Mar 04, 2018
Chronic obstructive pulmonary disease is a disease characterized by irreversible or partially reversible, progressive obstruction( impaired patency) of the bronchi. These are diseases that lead to blockage of airways( bronchi) or damage to small air sacs( alveoli) in the lungs, which causes difficulty in breathing. Two major diseases;included in this group, is emphysema and chronic bronchitis;in many people with chronic obstructive pulmonary diseases, both of these diseases are observed.
Chronic bronchitis is a constant inflammation of the bronchi leading to a constant cough with large amounts of mucus. When the cells lining the airways are irritated above a certain degree, tiny cilia( hair-like outgrowths), which usually catch and throw out foreign objects, stop working properly. Increased irritation leads to excessive production of mucus, which clogs the air passages and causes a severe cough, characteristic of bronchitis. Bronchitis is considered chronic when the patient coughs with phlegm for three months, and this is repeated for two consecutive years.
Emphysema is a gradual damage to the lungs as a result of tissue destruction and loss of elasticity of the alveoli in which oxygen enters the blood and carbon dioxide leaves it. If the lungs are damaged by chemicals contained in cigarette smoke, or as a result of persistent inflammation or chronic bronchitis, the thin walls of the alveoli can gradually become thicker, lose elasticity and become much less functional. The loss of elasticity, often in combination with narrowing of small air passages in the lungs( sometimes with complete blockage), leads to a delay in the used air, instead of allowing it to escape. Thus, the affected air sacs are not able to supply oxygen to or remove carbon dioxide from the blood;this causes characteristic shortness of breath for emphysema. Damage to the lung can progress until the difficulty of breathing becomes very strong;from this moment the disease becomes potentially life-threatening. Low levels of oxygen in the blood can lead to increased pressure in the pulmonary arteries( pulmonary hypertension), which in turn can prevent the right side of the heart from pumping blood through the lungs properly.
The development of chronic airway obstruction usually occurs gradually. It takes many years before symptoms appear, and by this time the disease has already reached a significant development. Damage to the lungs is constant, but in many cases it can be prevented by avoiding smoking. Chronic airway obstruction occurs two to three times more often in men than in women. COPD is considered as a disease of the second half of life. The usual age of patients is over 40 years. Men are sick more often. The disease is more common in socially-advantaged countries.
COPD is a very insidious disease characterized by a slow progressive course. From the actual onset of the disease to its manifestations is from 3 to 10 years. Symptoms of COPD begin to appear only in the second stage of the disease.
• Dyspnoea that worsens during exercise.
• Persistent cough with mucus, especially in the morning( sign of chronic bronchitis).
• Chronic dry cough( symptom of emphysema).
• In severe cases, the symptoms of chronic obstructive pulmonary disease may include a cough with blood, chest pain and a purple complexion.
• Swollen legs and ankles due to lack of right heart( pulmonary heart).
• Difficulty breathing out.
• Smoking is the most common cause of chronic obstructive pulmonary disease.
• Air pollution can also become a contributing factor.
• Industrial emissions or vapors containing chemicals can damage airways.
• Repeated viral or bacterial diseases of the lung can lead to thickening of the walls of the bronchi, narrow the air passages and stimulate excessive production of mucus in the lungs.
• Hereditary deficiency of the enzyme alpha-1-antitrypsin can lead to damage to the walls of the alveoli.
• People who are constantly exposed to dust, chemicals or other irritants of the lungs, and those whose profession requires constant strong use of light, such as glass blowers or musicians playing on wind instruments, are more likely to be emphysema.
• Young children living near smokers are more susceptible to chronic inflammation of the respiratory tract.
• Need a medical history and physical examination.
• A saliva sample can be taken for analysis.
• Blood tests from the artery and vein are needed( to measure the level of oxygen and carbon dioxide).
• Breast X-ray is required.
• Spirometry and other lung function testing methods are required, in which the respiratory capacity and lung capacity are measured.
• It is possible to measure the strength and efficiency of the heart muscle.
• Do not smoke;avoid smoke-filled premises.
• Drink more liquid to soften the mucus.
• Avoid caffeine and alcohol, as they have a diuretic effect and can lead to dehydration.
• Moisten the air in the room.
• Try not to go out on cold days or when air is dirty, and avoid cold wet weather. If the bronchitis has reached the expressed stage and is incurable, you can consider moving to places with a warmer and drier climate.
• Do not use cough suppressants. Cough is necessary to remove accumulated mucus from the lungs, and its suppression can lead to serious complications.
• Viral infection of the respiratory tract can cause an exacerbation of the disease;Reduce the risk of an infectious disease, minimizing contact with people suffering from infectious airways diseases, wash your hands more often. Annually vaccinate against influenza and pneumonia.
• A bronchodilator may be prescribed to expand the bronchial passages. In more serious cases, oxygen can be prescribed.
• A physician may prescribe antibiotics to treat or prevent bacterial infectious lung diseases, as patients with chronic obstructive pulmonary diseases are more susceptible to them. Antibiotics should be taken for the entire prescribed period.
• The doctor can instruct you how to remove mucus from the lungs, assuming different positions in which the head is below the trunk.
• Breathing exercises may be useful.
• In very serious cases, when there is severe damage to the lungs as a result of emphysema, a lung transplant can be performed( if the disease has weakened the heart, heart and lung transplantation is recommended).
At this stage, the disease, as a rule, has no clinical manifestations and does not require constant drug therapy. It is recommended seasonal flu vaccination and mandatory vaccination against pneumococcal infection every five years( for example, PNEVMO 23 vaccine).
With severe symptoms of dyspnea short-acting Inhalation bronchodilators may be used. Preparations Salbutamol, terbutaline, ventolin, fenoterol, berrotek. Contraindications: tachyarrhythmias, myocarditis, heart defects, aortic stenosis, decompensated diabetes mellitus, thyrotoxicosis, glaucoma. The drugs can be used no more than 4 times a day.
It is important to do the inhalation correctly. If to you for the first time have appointed or nominated a similar preparation, it is better to make the first inhalation together with the doctor that he has specified possible or probable errors. The drug must be inhaled( injected into the mouth) exactly on the background of inspiration, so that it fell into the bronchi, and not just "in the throat".After inhalation, it is necessary to hold your breath at the inspiration height for 5-10 seconds.
Separately in this group is the drug berodual. Its distinctive features is a duration of action of at least 8 hours and a good expression of the therapeutic effect. The first two days of taking the drug can cause a reflex cough, which then passes.
In the presence of a cough with sputum, patients are prescribed Mucolytics( drugs that dilute sputum).
At present, a large number of drugs with this effect is represented on the pharmaceutical market, but, in my opinion, one should prefer drugs based on acetylcysteine.
For example, ATSTS( packages for the preparation of a solution for ingestion, effervescent tablets of 100, 200 and 600 mg), Fluimucil in effervescent tablets. The daily dose of drugs for an adult is 600 mg.
There is also a dosage form( acetylcysteine rr for inhalations of 20%) for nebulizer inhalations. The nebulizer is an appliance for converting liquid medicinal substances into an aerosol form. In this form, the drug enters the smallest bronchi and alveoli and its efficacy is significantly increased. Such a method of administration of medicinal substances is preferred for patients with chronic diseases of the upper respiratory tract.
2. Treatment of the moderate form
To the drugs used at the 1( mild) stage of the disease, bronchodilators of long-acting action are added.
Serum( salmeterol).Produced in the form of a metered dose inhaler. The recommended daily dosage for adults is 50-100 μg / 2 times a day. It is necessary to closely monitor the technique of inhalation.
Formoterol( foradyl).It is produced in capsules containing powder for inhalations with the help of a special device( handihailer).The recommended daily dosage is 12 mcg / 2 times a day.
Alternatively, you can regularly use a sparrow. If the drug is used in the form of a metered aerosol, then two inhalations( two inhalations) of the drug are administered three times a day: in the morning, at lunch and in the evening. Also, the drug is available as a solution for inhalation through a nebulizer. In this case, the recommended dosage for an adult is 30-40 drops through a nebulizer - 3 times a day.
Relatively new, but already well-established, a drug from this group Spiriva( tiotropium bromide).Spiriva is prescribed once a day and is released in capsules for inhalations with the help of a special device. One of the most effective means for treating COPD is now. Active use is limited only by a relatively high cost.
At this stage of the disease, a constant anti-inflammatory treatment is necessary.
Inhaled glucocorticosteroids are prescribed in moderate to high doses. Preparations: беклазор, бекотид, бенакорт, pulmicort, флисотид etc. They are usually issued in the form of metered aerosols for inhalation or as solutions( pulmicort drug) for inhalation through a nebulizer.
Also for a given degree of severity of the disease, combination preparations containing both a long-acting bronchodilating drug and inhaled corticosteroid may be used. Preparations: sertid, simbikort. Combined drugs are currently considered to be the most effective therapy for COPD of this severity.
If you have been prescribed a drug containing an inhaled corticosteroid, be sure to ask your doctor how to properly inhale. Improperly performing the procedure significantly reduces the effectiveness of the drug, increases the risk of side effects. After inhalation, rinse your mouth.
In addition to the drugs used in the severe form of the disease, oxygen therapy is added( regular inhalation of air enriched with oxygen).For this purpose, in shops of medical equipment or in large pharmacies, you can find both large enough devices for home use, and small cartridges that you can take with you for a walk and use with increasing dyspnea.
If the condition and age of the patient allow, surgical treatment is performed.
In extremely severe conditions, the patient may require mechanical ventilation.
When an infection is attached, antibacterial agents are added to the therapy. It is recommended to use derivatives of penicillin, cephalosporins, fluoroquinolones. Specific drugs and their dosages are determined by the attending physician depending on the patient's condition and the presence of concomitant diseases, for example, in the pathology of the liver and / or kidneys - the dosage is reduced.
• Do not smoke( smoking is the first cause of chronic obstructive pulmonary disease).
• Do not spend much time on the street in the days when the air is polluted.
• Consult your doctor if the symptoms become severe, for example if dyspnea or chest pain increases, the cough worsens or you cough with blood, if you develop a fever, vomiting, or your legs and ankles swelled more than usual.
• Make an appointment with a doctor if you have a persistent cough with phlegm over the past two years or if you experience constant shortness of breath.
• Attention! Immediate medical attention is needed if your lips or face have acquired a bluish or purple hue.