.
• "Samovar". Stand up straight and take a short breath and a quick exhale. Wait a couple of seconds, repeat.

Respiratory gymnastics offers a huge variety of exercises that can reduce the systemic effects of COPD. But you need to apply it, firstly, only after consulting a doctor, and secondly, only regularly, two to three times every day.

Also, in the early stages, patients who have been diagnosed with COPD need to engage in aerobic physical activity - of course, sparing:

• yoga - allows you to learn how to breathe correctly, corrects posture, trains stretching and allows you to at least partially cope with depression;
• swimming is a pleasant and simple exercise that is shown to everyone, even the elderly;
• walking - not too intense, but regular, like a daily walk in the park.

Exercise therapy, aerobics for patients - you can use any system you like, but also regularly and after consulting with your doctor.

In the later stages, when the clinic of the disease is such that the treatment of moderate COPD will no longer help, oxygen therapy is used:

• at home, the patient acquires an oxygen cylinder and puts a mask on his face for several hours a day and all night - this allows him to breathe normally;
• in a hospital, the patient is connected to a special apparatus that provides breathing - this is done if oxygen therapy is indicated for fifteen or more hours.

In addition to oxygen therapy, surgical intervention is also used:

• removal of part of the lung is indicated if it has fallen asleep and still does not benefit;
• lung implantation in this moment not too common and expensive, but at the same time it has an extremely positive effect, although it requires a long recovery.

Death from COPD remains likely even if the patient adheres to the correct lifestyle and adheres to the treatment regimen, but the chance is much less than with cancer.

The main thing is to monitor your health and not put small harmful pleasures above it.

Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive pulmonary disease (COPD) and chronic obstructive airway disease (COPD), among others, is an obstructive pulmonary disease characterized by chronic shortness of breath. Usually worsens over time. The main symptoms include shortness of breath, cough and sputum production. Most people with chronic bronchitis have COPD. Tobacco smoking is the most common cause of COPD, with other factors such as air pollution and genetics playing a lesser role. In developing countries, one of the common sources of air pollution is poor ventilation in the preparation and heating of food. Long-term exposure to these irritants causes an inflammatory response in the lungs leading to narrowing of the small airways and decomposition of lung tissue known as emphysema. Diagnosis is based on difficulty breathing, which is determined by lung function tests. Unlike asthma, difficulty breathing is not significantly relieved by medication. COPD can be prevented by reducing exposure to causative factors. These include measures to reduce smoking intensity and improve indoor and outdoor air quality. Treatment for COPD includes smoking cessation, vaccinations, rehabilitation, and often inhaled bronchodilators and steroids. Some people may benefit from long-term oxygen therapy or a lung transplant. Patients experiencing periods of acute deterioration may require increased drug use and hospitalization. Globally, COPD affects 329 million people or approximately 5% of the population. It caused 2.9 million deaths in 2013, up from 2.4 million deaths in 1990. The number of deaths is on the rise due to increased smoking and aging populations in many countries. It resulted in an estimated economic cost of $2.1 trillion in 2010.

Signs and symptoms

The most common symptoms of COPD are sputum production, shortness of breath, and a wet cough. These symptoms are observed over a long period of time and usually worsen over time. It is not clear if there are different types of COPD. With respect to the previous division into emphysema and chronic bronchitis, emphysema is just a description of a change in the lungs, not the disease itself, and chronic bronchitis is just a description of the symptoms that COPD may or may not have.

Cough

Chronic cough is the first symptom to appear. When present for more than three months a year for more than two years, with sputum production and no other explanation, it is consistent with chronic bronchitis. This condition can be observed until the full development of COPD. The amount of sputum produced can vary from hours to days. In some cases, the cough may be absent or appear from time to time and not be wet. Some people with COPD attribute their symptoms to "smoker's cough". Sputum may be swallowed or spit out, often depending on social and cultural factors. A violent cough can lead to broken ribs or a brief loss of consciousness. People with COPD often have a long history of viral upper respiratory infections.

Lack of air

Shortness of breath is often a symptom that worries most people. Often described as: "My breathing takes effort," "I feel difficulty breathing," or "I can't get enough air." However, different cultures may use different concepts. Usually, shortness of breath worsens as the disease progresses and over time. In the later stages, it occurs during rest and can occur all the time. It is a source of anxiety and low quality of life in those suffering from COPD. Many people with more advanced COPD breathe through pursed lips, as this action can relieve shortness of breath in some people.

Other salient features

In COPD, exhaling may take longer than inhaling. There may be tightness in the chest, but this is rare and may be caused by another problem. People with difficulty breathing may have wheezing or low-pitched breathing sounds when examining their chest with a stethoscope. Emphysematous chest is a characteristic feature of COPD, but is relatively rare. A tripod position may occur as the disease worsens. Advanced COPD causes high blood pressure in the pulmonary arteries, which presses on the right ventricle of the heart. This situation is referred to as cor pulmonale and causes symptoms of swollen legs and distended jugular veins. COPD is more common than other lung diseases as a cause cor pulmonale. Cor pulmonale becomes less common when supplemental oxygen is used. COPD often occurs along with several other conditions with which it shares risk factors. Status data includes ischemic disease hearts, high blood pressure, diabetes muscle atrophy, osteoporosis, lung cancer, anxiety disorder and depression. People with severe illness always feel tired. Finger knuckle thickening is not specific to COPD and warrants testing for lung cancer.

Aggravation

An acute COPD attack is defined as increased shortness of breath, increased sputum production, sputum color change from clear to green or yellow, or increased coughing in COPD sufferers. It may manifest through signs of increased work of breathing, such as rapid breathing, rapid heart rate, sweating, active use of the neck muscles, bluish skin tone, and confusion or aggressive behavior in the most severe exacerbations. Moist rales may also be heard when examined with a stethoscope.

Causes

The predominant cause of COPD is tobacco smoking, with occupational exposure and pollution from indoor open flames being significant causes in some countries. Typically, this exposure can last several decades before symptoms develop. A person's genetic makeup also influences risk.

Smoking

Tobacco smoking is the number one risk factor for COPD worldwide. Of those who smoke, about 20% develop COPD, and of those who smoke throughout their lives, about half develop COPD. In the US and UK, of all COPD sufferers, 80-95% are either current smokers or have smoked previously. The likelihood of developing COPD increases with overall exposure to tobacco smoke. In addition, women are more susceptible to the harmful effects of smoke than men. In non-smokers, passive smoking accounts for about 20% of cases. Other types of smoking, such as smoking marijuana, cigars, and hookah, also carry risks. Women who smoke during pregnancy may increase their child's risk of developing COPD.

Air pollution

Poorly ventilated roasting (smoking stage), often done with coal or vegetable fuels such as wood or manure, leads to indoor air pollution and is one of the most common causes of COPD in developing countries. Cooking is the method of cooking and heating food for about 3 billion people, with greater health effects seen in women due to longer exposure times. Such a fire is used as the main source of energy in 80% of the homes of India, China and sub-Saharan Africa. People living in large cities show an increased prevalence of COPD compared to people living in rural areas. While urban air pollution is a contributing factor, its overall role as a cause of COPD is not clear. Areas with poor ambient air quality, including exhaust pollution, tend to have an increased incidence of COPD. Overall exposure compared to smoking, however, is presumably less.

Workplace exposure

Intense and prolonged workplace exposure to dust, chemicals, and fumes increases the risk of developing COPD in both smokers and non-smokers. Occupational exposure is estimated to be responsible for 10–20% of cases. In the US, it is believed to be associated with more than 30% of never-smokers and is likely to be at increased risk in countries without appropriate technical regulations. Exposure spans multiple industries and sources including high levels of dust from coal mining, gold mining and the cotton textile industry, exposures include cadmium and isocyanates, and welding fumes. Working in the agricultural industry is also risky. In some professions, the risks are estimated to be equivalent to those of half to two packs of cigarettes a day. Exposure to quartz dust also leads to COPD, although the risk does not extend to silicosis. The negative effects of dust and tobacco smoke are additive, or perhaps more than additive.

Genetics

Genetics also play a role in the development of COPD. The disease is more common among relatives of COPD sufferers who smoke than among unrelated smokers. To date, the only certain hereditary risk factor is alpha 1-antitrypsin (AAT) deficiency. This risk is definitely higher if someone with alpha 1 antitrypsin deficiency is also a smoker. This covers approximately 1-5% of cases, and the condition occurs in about 3-4 out of 10,000 people. Other genetic factors are being investigated, of which there are supposed to be many.

Other

There are several other factors that are less closely associated with COPD. The risk is higher for those who are poor, although it is not clear whether this is due to poverty itself or to other risk factors associated with poverty, such as air pollution or malnutrition. There is conditional evidence that people with asthma and airway hyperresponsiveness are at increased risk of developing COPD. Birth factors such as low birth weight may also play a role, as may some infectious diseases including HIV/AIDS and tuberculosis. Respiratory infections such as pneumonia do not increase the risk of developing COPD, at least in adults.

Seizures

Acute attack (abrupt worsening of symptoms) often triggered by infection or contaminants environment or, in some cases, other factors such as misuse of medications. Infections cause 50 to 75% of cases, with bacteria accounting for 25%, viruses 25%, and both 25%. Environmental pollutants refer to poor air quality in both indoor and outdoor environments. Exposure to smoking and secondhand smoke increases the risk. Cold temperatures may also play a role, as seizures are more common in winter. People with more severe disease show more frequent attacks: mild disease 1.8 per year, moderate disease 2 to 3 per year, and severe disease 3.4 per year. People with more frequent attacks have a higher rate of lung function depletion. Pulmonary embolism (blood clots in the lungs) can worsen symptoms in those who already have COPD.

Pathophysiology

COPD is a type of obstructive lung disease in which there is chronic, incomplete, bilateral failure to breathe (airflow limitation) and an inability to exhale fully (air trapping). Inadequate breathing is the result of decomposition of the lung tissue (known as emphysema) and a minor airway disease known as obstructive bronchiolitis. The relative contribution of these two factors varies from person to person. Severe destruction of the small airways can lead to the formation of large air bubbles—known as bullae—that replace lung tissue. This form of the disease is called bullous emphysema. COPD develops as a severe chronic inflammatory response to inhaled stimuli. A bacterial infection can also be added to this inflammatory condition. The inflammatory cells involved include neutrophil granulocytes and macrophages, two types of white blood cells. Smokers additionally show Tc1 lymphocyte involvement, and some people with COPD have eosinophil involvement similar to those with asthma. Part of this cellular response is triggered by inflammatory mediators such as chemotactic factors. Other processes implicated in lung injury include oxidative stress caused by high concentrations of free radicals in tobacco smoke and released by inflammatory cells, as well as the degradation of lung connective tissue by proteases that are not sufficiently inhibited by protease inhibitors. The breakdown of the connective tissue of the lungs is what is called emphysema, which then leads to shortness of breath and ultimately poor absorption and release of respiratory gases. The general muscle wasting that is often seen in COPD may be due in part to inflammatory mediators released from the lungs into the blood. Narrowing of the airways occurs due to inflammation and scarring. This leads to an inability to exhale fully. The maximum decrease in air flow occurs during exhalation, as pressure in the chest compresses the airways at this time. This causes more air from the previous breath to remain in the lungs when the next breath begins, causing the total volume of air in the lungs to rise each time, a process called overexpansion or air entrapment. Excessive expansion due to exercise is associated with shortness of breath in COPD, as it becomes less comfortable to breathe when the lungs are already partially full. Some also have some degree of airway hyperresponsiveness to stimuli, similar to those with asthma. There may be low oxygen levels and eventually high blood carbon dioxide levels due to insufficient gas exchange due to reduced saturation due to lung obstruction, over-expansion, and a decreased urge to breathe. During attacks, inflammation of the airways increases, causing over-expansion of the lungs, insufficient gas exchange, and ultimately low oxygen levels in the blood. Low oxygen levels, if present for a long time, can cause narrowing of the arteries in the lungs, while emphysema leads to breakdown of the lung capillaries. Both changes cause an increase blood pressure in the pulmonary arteries, which can lead to cor pulmonale.

Diagnostics

Diagnosis of COPD should be made for anyone aged 35 to 40 who demonstrates shortness of breath, chronic cough, sputum production, or frequent colds during the winter, as well as a history of exposure to risk factors for the disease. Spirometry is then used to confirm the diagnosis.

Spirometry

Spirometry measures the number of airway obstructions present and is typically performed after using a bronchodilator, a drug used to open the airways. To make a diagnosis, two main components are evaluated: forced expiratory volume in one second (FEV1), which is the largest volume of air that can be exhaled in the first second, and forced vital capacity (FVC), which is the largest volume of air, which can be exhaled in one large exhalation. Typically, 75-80% of FVC is released in the first second, and an FEV1/FVC ratio of less than 70% in a person with symptoms of COPD means that the person has the disease. Based on these findings, spirometry may lead to overdiagnosis of COPD in the elderly. Criteria National Institute Health and Care Excellence UK additionally requires an FEV1 of at least 80% of expected. Facts regarding the use of spirometry among asymptomatic people in an attempt to diagnose disease at early stage are uncertain and, as a result, it is not currently recommended. Maximum expiratory flow ( maximum speed expiration), which is widely used in asthma, is insufficient for diagnosing COPD.

Severity

There are several methods for determining how much COPD affects a particular individual. The Modified British Medical Research Council (mMRC) or the COPD Assessment Test (CAT) are simple questionnaires that can be used to determine the severity of symptoms. CAT scores are 0–40, with the highest score corresponding to more severe disease. Spirometry can help determine the severity of airflow limitation. It is usually based on FEV1, expressed as a percentage of the expected "normal" value, appropriate for a person's age, sex, height, and weight. US and European guidelines recommend that treatment recommendations be partly based on FEV1. The recommendations of the Global Initiative on Chronic Obstructive Pulmonary Disease divide people into four categories based on the definition of symptoms and airflow limitation. In addition, weight loss and muscle atrophy, as well as the presence of other diseases, should be taken into account.

Other tests

chest x-ray and general analysis blood tests may be useful in ruling out other diseases at the time of diagnosis. Characteristic features present on radiographs as over-expanded lungs, a flat diaphragm, an enlarged retrosternal lumen, and bullae, and may help rule out other lung diseases such as pneumonia, pulmonary edema, or pneumothorax. CT scan High-resolution chest can show the distribution of emphysema in the lungs, and is also useful for ruling out other diseases. Except for planned surgery, however, the disease is rarely manageable. An arterial blood test is used to determine the need for oxygen; it is recommended for those with FEV1 less than 35% predicted, peripheral oxygen saturation less than 92%, and people with symptoms of congestive heart failure. In regions of the world where alpha-1 antitrypsin deficiency is common, people with COPD should be tested (particularly those under the age of 45 and emphysema affecting the lower lung).

Differential Diagnosis

It may be necessary to separate COPD from other causes of shortness of breath, such as congestive heart failure, pulmonary embolism, pneumonia, or pneumothorax. Many people with COPD mistakenly believe they have asthma. The distinction between asthma and COPD is made based on symptoms, smoking history, and whether airflow restriction with bronchodilators is reversible, as measured by spirometry. Tuberculosis can also present as a chronic cough and should be taken into account in areas where it is common. Less common conditions that may resemble COPD include bronchopulmonary dysplasia and bronchiolitis obliterans. Chronic bronchitis may have normal airflow and is not classified as COPD.

Prevention

Most cases of COPD are potentially reversible through reduced exposure to smoke and improved air quality. Annual influenza vaccination in people with COPD reduces the incidence of seizures, hospitalization, and death. The pneumococcal vaccine may also be helpful.

To give up smoking

Keeping people from starting to smoke is a key aspect of COPD prevention. Government, public health, and anti-smoking policies can reduce smoking intensity by preventing people from starting to smoke and encouraging people to stop smoking. Smoking bans in public places and the workplace are important measures to reduce the impact of secondhand smoke, and smoking bans in more places are recommended. For smokers, smoking cessation is the only measure to slow the deterioration of COPD. Even at an advanced stage of the disease, it can reduce the degree of deterioration in lung function and slow the onset of disability and death. Smoking cessation begins with a decision to stop smoking, followed by an attempt to quit. It often takes several attempts before long-term abstinence is achieved. Attempts over 5 years lead to success in approximately 40% of people. Some smokers can achieve long-term smoking cessation with willpower alone. Smoking, however, is highly addictive and many smokers require further support. The chance of quitting smoking is increased through social support, participation in smoking cessation programs and the use of drugs such as replacement therapy nicotine, bupropion or varenicline.

Occupational health

There are several measures to reduce the likelihood that workers in high-risk industries—such as coal mining, construction, and quarry masonry—will develop COPD. Examples of such activities include: developing community interventions, educating workers and management about the risks, promoting smoking cessation, screening workers for early signs of COPD, use of respirators, and dust control. Effective dust control can be achieved through improved ventilation, the use of water sprinklers, and the use of mining technologies that minimize dust generation. If a worker develops COPD, further lung damage can be reduced by avoiding dust exposure, for example by changing job duties.

Air pollution

Indoor and outdoor air quality can be improved, which can prevent the development of COPD and slow down the worsening of an existing disease. This can be achieved through community events, cultural change and caring. Several developed countries have been able to successfully improve outdoor and indoor air quality through regulations. This has led to an improvement in the lung function of the populations of these countries. People with COPD may experience fewer symptoms if they stay indoors on days when air quality is poor. A key measure is to reduce exposure to smoke from raw materials for cooking and reheating by improving home ventilation and using better stoves and chimneys. Using the right stoves can improve indoor air quality by up to 85%. The use of alternative energy sources such as solar cooking and electric heating is efficient, as is the use of fuels such as kerosene and coal rather than vegetable.

Control

There is no cure for COPD, but symptoms can be treated and disease progression slowed down. The main goals of management are to reduce risk factors, maintain sustainable COPD, prevent and treat acute attacks, and manage comorbidities. Mortality-reducing interventions include smoking cessation and supplemental oxygen. Stopping smoking reduces the risk of death by 18%. Other recommendations include influenza vaccination once a year, pneumococcal vaccine once every 5 years, and reducing exposure to ambient air pollution. In people with advanced disease, symptomatic treatment can relieve symptoms, with morphine alleviating the sensation of shortness of breath. Non-invasive ventilation may be used to support breathing.

Pulmonary rehabilitation is a program of exercise, disease management, and psychological counseling used to benefit the individual. For those who have experienced a recent episode of illness, pulmonary rehabilitation improves overall quality of life and exercise capacity, and reduces mortality. It also improves a person's sense of the ability to manage their disease and emotional state. Breathing exercises in the complex and in themselves have a limited role. Being underweight or overweight can affect symptoms, disability, and prognosis for COPD. People with COPD who are underweight can increase respiratory muscle strength by increasing calorie intake. When combined with regular exercise or a pulmonary rehabilitation program, this may result in relief of COPD symptoms. Supplementation with nutrients can be helpful for those who are malnourished.

Bronchodilators

Inhaled bronchodilators are predominantly used drugs that have little overall benefit. There are two main types, β2 agonists and anticholinergics; both types are long-acting and short-acting. They alleviate shortness of breath, wheezing and limitation of physical activity, thereby causing an improvement in the quality of life. It is not clear whether they are able to change the course of the disease. For people with mild disease, short-acting agents are recommended as needed. For people with more severe symptoms, long-acting agents are recommended. If long-acting bronchodilators are ineffective, inhaled corticosteroids are usually used. As far as long acting agents are concerned, it is not clear which is more effective, tiotropium (a long acting anticholinergic agent) or long acting beta agonists (LABAs), it is advisable to try each and continue with whichever works best. Both types of agents reduce the risk of acute attacks by 15–25%. While both can be used at the same time, the benefit is of dubious value. There are several short-acting β2 agonists available, including salbutamol (ventaline) and terbutaline. They provide some degree of symptomatic relief for four to six hours. Long-acting β2 agonists such as salmeterol and formoterol are often used as maintenance therapy. Some feel that the useful action is limited, while others consider the useful action obvious. Long-term use in COPD is safe, with side effects including shakiness and palpitations. When used with inhaled steroids, they increase the risk of pneumonia. While steroids and long-acting β2 agonists may work better together, it is not clear whether these modest benefits outweigh the increased risks. There are two main anticholinergics used in COPD, ipratropium and tiotropium. Ipratropium is a short acting agent while tiotropium is long acting. Tiotropium has been associated with reduced exacerbations and improved quality of life, and tiotropium provides this benefit more than ipratropium. It has no effect on mortality or overall hospitalization rate. Anticholinergics can cause dry mouth and symptoms associated with urinary tract. They are also associated with an increased risk cardiovascular disease and stroke. Aclidinium, another long-acting agent that entered the market in 2012, has been used as an alternative to tiotropium.

Corticosteroids

Corticosteroids are usually taken in inhaled form, but can also be taken as tablets to treat and prevent acute attacks. While inhaled corticosteroids (ICS) do not show useful action on people with mild COPD, they relieve acute attacks in people with moderate or severe disease. When used in combination with long-acting β2 agonists, they reduce mortality more than inhaled corticosteroids or long-acting β2 agonists alone. By themselves, they have no effect on total annual mortality and are associated with an increased incidence of pneumonia. It is not clear whether they affect the progression of the disease. Long-term treatment with steroid tablets is associated with significant side effects.

Other medicines

Long-acting antibiotics, especially those belonging to the macrolide class, such as erythromycin, reduce the frequency of exacerbations in patients who experience two or more attacks per year. This practice may be cost-effective in some regions of the world. There are concerns about antibiotic resistance and hearing problems associated with azithromycin. Methylxanthines such as theophylline are generally more harmful than helpful and thus not recommended, but may be used as a second line agent in those who are not controlled by other measures. Mucolytics may be useful for those people who have very thin mucous membranes, but are generally not required. Cough suppressants are not recommended.

Oxygen

Supplemental oxygen is recommended for people with low resting oxygen levels (oxygen partial pressure less than 50–55 mmHg or oxygen saturation less than 88%). In this group of people, it reduces the risk of heart failure and death if taken 15 hours a day, and may increase a person's ability to exercise. In people with normally or moderately low oxygen levels, supplemental oxygen can relieve the shortness of breath. There is a risk of fires and little benefit if oxygen patients continue to smoke. In this case, some recommend to abandon the use of oxygen supply. During acute attacks, many require oxygen therapy; the use of high concentrations of oxygen without taking into account human oxygen saturation can lead to an increase in carbon dioxide levels and poor results. For people at high risk for high carbon dioxide levels, an oxygen saturation of 88–92% is recommended, while for people outside this risk group, the recommended level is 94–98%.

Surgical intervention

For people with severe enough disease, surgery may be helpful in some cases, which may include a lung transplant or lung volume reduction surgery. Lung reduction surgery involves removing the parts of the lungs most affected by emphysema, allowing the remaining relatively healthy lung to expand and function better. Sometimes at very serious illness a lung transplant is performed, particularly in young individuals.

Seizures

Acute attacks are usually treated with increased use of short-acting bronchodilators. It usually includes a combination of a short-acting inhaled beta-agonist and an anticholinergic agent. These drugs must be taken either via a metered dose inhaler with a spacer or an individual aerodynamic inhaler, both of which are equally effective. Spraying may be more convenient for those who are more unwell. Oral corticosteroids increase the chance of recovery and reduce the overall duration of symptoms. They act equivalent to intravenous steroids, but have less side effects. It has the effect of taking steroids for five days, as well as taking for ten and fourteen days. In people with a severe exacerbation, antibiotics improve outcomes. Several different antibiotics may be used, including amoxicillin, doxycycline, and azithromycin; it is not clear whether any of them works better than the others. There is no definitive evidence for people with less severe symptoms. In people with type 2 respiratory failure (acutely elevated level CO2) non-invasive supply and exhaust ventilation reduces the likelihood of death or the need for intensive care. In addition, theophylline may be helpful for those who do not respond to other measures. Less than 20% of seizures require hospitalization. In people without acidosis due to respiratory failure home care("hospital at home") helps to avoid hospitalization.

Forecast

COPD tends to get progressively worse over time and may eventually lead to death. It is estimated that 3% of all disability cases are due to COPD. The proportion of disability due to COPD worldwide declined from 1990 to 2010 due to improved indoor air quality, mainly in Asia. Total number years of resignation to disability due to COPD, however, increased. The rate at which COPD worsens varies due to the presence of factors that predispose to poor outcomes, including severe respiratory failure, poor exercise capacity, shortness of breath, severely underweight or overweight, congestive heart failure, long-term smoking, and frequent flare-ups . Long-term outcomes in COPD can be calculated using the BODE index, which is assigned a score of one to ten based on FEV1, body mass index, distance walked in six minutes, and the Medical Research Council's Modified Dyspnea Scale. Significant weight loss is a bad sign. Spirometry results are also good predictors of future disease progression, but not as good as the BODE index.

Epidemiology

Globally, as of 2010, approximately 329 million people (4.8% of the population) suffered from COPD. Both women and men are almost equally susceptible to the disease, as there has been an increase in tobacco smoking among women in developed countries. Growth in developing countries from the 1970s to the 2000s is thought to be due to increased smoking in the region, population growth and an aging population due to fewer deaths from other causes such as infectious diseases. Some countries show increased prevalence, some remain stable, and some show a decline in COPD. Global numbers are expected to continue rising as risk factors remain prevalent and populations continue to age. From 1990 to 2010, COPD deaths dropped slightly from 3.1 million to 2.9 million, and the disease became the fourth leading cause of death. It became the third leading cause of death in 2012 as the number of deaths rose again to 3.1 million. In some countries, mortality has decreased among men but increased among women. This is most likely due to the fact that the intensity of smoking among women and men is becoming the same. COPD is most common among the elderly; it affects 34-200 out of 1,000 people over 65, depending on the population considered. In the UK, it is estimated that 0.84 million people (out of 50 million) are diagnosed with COPD; this translates to about one in 59 people receiving a diagnosis of COPD at some point in their lives. In the most socioeconomically disadvantaged parts of the country, one in 32 people are diagnosed with COPD compared to one in 98 in wealthier areas. In the United States, approximately 6.3% of the adult population, totaling approximately 15 million people, is diagnosed with COPD. COPD could affect 25 million people if undiagnosed causes are considered. In 2011, approximately 730,000 US hospital admissions were due to COPD.

Story

The word "emphysema" is derived from the Greek ἐμφυσᾶν emphysanus meaning "inflate" (to inflate), made up of ἐν en meaning "in" and φυσᾶν physanus meaning "breath, flow of air". The term chronic bronchitis came into use in 1808, while the term COPD is believed to have first been used in 1965. It was previously known by several different terms, including chronic obstructive bronchopulmonary disease, chronic obstructive respiratory disease, and chronic difficulty breathing. , chronic airflow limitation, chronic obstructive pulmonary disease, non-specific chronic lung disease, and diffuse obstructive pulmonary syndrome. The terms chronic bronchitis and emphysema were formally used in 1959 at a CIBA guest symposium and in 1962 and at a committee meeting of the American Thoracic Society regarding diagnostic standards. Early descriptions of supposed emphysema include: T. Bonet of a condition of "voluminous lungs" in 1679 and Giovanni Morgagni of lungs that were "swollen, in part due to air" in 1769. The first description of emphysema was made in 1721. Ruish. This was followed by drawings by Matthew Bailey in 1789 and a description of the destructive nature of the disease. In 1814 Charles Badham used "catarrh" to describe the cough and excess mucus in chronic bronchitis. René Laennec, the physician who invented the stethoscope, used the term "emphysema" in his Monograph on Diseases of the Chest and Indirect Auscultation (1837) to describe lungs that did not collapse when he opened the chest during an autopsy. He noted that they did not fall down as usual, as they were full of air, and the airways were filled with mucus. In 1842, John Hutchinson invented the spirometer, which made it possible to measure the vital capacity of the lungs. However, his spirometer was only capable of measuring volume, not airflow. Tiffno and Pinelli in 1947 described the principles of measuring airflow. In 1953, Dr. George L. Waldbott, an American allergist, first described a new disease, which he called "smoker's respiratory syndrome", in the 1953 Journal of the American Medical Association. This was the first mention of an association between tobacco smoking and chronic respiratory disease. Previous treatments have included garlic, cinnamon, and ipecac, among others. Modern methods of treatment were developed in the second half of the 20th century. Evidence supporting the use of steroids in COPD was published in the late 1950s. Bronchodilators came into use in the 1960s as a result of promising research on isoprenaline. Late bronchodilators such as salbutamol were developed in the 1970s, and the use of long-acting β2 agonists began in the mid-1990s.

Society and culture

COPD has been referred to as "smoker's lungs". People with emphysema were known as "pink puffers" or "type A" due to frequent pink complexion, rapid breathing, and pursed lips, while people with chronic bronchitis were referred to as "blue puffers" or "type B" due to frequent bluish discoloration of the skin and lips as a result of low oxygen levels and swelling of the lower legs. This terminology is no longer considered useful because most people with COPD have a combination of both types. Many systems face challenges in providing adequate definition, diagnosis and care for people with COPD; The UK Department of Health has identified this as a major problem for the NHS and has developed a specific strategy to address these issues.

Economy

Globally, as of 2010, COPD is estimated to have resulted in an economic cost of $2.1 trillion, half of which is in developing countries. Of the total costs, $1.9 trillion are direct costs, such as medical care, while $0.2 trillion are indirect costs, such as lost jobs. Costs are expected to more than double by 2030. In Europe, COPD accounts for 3% of healthcare costs. In the US, the cost of the disease is estimated to be $50 billion, most of which is related to exacerbations. COPD is among the most costly diseases seen in US hospitals in 2011, with a total cost of approximately US$5.7 billion.

Research

Infliximab, an immunosuppressive antibody, has been tested for COPD but found no evidence of benefit, with potential for harm. Roflumilast showed promise in reducing the intensity of seizures, but did not change the quality of life. Several new long acting agents are in development. Stem cell therapy is in the process of being researched, with generally safe and promising animal data, but insufficient human data as of 2014.

Other animals

Chronic obstructive pulmonary disease can occur in several other animals and can be caused by exposure to tobacco smoke. Most cases, however, are relatively mild. In horses, the disease is known as recurrent airway obstruction and is usually associated with an allergic reaction to fungi found in straw. COPD is also common in older dogs.

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Chronic obstructive pulmonary disease (COPD) - stage 4

Chronic obstructive pulmonary disease is a pathology in which irreversible changes in the lung tissue occur. As a result of an inflammatory reaction to the influence of external factors, the bronchi are affected, emphysema develops.

The airflow rate decreases, resulting in respiratory failure. The disease inevitably progresses, gradually causing the destruction of the lungs. In the absence of timely measures, the patient is threatened with disability.

A lethal outcome is not excluded - according to the latest data, the disease is in fifth place in terms of mortality. Great importance for the correct selection of therapeutic therapy has a classification specially developed for COPD.

Causes of the disease

The development of lung obstruction occurs under the influence of various factors.

Among them, it is worth highlighting the conditions predisposing to the onset of the disease:

• Age. The highest incidence rate is observed among men over 40 years of age.
• genetic predisposition. People with congenital deficiencies in certain enzymes are particularly susceptible to COPD.
• The impact of various negative factors on the respiratory system during fetal development.
• Bronchial hyperactivity - occurs not only with prolonged bronchitis, but also with COPD.
• Infectious lesions. Frequent colds both in childhood and at an older age. COPD has common diagnostic criteria with diseases such as chronic bronchitis, bronchial asthma.

Factors that provoke obstruction:

• Smoking. This is the main cause of morbidity. According to statistics, in 90% of all cases, COPD sufferers are long-term smokers.
• Harmful working conditions, when the air is filled with dust, smoke, various chemicals that cause neutrophilic inflammation. Risk groups include builders, miners, cotton mill workers, grain dryers, and metallurgists.
• Air pollution by products of combustion during the combustion of wood, coal).

Long-term influence of even one of these factors can lead to obstructive disease. Under their influence, neutrophils manage to accumulate in the distal parts of the lungs.

Pathogenesis

Harmful substances, such as tobacco smoke, adversely affect the walls of the bronchi, which leads to damage to their distal sections. As a result, mucus discharge is disturbed, and small bronchi are blocked. With the addition of infection, inflammation passes to muscle layer, provoking the proliferation of connective tissue. There is a broncho-obstructive syndrome. The parenchyma of the lung tissue is destroyed, and emphysema develops, in which the exit of air is difficult.

This becomes one of the causes of the most basic symptom of the disease - shortness of breath. In the future, respiratory failure progresses and leads to chronic hypoxia, when the entire body begins to suffer from a lack of oxygen. Subsequently, with the development of inflammatory processes, heart failure is formed.

Classification

The effectiveness of treatment largely depends on how accurately the stage of the disease is established. COPD criteria were proposed by the GOLD Expert Committee in 1997.

FEV1 indicators were taken as the basis - forced expiratory volume in the first second. According to the severity, it is customary to determine the four stages of COPD - mild, moderate, severe, extremely severe.

Light degree

Pulmonary obstruction is mild and rarely accompanied by clinical symptoms. Therefore, diagnosing mild COPD is not easy. V rare cases there is a wet cough, in most cases this symptom is absent. With emphysematous obstruction, there is only slight shortness of breath. The air permeability in the bronchi is practically not disturbed, although the function of gas exchange is already declining. The patient does not experience a deterioration in the quality of life at this stage of the pathology, therefore, as a rule, he does not go to the doctor.

Average degree

In the second degree of severity, a cough begins to appear, accompanied by the release of viscous sputum. Especially a large number of it is collected in the morning. Endurance is markedly reduced. At physical activity shortness of breath is formed.

COPD grade 2 is characterized by periodic exacerbations, when the cough is paroxysmal. At this point, sputum with pus is released. During an exacerbation of emphysematous COPD moderate characterized by the appearance of shortness of breath even in a relaxed state. With a bronchitis type of illness, you can sometimes listen to wheezing in the chest.

Severe degree

COPD grade 3 occurs with more noticeable symptoms. Exacerbations occur at least twice a month, which dramatically worsens the patient's condition. The obstruction of the lung tissue grows, obstruction of the bronchi is formed. Even with a slight physical exertion, shortness of breath, weakness, darkens in the eyes. Breathing is noisy, heavy.

When the third stage of the disease occurs, external symptoms also appear - the chest expands, acquiring a barrel-shaped shape, vessels become visible on the neck, body weight decreases. With bronchitis type of pulmonary obstruction skin acquire a bluish tint. Given that physical endurance is reduced, the slightest effort can lead to the fact that the patient may receive a disability. Patients with third degree bronchial obstruction, as a rule, do not live long.

Extremely severe degree

At this stage, respiratory failure develops. In a relaxed state, the patient suffers from shortness of breath, coughing, wheezing in the chest. Any physical effort causes discomfort. A pose in which you can lean on something helps to facilitate exhalation.

Complicates the condition of the formation of cor pulmonale. This is one of the most severe complications of COPD, resulting in heart failure. The patient is unable to breathe on his own and becomes disabled. He needs constant inpatient treatment, he has to constantly use a portable oxygen tank. The life expectancy of a person with stage 4 COPD is no more than two years.

For this classification, COPD severity is determined based on the readings of the spirometry test. Find the ratio of forced expiratory volume in 1 second (FEV1) to the forced vital capacity of the lungs. If it is no more than 70%, this is an indicator of developing COPD. Less than 50% indicates local changes in the lungs.

Classification of COPD in modern conditions

In 2011, it was decided that the previous GOLD classification was insufficiently informative.

Additionally, a comprehensive assessment of the patient's condition was introduced, which takes into account the following factors:

• Symptoms.
• Possible exacerbations.
• Additional clinical manifestations.

The degree of shortness of breath can be assessed using a modified questionnaire in the diagnosis called MRC Scale.

A positive answer to one of the questions determines one of the 4 stages of obstruction:

• The absence of the disease is indicated by the appearance of shortness of breath only with excessive physical exertion.
• Mild degree - shortness of breath occurs from fast walking or with a slight rise up.
• A moderate pace when walking, causing shortness of breath, indicates a moderate degree.
• The need to rest while walking at a leisurely pace on a flat surface every 100 meters is a suspicion of moderate COPD.
• An extremely severe degree - when the slightest movement causes shortness of breath, because of which the patient cannot leave the house.

To determine the severity of respiratory failure, an indicator of oxygen tension (PaO2) and an indicator of hemoglobin saturation (SaO2) are taken. If the value of the first is more than 80 mm Hg, and the second is at least 90%, this indicates that the disease is absent. The first stage of the disease is indicated by a decrease in these indicators to 79 and 90, respectively.

At the second stage, memory impairment, cyanosis is observed. Oxygen tension is reduced to 59 mm Hg. Art., saturation of hemoglobin - up to 89%.

The third stage is characterized by the features indicated above. PaO2 is less than 40 mmHg. Art., SaO2 is reduced to 75%.

All over the world, physicians use the CAT test (COPD Assessment Test) to assess COPD. It consists of several questions, the answers to which allow you to determine the severity of the disease. Each answer is evaluated on a five-point system. The presence of a disease or an increased risk of acquiring it can be said if the total score is 10 or more.

To give an objective assessment of the patient's condition, to assess all possible threats, complications, it is necessary to use a complex of all classifications and tests. The quality of treatment and how long a patient with COPD will live will depend on the correct diagnosis.

Phases of the course of the disease

Generalized obstruction is characterized by a stable course, followed by exacerbation. It manifests itself in the form of pronounced, developing signs. Shortness of breath, coughing, general well-being worsens sharply. The previous treatment regimen does not help, it is necessary to change it, increase the dosage of drugs.

The cause of an exacerbation can be even a minor viral or bacterial infection. A harmless ARI can reduce lung function, which will take a long time to return to its previous state.

In addition to the patient's complaints and clinical manifestations, a blood test, spirometry, microscopy, and laboratory examination of sputum are used to diagnose an exacerbation.

Video

Chronic obstructive pulmonary disease.

Clinical forms of COPD

Doctors distinguish two forms of the disease:

1. emphysematous. The main symptom is expiratory dyspnea, when the patient complains of difficulty exhaling. In rare cases, a cough occurs, usually without sputum production. External symptoms also appear - the skin turns pink, the chest becomes barrel-shaped. For this reason, patients with COPD, which develops according to the emphysematous type, are called "pink puffers." They usually, they can live a lot longer.
2. Bronchitis. This type is less common. Of particular concern to patients is a cough with a large amount of sputum, intoxication. Heart failure quickly develops, as a result of which the skin becomes bluish. Conventionally, such patients are called "blue puffers".

The division into emphysematous and bronchitis types of COPD is rather arbitrary. Usually there is a mixed type.

Basic principles of treatment

Considering that the first stage of COPD is almost asymptomatic, many patients come to the doctor late. Often the disease is detected at the stage when disability has already been established. Therapeutic therapy is reduced to alleviate the patient's condition. Improving the quality of life. There is no talk of a complete recovery. Treatment has two directions - drug and non-pharmacological. The first includes taking various medications. The goal of non-pharmacological treatment is to eliminate the factors influencing the development of the pathological process. This is smoking cessation, use of funds personal protection under harmful working conditions, physical exercises.

It is important to correctly assess how serious the patient's condition is, and if there is a threat to life, ensure timely hospitalization.

Drug treatment of COPD is based on the use of inhaled drugs that can expand the airways.

The standard regimen includes the following drugs based on:

• Spirivatiotropy bromide. These are first-line drugs for adults only.
• Salmeterol.
• Formoterol.

They are produced both in the form of ready-made inhalers, and in the form of solutions, powders. Prescribed for moderate to severe COPD,

When basic therapy does not give a positive result, glucocorticosteroids can be used - Pulmicort, Beclazon-ECO, Flixotide. Hormonal agents in combination with bronchodilators have an effective effect - Symbicort, Seretide.

Disabling dyspnea, chronic cerebral hypoxia are indications for long-term use of humidified oxygen inhalation.

Patients diagnosed with severe COPD require ongoing care. They are unable to perform even the most basic self-care activities. It is very difficult for such patients to take several steps. Oxygen therapy, carried out at least 15 hours a day, helps to alleviate the situation and prolong life. The effectiveness of treatment is affected by social status sick. The treatment regimen, dosage and duration of the course is determined by the attending physician.

Prevention

The prevention of any disease is always easier to perform than to treat. Lung obstruction is no exception. Prevention of COPD can be primary and secondary.

The first one is:

• Complete cessation of smoking. If necessary, nicotine replacement therapy is carried out.
• Termination of contact with occupational pollutants both at the workplace and at home. If you live in a polluted area, it is recommended to change your place of residence.
• Timely treat colds, SARS, pneumonia, bronchitis. Get a flu shot every year.
• Observe hygiene.
• Engage in hardening of the body.
• Perform breathing exercises.

If it was not possible to avoid the development of pathology, secondary prevention will help reduce the likelihood of an exacerbation of COPD. It includes vitamin therapy, breathing exercises, the use of inhalers.

Periodic treatment in specialized sanatorium-type institutions helps to maintain the normal state of the lung tissue. It is important to organize working conditions depending on the severity of the disease.