Chronic obstructive pulmonary disease is a pathology, which in recent years has begun to rapidly gain momentum, and which often becomes the cause of death of patients over 45 years of age. It affects the pathological process, mainly people who smoke.
The disease is insidious in that its first signs, in particular, in smokers appear only 20 years after the start of smoking. For many years, the pathological process can be absolutely asymptomatic. However, if untreated, airway obstruction is prone to progression, which leads to early loss of working ability and reduction of the patient’s life expectancy.
That is why the problem of COPD in our time is particularly relevant.
What it is?
Chronic pulmonary disease, or COPD, is an independent disease in which a partially irreversible process of restricting airflow in the respiratory tract occurs. Pathology is prone to gradual but steady progression, and is often triggered by inflammatory processes in the tissues of the lungs, developing under the influence of various pathogenic particles or gases.
The disease begins with the defeat of the mucous membranes of the bronchi. Under the influence of adverse external factors, the functioning of their secretory apparatus changes. They begin to intensively secrete mucus, which at the same time changes its properties. Against this background, the accession of a secondary infection occurs, which provokes a number of reactions affecting directly the bronchi, bronchioles and adjacent alveoli. The situation is only aggravated by the violation of the ratios of proteolytic enzymes with antiproteases, as well as in the presence of defects in the antioxidant protection of the lungs.
Important criteria in the diagnosis of COPD are clinical manifestations (cough with sputum and shortness of breath), history data (presence of factors predisposing to the disease) and functional manifestations (decrease in FEV1 to 80% and below, which occurs after proper inhalation of the bronchodilator from proper indicators, combined with a decrease in FEV1 / FZHEL ratios below 70%).
COPD today is a very urgent problem, because it can lead to disability of the patient and physical disability.
Causes of COPD
The dominant number of patients suffering from this pathology are heavy smokers, while the ratio of the number of smoked cigarettes and the period during which the patient has this bad habit is always taken into account. In addition, persons with a broncho-pulmonary system are weak even without obvious clinical manifestations of asthma.
In addition, COPD exposed persons:
- low body weight;
- suffering from frequent recurrence of respiratory diseases (especially children);
- being passive smokers;
- in adverse environmental conditions over a long period of time.
Chronic obstructive pulmonary disease can also develop in non-smoking patients. In this case, we are talking about a person’s genetic predisposition to this pathology. The lack of alpha-trypsin leads to an imbalance between the ratios of protease and antiprotease activity of the lung tissue.
Normally, the action of protease activity in the form of neutrophil elastase, tissue metalloproteinase, destruction of connective tissue structures and elastin occurs. It promotes the regeneration of the lung parenchyma.
As for the anti-protease activity of alpha-antitrypsin and a secretory proteinase inhibitor, its main task is the regulation of elastin destruction processes. In this connection, manifestations of antiprotease activity are observed on an ongoing basis in patients with COPD. In this regard, destructive changes in lung tissue occur. Activation of neutrophils causes the development of bronchospasm, excessive production of intrabronchial mucus and pronounced swelling of the mucous membranes of the respiratory tract.
Severe COPD is always accompanied by the addition of a secondary infection, which occurs against the background of reduced clearance of mucus in the projection of the distal respiratory tract. Repeated infection of the bronchi causes exacerbation of COPD, which leads to a significant deterioration in the course of the underlying pathology.
Thus, the disease has its pathogenetic chain of reactions. It is the occurrence of obstructive changes in the bronchial passages. As a rule, they affect the distal parts due to a sharp increase in the volume of mucus produced and developing bronchospasm.
According to the generally accepted classification, COPD is divided into 4 stages. The main criterion for the gradation of pathology is a decrease in the ratios of the forced expiratory volume (or FEV) and the forced vital capacity of the lungs (or FVC) below 70%, which is fixed after the use of bronchodilators.
- Stage Zero, or Pre-Illness. This stage is characterized by an increased likelihood of developing HBL, but the transformation into this disease does not occur in all cases. For stage 0, the presence of cough with sputum production without impairment of lung function is characteristic.
- The first stage of COPD is characterized by a mild course, and is accompanied by minor obstructive disorders (FEV for 1 s below 80% of generally accepted norms), chronic cough with sputum discharge.
- The second stage is moderate. Obstructive disorders begin to progress (50% less FEV1 <80% of normal). Dyspnea and other symptoms begin to manifest, aggravated by physical exertion.
- The third stage of the disease is characterized by severe course. In this case, there is a significant limitation of the air flow during expiration (30% <FEV, <50% of the norm). Dyspnea increases, exacerbations of pathology increase.
- The fourth, last, stage is the most dangerous. In this case, bronchial obstruction becomes extremely severe, even fraught with death. Respiratory failure is aggravated and the pulmonary heart develops, and FEV, <30% of normal.
Symptomatic manifestations of COPD are very scarce. More specifically, the clinical picture of this pathology consists of only 3 manifestations:
- Cough This symptom is present at all stages of the development of pathology. Often it is ignored by the patient, since its occurrence is attributed to smoking, allergies or other factors. Cough is not accompanied by pain, but as the disease progresses, it begins to increase. It often occurs at night, but many patients suffer from this symptom during the daytime.
- Sputum discharge Even in a healthy person, the secretion of a small amount of sputum occurs, therefore, often patients are unaware of the presence of a dangerous pathology. Sputum in COPD is excreted in increased volumes, it has neither color, nor taste, nor smell. With exacerbation of the disease, it may acquire a yellowish or greenish tint. This indicates the accession of a secondary bacterial infection.
- Dyspnea. It is with complaints of difficulty breathing, even without any particular physical exertion, in most cases, the patients present at the first visit to a pulmonologist or a general practitioner. The development of this symptom occurs gradually. As a rule, it occurs 10 years after the appearance of cough. Gradation of COPD depends on the severity of shortness of breath. At the initial stages, the disease does not give out itself, and does not affect the quality of life of the patient. And only with time the patient can notice the appearance of difficulties during fast walking, and then - and during low walking rates. Grade 3 shortness of breath causes the person to make stops to catch his breath. With 4 degrees of dyspnea, these measures have to be resorted to even when performing elementary household chores. It comes to the fact that the patient begins to choke, even while changing clothes.
Constant oxygen starvation of the brain, as well as the realization that it cannot perform an elementary action, leads to the development of mental disorders in the patient. He becomes silent, self-contained, apathetic. The patient is tormented by depressive states, sleep disturbances, anxiety levels increase, up to the development of paranoia.
In the latter stages, the patient has cognitive impairment. You may experience sleep problems, as well as bouts of sudden respiratory arrest during sleep — apnea.
Complications of COPD include the development of infectious diseases, respiratory failure or chronic pulmonary heart disease. Also, patients with this pathology are susceptible to bronchogenic carcinoma (lung cancer), although not all patients have this complication.
- Respiratory failure manifests itself, usually with shortness of breath.
- Chronic pulmonary heart is a pathological process accompanied by expansion and enlargement of the right heart regions. Developed due to increased pressure in the small circle of blood circulation. This jump, in turn, is due to lung disease. The main ailment that patients complain of is shortness of breath.
Diagnosing COPD is not particularly difficult. It is based on:
- Detailed collection history. The doctor records in detail all the complaints of the patient, learns about the possible prerequisites for pathology. In particular, the number of cigarettes smoked by the patient per day is calculated. After that, the resulting figure is multiplied by the smoking experience. If the result exceeds the number 10, then the cause of COPD indicates the smoking.
- External examination. In patients with COPD, the skin becomes bluish due to oxygen starvation. The chest becomes barrel-shaped, the veins in the neck swell, the subclavian fossae and intercostal spaces begin to bulge.
- Auscultations during which carrying out whistling, loud rattles, and also lengthening of an exhalation are noted.
- Laboratory blood and urine tests. Due to the fact that the disease is well studied, based on the results of these studies, you can create a clear picture of the pathology and get an idea of the patient's health status.
- X-ray. On the radiograph there are signs of emphysema.
- Spirography This procedure helps to evaluate the respiratory function of the lungs.
- The use of drug diagnostic method. It is necessary for the differentiation of COPD from asthma. So, a certain drug is injected into the patient, after which the doctor observes its effect on the body. In asthma, medications show pronounced efficacy, while in COPD it is much lower.
Based on the data obtained, a diagnosis is made, the intensity of the symptoms of the disease is determined, and adequate treatment is prescribed.
Treatment of Chronic Obstructive Pulmonary Disease
The basic principles of treatment for COPD are:
- tobacco cessation;
- timely start of medical treatment;
- developing a treatment regimen by the attending physician for each patient individually, taking into account the severity of his condition, the symptoms present and their intensity;
- vaccination of patients against influenza and pneumococcal infections (of course, only on a voluntary basis);
- physical exertion to improve respiratory function (well helps to strengthen the lungs daily 20-minute walk in the fresh air).
In severe COPD and the development of respiratory failure are inhaled oxygen.
To give up smoking
Quitting smoking is not as easy as it sounds. Since COPD develops mainly in people who are heavy smokers, it will be very difficult for them to give up their bad habit. However, it is this step that gives hope for the relief of symptoms of the disease, and the improvement in life projections.
To speed up the process of getting rid of tobacco addiction, you can resort to the following measures:
- the use of skin patches used as nicotine replacement treatment;
- consultations with a narcologist, a psychologist and other medical specialists;
- attendance of group programs and self-help sessions for smokers;
- self-shaping by the patient of the psychological mood that smoking is harmful and dangerous to health and also to life.
Anti-tobacco programs contribute to prolonging the life of a patient with COPD, on average, for 1 year. Of course, they are not free, but very effective, as the practice of many developed European and non-European countries (Great Britain, USA) has shown.
Pharmacotherapy has several goals:
- reducing the intensity of symptoms of COPD;
- inhibition of the progression of the pathological process;
- prevention of frequent recurrence of pathology.
The disease cannot be completely cured, but it is quite possible to alleviate its course by using certain drugs. To this end, resorted to the appointment:
- drugs based on GCS;
- expectorant drugs;
- phosphodiesterase-4 inhibitors;
Each of the above groups of medications has its own mechanism of action, and application features. About any self-treatment can not go!
The mechanism of action of bronchodilators is to expand the bronchial lumen, thereby facilitating the movement of air through them during exhalation. In addition, this group of drugs significantly improves the tolerance of physical stress.
Bronchodilator drugs are divided into several subgroups:
- Beta stimulators of short duration. These include drugs Salbutamol, Ventolin, Fenoterol.
- Long-acting beta stimulants: Salmoterol, Formoterol.
- Cholinolytics of short efficacy: Atrovent (ipratropium bromide).
- Cholinolytics with prolonged effect: Spiriva (tiotropium bromide).
- Xanthines (Euphyllinum, Theophylline, Neofillin).
Most bonholitikov intended for inhalation. At the same time, they can be dispensed in different forms - inhalation powders, aerosols, inhalers that are activated during inspiration, nebulas with a nebulizer solution, etc. It is noteworthy that for severe patients, as well as for patients with mental disabilities, it is preferable to use liquid solutions for inhalation through a nebulizer.
Bronchodilators - the main component of therapy for COPD. They can be used both independently and as part of a comprehensive treatment.
The second and fourth group of bronchodilators are recommended for permanent use, as they have a prolonged effect. If necessary, in the appointment of short-range drugs, preference is given to the combination of fenoterol with ipratropium bromide (for example, Berodual).
Xanthines (Euphyllinum, Theophylline, Neofillin) are taken in tablet form. However, they can cause serious adverse reactions, so their prolonged use is impractical.
Glucocorticosteroid hormones (GCS)
GCS - potent anti-inflammatory drugs.They are prescribed to patients with severe and extremely severe COPD, as well as with the exacerbation of the disease, which proceeds to a moderate degree.
It is best to use the GCS in the form of inhalation (budesonide, beclomethasone, etc.). Such use minimizes the frequency of systemic side effects, which are often manifested when the hormonal drugs of this group are taken orally.
GCS is practically not prescribed in isolation - it is preferable to combine them with beta-agonists. This combination is the best suited for long-term treatment of COPD. The list of the most frequently appointed combined GKS:
- Symbicort (active ingredients - formoterol and budesonide);
- Seretide (salmoterol and fluticasone).
In severe COPD, systemic use of glucocorticosteroids, Prednisolone, Dexamethasone, Kenalog, may be required. However, their prolonged use threatens with the development of serious side effects that can manifest themselves in the form of erosive and ulcerative lesions of the digestive tract, the development of Itsenko-Cushing syndrome, steroid diabetes, bone osteoporosis, etc.
It is important to bear in mind that although bronchodilators are the basis for the treatment of COPD, they can lead to serious discomforts, therefore the treatment regimen, including the prescription of specific drugs, their dosage and the duration of the course of their use, is developed only by the attending physician individually for each patient.
If it is difficult to cough and sputum, mucolytics are prescribed. One of the most effective is the drug Daxas.
This is a relative new drug belonging to the group of phosphodiesterase-4 inhibitors. Differs in long anti-inflammatory action, and can be appointed as an alternative to GCS. It is released in the form of tablets.
Take 1 tablet (500 mg) 1 time per day for severe and extreme severe COPD. However, the drug has its drawbacks, the main of which are the high cost and high risks of side effects (nausea, vomiting, dizziness, etc.).
The drug Erespal also has a pronounced anti-inflammatory effect, so it can also be used to alleviate the condition of a patient with COPD.
In parallel with the pharmacotherapy is a course of physiotherapy. In particular, intrapulonal percussion ventilation of the lungs is a manipulation during which the generation of small streams of air entering the lungs with the help of rapid tremors. They are created by a special medical device.
Care for patients with severe COPD
As already noted, COPD is a rapidly progressive pathology. But the speed of its development depends on how quickly a person adjusts his lifestyle. A particularly important role is played by the complete cessation of smoking. When diagnosing the moderate form of the disease, the patient undergoes a special medical examination to obtain a group of disabilities.
With an extremely severe degree of COPD, the patient can no longer tolerate exercise. Sometimes it is extremely difficult for him to take even a few steps. In such circumstances, the patient can not do without outside help.
Inhalations are carried out only using a nebulizer. Low-flow oxygen therapy has good efficacy.
For the purpose of its implementation specially made portable hubs are used. They do not require additional filling with oxygen, since they generate it directly from the air. Oxygen therapy contributes to the prolongation of the life of a patient with COPD.
Forecast and life expectancy
There is no talk of complete recovery for COPD. With the steady progression of pathology, the patient becomes disabled. Projections for COPD depend on:
- the possibility of excluding the effects of provoking factors;
- full compliance by the patient with all recommendations of the doctor regarding the prescribed treatment;
- social and economic status of the patient.
Prognosis is unfavorable for patients with severe CVD, respiratory failure, bronchitis type of pathology, as well as for elderly patients. Many people with severe illness die within a year.
For the prevention of COPD, it is necessary to give up smoking, to follow the safety regulations when working in hazardous enterprises, to prevent the exacerbation of other bronchopulmonary diseases.