Chronic obstructive bronchitis symptoms

Chronic obstructive bronchitis - Symptoms

The clinical picture of COPD consists of a different combination of several interrelated pathological syndromes.

COPD is characterized by a slow gradual progression of the disease, which is why most patients turn to the doctor late, at the age of 40-50 years, when there is already enough expressed clinical signs of chronic inflammation of bronchi and bronchial obstructive syndrome in the form of cough, shortness of breath and reduced tolerance to daily physical load.

Resolve

When questioning, as a rule, it is possible to find out that the appearance of these symptoms is preceded by cigarette smoking on for at least 15-20 years and / or a more or less prolonged impact of the relevant production harmfulness. Often the patient notes frequent bronchopulmonary infections ("cold" diseases, viral infections, "Acute bronchitis etc.), as well as chronic diseases of ENT organs or aggravating heredity.

In most cases it is important to conduct a semi-quantitative assessment of one of the most important risk factors for COPD - smoking. For this purpose, the so-called index of a smoker is counted. To do this, the average number of cigarettes smoked per day is multiplied by the number of months in a year, i.e. at 12. If the index exceeds 160, smoking in this patient is considered a serious risk factor for COPD. If the index exceeds 200, such a patient should be classified as a "malicious" smoker.

Other methods of quantitative evaluation of smoking are suggested. For example, to determine the total number of so-called "packs / years" of smoking, the average number of cigarettes smoked per day is multiplied by the number of years during which the patient continues to smoke, and divide the result by 20 (the number of cigarettes in the standard pack). If the number of "packs / years" reaches 10, the patient is considered an "unconditional" smoker. If this figure exceeds 25 "packs / years the patient belongs to the category of "malicious" smokers.

It is very important to find out in detail the possible impact on the patient of various adverse environmental factors and production Harmfulness, in particular, long-term residence in ecologically unfavorable terrain, work in harmful production, contact with volatile pollutants, etc.

Finally, no less important is the information about frequent "cold" diseases, in the first place, respiratory viral infections, which have a powerful damaging effect on the respiratory mucosa and parenchyma of the lungs.

Complaints

The earliest symptom that appears in COPD patients at a young age, long before seeking medical help, is a cough with a small separation of mucous or mucopurulent sputum, which for a long time arise only in the morning ("morning cough smoker "). Just as in patients with chronic non-obstructive bronchitis, cough is an important mechanism for clearing the bronchi from excess bronchial secretion, which is formed due to insufficiency of mucociliary transport, manifested at first only in night time. The immediate cause of coughing is irritation of cough reflexogenic zones located at the places of division of large bronchi and in the region of bifurcation of the trachea.

Over time, cough becomes "habitual" and worries the patient during the day and especially at night, when patients occupy a horizontal position in bed. Cough usually intensifies during the cold and damp season, when the most frequent exacerbations of COPD occur. As a rule, such exacerbations differ relatively poor in symptoms and occur with normal or slightly elevated subfebrile body temperature. Nevertheless, even during this period, patients noted difficulty in breathing, dyspnea, as well as malaise, general weakness, rapid muscle fatigue, decreased efficiency. Cough intensifies, becomes more permanent. The sputum becomes purulent, the amount of it increases. The duration of such exacerbations is increasing and reaches 3-4 weeks, especially if they developed against the background of respiratory viral infections.

Especially severe exacerbations of chronic purulent bronchitis, which is characterized by febrile body temperature, marked intoxication and the laboratory of inflammation (leukocytosis, a shift of the blood formula to the left, an increase in ESR, an increase in the blood protein content of the acute phase of inflammation and etc.).

The immediate causes of exacerbation of chronic bronchitis are "supercooling viral infections, massive effects of volatile irritants (for example, excessive smoking or exposure to industrial or household pollutants), as well as severe intercurrent illnesses, physical fatigue and other

The second mandatory symptom, characteristic for almost all COPD patients, is shortness of breath, which indicates the formation of bronchial obstructive syndrome and lesion of the respiratory parts of the lungs.

In most cases in COPD patients, shortness of breath appears after several years from the onset of the disease, i.e. significantly after the appearance of cough with phlegm. Often, the initial manifestations of obstructive syndrome and respiratory failure are perceived patients only as a small difficulty in breathing, respiratory comfort arising from physical load. Moreover, patients during this period alone can not complain about shortness of breath or shortness of breath, and only careful analysis of all subjective sensations of the patient allows the doctor to initial manifestations of the respiratory insufficiency.

In these cases, patients with COPD can observe an increasing decrease in exercise tolerance, which is manifested by an intuitive decrease in the pace of walking, the need to stop For recreation, for example, when climbing stairs, etc. Often, there is a feeling of pronounced muscular fatigue during the performance of the usual exercise for a given patient

Over time, the difficulty of breathing becomes more and more specific and the patients themselves pay attention to this important symptom of the disease. Moreover, dyspnea becomes the main complaint of a COPD patient. In the expanded stage, dyspnea becomes expiratory, intensifying with physical exertion and exacerbations of chronic bronchitis. Inhalation of cold air, lowering of atmospheric pressure (high mountains, airplane flights) also cause an increase in dyspnea.

Finally, in severe cases, bronchoobstructive syndrome, manifested by attacks of a superficial, low-performance cough, diagnostic and the prognostic value of which is fundamentally different from the cough caused by the insufficiency of mucociliary transport and hypersecretion mucus. Attacks are often accompanied by a brief increase in signs of obstructive respiratory failure - dyspnea, cyanosis, tachycardia, and swelling of the cervical veins, which may be due to the manifestation of an early expiratory collapse of small bronchi. As you know, this mechanism of bronchial obstruction is based on two main reasons:

1. If the movement of air on small bronchi is difficult due to the presence of sputum, edema of the mucous membrane or bronchospasm during exhalation increased pulmonary pressure, which leads to an additional compression of small bronchi and an even greater increase in their resistance to flow air. The role of this mechanism increases with attacks of painful, ineffective cough and emphysema, accompanied by a marked decrease in the elasticity of the lung tissue.
2. The phenomenon of Bernoulli is the second most important mechanism of early expiratory collapse of the bronchi in narrowing them. The sum of the air pressure along the longitudinal axis and the lateral pressure on the bronchial wall is constant. With normal bronchial lumen and a relatively small linear airflow rate during exhalation, the lateral pressure of air on the wall of the bronchi is large enough that it prevents their early collapse.

With narrowing of the bronchi and during cough, the linear velocity of the air flow increases, and lateral pressure decreases sharply, which contributes to the early collapse of small airways in the very beginning of exhalation.

Thus, the most characteristic sign of COPD is the early appearance of cough with phlegm, and only after a few years - the attachment of expiratory dyspnoea. Only in rare cases, dyspnea may be a manifesting symptom of the disease that occurs simultaneously with a productive cough. This feature of the development of clinical manifestations of COPD is typical for patients who are subject to simultaneous intense action several risk factors, such as malicious smoking in combination with work in hazardous production in the atmosphere of volatile pollutants.

Physical examination

When general examination of COPD patients in the initial stages of the disease, significant differences from the norm, as a rule, do not show. With further progression of the disease, the formation of bronchial obstructive syndrome and severe respiratory failure in COPD patients, cyanosis appears. As a consequence of arterial hypoxemia, reduction of oxyhemoglobin and an increase in the concentration of reduced hemoglobin in blood flowing from the lungs, cyanosis usually acquires a diffuse character and has a peculiar grayish shade (diffuse gray cyanosis). Mostly it is noticeable on the face, the upper half of the trunk. The skin is warm to this touch if there are no signs of cardiac decompensation in patients with a chronic pulmonary heart. It should be remembered that there is no direct correlation between the degree of respiratory failure and the severity of cyanosis.

In the presence of concomitant bronchiectasis or chronic purulent bronchitis, in some cases, during examination, it is possible to identify a peculiar thickening of the terminal phalanges of the fingers in the form of tympanic sticks and changing nails in the form of watch glasses (a symptom of "drumsticks" and "sentries glasses ").

Finally, the development of decompensated chronic pulmonary heart disease and right ventricular failure may be accompanied by the appearance of peripheral edema, as well as changes the nature of cyanosis - it becomes mixed: against a background of diffuse coloring of the skin, a more intense blueness of the lips, fingertips, and the like is revealed. (acrocyanosis).

Practically all COPD patients have an emphysematous thoracic mark when examined. In typical cases, it is observed:

• an increase in the transverse and especially anteroposterior size of the thorax (in some cases it becomes "barrel-like");
• "Short neck" due to the fact that the chest is frozen at the height of inspiration;
• deployed (more than 90 °) epigastric angle;
• smoothness or swelling of the supraclavicular pits;
• more horizontal direction of the ribs and an increase in intercostal spaces;
• tight fit of the blades to the chest, etc.

Voice tremor due to the development of emphysema is weakened, but equally in the symmetrical areas of the chest.

Percussion over the whole surface of the lungs determine the box percussion sound. The lower borders of the lungs are shifted downward, and the upper ones are upward. The respiratory excursion of the lower edge of the lung, normally 6-8 cm, is reduced.

With auscultation, weakened vesicular breathing is more likely to occur, acquiring a particularly low shade (cotton breath), which is also associated with the presence of m emphysema of the lungs. Attenuation of respiration, as a rule, is expressed equally over symmetrical sites of the lungs. There is also an elongation of the exhalation phase due to the presence of bronchial obstructive syndrome (normally the ratio of inhalation and expiration is 1 or 2). At the initial stages of COPD development, when inflammatory changes in the bronchi predominate, and emphysema of the lungs is not so pronounced, hard lungs can be heard above the pulmonary fields.

The most characteristic auscultative sign of chronic obstructive bronchitis is scattered dry wheezes. Their tonality depends on the caliber of the bronchi in which they form. High (treble) dry wheezes indicate a significant narrowing of the distal (small) bronchi due to the presence there of a large amount of viscous sputum, mucosal edema or spasm of small bronchi. Chryps are better heard during the exhalation and change when you cough (the bowl disappears or decreases). The forced exhalation, on the contrary, leads to the intensification or appearance of high-toned dry wheezes.

Low (bass) buzzing and "buzzing" dry wheezes indicate a presence of viscous sputum in proximal (large and medium) bronchi.

In some, relatively rare cases, patients with COPD can listen to wet and small- and mid-bubble rales, indicating the presence of liquid sputum in the bronchi or in the cavity, associated with bronchi. In these cases, most often we are talking about the presence of bronchiectasises.

An important auscultatory phenomenon in patients with chronic obstructive bronchitis and COPD is remotely audible at a distance. They usually have the character of long, prolonged, multi-tone dry wheezes, usually more pronounced in exhalation.

When the syndrome of bronchial obstruction is expressed, remote rales are often audible much better than dry wheezing revealed during chest auscultation.

In patients with COPD, it is always important to correctly assess the physical data obtained during the study cardiovascular system, which may indicate the presence of pulmonary arterial hypertension and pulmonary heart. Among these signs include increased and diffuse cardiac shock and epigastric pulsation, indicating the presence of severe hypertrophy and dilatation of the right ventricle. With percussion in these cases, you can find a rightward displacement of the right border of relative dullness of the heart (dilatation of the right ventricle and right atrium), and with auscultation weakening of I tone and mild systolic murmur of tricuspid regurgitation, which, as a rule, develops with pronounced dilatation of the right ventricle in patients with decompensated pulmonary heart. Noise is often amplified during a deep inspiration (Symptom Rivero-Corvallo), because during this period of respiratory cycle increases the flow of blood to the right heart and, accordingly, the volume of blood regurgitating in the right atrium.

In severe disease, accompanied by the formation of pulmonary arterial hypertension and pulmonary heart disease in patients with COPD you can identify a paradoxical pulse - a decrease in systolic blood pressure during a calm deep inspiration of more than 10 mm Hg. Art. The mechanism of this phenomenon and its diagnostic significance are described in detail in Chapter 13 of the first volume of this manual.

It should be noted that most of these symptoms appear with the development of pronounced signs of the pulmonary heart and chronic heart failure. Sensitivity of the most characteristic clinical sign of hypertrophy of the right ventricle - strengthened cardiac shock and epigastric pulsations - even in severe cases, does not exceed 50-60%.

The most characteristic signs of bronchoobstructive syndrome in COPD patients are:

• Dyspnoea, predominantly of an expiratory nature, appearing or intensifying with physical exertion and coughing.
• Attacks of a superficial, low-productivity cough, in which a small number of sputum requires a large number of coughing thrusts, the strength of each of which decreases markedly.
• Extension of the exhalation phase with calm and especially forced breathing.
• Secondary emphysema of the lungs.
• Scattered high-toned dry wheezing in the lungs, heard with calm or forced breathing, and also remote rales.

Thus, chronic obstructive bronchitis is a slowly progressing disease with a gradual increased severity of clinical symptoms and mandatory occurrence at different stages of progression diseases:

• syndrome of mucociliary transport disorders (cough, sputum);
• bronchoobstructive syndrome;
• respiratory failure according to the obstructive type, accompanied by arterial hypoxemia, and then hypercapnia;
• pulmonary arterial hypertension;
• compensated and decompensated chronic pulmonary heart.

The possibility of a different combination of clinical manifestations of these syndromes explains the diversity of the individual clinical course of the disease.

Of practical importance are different combinations of signs of chronic bronchitis and emphysema, depending on which the bottom of the main clinical types of XOBL are isolated:

Emphysematous type (type A, "dyspnea "pink puffer" - "pink puffing") is characterized by a significant predominance of morphological and functional signs of emphysema, whereas the symptoms of chronic bronchitis proper are much less pronounced. Emphysematous type COPD more often develops in individuals with asthenic build and reduced body weight. Increase in the airyness of the lungs is provided by the valve mechanism ("air trap"): during inhalation, the airflow enters alveoli, and in the beginning or in the middle of exhalation the small airways are closed due to the expiratory collapse of small bronchi. On exhalation, thus, the resistance of the respiratory tract to the air flow increases substantially.

The presence of severe, usually panacinar, emphysema of the lungs and increased dilatability of the lung tissue, which does not exert significant resistance to inspiration, causes a significant increase in alveolar ventilation and a minute volume respiration. Therefore, respiration at rest, as a rule, is rare and deep (hypoventilation is absent).

Thus, in patients with emphysematous type of COPD, a normal vertical gradient of ventilation and blood flow in the lungs remains, so at rest there are no significant violations of ventilation-perfusion relations and, accordingly, gas exchange disturbances and the normal gas composition blood.

Nevertheless, the diffusion capacity of the lungs and the reserve volume of ventilation are sharply reduced due to a decrease in the total surface of the alveolar-capillary membrane and the reduction of capillaries and alveoli. Under these conditions, the slightest physical load leads to an acceleration of pulmonary blood flow, whereas a corresponding increase in the diffusivity of the lungs and the volume of ventilation does not occur. As a result, PaO2 decreases, arterial hypoxemia develops, and dyspnea appears. Therefore, in patients with emphysematous type of COPD for a long time, shortness of breath appears only with physical exertion.

Progression of the disease and a further decrease in the diffusive capacity of the lungs is accompanied by the appearance of dyspnea at rest. But even in this stage of the disease there is a clear dependence of the manifestation of dyspnea on the amount of physical activity.

In accordance with this dynamics of respiratory disorders in patients with emphysematous type of COPD, it is comparatively late formed a detailed picture of respiratory failure, pulmonary arterial hypertension and chronic pulmonary heart. Cough with a small sputum in these patients, usually occurs after the onset of dyspnea. According to Mitchell R.S., all the symptoms of COPD develop 5-10 years later than in the bronchial type of COPD.

The presence of dyspnoea with physical exertion, after which the patients "puff" for a long time, inflating their cheeks, intuitively seeking an increase intrapulmonary pressure, which somewhat reduces the phenomenon of early expiratory collapse of the bronchi, as well as a prolonged absence cyanosis and signs of the pulmonary heart has served as the basis for the fact that patients with emphysematous type COPD are called "pink puffer ".

The bronchitis type (type B, "blue bloater" - "cyanotic edematous") generally corresponds to the above described manifestations of chronic obstructive bronchitis in combination with centroacinar pulmonary emphysema. With this variant of the course of COPD, as a result of hypersecretion of mucus, edema of the mucosa and bronchospasm, there is a significant increase in resistance both exhalation and inspiration, which determines the occurrence of general and alveolar hypoventilation, mainly in the lower parts of the lungs, a change vertical gradient of ventilation and early onset of violations of ventilation-perfusion relations leading to the appearance of arterial hypoxemia and Shortness of breath. At later stages of the disease, as a result of fatigue of the respiratory muscles and increase in functional dead space, RaCO2 increases and hypercapia occurs.

In patients with bronchitis of COPD, pulmonary arterial hypertension develops earlier than with emphysematous type, signs of decompensated chronic pulmonary heart appear.

In the lungs, auscultatory signs of bronchial obstructive syndrome (dry wheezing, expiratory exhalation) are revealed, cyanosis, peripheral edema and other signs of respiratory failure and chronic pulmonary heart in connection with which such patients are sometimes figuratively called "cyanotic edematous" bloater ").

The described two clinical variants of the disease course in pure form are rare, especially emphysematous type COPD. Practitioners often meet with a mixed version of the course of the disease.

Complications of chronic obstructive bronchitis

The most significant complications of chronic obstructive bronchitis include

• emphysema of the lungs;
• respiratory failure (chronic, acute, acute on the background of chronic);
• bronchiectasis;
• secondary pulmonary arterial hypertension;
• pulmonary heart (compensated and decompensated).

It should pay attention to the high incidence of acute pneumonia in patients with chronic obstructive bronchitis. This is due to the blockage of the bronchi viscous sputum, a violation of their drainage function and a sharp decrease in the function of the local bronchopulmonary protection system. In turn, acute pneumonia, which can be severe, aggravates violations of bronchial patency.

An extremely serious complication of chronic obstructive bronchitis is acute respiratory failure with the development of acute respiratory acidosis. The development of acute respiratory failure is often due to the effect of acute viral, mycoplasma or bacterial infection, less often - pulmonary thromboembolism arteries, spontaneous pneumothorax, iatrogenic factors (treatment with beta-blockers, hypnotics, sedatives, narcotics that depress respiratory Centre).

One of the most common and prognostically unfavorable complications of long-term chronic obstructive bronchitis is the chronic pulmonary heart.

Current and forecast

The course of COPD is characterized by a steady progression of bronchial obstruction and respiratory failure. If normal non-smokers healthy individuals over the age of 35-40 years FEV1 annually decreases to 25-30 ml, the rate Reduction of this integral index of pulmonary ventilation in COPD patients and smokers significantly higher. It is believed that the annual decline in FEV1 in COPD patients is at least 50 ml.

The main factors that determine the unfavorable prognosis in COPD patients are;

• age over 60 years;
• a long history of smoking and a large number of cigarettes smoked at the present time;
• frequent exacerbations of the disease;
• baseline low values ​​and rates of decline in FEV1;
• formation of pulmonary arterial hypertension and chronic pulmonary heart;
• presence of severe concomitant diseases;
• male;
• low social status and general cultural level of COPD patients.

The most common causes of death in COPD patients are acute respiratory failure and chronic heart failure. Less often COPD patients die from severe pneumonia, pneumothorax, heart rhythm disturbances and pulmonary embolism.

It is known that approximately 2/3 of patients with severe COPD die within the first 5 years after the signs of decompensation of the blood circulation against the background of the formed chronic pulmonary heart. According to research data, during 2 years of observation,% of patients with COPD with compensated and 29% of patients with decompensated pulmonary heart die.

The appointment of adequate therapy and the implementation of preventive measures can reduce the rate of buildup of bronchial obstruction and improve the prognosis of the disease. So, only cessation of smoking after a few months can lead to a significant decrease in the rate of growth of the bronchial obstruction, especially if it is largely due to a reversible component of obstruction, this leads to an improvement in the prognosis disease.

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Chronic obstructive bronchitis - causes, symptoms and treatment

Bronchitis is the most common disease. It occurs in both adults and children. Chronic obstructive bronchitis is not only an inflammatory disease of the bronchi, but also the presence of damage to the bronchial mucosa. As a result, the process of proper ventilation of the bronchi is disrupted.

In this case, spasms and an obstruction to sputum are observed. It develops as an independent disease, and occurs as complications after other diseases such as influenza, acute respiratory infections, acute respiratory infections, inflammation of the nasopharynx, as the result of the influence of harmful substances in the production (work with cement, cadmium, silicon, in coal mines, metallurgy) as well as bad habits (smoking) and genetic inclinations.

Symptoms of obstructive bronchitis:

- A strong cough is the most common symptom of any type of bronchitis. Usually cough with bronchitis delivers a strong discomfort to the patient and makes him immediately consult a doctor.

- Cough oscillations in intensity, fluctuations in body temperature.

Tachycardia and pallor.

- A long, wheezy exhalation, wheezing.

- Shortness of breath, which occurs as a symptom of bronchitis even at the lowest physical exertion.

- Severe fatigue. This symptom occurs sharply with the onset of the development of the disease. At the same time the patient's fatigue exists at the slightest physical exertion.

In the case of obstructive chronic bronchitis, participation in the act of respiration of additional musculature is observed.

- The raised temperature characterizes an acute period of disease. When the disease goes to a chronic stage, the immunity falls so much that the body does not react to the inflammation process and the temperature does not increase.

Key mechanisms of the disease:

- Inflammation of not only medium and large bronchi, but also small ones, including the alveoli.

- Development of broncho-obstructive syndrome.

- Occurrence of diffuse secondary emphysema of the lungs.

- Hypoxemia and hypercapnia, as a consequence of the violation of gas exchange and ventilation.

- Pulmonary arterial hypertension.

Diagnosis of obstructive bronchitis

To diagnose this disease, the following studies are prescribed:

- Urine and blood tests.

- LHC, which determines the presence of a common protein and protein derivatives (fibrin, creatinine, haptoglobin, etc.).

- IAK for determination of blood content and functionality of T-B-lymphocytes, immune complexes.

- X-rays of light.

- Spirography.

- Echocardiography.

- Analysis of total and bacteriological sputum.

Treatment of obstructive bronchitis

Like any other serious illness, obstructive bronchitis requires proper targeted treatment. If the patient refuses treatment, the disease can go into a chronic form and give an inflammation to the lungs, promote the development of asthma.

For correct treatment, a clear and adequate correctly diagnosed diagnosis is necessary. Modern methods of diagnosis help the doctor accurately and in the shortest possible time to diagnose the disease, namely, the absence or presence of an obstructive form of bronchitis.

The beginning of treatment is characterized by bed rest and complete rest. As the patient's condition improves, walks and ordinary household duties are allowed.

Special conditions for proper treatment:

- Elimination of a variety of aggressively influencing factors, such as cosmetics, household chemicals and polluted air.

- To give up smoking. Among smokers, about 80% of patients suffer from obstructive bronchitis.

- The correct diet, diet, which will promote a speedy recovery. You should give up fried foods, spicy, oily and salty. Best suited are sour-milk products, cereals and broths. Such products will provide the body with the right amount of calories and do not overload it.

Medications for treatment

Drugs and procedures prescribed by a doctor are aimed at alleviating the symptoms of the disease and an obligatory hindrance to its development. Usually doctors prescribe such medicines:

- Adenoreceptors (terbutaline or salbutamol). These drugs contribute to the expansion of bronchial alveoli.

- Expectorants and mucolytics, such as Ambroxol or ATSTS. Very good effect has drugs based on herbs, in particular, thyme.

- Preparations are antibacterial. The most effective macrolide preparations are Erythromycin, Azithromycin, as well as drugs from the penicillin group, such as Amoxicillin. Such drugs are prescribed in the form of tablets, very rarely in the form of injections or inhalations in order to avoid complications.

- Inhalations with medicinal herbs (peppermint, chamomile, thyme) and essential oils are a great way to treat obstructive bronchitis.

- Antibiotics are used in case of severe forms of the disease, or when there are no positive results from treatment by other methods.

Traditional methods of treatment

The main methods used in non-traditional medicine are the reception of phytopreparations and the use of various compresses. For example, apply a compress of butter and honey. In equal proportions, the heated above ingredients are applied to the chest and back in the form of a normal compress. The course of treatment is one month.

Therapeutic exercise is also used in connection with the fact that in adults it is difficult to get rid of sputum. Thanks to physical exercises, recovery is faster. Also used breathing exercises, which improve the process of ventilation.

These methods are effective, but more moderate, compared with medicines, but have the right to exist. In any case, one should be cautious and do not resort to self-medication, since to diagnose the correct diagnosis it is necessary a specialist with special knowledge and able to choose the only correct treatment of one or another disease.

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Chronic obstructive bronchitis and COPD

Chronic obstructive bronchitis is a diffuse inflammatory disease of the bronchi characterized by an early lesion respiratory structures of the lung and leading to the formation of bronchial obstructive syndrome, diffuse lung emphysema and progressive disruption pulmonary ventilation and gas exchange, which are manifested by cough, dyspnoea and sputum, not associated with other diseases of the lungs, heart, system of blood, etc.

Thus, unlike chronic non-obstructive bronchitis, the key mechanisms that determine the characteristics of the course of chronic non-obstructive bronchitis are:

1. Involvement in the inflammatory process is not only large and medium, but also small bronchi, as well as alveolar tissue.
2. The development as a result of this bronchoobstructive syndrome, consisting of irreversible and reversible components.
3. Formation of secondary diffuse emphysema of the lungs.
4. Progressive violation of ventilation and gas exchange, leading to hypoxemia and hypercapnia.
5. Formation of pulmonary arterial hypertension and chronic pulmonary heart (CHS).

If at the initial stage of the formation of chronic obstructive bronchitis the mechanisms of damage to bronchial mucosa resemble those in chronic non-obstructive bronchitis (violation of mucociliary transport, hypersecretion of mucus, seeding of mucous pathogenic microorganisms and initiation of humoral and cellular factors inflammation), then the further development of the pathological process with chronic obstructive bronchitis and chronic non-obstructive bronchitis is fundamentally different from friend. The central link in the formation of progressive respiratory and pulmonary heart failure, characteristic of chronic obstructive bronchitis, is centroacinar pulmonary emphysema that occurs as a result of early damage to the respiratory parts of the lungs and an increasing bronchial obstruction.

Recently, to denote such a pathogenetically conditioned combination of chronic obstructive bronchitis and emphysema with progressive respiratory failure, the term "chronic obstructive pulmonary disease (COPD)" is recommended, which, according to the latest version of the international classification of diseases (ICD-X), it is recommended to use in clinical practice instead of the term "chronic obstructive bronchitis". According to many researchers, this term largely reflects the essence of the pathological process in the lungs with chronic obstructive bronchitis in the late stages of the disease.

Chronic obstructive pulmonary disease (COPD) is a collective concept that combines chronic inflammatory diseases of the respiratory system with a predominant lesion of the distal sections of the respiratory tract with irreversible or partially reversible bronchial obstruction, which are characterized by a constant progression and an increasing chronic respiratory insufficiency.. The most common causes of COPD include chronic obstructive bronchitis (in 90% of cases), bronchial asthma of severe course (about 10%), emphysema, developed as a result of deficiency of alpha1-antitrypsin (about 1%).

The main sign on which the COPD group is formed is the steady progression of the disease with the loss of the reversible component of bronchial obstruction and the growing phenomena of respiratory failure, the formation of centroacinar pulmonary emphysema, pulmonary arterial hypertension and pulmonary heart. At this stage of COPD development, the nosological affiliation of the disease is indeed leveled.

In the United States and Great Britain, the term "Chronic obstructive pulmonary disease" (COPD - chronic obstructive pulmonary disease; in the Russian transcription of COPD) also includes cystic fibrosis, obliterans bronchiolitis and bronchiectasis disease. Thus, at present, there is a clear inconsistency in the definition of COPD in the world literature.

Nevertheless, despite the similarity of the clinical picture of these diseases at the final stage of the disease development, at the early stages of the formation of these diseases it is advisable to preserve their nosological independence, since the treatment of these diseases has its own specific characteristics (especially cystic fibrosis, bronchial asthma, bronchiolitis, etc.).

There are still no reliable and accurate epidemiological data on the prevalence of this disease and the mortality of COPD patients. This is mainly due to the uncertainty of the term "COPD" that existed for many years. It is known that at present in the United States the prevalence of COPD among people over 55 is almost 10%. From 1982 to 1995 the number of patients with COPD increased by 4%. In 1992, the death rate from COPD in the United States was 1 per 10, 00 population and was the fourth leading cause of death in that country. In European countries, COPD mortality ranges from, (Greece) to 4, (Hungary) per 100 000 population. In the UK, approximately 6% of men's deaths and 4% of women's deaths are due to COPD. In France, 1, 00 deaths per year are also associated with COPD, accounting for a% of all deaths in this country.

In Russia, the prevalence of COPD in 1990-1998, according to official statistics, reached an average of 16 per 1000 population. Mortality from COPD in the same years was from 1 to 2, per 100 000 population. According to some data, COPD reduces the natural life expectancy by an average of 8 years. COPD leads to a relatively early loss of work capacity of patients, and most of them disability occurs approximately 10 years after the diagnosis of COPD.

ICD-10 code J44.8 Other specified chronic obstructive pulmonary disease J44.9 Chronic obstructive pulmonary disease, unspecified

Risk factors for chronic obstructive bronchitis

The main risk factor for COPD in 80-90% of cases is tobacco smoking. Among "smokers" chronic obstructive pulmonary disease develops 3-9 times more often than in non-smokers. The mortality from COPD determines the age at which smoking was started, the number of cigarettes smoked and the duration of smoking. It should be noted that the problem of smoking is especially relevant for Ukraine, where the prevalence of this harmful habit is 60-70% among men and 17-25% among women.

Chronic obstructive bronchitis - Causes and pathogenesis

Symptoms of chronic obstructive bronchitis

The clinical picture of COPD consists of a different combination of several interrelated pathological syndromes.

COPD is characterized by a slow gradual progression of the disease, which is why most patients turn to the doctor late, at the age of 40-50 years, when there is already enough expressed clinical signs of chronic inflammation of bronchi and bronchial obstructive syndrome in the form of cough, shortness of breath and reduced tolerance to daily physical load.

Chronic obstructive bronchitis - Symptoms

What's bothering you?

Coughing in the lungs Shortness of breath

Diagnosis of chronic obstructive bronchitis

At the initial stages of the development of the disease, careful examination of the patient, evaluation of anamnestic data and possible risk factors During this period, the results of objective clinical research, as well as data from laboratory and instrumental methods, are few informative. Over time, when the first signs of bronchial obstructive syndrome and respiratory failure appear, objective clinical and laboratory and instrumental data become increasingly diagnostic value. Moreover, an objective assessment of the stage of the development of the disease, the severity of the course of COPD, the effectiveness of the therapy is possible only with the use of modern research methods.

Chronic obstructive bronchitis - Diagnosis

What it is necessary to survey?

Bronchi Lungs

How to inspect?

Bronchoscopy Examination of bronchi and trachea X-ray of lungs Examination of respiratory (lung) organs Computed tomography of thorax

What tests are needed?

Sputum examination

Who to contact?

Pulmonologist

Treatment of chronic obstructive bronchitis

Treatment of COPD patients in most cases is an extremely difficult task. First of all, this is explained by the main regularity of the development of the disease - the steady progression of bronchial obstruction and respiratory failure due to inflammatory process and hyperreactivity of the bronchi and the development of persistent irreversible violations of bronchial patency caused by the formation of obstructive emphysema lungs. In addition, the low efficiency of treatment for many COPD patients is due to their late referral to the doctor, when there are already signs of respiratory failure and irreversible changes in the lungs.

Nevertheless, modern adequate complex treatment of patients with COPD in many cases allows to achieve a decrease in the rate of progression of the disease leading to increasing bronchial obstruction and respiratory failure to reduce the frequency and duration of exacerbations, improve efficiency and tolerance to physical activity.

Chronic obstructive bronchitis - Treatment

In addition to treatment

Treatment of bronchitis Physiotherapy with bronchitis Obstructive bronchitis: treatment with folk remedies Treatment of obstructive bronchitis in adults Antibiotics for bronchitis Antibiotics for bronchitis in adults: when appointed, the names What to treat? Tavanik Daksas

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Obstructive bronchitis in adults

Obstructive bronchitis in adults - diffuse bronchial damage caused by prolonged irritation and inflammation, at which there is a narrowing of the bronchi, accompanied by difficulty in getting out the accumulated mucus, phlegm. With bronchospasm, which are inherent in this disease, there is difficulty breathing, shortness of breath, wheezing, not associated with the defeat of other systems and organs. Progressive inflammatory process leads to impaired ventilation of the lungs.

The causes of bronchial obstruction

Factors affecting the development of obstructive bronchitis:

Medical factors:

• Infectious and inflammatory diseases of the respiratory system and violation of nasal breathing, foci of infection in the upper respiratory tract - bronchitis, pneumonia
• Recurrent viral infections and nasopharyngeal diseases
• Tumors of the trachea and bronchi
• Hyperreactivity of the respiratory tract
• Genetic predisposition
• Propensity to allergic reactions
• Injuries and burns
• Poisoning

Socio-economic factors:

• Smoking, second-hand smoke (see video from what do cigarettes)
• Alcohol abuse
• Unfavorable living conditions
• Elderly age

Environmental factors:

• Long-term effects on the bronchial mucosa of physical stimuli in the external environment are allergens, such as pollen of some plants, house dust, animal hair, etc.
• The presence of chemical stimuli in the air at work or at home - inorganic and organic dust, acid fumes, ozone, chlorine, ammonia, silicon, cadmium, sulfur dioxide, etc. (cm. influence of household chemicals on health).

Types of obstructive bronchitis

Acute obstructive bronchitis- An acute form of bronchial obstruction for adults is not typical, as most often acute obstructive bronchitis occurs in children under 4 years old. However, in adults primary obstructive bronchitis is observed - due to the addition of several risk factors described above, an inflammatory process develops. On the background of acute respiratory viral infection, influenza, pneumonia, with inadequate treatment and other provoking factors, the onset of obstruction may begin. In acute obstructive bronchitis, the main symptoms in patients are as follows:

• First observed catarrh of the upper respiratory tract
• Severe dry cough, with hard-to-recover sputum
• Coughing attacks especially worse at night
• Difficulty breathing, with exhaled breath
• The temperature is subfebrile, no higher than 3, this distinguishes acute obstructive bronchitis from simple acute bronchitis, which is usually a high temperature.

Acute bronchial obstruction is curable, but if it acquires a chronic form, it can become a progressive, irreversible disease.

Chronic obstructive bronchitisis a progressive obstruction of the bronchi in response to various stimuli. Violation of bronchial patency is conditionally divided into: reversible and irreversible. Symptoms with which patients usually consult a doctor:

• Strong cough, with a discharge in the morning of sparse phlegm mucus
• Shortness of breath, first appears only with physical exertion
• Wheezing, shortness of breath
• Sputum can become purulent in the period of addition of other infections and viruses and is regarded as a relapse of obstructive bronchitis.

Over time, with an irreversible chronic process, the disease progresses, and the intervals between relapses become shorter. In chronic course,

How to treat obstructive bronchitis

Treatment of obstructive bronchitis should be with the active participation of the patient in the treatment process. If possible, it is necessary to eliminate the negative factors provoking the progression of the disease - this is primarily a refusal to smoke, the desire to lead a maximally healthy lifestyle, if the main cause of the development of bronchial obstruction is industrial hazards - is desirable change of work.

Bronchodilating therapy.It consists of three groups of medicines:

• Anticholinergic drugs. The most effective and known of them Ipratropium bromide in metered aerosols is Atrovent. The effect of inhalation drugs is slow for about an hour and lasts 4-8 hours. Daily dosage 2-4 inhalations 3-4 times.
• Beta is a 2-agonist. These medications are recommended to be used 3-4 times a day. If the patient does not have a clear manifestation of the symptoms of the disease, then they can be used only as a prophylaxis immediately before physical exertion. The most famous drugs: Berotek, salbutamol.
• Methylxanthines. Widespread use of prolonged theophylline, they are used 1 -2 times a day. The most famous of these drugs is Teopek. A solution of euphyllin is administered only in hospitals according to indications. Caution is necessary when treating methylxanthines in patients with heart failure.

Mukoregulatory drugs.To improve sputum discharge, in cases of violation of its secretion, use Acetylcysteine, Ambroxol or Lazolvan (see. list of all expectorants for cough).

Antibacterial therapy.In cases of bacterial infection, in the presence of purulent sputum and signs of general intoxication, antibiotics are prescribed for bronchitis of a wide spectrum of action for 7-14 days. In inhalations, antibiotics are not used. If the patient has chronic obstructive bronchitis, antibiotic treatment prophylactically, in order to avoid exacerbations, do not.

Corticosteroids. Their use is limited, and systemic corticosteroids are prescribed only with severe respiratory failure. Perhaps the use of inhaled hormones, because the side effects in this application are significantly reduced.

Therapeutic breathing exercises.The training of the respiratory muscles is indicated to all patients with chronic obstructive bronchitis. This gymnastics exercises in Strelnikova, and breathing Buteyko, and the use of Frolov's breathing apparatus.

Indications for inpatient treatment

• Exacerbation of chronic obstructive bronchitis, which does not stop with outpatient treatment (persistent cough with purulent sputum, shortness of breath, signs of respiratory failure increase)
• Respiratory failure, which developed sharply.
• Attachment of pneumonia.
• Signs of heart failure with the development of the pulmonary heart.
• Need for bronchoscopy.

Advantages of nebulizers for the administration of medicines for COPD

Medicinal products for the treatment of obstructive bronchitis should be used in the form of inhalations. Most often in the home for this purpose use nebulizers. Their advantages are as follows.

• The drug is sprayed in the form of fine particles in the composition of the aerosol, due to which the depth of penetration of the substance in the respiratory tract increases.
• Ease of use in children and the elderly (do not coordinate inhalation with inhalation, which is difficult to teach a small child or elderly).
• The nebulizer allows you to inject high doses of the drug and can be used to stop attacks of suffocation.

zdravotvet.ru

Obstructive bronchitis

Bronchitis is an inflammatory disease of the respiratory system, which results in coughing, sputum separation, shortness of breath and respiratory failure. Obstructive bronchitis develops as a result of the narrowing of the lumen of the bronchi, resulting from spasm, edema of the bronchial mucosa and obstruction of the airway of the respiratory tract by sputum. This type of bronchitis often develops as a complication of influenza or viral infection in children of the first years of life, but also adults suffer from this disease.

The incidence of the disease in young children is associated with the peculiarities of the anatomical structure of the bronchi - a narrow lumen of respiratory tract, imperfection of children's immunity and frequency of occurrence of viral infections.

Obstructive bronchitis is a serious and dangerous disease that can lead to complications and become a cause of respiratory distress, especially in young children. Parents may underestimate the severity of the child's condition and do not pay enough attention to treatment, often this leads to a chronic process or the development of complications.

Causes and mechanism of disease development

Obstructive bronchitis develops on the background of viral infections, most often this disease affects children under 3 years old, who have had an acute respiratory viral infection or influenza caused by a PC infection, adenoviruses, influenza A viruses or mycoplasmal and chlamydial infection.

When a viral agent enters the upper respiratory tract, inflammation of the bronchial mucosa develops, inflammatory mediators are released, which provokes mucus edema and sputum production. The narrowing of the bronchi in children is mainly caused by the edema of all the walls of the bronchi and the clogging of their phlegm, and bronchospasm often causes obstruction in adults.

Acute and chronic course of the disease

Acute obstructive bronchitis - occurs in childhood, occurs against the background of a previous viral infection and with proper treatment, takes place within a few weeks. That is why it is very important to cure all diseases to the end, so that it does not become chronic.

Chronic obstructive bronchitis - develops gradually, this disease affects mainly adults, the cause of its development are bad habits (bronchitis smoker), occupational hazards (when working with harmful substances or with the constant inhalation of dust), adverse environmental factors and hereditary predisposition. The diagnosis of "chronic obstructive bronchitis" is set in the event that the symptoms of the disease - cough with sputum, diagnosed in the patient for 3 months a year for 2 years, in the absence of other bronchopulmonary diseases.

The main symptoms of the disease

Acute obstructive bronchitis and exacerbation of chronic bronchitis occur approximately equally - against a background of mild ailment or a viral infection, the patient has the following symptoms:

1. A severe painful cough is the main symptom of the disease, at first a rare dry cough develops into long excruciating attacks, which greatly exhaust the patient, do not bring relief and cause pain in the chest. This cough intensifies at night and prevents the patient from sleeping peacefully.
2. Shortness of breath - difficulty with bronchitis occurs during exhalation, a person begins to gasp, can not breathe out calmly because of the narrowing of the lumen of the bronchi and the clogging of their mucus, this causes a gradual fatigue of the patient and leads to the development emphysema. Emphysemic lungs are excessively stretched and air-filled lungs, if obstructive bronchitis is chronic, then the thoracic the human cell gradually changes - it becomes barrel-shaped, the lower ribs widen, respiratory failure and emphysema occur disease.
3. Coryza - except for difficulty breathing in the bronchi, with bronchitis, nasal breathing can be disturbed, which further exacerbates the situation.
4. Body temperature rise - with bronchitis the body temperature can remain normal, but more often it is on the numbers 33-3 degrees.
5. Headache, weakness, poor health - as the disease develops, the patient's condition can deteriorate greatly, lack of air, painful coughing attacks, constant fatigue due to shortness of breath, lack of sleep - all this makes the sick weak and strongly affects the overall state of health.
6. Redness of the throat - bronchitis also inflames the palatine tonsils and the back wall of the throat, except for a cough and runny nose, the patient can complain of a sore throat and the inability to swallow anything.

Chronic bronchitis even during an exacerbation can not give such a bright clinical picture, most often patients suffer from a constant dry or wet cough, periodically they have shortness of breath and a shortage of air and a general deterioration state. But, since, chronic bronchitis can last for years, the person no longer pays attention to such symptoms and takes for granted a constant cough and chest pain.

And instead of conducting a full-fledged treatment and finding out what factors provoke an exacerbation, such patients try to mitigate the symptoms of the disease, not caring about what provokes the development of respiratory failure. So do not wait until the disease goes into a more severe form, take all measures to get rid of this disease and improve your body.

Principles of treatment of obstructive bronchitis

Treatment of obstructive bronchitis both in children and in adults should necessarily be complex, it is necessary to use several methods of treatment. Good results are obtained by the simultaneous use of antibiotics, mucolytics, expectorants, physiotherapy, massage and traditional medicine.

Treatment of obstructive bronchitis in children will require a lot of cares and efforts from parents. If your child has been exposed to such a diagnosis, then in no case can not start treatment on its own or hope to get by taking antibiotics and antipyretics. Complex treatment includes all the necessary procedures and is carried out until all the signs of the disease disappear. Treatment of obstructive bronchitis should appoint a doctor, do not try to cope with the disease, especially in young children, it can lead to serious complications.

1. Bed rest regime - the child should always be in bed and avoid any physical exertion.
2. A plentiful warm drink and light nutritious food - it is necessary to provide the child with a lot of warm alkaline drink, this will help him to soften the throat and make up moisture reserves in the body. Food during illness should be light and nutritious, if the patient has no appetite, it is better not to force him to eat, but to offer fresh fruits and vegetables or dairy products.
3. Antibiotic therapy - despite the fact that the most common cause of infection are viruses, it is not necessary To refuse from application of antibiotics, the risk of development of bacterial complications on a background obstruction. When taking any antibiotics, one should not forget that they violate the intestinal microflora, simultaneously with antibiotics should take linex, hilak-forte, bifidobacterin or other drugs to combat a dysbacteriosis.
4. Mucolytics and expectorants - to dilute the accumulation of sputum in the bronchi and ensure its removal therefrom, it is recommended to conduct steam inhalations with any alkaline solutions. You can also use aerosols that help to soften the throat and dilute sputum - it is especially convenient to use aerosol inhalation in young children. It is also necessary to take expectorants - licorice root, althea, ipecacuanas, thermopsis solution, breastfeeding, broncholitin, mucaltin and others.
5. It is necessary to try to get rid of mucus and rinse the nasopharynx - with the accumulation of mucus it is prescribed to take it from the nasal passages with the help of a rubber a pear or an electric pump, this is of great importance in the treatment of children of the first years of life who do not yet know how to clean their noses and do not allow rinsing throat. To wash the nasopharynx in older children, saline solution, Borjomi and washing facilities can be used.
6. To reduce the common cold, it is possible to use vasoconstrictors suitable for the child's age. For babies it is recommended to use Aquamaris - drops containing only a little salt or nazivin for children older than 1 year, all these drugs can not be used more than 2-3 times a day and not more than 3 days contract.
7. Breathing exercises and massage - help restore normal breathing and drainage function of the bronchi. Any person can do the usual vibrating massage, it is enough to knock the ribs of the palm along the back and chest painfully, several times a day, to get the effect of vibration. But much more benefit will be with a professional massage, great value massage has for the treatment of young children who have an outflow sputum is very difficult, in this case you need to seek help from professional masseurs specializing in children's massage.

Traditional methods of treatment

For the treatment of bronchitis, folk medicine offers the following recipes:

1. Inhalation - with eucalyptus leaves (2 teaspoons for 0, 5 cups of boiling water), with collection (30 grams of chamomile and elderberry, mixed with 25 g of lime-colored and peppermint.
2. To facilitate the departure of phlegm, cranberry juice mixed with honey in equal proportions is used.
3. Treatment of bronchitis with the help of fat - melt fresh fat, better interior, on slow heat and drink warm 1-2 tablespoons 5-6 times a day.
4. Compress of oil with honey - take 1 tablespoon of oil and honey, warm in a water bath and spread a mixture of chest and back. Compresses do daily until the end of the course of treatment.

Preventive measures

Preventing the disease is much easier than treating the consequences:

1. Increased immunity - the intake of vitamins, the constant presence in the menu of fresh vegetables and fruits,
2. Hardening - helps to avoid viral infections and colds,
3. Timely treatment of ARVI and other infections.
4. Walking in the fresh air and physical training.

Obstructive bronchitis - Dr. Komarovsky

ingalin.ru

COPD - symptoms

COPD- an abbreviation for chronic obstructive pulmonary disease. The disease of non-allergic etiology of COPD arises from the ingress of toxic substances into the bronchi and lung tissue together with dust and gases. Doctors warn: COPD is a dangerous disease, so it is important to identify its symptoms as early as possible.

Symptoms of COPD

COPD is a disease that progresses over several years. Moreover, manifestations of the illness periodically exacerbated, and the patient's state of health deteriorates sharply. Exacerbation of COPD is most often perceived as symptoms of acute respiratory viral infection or bacterial bronchitis. After a while, there is a temporary improvement in the condition, but further periods of aggravation are inevitable. As COPD progresses, there is a tendency to frequent acute periods of the disease. The main symptoms in an adult that allow you to suspect COPD are:

• chronic cough, worse in the morning;
• a large amount of viscous sputum secreted by coughing;
• dyspnoea with physical exertion, and with the development of the disease even with a slight load;
• weight loss;
• permanent muscular weakness, decreased ability to work;
• headaches and dizziness;
• drowsiness.

In addition, as the development of lung disease, typical symptoms of COPD are noted, such as:

• change in the size of the chest (the so-called "barrel chest");
• weakening of breathing and heart sounds;
• cyanosis - a change in the coloration of the skin, they become pale with a pronounced bluish tinge;
• swelling of the cervical veins.

At medical examination the doctor draws attention to signs of a "pulmonary heart

• when listening to the splitting of the second cardiac tone with the pulmonary component;
• listening to dry wheezing;
• peripheral edema is noticeable;
• sometimes there is a bulging of the right ventricle of the heart due to hyperventilation of the lungs.

Unfortunately, COPD is often diagnosed at very late stages, when the patient's condition becomes severe and even hopeless.

Diagnosis of COPD

The diagnosis of COPD is made on the basis of spirometry. This basic method of investigation is a measurement of the function of external respiration. The patient is offered to take a deep breath first, and then - as much exhalation as possible. Using a computer connected to the device, the indicators are evaluated and compared with the norm. Secondary study is carried out in half an hour, pre-letting the patient inhale the medicine through the inhaler.

Additionally, the following survey methods can be assigned:

• general blood analysis;
• general sputum analysis;
• indicators of the content of gases in the blood;
• bronchography;
• bronchoscopy;
• ECG;
• X-ray computed tomography;
• fluorography or roentgen.

If the diagnosis of COPD is confirmed, then the therapy patient begins to deal with a doctor-pulmonologist. At the same time during the exacerbation of the disease, the patient is recommended to stay

in a hospital under the supervision of medical staff. The treatment of the disease is aimed at preventing complications and promoting health in general. When choosing medicines, the doctor is guided by the stage at which COPD is located.

Attention!Pulmonary specialists warn that smoking is a major risk factor for COPD. This disease develops in about 15% of smokers with experience. Passive smoking is also a predisposing factor for the development of a dangerous ailment, so smokers should not only think about their own health, but also the safety of their loved ones.

WomanAdvice.ru

What are the symptoms of hobbl and their nature?

Chronic obstructive pulmonary disease (COPD) is quite an insidious disease. The first symptoms of COPD a person can feel only after 5-10 years after the onset of the disease. Usually by this time the disease is already entering the second stage of its development.

The main cause of COPD is smoking, so the patient does not take the symptoms of the disease (cough, phlegm, dyspnea) for the disease, but considers it a cost of smoking. He does not hurry to the doctor, thereby delaying with treatment.

What provokes the development of COPD

This disease is chronic, which is inflammatory in the respiratory system, not associated with allergic reactions. There is an ailment due to irritation of the respiratory system with light toxic substances. It affects the bronchi and pulmonary parenchyma (the so-called respiratory tissue).

The disease develops due to the influence of harmful substances (dust and gas) on the respiratory system. Over time, the disease progresses, the symptoms become more pronounced. The patient's condition worsens.

The mechanisms of the changes occurring in the lungs are as follows:

• the formation of emphysema, in which there is swelling of the body and rupture of the walls of the alveoli of the lungs;
• in the bronchi there is an irreversible obstruction, which is characterized by difficulty in the passage of airflow due to the fact that the walls of the bronchi become more thickened;
• insufficiency of breathing becomes chronic and increases.

When a person constantly breathes the smoke of cigarettes, toxic gases or dust, the inflammatory process begins in the airways. It destroys the lung tissue responsible for breathing, forms emphysema, destroys the natural protective functions of the body, its restorative mechanisms. In small bronchi begins fibrosis.The functioning of the respiratory system is disrupted, the airflow reduces its speed due to delay in the lungs.The patient begins to have shortness of breath even at the slightest load. There are other signs of the disease.

According to statistics, in Russia every third person is a smoker, and smoking is the main cause of COPD. WHO voices its data - smoking causes deaths in 25% of cases of ischemia and in 75% of cases of bronchitis and obstructive pulmonary disease.

Smoking in conjunction with the influence of harmful industrial substances increases the risk of COPD. Against this background, one of its severe forms develops, leading to irreversible processes and death, which comes from lack of breathing.

Throughout the world, this disease is one of the main causes of death.

What are the signs and symptoms of the disease?

The presence of chronic obstructive pulmonary disease can be suspected by a constant cough, dry or with sputum, along dyspnea.

These signs are not grounds for diagnosing the disease, but if they are available, and risk factors are attached to them, the doctor is more likely to suspect the patient's ailment.

The first symptom of COPD is a chronic cough. Usually the patient does not associate it with any disease. For him, he is only the consequence of smoking, pollution of the environment. At the onset of COPD, coughing manifests itself at times. Gradually the patient begins to cough daily. Cough dry or with sputum secretion.

The main symptom of the disease is shortness of breath during physical stress. The patient is overcome by heaviness in the chest, suffocation. He does not have enough air, he has to exert a lot of energy for breathing.

Sputum, coughing up by the patient, is viscous. It is allocated a little. If there is pus in it, then, probably, there was an exacerbation of the inflammatory process in the respiratory system. Cough will constantly torment the patient for several years, which will lead to shortness of breath. Reduction in the air flow rate in the bronchi can occur without the development of chronic cough, as well as sputum discharge.

In addition, the following symptoms of COPD are observed: weakness in the whole body, persistent sickness, worsening mood, excessive irritability, weight loss.

What can the doctor detect when he examines the patient

When chronic obstructive pathology is just beginning to develop, examination of the patient will not reveal any abnormalities that are usually observed in this disease. Gradually, the swelling of the lungs increases, the permeability of the bronchi is impaired. At this time, the deformation of the body begins to appear in the patient - the thorax becomes barrel shaped, widened in the antero-posterior dimension. The swelling level affects the force of deformation.

All patients with this diagnosis are divided into two types:

• "Pink flutterers" - they have more pronounced swelling symptoms;
• "Blue fathers" - they are at the forefront of signs of obstruction.

In both groups of patients, the presence of these and other signs is mandatory.

If the disease has gone far, then the patient loses muscle mass and, accordingly, weight. If the patient is obese, then muscle mass is still reduced.

Due to prolonged work, the respiratory muscles become tired. If the patient does not eat well, the process is aggravated. Movement of the abdominal cavity indicates fatigue of the respiratory muscle - at the time of inspiration, its front part is retracted.

Cyanosis of the skin shows that there is not enough oxygen in the blood of a person. Also, he has a lack of breathing. Emergency medical care requires such a condition of the patient, in which he is inhibited, drowsy or vice versa, too excited. This is evidence of oxygen starvation, which threatens life.

Methods of diagnosing the disease

The doctor, examining the patient at the beginning of the illness, receives little information. If the percussion method is used, then a box sound is heard. Listening to the lungs at the time of exacerbation will allow the doctor to hear a dry or wheezing wheeze.

If the study occurs during a period of significant development of the disease, the specialist will see a significant swelling of the lungs and a violation in the patency of the respiratory system.

During the study, the doctor will find the patient a lot of signs of COPD:

• when tapping - boxed sound;
• insufficient diaphragm motion;
• stiffness of the breast cage;
• weak breathing;
• rattling wheezing or buzzing sight, scattered in nature.

The diagnosis of the disease is confirmed by instrumental diagnostics and laboratory methods of investigation.

Spirometry is performed, at which the functionality of the lungs is examined.

The speed of air in the bronchi is revealed, the irreversibility of obstruction, as indicated by the fact that bronchi can not expand with inhalation.

X-rays and CT are also used for diagnostic purposes, but they are used to exclude other lung diseases having symptoms similar to COPD.

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The level of oxygen and carbon dioxide in the blood is estimated. With a small amount of oxygen, he is prescribed inhalation.

On what principles is the treatment of the disease

During treatment, patients should follow certain recommendations:

• smokers should quit smoking, as taking medication while smoking does not make sense;
• to facilitate withdrawal from tobacco should take nicotine-substituting agents in the form of patches, inhalers, sprays, etc .;
• take medications to expand the bronchi (bronchodilators) in order to minimize shortness of breath and swelling;
• use roflumilast, this is a fairly new remedy against COPD, it reduces inflammation in exacerbations;
• with a small amount of oxygen in the blood, it is necessary to undergo long-term oxygen therapy;
• at a lower level of inspiration, use a nebulizer - a compressor inhaler;
• with purulent sputum, take antibiotics and expectorate doctors;
• undergo a program of pulmonary rehabilitation;
• annually vaccinated against influenza and pneumococcus to prevent infectious exacerbations in COPD.

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It is also important to carry out preventive measures. Again, the first place is smoking cessation. If the patient is working in hazardous production, then he must comply with all precautions and safety precautions. Do not work there above the permissible time limits.

So that the child does not begin to have problems with the lungs, he should, from childhood, set an example of a healthy lifestyle and inculcate intolerance and aversion to tobacco.

respiratoria.ru

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