Chronic obstructive pulmonary disease (COPD) is an independent progressive disease, which is characterized not only by the inflammatory component, but also by structural changes in the vessels and lung tissue. In addition, serious violations of bronchial obstruction should be mentioned. Such obstruction is localized in the region of the distal bronchi. This disease is delimited from a number of typical chronic processes of the important respiratory system.

It has been proven that chronic obstructive pulmonary disease most often affects men over 40 years of age. It occupies a leading position among all causes of disability. Moreover, the risk of mortality is high even among the able-bodied part of the population.

With an increase in the production of bronchial mucus and an increase in its viscosity, the most favorable conditions are created for the rapid reproduction of bacteria. In this case, the patency of the bronchi is disturbed, the lung tissue and alveoli change. The progression of the disease directly leads to swelling of the bronchial mucosa, secretion of mucus and spasms of smooth muscles. Often, bacterial complications join COPD and recurrences of pulmonary infections occur.

It happens that the course of chronic obstructive pulmonary disease is greatly aggravated by serious gas exchange disorders, which are manifested by a significant decrease in oxygen in the blood and an increase in blood pressure. Such conditions provoke circulatory failure, which leads to death in approximately 30% of patients with this diagnosis.

Causes of COPD

The main reason is considered to be smoking. Among other factors that cause the development of chronic obstructive pulmonary disease, there are respiratory infections in childhood, occupational hazards, concomitant bronchopulmonary pathologies, as well as a deplorable state of the environment. In a small number of patients, the disease is based on a genetic predisposition, which is expressed by a deficiency of the alpha-1 antitrypsin protein. It is he who is formed in the tissues of the liver, protecting the lungs from serious damage.

As a rule, chronic obstructive pulmonary disease is considered an occupational disease of many railway workers, miners, construction workers, and workers who come into contact with cement. Often this disease occurs in specialists in the metallurgical and pulp and paper industries. Genetic predisposition and environmental factors cause inflammation of the inner lining of the bronchi of a chronic nature, which significantly reduces local immunity.

Symptoms and stages of COPD

There are several classifications of chronic obstructive pulmonary disease. At the zero stage, the disease is manifested by a strong secretion of sputum and a constant cough against the background of unchanged lung function. The first stage is characterized by chronic, sputum production and minor obstructive disorders. In moderate conditions, various clinical symptoms can be observed, which increase with a certain load. At the same time, pronounced obstructive disorders progress.

In the third stage of the disease, airflow limitation increases during exhalation. An increase in exacerbations and increased shortness of breath can be noted. In extremely severe conditions, severe forms of bronchial obstruction appear, which can threaten a person's life. Cor pulmonale develops and dangerous respiratory failure is diagnosed.

It should be mentioned that in the earliest stages of chronic obstructive pulmonary disease can be secretive. Often, the characteristic clinic of the disease manifests itself in moderate conditions. The course of COPD is characterized by a strong cough with shortness of breath and sputum. Sometimes in the early stages there is an episodic cough, accompanied by the release of a large amount of mucous sputum. During this period, shortness of breath during intense exertion also worries. Cough becomes permanent only as the disease progresses.

With the onset of a specific infection, shortness of breath is observed at rest, and sputum becomes purulent. The course of chronic obstructive pulmonary disease develops either according to the emphysematous or bronchial type. Many patients with bronchial types of the disease complain of cough, copious sputum. Intoxication, cyanosis of the skin and dangerous purulent inflammation in the bronchi can also be noted, as well as a significant expression of obstruction with mild pulmonary emphysema.

Patients with emphysematous type of COPD are characterized by expiratory dyspnea, which is characterized by difficult exhalation. At the same time, pulmonary emphysema strongly predominates over typical bronchial obstruction. The skin of patients is gray-pink, and the chest is barrel-shaped. It should be mentioned that with a favorable benign course, all patients survive to old age.

In most cases, the progressive development of the disease is complicated by acute respiratory failure and pneumonia. Spontaneous pneumothorax, secondary polycythemia, pneumosclerosis, and congestive heart failure are sometimes diagnosed. In very severe stages, some patients may develop cor pulmonale or pulmonary hypertension. In absolutely all cases, the disease leads to a decrease in the quality of life and activity.

Diagnosis of COPD

Timely diagnosis of chronic obstructive pulmonary disease can increase the life expectancy of patients and significantly improve their quality of life. When collecting anamnestic data, modern specialists always pay attention to production factors and the presence of bad habits. Spirometry is considered the main method of functional diagnostics. It reveals the initial signs of the disease.

Also important is the measurement of volume and speed indicators. These include vital capacity, forced capacity, and the volume of one forced exhalation per second. For diagnosing, the ratio and summation of the identified indicators is sufficient. To assess the severity and nature of inflammation of the bronchi, a cytological method is used to study the sputum of patients. In the acute phase, sputum always has a viscous and at the same time purulent character.

Clinical blood tests help to identify polycetomy, which is possible due to the development of dangerous hypoxemia only with the bronchial type of the disease. The number of red blood cells, hemoglobin, hematocrit and blood viscosity are determined. The gas composition of the blood is considered to be the main manifestation of respiratory failure. To rule out other similar diseases, a chest x-ray is indicated. COPD is characterized by deformation of the bronchial walls, as well as changes in the lung tissue of an emphysematous nature.

An ECG can reveal the development of pulmonary hypertension, and diagnostic bronchoscopy is necessary to assess the condition of the bronchial mucosa and take an analysis of their secret.

COPD treatment

The main goal of therapy for the disease is considered to slow down all progressive processes, remove obstructions and exclude respiratory failure. This is what is needed to increase the duration and quality of life of patients. Elimination of the cause of the disease, such as smoking or production factors, is a necessary treatment for complex therapy. Treatment begins with teaching the patient how to use spacers, inhalers and nebulizers, as well as self-assessment of their condition.

At the same time, mucolytics and bronchodilators are prescribed to thin the sputum and expand the lumen of the bronchi. Then, inhaled glucocorticosteroids are usually prescribed, and antibiotic therapy is administered during exacerbations. If necessary, pulmonary rehabilitation and oxygenation of the body are prescribed. Reducing the rate of development of COPD is possible only with methodical complex treatment, which is adequately selected for each individual patient.

As a rule, regarding the complete recovery of patients, the prognosis is favorable. With the steady progression of the disease, they speak of disability. It should be noted that the main prognostic criteria include the exclusion of provoking factors, and most importantly, patient compliance with therapeutic measures and all recommendations.

COPD prevention

Preventing the further development of chronic obstructive pulmonary disease is the most important preventive measure. Abstinence from smoking is the main requirement for the progression of the disease. Passive smoking is also considered unacceptable. An integrated approach against the disease guarantees an increase in life expectancy.

You should also pay special attention to other respiratory infections that can provoke relapses of COPD. For the prevention of exacerbations, long-term use of special mucolytics, which have antioxidant activity, is considered promising.

Since COPD is an incurable disease, it is necessary to lead a proper lifestyle, control symptoms, which can significantly slow down the development of the disease. The correct preventive criteria will allow the patient to return to quality living conditions.

Expert editor: Mochalov Pavel Alexandrovich| MD general practitioner

Education: Moscow Medical Institute. I. M. Sechenov, specialty - "Medicine" in 1991, in 1993 "Occupational diseases", in 1996 "Therapy".

This is a progressive disease characterized by an inflammatory component, impaired bronchial patency at the level of the distal bronchi, and structural changes in the lung tissue and blood vessels. The main clinical signs are cough with the release of mucopurulent sputum, shortness of breath, discoloration of the skin (cyanosis or pinkish color). Diagnosis is based on data from spirometry, bronchoscopy, and blood gases. Treatment includes inhalation therapy, bronchodilators

General information

Chronic obstructive disease (COPD) is now isolated as an independent lung disease and delimited from a number of chronic processes of the respiratory system that occur with obstructive syndrome (obstructive bronchitis, secondary pulmonary emphysema, bronchial asthma, etc.). According to epidemiological data, COPD more often affects men over 40 years of age, occupies a leading position among the causes of disability and 4th among the causes of mortality in the active and able-bodied part of the population.

Causes of COPD

Among the causes that cause the development of chronic obstructive pulmonary disease, 90-95% is given to smoking. Among other factors (about 5%), there are occupational hazards (inhalation of harmful gases and particles), childhood respiratory infections, concomitant bronchopulmonary pathology, and the state of the environment. In less than 1% of patients, COPD is based on a genetic predisposition, expressed in a deficiency of alpha1-antitrypsin, which is formed in the liver tissues and protects the lungs from damage by the elastase enzyme.

COPD is an occupational disease of miners, railroad workers, construction workers in contact with cement, workers in the pulp and paper and metallurgical industries, and agricultural workers involved in the processing of cotton and grain. Among the occupational hazards, the leading causes of COPD development are:

• contacts with cadmium and silicon
• metalworking
• the harmful role of products formed during the combustion of fuel.

Pathogenesis

Environmental factors and genetic predisposition cause a chronic inflammatory lesion of the inner lining of the bronchi, leading to impaired local bronchial immunity. At the same time, the production of bronchial mucus increases, its viscosity increases, thereby creating favorable conditions for the reproduction of bacteria, impaired bronchial patency, changes in lung tissue and alveoli. The progression of COPD leads to the loss of a reversible component (edema of the bronchial mucosa, spasm of smooth muscles, mucus secretion) and an increase in irreversible changes leading to the development of peribronchial fibrosis and emphysema. Progressive respiratory failure in COPD may be accompanied by bacterial complications leading to recurrent lung infections.

The course of COPD is aggravated by a gas exchange disorder, manifested by a decrease in O2 and CO2 retention in arterial blood, an increase in pressure in the pulmonary artery and leading to the formation of cor pulmonale. Chronic cor pulmonale causes circulatory failure and death in 30% of patients with COPD.

Classification

International experts distinguish 4 stages in the development of chronic obstructive pulmonary disease. The criterion underlying the classification of COPD is a decrease in the ratio of FEV (forced expiratory volume) to FVC (forced vital capacity)

• Stage 0(predisease). It is characterized by an increased risk of developing COPD, but does not always transform into it. Manifested by persistent cough and sputum secretion with unchanged lung function.
• Stage I(mild COPD). Minor obstructive disorders (forced expiratory volume in 1 second - FEV1> 80% of normal), chronic cough and sputum production are detected.
• Stage II(moderate course of COPD). Progressive obstructive disorders (50%
• Stage III(severe course of COPD). Increased airflow limitation during exhalation (30%
• Stage IV(extremely severe COPD). It is manifested by a severe form of life-threatening bronchial obstruction (FEV, respiratory failure, development of cor pulmonale.

Symptoms of COPD

In the early stages, chronic obstructive pulmonary disease proceeds secretly and is not always detected on time. A characteristic clinic unfolds, starting with the moderate stage of COPD.

The course of COPD is characterized by cough with sputum and shortness of breath. In the early stages, there is an episodic cough with mucus sputum (up to 60 ml per day) and shortness of breath during intense exertion; as the severity of the disease progresses, the cough becomes constant, shortness of breath is felt at rest. With the addition of infection, the course of COPD worsens, the nature of sputum becomes purulent, and its amount increases. The course of COPD can develop in two types of clinical forms:

• Bronchitis type. In patients with the bronchitis type of COPD, the predominant manifestations are purulent inflammatory processes in the bronchi, accompanied by intoxication, cough, and copious sputum. Bronchial obstruction is pronounced significantly, pulmonary emphysema is weak. This group of patients is conditionally referred to as "blue puffers" due to diffuse blue cyanosis of the skin. The development of complications and the terminal stage occur at a young age.
• emphysematous type. With the development of COPD according to the emphysematous type, expiratory dyspnea (with difficult exhalation) comes to the fore in the symptoms. Emphysema prevails over bronchial obstruction. According to the characteristic appearance of patients (pink-gray skin, barrel-shaped chest, cachexia), they are called "pink puffers." It has a more benign course, patients tend to live to old age.

Complications

The progressive course of chronic obstructive pulmonary disease can be complicated by pneumonia, acute or chronic respiratory failure, spontaneous pneumothorax, pneumosclerosis, secondary polycythemia (erythrocytosis), congestive heart failure, etc. In severe and extremely severe COPD, patients develop pulmonary hypertension and cor pulmonale . The progressive course of COPD leads to changes in the daily activity of patients and a decrease in their quality of life.

Diagnostics

The slow and progressive course of chronic obstructive pulmonary disease raises the question of timely diagnosis of the disease, which helps to improve the quality and increase life expectancy. When collecting anamnestic data, it is necessary to pay attention to the presence of bad habits (smoking) and production factors.

• FVD research. The most important method of functional diagnostics is spirometry, which reveals the first signs of COPD. It is mandatory to measure the speed and volume indicators: vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second. (FEV1) and others in the post-bronchodilator test. The summation and ratio of these indicators makes it possible to diagnose COPD.
• Sputum analysis. Cytological examination of sputum in patients with COPD makes it possible to assess the nature and severity of bronchial inflammation, to exclude cancer alertness. Outside of exacerbation, the nature of sputum is mucous with a predominance of macrophages. In the acute phase of COPD, sputum becomes viscous, purulent.
• Blood test. A clinical blood test for COPD reveals polycythemia (an increase in the number of red blood cells, hematocrit, hemoglobin, blood viscosity) as a result of the development of hypoxemia in the bronchitis type of the disease. In patients with severe symptoms of respiratory failure, the gas composition of the blood is examined.
• Chest X-ray. X-ray of the lungs excludes other diseases with similar clinical manifestations. In patients with COPD, the x-ray shows compaction and deformation of the bronchial walls, emphysematous changes in the lung tissue.

ECG changes are characterized by hypertrophy of the right heart, indicating the development of pulmonary hypertension. Diagnostic bronchoscopy in COPD is indicated for differential diagnosis, examination of the bronchial mucosa and assessment of its condition, sampling of bronchial secretions for analysis.

COPD treatment

The goals of therapy for chronic obstructive pulmonary disease are to slow down the progression of bronchial obstruction and respiratory failure, reduce the frequency and severity of exacerbations, improve the quality and increase the life expectancy of patients. A necessary element of complex therapy is the elimination of the cause of the disease (primarily smoking).

COPD treatment is carried out by a pulmonologist and consists of the following components:

• patient education in the use of inhalers, spacers, nebulizers, criteria for assessing their condition and self-care skills;
• the appointment of bronchodilators (drugs that expand the lumen of the bronchi);
• the appointment of mucolytics (drugs that thin sputum and facilitate its discharge);
• appointment of inhaled glucocorticosteroids;
• antibiotic therapy during exacerbations;
• oxygenation of the body and pulmonary rehabilitation.

In the case of a comprehensive, methodical and adequately selected treatment of COPD, it is possible to reduce the rate of development of respiratory failure, reduce the number of exacerbations and prolong life.

Forecast and prevention

Regarding complete recovery, the prognosis is unfavorable. The steady progression of COPD leads to disability. The prognostic criteria for COPD include: the possibility of excluding the provoking factor, the patient's compliance with recommendations and therapeutic measures, the patient's social and economic status. An unfavorable course of COPD is observed in severe concomitant diseases, heart and respiratory failure, elderly patients, bronchitis type of the disease. A quarter of patients with severe exacerbations die within a year. Measures to prevent COPD are the exclusion of harmful factors (cessation of smoking, compliance with labor protection requirements in the presence of occupational hazards), prevention of exacerbations and other bronchopulmonary infections.

Chronic obstructive pulmonary disease is a chronic non-allergic inflammatory disease of the respiratory system that occurs due to irritation of the lungs by toxic substances. The abbreviated name of the disease - COPD, is an abbreviation made up of the first letters of the full name. The disease affects the final sections of the respiratory tract - the bronchi, as well as the respiratory tissue - the lung parenchyma.

COPD is the result of exposure to harmful dust and gases on the human respiratory system. The main symptoms of COPD are cough and shortness of breath during exercise. Over time, the disease progresses steadily, and the severity of its symptoms increases.

The main mechanisms of painful changes in the lungs in COPD:

• development of emphysema - swelling of the lungs with rupture of the walls of the respiratory vesicles-alveoli;
• the formation of irreversible bronchial obstruction - difficulties for the passage of air through the bronchi due to the thickening of their walls;
• a steady increase in chronic respiratory failure.

About the causes of COPD and its dangers

Inhalation of tobacco smoke, toxic gases and dust causes inflammation in the airways. This chronic inflammation destroys the respiratory tissue of the lungs, forms emphysema, disrupts the natural protective and regenerative mechanisms, and causes fibrous degeneration of the small bronchi. As a result, the correct functioning of the respiratory system is disrupted, air is retained in the lungs, and the airflow rate in the bronchi progressively decreases. These internal disturbances cause the patient to experience shortness of breath on exertion and other symptoms of COPD.

Smoking is the main causative factor in COPD. According to statistics, every 3rd resident smokes in Russia. Thus, the total number of smoking Russians is about 55 million people. In absolute terms, the Russian Federation ranks 4th in the world in terms of the number of smokers.

Smoking is both a risk factor for COPD and cardiovascular disease.

Experts predict that by 2020 smoking will kill 20 people per minute. According to WHO estimates, smoking is the cause of 25% of deaths in patients with coronary heart disease and 75% of deaths in patients with chronic bronchitis and COPD.

The combined effect on the lungs of tobacco smoking and harmful industrial aerosols is a particularly deadly combination. People with this combination of risk factors develop the most severe form of the disease, rapidly leading to permanent lung damage and death from respiratory failure.

COPD is one of the leading causes of morbidity and mortality worldwide, which leads to significant, ever-increasing economic and social damage to society.

What signs will help to suspect COPD?

The presence of COPD should be suspected in people with persistent cough, shortness of breath, sputum production, with past or present exposure to risk factors. These symptoms alone are not diagnostic, but the combination of them greatly increases the likelihood of a diagnosis of COPD being made.

Chronic cough is often the 1st symptom of COPD and is underestimated by the patient himself. People consider these coughs to be a natural consequence of smoking or exposure to other harmful air pollutants. At first, the cough may be intermittent, but over time it becomes daily, constant. In COPD, chronic cough may be without sputum (unproductive).

Shortness of breath on exertion is the main symptom of COPD. Patients describe shortness of breath as a feeling of heaviness in the chest, suffocation, lack of air, the need to make efforts to breathe.

Typically, people with COPD cough up a small amount of sticky sputum after a coughing episode. The purulent nature of sputum indicates an exacerbation of inflammation in the airways. A persistent cough with phlegm can bother a person for several years before the onset of shortness of breath (before the start of airflow limitation). However, a decrease in airflow rate in COPD can develop without chronic cough and sputum production.

As the disease progresses, complaints of general weakness, constant malaise, bad mood, increased irritability, and weight loss may appear.

What does an examination reveal in a COPD patient?

In the initial period of the disease, the examination does not reveal any abnormalities characteristic of COPD. Over time, with an increase in bloating and an irreversible violation of the patency of the bronchi, a barrel-shaped deformation of the chest appears - its characteristic expansion in the anterior-posterior size. The appearance and severity of deformity depend on the degree of swelling of the lungs.

Widely known are 2 types of COPD patients - "pink puffers" and "blue puffers". In a number of patients, symptoms of pulmonary distention come to the fore, and in others, airway obstruction. But those and others have both signs.

In severe forms of the disease, there may be a loss of muscle mass, which leads to a lack of weight. In obese patients, despite the increased weight, one can also notice a decrease in muscle mass.

Prolonged intense work of the respiratory muscles leads to its fatigue, which is further aggravated by malnutrition. A sign of fatigue of the main respiratory muscle (diaphragm) is the paradoxical movement of the anterior wall of the abdominal cavity - its retraction during inspiration.

Cyanosis (cyanosis) of the skin of a gray-ashy hue indicates a severe lack of oxygen in the blood and a severe degree of respiratory failure. It is important to determine the level of consciousness. Lethargy, drowsiness, despite severe shortness of breath, or, conversely, the excitement accompanying it, indicate oxygen starvation, life-threatening, which requires emergency care.

Symptoms of COPD on external examination

An external examination of the lungs in the initial period of the disease carries scarce information. When percussion of the chest, a box sound may appear. When listening to the patient's lungs during an exacerbation, dry whistling or buzzing rales appear.

In the clinically significant stage of COPD, external examination data reflect severe pulmonary emphysema and severe bronchial obstruction. The doctor finds during the study: boxed sound when percussion, limitation of diaphragm mobility, chest rigidity, weakening of breathing, wheezing or buzzing scattered wheezing. The predominance of one or another sound phenomenon depends on the type of disease.

Instrumental and laboratory diagnostics

The diagnosis of COPD must be confirmed with spirometry, a lung function test. Spirometry in COPD detects bronchial airflow limitation. A characteristic feature of the disease is the irreversibility of bronchial obstruction, that is, the bronchi practically do not expand when inhaled with a standard dose of a bronchodilator drug (400 μg of salbutamol).

Radiation diagnostic methods (X-ray, CT) are used to exclude other severe lung diseases that have similar symptoms.

With clinical signs of severe respiratory failure, an assessment of the levels of oxygen and carbon dioxide in the arterial blood is necessary. If this analysis is not possible, a pulse oximeter that measures saturation can help assess the lack of oxygen. When blood saturation is less than 90%, immediate administration of oxygen inhalation is indicated.

Principles of COPD treatment

Key points in the treatment of patients with COPD:

• smoking patients need to stop smoking, otherwise taking medication loses its meaning;
• smoking cessation is facilitated by nicotine replacement drugs (chewing gum, inhaler, nasal spray, skin patch, sublingual tablets, lozenges);
• to reduce shortness of breath and swelling of the lungs, drugs are used that expand the bronchi for 12-24 hours (long-acting bronchodilators) in inhalations;
• to reduce the severity of inflammation with frequent exacerbations, roflumilast, a new drug for the treatment of COPD, is prescribed;
• patients with decreased oxygen saturation in the blood<90%, показана длительная кислородотерапия >15 hours a day;
• for patients with a low inhalation rate, inhalation of drugs can be carried out using a nebulizer - a special compressor inhaler;
• exacerbation of the disease with expectoration of purulent sputum is treated with antibiotics and expectorants;
• all patients with COPD are shown classes in the pulmonary rehabilitation program, including smoking cessation, education, feasible physical training, nutritional counseling and social support;
• to prevent infectious exacerbations, COPD patients are recommended annual influenza vaccination, as well as vaccination against pneumococcus.

COPD prevention

The most effective prevention of COPD would be a worldwide ban on the production, sale and smoking of tobacco and tobacco products. But while the world is ruled by capital and greed, this can only be dreamed of.

The drowning will have to take their salvation into their own hands:

• to prevent the development of COPD in a smoker, you need to part with cigarettes (cigarettes, tobacco, etc.);
• to prevent the development of COPD in a non-smoker, he does not need to start smoking;
• to prevent the development of COPD in workers in hazardous industries, it is necessary to strictly observe safety precautions and the maximum allowable periods of continuous work in this industry.

To prevent COPD in your children and grandchildren, set an example of a healthy lifestyle and zero tolerance for smoking.

Despite the rapid development of medicine and pharmacy, chronic obstructive pulmonary disease remains an unresolved problem of modern healthcare.

The term COPD is the product of many years of work by experts in the field of diseases of the human respiratory system. Previously, diseases such as chronic obstructive bronchitis, chronic simple bronchitis and emphysema were treated in isolation.

According to WHO forecasts, by 2030, COPD will take third place in the structure of mortality worldwide. At the moment, at least 70 million inhabitants of the planet suffer from this disease. Until an adequate level of measures to reduce active and passive smoking is achieved, the population will be at significant risk of this disease.

Background

Half a century ago, significant differences were noted in the clinic and pathological anatomy in patients with bronchial obstruction. Then, with COPD, the classification looked conditional, more precisely, it was represented by only two types. Patients were divided into two groups: if the bronchitis component prevailed in the clinic, then this type in COPD figuratively sounded like “blue puffers” (type B), and type A was called “pink puffers” - a symbol of the prevalence of emphysema. Figurative comparisons have been preserved in the everyday life of doctors to this day, but the classification of COPD has undergone many changes.

Later, in order to rationalize preventive measures and therapy, a classification of COPD according to severity was introduced, which was determined by the degree of airflow limitation according to spirometry. But such a breakdown did not take into account the severity of the clinic at a given point in time, the rate of deterioration of spirometry data, the risk of exacerbations, intercurrent pathology and, as a result, could not allow managing the prevention of the disease and its therapy.

In 2011, experts from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) global strategy for the treatment and prevention of COPD integrated the assessment of the course of this disease with an individual approach to each patient. Now, the risk and frequency of exacerbations of the disease, the severity of the course and the influence of concomitant pathology are taken into account.

An objective determination of the severity of the course, the type of disease are necessary for the choice of rational and adequate treatment, as well as the prevention of the disease in predisposed individuals and the progression of the disease. To identify these characteristics, the following parameters are used:

• the degree of bronchial obstruction;
• severity of clinical manifestations;
• the risk of exacerbations.

In the modern classification, the term "COPD stages" is replaced by "degrees", but operating with the concept of staging in medical practice is not considered a mistake.

Severity

Bronchial obstruction is a mandatory criterion for the diagnosis of COPD. To assess its degree, 2 methods are used: spirometry and peak flowmetry. When conducting spirometry, several parameters are determined, but 2 are important for making a decision: FEV1 / FVC and FEV1.

The best indicator for the degree of obstruction is FEV1, and the integrating one is FEV1/FVC.

The study is carried out after inhalation of a bronchodilator drug. The results are compared with age, body weight, height, race. The severity of the course is determined on the basis of FEV1 - this parameter underlies the GOLD classification. Threshold criteria are defined for ease of use of the classification.

The lower the FEV1, the higher the risk of exacerbations, hospitalization, and death. At the second degree, the obstruction becomes irreversible. During an exacerbation of the disease, respiratory symptoms worsen, requiring a change in treatment. The frequency of exacerbations varies from patient to patient.

Clinicians noted during their observations that the results of spirometry do not reflect the severity of dyspnea, reduced resistance to physical exertion and, as a result, quality of life. After treatment of an exacerbation, when the patient notices a significant improvement in well-being, the FEV1 indicator may not change much.

This phenomenon is explained by the fact that the severity of the course of the disease and the severity of symptoms in each individual patient is determined not only by the degree of obstruction, but also by some other factors that reflect systemic disorders in COPD:

• amyotrophy;
• cachexia;
• weight loss.

Therefore, GOLD experts proposed a combined classification of COPD, including, in addition to FEV1, an assessment of the risk of exacerbations of the disease, the severity of symptoms according to specially developed scales. Questionnaires (tests) are easy to perform and do not require much time. Testing is usually done before and after treatment. With their help, the severity of symptoms, general condition, quality of life are assessed.

Severity of symptoms

For COPD typing, specially developed, valid questionnaire methods MRC - "Medical Research Council Scale" are used; CAT, COPD Assessment Test, developed by the global initiative GOLD - "Test for the assessment of COPD". Please tick a score from 0 to 4 that applies to you:

Test results: CAT≥10 or MRC≥2 scales indicate a significant severity of symptoms and are critical values. To assess the strength of clinical manifestations, one scale should be used, preferably CAT, because. it allows you to fully assess the state of health. Unfortunately, Russian doctors rarely resort to questionnaires.

Risks and groups of COPD

When developing a risk classification for COPD, we were based on conditions and indicators collected in large-scale clinical trials (TORCH, UPLIFT, ECLIPSE):

• a decrease in spirometric indicators is associated with the risk of death of the patient and the recurrence of exacerbations;
• hospitalization caused by an exacerbation is associated with poor prognosis and a high risk of death.

At various degrees of severity, the prognosis of the frequency of exacerbations was calculated based on the previous medical history. Table "Risks":

There are 3 ways to evaluate exacerbation risks:

1. Population - according to the classification of COPD severity based on spirometry data: at grade 3 and 4, a high risk is determined.
2. Individual history data: if there are 2 or more exacerbations in the past year, then the risk of subsequent exacerbations is considered high.
3. The patient's medical history at the time of hospitalization, which was caused by an exacerbation in the previous year.

Step-by-step rules for using the integral assessment method:

1. Assess symptoms on the CAT scale, or dyspnea on the MRC.
2. See which side of the square the result belongs to: on the left side - "fewer symptoms", "less shortness of breath", or on the right side - "more symptoms", "more shortness of breath".
3. Evaluate which side of the square (upper or lower) the result of the risk of exacerbations according to spirometry belongs to. Levels 1 and 2 indicate low risk, while levels 3 and 4 indicate high risk.
4. Indicate how many exacerbations the patient had last year: if 0 and 1 - then the risk is low, if 2 or more - high.
5. Define a group.

Initial data: 19 b. according to the CAT questionnaire, according to spirometry parameters, FEV1 - 56%, three exacerbations over the past year. The patient belongs to the category “more symptoms” and it is necessary to define him in group B or D. According to spirometry - “low risk”, but since he had three exacerbations over the past year, this indicates “high risk”, therefore this patient belongs to group D. This group is at high risk of hospitalizations, exacerbations and death.

Based on the above criteria, patients with COPD are divided into four groups according to the risk of exacerbations, hospitalizations and death.

The result of this grouping provides for a rational and individualized treatment. The disease proceeds most easily in patients from group A: the prognosis is favorable in all respects.

Phenotypes of COPD

Phenotypes in COPD are a set of clinical, diagnostic, pathomorphological features formed in the course of the individual development of the disease.

Identification of the phenotype allows you to optimize the treatment regimen as much as possible.

Assessment of biochemical parameters is carried out in the stage of exacerbation in terms of the state of the antioxidant system of the blood and is assessed by the activity of erythrocyte enzymes: catalase and superoxide dismutase.

Table "Determination of the phenotype by the level of deviation of the enzymes of the antioxidant system of the blood":

The problem of the combination of COPD and bronchial asthma (BA) is considered an urgent issue of respiratory medicine. Manifestation of obstructive lung disease insidiousness in the ability to mix the clinic of two diseases leads to economic losses, significant difficulties in treatment, prevention of exacerbations and prevention of mortality.

The mixed phenotype of COPD - BA in modern pulmonology does not have clear criteria for classification, diagnosis and is the subject of a thorough comprehensive study. But some differences make it possible to suspect this type of disease in a patient.

If the disease worsens more than 2 times a year, then they talk about the COPD phenotype with frequent exacerbations. Typing, determining the degree of COPD, various types of classifications and their numerous improvements set important goals: to correctly diagnose, adequately treat and slow down the process.

Differentiating differences between patients with this disease is extremely important, since the number of exacerbations, the rate of progression or death, and the response to treatment are individual indicators. Experts do not stop there and continue to look for ways to improve the classification of COPD.

Among the pathologies that affect the organs of the respiratory system, obstructive lesions stand apart, due to the specificity of clinical manifestations. For this reason, these diseases are not well known, and patients are often frightened, and rightly so, when they are diagnosed with COPD. What is it and how is it treated, our experts will tell.

Under the obscure abbreviation COPD is 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, the COPD code set for ICD 10 means that according to the International Classification of Diseases of the tenth revision, the disease belongs to the category of respiratory organs.

Activities to reduce the number of factors that reduce the risk of developing COPD are considered a priority by WHO experts.

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

Clinical picture

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

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

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

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

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

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

Provoking factors

Harmful factors are the basis for the occurrence of COPD. One of the main factors causing irreversible lung obstruction is smoking. In vain do smokers think that for many years of adherence to a bad habit, their health remains the same. The prerequisites for the development of the disease are formed more than one day, and not even a year - most often, a disappointing diagnosis is made to those who are over 40.

Passive smokers are also at risk.

Inhalation of tobacco smoke not only irritates the respiratory mucosa, but also gradually destroys their tissues. Loss of elasticity of the 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 a sick person to turn to medicine for help.

Additional triggers for COPD:

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

The emergence and development of COPD is not associated with the course of other chronic processes in the organs of the respiratory system. But it refers to a number of occupational pathologies that affect metallurgists, builders, miners, railway workers, workers of pulp and processing enterprises, as well as agricultural workers 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.

Features of the classification

The classification of COPD provides for four stages in the development of pathology, 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 with a bronchodilator.

The main stages of the course of COPD:

• light. Functionality of external respiration corresponds to the norm. The ratio between FEV1 and FVC is less than 70% of the norm, which is regarded as a sign of early development of bronchial obstruction. Chronic symptoms may not be observed;
• average. Indicators of the functions of external respiration are less than 80%. The ratio between FEV1 and FVC is less than 70% of the norm, which confirms the progress of obstruction. The cough gets worse. There are other characteristic symptoms of the disease;
• heavy. OVF1 indicators are less than 50% of the norm. The ratio of FEV1 and FVC is less than 70% of the norm. Accompanied by a strong cough, copious sputum and significant shortness of breath. There are attacks of exacerbations;
• 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 an abnormal expansion of the right-sided heart.

The only thing that a sick person can do is to diligently follow all the recommendations of doctors 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 occurrence of disease by making efforts to ensure preventive measures.

Symptoms of chronic obstructive pulmonary disease

The characteristic signs of the development of COPD appear at the stage of moderate severity. Before the onset of the later stages, the disease proceeds in a latent form and may be accompanied by a small episodically appearing cough. As the pathology develops, the secretion of mucous sputum joins the cough.

Approximately ten years after the onset of 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 causes a person to stop every hundred meters. With an extremely severe form of the disease, the patient is not able not only 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 fits become long and regular;
• the volume of secreted mucous sputum increases significantly, with the onset of an extremely severe stage, pus appears in the sputum;
• shortness of breath occurs even at rest.

Pathological processes characteristic of the course 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 expression of the symptoms of the disease and their characteristics, there are two clinical forms of COPD - bronchial and emphysema.

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

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

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, COPD treatment is most often started at the onset of the moderate or severe stage. The collection of anamnesis provides for the identification of individual risk factors - the determination of the smoker's index, the presence of infections.

For differential diagnosis with bronchial asthma, parameters characterizing shortness of breath when exposed to a provocative stimulus are studied.

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

As additional diagnostic measures apply:

• sputum cytology,
• a blood test to detect polycythemia;
• study of the gas composition of the blood;
• x-ray of the lungs;
• bronchoscopy.

Only after the diagnosis has been clarified and the stage and form of the disease determined, 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 thin sputum, as well as inhaled glucocorticosteroids.

With 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 manifestations of the disease, pulmonologists prescribe antibiotic therapy.

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

In the elderly

The treatment of COPD in the elderly is 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.

Alternative methods and means of treating COPD

The application of the recommendations of traditional medicine in COPD has several goals:

• mitigation of symptoms;
• slow pathological progress;
• launch of regeneration mechanisms;
• restoration of vitality of the patient.

The most effective way to influence tissues affected by COPD are inhalations based on plant materials - oregano, mint, calendula, chamomile, as well as essential oils of 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 for the rehabilitation of patients with COPD. Thanks to respiratory gymnastics, the weakened intercostal muscles are included in the breathing process, the smooth muscles of the lungs are strengthened, and at the same time, the psychological state of the patient improves.

One of the exercises: inhale through your nose and at the same time raise your arms up, arch your back and take your leg back. Then exhale through your mouth and return to the starting position. When repeating the exercise, then the left, then the right leg is taken alternately.

Exercise is allowed only during the remission period.

COPD prevention

Smoking cessation is considered the basis of COPD prevention, 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 in hazardous work;
• respiratory protection from contact with substances hazardous to health;
• strengthening immunity - physical activity, hardening, adherence to the daily routine;
• healthy food.

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