How to treat chronic obstructive pulmonary disease. Hoble - in detail about the disease and its treatment. Four stages of the disease

This name of a terrible disease appeared in Russia about 20 years ago. Previously, it was called bronchial asthma, emphysema, chronic bronchitis ...

Under the mysterious abbreviation COPD (chronic obstructive pulmonary disease) is a dangerous disease that cannot be cured completely if you miss the beginning of its development. In the modern world, it ranks third in the number of deaths after cardiovascular and oncological diseases. In European countries, for every 100 thousand population, there are up to 40 deaths from COPD per year.

The main causes of the disease

Risk factors for COPD are different. Critical to health are:
  • long-term active smoking,
  • industrial hazards,
  • unfavorable ecology.

Smokers make up the majority of the COPD risk group. The main reason lies in tobacco smoke. A huge amount (more than 500) of harmful components found in tobacco, when inhaled, causes irritation of the bronchial mucosa. Long-term negative effects cause inflammation, eventually COPD develops. Not only smokers themselves suffer, but also household members (including children) and non-smoking colleagues: secondhand smoke can also lead to this ailment.

The occurrence of COPD can also be due to occupational factors that contribute to the development of the disease. They can include inhalation of toxic fumes, working in dusty environments, contact with harmful metals.(for example, with cadmium or silicon). The occupational risk group includes workers in the chemical industry, construction trades, road workers, miners.

Unfavorable ecology can negatively affect health not only during walks (inhalation of exhaust gases from cars, products of any combustion, strong wind with dust), but also at home. If the house is not heated by coal and the hostess cooks food on an electric stove, and not on a gas stove, then all households have a reduced risk of developing obstruction of the lungs.

Signs of COPD

  1. Shortness of breath and cough with sputum production are early symptoms of the disease. The cough usually hurts in the morning. But it can also occur against the background of an infection. In any case, it is necessary to visit a doctor for an accurate diagnosis.
  2. It's natural to feel short of breath after strenuous exercise. But if she bothers as a result of the most ordinary actions, then you need to go to an appointment with a pulmonologist or therapist to diagnose the disease based on the symptoms.

There is a modern gradation according to the severity of COPD.

  1. Mild, grade 1 COPD is rapid breathing when walking quickly or when climbing low altitudes.
  2. Moderately severe, grade 2 COPD - a sick person has difficulty walking fast, he is forced to walk slowly even on a flat surface. Based on the general condition of the patient, disability in case of COPD of the III group of this degree may be formalized.
  3. Severe, grade 3 COPD - the patient begins to choke after minutes of walking on a flat surface. The members of the commission will give II or III disability group (the disability group will depend on his general condition).
  4. Very severe shortness of breath, grade 4 COPD - the patient suffocates even during normal activities or going out into the street, cannot take care of himself. Gradually, his condition is getting worse, complications arise. With COPD of this degree, the first group of disabilities is drawn up.

With COPD, disability is given on the basis of a medical certificate of the presence of a severe degree of the disease... In addition, it is taken into account how a person is able to work, whether he has been transferred to a lower-paid position, whether he can serve himself and, if necessary, provide himself with emergency assistance.

If the patient is not able to independently get to the inhaler or call a doctor by phone, then there is a high probability of death from COPD. To exclude a lethal outcome, a disabled person needs the help of a nurse or a loved one.

Complications

Complications of COPD are as dangerous as the disease itself. Like any chronic inflammation, this disease has a negative effect on the body's systems and leads to a number of consequences such as:

  • pneumonia;
  • respiratory failure;
  • increased pressure in the pulmonary artery (often a reason for hospitalization, can even lead to the death of the patient);
  • ischemic heart disease (CHD);
  • the appearance on the walls of blood vessels of atherosclerotic plaques (this can be the starting point for the development of epilepsy) and the formation of blood clots;
  • development of bronchial inferiority;
  • cor pulmonale - expansion of the right ventricle of the heart;
  • arrhythmia.

Video

Video - who is at risk of getting COPD?

Life expectancy in COPD

In COPD, life expectancy depends entirely on whether the severity of the disease is correctly determined and whether treatment is started in a timely manner. At the beginning of the development of this insidious disease, the prognosis for a complete cure is very favorable: there is an opportunity to say goodbye to it forever and live fully. But not all sick people go to the doctor with a complaint of a wet cough. After all, smoker's bronchitis is the norm with prolonged smoking, as smokers themselves believe.

If there is no appropriate medical care, then the prognosis of the course of the disease is disappointing: the disease will only progress, this will certainly lead the patient to disability. But thanks to the correct treatment, it is possible to achieve stabilization of the course of the disease. Such people can live long lives.

How long patients with COPD live depends on their condition and timeliness of treatment - some of them live for several decades, and some much less. Life expectancy is negatively affected by such factors as oxygen starvation of the blood, the presence of arrhythmias, disorders in the right heart, high pulmonary pressure.

How and how to treat the disease

Prevention of COPD, like any disease, is in the first place in its treatment.

It assumes compliance with the rules:

  1. Most importantly, you need to urgently and permanently quit smoking, otherwise any treatment for COPD will not be effective.
  2. The use of a respirator to protect the respiratory system, reducing the number of harmful factors in the workplace. If it is impossible to fulfill these conditions, it is necessary to change the place of work.
  3. Complete and healthy food with sufficient protein and vitamins.
  4. Regular breathing exercises, swimming, walking - at least 20 minutes a day.

All of the above, together with the use of medicines and folk remedies, will improve the condition and be able to give a chance for recovery.

Drug treatment

The goal of drug treatment is to reduce the frequency of exacerbations (it is during exacerbations that most patients die) and to prevent complications. Exacerbation of COPD can be caused by several reasons: damp cool weather, respiratory infections (bacterial, viral). As the disease progresses or during an exacerbation, the amount of treatment increases.

Basic drugs:

  • Bronchodilators are the main drugs that dilate the bronchi (these include atrovent, formoterol, salbutamol, berodual). Berodual is the most popular: it has a minimum of side effects. But overdose should not be allowed, you must strictly follow the recommendations in the instructions. It is recommended to control the heart rate (HR): it should be no more than 90 beats per minute. Bronchodilators are used in most cases in the form of inhalation.
  • Glucocorticosteroids (GCS) are used to treat severe disease or exacerbations ( prednisone, budesonide). In severe respiratory failure, glucocorticosteroids are administered by injection to relieve attacks

  • Mucolytics are taken to thin phlegm and facilitate its excretion ( carbocisteine, ambroxol, bromhexine, ACC). Only used for viscous mucus.
  • Vaccines. Vaccination against influenza and pneumonia can significantly reduce the risk of death. It is carried out annually before the winter period.
  • Antibiotics are used only for exacerbation of the disease - in the form of tablets, injections, inhalations.
  • Antioxidants reduce the duration and severity of exacerbations, but are used in long courses - up to six months.

It must be remembered that all drugs are prescribed only by a doctor.

Surgery

Bullectomy. Resection (removal) of that part of the lung that can no longer perform its function, can reduce shortness of breath, improve the general condition of the patient.

Transplantation effectively increases the patient's working capacity, improves the functioning of the lungs. But the disadvantage of using this operation is its high cost and the problem with finding a donor.

Oxygen therapy

Oxygen therapy is prescribed either for patients with the fourth degree of COPD, or for exacerbations to restore the respiratory function of the lungs, or if drug treatment of the disease has not yielded the desired results.

Important ! Oxygen therapy is never prescribed to people who smoke or who are susceptible to alcoholism.

With the development of COPD, oxygen deprivation of tissues increases. For this reason, additional oxygen therapy is necessary (when the arterial blood oxygen saturation is less than 88%). Therapy should be continued for at least 15 hours a day. Indications for oxygen therapy are cor pulmonale, edema, thick blood.

Patients with sufficiently "tolerant" ventilation impairments can afford to perform the procedure at home. But the selection of modes is carried out only by a specialist.

Other respiratory therapies

Percussion drainage is a fairly new technique. It is based on the supply of small portions of air to the bronchi at the right pressure and with a set frequency. The patient immediately feels relief of breathing.

Respiratory gymnastics according to the Strelnikova method, inflation of balls, exhalation through the mouth through a tube dipped in water will serve as a useful addition to medications.

The rehabilitation centers provide assistance to all patients with COPD, starting with the 2nd degree of severity. They teach breathing exercises, physical exercises, and if the patient takes oxygen therapy sessions at home, then they teach them how to conduct them correctly. Specialists will also provide psychological assistance to patients, help them switch to a healthy lifestyle, teach them how to quickly seek medical help or provide it on their own.

Folk remedies for the treatment of COPD

Treatment of COPD with medications is recommended in conjunction with medications. In another way, a good result from the use of traditional medicine recipes should not be expected. Below are simple, but effective folk recipes for the treatment of obstructive bronchitis, which can help in the treatment of COPD.

Herbal infusions. They are prepared by brewing a tablespoon of the collection with a glass of boiling water, each taken within 2 months.

  • Take 100 g of flax seeds, 200 g each of chamomile and linden flowers. Insist half an hour. Eat half a glass once a day.
  • 200 g nettle, 100 g sage. Insist for about an hour. Take half a glass twice a day.
  • 300 g of flax seeds, 100 g each of chamomile flowers, licorice roots, marshmallow, anise berries. Collection to insist half an hour. Drink half a glass once / day.
  • Take one part sage and two parts chamomile and mallow. Insist half an hour. Take half a glass twice a day.
  • One part flaxseed, two parts each eucalyptus, linden flowers, chamomile. Insist half an hour. Drink half a glass twice a day.
  • 2 tsp Brew anise seeds with 400 ml of boiling water, leave for 20 minutes to infuse. Consume the entire infusion in four doses per day.

Inhalation. For their implementation, you can use decoctions of herbs (chamomile, oregano, mint, pine needles), a solution of sea salt, finely chopped onions, essential oils (coniferous or eucalyptus).

At the current level of development of medicine, it is possible not only to facilitate the course of chronic obstructive pulmonary disease, but also to prevent the appearance of the disease itself.

A healthy lifestyle, proper nutrition, physical education, respiratory exercises will help provide a positive prognosis in curing the disease.

Smoking is the leading cause of COPD, and most people with COPD either still smoke or have smoked in the past. Long-term exposure to other lung irritants, such as air pollution, chemical fumes, or dust, can also contribute to the development of COPD.

What is chronic obstructive pulmonary disease (COPD)

The air that you breathe flows down through the windpipe into a branch of the windpipe called the bronchi.

In the lungs, your bronchi branch out into thousands of small, thin tubes called bronchioles. These tubes end in clusters of tiny, round air sacs called alveoli.

Small blood vessels called capillaries pass through the walls of the alveoli. When air reaches the alveoli, oxygen flows through their walls into the blood in the capillaries. At the same time, carbon dioxide (carbon dioxide) moves from the capillaries to the alveoli. This process is called gas exchange.

The airways and alveoli are elastic, and when you inhale, each alveoli fills with air like a small balloon, and when you exhale, the alveoli shrink.

In chronic obstructive pulmonary disease, less air enters the lungs and, accordingly, less air leaves them. This happens for one or more of these reasons:

  • The airways and alveoli lose elasticity.
  • The walls between many alveoli collapse.
  • The walls of the airways are swollen and inflamed.
  • The airways produce more mucus than normal, which can clog them.

The term COPD includes two main diseases - emphysema and chronic bronchitis. In emphysema, the walls between many of the alveoli are damaged or even destroyed. As a result, the alveoli lose their shape, which leads to the formation of fewer shapeless large alveoli instead of many small ones. If this happens, then gas exchange in the lungs deteriorates.

In chronic bronchitis, the mucous membrane of the respiratory tract is constantly irritated and inflamed. This leads to swelling of the mucous membrane and narrowing of the airways. During chronic bronchitis, thick mucus is present in the respiratory system, which also makes breathing difficult.

Most people with COPD also have emphysema and chronic bronchitis. Thus, the general term "COPD" is more accurate.

Forecast

COPD is one of the leading causes of disability and is the third leading cause of death in developed countries. Currently, chronic obstructive pulmonary disease has been diagnosed in millions of people. And many more people may have this disease without even knowing it.

COPD develops slowly. Symptoms often get worse over time and can limit your ability to engage in daily activities. Severe COPD can almost completely incapacitate you, becoming an obstacle to even basic activities such as walking, cooking, or taking care of yourself.

Most cases of COPD are diagnosed in middle-aged or elderly people. The disease does not spread from person to person, so you cannot catch it from someone else.

COPD is currently not cured because doctors do not know how to reverse damage to the airways and lungs. However, existing treatments and lifestyle changes can help you feel better, stay more active, and slow the progression of the disease.

Causes of COPD

Long-term exposure to irritants that damage the lungs and airways is usually the cause of COPD.

The most common irritant causing COPD is tobacco smoke. Tobacco smoke from smoking pipes, cigars, cigarettes, etc. can also cause chronic obstructive pulmonary disease, especially if the smoke is inhaled directly into the lungs.

Secondhand smoke, air pollution, chemical fumes, or dust from the environment or workplace can also contribute to the development of COPD. (Secondhand smoke is inhaling tobacco smoke when other people smoke near you.)

In rare cases, a genetic disorder called alpha-1 antitrypsin deficiency may play a role in COPD. People with this condition have low levels of alpha-1-antitrypsin (AAT), a protein made in the liver.

If a person has low AAT protein levels, it can damage the lungs and develop COPD if you are exposed to smoke or other lung irritants. If you have this condition and smoke, COPD can get worse very quickly.

Although rare, some people with asthma can develop COPD. Asthma is a chronic lung disease in which the airways become inflamed and swollen. Treatment can usually reverse inflammation and reduce swelling. However, if asthma is left untreated, COPD can develop.

Who is at risk of developing COPD

Smoking is the main risk factor for developing COPD. Most people with COPD currently smoke or have smoked in the past. People with a family history of chronic obstructive pulmonary disease (COPD) are usually more likely to develop COPD if they smoke.

Long-term exposure to other lung irritants is also a risk factor for developing COPD. These irritants include:

  • passive smoking
  • air pollution
  • chemical fumes
  • dust in the environment
  • house dust

People in their 40s or older usually begin to develop symptoms of chronic obstructive pulmonary disease. Rarely enough, people under the age of 40 can develop COPD. This can happen if the person is deficient in alpha-1-antitrypsin (an inherited disorder).

What are the signs and symptoms of COPD

First, COPD may cause no symptoms or only mild symptoms. As the disease progresses, the symptoms usually become more severe. Common signs and symptoms of chronic obstructive pulmonary disease are:

  • A persistent cough or cough that produces a lot of mucus (often called "smoker's bronchitis").
  • Difficulty breathing, especially during physical activity.
  • Shortness of breath (wheezing or wheezing when breathing).
  • Oppression in the chest.

If you have COPD, you may also have frequent colds or flu.

Not every person who has the above symptoms has COPD. Also, not every person with COPD experiences these symptoms. Some of the symptoms of chronic obstructive pulmonary disease are similar to those of other diseases and conditions. For an accurate diagnosis, you need to see your doctor.

If your symptoms are mild, you may not even notice them, or you may make some lifestyle changes to make breathing easier. For example, you can use the elevator instead of the stairs.

Over time, COPD symptoms can become severe enough to require medical attention. For example, you may develop shortness of breath during physical activity.

The severity of your symptoms will depend on how badly your lungs are damaged. If you continue to smoke, your lung tissue will be destroyed faster than if you quit smoking.

Severe COPD can cause other symptoms such as swelling in the ankles, feet, or legs, weight loss, and decreased muscle endurance.

Some severe symptoms may require hospital treatment. You or your loved ones (if you are not able to) should seek emergency medical attention if:

  • You have great difficulty breathing (you are out of breath and have difficulty speaking).
  • Your lips or nails turn blue or gray. (This is a sign of low blood oxygen levels.)
  • Your brain functions have worsened (disturbances in thinking, poor thinking).
  • Your heart rate is very fast.
  • The recommended treatment for symptoms that are getting worse does not work.

COPD diagnosis

Your doctor will diagnose COPD based on your symptoms, your medical and family history, and test results and diagnostic procedures.

Your doctor may ask if you smoke or if you come into contact with lung irritants such as tobacco smoke (secondhand smoke), air pollution, chemical fumes, or dust.

If you have a chronic cough, you need to tell your doctor about it (how long have you been suffering from persistent coughing, how much mucus is coughing up when you cough). In addition, if your family has had a history of COPD, you should also tell your doctor about it.

The doctor will examine you and listen to your lungs with a stethoscope to check your breathing for wheezing or other unusual sounds in your chest. He may also recommend one or more diagnostic procedures to diagnose COPD.

Pulmonary function tests

A lung function test measures how much air you can breathe in and out, how quickly you can breathe out, and how well your lungs deliver oxygen to your blood.

The main diagnostic procedure for diagnosing COPD is spirometry. Other lung function tests, such as a lung diffusion test, can also be used.

Spirometry

During this painless procedure, your doctor will ask you to take a deep breath. Then, you will blow as hard as you can into the tube attached to the small appliance. This device is called a spirometer.

This device measures the amount of air you breathe out. It also measures the maximum expiratory flow rate.

Your doctor may give you a medication to help open your airways and then ask you to blow again. He can then compare the test results before and after taking the medication.

Spirometry can detect COPD before symptoms appear. Your doctor may also use the test results to find out how severe your COPD is and help set treatment goals.

Diagnostic results can also help identify other medical conditions, such as asthma or heart failure, as these may also be the cause of your symptoms.

Other diagnostic procedures

  • Chest X-ray (Computed Tomography or CT). CT diagnostics take pictures of the internal organs of the chest, such as the heart, lungs, and blood vessels. Images may show signs of COPD. They can also show another medical condition, such as heart failure, which may also be causing your symptoms.
  • Arterial blood gas analysis. This blood test measures the oxygen level in the blood using a blood sample taken from an artery. The results of this test can show how serious your COPD is and whether you need oxygen therapy.

COPD treatment

Chronic obstructive pulmonary disease cannot be cured. However, lifestyle changes and treatments can help you feel better, stay more active, and slow the progression of the disease.

COPD treatment goals:

  • Easing your symptoms.
  • Slowing the progression of the disease.
  • Making you feel better with exercise (increasing your ability to stay active).
  • Prevention and treatment of complications.
  • Improving overall health.

To start treatment for your condition, you need to see a pulmonologist (a doctor who specializes in diseases of the respiratory tract).

Lifestyle changes

Quit smoking and avoid exposure to lung irritants

Quitting smoking is the most important step you can take to treat COPD. Talk with your doctor about programs and remedies that can help you quit smoking.

Also, try to avoid secondhand smoke, stay away from smoking areas, dusty places, and avoid inhaling chemical fumes or other toxic substances that you may inhale.

Other lifestyle changes

If you have chronic obstructive pulmonary disease, you may have trouble eating enough food due to symptoms such as shortness of breath and fatigue. (This problem is more common in severe cases.)

As a result, you cannot get the calories and nutrients you need, which can worsen your condition and increase your risk of infections.

Talk to your doctor about a nutritional plan that suits your body's needs. Your doctor may suggest eating less, but more often; rest before eating; and take vitamins or nutritional supplements.

Also, talk with your doctor about which activities are safe for you. You may find it difficult to be active with COPD symptoms. However, physical activity can strengthen muscles that help you breathe and improve your overall health.

Medicines

Bronchodilators (bronchodilators)

Bronchodilators relax the muscles in the airway. This helps open the airways and makes breathing easier.

Depending on the severity of your COPD symptoms, your doctor may prescribe short-acting or long-acting bronchodilators. Short-acting bronchodilators are drugs that last about 4-6 hours and should only be used when needed. Long-acting bronchodilators work for about 12 hours or more and are used daily.

Most bronchodilators are taken with a device called an inhaler. This device allows the medication to flow directly into the lungs. Not all inhalers are used in the same way. Ask your doctor to show you the correct way to use the inhaler.

If your COPD symptoms are mild, your doctor may only prescribe short-acting bronchodilators. In this case, you can only use the medication when symptoms appear.

If you have moderate to severe COPD, your doctor may prescribe regular use of short-acting and long-acting bronchodilators.

Combination of bronchodilators with inhaled glucocorticosteroids (ICS)

If your COPD symptoms are more severe, or if your symptoms occur frequently, your doctor may prescribe a combination of medications such as bronchodilators and inhaled steroids. Steroids help reduce airway inflammation.

In general, the use of inhaled steroids by themselves is not the preferred treatment.

Your doctor may recommend that you try using inhaled steroids with bronchodilators for 6 weeks to 3 months to see if adding a steroid helps relieve your breathing problems.

Vaccines

Flu shot

The flu can cause serious problems for people with COPD. Flu shots can reduce your risk of getting the flu (not proven to be life-threatening). Talk with your doctor about getting your yearly flu vaccine.

Vaccination against pneumococcal infection

This vaccine reduces the risk of developing pneumococcal pneumonia and its complications. People with COPD are at a higher risk of developing pneumonia than people without COPD. Talk with your doctor about whether you should get this vaccine.

Pulmonary rehabilitation

A pulmonary rehabilitation (recovery) program helps improve the condition of people with chronic breathing problems.

Rehabilitation may include an exercise program, disease control training, nutritional counseling, and psychological support. The goal of the program is to help you stay active and carry out your daily activities.

Doctors, nurses, physiotherapists, pulmonologists, rehabilitation therapists and nutritionists will help you with this. These healthcare professionals will help you create a program that meets your needs.

Oxygen therapy

If you have severe COPD and low blood oxygen levels, oxygen therapy can help you breathe better. With this type of treatment, oxygen is supplied to your lungs through nasal cannulas or an oxygen mask.

You may need supplemental oxygen all the time or only at certain times. For some people with severe COPD, using oxygen therapy for most of the day can help with the following:

  • Perform tasks or activities while experiencing fewer symptoms.
  • Protect your heart and other organs from damage.
  • Sleep more during the night and improve alertness during the day.
  • Live longer.

Oxygen therapy for chronic obstructive pulmonary disease

Surgery

Surgery may benefit some people with COPD. Surgery is usually the last resort for people experiencing severe symptoms that do not improve with medication.

People with chronic obstructive pulmonary disease, which is mainly associated with emphysema, usually have bullectomy or lung volume reduction surgery. A lung transplant may be an option for people with very severe COPD.

Bullectomy

When the walls of the alveoli collapse, large air spaces called bullae begin to form in the lungs. These air spaces can become so large that they interfere with breathing. During a bullectomy, doctors remove one or more very large bullae from the lungs.

Lung volume reduction surgery

During lung volume reduction (LVR) surgery, surgeons remove damaged tissue from the lungs. This helps the lungs to function better. This surgery is only performed on some people with COPD, and if done successfully, it can help improve a person's breathing and quality of life.

Lung transplant

During a lung transplant, your damaged lung is removed and replaced with a healthy lung from a deceased donor.

A lung transplant can improve your lung function and quality of life. However, there are many risks involved with lung transplant, such as infections. The operation can be fatal if the body rejects the transplanted lungs.

If you have very serious COPD, talk to your doctor about whether a lung transplant is necessary for you. Ask your doctor about the benefits and risks of this type of surgery.

Complications of COPD

COPD symptoms usually get worse over time. However, they can also get worse suddenly. For example, a cold, flu, or a lung infection can make you feel worse quickly, which can make it very difficult for you to breathe. You may also have worse chest tightness and coughing, a change in the color or amount of phlegm coming from your lungs, and a rise in body temperature.

Call your doctor right away if your symptoms suddenly get worse. To help you breathe, he may prescribe antibiotics to treat the infection, as well as other medications such as bronchodilators and inhaled steroids. Some severe symptoms may require hospitalization.

Prevention of COPD

There are some steps you can take to prevent COPD even before it starts. If you are already suffering from this condition, you can take steps to prevent complications and slow the progression of the disease.

Preventing COPD Before Onset

If you do not smoke, never try to start smoking, as smoking is the main cause of chronic obstructive pulmonary disease. If you already smoke, you need to get rid of this bad habit completely. If you smoke and want to quit but can't do it yourself, talk to your doctor about programs and remedies that can help you quit smoking.

Also, try to avoid inhaling harmful substances that irritate the lungs, as exposure to them can contribute to the development of COPD. Secondhand smoke, air pollution, chemical fumes and dust can all contribute to the development of this disease.

Preventing complications and slowing the progression of COPD

If you already have the first signs of COPD, the most important step you can take is to quit smoking completely. This can help you prevent complications from developing and slow the progression of the disease. You should also avoid exposure to the lung irritants mentioned above.

Follow the treatment regimen for COPD that your doctor has prepared for you. It can help you breathe easier, stay more active, and avoid and control severe symptoms.

Talk to your doctor about whether you should get flu and pneumonia shots. These vaccines can reduce the risk of these diseases (insufficient evidence - vaccines can be life-threatening), which are major health risks for people with COPD.

Living with COPD

Chronic obstructive pulmonary disease is currently not treated. However, you can take steps to control your symptoms and slow the progression of the disease. You need:

  • Get ongoing care
  • Keep your disease and its symptoms under control
  • Prepare for emergencies

Avoid lung irritants

If you smoke, you need to quit smoking. Smoking is the leading cause of COPD. Talk with your doctor about programs and remedies that can help you quit smoking.

Also, try to avoid inhaling substances that irritate the lungs, as these can contribute to the development of COPD. The main lung irritants are:

  • passive smoking
  • air pollution
  • chemical fumes

Try to keep these irritants out of your home. If your home is painted or has been killing insects with insect sprays, you should be outside the house for as long as possible.

If the air is very polluted and dusty, keep windows closed and stay at home (if possible).

Get ongoing care

If you are suffering from chronic obstructive pulmonary disease, it is very important to receive ongoing medical attention. Take all medicines your doctor has prescribed for you. Bring a list of all your medications to your regular check-ups.

Talk with your doctor about whether you should get the flu and pneumonia vaccine. Also, ask him about other conditions that may increase the risk of COPD. These can include heart disease, lung cancer, and pneumonia.

Controlling COPD Symptoms

There are several things you can do to control your COPD symptoms. For instance:

  • Do physical activities slowly.
  • Place items you frequently use in one place so that they are easy to reach.
  • Find very easy ways to cook, clean, and do other household chores.
  • Wear clothes and shoes that are easy to put on and take off.

Depending on how serious your illness is, you may want to ask your family and friends for help with daily tasks.

Preparing for emergencies

If you have COPD, you need to know when and where to seek help in an emergency. You should seek emergency medical attention if you have severe symptoms such as shortness of breath or inability to speak normally.

Call your doctor if you notice your symptoms are getting worse or if you have signs of an infection such as a fever. Your doctor may change or adjust treatments to relieve and treat the symptoms of chronic obstructive pulmonary disease.

Keep the phone numbers of your doctor, hospital, or someone else who can provide medical assistance to you handy. You should also have a referral to your doctor and a list of all medications you are taking on hand.

Chronic obstructive pulmonary disease (COPD) is a progressive disease of the bronchi and lungs associated with an increased inflammatory response of these organs to the action of harmful factors (dust and gases). It is accompanied by impaired ventilation due to impaired bronchial patency.

Doctors also include pulmonary emphysema in the concept of COPD. Chronic bronchitis is diagnosed by symptoms: having a cough with sputum for at least 3 months (not necessarily in a row) in the last 2 years. Emphysema of the lungs is a morphological concept. This is the expansion of the airways behind the terminal sections of the bronchi, associated with the destruction of the walls of the respiratory vesicles, alveoli. In patients with COPD, these two conditions are often combined, which determines the characteristics of the symptoms and treatment of the disease.

The prevalence of the disease and its socio-economic importance

COPD is recognized as a worldwide medical problem. In some countries, such as Chile, it affects one in five adults. In the world, the average prevalence of the disease among people over 40 is about 10%, and men are sick more often than women.

In Russia, the morbidity data largely depend on the region, but in general they are close to world indicators. The prevalence of the disease increases with age. In addition, it is almost twice as high in people living in rural areas. For example, in Russia every second person living in a village suffers from COPD.

In the world, this disease is the fourth in the list of leading causes of death. The mortality rate in COPD is growing very rapidly, especially among women. The factors that increase the risk of dying from this disease are overweight, severe bronchospasm, low endurance, severe shortness of breath, frequent exacerbations of the disease and pulmonary hypertension.

The costs of treating the disease are also high. Most of them are inpatient treatment of exacerbations. COPD therapy is more expensive for the government than treatment. The frequent incapacity for work of such patients, both temporary and permanent (disability), is also important.

Causes and mechanism of development

The main cause of COPD is smoking, active and passive. Tobacco smoke damages the bronchi and lung tissue itself, causing inflammation. Only 10% of cases of the disease are associated with the influence of occupational hazards, constant air pollution. In the development of the disease, genetic factors can also be involved, causing the deficiency of some of the substances protecting the lungs.

Predisposing factors for the development of the disease in the future are low birth weight, as well as frequent respiratory diseases suffered in childhood.

At the onset of the disease, mucociliary transport of sputum is disrupted, which ceases to be excreted from the respiratory tract in time. Mucus stagnates in the lumen of the bronchi, creating conditions for the reproduction of pathogenic microorganisms. The body reacts with a defensive reaction - inflammation, which becomes chronic. The walls of the bronchi are impregnated with immunocompetent cells.

Immune cells release a variety of inflammatory mediators that damage the lungs and trigger a vicious cycle of disease. Oxidation and the formation of free oxygen radicals are enhanced, which damage the walls of the lung cells. As a result, they are destroyed.

Violation of bronchial patency is associated with reversible and irreversible mechanisms. Reversible ones include spasm of the muscles of the bronchi, edema of the mucous membrane, an increase in mucus secretion. Irreversible ones are caused by chronic inflammation and are accompanied by the development of connective tissue in the walls of the bronchi, the formation of emphysema (swelling of the lungs, in which they lose their ability to ventilate normally).

The development of emphysema is accompanied by a decrease in blood vessels through the walls of which gas exchange occurs. As a result, the pressure in the vasculature of the lungs increases - pulmonary hypertension occurs. The increased pressure overloads the right ventricle, which forces blood into the lungs. It develops with the formation of cor pulmonale.

Symptoms


COPD patients are concerned about coughing and shortness of breath.

COPD develops gradually and lasts for a long time without external manifestations. The first symptoms of the disease are cough with light sputum or, especially in the morning, and frequent colds.

The cough is worse during the cold season. Shortness of breath increases gradually, appearing first during exertion, then during normal activity, and then at rest. It occurs about 10 years later than the cough.

Periodic exacerbations occur, lasting several days. They are accompanied by increased coughing, shortness of breath, wheezing, pressing chest pain. Reduced exercise tolerance.

The amount of sputum increases or decreases sharply, its color, viscosity changes, it becomes purulent. The frequency of exacerbations is directly related to life expectancy. Exacerbations of the disease are more common in women and greatly reduce their quality of life.

Sometimes you can find the division of patients on a predominant basis. If inflammation of the bronchi is important in the clinic, cough prevails in such patients, a lack of oxygen in the blood, which causes a blue tint of the hands, lips, and then the entire skin (cyanosis). Heart failure develops rapidly with the formation of edema.

If emphysema, manifested by severe shortness of breath, is of greater importance, then cyanosis and cough are usually absent or they appear in the later stages of the disease. These patients are characterized by progressive weight loss.

In some cases, there is a combination of COPD and bronchial asthma. In this case, the clinical picture takes on the features of both of these diseases.

Differences between COPD and bronchial asthma

In COPD, a variety of extrapulmonary symptoms associated with a chronic inflammatory process are recorded:

  • weight loss;
  • neuropsychiatric disorders, sleep disturbance.

Diagnostics

The diagnosis of COPD is based on the following principles:

  • confirmation of the fact of smoking, active or passive;
  • objective research (examination);
  • instrumental confirmation.

The problem is that many smokers deny that they have the disease, considering coughing or shortness of breath as a consequence of a bad habit. They often seek help in advanced cases when they become disabled. It is no longer possible to cure the disease or slow down its progression at this time.

In the early stages of the disease, an external examination does not reveal changes. In the future, exhalation through closed lips, a barrel-shaped chest, participation in breathing of additional muscles, retraction of the abdomen and lower intercostal spaces during inhalation is determined.

With auscultation, dry wheezing is determined, with percussion - a box sound.

From laboratory methods, a general blood test is required. It may show signs of inflammation, anemia, or blood clots.

Cytological examination of sputum allows you to exclude malignant neoplasm, as well as assess inflammation. For the selection of antibiotics, sputum culture (microbiological examination) can be used or the bronchial contents, which are obtained during bronchoscopy, can be analyzed.
Chest x-rays are taken to rule out other diseases (pneumonia, lung cancer). For the same purpose, bronchoscopy is prescribed. To assess pulmonary hypertension, electrocardiography is used and.

The main method for diagnosing COPD and evaluating the effectiveness of treatment is spirometry. It is performed at rest and then after inhalation of bronchodilators such as salbutamol. Such a study helps to identify bronchial obstruction (decreased airway patency) and its reversibility, that is, the ability of the bronchi to return to normal after using drugs. In COPD, irreversible bronchial obstruction is common.

With an already confirmed diagnosis of COPD, peak flow measurement with the determination of the peak expiratory flow rate can be used to control the course of the disease.

Treatment

The only way to reduce the risk of illness or slow its progression is to stop smoking. Do not smoke with children!

Attention should be paid to the cleanliness of the surrounding air, respiratory protection when working in hazardous conditions.

Medicinal treatment is based on the use of drugs that dilate the bronchi - bronchodilators. They are mainly used. Combined remedies are most effective.

The doctor may prescribe the following groups of drugs, depending on the severity of the disease:

  • Short-acting M-anticholinergics (ipratropium bromide);
  • Long-acting M-anticholinergics (tiotropium bromide);
  • long-acting beta-adrenergic agonists (salmeterol, formoterol);
  • short-acting beta-adrenergic agonists (salbutamol, fenoterol);
  • long-acting theophyllines (theotard).

For moderate to severe inhalation, it can be carried out with. In addition, spacers are often useful for the elderly.

Additionally, in severe cases of the disease, inhaled glucocorticosteroids (budesonide, fluticasone) are prescribed, usually in combination with long-acting beta-adrenergic agonists.

(sputum-thinning agents) are indicated only for some patients with thick, hard-to-cough mucus. For long-term use and prevention of exacerbations, only acetylcysteine ​​is recommended. Antibiotics are prescribed only during an exacerbation of the disease.

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

This disease, which occurs with long-term damage to the lungs, is currently considered incurable, therapy can only reduce the frequency and severity of exacerbations, and reduce the level of deaths.
COPD (Chronic Obstructive Pulmonary Disease) is a disease in which airflow is limited in the airways, which is partially reversible. This obstruction is constantly progressing, impairing lung function and leading to chronic respiratory failure.

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Who has COPD?

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

The origin of the disease

With long-term irritation of the lungs with harmful gases and microorganisms, chronic inflammation gradually develops. As a result, there is a narrowing of the bronchi and destruction of the alveoli of the lungs. In the future, all respiratory tract, tissues and blood vessels of the lungs are affected, leading to irreversible pathologies that cause a lack of oxygen in the body. COPD (chronic obstructive pulmonary disease) develops slowly, progressing steadily over many years.

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

The main causes of the disease

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

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


The disease is classified by severity:

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

Moderate severity - increased obstructive disorders in the lungs. Shortness of breath appears with physical. loads. The disease is diagnosed upon treatment of patients due to exacerbations and shortness of breath.

Severe - Significant air restriction occurs. Frequent exacerbations begin, shortness of breath increases.

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

Diagnostic methods

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

Test with a bronchodilator - shows the likelihood of reversibility of the process of narrowing the bronchus.

X-ray examination - establishes the severity of pulmonary changes. The same is done.

Sputum analysis - for the determination of microbes during an exacerbation and the selection of antibiotics.

Differential diagnosis


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

How to treat a disease

General rules

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

Drug treatment

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

  • Bronchodilators are the main drugs that stimulate the expansion of the bronchi (atrovent, salmeterol, salbutamol, formoterol). Preferably administered by inhalation. Short-acting drugs are used as needed, long-acting drugs are used constantly;
  • glucocorticoids in the form of inhalation - used for severe disease, with exacerbations (prednisolone). With severe respiratory failure, attacks are stopped with glucocorticoids in the form of tablets and injections;
  • Vaccines - Vaccination against influenza can reduce mortality in half of the cases. It is carried out once in October - early November;
  • mucolytics - thin the mucus and facilitate its excretion (carbocisteine, ambroxol, trypsin, chymotrypsin). Used only in patients with viscous sputum;
  • antibiotics - used only for exacerbation of the disease (penicillins, cephalosporins, possibly the use of fluoroquinolones). Pills, injections, inhalations are used;
  • antioxidants - able to reduce the frequency and duration of exacerbations, are used in courses of up to six months (N-acetylcysteine).

Surgery

  • Bullectomy - removal can reduce shortness of breath and improve lung function;
  • reduction of pulmonary volume by surgery - is under study. The operation can improve the physical condition of the patient and reduce the percentage of mortality;
  • lung transplantation - effectively improves the quality of life, lung function and physical performance of the patient. Application is hampered by the problem of donor selection and the high cost of the operation.

Oxygen therapy

Oxygen therapy is performed to correct respiratory failure: short-term - with exacerbations, long-term - with the fourth degree of COPD. With a stable course, constant long-term oxygen therapy is prescribed (at least 15 hours daily).

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

Treatment with folk remedies

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

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

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

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

  • Infusion of radish. Grate black radish and medium-sized beets, mix and cover with cooled boiling water. Leave on for 3 hours. Drink 50 ml three times a day for a month.
  • Nettle. Grind nettle roots into gruel and mix with sugar in a ratio of 2: 3, leave for 6 hours. The syrup removes phlegm, relieves inflammation and relieves cough.
  • Milk:

√ With a glass of milk, brew a spoonful of cetraria (Icelandic moss), drink during the day;

√ in a liter of milk, boil 6 chopped onions and a head of garlic for 10 minutes. Drink half a glass after meals. every mother must know!

Coughing spells keep you awake at night? You may have tracheitis. You can learn more about this disease


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

Forecast

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

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

The incurable and deadly COPD simply encourages people to quit smoking for good. And for those at risk of people, there is only one advice - if you find signs of the disease in yourself, immediately contact a pulmonologist. After all, the earlier the disease is detected, the less the likelihood of a premature death.

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

Since the disease is often detected already in the last stages, mortality within 10 years after visiting a doctor is 55% of all recorded cases. In addition, its complications often lead to loss of performance and disability. Therefore, it is imperative that a timely diagnosis and treatment of COPD be initiated.

COPD is a disease in its own right. It is characterized by a restriction of air passage through the respiratory tract, and in some cases this process is irreversible. This pathological condition is caused by inflammation of the lung tissue, in turn due to a nonspecific response of the patient's body to some pathogenic microparticles or gases.

COPD diagnosis is a collective term that includes:

  • chronic obstructive bronchitis (including purulent);
  • pneumosclerosis;
  • pulmonary hypertension;
  • emphysema resulting from a violation of the patency of the bronchial tree;
  • chronic cor pulmonale.

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

Causes

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

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

There are several other factors that are believed to lead to this disease. These include underweight, air pollution, familial illness, and regular inhalation of biofuel combustion products during cooking (observed in people living in underdeveloped countries).

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

Of course, the above risk factors, when present individually, are unlikely to cause chronic obstructive pulmonary disease. But since in the modern world with a developed industry, high air pollution and other consequences of human life, they act together with improper diet and bad habits. Therefore, the number of diseases is increasing every year, and the life expectancy of patients due to untimely detection in the general percentage decreases.

Development mechanism

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

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

Classification

The wording of the diagnosis is largely based on the severity of the disease. For this, the reduction in the flow rate of the inhaled air is determined and, on the basis of the data obtained, the so-called Tiffeneau index is calculated - an indicator of a possible decrease in the throughput of the patient's respiratory tract.

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

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

  • It proceeds easily, manifests itself as a periodic wet cough. Shortness of breath in most cases is not observed. FEV / FVC<70% от исходного значения. ОФВ>80% of the norm.
  • Moderate course of the disease with noticeable shortness of breath on exertion and persistent cough. Obstruction increases, possibly exacerbation of COPD. FEV / FVC<70%, ОФВ<80% от должного.
  • The disease is characterized by severe symptoms. The patient has a constant wet cough, wheezing in the sternum, the slightest physical exertion causes severe shortness of breath. Periods of exacerbation occur regularly. FEV / FVC<70%, ОФВ<50% от исходного значения.
  • The condition is extremely serious, in some cases even life-threatening. Obstruction of the bronchi is pronounced,. At this stage, destructive processes in the body lead to disability. FEV / FVC<70%, ОФВ<80% от нормы.

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

  • Bronchodilator... Here, cough is the predominant symptom. At the same time, it is pronounced. Since cor pulmonale develops early, the skin acquires a bluish color over time. The concentration of erythrocytes in the blood, as well as its total volume, is constantly increased, which often leads to the formation of blood clots, hemorrhages, and heart attack.
  • Emphysematous. This type includes COPD with prevailing dyspnea. Patients are characterized by intense breathing that exceeds the need for oxygen. Patients often complain of weakness, depression, and weight loss. There is a strong depletion of the body.

Symptoms

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

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

  • Cough . Of all the signs, it arises in the first place, having an episodic character. Then it becomes daily. In the absence of an exacerbation, sputum usually does not come out.
  • Sputum. Appears some time after the development of a periodic cough into a permanent one. Initially observed mainly in the morning. If the sputum becomes purulent, this indicates the development of an exacerbation.
  • Dyspnea. This symptom means the transition of the disease to stage 2. Usually it is of the mixed type, less often - only with difficulty in exhaling. In the initial stages, it manifests itself only with strong physical stress, intensifying during acute respiratory infections. As the patient progresses, shortness of breath increases, limiting the patient's activity. In severe pathology, it develops into respiratory failure.

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

Exacerbation of COPD

If the patient's condition constantly worsens for 2 or more days, this phase is called an exacerbation. In this case, the main symptoms of the disease intensify, an increased temperature is observed. Depending on the severity of the pathology, the frequency of recurrence of such periods can fluctuate within wide limits. The intervals between them are called remission phases. Exacerbation of the disease has its own characteristics of the course:

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

Complications

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

  • Bronchial obstruction... It develops from the first stages of chronic obstructive pulmonary disease and gradually progresses. This process usually begins in the small bronchi. This results in increased resistance in the lower airways. Due to the deformation of the alveoli, the lung tissue loses its elasticity, pulmonary fibrosis is formed.
  • Pulmonary hypertension... The main complications of COPD affect the cardiovascular system. Hypertension provokes a narrowing of the circulatory system in the respiratory organs, aggravated by thickening of the walls of blood vessels. This increases the level of pressure required for blood to flow through the network of capillaries that feed the lung.
  • Pulmonary heart e. For what reasons in some patients there is an increase in the right ventricle, is still not fully known.
  • Hyperinflation of the lungs... At the same time, the lungs overflow with air and are not completely emptied when exhaling. This gradually weakens the breathing muscles, changing the shape of the diaphragm. This state is especially felt during physical exertion, not allowing to increase the depth of breathing.
  • Emphysema. Since the connection of the small bronchi with the alveoli is broken, this negatively affects their patency.
  • General intoxication of the body... In some patients, muscle weakness develops, and an inflammatory reaction syndrome is often present. All this leads to a decrease in physical activity, a general deterioration in well-being.

Diagnostics

For a correct diagnosis, it is initially necessary to determine whether a person is exposed to risk factors for developing chronic obstructive pulmonary disease. If the patient smokes, the level of possible danger caused by this habit should be calculated at all times. This will help the so-called smoker's index, calculated by the formula: (number of daily smoked cigarettes * total experience (years)) / 20. If the resulting number is more than 10, the danger of getting sick is very real. Diagnosis of COPD includes the following steps:

  • Clinical and biochemical blood test... It is recommended to do it 2 times a year, as well as during periods of exacerbation.
  • Sputum analysis. Determination of its macro- and microscopic properties. If necessary, conduct a study for bacteriology.
  • Electrocardiogram... Since chronic obstructive pulmonary disease often causes complications in the heart, it is advisable to repeat this procedure 2 times a year.
  • X-ray of the sternum. You need to do it annually (this is at least).
  • Spirometry. It allows you to determine how severe the condition of the pathologies of the respiratory system is. It is necessary to pass once a year and more often in order to adjust the course of treatment in time.
  • Blood gas and pH analysis... Do at 3 and 4 degrees.
  • Oxyhemometry. Assessment of the degree of blood oxygen saturation by a non-invasive method. It is used in the exacerbation phase.
  • Monitoring the ratio of fluid to salt in the body... The presence of a pathological shortage of certain microelements is determined. It is important in exacerbation.
  • Differential diagnosis... Most often diff. diagnosed with lung cancer. In some cases, it is also required to exclude heart failure, tuberculosis, pneumonia.

The differential diagnosis of bronchial asthma and COPD is especially noteworthy. Although they are two separate diseases, they often occur in the same person (called overlap syndrome). The reasons and mechanisms of this are not fully understood, therefore, it is necessary to know the differences in their clinical manifestations. So, starting from grade 2, patients experience shortness of breath. After the addition of bronchial asthma, it intensifies, and as the pathologies progresses, asthma attacks become more frequent. This is a rather dangerous condition that can lead to death.

A full range of laboratory studies and a thorough study of the patient's history will allow to give the correct formulation of the diagnosis of the disease. These include the degree and severity of COPD, the presence of an exacerbation, the type of clinical presentation, and complications that have arisen.

Chronic obstructive disease treatment

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

COPD can be treated at home. The exceptions are the following cases:

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

In remission

To expand the bronchi, a complex of inhalations of bronchodilators is made (check the dosage with your doctor):

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

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

  • "Bromhexin", "Ambroxol" - reduce the secretory function of the respiratory system and change the composition of mucus, weakening its internal connections;
  • "Trypsin", "Chymotrypsin" - medications of a protein nature, actively interacting with the accumulated secretion, reducing its viscosity and eventually leading to destruction.

With exacerbation

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

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

In the elderly

For the elderly, an individual approach is required, since, due to some peculiarities, the course of the disease is most often severe. There are a number of factors to consider before treating them:

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

Nutrition

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

  • the use of a sufficient amount of proteins (slightly more than the norm) - meat and fish dishes, dairy products;
  • with a reduced body weight, you need a high-calorie diet;
  • multivitamin complexes;
  • reduced salt content in case of complications (pulmonary hypertension, bronchial asthma and others).

Prophylaxis

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

Effective prevention of COPD includes learning all the information about the disease, as well as knowing how to use the medical devices required during treatment. The patient should know how to do inhalations correctly, measure the highest rate of air exit from the lungs using a peak flow meter. And, of course, it is necessary to follow all the recommendations of the doctors.

COPD is a slowly progressive disease that can worsen and even die over time. Therapy can only slow down these processes, and the adequacy of its application directly depends on how much more the patient will be able to work. In some cases, periods of remission last up to several years, so such patients live for decades.

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