Pulmonary obstruction is a disease that results in inflammation and narrowing of the bronchi and severe disruption of the structure and function of the lungs. The disease tends to progress and become chronic.

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The pathology is called COPD - chronic obstructive pulmonary disease.

What happens with pulmonary obstruction

The mucous membrane of the airways has villi that trap viruses and harmful substances that enter the body. As a result of long-term negative effects on the bronchi, provoked by various factors (tobacco smoke, dust, toxic substances), the protective functions of the bronchi are reduced, and inflammation develops in them.

The consequences of inflammation in the bronchi are swelling of the mucous membrane, as a result of which the bronchial passage narrows. During examination, the doctor hears hoarse, whistling sounds from the chest, characteristic of obstruction.

Normally, when you inhale, the lungs expand; when you exhale, they completely contract. With obstruction, air enters them when you inhale, but does not completely leave them when you exhale. Over time, as a result of improper functioning of the lungs, patients may develop emphysema.

The reverse side of the disease is insufficient oxygen supply to the lungs, as a result of which necrotization of the lung tissue occurs, the organ decreases in volume, which will inevitably lead to human disability and death.

Symptoms of the disease

In the first and second stages of the disease, the disease manifests itself only as a cough, to which rarely any patient pays due attention. More often people go to the hospital in the third and fourth stages of the disease, when serious changes develop in the lungs and bronchi, accompanied by pronounced negative symptoms.

Characteristic symptoms of pulmonary obstruction:

• Dyspnea,
• Discharge of purulent sputum,
• bubbling breath
• Hoarse voice
• Swelling of the limbs.

Causes of pulmonary obstruction

The most important cause of pulmonary obstruction is long-term tobacco smoking, against the background of which there is a gradual decrease in the protective function of the bronchi, they narrow and provoke changes in the lungs. The characteristic cough of this disease is called “smoker’s cough” - hoarse, frequent, disturbing a person in the morning or after physical exertion.

Every year it will become more and more difficult for a smoker; shortness of breath, weakness, and sallow skin will be added to a lingering cough. Habitual physical activity will be difficult, and when coughing up, purulent greenish sputum may appear, sometimes mixed with blood.

More than 80% of patients with chronic obstructive pulmonary disease are experienced smokers.

Obstruction may occur due to diseases:

• Bronchiolitis. A severe disease accompanied by chronic inflammation of the bronchioles.
• Pneumonia.
• Poisoning with toxic substances.
• Heart diseases.
• Various formations arising in the area of ​​the trachea and bronchi.
• Bronchitis.

Against the background of the development of pneumonia, the symptoms are not very pronounced, but the most serious destruction occurs. To avoid the consequences of the disease, it is necessary to undergo a thorough examination during the period of illness and after it.

The cause of COPD is prolonged exposure to harmful and toxic substances.

The disease is diagnosed in people who, by the nature of their profession, are forced to work in “harmful” industries.

If a disease is detected, it will be necessary to refuse such work, and then undergo comprehensive recommended treatment.
More often, obstructive pulmonary disease affects adults, but the inexorable trend of early smoking may soon change the statistics.

There is no need to exclude a genetic predisposition to the disease, which can often be traced within the family.

Video

Emphysema as a consequence of obstruction

As a result of partial blockage of the lumen in the bronchi, formed against the background of inflammatory processes in the mucous membrane, obstructive changes occur in the lungs. With pathology, air does not leave the lungs when exhaled, but accumulates, stretching the lung tissue, resulting in a disease - emphysema.

The symptoms of the disease are similar to other respiratory diseases - obstructive bronchitis or bronchial asthma. A common cause of emphysema is long-term, chronic bronchitis, which occurs more often in men and women of mature age.

The disease can be triggered by various lung diseases, including tuberculosis.

Emphysema will be caused by:

• Smoking,
• Polluted air
• Work in “harmful” production associated with inhalation of parts of silicon and asbestos

Sometimes emphysema can develop as a primary disease, causing severe lung failure.

Common symptoms of emphysema include:

• Severe shortness of breath
• Blueness of the skin, lips, tongue and nose area,
• Noticeable swelling in the rib area,
• Extension above the collarbone.

With emphysema or COPD, the first symptom is shortness of breath, which first appears with mild physical exertion. If the disease is not treated at this stage, the disease will progress rapidly.

The patient will begin to experience difficulty breathing with little physical exertion, at rest. The disease should be treated at the first appearance of bronchitis; subsequently, irreversible changes in organs may develop, which will lead to disability of the patient.

Diagnosis of obstructive syndrome

Patient examination begins with interviewing and examining the patient. Signs of obstructive disease are detected already at these stages.

Conducted:

• Listening with a phonendoscope,
• Tapping (percussion) in the chest area (with bronchial and pulmonary diseases there will be an “empty” sound),
• X-ray of the lungs, with which you can find out about pathological changes in the lung tissue, learn about the condition of the diaphragm,
• Computed tomography helps determine whether there are formations in the lungs, what shape they have,
• Lung function tests that help determine how much air a person inhales and how much air they exhale.

After identifying the degree of the obstructive process, treatment measures begin.

Complex therapy of the disease

If lung disorders occur as a result of long-term smoking, it is necessary to get rid of the bad habit. You need to quit smoking not gradually, but completely, as quickly as possible. Due to constant smoking, even greater injury occurs to the lungs, which already function poorly as a result of pathological changes. In the beginning, you can use nicotine patches or e-cigarettes.

If the cause of obstruction is bronchitis or asthma, then these diseases must be treated to prevent the development of pathological changes in the lungs.

If the obstruction is caused by an infectious disease, then antibiotics are used as treatment to destroy bacteria in the body.

Treatment can be carried out instrumentally, using a special device that is used for alveolar massage. Using this device, you can influence the entire lungs, which is impossible when using medications that are fully received by the healthy part of the organ, and not the diseased one.

As a result of the use of such acupressure, oxygen is evenly distributed throughout the bronchial tree, which nourishes the damaged lung tissue. The procedure is painless and involves inhaling air through a special tube, which is supplied using pulses.




In the treatment of pulmonary obstruction, oxygen therapy is used, which can be performed in the hospital or at home. At the initial stage of the disease, therapeutic exercises are used as treatment.

At the last stage of the disease, the use of conservative methods will not bring results, so surgical removal of the overgrown lung tissue is used as treatment.

The operation can be performed in two ways. The first method involves a complete opening of the chest, and the second method is characterized by the use of an endoscopic method, in which several punctures are made in the chest area.

To prevent the disease, it is necessary to lead a healthy lifestyle, give up bad habits, treat emerging diseases in a timely manner, and at the first unpleasant symptoms go to the doctor for examination.

Surgical treatment of pathology

The surgical treatment of this disease is still being discussed. One of the methods of such treatment is to reduce lung volume and transplant new organs. Bullectomy for pulmonary obstruction is prescribed only to those patients who have bullous emphysema with enlarged bullae, which is manifested by hemoptysis, shortness of breath, chest pain and infection in the lungs.

Scientists have conducted a number of studies on the effect of reducing lung volume in the treatment of obstruction, which have shown that such surgical intervention has a positive effect on the patient’s condition. It is much more effective than drug treatment for the disease.

After such an operation, you can observe the following changes:

• Restoration of physical activity;
• Improving quality of life;
• Reducing the chance of death.

This surgical treatment is in the experimental phase and is not yet available for widespread use.

Another type of surgical treatment is lung transplantation. With it you can:

• Restore normal lung function;
• Improve physical performance;
• Improve the patient's quality of life.

Treating yourself at home using folk remedies

Treatment of such a disease with folk remedies is best combined with taking medications prescribed by the attending physician. This is much more effective than using home treatment alone.

Before using any herbs or infusions, you should consult a doctor so as not to aggravate the condition.

For pulmonary obstruction, the following folk recipes are used:

1. Grind and mix 2 parts nettle and one part sage. Add a glass of boiling water and leave for one hour. Then strain and drink every day for several months.
2. To remove phlegm from the lungs, you need to use an infusion of flax seeds 300 g, chamomile 100 g, the same amount of marshmallow, anise and licorice root. Pour boiling water over the mixture for one hour, strain and drink half a glass every day.
3. A decoction of spring primrose horse gives excellent results. To prepare, pour boiling water over a tablespoon of chopped root and place in a water bath for 20-30 minutes. Take a spoonful 1 hour before meals several times a day.
4. If a severe cough bothers you, adding 10-15 drops of propolis to a glass of warm milk will help to quickly remove it.
5. Pass half a kilogram of aloe leaves through a meat grinder, add half a liter jar of honey and 300 ml of Cahors to the resulting pulp, mix everything thoroughly and put it in a jar with a tight lid. You need to insist for 8-10 days in a cool place. Take a spoonful several times every day.
6. A decoction of elecampane will ease the patient’s well-being and help remove phlegm. Pour boiling water over a spoonful of herbs and drink as tea every day.
7. It is effective to take yarrow juice. Take 2 spoons several times a day.
8. Black radish with honey is an ancient way to treat all respiratory diseases. It helps remove phlegm and helps with expectoration. To prepare, you need to cut a small hole in the radish and pour honey. Wait a little until the juice is released, drink a teaspoon several times a day. You cannot drink it with water or tea.
9. Mix coltsfoot, nettle, St. John's wort, motherwort and eucalyptus in equal proportions. Pour a spoonful of the resulting mixture with a glass of boiling water and let it brew. Then strain and drink as tea every day for several months.
10. Onions and honey work well. First, boil the whole onions until softened, then pass them through a meat grinder, add a few tablespoons of honey, 2 tablespoons of sugar, 2 tablespoons of vinegar. Mix everything thoroughly and press down a little. Take a spoonful every day.
11. To relieve a strong cough, you need to use viburnum with honey. Pour 200 g of berries with a glass of water, add 3-4 tablespoons of honey, and cook over low heat until all the water has evaporated. Take the resulting mixture one teaspoon per hour for the first 2 days, then several spoons per day.
12. Mix half a teaspoon each of the following herbs: marshmallow, sage, coltsfoot, fennel, dill, and pour boiling water into a container with a tight lid. Leave for 1-2 hours. Drink 100 ml every day 3 times.

Possible consequences and complications

The disease has dire consequences if treatment is not started in time. Among the possible complications, the most dangerous are:

• Pulmonary hypertension;
• Respiratory failure;
• Poor circulation.

Frequent consequences of the advanced initial form of the disease are:

• Dyspnea;
• hacking cough;
• Increased fatigue;
• Chronic weakness;
• Heavy sweating;
• Decreased performance.

Complications are dangerous for a child’s body. They can appear if you do not pay attention to the first symptoms of the disease in time. Among them is a regular cough.

Prevention of pathology and prognosis

Pulmonary obstruction is highly treatable. The process goes unnoticed and without complications if you notice the first symptoms in time, do not start the disease and get rid of the causes of its occurrence. Timely and effective treatment helps to remove all unpleasant symptoms and delay the progression of the pathology.

There are several factors that can adversely affect the prognosis:

• Bad habits, mainly smoking;
• Frequent exacerbations;
• Formation of the pulmonary heart;
• Old age;
• Negative reaction to therapy.

To avoid developing pulmonary obstruction, you need to carry out prevention:

1. Give up bad habits. Smoking is one of the main causes of this disease.
2. Increase your immunity level. Consume vitamins and microelements in sufficient quantities regularly.
3. Avoid junk and fatty foods and eat plenty of vegetables and fruits.
4. To maintain the protective function, do not forget about garlic and onions, which help protect the body from viruses.
5. Avoid all foods and items that cause an allergic reaction.
6. Combating occupational factors that cause this disease. This includes providing individual respiratory protection and reducing the concentration of harmful substances in the air.
7. Avoid infectious diseases and vaccinate on time.
8. Lead a healthy lifestyle and regularly strengthen the body, increasing its endurance.
9. Walk outdoors regularly.
10. Do physical exercise.

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COPD (chronic obstructive pulmonary disease) is a pathology that is accompanied by inflammation in the organs of the respiratory system. The reasons may be environmental factors and a number of others, including smoking. The disease is characterized by regular progression, leading to a decrease in the functionality of the respiratory system. Over time, this leads to respiratory failure.

The disease is predominantly observed at the age of 40 years and older. In some cases, patients with COPD are admitted to the hospital at a younger age. As a rule, this is due to a genetic predisposition. There is also a high risk of getting sick among those who smoke for a very long time.

Risk group

The diagnosis of COPD in adult men in Russia is observed in every third person who has crossed the threshold of 70 years. Statistics allow us to confidently say that this is directly related to tobacco smoking. There is also a clear connection with lifestyle, namely the place of work: the likelihood of developing pathology is higher when a person works in hazardous conditions and with a lot of dust. Living in industrial cities has an effect: here the percentage of cases is higher than in places with a clean environment.

COPD develops more often in older people, but if you have a genetic predisposition, you can get sick at a young age. This is due to the specifics of the body’s generation of connective pulmonary tissue. There are also medical studies that suggest a connection between the disease and the baby’s prematurity, since in this case there is not enough surfactant in the body, which is why organ tissues cannot expand correctly at birth.

What do scientists say?

COPD, the causes of the disease, treatment methods - all this has long attracted the attention of doctors. In order to have sufficient materials for research, data was collected, during which cases of the disease were studied in residents of rural areas and urban residents. The information was collected by Russian doctors.

It was possible to reveal that if we are talking about those who live in a town or village, then here with COPD the severe course often becomes ineffective, and in general the pathology torments the person much more severely. Endobronchitis with purulent discharge or tissue atrophy was often observed in villagers. Complications with other somatic diseases occur.

It has been suggested that the main reason is the low quality of medical care in rural areas. In addition, in villages it is impossible to do spirometry, which is necessary for smoking men aged 40 years or more.

How many people know COPD - what is it? How is it treated? What happens when this happens? Largely due to ignorance, lack of awareness, and fear of death, patients become depressed. This is equally characteristic of both urban and rural residents. Depression is additionally associated with hypoxia, which affects the patient’s nervous system.

Where does the disease come from?

Diagnosis of COPD is still difficult today, since it is not known exactly for what reasons the pathology develops. However, it was possible to identify a number of factors that provoke the disease. Key aspects:

• smoking;
• unfavorable working conditions;
• climate;
• infection;
• prolonged bronchitis;
• pulmonary diseases;
• genetics.

More about the reasons

Effective prevention of COPD is still under development, but people who want to maintain their health should understand how certain causes affect the human body, provoking this pathology. By recognizing their danger and eliminating harmful factors, you can reduce the likelihood of developing the disease.

The first thing that deserves mention in connection with COPD is, of course, smoking. Both active and passive influences are equally negative. Now medicine says with confidence that smoking is the most important factor in the development of pathology. The disease is provoked by both nicotine and other components contained in tobacco smoke.

In many ways, the mechanism of the appearance of the disease when smoking is associated with the one that provokes pathology when working in harmful conditions, since here a person also breathes air filled with microscopic particles. When working in dusty conditions, in alkali and steam, constantly breathing chemical particles, it is impossible to keep your lungs healthy. Statistics show that COPD is more often diagnosed in miners and people working with metal: grinders, polishers, metallurgists. Welders and employees of pulp factories and agricultural workers are also susceptible to this disease. All these working conditions are associated with aggressive dust factors.

An additional risk is associated with insufficient medical care: some do not have qualified doctors nearby, others try to avoid regular medical examinations.

Symptoms

COPD disease - what is it? How is it treated? How can you suspect him in yourself? This abbreviation (as well as its decoding - chronic obstructive pulmonary disease) still does not mean anything to many. Despite the widespread prevalence of pathology, people do not even know the risk to their lives. What to look for if you suspect pulmonary disease and suspect that it may be COPD? Remember that the following symptoms are typical at first:

• cough, mucous sputum (usually in the morning);
• shortness of breath, which initially occurs during exertion and eventually accompanies rest.

If there is an exacerbation of COPD, it is usually due to an infection, which affects:

• shortness of breath (increases);
• sputum (becomes purulent and is released in larger volumes).

As the disease develops, if chronic obstructive pulmonary disease has been diagnosed, the symptoms are as follows:

• heart failure;
• heart pain;
• fingers and lips become bluish;
• bones ache;
• muscles weaken;
• fingers thicken;
• nails change shape and become convex.

Diagnosis of COPD: stages

It is customary to distinguish several stages.

The beginning of the pathology is zero. It is characterized by the production of sputum in large volumes, the person coughs regularly. Lung function at this stage of the disease is preserved.

The first stage is the period of development of the disease during which the patient chronically coughs. The lungs regularly produce large volumes of mucus. The examination reveals minor obstruction.

If a moderate form of the disease is diagnosed, it is distinguished by clinical symptoms (described earlier) that appear during physical activity.

A diagnosis of COPD, stage three, means it has become life-threatening. With this form of the disease, the so-called “pulmonary heart” appears. Obvious manifestations of the disease: restriction of air flow when exhaling, shortness of breath is frequent and severe. In some cases, bronchial obstruction is observed, which is typical for an extremely severe form of the pathology. This is dangerous for human life.

Not easy to identify

In fact, the diagnosis of COPD is made in the initial form of the disease much less often than it actually occurs. This is due to the fact that the symptoms are not clearly expressed. At the very beginning, pathology often flows secretly. The clinical picture can be seen when the condition progresses to moderate severity and the person consults a doctor complaining of sputum and cough.

At an early stage, there are often occasional cases when a person coughs up a large volume of sputum. Because it occurs infrequently, people rarely worry and do not seek medical attention in a timely manner. They come to the doctor later, when the progression of the disease leads to a chronic cough.

The situation is getting more complicated

If the disease has been diagnosed and treatment measures have been taken, for example, traditional treatment for COPD does not always show good results. Often the complication occurs due to a third-party infection.

When additional infection occurs, even at rest the person suffers from shortness of breath. There is a change in the nature of the discharge: the sputum turns into purulent. There are two possible ways of developing the disease:

• bronchial;
• emphysematous.

In the first case, sputum is released in very large volumes and the cough is regularly tormented. There are frequent cases of intoxication, the bronchi suffer from purulent inflammation, and cyanosis of the skin is possible. The obstruction develops strongly. Pulmonary emphysema for this type of disease is characterized by mild.

With the emphysematous type, shortness of breath is fixed respiratory, that is, it is difficult to exhale. Pulmonary emphysema predominates. The skin takes on a pinkish gray tint. The shape of the chest changes: it resembles a barrel. If the disease follows this path, and also if the correct drugs for COPD have been chosen, the patient has a high probability of living to an old age.

Progress of the disease

With the development of COPD, complications appear:

• pneumonia;
• respiratory failure, usually in acute form.

Less commonly observed:

• pneumothorax;
• heart failure;
• pneumosclerosis.

In severe cases, pulmonary:

• heart;
• hypertension.

Stability and instability in COPD

The disease can be in one of two forms: stable or acute. With a stable development, no changes in the body can be found when observing the dynamics of changes over weeks or months. You can notice a certain clinical picture if you regularly examine the patient for at least a year.

But with an exacerbation, just a day or two already shows a sharp deterioration in the condition. If such exacerbations occur twice a year or more often, they are considered clinically significant and may cause the patient to be hospitalized. The number of exacerbations directly affects the quality of life and its duration.

In special cases, patients are smokers who previously suffered from bronchial asthma. In this case, they talk about “cross syndrome”. The body tissues of such a patient are not able to consume the amount of oxygen necessary for normal functioning, which sharply reduces the body’s ability to adapt. In 2011, this type of disease was no longer officially classified as a separate class, but in practice, some doctors still use the old system today.

How will a doctor detect the disease?

When visiting a doctor, the patient will have to undergo a series of tests to determine COPD or find another cause of health problems. Diagnostic measures include:

• general examination;
• spirometry;
• a test through a bronchodilator, which includes inhalations for COPD, before and after which a special study of the respiratory system is carried out, observing changes in indicators;
• radiography, additionally - tomography, if the case is unclear (this allows you to assess how large the structural changes are).

Sputum samples must be collected for analysis of secretions. This allows us to draw conclusions about how severe the inflammation is and what its nature is. If we are talking about an exacerbation of COPD, then from the sputum we can draw conclusions about which microorganism provoked the infection, as well as what antibiotics can be used against it.

Body plethysmography is performed, during which it is assessed. This makes it possible to clarify lung volume, capacity, as well as a number of parameters that cannot be assessed with spirography.

Be sure to take blood for a general analysis. This makes it possible to identify hemoglobin and red blood cells, against the background of which conclusions are drawn about oxygen deficiency. If we are talking about an exacerbation, then a general analysis provides information about the inflammatory process. The number of leukocytes and ESR are analyzed.

The blood is also examined for gas content. This makes it possible to detect not only the concentration of oxygen, but also carbon dioxide. It is possible to correctly assess whether the blood is sufficiently saturated with oxygen.

Indispensable tests are ECG, ECHO-CG, ultrasound, during which the doctor receives correct information about the condition of the heart, and also finds out the pressure in the pulmonary artery.

Finally, fiberoptic bronchoscopy is performed. This is a type of study during which the condition of the mucous membrane inside the bronchi is clarified. Doctors, using special preparations, obtain tissue samples that allow them to study the cellular composition of the mucosa. If the diagnosis is unclear, this technology is indispensable for clarifying it, as it allows us to exclude other diseases with similar symptoms.

Depending on the specifics of the case, an additional visit to a pulmonologist may be prescribed to clarify the condition of the body.

We treat without medications

Treatment of COPD is a complex process that requires an integrated approach. First of all, we will consider non-drug measures that are mandatory for the disease.

• completely stop smoking;
• balance your diet, include protein-rich foods;
• adjust physical activity, do not overexert;
• reduce weight to the standard if you have extra pounds;
• regularly walk slowly;
• go swimming;
• practice breathing exercises.

What if with medications?

Of course, you can’t do without drug therapy for COPD either. First of all, pay attention to vaccines against influenza and pneumococcus. It is best to get vaccinated in October-mid-November, since then the effectiveness decreases, the likelihood increases that there have already been contacts with bacteria and viruses, and the injection will not provide an immune response.

They also practice therapy, the main goal of which is to expand the bronchi and keep them in normal condition. To do this, they fight spasms and use measures that reduce the production of sputum. The following medications are useful here:

• theophyllines;
• beta-2 agonists;
• M-anticholinergics.

The listed drugs are divided into two subgroups:

• long-acting;
• short action.

The first group maintains the bronchi in normal condition for up to 24 hours, the second group lasts 4-6 hours.

Short-acting medications are relevant at the first stage, as well as in the future, if there is a short-term need for this, that is, symptoms suddenly appear that need to be urgently eliminated. But if such medications do not provide sufficient results, they resort to long-acting medications.

Also, anti-inflammatory drugs should not be neglected, as they prevent negative processes in the bronchial tree. But you also can’t use them outside of doctors’ recommendations. It is very important that the doctor supervise drug therapy.

Serious therapy is not a reason to be afraid

For COPD, glucocorticosteroid hormonal drugs are prescribed. Typically in the form of inhalations. But in tablet form, such drugs are good during an exacerbation. They are taken in courses if the disease is severe and has developed to a late stage. Practice shows that patients are afraid to use such remedies when the doctor recommends them. This comes with concerns about side effects.

You should remember that most often adverse reactions are caused by hormones taken in the form of tablets or injections. In this case, it is not uncommon:

• osteoporosis;
• hypertension;
• diabetes mellitus

If the drugs are prescribed in the form of inhalations, their effect will be milder due to the small dose of the active substance entering the body. This form is applied topically, affecting primarily what and helps to avoid most side effects.

You also need to take into account that the disease is associated with chronic inflammatory processes, which means that only long courses of medications will be effective. To understand whether there is a result from the chosen drug, you will have to take it for at least three months, and then compare the results.

Inhalation forms may cause the following side effects:

• candidiasis;
• hoarse voice.

To avoid this, you need to rinse your mouth every time after taking the product.

What else will help?

For COPD, antioxidant drugs containing a complex of vitamins A, C, and E are actively used. Mucolytic agents have proven themselves well, as they dilute the sputum produced by the mucous membrane and help cough it up. In case of severe development of the situation, artificial ventilation of the pulmonary system is useful. If the disease worsens, you can take antibiotics, but under the supervision of a doctor.

Selective phosphodiesterase-4 inhibitors have brought considerable benefit. These are quite specific drugs that can be combined with some drugs used in the treatment of COPD.

If the disease is caused by a genetic defect, then it is customary to resort to replacement therapy. For this purpose, alpha-1-antitrypsin is used, which, due to a congenital defect, is not produced sufficiently by the body.

Surgery

Preventive measures

What is the practice for preventing COPD? Are there effective ways to prevent the development of the disease? Modern medicine says that it is possible to prevent disease, but for this a person must take care of his health and treat himself responsibly.

First of all, you need to stop smoking, and also about the possibility of avoiding being in harmful conditions.

If the disease has already been detected, its progression can be slowed by applying secondary preventive measures. The most effective ones were:

• vaccination to prevent influenza and pneumococcus;
• Regularly taking medications prescribed by your doctor. Remember that the disease is chronic, so temporary therapy will not bring real benefit;
• control over physical activity. This helps train the muscles of the respiratory system. You should walk and swim more, use breathing exercises;
• inhalers. They need to be able to use correctly, since incorrect use leads to the absence of results from such therapy. As a rule, the doctor is able to explain to the patient how to use the medication so that it is effective.

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

This disease, which occurs as a result of long-term damage to the lungs, is currently considered incurable; therapy can only reduce the frequency and severity of exacerbations and reduce the level of deaths.
COPD (chronic obstructive pulmonary disease) is a disease in which air flow in the airways is limited, partially reversible. This obstruction continually progresses, reducing lung function and leading to chronic respiratory failure.

Who has COPD

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

Origin of the disease

With many years of irritation of the lungs by harmful gases and microorganisms, chronic inflammation gradually develops. As a result, narrowing of the bronchi occurs and destruction of the alveoli of the lungs. Subsequently, all respiratory tracts, tissues and blood vessels of the lungs are affected, leading to irreversible pathologies that cause a lack of oxygen in the body. COPD (chronic obstructive pulmonary disease) develops slowly, progressing steadily over many years.

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

Main causes of the disease

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

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

The disease is classified according to severity:

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

Moderate severity - obstructive disorders in the lungs increase. Shortness of breath appears during exercise. loads The disease is diagnosed when patients present due to exacerbations and shortness of breath.

Severe - there is a significant restriction of air flow. Frequent exacerbations begin, shortness of breath increases.

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

Diagnostic methods

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

A test with a bronchodilator - shows the likelihood of reversibility of the process of bronchial narrowing.

X-ray examination - determines the severity of pulmonary changes. The same is carried out.

Sputum analysis - to identify microbes during exacerbation and select antibiotics.

Differential diagnosis

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

How to treat the disease

General rules

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

Treatment with drugs

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

• Bronchodilators are the main drugs that stimulate bronchodilation (atrovent, salmeterol, salbutamol, formoterol). Administered preferably in the form of inhalations. Short-acting drugs are used as needed, long-acting drugs are used constantly;
• glucocorticoids in the form of inhalations - used for severe degrees of the disease, for exacerbations (prednisolone). In case of severe respiratory failure, attacks are stopped with glucocorticoids in the form of tablets and injections;
• vaccines – vaccination against influenza can reduce mortality in half of cases. It is carried out once in October - early November;
• mucolytics – thin mucus and facilitate its removal (carbocysteine, ambroxol, trypsin, chymotrypsin). Used only in patients with viscous sputum;
• antibiotics - used only during exacerbation of the disease (penicillins, cephalosporins, fluoroquinolones may be used). Tablets, injections, inhalations are used;
• antioxidants – capable of reducing the frequency and duration of exacerbations, used in courses of up to six months (N-acetylcysteine).

Surgical treatment

• Bullectomy – removal can reduce shortness of breath and improve lung function;
• Reducing lung volume through surgery is currently under study. The operation improves the patient’s physical condition and reduces the mortality rate;
• Lung transplantation – effectively improves the quality of life, lung function and physical performance of the patient. Application is hampered by the problem of donor selection and the high cost of the operation.

Oxygen therapy

Oxygen therapy is carried out to correct respiratory failure: short-term - for exacerbations, long-term - for the fourth degree of COPD. If the course is stable, continuous long-term oxygen therapy is prescribed (at least 15 hours daily).

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

Treatment with folk remedies

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

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

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

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

• Radish infusion. Grate black radish and medium-sized beets, mix and pour cooled boiling water over them. Leave for 3 hours. Drink 50 ml three times a day for a month.
• Nettle. Grind the nettle roots into a paste and mix with sugar in a ratio of 2:3, leave for 6 hours. The syrup removes mucus, relieves inflammation and relieves cough.
• Milk:

√ Brew a spoonful of cetraria (Icelandic moss) with a glass of milk and drink throughout the day;

√ Boil 6 chopped onions and a head of garlic in a liter of milk for 10 minutes. Drink half a glass after meals. Every mother should know this!

Are coughing attacks keeping you up at night? You may have tracheitis. You can learn more about this disease

Secondary

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

Forecast

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

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

Incurable and deadly, COPD simply encourages people to quit smoking for good. And for people at risk, there is only one piece of advice - if you notice signs of the disease, immediately contact a pulmonologist. After all, the earlier the disease is detected, the lower the likelihood of premature death.

COPD (chronic obstructive pulmonary disease) is a disease that develops as a result of an inflammatory reaction to the action of certain environmental irritants, with damage to the distal bronchi and the development of emphysema, and which is manifested by a progressive decrease in the speed of air flow in the lungs, an increase, as well as damage to other organs.

COPD ranks second among chronic non-communicable diseases and fourth among causes of death, and this figure is steadily increasing. Due to the fact that this disease is inevitably progressive, it occupies one of the first places among the causes of disability, as it leads to disruption of the main function of our body - the respiratory function.

COPD is truly a global problem. In 1998, an initiative group of scientists created the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The main objectives of GOLD are to widely disseminate information about this disease, systematize experience, explain the causes and corresponding preventive measures. The main idea that doctors want to convey to humanity: COPD can be prevented and treated this postulate is even included in the modern working definition of COPD.

Causes of COPD development

COPD develops through a combination of predisposing factors and provoking environmental agents.

Predisposing factors

1. Hereditary predisposition. It has already been proven that congenital deficiency of certain enzymes predisposes to the development of COPD. This explains the family history of this disease, as well as the fact that not all smokers, even with long experience, get sick.
2. Gender and age. Men over 40 years of age suffer more from COPD, but this can be explained by both the aging of the body and the length of smoking experience. Data is provided that the incidence rate among men and women is now almost equal. The reason for this may be the spread of smoking among women, as well as the increased sensitivity of the female body to passive smoking.
3. Any negative impacts which affect the development of the child’s respiratory system in the prenatal period and early childhood, increase the risk of COPD in the future. Physical underdevelopment itself is also accompanied by a decrease in lung volume.
4. Infections. Frequent respiratory infections in childhood, as well as increased susceptibility to them in older age.
5. Bronchial hyperreactivity. Although bronchial hyperresponsiveness is the main mechanism of development, this factor is also considered a risk factor for COPD.

Provoking factors

Pathogenesis of COPD

Exposure to tobacco smoke and other irritants leads to chronic inflammation in the walls of the bronchi in predisposed individuals. The key is the damage to their distal parts (that is, located closer to the pulmonary parenchyma and alveoli).

As a result of inflammation, the normal secretion and discharge of mucus is disrupted, small bronchi are blocked, infection easily sets in, inflammation spreads to the submucosal and muscular layers, muscle cells die and are replaced by connective tissue (the process of bronchial remodeling). At the same time, destruction of the parenchyma of the lung tissue and the bridges between the alveoli occurs - emphysema develops, that is, hyperairiness of the lung tissue. The lungs seem to be inflated with air, their elasticity decreases.

Small bronchi do not straighten well when exhaling - air has difficulty leaving the emphysematous tissue. Normal gas exchange is disrupted, as the inhaled volume also decreases. As a result, the main symptom of all patients with COPD occurs - shortness of breath, especially worse with movement and walking.

The consequence of respiratory failure is chronic hypoxia. The whole body suffers from this. Prolonged hypoxia leads to a narrowing of the lumen of the pulmonary vessels - it occurs, which leads to expansion of the right chambers of the heart (pulmonary heart) and the addition of heart failure.

Why is COPD identified as a separate nosology?

Awareness of this term is so low that most patients already suffering from this disease do not know that they have COPD. Even if such a diagnosis is made in the medical documentation, the previously familiar “emphysema” still prevails in everyday life of both patients and doctors.

The main components in the development of COPD are indeed chronic inflammation and emphysema. So why then is COPD singled out as a separate diagnosis?

In the name of this nosology we see the main pathological process - chronic obstruction, that is, narrowing of the lumen of the airways. But the process of obstruction is also present in other diseases.

The difference between COPD and bronchial asthma is that in COPD the obstruction is almost or completely irreversible. This is confirmed by spirometric measurements using bronchodilators. In bronchial asthma, after the use of bronchodilators, FEV1 and PEF improve by more than 15%. Such obstruction is interpreted as reversible. With COPD, these numbers change slightly.

Chronic bronchitis may precede or accompany COPD, but it is an independent disease with clearly defined criteria (prolonged cough and), and the term itself implies damage only to the bronchi. With COPD, all structural elements of the lungs are affected - bronchi, alveoli, blood vessels, pleura. Chronic bronchitis is not always accompanied by obstructive disorders. On the other hand, increased sputum production is not always observed with COPD. That is, in other words, there can be chronic bronchitis without COPD, and COPD does not quite fall under the definition of bronchitis.

Chronic obstructive pulmonary disease

Thus, COPD is now a separate diagnosis, has its own criteria, and in no case replaces other diagnoses.

Diagnostic criteria for COPD

COPD can be suspected if there is a combination of all or several signs if they occur in people over 40 years of age:

Reliable confirmation of COPD is a spirometric indicator of the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC), carried out 10-15 minutes after the use of bronchodilators (beta-sympathomimetics salbutamol, Berotek or 35-40 minutes after short-acting anticholinergics – ipratropium bromide). The value of this indicator<0,7 подтверждает ограничение скорости воздушного потока и в сочетании с подтвержденными факторами риска является достоверным критерием диагноза ХОБЛ.

Other spirometry indicators - peak expiratory flow, as well as measurement of FEV1 without a test with bronchodilators can be carried out as a screening examination, but do not confirm the diagnosis of COPD.

Other methods prescribed for COPD, in addition to the usual clinical minimum, include chest x-ray, pulse oximetry (determining blood oxygen saturation), blood gas testing (hypoxemia, hypercapnia), bronchoscopy, chest CT, and sputum examination.

COPD classification

There are several classifications of COPD according to stages, severity, and clinical variants.

Classification by stages takes into account the severity of symptoms and spirometry data:

• Stage 0. Risk group. Exposure to adverse factors (smoking). There are no complaints, lung function is not impaired.
• Stage 1. Mild COPD.
• Stage 2. Moderate COPD.
• Stage 3. Severe course.
• Stage 4. Extremely severe course.

The latest GOLD report (2011) proposed eliminating the classification by stages; it remains classification according to severity, based on FEV1 indicators:

In patients with FEV1/FVC<0,70:

• GOLD 1: Mild FEV1 ≥80% predicted
• GOLD 2: Moderate 50% ≤ FEV1< 80%.
• GOLD 3: Severe 30% ≤ FEV1< 50%.
• GOLD 4: Extremely severe FEV1<30%.

It should be noted that the severity of symptoms does not always correlate with the degree of bronchial obstruction. Patients with a mild degree of obstruction may be bothered by fairly severe shortness of breath, and, conversely, patients with GOLD 3 and GOLD 4 may feel quite satisfactory for a long time. To assess the severity of shortness of breath in patients, special questionnaires are used, the severity of symptoms is determined in points. When assessing the course of the disease, it is also necessary to focus on the frequency of exacerbations and the risk of complications.

Therefore, this report proposes, based on an analysis of subjective symptoms, spirometric data and the risk of exacerbations, to divide patients into clinical groups - A, B, C, D.

Practitioners also identify clinical forms of COPD:

1. Emphysematous variant of COPD. The most common complaint in such patients is shortness of breath. Cough is observed less frequently, and there may be no sputum. Hypoxemia and pulmonary hypertension occur late. Such patients, as a rule, have low body weight and pink-gray skin color. They are called "pink puffers."
2. Bronchitic variant. Such patients complain mainly of cough with sputum, shortness of breath is less of a concern, they quickly develop cor pulmonale with the corresponding picture of heart failure - cyanosis, edema. Such patients are called “blue swelling”.

The division into emphysematous and bronchitis variants is quite arbitrary; mixed forms are more often observed.

During the course of the disease, a stable phase and an exacerbation phase are distinguished.

Exacerbation of COPD

An exacerbation of COPD is an acutely developing condition when the symptoms of the disease go beyond its normal course. There is an increase in shortness of breath, cough and a deterioration in the general condition of the patient. The usual therapy that he used previously does not relieve these symptoms to the usual state; a change in the dose or treatment regimen is required. An exacerbation of COPD usually requires hospitalization.

Diagnosis of exacerbations is based solely on complaints, history, clinical manifestations, and can also be confirmed by additional studies (spirometry, general blood test, microscopy and bacteriological examination of sputum, pulse oximetry).

The causes of exacerbation are most often respiratory viral and bacterial infections, less often - other factors (exposure to harmful factors in the ambient air). What is common in a patient with COPD is an event that significantly reduces lung function, which may take a long time to return to baseline or may stabilize at a more severe stage of the disease.

The more often exacerbations occur, the worse the prognosis of the disease and the higher the risk of complications.

Complications of COPD

Due to the fact that patients with COPD exist in a state of constant hypoxia, they often develop the following complications:

Treatment of COPD

Basic principles of treatment and preventive measures for COPD:

1. Quitting smoking. At first glance, it is simple, but the most difficult to implement point.
2. Pharmacotherapy. Early initiation of basic drug treatment can significantly improve the patient’s quality of life, reduce the risk of exacerbations and increase life expectancy.
3. The drug therapy regimen should be selected individually, taking into account the severity of the disease, the patient’s adherence to long-term treatment, the availability and cost of drugs for each individual patient.
4. Influenza and pneumococcal vaccinations should be offered to patients with COPD.
5. The positive effect of physical rehabilitation (training) has been proven. This method is at the development stage, there are no effective therapeutic programs yet. The easiest way that can be offered to a patient is to walk daily for 20 minutes.
6. In cases of severe disease with severe respiratory failure, long-term oxygen inhalation as a means of palliative care can improve the patient's condition and prolong life.

Quitting smoking

It has been proven that quitting tobacco smoking has a significant impact on the course and prognosis of COPD. Although the chronic inflammatory process is considered irreversible, stopping smoking slows its progression, especially in the early stages of the disease.

Tobacco addiction is a serious problem that requires a lot of time and effort not only from the patient himself, but also from doctors and relatives. A special long-term study was conducted with a group of smokers, which proposed various activities aimed at combating this addiction (conversations, persuasion, practical advice, psychological support, visual propaganda). With such an investment of attention and time, it was possible to achieve smoking cessation in 25% of patients. Moreover, the longer and more often the conversations are held, the greater the likelihood of their effectiveness.

Anti-tobacco programs are becoming national tasks. There is a need not only to promote a healthy lifestyle, but also to legislate punishment for smoking in public places. This will help limit the harm at least from passive smoking. Tobacco smoke is especially harmful for pregnant women (both active and passive smoking) and children.

In some patients, tobacco addiction is similar to drug addiction, and in this case, conducting conversations will not be enough.

In addition to campaigning, there are also medicinal ways to combat smoking. These are nicotine replacement tablets, sprays, chewing gum, and skin patches. The effectiveness of some antidepressants (bupropion, nortriptyline) in promoting long-term smoking cessation has also been proven.

Pharmacotherapy for COPD

Drug therapy for COPD aims to relieve symptoms, prevent exacerbations, and slow the progression of chronic inflammation. It is impossible to completely stop or cure destructive processes in the lungs with currently existing medications.

The main drugs used to treat COPD:

Bronchodilators

Bronchodilators used to treat COPD relax the smooth muscles of the bronchi, thereby expanding their lumen and facilitating the passage of air during exhalation. All bronchodilators have been shown to improve exercise capacity.

Bronchodilators include:

1. Short acting beta stimulants ( salbutamol, fenoterol).
2. Long acting beta stimulants ( salmoterol, formoterol).
3. Short-acting anticholinergics ( ipratropium bromide – atrovent).
4. Long-acting anticholinergics ( Tiotropium bromide – Spiriva).
5. Xanthines ( aminophylline, theophylline).

Almost all existing bronchodilators are used in inhalation form, which is a more preferable method than oral administration. There are different types of inhalers (metered dose aerosol, powder inhalers, breath-activated inhalers, liquid nebulizer inhalers). In severely ill patients, as well as in patients with intellectual disabilities, inhalation is best done through a nebulizer.

This group of drugs is the main one in the treatment of COPD; it is used at all stages of the disease as monotherapy or (more often) in combination with other drugs. For continuous therapy, the use of long-acting bronchodilators is preferable. If it is necessary to prescribe short-acting bronchodilators, preference is given to combinations fenoterol and ipratropium bromide (berodual).

Xanthines (aminophylline, theophylline) are used in the form of tablets and injections, have many side effects, and are not recommended for long-term treatment.

Glucocorticosteroid hormones (GCS)

GCS are a powerful anti-inflammatory agent. They are used in patients with severe and extremely severe degrees, and are also prescribed in short courses for exacerbations in the moderate stage.

The best form of use is inhaled corticosteroids ( beclomethasone, fluticasone, budesonide). The use of such forms of GCS minimizes the risk of systemic side effects of this group of drugs, which inevitably occur when they are taken orally.

GCS monotherapy is not recommended for patients with COPD; they are more often prescribed in combination with long-acting beta-agonists. Main combination drugs: formoterol + budesonide (Symbicort), salmoterol + fluticasone (Seretide).

In severe cases, as well as during exacerbations, systemic corticosteroids may be prescribed - prednisolone, dexamethasone, kenalog. Long-term therapy with these drugs is fraught with the development of severe side effects (erosive and ulcerative lesions of the gastrointestinal tract, Itsenko-Cushing syndrome, steroid diabetes, osteoporosis and others).

Bronchodilators and corticosteroids (and more often their combination) are the main, most accessible drugs prescribed for COPD. The doctor selects the treatment regimen, doses and combinations individually for each patient. In the choice of treatment, not only the recommended GOLD regimens for different clinical groups are important, but also the patient’s social status, the cost of medications and their availability for a particular patient, learning ability, and motivation.

Other drugs used for COPD

Mucolytics(sputum thinners) are prescribed in the presence of viscous, difficult to cough up sputum.

Phosphodiesterase-4 inhibitor roflumilast (Daxas) is a relatively new drug. It has a prolonged anti-inflammatory effect and is a kind of alternative to GCS. Used in tablets of 500 mg 1 time per day in patients with severe and extremely severe COPD. Its high effectiveness has been proven, but its use is limited due to the high cost of the drug, as well as a fairly high percentage of side effects (nausea, vomiting, diarrhea, headache).

There are studies that the drug fenspiride (Erespal) has an anti-inflammatory effect similar to GCS, and can also be recommended for such patients.

Among the physiotherapeutic methods of treatment, the method of intrapulmonary percussion ventilation is becoming widespread: a special device generates small volumes of air that are supplied to the lungs in quick bursts. This pneumomassage straightens the collapsed bronchi and improves lung ventilation.

Treatment of exacerbation of COPD

The goal of treating exacerbations is to relieve the current exacerbation as much as possible and prevent their occurrence in the future. Depending on the severity, treatment of exacerbations can be carried out on an outpatient basis or in a hospital.

Basic principles of treatment of exacerbations:

• It is necessary to correctly assess the severity of the patient’s condition, exclude complications that may masquerade as exacerbations of COPD, and promptly refer for hospitalization in life-threatening situations.
• During exacerbation of the disease, the use of short-acting bronchodilators is preferable to long-acting ones. Doses and frequency of administration are usually increased compared to usual. It is advisable to use spacers or nebulizers, especially in severely ill patients.
• If the effect of bronchodilators is insufficient, intravenous aminophylline is added.
• If monotherapy was previously used, a combination of beta-stimulants with anticholinergics (also short-acting) is used.
• If there are symptoms of bacterial inflammation (the first sign of which is the appearance of purulent sputum), broad-spectrum antibiotics are prescribed.
• Connecting intravenous or oral administration of glucocorticosteroids. An alternative to the systemic use of GCS is inhalation of Pulmicort through a nebulizer, 2 mg twice a day after inhalation of Berodual.
• Dosed oxygen therapy in the treatment of patients in a hospital through nasal catheters or a Venturi mask. The oxygen content in the inhaled mixture is 24-28%.
• Other measures include maintaining fluid balance, anticoagulants, treatment of concomitant diseases.

Caring for patients with severe COPD

As already mentioned, COPD is a steadily progressive disease and inevitably leads to the development of respiratory failure. The speed of this process depends on many things: the patient’s cessation of smoking, adherence to treatment, the patient’s financial capabilities, his mental abilities, and the availability of medical care. Starting with moderate COPD, patients are sent to MSEC to receive a disability group.

With an extremely severe degree of respiratory failure, the patient cannot even perform ordinary household activities, sometimes he cannot even take a few steps. Such patients require constant outside care. Inhalations for seriously ill patients are carried out only using a nebulizer. The condition is greatly alleviated by long-term low-flow oxygen therapy (more than 15 hours a day).

For these purposes, special portable oxygen concentrators have been developed. They do not require refilling with pure oxygen, but concentrate oxygen directly from the air. Oxygen therapy increases the life expectancy of such patients.

Prevention of COPD

COPD is a preventable disease. It is important that the level of COPD prevention depends very little on doctors. The main measures should be taken either by the person himself (quitting smoking) or by the state (anti-tobacco laws, improving the environment, promoting and stimulating a healthy lifestyle). It has been proven that prevention of COPD is economically beneficial due to the reduction of morbidity and disability of the working population.

Video: COPD in the “Live Healthy” program

Video: what is COPD and how to detect it in time

COPD is a progressive disease that is characterized by chronic inflammation of the bronchial tree and destruction of lung tissue in response to inhalation of harmful substances. Tobacco smoke, industrial dust or harmful gaseous substances top this list of substances. Inflammation inside the bronchi leads to a decrease in the lumen of the bronchi - bronchial obstruction. Consequences of obstruction - reduced air flow speed, impaired pulmonary ventilation. This is a broncho-obstructive pulmonary disease that requires constant treatment and medical supervision, especially during exacerbation of the disease. Emphysema, bullous emphysema, chronic obstructive bronchitis are variants of the manifestation of COPD.

Being in a state of inflammation for a long time, the airways undergo significant pathological changes. The cough begins to bother you, it is difficult to breathe, and shortness of breath occurs.

When obstruction damage to the bronchi and bronchioles becomes severe, a serious problem of gas exchange in the body arises: it becomes more difficult to obtain enough oxygen and get rid of excess carbon dioxide. These changes lead to shortness of breath and other symptoms.

Causes of chronic obstructive disease

To understand why COPD develops, it is important to understand how the lungs work. Typically, inhaled air passes from the nasopharynx through the respiratory tract (bronchi, bronchioles) to the tiny air sacs of the lung - the alveoli. In the alveoli, the oxygen we inhale passes through the alveoli wall into the bloodstream. Carbon dioxide travels in the opposite direction, from the bloodstream, back into the alveoli, and is eliminated when you exhale (Figure 1).

Inhaling smoke while smoking, or being a passive smoker, inhaling various irritating gaseous substances or small particles, a person experiences damage to the mucous membrane of the respiratory tract, chronic inflammation occurs, damaging lung tissue (Figure 2), and coughing attacks occur.

When the lung is damaged, a situation arises in which normal inhalation is a problem, and the exchange of oxygen and carbon dioxide in the alveoli becomes difficult, which naturally requires therapy.

In most cases, this is a disease acquired during life. Smoking (tobacco, marijuana, etc.) contributes to this dubious acquisition. Other factors that increase the risk include increased sensitivity to inhaled substances. This is especially true for inhalation of tobacco smoke from passive smokers, inhalation of organic, inorganic, house dust or polluted atmospheric air, prolonged exposure to occupational irritants (vapors of acids and alkalis, industrial dust).

Chronic obstructive disease can be hereditary. Genetic risk factors include a severe deficiency of alpha 1-antitrypsin, a protein that protects the lungs. There are also other hereditary defects. This may also explain the development of COPD in patients who do not smoke. About 20 percent of people who develop the disease have never smoked.

In any of the variants of the development of the disease, it is a progressive disease! All the drama is in the word progressive. Once formed, it will uncontrollably strive for the death of the patient. And this must be understood by absolutely every patient suffering from lung and bronchial diseases. Death occurs from progressive respiratory failure. In other words, a person slowly dies from lack of oxygen in the blood.

Question from a patient

Is COPD bronchitis, pneumonia or emphysema?

The term chronic obstructive pulmonary disease is often used along with diseases such as bronchitis and/or emphysema because they are the most common clinical forms of the pathology. Moreover, current treatments for COPD, chronic bronchitis, and emphysema are similar. But the outcomes of chronic bronchitis and pulmonary obstruction are different. This is why it is so important to make a correct diagnosis.

Manifestations of COPD

• Dyspnea. Two thirds of patients who suffer from COPD consult a doctor when they experience shortness of breath. Difficulty breathing and shortness of breath interfere with life and work, so the patient comes to see a doctor. Three or five years pass between the first feeling of shortness of breath and a visit to a pulmonologist.
• Cough. The cough is as common as a smoker's cough. Coughing is not taken seriously. Sputum when coughing is gray, green or brown. Microbes that live and multiply in the bronchi give sputum these colors.
• Wheezing. Shortness of breath and cough are accompanied by wheezing and whistling in the chest. The narrowing of the lumen of the bronchus causes whistling sounds when breathing. Phlegm inside the bronchi enhances or changes these sounds.

Diagnosis of chronic obstructive pulmonary disease

Over 10 years, 9.5 thousand patients with COPD received help at the IntegraMed clinic. The knowledge and experience acquired while working at the Pulmonology Research Institute helps our pulmonologists choose the right treatment regimen.

During your appointment with the doctor, your complaints will be listened to carefully. Complaints and anamnesis help to correctly assess the development of the disease and severity. The severity of the disease is assessed according to the international recommendations GOLD 2018. Dyspnea is measured in points using a patient questionnaire, using the MRC scale. Assessment of dyspnea is necessary to monitor treatment. The patient's appetite, height and weight, chest shape and skin are assessed. The oxygen level in the blood must be measured.

After the examination, breath tests are performed. Doctors perform spirometry themselves. The test result becomes accurate when a breath test is performed by a doctor. If necessary, a comprehensive study of respiratory function and lung diffusion capacity will be performed.

Treatment of COPD

Treatment of COPD is a long and consistent process under the supervision of doctors. Control is carried out during visits to the doctor or online consultations via Skype. The goal of a COPD treatment program is to reduce the number of exacerbations, improve respiratory function, and quickly cope with exacerbations.

Skype consultations

Online consultations save our patients time and effort. The patient sends tests and CT scans to the clinic. Then, at a pre-agreed hour, the pulmonologist who is treating you gets in touch via Skype. If during a consultation via Skype the doctor understands that an examination is required to correct treatment, then you will be invited to an appointment.

Calling a doctor to your home

For severe patients with COPD, the service Call a pulmonologist to your home is offered. Viktor Aleksandrovich Samoilenko consults at home, pulmonologist, candidate of medical sciences, nominee of the National Award for the best doctors of Russia “Calling”, student of the academician of the Russian Academy of Sciences, prof. Chuchalina A.G. During the on-site consultation, the doctor will adjust the treatment, change oxygen therapy regimens, and make new prescriptions.

Hospitalization

If it turns out that only a pulmonology hospital is required for treatment, then we will organize URGENT hospitalization in a pulmonology hospital. We will monitor the treatment together with our colleagues at the hospital.

"Day hospital"

In the “Day Hospital” we fight exacerbations of COPD with intravenous injections in combination with intensive nebulizer therapy. Two to three days of intensive treatment will lead to improved health. When breathing is restored, it will be possible to prescribe basic therapy.

Pulmonary rehabilitation for COPD

Our pulmonology department has developed a “Pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease.”

A course of complex therapy can replace bronchoscopic sanitation in patients with bronchiectasis.

• sputum becomes easily coughed up, coughing occurs naturally, medications are poured into the smallest bronchi, including antimicrobial agents.
• the introduction of drugs into the bronchus and removal of sputum is not invasive and traumatic.
• Due to the positive effect of drainage techniques and special exercises included in the course, lymphatic drainage of the bronchi and their blood supply improve. As a result, the protective properties of the mucous membrane of damaged bronchi and surrounding lung tissue are enhanced.
• There are no risks inherent in bronchoscopy: the risk of bleeding, damage and allergic reaction to anesthesia.

Symptoms

Radiological signs

Emphysema in a patient with COPD

COPD should be considered if you have:

• Shortness of breath on exertion or at rest.
• Chronic cough with expectoration of sputum and/or shortness of breath;
• The presence of a cough long before the onset of shortness of breath;
• Wheezing and whistling in the chest

If at least one of the above signs is present, a pulmonary function test is indicated to detect airflow limitation, even if there is no shortness of breath.

The most common symptoms are: cough without/with expectoration of sputum; shortness of breath during exercise or even at rest; headaches; increasing fatigue.

The disease usually does not initially cause or causes very mild clinical manifestations. As they progress, they increase, and the patient's condition worsens.

Question from a patient

Is COPD as dangerous as they say?

This is a disease with a slow progression. It will take 10-15 years before the main symptoms of the disease appear, usually shortness of breath and cough. This is due to the characteristics of inflammation in the respiratory tract under the influence of tobacco smoke or dust. As a result of their prolonged exposure and prolonged inflammation, oxygen transport in the alveoli and respiratory bronchioles is hampered. Less oxygen enters the blood and when exerted, the patient begins to experience shortness of breath - first from heavy loads, then from habitual ones, and then the patient can hardly get dressed or walk to the toilet. Therefore, the answer to the question whether COPD is dangerous or not, in my opinion, is obvious - DANGEROUS! Deadly DANGEROUS!

Question from a patient

Can asthma develop into chronic obstructive disease?

No. Quite a common misconception. These are two different diseases with the same broncho-obstructive syndrome. In both cases, the pulmonologist is faced with narrowing of the bronchi - broncho-obstruction. In the case of COPD it is not reversible, in the case of asthma it is reversible. Disease outcomes are also different. There are common features in the treatment of pulmonary respiratory failure, but these are different diseases. Many therapists and pulmonologists immediately prescribe drugs used for asthma to the patient. But this is not correct.
Why? Come to an appointment with us, we will tell you and will definitely help you.

The following tests are used to diagnose COPD:

• spirometry allows you to quickly and informatively assess the decrease in the lumen of the bronchial tree, as well as assess the degree of reversibility of this process;
• Body plethysmography allows you to diagnose emphysema and assess the impairment of the diffusion capacity of the lungs;
• peak flowmetry the simplest and fastest assessment test, but has low sensitivity. Can be effectively used to identify risk groups.

The main functional syndromes are:

• violation of bronchial obstruction;
• changes in the structure of static volumes, diffusion capacity of the lungs;
• decreased physical performance.

Thus, the diagnosis of chronic obstructive pulmonary disease is made based on:

• presence of risk factors;
• cough and shortness of breath;
• steadily progressing bronchial obstruction;
• excluding other diseases that lead to similar symptoms.

Probable portrait of the patient:

1. smoker;
2. middle or old age;
3. suffers from shortness of breath;
4. there is a cough with phlegm, especially in the morning;
5. complains of frequent exacerbations of bronchitis.

Question from a patient

What is important in pathological diagnosis?

Timeliness! The sooner the disease is diagnosed, the greater the likelihood of getting rid of its symptoms. We can help to fully control the disease in the early stages, with full contact with the patient and his relatives.

Stages of the disease 4. Treatment at the first and second stages of the disease shows the best results. Control with the third and fourth stages is possible, but these are already disabling phases of COPD. In our IntegraMedservice clinic, all necessary studies are carried out according to the standards of ERSATS and the Russian Respiratory Society.

Diagnostics requires careful execution of test methodology. Sometimes it is enough to conduct a physical examination to determine the severity of the current condition. But in most clinics, FVD is methodologically incorrect. Our tests are carried out by doctors themselves who have undergone special training, so mistakes are excluded. If emphysema is suspected, we perform body plethysmography to measure the diffusion capacity of the lungs - this is a painless test, carried out by our colleagues at the Pulmonology Research Institute.

Of course, chest CT is indispensable for suspected emphysema and bronchiectasis in patients with COPD. High-resolution CT used in our center completely solves the problem. In difficult cases, we consult with the chief radiologist of Russia, Prof. Tyurin I.E.

Non-drug treatment of COPD

• Categorical and complete cessation of smoking.
• Oxygen therapy.
• Proper nutrition.

Question from a patient

I have COPD and I decided to reduce the amount of cigarettes I smoke from 2 packs to 2 cigarettes a day. Will this protect me from progression of the disease?

No. If the disease is diagnosed, it does not matter how many cigarettes you smoke. Does the inflammatory process in the bronchi not matter since COPD has already formed? If you continue to smoke, the progression of the disease will still continue at the same rate.

Question from a patient

I have severe COPD and nothing depends on me quitting smoking! I’ll die, I’ll die, but I won’t quit smoking!

A frequent argument in the practice of our clinic. This is a tragic misconception that has cost many their lives. As soon as the patient stops smoking, the rate of inflammation drops sharply and the progression of the disease slows down sharply. Yes, there is no cure for this pathology, but you can win back 10-15 years of life simply by quitting smoking. The lungs will not recover as in their youth, but the disease will stop. Then it’s up to you and the pulmonologists.

If quitting smoking is a problem for you, you can contact the head of the pulmonology department at IntegraMedservice, Ph.D. Chikina S. Yu. Being a pulmonologist of the highest category, in addition to treating COPD, she can help get rid of the smoking habit. Methods generally accepted in the world of respiratory medicine are at your service. And I am sure that together we will be able to tame such a beast as obstructive pulmonary disease.

Question from a patient

Does COPD require oxygen?

Prescribing oxygen therapy is no less complex than prescribing drug treatment for a disease. Not every patient with COPD needs oxygen. Incorrectly prescribed oxygen therapy can worsen the prognosis of the disease or fail to achieve the desired effect. Many unfortunate pulmonologists, seeing reduced oxygen levels in a patient, rush to prescribe oxygen therapy without finding out whether it is necessary or safe?!

Patients with advanced obstructive pulmonary disease may have low levels of oxygen in the blood. This condition is called hypoxemia. Oxygen levels are measured by a device worn on a finger (pulse oximeter) or in a blood test (arterial blood gas test). People with hypoxemia should be treated with long-term oxygen therapy, which improves the quality and length of life.

We use LCT (long-term oxygen therapy) according to clear, proven indications. This is always preceded by serious analysis and testing on modern equipment. The qualifications of our pulmonologists allow us to prescribe this therapy on time. We set up oxygen supply modes, duration of sessions and monitor the effect.

Nutrition

More than 30% of people with severe chronic pulmonary obstruction are unable to eat enough due to shortness of breath and fatigue. Unintentional weight loss caused by shortness of breath is common in patients with advanced disease and severe respiratory failure. Irregular eating habits lead to malnutrition, which will worsen obstructive pulmonary disease and increase the risk of developing a respiratory tract infection.

FOR this reason, the following is indicated in the treatment of COPD:

• Eat small portions and often, with a predominance of nutritious foods;
• Eat foods that require little preparation;
• Rest before eating;
• Introduce multivitamins into your diet.

Dietary supplements are also a good source of extra calories as they are easily digestible and require no preparation.

Treatment of COPD with folk remedies

Despite the developed pharmacotherapy of COPD, the efforts of the world's leading specialists and various clinics, people have a craving for alternative methods of treatment. From a psychological point of view, this is understandable, but just as ineffective. Dear patients, there are no folk remedies that can affect this pathology! This is nonsense!!

There are medicinal herbs that can improve expectoration. This is true. They are not comparable to the strength and effectiveness of, for example, acetylcysteine, ambraxol. But...If you want to introduce folk remedies into your treatment regimen, then at least purchase medicinal preparations for expectoration of sputum in pharmacies.

Due to the unscientific nature of treatment with traditional methods, there is no single recipe for these remedies. There are many thousands of them. Marshmallow and plantain helped someone, someone couldn’t clear their throat without elecampane, etc. If we summarize all the material on the topic of traditional medicine and COPD, we were able to notice that the use of licorice, elecampane, marshmallow root and plantain are the most common names of herbs to improve expectoration. Actually, the effectiveness of such an “ancient” drug as Mucaltin is due to the fact that it contains marshmallow root.

Therefore, we would like to advise patients to use modern prescriptions from pulmonologists for the treatment of COPD. But if you are irresistibly drawn to the use of traditional medicine, do not cancel the appointment of your pulmonologist.

Question from a patient

Is there any surgical treatment for COPD?

Yes, surgical treatment is available for some forms of the disease. First of all, this is bullous emphysema. This is a variant of emphysema in which cysts and bullae (cavities in the form of large bubbles) form in the lungs. Surgery is performed using modern endoscopic technology. Also, according to indications, in case of extremely severe COPD, a lung transplant is possible.

In both cases, the operations are dangerous and complex manipulations that require high skill from thoracic surgeons. We have been working with such a specialist for a long time - the chief thoracic surgeon of Moscow E. A. Tarabrin, and are ready to refer our patients to him for treatment if necessary.

Question from a patient

What is the difference between the IntegraMedservice Center for Respiratory Medicine and other medical centers?

When prescribing treatment and caring for a patient with COPD of any severity, we first place the safety and effectiveness of therapy at the forefront. We do not treat tests or test results, we treat the patient.

We are the only private center that seriously and specifically deals only with respiratory problems, and especially pulmonology. We are not therapists, but real specialists in the field of pulmonology. The experience and knowledge gained while working at the Research Institute of Pulmonology allows us to guarantee the quality of treatment, diagnosis and prevention of COPD.

Making a diagnosis, diagnosing its phenotypes, choosing treatment tactics is a multidisciplinary work. Pulmonologists, otolaryngologists, specialists in functional and x-ray diagnostics, specialists in pulmonary rehabilitation and smoking cessation rehabilitation, and sometimes thoracic surgeons should actively participate in it. Moreover, reliable specialists with up-to-date knowledge work at every stage of diagnosis and treatment. Together, this ensures the success of therapy and the quality of life of our patients.

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