Chronic obstructive pulmonary disease - complications of COPD. Early signs of COPD COPD treatment methods

Among the pathologies to which organs are susceptible respiratory system, obstructive lesions stand apart due to the specific clinical manifestations. For this reason, such diseases are little known, and patients are often frightened, and with good reason, when they are diagnosed with COPD. Our experts will tell you what it is and how to treat it.

The obscure acronym COPD hides chronic obstructive pulmonary disease - a progressive disease characterized by irreversible processes in the tissues of all parts of the respiratory system.

According to the standards of the World Health Organization, a COPD code according to ICD 10 means that International classification diseases of the tenth revision, the disease belongs to the category of respiratory organs.

WHO experts consider activities to reduce the number of factors that reduce the risk of developing COPD to be a priority.

To understand how serious such lung lesions are for health, it is not necessary to delve into the underlying processes that occur during the development of COPD. What kind of disease this is becomes clear from his prognosis - there is practically no chance of recovery.

Clinical picture

A characteristic feature of COPD is a modification of the structure of the bronchi, as well as lung tissue and blood vessels. As a result of exposure to irritating factors, inflammatory processes occur on the bronchial mucosa, reducing local immunity.

Against the background of inflammation, the production of bronchial mucus becomes more intense, but its viscosity increases, making it difficult to remove secretions naturally. For bacteria, such stagnation is the best stimulator for development and reproduction.

Due to bacterial activity, the patency of bronchial communications connecting the alveoli with air, the structure of the trachea and lung tissue are gradually disrupted.

Further progress of the disease leads to irreversible processes causing the development of fibrosis and emphysema:

swelling of the bronchial mucosa;
spasms of smooth pulmonary muscles;
increasing secretion viscosity.

These pathologies are characterized by proliferation connective tissue and abnormal expansion of distal air-filled areas.

Provoking factors

Harmful factors are the basis for the occurrence of COPD. One of the main factors causing irreversible pulmonary obstruction is smoking. It is in vain that smokers think that their health remains the same after many years of adherence to a bad habit. The prerequisites for the development of the disease take more than one day, or even a year, to form - most often, a disappointing diagnosis is given to those over 40.

Passive smokers are also at risk.

Inhalation tobacco smoke not only irritates the mucous membrane of the respiratory tract, but also gradually destroys their tissue. Loss of elasticity of alveolar fibers is one of the first signs of developing obstruction. However, at this stage, the symptoms of the disease are not sufficiently pronounced for the sick person to seek help from medicine.

Additional precipitating factors for COPD:

infectious diseases of the respiratory tract;
inhalation of harmful substances or gases;
pathogenic influence of the professional environment;
genetic predisposition to damage to lung tissue by elastase, due to deficiency of the protein alpha-1-atrypsin.

The occurrence and development of COPD is not associated with the course of other chronic processes in the organs of the respiratory system. But it belongs to a number of occupational pathologies affecting metallurgists, builders, miners, railway workers, employees of pulp and processing enterprises, as well as workers Agriculture involved in the processing of grain and cotton.

In terms of the number of deaths, COPD ranks fourth among the main pathologies of the working population.

Classification Features

The COPD classification provides for four stages of pathology development, determined by the level of complexity of its course. The main criteria for stratification are the presence of characteristic symptoms, as well as forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC), recorded after inhalation of a bronchodilator.

The main stages of COPD:

light. The functionality of external respiration is normal. The ratio between FEV1 and FVC is less than 70% of normal, which is regarded as a sign early development bronchial obstruction. Chronic symptoms may not be observed;
average. External respiratory function indicators are less than 80%. The ratio between FEV1 and FVC is less than 70% of normal, which confirms the progress of obstruction. The cough gets worse. Others present characteristic symptoms illness;
heavy. CVF1 indicators are less than 50% of the norm. The ratio of FEV1 and FVC is less than 70% of normal. Accompanied by a strong cough, copious sputum production and significant shortness of breath. Attacks of exacerbations appear;
extremely heavy. The functionality of external respiration is provided by less than 30%. It is characterized by the appearance of respiratory failure and the development of cor pulmonale with abnormal expansion of the right-sided parts of the heart.

The only thing a sick person can do is to diligently follow all the doctors’ recommendations in order to slow down the progress of the disease and improve overall well-being. The best thing a healthy person can and should do is to prevent the onset of the disease by making efforts to ensure preventive measures.

Symptoms of chronic obstructive pulmonary disease

Characteristic signs of COPD development appear at the stage of moderate severity. Until the onset of later stages, the disease occurs in a latent form and may be accompanied by a slight cough that appears occasionally. As the pathology develops, the cough is accompanied by the production of mucous sputum.

About ten years after the appearance early symptoms, shortness of breath develops - a feeling of lack of air accompanies physical activity. Over the years, the intensity of shortness of breath increases. In severe COPD, shortness of breath forces a person to stop every hundred meters. In an extremely severe form of the disease, the patient is not only unable to leave the house on his own, but also to change clothes.

Severe symptoms of COPD occur when the development of the pathology reaches a severe phase:

coughing attacks become prolonged and regular;
the volume of secreted mucous sputum increases significantly, and when an extremely severe stage occurs, pus appears in the sputum;
shortness of breath occurs even at rest.

Pathological processes characteristic of COPD lead to pathophysiological changes in all parts of the respiratory system and are accompanied by systemic manifestations in the form of skeletal muscle dysfunction and loss of muscle mass.

Clinical forms

Depending on the intensity of the expression of the symptoms of the disease and their characteristics, two clinical forms of COPD are distinguished - bronchial and emphysema.

The main criteria for determining the clinical form are applicable only at the last stages of pathology development:

predominance of cough, shortness of breath;
severity of bronchial obstruction;
severity of pulmonary hyperventilation - weak or strong;
cyanosis color - blue or pinkish-gray;
period of formation of the pulmonary heart;
presence of polycythemia;
severity of cachexia;
age at which it is possible death.

Loss of physical performance, as well as disability, is an inevitable consequence of the progress of COPD.

Treatment of chronic obstructive disease:

Due to the fact that timely diagnosis is not possible, treatment for COPD most often begins when the moderate or severe stage occurs. Anamnesis collection involves identifying individual risk factors - determining the smoker index, the presence of infections.

For differential diagnosis with bronchial asthma study the parameters characterizing shortness of breath when exposed to a provoking stimulus.

To confirm the diagnosis, spirometry is performed - measuring the volume and speed characteristics of breathing to determine its functionality.

The following are used as additional diagnostic measures:

sputum cytology,
blood test to detect polycythemia;
study of blood gas composition;
chest x-ray;
bronchoscopy.

Only after clarifying the diagnosis and determining the stage and form of the disease, treatment is prescribed.

In remission

During periods of decline in acute manifestations of COPD, patients are recommended to use bronchodilators that increase the lumen of the bronchi, mucolytics that dilute sputum, as well as inhaled glucocorticosteroids.

During exacerbations

The exacerbation phase of COPD is characterized by a sharp and significant deterioration in the patient’s well-being and lasts about two days. To reduce the intensity of the disease, pulmonologists prescribe antibacterial therapy.

The choice of antibiotic drugs is carried out taking into account the type of bacterial flora inhabiting the lungs. Preference is given to drugs combining penicillins and clavulanic acid, respiratory fluoroquinolones, and second-generation cephalosporins.

In the elderly

Treatment of COPD in older people involves not only the use of drug therapy, but also the use of folk remedies, providing aerobic exercise and preventive measures, including quitting smoking and correcting respiratory failure.

Traditional methods and means of treating COPD

The use of traditional medicine recommendations for COPD has several goals:

alleviation of symptoms;
slowing down pathological progress;
launch of regeneration mechanisms;
restoration of the patient's vitality.

Most effective way effects on tissues affected by COPD are considered inhalations based on plant materials - oregano, mint, calendula, chamomile, as well as essential oils pine and eucalyptus.

To enhance the therapeutic effect, infusions of anise seeds, pansies, marshmallow, lungwort, plantain, heather, Icelandic moss, thyme and sage are used.

Breathing exercises

Aerobic exercise and a set of breathing exercises form the basis of rehabilitation for patients with COPD. Thanks to breathing exercises, weakened intercostal muscles are included in the breathing process, the smooth muscles of the lungs are strengthened, and at the same time, the psychological condition sick.

One of the exercises: inhale through your nose and at the same time raise your arms up, bend your back and move your leg back. Then exhale through your mouth and return to the starting position. When repeating the exercise, the left and right legs are abducted alternately.

Exercises are allowed only during the period of remission.

Prevention of COPD

The basis for the prevention of COPD is considered to be smoking cessation, since it is tobacco smoke that provokes the appearance of destructive processes in the lungs.

In addition, the following measures will help eliminate the likelihood of developing COPD:

compliance with labor protection requirements during hazardous work;
protection of the respiratory system from contact with substances hazardous to health;
strengthening the immune system - physical activity, hardening, maintaining a daily routine;
healthy eating.

To prevent COPD, the World Health Organization has developed a convention to combat the globalization of tobacco products. The agreement was signed by representatives of 180 countries.

The disease in question is an inflammatory disease that affects the distal parts of the lower respiratory tract, and which is chronic. Against the background of this pathology, the lung tissue and blood vessels are modified, and the patency of the bronchi is significantly impaired.

Main sign of COPD– the presence of obstructive syndrome, in which patients can be diagnosed with bronchial inflammation, bronchial asthma, secondary pulmonary emphysema, etc.

What is COPD - the causes and mechanism of chronic obstructive pulmonary disease

According to the World Health Organization, the disease in question tops the 4th place in the list of causes of death.

Video: Chronic obstructive pulmonary disease

This pathology is formed under the influence of not one, but a number of factors, which include:

Tobacco smoking. This bad habit– the most common cause of COPD. An interesting fact is that among village residents, chronic obstructive pulmonary disease occurs in more severe forms than among urban residents. One of the reasons for this phenomenon is the lack of lung screening among smokers after 40 years of age in Russian villages.
Inhalation of harmful microparticles at work. In particular, this applies to cadmium and silicon, which are released into the air during the processing of metal structures, as well as due to fuel combustion. Those at increased risk include miners, railway workers, construction workers who often come into contact with cement-containing mixtures, and agricultural workers who process cotton and grain crops.
Unfavorable environmental conditions.
Frequent respiratory infections in preschool and school periods.
Associated ailments of the respiratory system: bronchial asthma, tuberculosis, etc.
Prematurity of babies. At birth, their lungs do not expand completely. This affects their functioning and can cause serious exacerbations in the future.
Congenital protein deficiency, which is produced in the liver and is designed to protect lung tissue from the destructive effects of elastase.

Against the background of genetic aspects, as well as unfavorable natural factors, inflammatory phenomena occur in the inner lining of the bronchi, which become chronic.

This pathological condition leads to a modification of the bronchial mucus: it becomes larger, its consistency changes. This causes disruptions in the patency of the bronchi, and provokes the development degenerative processes in the pulmonary alveoli. The overall picture may be aggravated by the addition of bacterial exacerbations, which provokes re-infection of the lungs.

In addition, the disease in question can cause disturbances in the functioning of the heart, which is reflected in the quality of blood supply to the respiratory system. This condition when chronic forms– the cause of death in 30% of patients diagnosed with chronic obstructive pulmonary disease.

Signs and symptoms of chronic obstructive pulmonary disease - how to notice in time?

On initial stages development, the pathology in question is often doesn't show itself at all. The typical symptomatic picture appears in moderate stages.

Video: What is COPD and how to detect it in time?

This pulmonary disease has two typical symptoms:

Cough. It makes itself felt most often after waking up. During the coughing process, a certain amount of sputum is released, which is viscous in consistency. When bacterial agents are involved in the pathological process, the sputum becomes purulent and profuse. Patients often associate this phenomenon with smoking or working conditions; therefore, they do not often go to a medical institution for advice.
Shortness of breath. At the beginning of the development of the disease, a similar symptom appears when walking quickly or climbing a hill. As COPD develops, a person becomes out of breath even when walking a hundred meters. This pathological condition causes the patient to move slower than healthy people. In some cases, patients complain of shortness of breath while undressing/dressing.

According to its clinical manifestations, this pulmonary pathology is divided into 2 types:

Bronchitic. The symptomatic picture here is clearly expressed. This is associated with purulent-inflammatory phenomena in the bronchi, which is manifested by a strong cough and copious mucous discharge from the bronchi. The patient's body temperature rises, he constantly complains of fatigue and lack of appetite. The skin acquires a bluish tint.
Emphysematous. It is characterized by a more favorable course - patients with this type of COPD often live up to 50 years of age. A typical symptom of the emphysematous type of disease is difficulty breathing. The sternum becomes barrel-shaped and the skin becomes pinkish-gray.

Chronic obstructive pulmonary disease affects not only the functioning of the respiratory system; almost the entire body suffers.

The most common violations include:

Degenerative phenomena in the walls of blood vessels, which provokes the formation of atherosclerotic plaques - and increases the risk of blood clots.
Errors in heart function. Patients with COPD are often diagnosed with a systematic increase blood pressure, coronary heart disease. The possibility cannot be ruled out acute heart attack myocardium.
Atrophic processes in muscles that are involved in respiratory function.
Serious impairment of kidney function.
Mental disorders, the nature of which is determined by the stage of development of COPD. Such disorders may include sleep apnea, poor sleep, difficulty remembering events, and difficulty thinking. In addition, patients often feel sad and anxious and often become depressed.
Reduced defense reactions of the body.

COPD stages - classification of chronic obstructive pulmonary disease

According to the international medical classification, the disease in question goes through 4 stages.

Video: COPD. Why is it not easy for the lungs?

At the same time, when dividing the disease into specific forms, two main indicators are taken into account:

Forced expiratory volume - FEV .
Forced vital capacity - FVC – after taking medications that relieve symptoms of acute bronchial asthma. Normally, FVC should not exceed 70%.

Let us consider the main stages of development of this pulmonary pathology in more detail:

Zero stage. Standard symptoms at this stage are a regular cough with slight sputum production. At the same time, everyone’s lungs function without disturbance. This pathological condition does not always develop into COPD, but there is still a risk.
First (mild) stage. The cough becomes chronic and sputum is produced regularly. Diagnostic measures can reveal minor obstructive errors.
Second (moderate) stage. Obstructive disorders intensify. The symptomatic picture becomes more pronounced when physical activity. There are difficulties with breathing.
Third (severe) stage. The air flow during exhalation is limited in volume. Exacerbations become a regular occurrence.
Fourth (extremely severe) stage. Exists serious risk for the life of the patient. Typical complications at this stage of COPD development are respiratory failure and serious disruptions in the functioning of the heart, which affect the quality of blood circulation.

Chronic obstructive pulmonary disease (COPD diagnosis) is a pathological process characterized by partial restriction of air flow in the respiratory tract. The disease causes irreversible changes in the human body, so there is a great threat to life if treatment is not prescribed on time.

Causes

The pathogenesis of COPD is not yet fully understood. But experts identify the main factors causing the pathological process. As a rule, the pathogenesis of the disease includes progressive bronchial obstruction. The main factors influencing the formation of the disease are:

Smoking.
Unfavorable conditions of professional activity.
Damp and cold climate.
Infection of mixed origin.
Acute protracted bronchitis.
Lung diseases.
Genetic predisposition.

What are the manifestations of the disease?

Chronic obstructive pulmonary disease is a pathology that is most often diagnosed in patients aged 40 years. The first symptoms of the disease that the patient begins to notice are cough and shortness of breath. Often this condition occurs in combination with whistling breathing and sputum discharge. At first it comes out in a small volume. Symptoms become more pronounced in the morning.

Cough is the very first sign that worries patients. During the cold season, respiratory diseases worsen, which play an important role in the formation of COPD. Obstructive pulmonary disease has the following symptoms:

Shortness of breath, which bothers you when doing physical activity, and then can affect a person during rest.
When exposed to dust and cold air, shortness of breath increases.
Symptoms are complemented by an unproductive cough with difficult to produce sputum.
Dry wheezing at a high rate when exhaling.
Symptoms of emphysema.

Stages

The classification of COPD is based on the severity of the disease. In addition, it assumes the presence clinical picture and functional indicators.

The classification of COPD involves 4 stages:

The first stage - the patient does not notice any pathological abnormalities. He may have a chronic cough. Organic changes are uncertain, so it is not possible to diagnose COPD at this stage.
The second stage - the disease is not severe. Patients consult a doctor about shortness of breath while performing physical exercise. Chronic obstructive pulmonary disease is also accompanied by an intense cough.
The third stage of COPD is accompanied by a severe course. It is characterized by the presence of limited air flow into Airways, therefore, shortness of breath occurs not only during physical exertion, but also at rest.
The fourth stage is an extremely severe course. The resulting symptoms of COPD are life-threatening. Obstruction of the bronchi is observed and a pulmonary heart is formed. Patients diagnosed with stage 4 COPD receive disability.

Diagnostic methods

Diagnosis of the presented disease includes the following methods:

Spirometry is a research method that makes it possible to determine the first manifestations of COPD.
Measuring the vital capacity of the lungs.
Cytological examination of sputum. This diagnosis makes it possible to determine the nature and severity of the inflammatory process in the bronchi.
A blood test can detect increased concentrations of red blood cells, hemoglobin and hematocrit in COPD.
X-ray of the lungs allows you to determine the presence of compaction and changes in the bronchial walls.
ECGs provide data on the development of pulmonary hypertension.
Bronchoscopy is a method that allows you to establish a diagnosis of COPD, as well as view the bronchi and determine their condition.

Treatment

Chronic obstructive pulmonary disease is a pathological process that cannot be cured. However, the doctor prescribes a certain therapy to his patient, thanks to which it is possible to reduce the frequency of exacerbations and prolong a person’s life. The course of prescribed therapy is greatly influenced by the pathogenesis of the disease, because it is very important to eliminate the cause that contributes to the occurrence of pathology. In this case, the doctor prescribes the following measures:

Treatment of COPD involves the use of medications whose action is aimed at increasing the lumen of the bronchi.
To liquefy sputum and remove it, mucolytic agents are used in the therapy process.
Help to dock inflammatory process with the help of glucocorticoids. But their long-term use is not recommended, as serious side effects begin to occur.
If there is an exacerbation, then this indicates the presence of an infectious origin. In this case, the doctor prescribes antibiotics and antibacterial drugs. Their dosage is prescribed taking into account the sensitivity of the microorganism.
For those suffering from heart failure, oxygen therapy is necessary. In case of exacerbation, the patient is prescribed sanitary treatment.
If the diagnosis confirms the presence of pulmonary hypertension and COPD, accompanied by reporting, then treatment includes diuretics. Glycosides help eliminate manifestations of arrhythmia.

COPD is a disease that cannot be treated without a properly formulated diet. The reason is that loss of muscle mass can lead to death.

A patient may be admitted to hospital treatment if he:

greater intensity of increase in the severity of manifestations;
treatment does not give the desired result;
new symptoms arise;
heart rhythm is disrupted;
diagnostics determines diseases such as diabetes, pneumonia, insufficient performance of the kidneys and liver;
it is not possible to provide medical care on an outpatient basis;
Difficulties in diagnosis.

Preventive actions

Prevention of COPD includes a set of measures thanks to which every person can protect their body from this pathological process. It consists of implementing the following recommendations:

Pneumonia and influenza are the most common reasons formation of COPD. Therefore, it is necessary to get a flu shot every year.
Once every 5 years, vaccinate against pneumococcal infection, thanks to which you can protect your body from pneumonia. Only the attending physician can prescribe vaccination after an appropriate examination.
Smoking taboo.

Complications of COPD can be very diverse, but, as a rule, they all lead to disability. Therefore, it is important to carry out treatment on time and be under the supervision of a specialist at all times. And it is best to carry out high-quality preventive measures in order to prevent the formation of a pathological process in the lungs and to protect yourself from this disease.

Is everything in the article correct from a medical point of view?

Answer only if you have proven medical knowledge

Diseases with similar symptoms:

Asthma is a chronic disease characterized by short-term attacks of breathlessness caused by spasms in the bronchi and swelling of the mucous membrane. This disease has no specific risk group or age restrictions. But, as it shows medical practice, women suffer from asthma 2 times more often. According to official data, today there are more than 300 million people living with asthma in the world. The first symptoms of the disease most often appear in childhood. Elderly people suffer from the disease much more difficult.

Update: October 2018

Chronic obstructive pulmonary disease (COPD) is a pressing problem of modern pulmonology, directly related to violations of the environmental well-being of humanity and, first of all, to the quality of inhaled air. This pulmonary pathology is characterized by a continuing disturbance in the rate of air movement in the lungs with a tendency to progress and involve other organs and systems in the pathological process in addition to the lungs.

COPD is based on inflammatory changes in the lungs that occur under the influence of tobacco smoke, exhaust gases and other harmful impurities of atmospheric air.

The main feature of COPD is the ability to prevent its development and progression.

Today, according to WHO, this disease is the fourth most common cause of death. Patients die from respiratory failure, cardiovascular pathologies associated with COPD, lung cancer and tumors of other localizations.

Overall, a person with this disease in terms of economic losses (absenteeism, less efficient work, hospitalization costs and outpatient treatment) exceeds a patient with bronchial asthma three times.

Who is at risk of getting sick?

In Russia, approximately every third man over 70 has chronic obstructive pulmonary disease.

Smoking is the number one risk for COPD.
This is followed by hazardous industries (including those with high dust levels in the workplace) and life in industrial cities.
Persons over 40 years of age are also at risk.

Predisposing factors for the development of pathology (especially in young people) include genetically determined disorders of the formation of connective tissue of the lungs, as well as prematurity of infants, in which the lungs lack the surfactant that ensures their full expansion with the onset of breathing.

Epidemiological studies of differences in the development and course of COPD in urban and rural residents of the Russian Federation are interesting. More severe forms of pathology, purulent and atrophic endobronchitis, are more typical for rural residents. In them, chronic obstructive pulmonary disease is more often combined with other severe somatic diseases. The culprits for this are most likely the insufficient availability of qualified medical care in a Russian village and the lack of screening studies (spirometry) among a wide range of smokers over 40 years of age. At the same time, the psychological status of rural residents with COPD does not differ from that of city residents, which demonstrates both chronic hypoxic changes in the central nervous system in patients with this pathology, regardless of place of residence, and the general level of depression in Russian cities and villages.

Variants of the disease, stages

There are two main types of chronic obstructive pulmonary disease: bronchitis and emphysematous. The first includes predominantly manifestations of chronic bronchitis. The second is emphysema. Sometimes a mixed variant of the disease is also isolated.

With emphysematous variant there is an increase in the airiness of the lungs due to the destruction of the alveoli, functional disorders are more pronounced, determining a drop in blood oxygen saturation, a decrease in performance and manifestations of cor pulmonale. When describing the appearance of such a patient, the phrase “pink puffer” is used. Most often, this is a smoking man about 60 years old with underweight, a pink face and cold hands, suffering from severe shortness of breath and a cough with scanty mucous sputum.
Chronical bronchitis manifests itself as a cough with sputum (for three months over the last 2 years). A patient with this type of pathology fits the “blue edema” phenotype. This is a woman or man about 50 years old with a tendency to be overweight, with diffuse cyanosis of the skin, a cough with copious mucopurulent sputum, prone to frequent respiratory infections, often suffering from right ventricular heart failure (cor pulmonale).

In this case, the pathology can occur for a fairly long period of time without manifestations registered by the patient, developing and progressing slowly.

The pathology has phases of stability and exacerbation. In the first case, the manifestations remain unchanged for weeks or even months, the dynamics are monitored only when observed over the course of a year. An exacerbation is marked by worsening symptoms for at least 2 days. Frequent exacerbations (from 2 in 12 months or exacerbations that resulted in hospitalization due to the severity of the condition), after which the patient leaves with reduced lung functionality, are considered clinically significant. In this case, the number of exacerbations affects the life expectancy of patients.

A separate option highlighted in last years, there was an association of bronchial asthma/COPD, which developed in smokers who had previously suffered from asthma (the so-called overlap syndrome or cross syndrome). At the same time, oxygen consumption by tissues and the body’s adaptive capabilities are further reduced.

The stage classification of this disease was canceled by the GOLD expert committee in 2011. The new assessment of severity levels combined not only indicators of bronchial patency (according to spirometry data, see Table 3), but also clinical manifestations recorded in patients, as well as the frequency of exacerbations. See table 2

To assess risks, questionnaires are used, see Table 1

Diagnosis

The diagnosis of chronic obstructive pulmonary disease looks like this:

chronic obstructive pulmonary disease
(bronchitis or emphysematous variant),
mild (moderate, severe, extremely severe) COPD,
expressed clinical symptoms(risk according to the questionnaire is greater than or equal to 10 points), unexpressed symptoms (<10),
rare (0-1) or frequent (2 or more) exacerbations,
accompanying pathologies.

Sex differences

In men, COPD is statistically more common (due to smoking). Moreover, the frequency of the occupational variant of the disease is the same for people of both sexes.

In men, the disease is better compensated by breathing exercises or physical training, they are less likely to suffer from exacerbations and rate their quality of life more highly during illness.
Women are characterized by increased bronchial reactivity, more pronounced shortness of breath, but better indicators of oxygen saturation of tissues with the same patency of the bronchial tree as men.

Symptoms of COPD

Early manifestations of the disease include complaints of cough and (or) shortness of breath.

The cough most often appears in the morning, and this or that amount of mucous sputum is released. There is a connection between cough and periods of upper respiratory tract infections. Since the patient often associates a cough with smoking or the influence of unfavorable factors in the air environment, he does not pay due attention to this manifestation and is rarely examined in more detail.
The severity of shortness of breath can be assessed using the British Medical Council (MRC) scale. It is normal to feel short of breath during intense physical activity.
1. Mild shortness of breath 1st degree- this is forced breathing when walking quickly or climbing a gentle hill.
2. Moderate severity and 2nd degree- shortness of breath, forcing you to walk slower on level ground than a healthy person.
3. Severe shortness of breath 3rd degree a condition is recognized when the patient suffocates while walking a hundred meters or after a few minutes of walking on level ground.
4. Very severe shortness of breath, grade 4 occurs when dressing or undressing, as well as when leaving the house.

The intensity of these manifestations varies from stability to exacerbation, during which the severity of shortness of breath increases, the volume of sputum and the intensity of cough increase, the viscosity and nature of the sputum discharge changes. The progression of the pathology is uneven, but gradually the patient’s condition worsens, and extrapulmonary symptoms and complications appear.

Non-pulmonary manifestations

Like any chronic inflammation, chronic obstructive pulmonary disease has a systemic effect on the body and leads to a number of disorders not related to the physiology of the lungs.

Dysfunction of skeletal muscles involved in breathing (intercostal muscles), muscle atrophy.
Damage to the internal lining of blood vessels and the development of atherosclerotic lesions, increasing the tendency to thrombus formation.
Damage to the cardiovascular system arising from the previous circumstance (arterial hypertension, coronary heart disease, including acute myocardial infarction). At the same time, for people with arterial hypertension against the background of COPD, left ventricular hypertrophy and its dysfunction are more typical.
Osteoporosis and associated spontaneous fractures of the spine and tubular bones.
Renal dysfunction with a decrease in glomerular filtration rate, reversible decrease in the amount of urine excreted.
Emotional and mental disorders are expressed in disability, a tendency to depression, reduced emotional background, and anxiety. Moreover, the greater the severity of the underlying disease, the less amenable to correction are emotional disorders. Patients also experience sleep disturbances and sleep apnea. A patient with moderate to severe COPD often demonstrates cognitive impairment (memory, thinking, and learning ability suffer).
In the immune system, there is an increase in phagocytes and macrophages, which, however, decrease in activity and ability to absorb bacterial cells.

Complications

Pneumonia
Pneumothorax
Acute respiratory failure
Bronchiectasis
Pulmonary hemorrhages
Pulmonary hypertension complicates up to 25% of moderate cases of pulmonary obstruction and up to 50% of severe forms of the disease. Its numbers are slightly lower than for primary pulmonary hypertension and do not exceed 50 mmHg. Often it is the increase in pressure in the pulmonary artery that becomes the culprit in hospitalization and mortality of patients.
Cor pulmonale (including its decompensation with severe circulatory failure). The formation of cor pulmonale (right ventricular heart failure) is undoubtedly influenced by the length and amount of smoking. In smokers with forty years of experience, cor pulmonale is an almost mandatory accompaniment of COPD. Moreover, the formation of this complication does not differ for bronchitis and emphysematous variants of COPD. It develops or progresses as the underlying pathology progresses. In approximately 10-13 percent of patients, cor pulmonale decompensates. Pulmonary hypertension is almost always associated with dilatation of the right ventricle; only in rare patients the size of the right ventricle remains normal.

The quality of life

To assess this parameter, the SGRQ and HRQol Questionnaires, Pearson χ2 and Fisher tests are used. The age at which smoking began, the number of packs smoked, the duration of symptoms, the stage of the disease, the degree of shortness of breath, the level of blood gases, the number of exacerbations and hospitalizations per year, the presence of concomitant chronic pathologies, the effectiveness of basic treatment, participation in rehabilitation programs are taken into account.

One of the factors that must be taken into account when assessing the quality of life of patients with COPD is the length of smoking and the number of cigarettes smoked. Research confirms this. That with increasing smoking experience in COPD patients, social activity significantly decreases, and depressive symptoms increase, which are responsible for a decrease not only in working capacity, but also in the social adaptability and status of patients.
The presence of concomitant chronic pathologies of other systems reduces the quality of life due to the syndrome of mutual burden and increases the risk of death.
Older patients have worse functional indicators and ability to compensate.

Diagnostic methods for detecting COPD

Spirometry becomes a screening method for detecting pathology. The relative cheapness of the method and the ease of diagnostics make it possible to reach a fairly wide mass of patients at the primary diagnostic and treatment level. Diagnostically significant signs of obstruction are difficulties with exhalation (a decrease in the ratio of forced expiratory volume to forced vital capacity less than 0.7).
In persons without clinical manifestations of the disease, changes in the expiratory part of the flow-volume curve may be alarming.
Additionally, if difficulties with exhalation are detected, drug tests are performed using inhaled bronchodilators (Salbutamol, Ipratropium bromide). This makes it possible to separate patients with reversible obstructions of bronchial obstruction (bronchial asthma) from patients with COPD.
Less commonly used are daily monitoring of respiratory function in order to clarify the variability of disorders depending on the time of day, load, and the presence of harmful factors in the inhaled air.

Treatment

When choosing a strategy for managing patients with this pathology, the urgent tasks are to improve the quality of life (primarily by reducing the manifestations of the disease and improving exercise tolerance). In the long term, we need to strive to limit the progression of bronchial obstruction, reduce possible complications, and ultimately limit the risks of death.

Primary tactical measures should be considered non-drug recovery: reducing the effect of harmful factors in the inhaled air, educating patients and potential victims of COPD, familiarizing them with risk factors and methods for improving the quality of inhaled air. Also, for patients with mild pathology, physical activity is indicated, and for severe forms, pulmonary rehabilitation.

All patients with COPD should be vaccinated against influenza, as well as against pneumococcal infection.

The volume of medication provided depends on the severity of clinical manifestations, stage of pathology, and the presence of complications. Today, preference is given to inhaled forms of drugs received by patients both from individual metered dose inhalers and using nebulizers. The inhalation route of administration not only increases the bioavailability of drugs, but also reduces the systemic exposure and side effects of many groups of drugs.

It should be remembered that the patient must be trained to use inhalers of various modifications, which is important when replacing one drug with another (especially with preferential drug provision, when pharmacies are often not able to supply patients with the same dosage forms constantly and a transfer from one drug is required drugs to others).
Patients themselves should carefully read the instructions for spinhallers, turbuhallers and other dosing devices before starting therapy and do not hesitate to ask doctors or pharmacists about the correct use of the dosage form.
You should also not forget about rebound phenomena, which are relevant for many bronchodilators, when if the dosage regimen is exceeded, the drug ceases to help effectively.
When replacing combination drugs with a combination of individual analogues, the same effect is not always achieved. If the effectiveness of treatment decreases and painful symptoms recur, you should inform your doctor rather than try to change the dosage regimen or frequency of administration.
The use of inhaled corticosteroids requires constant prevention of fungal infections of the oral cavity, so one should not forget about hygienic rinses and limiting the use of local antibacterial agents.

Medicines, drugs

Bronchodilators assigned either permanently or on a demand basis. Long-acting inhalation forms are preferred.
- Long-term beta-2 agonists: Formoterol (aerosol or powder inhaler), Indacaterol (powder inhaler), Olodaterol.
- Short-acting agonists: Salbutamol or Fenoterol aerosols.
- Short-acting anticholinergic dilators - Ipratropium bromide aerosol, long-term - powder inhalers Tiotropium bromide and Glycopyrronium bromide.
- Combined bronchodilators: aerosols Fenoterol plus Ipratropium bromide (Berodual), Salbutamol plus Ipratropium bromide (Combivent).
Glucocorticosteroids in inhalers have low systemic and side effects, well increase bronchial patency. They reduce the number of complications and improve the quality of life. Aerosols of Beclamethasone dipropionate and Fluticasone propionate, powder Budesonide.
Combinations of glucocorticoids and beta2-agonists helps reduce mortality, although it increases the risk of developing pneumonia in patients. Powder inhalers: Formoterol with Budesonide (Symbicort turbuhaller, Formisonide, Spiromax), Salmeterol, aerosols: Fluticasone and Formoterol with Beclomethasone dipropionate (Foster).
Methylxanthine Theophylline in low doses reduces the frequency of exacerbations.
Phosphodiesterase-4 inhibitor – Roflumilast reduces exacerbations of severe forms of the bronchitis variant of the disease.

Dosing regimens and regimens

For mild and moderate COPD with mild symptoms and rare exacerbations, Salbutamol, Fenoterol, Ipratropium bromide in an “on demand” mode are preferable. An alternative is Formoterol, Tiotropium bromide.
For the same forms with clear clinical manifestations, Foroterol, Indacaterol or Tiotropium bromide, or their combinations.
Moderate and severe course with a significant decrease in forced expiratory volume with frequent exacerbations, but unexpressed clinical symptoms, requires the appointment of Formoterol or Indacaterol in combination with Budesonide, Beclamethoazone. That is, they often use inhaled combination drugs Symbicort and Foster. Isolated administration of Tiotropium bromide is also possible. An alternative is to prescribe long-term beta-2 agonists and tiotropium bromide in combination or tiotropium bromide and roflumilast.
Moderate and severe course with severe symptoms are Formoterol, Budesonide (Beclamethasone) and Tiotropium bromide or Roflumilast.

Exacerbation of COPD requires not only an increase in the dose of the main drugs, but also the addition of glucocorticosteroids (if they were not previously prescribed) and antibiotic therapy. Severe patients often have to be transferred to oxygen therapy or artificial ventilation.

Oxygen therapy

The increasing deterioration of oxygen supply to tissues requires additional oxygen therapy in a constant mode when the partial pressure of oxygen decreases from 55 mmHg and saturation is less than 88%. Relative indications include cor pulmonale, blood thickening, and edema.

However, patients who continue to smoke, are not receiving medication, or are not amenable to oxygen therapy do not receive this type of care.

The duration of treatment takes about 15 hours a day with breaks no longer than 2 hours. The average oxygen supply rate is from 1-2 to 4-5 liters per minute.

An alternative for patients with less severe ventilation disorders is long-term home ventilation. It involves the use of oxygen respirators at night and for several hours during the day. The selection of ventilation modes is carried out in a hospital or respiratory center.

Contraindications to this type of therapy include low motivation, patient agitation, swallowing disorders, and the need for long-term (about 24 hours) oxygen therapy.

Other methods of respiratory therapy include percussion drainage of bronchial contents (small volumes of air are supplied into the bronchial tree at a certain frequency and under a certain pressure), as well as breathing exercises with forced exhalation (inflating balloons, breathing through the mouth through a tube) or.

Pulmonary rehabilitation should be provided to all patients. starting from 2nd degree of severity. It includes training in breathing exercises and physical exercises, and, if necessary, oxygen therapy skills. Psychological assistance is also provided to patients, they are motivated to change their lifestyle, trained to recognize signs of worsening disease and the skills to quickly seek medical help.

Thus, at the present stage of development of medicine, chronic obstructive pulmonary disease, the treatment of which has been worked out in sufficient detail, is a pathological process that can not only be corrected, but also prevented.