How to treat COPD at home using folk remedies? COPD - treatment with folk remedies

– a disease in which the bronchi and lung tissue change their structure. The bronchial tract is obstructed, and the lung cells are replaced by emphysema cavities. System of blood vessels supplying blood lower section respiratory tract, degrades. The nutrition of the lungs and bronchi deteriorates, and their immunity decreases. The process is irreversible nature. There are no medications that can reverse the process. However, during the period of remission, treatment of COPD folk remedies will help the patient maintain immunity, improve well-being and mood.

In contact with

Since the cause of obstructive pulmonary disease is prolonged exposure to aggressive substances in the respiratory tract, the main recommendation is to completely eliminate the patient’s contact with any air pollutants:

• Tobacco smoke, including in the form of passive smoking;
• any other smoke, including from a fire, transport, industrial, etc.;
• small dust particles, for example, from cement, chalk and others formed during construction work in production;
• ordinary road dust, picked up on the street by wind and traffic.

These factors worsen the patient's health.

Among other health-supporting measures, the following recommendations may be helpful:

• Do physical exercises daily;
• practice breathing exercises;
• master eastern breathing stabilization practices;
• walk in the fresh air;
• support enough level humidity in the living space;
• install an air purifier or air conditioner in the apartment;
• promptly replace filters in cleaning devices;
• carry out wet cleaning twice or thrice a week;
• do not get too cold;
• protect yourself from respiratory infections;
• When going outside during epidemic periods, cover your face with a hygienic mask.

Traditional recipes for COPD

During the period of exacerbation

Exacerbation of COPD is infectious (more often) or viral (less often) in nature. During these periods, bacteria that surround us everywhere, and also live on our mucous membranes, enter the lower respiratory tract and provoke an inflammatory process. Viruses do the same thing, with the difference that the likelihood of contact with the virus is much less. Accordingly, treatment should involve systemic antibiotic therapy or be antiviral.

Treatment of COPD with folk remedies during exacerbations is not carried out.

During remission

Ginseng

Chinese ginseng is traditionally considered the best herbal remedy for pulmonary diseases. Additionally, Traditional Chinese Medicine states that this plant:

• Has immunostimulating properties;
• accelerates recovery after illness;
• tones;
• improves well-being and concentration.

To evaluate the effectiveness of ginseng in Chinese medicine Special studies were conducted that partially confirmed its effectiveness in the treatment of COPD with folk remedies.

Recipe:

Infuse ginseng flowers in boiled water at a temperature of 60-70 0 C for 30 minutes. Add as much plant material as you see fit. Focus on the taste of the resulting infusion: if it is too astringent or bitter, dilute boiled water. Use 3-5 times a day.

Echinacea

It is believed that Echinacea helps improve immunity, fights respiratory diseases, sore throat.

Recipe:

Take 1 spoon of echinacea flowers, St. John's wort, thyme, pour hot water and leave for 15-20 minutes. Drink half a glass 3-4 times a day.

Licorice or licorice root is used not only in traditional medicine. In the form of an extract, it is included in many medicines. Substances contained in licorice root are considered effective in treating throat diseases and bronchitis.

Recipe:

Mix licorice root (chopped or crushed) and eucalyptus leaves in equal proportions. Fill with hot water. Before use, add a spoonful of honey.

Licorice root has related undesirable effects: it can change the level of potassium and sodium, additionally retain water in the body, and lead to increased blood pressure. Side effect suggests limited use of this herbal preparation: every other day or less often for no more than a month.

Ginger root and garlic

When treating COPD with folk remedies, ginger and garlic are useful for their stimulating and antibacterial properties. The presence of these properties is evidenced by the burning taste of these root vegetables. The value of ginger and garlic for patients with bronchial and pulmonary obstruction lies, first of all, in their preventive properties against respiratory infections.

Recipe:

Take ginger and garlic in equal proportions, chop, add vegetable oil. Spread a thin layer on bread or crispbread, eat with other foods or separately.

Diet for the treatment of COPD

No special diet is required. It is recommended to eat as varied a diet as possible, including vegetables, cereals, fish, meat, and fruits. Since patients with COPD often lose weight, they may need to gain weight. daily calorie content consumed food.

Additional nutrition tips:

• Eat in small portions, but often - take 5-6 meals a day;
• exclude salt;
• drink more water;
• take vitamins.

Use of inhalations for COPD

Inhalation is the most effective way maintenance treatment of COPD with folk remedies.

Never inhale very hot steam. Do inhalations at a water temperature of 40-50 0C.

1. Sea salt

Dissolve 2 spoons sea ​​salt in 1 l. water. “Sea air” moisturizes the respiratory tract well, promotes the separation of mucus, and salt has a disinfecting effect.

1. Eucalyptus

Place 2 small handfuls of eucalyptus leaves in a pan of water and heat. Don't boil. Eucalyptus is a well-known folk remedy in the treatment of inflammatory diseases of the respiratory tract. The plant is considered good natural antiseptic. This means that eucalyptus inhalation is a good way to prevent bacterial exacerbations of COPD.

Do inhalations during the period of remission for 10-20 minutes daily or less often, depending on how you feel and the therapeutic effect.

Chronic obstructive pulmonary disease - long-term medical condition. Under the influence of therapy, its symptoms may weaken, and home care methods can reduce the intensity of the cough, eliminate excess mucus production and solve other problems.

Chronic obstructive pulmonary disease (COPD) is characterized by a reduction in the flow of air into and out of the lungs. With COPD, people often experience shortness of breath and may therefore have difficulty performing physical activities and daily living tasks.

There are currently no therapeutic strategies that can permanently cure COPD, but some home treatments can help open up the airways and improve quality of life.

In this material, we will describe home care methods that help manage COPD. In particular, we will discuss positive changes, which should be included in your lifestyle, and we will also talk about supplements and essential oils.

Below are home treatments and natural remedies that people can often manage the symptoms of COPD and slow the progression of the disease.

To give up smoking

Quitting smoking can slow the progression of COPD

Smoking - main reason COPD around the world. 90% of deaths associated with COPD are recorded due to humanity's addiction to cigarettes.

Smoking tobacco irritates the airways in the lungs. Inflammation of the airways causes them to narrow, making it difficult for air to pass in both directions.

A 2011 study by an international team of scientists found that lung function declines faster in smokers with COPD. In addition, such patients are associated with a higher risk of complications and mortality.

Smoking may also reduce the effectiveness of steroid inhalers, which are prescribed by doctors to treat COPD.

Quitting smoking is the most effective way to slow the progression of the disease. Patients with COPD should ask their doctor about ways to quit smoking faster and easier.

Improving environmental air quality

Certain irritants can make breathing difficult for people with COPD. These include the following:

• paints and varnishes;
• chemical cleaning products;
• pesticides;
• cigarette smoke;
• dust;
• pet hair.

The following recommendations will help improve the air quality in your home:

• limit contact with household chemicals;
• open a window to improve air flow;
• use air filtration systems;
• Clean air filtration systems regularly to prevent the growth of harmful mold;
• Vacuum and keep your home tidy to prevent dust from accumulating;
• wash weekly bed sheets to reduce the number of dust mites.

Breathing exercises

Breathing exercises are performed to relieve the symptoms of COPD by strengthening the muscles involved in breathing. Another goal of such exercises is to make it easier for the body to perceive physical activity.

In 2012, Australian scientists conducted a study in which, for 15 weeks, they compared the condition of patients with COPD who performed breathing exercises with the condition of those patients who did not perform such exercises.

Scientists included the following among breathing exercises.

• Breathing with tightly compressed lips. This exercise involves inhaling through your nose and exhaling through your mouth with your lips tightly pursed.
• Breathing with the diaphragm. To perform this exercise, you need to contract your diaphragm so that your breathing is deeper. The abdomen expands significantly when inhaling and relaxes when exhaling.
• Pranayama. This method of controlled breathing is often used in yoga. Pranayama involves concentration on those areas of the body that are involved in the breathing process.

The results of the study did not show a significant reduction in symptoms and improvement in quality of life with the use of these techniques, but people who did the exercises observed an improvement in the body's susceptibility to physical activity.

Stress management

Psychological stress weakens immune system and may contribute to COPD flare-ups

COPD can cause sudden flare-ups of symptoms that medical practice also called exacerbations. Anxiety and depression can increase the risk of developing such episodes. In addition, techniques that reduce stress improve general state health.

A study by American scientists, the results of which were published in 2016, showed that if a person suffering from COPD experiences depression, he has a higher chance of being readmitted to the hospital thirty days after his previous discharge. Emotional stress can weaken the immune system and thus increase the risk of developing respiratory infections.

Many people find mindfulness meditation helps reduce psychological stress. A small study conducted by American scientists in 2015 found that a two-month course of mindfulness meditation improved breathing rates in people with COPD. Participants in this study also reported improvements to their doctors. emotional state after six weeks of attending classes.

Healthy weight

Patients with COPD who are underweight are associated with an increased risk of mortality compared with those with chronic obstructive pulmonary disease who are obese.

If you have COPD and are low in body weight, you are more likely to develop the following:

• weakening of the respiratory muscles;
• decreased ability to take physical activity;
• decrease in pulmonary capacity.

According to a recent review by Dutch scientists, balanced diet may help people with COPD by improving lung function. In addition, a proper diet supports heart health and promotes metabolism. People with low body weight may benefit especially from eating foods that are rich in calories, protein, and unsaturated fat. All of the above in combination with physical activity leads to growth muscle mass and increasing energy levels.

Muscle strengthening

Many people with COPD find it difficult to perform various types of physical activity because breathing becomes more difficult when exerting themselves.

However, it should be understood that complete failure exercise may worsen COPD symptoms. In particular, this contributes to decreased muscle strength and increased fatigue.

The following types of physical activity help COPD patients strengthen muscles and increase lung capacity.

• Interval training. They involve alternating periods of low and high intensity loads. Interval training may be especially beneficial for people with severe degree of COPD, because they force the muscles to work, but do not overload the heart and lungs.
• Power training. In this case, resistance methods are used to improve muscle condition, e.g. heavy objects, tape expanders or a person’s own body weight. Building muscle in the lower body can reduce the severity of shortness of breath.

As soon as a person begins to lose physical fitness, the loads for him become more and more difficult, and lung function may deteriorate. Therefore, doctors recommend that people adhere to a physical activity regime from the initial stages of COPD.

Water exercises

People with COPD may have muscle or bone problems that make physical activity difficult. Aquatic exercise places less stress on the body's structures, which is why this type of exercise is considered more manageable and often more suitable for patients with chronic obstructive pulmonary disease.

In 2013, Australian scientists conducted a study and found that sports activities performed in water increase the intensity of acceptable physical activity and improve the quality of life. In the case of disabled people with COPD, aquatic exercise was more effective than regular exercise and no physical activity at all.

Scientists suggest that this is due to the unique properties of water, which supports the body's weight afloat and at the same time provides resistance, allowing for increased intensity of physical activity.

Supplements

COPD symptoms can be reduced by taking a range of supplements. Below are the most effective of them.

Vitamin D

Deficiency can increase inflammation of the airways and impair the body's ability to fight bacteria.

Coenzyme Q10 and creatine

Coenzyme Q10 and creatine are natural chemicals that promote the flow of energy to the body's cells.

In 2013, American scientists set out to find out whether coenzyme Q10 in combination with creatine reduces the symptoms of COPD in people with chronic respiratory failure.

After two months of supplementing with creatine and coenzyme Q10, patients experienced improved exercise capacity, decreased shortness of breath, and an increased quality of life.

Essential oils

COPD patients can also use essential oils to open up the airways and clear mucus from the lungs. These products can be taken through a diffuser or diluted with carrier oils and applied directly to the skin. Essential oils useful for COPD include eucalyptus oil.

Eucalyptus oil has anti-inflammatory properties

Eucalyptus oil contains eucalyptol. It is a naturally occurring chemical that may benefit patients with COPD because it has the following properties:

• is an antioxidant and natural anti-inflammatory agent;
• opens the airways in the lungs;
• reduces mucus production;
• helps clear mucus from the lungs;
• prevents outbreaks in moderate and severe forms of COPD.

As a result of another study, scientists suggested that people add 12 drops of eucalyptus oil to 150 milliliters of boiled water and breathe in the steam three times a day.

When should you see a doctor?

You should consult a doctor if symptoms of exacerbation of COPD appear, namely:

• more severe shortness of breath;
• increased volumes of mucus secreted;
• yellow, green or brown mucus;
• thicker or stickier mucus;
• fever;
• cold and flu symptoms;
• increased fatigue.

Some signs and symptoms indicate severe exacerbations of COPD, so seek emergency medical help if they occur. These signs include the following:

• dyspnea;
• blue lips and fingers;
• clouding of consciousness;
• drowsiness.

By treating exacerbations of COPD at an early stage, you can reduce the likelihood of developing further complications.

Conclusion

COPD is a chronic medical condition that is not easily controlled. People can manage its symptoms with home care methods that include physical activity, breathing techniques, nutritional supplements and essential oils.

If the symptoms of COPD worsen, then in this situation it is better to consult a doctor.

Modern methods of diagnosis and treatment of COPD
Modern methods of treating COPD

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

COPD is characterized by a progressive increase in irreversible obstruction as a result of chronic inflammation induced by pollutants, which is based on gross morphological changes in all structures of the lung tissue involving cardiovascular systems s and respiratory muscles.
COPD leads to limited physical performance, disability of patients and, in some cases, death.

The term “COPD”, taking into account all stages of the disease, includes chronic obstructive bronchitis, chronic purulent obstructive bronchitis, emphysema, pneumosclerosis, pulmonary hypertension, chronic cor pulmonale.

Each of the terms is Chronical bronchitis, pulmonary emphysema, pneumosclerosis, pulmonary hypertension, cor pulmonale - reflects only the peculiarity of the morphological and functional changes that occur with COPD.

The appearance of the term “COPD” in clinical practice is a reflection of the basic law of formal logic - “one phenomenon has one name.”

According to the International Classification of Diseases and Causes of Death, 10th revision, COPD is encrypted by the code of the underlying disease that led to the development of COPD - chronic obstructive bronchitis and sometimes bronchial asthma.

Epidemiology. It has been established that the prevalence of COPD in the world among men and women in all age groups is 9.3 and 7.3 per 1000 population, respectively.
For the period from 1990 to 1999. The incidence of COPD among women has increased more than among men - 69% compared to 25%.
This information reflects the changing situation among men and women in the prevalence of the most important risk factor for COPD, tobacco smoking, as well as the increased role of women's exposure to household airborne pollutants during food preparation and fuel combustion.

COPD is the single most common disease for which mortality continues to increase.
According to the US National Institutes of Health, mortality rates from COPD are low among people under 45 years of age, but in older age groups it ranks 4th-5th, making it one of the leading causes of death in the United States.

Etiology. COPD is defined by the disease that causes it.
COPD is based on a genetic predisposition, which is realized as a result of prolonged exposure to factors that have a damaging (toxic) effect on the bronchial mucosa.
In addition, several mutated gene loci have been discovered in the human genome to date, which are associated with the development of COPD.
First of all, this is a deficiency of aantitrypsin - the basis of the body's antiprotease activity and the main inhibitor of neutrophil elastase. In addition to congenital deficiency of a1-antitrypsin, hereditary defects of a1-antichymotrypsin, a2-macroglobulin, vitamin D-binding protein and cytochrome P4501A1 may be involved in the development and progression of COPD.

Pathogenesis. If we talk about chronic obstructive bronchitis, then the main consequence of the influence of etiological factors is the development of chronic inflammation. The localization of inflammation and the characteristics of the triggering factors determine the specificity pathological process with COB. Neutrophils are biomarkers of inflammation in COB.
They are predominantly involved in the formation of local deficiency of antiproteases, the development of “oxidative stress”, and play a key role in the chain of processes characteristic of inflammation, ultimately leading to irreversible morphological changes.
Impaired mucociliary clearance plays an important role in the pathogenesis of the disease. The efficiency of mucociliary transport, the most important component of the normal functioning of the airways, depends on the coordination of the action of the ciliated apparatus of the ciliated epithelium, as well as the qualitative and quantitative characteristics of the bronchial secretion.
Under the influence of risk factors, the movement of cilia is disrupted up to a complete stop, epithelial metaplasia develops with the loss of ciliated epithelial cells and an increase in the number of goblet cells. The composition of the bronchial secretion changes, which disrupts the movement of significantly thinned cilia.
This contributes to the occurrence of mucostasis, which causes blockage of small airways. The change in the viscoelastic properties of bronchial secretions is accompanied by significant qualitative changes in the composition of the latter: the content of nonspecific components of local immunity in the secretion, which have antiviral and antimicrobial activity - interferon, lactoferin and lysozyme, decreases. Along with this, the content of secretory IgA decreases.
Disorders of mucociliary clearance and the phenomenon of local immunodeficiency create optimal conditions for the colonization of microorganisms.
Thick and viscous bronchial mucus with reduced bactericidal potential is a good breeding ground for various microorganisms (viruses, bacteria, fungi).

The whole complex of the listed pathogenetic mechanisms leads to the formation of two main processes characteristic of COB: impaired bronchial obstruction and the development of centrilobular emphysema.
Bronchial obstruction in COB consists of irreversible and reversible components.
The irreversible component is determined by the destruction of the elastic collagen base of the lungs and fibrosis, changes in shape and obliteration of bronchioles. The reversible component is formed due to inflammation, contraction of bronchial smooth muscle and hypersecretion of mucus. Ventilation disorders in COB are mainly obstructive, which is manifested by expiratory shortness of breath and a decrease in FEV, an indicator reflecting the severity of bronchial obstruction. Disease progression as mandatory feature COB is manifested by an annual decrease in FEV1 by 50 ml or more.

Classification. Experts from the international program “Global Initiative for Chronic Obstructive Lung Disease” (GOLD - Global Strategy for Chronic Obstructive Lung Disease) identify the following stages of COPD:

■ Stage I - mild COPD. At this stage, the patient may not notice that his lung function is impaired. Obstructive disorders - the ratio of FEV1 to forced vital capacity of the lungs is less than 70%, FEV1 is more than 80% of the required values. Usually, but not always, chronic cough and sputum production.
■ Stage II - moderate COPD. This is the stage at which patients seek medical attention due to shortness of breath and exacerbation of the disease. It is characterized by an increase in obstructive disorders (FEV1 is more than 50%, but less than 80% of the expected values, the ratio of FEV1 to the forced vital capacity of the lungs is less than 70%). There is an increase in symptoms with shortness of breath appearing with physical activity.
■ Stage III - severe COPD. Characterized by a further increase in airflow limitation (the ratio of FEV1 to forced vital capacity is less than 70%, FEV1 is more than 30%, but less than 50% of the required values), an increase in shortness of breath, frequent exacerbations.
■ Stage IV - extremely severe COPD. At this stage, quality of life deteriorates markedly, and exacerbations can be life-threatening. The disease becomes disabling. It is characterized by extremely severe bronchial obstruction (the ratio of FEV1 to the forced vital capacity of the lungs is less than 70%, FEV1 is less than 30% of the expected values, or FEV1 is less than 50% of the expected values ​​in the presence of respiratory failure). Respiratory failure: paO2 less than 8.0 kPa (60 mm Hg) or oxygen saturation less than 88% in combination (or without) paCO2 more than 6.0 kPa (45 mm Hg). At this stage, the development of cor pulmonale is possible.

Course of the disease. When assessing the nature of the course of the disease, it is important not only to change the clinical picture, but also to determine the dynamics of the decline in bronchial patency. In this case, the determination of the FEV1 parameter - the forced expiratory volume in the first second - is of particular importance. Normally, as non-smokers age, FEV1 falls by 30 ml per year. In smokers, the decrease in this parameter reaches 45 ml per year. An unfavorable prognostic sign is an annual decrease in FEV1 by 50 ml, which indicates a progressive course of the disease.

Clinic. The main complaint at the relatively early stages of the development of chronic obstructive bronchitis is a productive cough, mainly in the morning. With the progression of the disease and the addition of obstructive syndrome, more or less constant shortness of breath appears, the cough becomes less productive, paroxysmal, and persistent.

Auscultation reveals a wide variety of phenomena: weakened or hard breathing, dry whistling and moist rales of various sizes; in the presence of pleural adhesions, a persistent pleural “crack” is heard. Patients with severe disease usually present with clinical symptoms of emphysema; dry wheezing, especially during forced exhalation; in the later stages of the disease, weight loss is possible; cyanosis (in its absence, slight hypoxemia may be present); there is the presence of peripheral edema; swelling of the neck veins, enlargement of the right side of the heart.

Auscultation reveals splitting of the first sound in the pulmonary artery. The appearance of noise in the projection area of ​​the tricuspid valve indicates pulmonary hypertension, although auscultatory symptoms may be masked by severe emphysema.

Signs of exacerbation of the disease: the appearance of purulent sputum; increased amount of sputum; increased shortness of breath; increased wheezing in the lungs; the appearance of heaviness in the chest; fluid retention.

Acute-phase blood reactions are weakly expressed. Erythrocytosis and an associated decrease in ESR may develop.
Causative agents of COB exacerbation are detected in sputum.
Chest x-rays may reveal increased and deformed bronchovascular patterns and signs of pulmonary emphysema. The function of external respiration is impaired by the obstructive type or mixed with a predominance of the obstructive type.

Diagnostics. A diagnosis of COPD should be considered in any person who has a cough, excess sputum production, and/or shortness of breath. It is necessary to take into account the risk factors for developing the disease in each patient.
If any of the specified symptoms it is necessary to conduct a study of the function of external respiration.
These signs are not diagnostically significant individually, but the presence of several of them increases the likelihood of the disease.
Chronic cough and excess sputum production often long precede ventilation disorders leading to the development of shortness of breath.
It is necessary to talk about chronic obstructive bronchitis if other causes of the development of bronchial obstruction syndrome are excluded.

Diagnosis criteria: risk factors + productive cough + bronchial obstruction.
Establishing a formal diagnosis of COB entails the next step of determining the degree of obstruction, its reversibility, and the severity of respiratory failure.
COB should be suspected if there is a chronic productive cough or shortness of breath, the origin of which is unclear, as well as if signs of slow forced expiration are detected.
The basis for the final diagnosis are:
- detection of functional signs of airway obstruction that persists despite intensive treatment using all possible means;
- exclusion of a specific pathology (for example, silicosis, tuberculosis or tumor of the upper respiratory tract) as the cause of these functional disorders.

So, the key symptoms for diagnosing COPD.
Chronic cough bothers the patient constantly or periodically; more often observed during the day, less often at night.
Cough is one of the leading symptoms of the disease; its disappearance in COPD may indicate a decrease in the cough reflex, which should be considered as an unfavorable sign.

Chronic sputum production: at the beginning of the disease the amount of sputum is small. The sputum is mucous in nature and is released mainly in the morning.
However, as the disease worsens, its quantity may increase, it becomes more viscous, and the color of the sputum changes. Shortness of breath: progressive (increases over time), persistent (daily). Intensifies with stress and during respiratory infectious diseases.
Action of risk factors in the anamnesis; smoking and tobacco smoke; industrial dust and chemicals; smoke from home heating appliances and fumes from cooking.

At clinical examination an extended expiratory phase in the respiratory cycle is determined, over the lungs - upon percussion there is a pulmonary sound with a boxy tint, upon auscultation of the lungs - a weakened sound vesicular respiration, scattered dry wheezing. The diagnosis is confirmed by examining respiratory function.

Determination of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and calculation of the FEV/FVC index. Spirometry shows characteristic decrease expiratory respiratory flow with slowing of forced expiration (decreased FEV1). The slowdown of forced expiration is also clearly visible in the flow-volume curves. VC and fVC are slightly reduced in patients with severe COB, but closer to normal than expiratory parameters.

FEV1 is much lower than normal; The FEV1/VC ratio in clinically overt COPD is usually below 70%.

The diagnosis can be considered confirmed only if these disorders persist despite long-term, maximally intensive treatment. An increase in FEV1 of more than 12% after inhalation of bronchodilators indicates significant reversibility of airway obstruction. It is often observed in patients with COB, but is not pathognomonic for the latter. The absence of such reversibility, when judged by single testing, does not always indicate fixed obstruction.
Often, the reversibility of obstruction is revealed only after long-term, maximally intensive drug treatment. The establishment of the reversible component of bronchial obstruction and its more detailed characterization are carried out by conducting inhalation tests with bronchodilators (anticholinergics and b2-agonists).

The berodual test allows for an objective assessment of both the adrenergic and cholinergic components of the reversibility of bronchial obstruction. Most patients experience an increase in FEV1 after inhalation of anticholinergic drugs or sympathomimetics.

Bronchial obstruction is considered reversible when FEV1 increases by 12% or more after inhalation of pharmaceuticals.
It is recommended to conduct a pharmacological test before prescribing bronchodilator therapy. Peak expiratory flow (PEF) measurements using peak flow meters are recommended for monitoring pulmonary function at home.

Steady progression of the disease is the most important sign of COPD. Expressiveness clinical signs at patients with COPD is constantly growing. Repeated FEV1 determinations are used to determine disease progression. A decrease in FEV1 by more than 50 ml per year indicates progression of the disease.

In COB, disturbances in the distribution of ventilation and perfusion occur and manifest themselves in various ways. Excessive ventilation of physiological dead space indicates the presence of areas in the lungs where it is very high in comparison with the blood flow, i.e. it goes “idle”. Physiological shunting, on the contrary, indicates the presence of poorly ventilated but well-perfused alveoli.
In this case, part of the blood flowing from the pulmonary arteries to the left heart is not completely oxygenated, which leads to hypoxemia.

In later stages, general alveolar hypoventilation occurs with hypercapnia, exacerbating hypoxemia caused by physiological shunting.
Chronic hypercapnia is usually well compensated and the blood pH is close to normal, except during periods of sharp exacerbation of the disease. X-ray of the chest organs.

The examination of the patient should begin with taking pictures in two mutually perpendicular projections, preferably on film measuring 35x43 cm with an X-ray image intensifier.
Polyprojection radiography allows one to judge the localization and extent inflammatory process in the lungs, the condition of the lungs in general, the roots of the lungs, the pleura, the mediastinum and the diaphragm. An image only in direct projection is allowed for patients in very serious condition. CT scan.
Structural changes in the lung tissue are significantly ahead of the irreversible obstruction of the respiratory tract, detected during the study of external respiration function and estimated by average statistical indicators of less than 80% of the required values.

In the zero stage of COPD, gross changes in the lung tissue are detected using CT. This raises the question of starting treatment for the disease at the earliest possible stages. In addition, CT allows one to exclude the presence of tumor diseases of the lungs, the likelihood of which is much higher in chronic smokers than in healthy people. CT can detect widespread birth defects development in adults: cystic lung, pulmonary hypoplasia, congenital lobar emphysema, bronchogenic cysts, bronchiectasis, as well as structural changes in the lung tissue associated with other past diseases lungs, which can significantly influence the course of COPD.

In COPD, CT allows one to examine the anatomical characteristics of the affected bronchi and determine the extent of these lesions in the proximal or distal part of the bronchus; With the help of these methods, bronchoetasis is better diagnosed and their localization is clearly established.

Using electrocardiography, the condition of the myocardium and the presence of signs of hypertrophy and overload of the right ventricle and atrium are assessed.

At laboratory research RBC counts may reveal erythrocytosis in patients with chronic hypoxemia.
When determining the leukocyte formula, eosinophilia is sometimes detected, which, as a rule, indicates COB of the asthmatic type.

Sputum examination is useful for determining the cellular composition of bronchial secretions, although the value of this method is relative. Bacteriological examination of sputum is necessary to identify the pathogen with signs of a purulent process in the bronchial tree, as well as its sensitivity to antibiotics. Symptom assessment.

The rate of progression and severity of COPD symptoms depend on the intensity of exposure to etiological factors and their combined effect. In typical cases, the disease makes itself felt over the age of 40 years. Cough is the earliest symptom, appearing by 40-50 years of age. By this time, during cold seasons, episodes of respiratory infection begin to occur, which at first are not associated with one disease.
Subsequently, the cough takes on a daily character, rarely worsening at night. The cough is usually unproductive; can be paroxysmal in nature and provoked by inhalation of tobacco smoke, changes in weather, inhalation of dry cold air and a number of other environmental factors.

Sputum is released in small quantities, often in the morning, and is mucous in nature. Exacerbations infectious nature are manifested by aggravation of all signs of the disease, the appearance of purulent sputum and an increase in its quantity, and sometimes a delay in its release. The sputum has a viscous consistency, often containing “lumps” of secretion.
As the disease worsens, the sputum becomes greenish in color and may appear bad smell.

The diagnostic significance of an objective examination for COPD is insignificant. Physical changes depend on the degree of airway obstruction and the severity of emphysema.
Classic signs of COB are wheezing with a single inhalation or with a forced exhalation, indicating a narrowing of the airways. However, these signs do not reflect the severity of the disease, and their absence does not exclude the presence of COB in the patient.
Other signs, such as weakened breathing, limited chest excursion, participation of additional muscles in the act of breathing, central cyanosis, also do not indicate the degree of airway obstruction.
Bronchopulmonary infection, although common, is not the only cause of exacerbation.
Along with this, an exacerbation of the disease may develop due to the increased effect of exogenous damaging factors or inadequate physical activity. In these cases, signs of damage to the respiratory system are less pronounced.
As the disease progresses, the intervals between exacerbations become shorter.
As the disease progresses, shortness of breath can vary from a feeling of lack of air during habitual physical activity to severe manifestations at rest.
Shortness of breath felt during physical activity occurs on average 10 years after the onset of cough.
It is the reason for most patients to see a doctor and the main cause of disability and anxiety associated with the disease.
As pulmonary function declines, shortness of breath becomes more severe. With emphysema, the onset of the disease is possible.

This occurs in situations where a person comes into contact with finely dispersed (less than 5 microns) pollutants at work, as well as in cases of hereditary deficiency of α1-antitrypsin, leading to early development panlobular emphysema.

The Medical Research Council Dyspnea Scale (MRC) is used to quantify the severity of dyspnea.

When formulating the diagnosis of COPD, the severity of the disease is indicated: mild course(stage I), moderate course (stage II), severe course (stage III) and extremely severe course (stage IV), exacerbation or remission of the disease, exacerbation of purulent bronchitis (if any); presence of complications (cor pulmonale, respiratory failure, circulatory failure), indicate risk factors, index smoking man.

Treatment of COPD in a stable condition.
1. Bronchodilators occupy a leading position in complex therapy COPD To reduce bronchial obstruction in patients with COPD, short- and long-acting anticholinergic drugs, short- and long-acting b2-agonists, methylxanthines and their combinations are used.
Bronchodilators are prescribed on an on-demand or regular basis to prevent or reduce symptoms of COPD.
To prevent the rate of progression of bronchial obstruction, long-term and regular treatment is a priority. M-anticholinergic drugs are considered first-line drugs in the treatment of COPD and their prescription is mandatory for all degrees of severity of the disease.
Regular treatment with long-acting bronchodilators (tiotropium bromide - Spiriva, salmeterol, formoterol) is recommended for moderate, severe and extremely severe COPD.
Patients with moderate, severe or extremely severe COPD are prescribed inhaled M-anticholinergics, long-acting b2-agonists as monotherapy or in combination with long-acting theophyllines. Xanthines are effective for COPD, but given their potential toxicity, they are “second-line” drugs. They can be added to regular inhaled bronchodilator therapy for more severe disease.

Anticholinergic drugs(AHP). Inhaled administration of anticholinergic drugs (M-anticholinergics) is advisable for all degrees of disease severity. Parasympathetic tone is the leading reversible component of bronchial obstruction in COPD. Therefore, ACPs are the first choice in the treatment of COPD. Anticholinergic drugs short acting.

The best-known short-acting ACP is ipratropium bromide, available in the form of a metered dose aerosol inhaler. Ipratropium bromide inhibits the reflexes of the vagus nerve, being an antagonist of acetylcholine, a mediator of the parasympathetic nervous system. Dosage is 40 mcg (2 doses) four times a day.
The sensitivity of M-cholinergic receptors of the bronchi does not weaken with age. This is especially important, as it allows the use of anticholinergic drugs in elderly patients with COPD. B
Due to low absorption through the bronchial mucosa, ipratropium bromide practically does not cause systemic side effects, which allows its widespread use in patients with cardiovascular diseases.
AHPs are not provided negative influence on the secretion of bronchial mucus and the processes of mucociliary transport.
Short-acting M-anticholinergics have a longer-lasting bronchodilator effect compared to short-acting b2-agonists.
Many studies have shown that long-term use Ipratropium bromide is more effective for the treatment of COPD than long-term monotherapy with short-acting β2-agonists.
Ipratropium bromide, with long-term use, improves sleep quality in patients with COPD.

Experts from the American Thoracic Society suggest using ipratropium bromide "...for as long as the symptoms of the disease continue to cause discomfort to the patient."
Ipratropium bromide improves the overall quality of life of patients with COPD when administered 4 times a day and reduces the number of exacerbations of the disease compared with the use of short-acting β2-agonists.

Using the inhaled anticholinergic drug ipratropium bromide 4 times a day improves general condition.
The use of IB as monotherapy or in combination with short-acting β2-agonists reduces the frequency of exacerbations, thereby reducing the cost of treatment.

Long-acting anticholinergic drugs.
A representative of the new generation of ACP is tiotropium bromide (Spiriva) in the form of capsules with powder for inhalation with a special metered dose powder inhaler Handi Haller. In one inhalation dose there is 0.018 mg of the drug, the peak of action is after 30-45 minutes, the duration of action is 24 hours.
Its only drawback is its relatively high cost.
The significant duration of action of tiotropium bromide, which makes it possible to use it once a day, is ensured by its slow dissociation with M-cholinergic receptors of smooth muscle cells. Long-term bronchodilation (24 hours), recorded after a single inhalation of tiotropium bromide, persists with long-term use for 12 months, which is accompanied by an improvement in bronchial patency, regression of respiratory symptoms, and improved quality of life. At long-term treatment In patients with COPD, the therapeutic superiority of tiotropium bromide over ipratropium bromide and salmeterol has been proven.

2. b2-agonists
short-acting b2-agonists.
For mild COPD, the use of short-acting inhaled bronchodilators “on demand” is recommended. The effect of short-acting b2-agonists (salbutamol, fenoterol) begins within a few minutes, reaching a peak after 15-30 minutes, and lasts for 4-6 hours.
Patients in most cases note relief in breathing immediately after using a b2-agonist, which is an undoubted advantage of the drugs.
The bronchodilator effect of b2-agonists is achieved through stimulation of b2 receptors of smooth muscle cells.
In addition, due to an increase in the concentration of AMP under the influence of b2-agonists, not only relaxation of the smooth muscles of the bronchi occurs, but also an increase in the beating of epithelial cilia and an improvement in the function of mucociliary transport. The bronchodilator effect is higher, the more distal the predominant disturbance of bronchial obstruction is.

After using short-acting b2-agonists, patients experience a significant improvement in their condition within a few minutes, the positive effect of which is often overestimated by them.
Regular use of short-acting b2-agonists as monotherapy for COPD is not recommended.
Drugs in this group can cause systemic reactions in the form of transient tremor, agitation, increased blood pressure, which may have clinical significance in patients with concomitant ischemic heart disease and hypertension.
However, with inhaled administration of b2-agonists in therapeutic doses these phenomena are rare.

Long-acting b2-agonists (salmeterol and formoterol), regardless of changes in bronchial obstruction, can improve the clinical symptoms and quality of life of patients with COPD and reduce the number of exacerbations.
Long-acting b2-agonists reduce bronchial obstruction by eliminating constriction of bronchial smooth muscle for 12 hours. In vitro, salmeterol has been shown to protect the epithelium of the respiratory tract from the damaging effects of bacteria (Haemophilus influenzae).

The long-acting β2-agonist salmeterol improves the condition of patients with COPD when used at a dose of 50 mcg twice daily.
Formoterol has a beneficial effect on respiratory function indicators, symptoms and quality of life in patients with COPD.
In addition, salmeterol improves the contractility of the respiratory muscles, reducing weakness and dysfunction of the respiratory muscles.
Unlike salmeterol, formoterol has a rapid onset of action (after 5-7 minutes).
The duration of action of prolonged b2-agonists reaches 12 hours without loss of effectiveness, which allows us to recommend the latter for regular use in the treatment of COPD.

3. Combinations bronchodilators.
The combination of an inhaled b2-agonist (fast-acting or long-acting) and ACP is accompanied by an improvement in bronchial patency to a greater extent than when prescribing either of these drugs as monotherapy.

In moderate to severe COPD, selective b2-agonists are recommended to be prescribed together with M-anticholinergics. Fixed combinations of drugs in one inhaler are very convenient and less expensive (berodual = IB 20 mcg + fenoterol 50 mcg).
Combining bronchodilators with different mechanisms of action increases effectiveness and reduces the risk of side effects compared to increasing the dose of a single drug.
At long-term use(for 90 days or more) IB in combination with b2-agonists does not develop tachyphylaxis.

In recent years, positive experience has begun to accumulate in combining anticholinergics with long-acting b2-agonists (for example, salmeterol).
It has been proven that to prevent the rate of progression of bronchial obstruction, long-term and regular treatment with bronchodilators, in particular ACP and long-acting b2-agonists, is a priority.

4. Long-acting theophimines
Methylxanthines are non-selective phosphodiesterase inhibitors.
The bronchodilating effect of theophyllines is inferior to that of b2-agonists and ACP, but oral administration (long-acting forms) or parenterally (inhaled methylxanthines are not prescribed) causes a number of additional effects that may be useful in a number of patients: reduction of systemic pulmonary hypertension, increased diuresis, stimulation of the central nervous system. systems, strengthening the work of the respiratory muscles. Xanthines can be added to regular inhaled bronchodilator therapy for more severe disease when ACP and b2-agonists are insufficiently effective.

Theophylline may have a beneficial effect in the treatment of COPD, but due to its potential toxicity, inhaled bronchodilators are preferable.
All studies showing the effectiveness of theophylline in COPD concern long-acting drugs. The use of prolonged forms of theophylline may be indicated for nocturnal manifestations of the disease.

Currently, theophyllines are classified as second-line drugs, i.e. they are prescribed after ACP and b2-agonists or their combinations.
It is also possible to prescribe theophyllines to those patients who cannot use inhaled delivery devices.

According to the results of recent controlled clinical trials, combination therapy with theophylline does not provide additional benefit in the treatment of COPD.
In addition, the use of theophylline in COPD is limited by the risk of adverse effects. adverse reactions.

Prescribing tactics and effectiveness of bronchodilator therapy.
Bronchodilators in patients with COPD can be prescribed both as needed (to reduce the severity of symptoms in a stable condition and during exacerbations) and regularly (for preventive purposes and to reduce the severity of symptoms).
The dose-response relationship, assessed by the dynamics of FEV, for all classes of bronchodilators is insignificant.
Side effects are pharmacologically predictable and dose-dependent. Adverse effects are rare and resolve more quickly with inhalation than with oral therapy.
In inhalation therapy, special attention should be paid to the effective use of inhalers and patient training in inhalation techniques.
When using b2-agonists, tachycardia, arrhythmia, tremor and hypokalemia may develop.
Tachycardia, disorders heart rate and dyspepsia may also occur when taking theophylline, in which doses providing a bronchodilator effect are close to toxic.
The risk of adverse reactions requires physician attention and monitoring of heart rate, serum potassium levels and ECG analysis, however, there are no standard procedures for assessing the safety of these drugs in clinical practice.

In general, the use of bronchodilators can reduce the severity of shortness of breath and other symptoms of COPD, as well as increase exercise tolerance, reduce the frequency of exacerbations of the disease and hospitalizations. On the other hand, regular use of bronchodilators does not prevent the progression of the disease and does not affect its prognosis.
For mild COPD (stage I) during remission, therapy with a short-acting bronchodilator on demand is indicated.
In patients with moderate, severe and extremely severe COPD (stages II, III, IV), bronchodilator therapy with a single drug or a combination of bronchodilators is indicated.

In some cases, patients with severe and extremely severe COPD (stages III, IV) require regular treatment high doses nebulized bronchodilators, especially if they noted subjective improvement from such treatment previously used for exacerbation of the disease.

To clarify the need for inhalation nebulizer therapy, peak flow metry monitoring is required for 2 weeks and continuation of nebulizer therapy if there is a significant improvement in indicators.
Bronchodilators are among the most effective symptomatic treatments for COPD.

Methods of delivery of bronchodilators
Exist various ways delivery of bronchodilators in the treatment of COPD: inhalation (ipratropium bromide, tiotropium bromide, salbutamol, fenoterol, formoterol, salmeterol), intravenous (theophylline, salbutamol) and subcutaneous (adrenaline) injections, oral administration of drugs (theophylline, salbutamol).
Considering that all bronchodilators are capable of causing clinically significant adverse reactions when administered systemically, the inhalation route of delivery is more preferable.

Currently on the domestic market there are drugs in the form of metered-dose aerosols, powder inhalers, and nebulizer solutions.
When choosing a method of delivery of inhaled bronchodilators, they are based, first of all, on the patient’s ability to correctly use a metered-dose aerosol or other pocket inhaler.
For elderly patients or patients with mental disorders, the use of a metered-dose aerosol with a spencer or a nebulizer is preferably recommended.

Determining factors in choosing delivery means are also their availability and cost. Short-acting M-anticholinergics and short-acting b2-agonists are used mainly in the form of metered-dose aerosol inhalers.

To increase the efficiency of drug delivery to the respiratory tract, spacers are used to increase the flow of the drug into the airways. In stages III and IV COPD, especially with respiratory muscle dysfunction syndrome, the best effect is achieved by using nebulizers. allowing to increase the delivery of the drug to the respiratory tract.

When comparing the main means of delivery of bronchodilators (metered dose aerosol inhaler with or without a spacer; nebulizer with mouthpiece or face mask; dry powder metered dose inhaler), their identity was confirmed.
However, the use of nebulizers is preferable in severely ill patients who, due to severe shortness of breath, cannot perform an adequate inhalation maneuver, which naturally complicates their use of metered-dose aerosol inhalers and spatial nozzles.
Upon achieving clinical stabilization, patients “return” to their usual means of delivery (metered-dose aerosols or powder inhalers).

Glucocorticosteroids for stable COPD
The therapeutic effect of GCS in COPD is much less pronounced than in BA, so their use in COPD is limited to certain indications. Inhaled corticosteroids (ICS) are prescribed in addition to bronchodilator therapy in patients with FEVg<50% от должной (стадия III: тяжелая ХОБЛ и стадия IV: крайне тяжелая ХОБЛ) и повторяющимися обострениями (3 раза и более за последние три года).

Regular treatment with ICS is indicated for patients with severe and extremely severe disease with annual or more frequent exacerbations over the past three years.
To establish the feasibility of systematic use of ICS, it is recommended to conduct trial therapy with systemic GCs at a dose of 0.4-0.6 mg/kg/day orally (prednisolone) for 2 weeks.
Long-term use of systemic corticosteroids (more than 2 weeks) in stable COPD is not recommended due to the high risk of adverse events.
The effect of steroids should complement the effects of continuous bronchodilator therapy.

ICS monotherapy is unacceptable for patients with COPD.

Corticosteroids are preferably administered in the form of metered-dose aerosols.
Unfortunately, even inhaled long-term use of GCS does not reduce the rate of annual decline in FEV in patients with COPD.
The combination of ICS and long-acting b2-agonists is more effective in the treatment of COPD than the use of individual components.

This combination demonstrates synergistic action and makes it possible to influence the pathophysiological components of COPD: bronchial obstruction, inflammation and structural changes in the airways, mucociliary dysfunction.
The combination of long-acting b2-agonists and ICS results in more advantageous risk/benefit ratios compared to individual components.

The combination of salmeterol/fluticasone propionate (Seretide) has the potential to increase survival in patients with COPD.
Each dose of Seretide (two puffs for a metered dose inhaler) contains 50 mcg of salmeterol xinafoate in combination with 100 mcg of fluticasone propionate, or 250 mcg or 500 mcg of fluticasone propionate.
It is advisable to use a fixed combination of formoterol and budesonide (Symbicort) in patients with moderate to severe COPD compared to the separate use of each of these drugs.

Other medicines
Vaccines. In order to prevent exacerbation of COPD during epidemic outbreaks of influenza, it is recommended to use vaccines containing killed or inactivated viruses, prescribed once in October-first half of November annually. The influenza vaccine can reduce the severity and mortality in patients with COPD by 50%.

A pneumococcal vaccine containing 23 virulent serotypes is also used, but there is insufficient data on its effectiveness in COPD.
However, according to the Committee of Advisors on Immunization Practices, patients with COPD are considered to be at high risk of developing pneumococcal disease and are included in the target group for vaccination. Polyvalent bacterial vaccines administered orally (ribomunil, bronchomunal, bronchovaxom) are preferable.
Antibacterial drugs. According to the current point of view, antibiotics are not prescribed for the prevention of exacerbations of COPD.

An exception is an exacerbation of COB with the appearance of purulent sputum (the appearance or intensification of “purulence”) along with an increase in its quantity, as well as signs of respiratory failure.
It must be borne in mind that the degree of eradication of etiologically significant microorganisms determines the duration of remission and the timing of subsequent relapse.

When choosing the optimal antibiotic for a given patient, one should focus on the spectrum of the main pathogens, the severity of the exacerbation, the likelihood of regional resistance, the safety of the antibiotic, the ease of use, and cost indicators.

First-line drugs for patients with mild exacerbations of COB are amoxiclav/clavulanic acid or its unprotected form, amoxicillin. Eradication of pathogens of respiratory tract infections makes it possible to break the vicious circle of the disease.

In the majority of patients with COB, macrolides are effective despite the registered resistance of S. pneumoniae to them and the low natural sensitivity of H. influenzae.
This effect may be partly due to the anti-inflammatory activity of macrolides.

Among macrolides, azithromycin and clarithromycin are mainly used.
An alternative to protected penicillins can be respiratory fluoroquinolones (sparfloxacin, moxifloxacin, levofloxacin), which have a wide spectrum of antimicrobial activity against gram-positive and gram-negative microorganisms, penicillin-resistant strains of S. pneumoniae and H. influenzae.
Respiratory fluoroquinolones are capable of creating high concentrations in the bronchial contents and have almost complete bioavailability when taken orally. In order to ensure high compliance of patients, the prescribed antibiotic should be taken orally 1-2 times a day and for at least 5, preferably 7 days, which meets modern requirements for antibacterial therapy for exacerbation of COB.

Mucolytic agents
Mucolytics (mucokinetics, mucoregulators) are indicated for a limited group of patients with stable COPD in the presence of viscous sputum. The effectiveness of mucolytics in the treatment of COPD is low, although the condition may improve in some patients with sticky sputum.
Currently, based on existing evidence, widespread use of these drugs cannot be recommended for stable COPD.

Ambroxol (lazolvan) and acetylcysteine ​​are most effective for COB. The previously practiced use of proteolytic enzymes as mucolytics is unacceptable.
To prevent exacerbation of COPD, long-term use of the mucolytic N-acetylcysteine ​​(NAC), which simultaneously has antioxidant activity, seems promising.

Taking NAC (fluimucil) for 3-6 months at a dose of 600 mg/day is accompanied by a significant decrease in the frequency and duration of exacerbations of COPD.

Other pharmacological agents. The prescription of psychotropic drugs to elderly patients with COPD for the treatment of depression, anxiety, and insomnia should be carried out with caution due to their inhibitory effect on the respiratory center.
In severe COPD with the development of drugs, there is a need for cardiovascular therapy,
In such cases, treatment may include ACE inhibitors, CCBs, diuretics, and possibly the use of digoxin.
The use of adrenergic blockers is contraindicated.

Non-drug treatment with stable COPD.
1. Oxygen therapy.
2. Surgical treatment (see below in the section “Treatment of emphysema”).
3. Rehabilitation.

Oxygen therapy. The main cause of death in patients with COPD is DN. Correction of hypoxemia with oxygen is the most pathophysiologically based method of treating DN.
The use of oxygen in patients with chronic hypoxemia must be constant, long-term and, as a rule, carried out at home, therefore this form of therapy is called long-term oxygen therapy (LCT).
VCT today is the only method of therapy that can reduce the mortality of patients with COPD.

Other beneficial physiological and clinical effects of VCT include:
reverse development and prevention of progression of pulmonary hypertension;
decreased shortness of breath and increased tolerance to physical activity;
decrease in hematocrit level;
improving the function and metabolism of respiratory muscles;
improvement of the neuropsychological status of patients;
reducing the frequency of hospitalizations of patients.

Indications for long-term oxygen therapy. Long-term oxygen therapy is indicated for patients with severe COPD.

Before prescribing VCT to patients, it is also necessary to make sure that the possibilities of drug therapy have been exhausted and the maximum possible therapy does not lead to an increase in O2 above the limit values. It has been proven that long-term (more than 15 hours per day) oxygen therapy increases the life expectancy of patients with DN.

The goal of long-term oxygen therapy is to increase PaO2 to at least 60 mmHg. Art. at rest and/or SaO2 at least 90%. It is considered optimal to maintain PaO within 60-65 mm Hg. Art.

Continuous oxygen therapy is indicated for:
- RaO2< 55 мм рт. ст. или SaО2 < 88% в покое;
- PaO2 56-59 mm Hg. Art. or SaO2 = 89% in the presence of CLS and/or erythrocytosis (Ht > 55%).

“Situational” oxygen therapy is indicated for:
- decrease in PaO2< 55 мм рт. ст. или Sa02 < 88% при физической нагрузке; - снижении РаО2 < 55 мм рт. ст. или Sa02 < 88% во время сна.

DCT is not indicated for patients with moderate hypoxemia (PaO2 > 60 mmHg).
The gas exchange parameters on which the indications for VCT are based should be assessed only during the stable condition of patients, i.e. 3-4 weeks after an exacerbation of COPD, since this is the time required to restore gas exchange and oxygen transport after a period of acute respiratory failure ( ODN).

Rehabilitation. Prescribed in all phases of COPD. Depending on the severity, phase of the disease and the degree of compensation of the respiratory and cardiovascular systems, the attending physician determines an individual rehabilitation program for each patient, which includes a regimen, exercise therapy, physiotherapeutic procedures, Spa treatment. Medical breathing exercises recommended for patients with COPD, even in the presence of severe obstruction.

An individually selected program leads to an improvement in the patient’s quality of life. It is possible to use transcutaneous electrical stimulation of the diaphragm. To give up smoking.
Quitting smoking is an extremely important intervention that improves the prognosis of the disease.
It should take first place in the treatment of this pathology. Smoking cessation reduces the extent and rate of decline in FEV1
The use of auxiliary artificial ventilation can be considered when pCO2 increases and blood pH decreases in the absence of effect from the listed therapy.

Indications for hospitalization: ineffective treatment in outpatient setting; increasing symptoms of obstruction, inability to move around the room (for a previously mobile person); increasing shortness of breath while eating and sleeping; progressive hypoxemia; the occurrence and/or increase of hypercapnia; the presence of concomitant pulmonary and extrapulmonary diseases; the emergence and progression of symptoms of “cor pulmonale” and its decompensation; mental disorders.

Treatment in a hospital setting
1. Oxygen therapy. In the presence of severe exacerbation of the disease and severe respiratory failure, continuous oxygen therapy is indicated.
2. Bronchodilator therapy is carried out with the same drugs as in the conditions outpatient treatment. Spraying b2-adrenergic agonists and anticholinergics is recommended using a nebulizer, inhaling every 4-6 hours.
If the effectiveness is insufficient, the frequency of inhalations can be increased. It is recommended to use combinations of drugs.
When therapy is administered via a nebulizer, it can be carried out within 24-48 hours.
Subsequently, bronchodilators are prescribed in the form of a metered aerosol or dry powder. If inhalation therapy is insufficient, intravenous administration of methylxanthines (aminophylline, aminophylline, etc.) is prescribed at a rate of 0.5 mg/kg/hour.
3. Antibacterial therapy is prescribed in the presence of the same indications that were taken into account outpatient stage treatment. If primary antibiotic therapy is ineffective, the selection of an antibiotic is carried out taking into account the sensitivity of the patient's sputum flora to antibacterial drugs.
4. Indications for use and regimens for prescribing glucocorticoid hormones are the same as at the outpatient stage of treatment. In severe cases of the disease, intravenous administration of GCS is recommended.
5. If edema is present, diuretics are prescribed.
6. In case of severe exacerbation of the disease, heparin is recommended.
7. Auxiliary artificial ventilation lungs is used in the absence of a positive effect from the above therapy, with an increase in pCO2 and a decrease in pH.

Non-drug methods treatments are used primarily to facilitate the production of sputum, especially if the patient is treated with expectorants, copious amounts of alkaline drinking.
Positional drainage - coughing up sputum using deep forced exhalation in a position that is optimal for the discharge of sputum. Coughing improves with vibration massage.

Forecast
The outcome of COPD is the development of chronic pulmonary heart disease and pulmonary heart failure.
Prognostically unfavorable factors are older age, severe bronchial obstruction (according to FEV1 indicators), severity of hypoxemia, and the presence of hypercapnia.
The death of patients usually occurs from complications such as acute respiratory failure, decompensation of the cor pulmonale, severe pneumonia, pneumothorax, and cardiac arrhythmias.

COPD is a disease that not everyone is familiar with because it is not that common. In fact, this abbreviation stands for quite simply, it is Chronic Obstructive Pulmonary Disease. And in order to be cured, it is not necessary to take expensive drugs; you can use folk remedies for lung disease. But these methods are not always effective; sometimes it is enough to simply reconsider your diet or apply other measures to promote a person’s health.

In order to achieve effective results from similar procedures it is necessary to engage in complex treatment; traditional methods alone will not be enough. How you can get rid of this disease will be discussed below. It is worth noting that the initial stages of the disease are much easier to cure, which is why at the first symptoms of the disease you need to consult a doctor.

As mentioned above, in order to cure a disease such as COPD, it will not be enough to take any medications, no matter the medicinal level or not. It is necessary to review your daily routine and use the following recommendations:

• Review your diet. First of all, when treating any disease, you need to start eating right and getting as many vitamins as possible from your food. Nutrition, first of all, should be balanced and rich in protein. You should include the following foods in your diet: fish, meat, legumes, soy, dairy products;
• Refuse to work in harsh conditions. A person with COPD should not work under hazardous working conditions;
• Minimize contact with sick people, this mainly concerns ARVI. You should not even have contact with sick children;
• Stop smoking. Everyone knows that smoking can have a bad effect on a person’s lungs, and therefore one must give up the bad habit;
• Start playing sports. Sport has a beneficial effect on a person and his body. If you don’t have time to exercise regularly, you can at least do morning exercises. It is advisable to constantly carry out breathing exercises. But it’s worth rationally distributing the load on your body, and don’t overdo it.

These methods can also be called prevention from COPD diseases, if they are followed, a person is unlikely to get sick with such a disease.

Herbal infusions

Treatment of COPD with folk remedies is one of the effective measures that many people suffering from this disease resort to. In fact, many ways have been invented to get rid of this disease. The simplest and at the same time effective methods will be discussed below.

To overcome COPD, use the following recipe:

1. Mix 100 gr. sage, 200g. mallow and the same amount of chamomile;
2. Powder the herbs using a blender;
3. Then pour the powder with hot water in the following ratio: 1 tablespoon per glass of water;
4. Leave the medicine to infuse for an hour.

This recipe is effective, but it should not be used more than two months. If after using it the disease does not go away, it is recommended to change the recipe. The medicine should be taken twice a day, at any time of the day.

There is one more no less effective recipe from treatment of COPD. For it we need to mix the following ingredients:

• 200 grams of chamomile;
• 200 grams of eucalyptus;
• 100 grams of flax;
• 200 grams of linden flowers.

After all the herbs are mixed, you need to follow the steps described in the recipe above. COPD disease treatment with folk remedies, which will be described in the article, is not so common today, and therefore not every person knows how to get rid of this disease. You can overcome the disease by using dried nettle roots. A syrup is prepared from them, which can be used at any time of the day, at least 3 times. To prepare it, use the following recipe:

1. Take nettle roots and sugar;
2. Mix two ingredients in a ratio of 2/3;
3. They need to be mixed until smooth;
4. Leave the resulting syrup for at least 6 hours.

Traditional methods of treating COPD were described above, which, compared to drug treatment do not cause harm to humans and have a good effect in the fight against this disease.

In order to get rid of the symptoms of COPD, you can use the following recipe:

1. You need to take 8 teaspoons of the following components; calamus, clover, knotweed, nettle, elecampane root;
2. Add three tablespoons of the following ingredients: licorice root, eucalyptus, bergenia;
3. Add 5 tablespoons of plantain to these herbs;
4. Mix all ingredients;
5. Take one tablespoon of the mixture;
6. Pour a glass of boiling water over it;
7. Place the resulting mixture on low heat and boil for ten minutes;
8. Cool the broth;
9. Strain it.

You need to drink a whole glass of water a day, dividing it into three doses. You should take the medicine before meals or an hour after meals. In order for the medicine to be effective it should be taken warm. There is another similar recipe, which is prepared in the same way, but its composition will be different.

To prepare another medicine you will need the following ingredients:

• Ten spoons of St. John's wort;
• Eight spoons of thyme, raspberries, calamus, oregano, lingonberries;
• Seven spoons of plantain;
• Six spoons of elecampane;
• Five spoons of wild rosemary;
• Four spoons of pine needles.

This recipe is also considered effective. If you are not allergic to such herbs, then you can safely use them for your treatment.

Different methods

In order to overcome COPD disease, you can resort to treatment with folk remedies that every person can do. Many people believe that salt can only harm the respiratory tract, however, this is absolutely not true and thanks to salt you can overcome a disease such as COPD.

In order to overcome such a serious disease, you can regularly visit salt cave or give yourself salt-based inhalations. Of course, we should not forget about the methods described above, which have nothing to do with treatment. It's about nutrition and rethinking your diet.

Tinctures

Below we will list how to treat COPD with folk remedies. The most simple recipes, which anyone can do. Below is a recipe for COPD, the main ingredient of which is radish. To prepare it, you can use the following recipe:

1. Take three hundred grams of black radish and the same amount of beets;
2. Grate the fruits;
3. Boil a liter of water;
4. Cool the water;
5. Add it to the beetroot and radish paste;
6. Infuse the medicine for three hours.

Above we talked about how to cure COPD using folk remedies. But it is worth noting that self-medication cannot always solve the problem; before starting any treatment, you need to consult a doctor. After all, only a doctor can determine the disease and prescribe the correct treatment.

Are you tormented by a chronic cough? If it lasts 1 week, then this usually indicates an infection of the body.

But if the cough has been present for a couple of years, then you should urgently consult a doctor! This symptom often indicates chronic obstructive pulmonary disease, and this disease should not be joked about: the mortality rate from it is 2.5 times higher than from cancer.

In today’s article, we will look at the causes and risk factors for developing COPD, symptoms and treatment with folk remedies and medications, and let’s not forget about preventive measures.

Lung dysfunction manifests itself in different ways. This can be hypo- and hyperventilation, slight shortness of breath and chronic shortness of breath, periodic or persistent cough. The danger of COPD lies in the irreversibility of destructive processes, which lead to death.

Doctors note that the disease affects all tissues in the chest area:

• ciliary epithelium;
• alveoli and respiratory tract;
• vessels;
• pleura;
• smooth muscles.

Causes of chronic obstructive pulmonary disease

What causes this disease? If we talk about the essence of COPD, then initially the cilia of the ciliated epithelium die, as a result of which mucus is not excreted normally from the lungs. An increase in the secretory function of the glands acts as a companion to this process.

Accumulation thick phlegm makes breathing difficult and causes coughing, which is not always accompanied by expectoration. In stagnant mucus, pathogenic bacteria develop, causing inflammation and an additional reduction in the lumen in the bronchi.

In addition, smooth muscle cells multiply at a faster rate, which leads to a rapid increase in their number and, as a result, muscle spasms. This course of events is determined by several factors, which doctors divide into external and internal.

External factors

According to clinical studies of the World Health Organization, in 80% of cases the disease occurs in smokers. It is tobacco smoke that inhibits the function of the ciliary epithelium and provokes irreversible destruction of their cellular structure.

Of course, the disease more often affects active cigarette users, but people who have spent a lot of time in the company of smokers for 5-10 years, regularly inhaling air poisoned by tobacco, are also hospitalized with COPD.

The second factor in this group is the person’s profession. Employees in the mining and construction industries face daily high concentration harmful components (cadmium, silicon, coal dust, etc.) settling in the lungs and contributing to the dysfunction of the ciliated epithelium and bronchi.

In some industries, especially metallurgical ones, increased levels of ozone, sulfur and nitrogen oxides are often recorded. In industrial cities, they even observe such a phenomenon as smog, consisting of similar impurities of chemical compounds. These substances affect inflammatory mediators, which provoke hyperplasia of the walls of the airways, which leads to a decrease in the lumen in them and complications of ventilation.

Internal factors

But not everything is so simple! Not every smoker, metallurgist or miner develops COPD. People not associated with these professions are also at risk of this disorder, although the reasons will be different:

1. Congenital or acquired deficiency of α 1 -antitrypsin, a protein that protects the lungs from the action of a catalyst for peptide destruction (elastase).
2. High levels of IgE - an antibody that promotes the release of inflammatory mediators into the blood.
3. Lack of IgA - an immunoglobulin that protects against pathogenic microbes.
4. Increased reaction of the bronchi to irritants (hyperreactivity).
5. Serious viral infection.
6. Chronic inflammation due to untreated pneumonia, bronchitis and other diseases.
7. Increased concentration of oxidizing compounds that destroy cells and increase inflammation.
8. Premature birth of a child sometimes causes underdevelopment of lung tissue.
9. Genetic factor.

Symptoms of the disease

A clear sign of chronic obstructive pulmonary disease is a cough. It is often accompanied by expectoration of mucus, but thick mucus is quite difficult to remove. If the patient is bothered by a dry cough, doctors recommend taking mucolytic drugs to thin the secretions.

After several years of progression of the disease, shortness of breath develops, which forces the person to go to the hospital. A similar disorder occurs both with and without physical activity, but serious lung dysfunction sometimes provokes acute air deficiency.

Cough and shortness of breath are signs of the disease in remission, and exacerbation is characterized by the following symptoms:

1. Increased amount of mucus.
2. The appearance in expectorated sputum of abundant purulent discharge.
3. Feeling of congestion in the chest.
4. Increased shortness of breath.
5. Shallow, rapid and wheezing breathing.
6. Increased body temperature.
7. Increase in heart rate.
8. Fainting state.

Stages of development of COPD

Externally, the disease does not appear immediately, although destructive processes are in full force inside the lungs. In this regard, doctors distinguish 4 stages of the disease, each of which has characteristic signs:

Mild stage (dry and wet cough):

• hypersecretion of mucus;
• dysfunction of cilia.

Middle stage (shortness of breath):

• morphological changes in the respiratory tract (narrowing of the lumen, increase in the number of smooth muscle cells);
• destruction of the alveoli;
• increased air content in the lungs (emphysema);
• development of inflammation and accumulation of exudate;
• spasms of the bronchial muscles;
• disturbance of blood gas composition.

Severe stage (acute respiratory failure):

• increased blood pressure in the vessels of the lungs;
• cor pulmonale (right ventricular hypertrophy).

Extremely severe stage (systemic manifestations):

• spread of inflammation and oxidative stress to other organs;
• muscle atrophy and decreased energy potential.

Diagnosis of the disease

Diagnosing the disease at an early stage is difficult, because not every person will consult a doctor if they have a cough. And this is the patient's mistake. If the clinic had diagnosed COPD at the very beginning, many problems would have been solved with less harm to the body.

There are several ways to identify pulmonary dysfunction, which very accurately determine the stage of the disease and the nature of the course (remission or exacerbation).

At the slightest suspicion of COPD, doctors perform spirometry. The essence of the technique is to measure two indicators of pulmonary activity:

1. FEV 1 is the volume of forced air output in 1 second.
2. FVC - forced vital capacity.

Deviation from the norm suggests the presence of this disease, and to clarify the diagnosis, an additional blood test is performed to determine the composition of gases, because it is red blood cells that perform the function of transporting oxygen and carbon dioxide molecules.

In addition, to identify cardiac failures, doctors prescribe an ECG, which clearly shows dysfunction of the right ventricle and even establishes pulmonary hypertension.

What treatments for COPD does official medicine offer?

Drug therapy for this disease aims to eliminate both symptoms and causes. For this purpose they use various groups drugs that are prescribed depending on the severity of the disease.

If the patient only has a chronic cough, then the medications will be very gentle, but in the case of a deep destructive process, serious medications are also prescribed. Doctors divide drugs into 4 groups:

Mucolytics promote active expectoration:

• means of indirect action affect the secretory function of the glands (Bromhexine, Ambroxol);
• direct-acting medications thin the mucus (Trypsin);
• combination drugs (Flegamine).

Bronchodilators relax smooth muscles and dilate bronchi:

• m-anticholinergic drugs are most often prescribed for COPD, and their distinctive feature is the absence of systemic side effects (Atrovent);
• β 2 -agonists reduce the tone of the airways by stimulating β-adrenergic receptors (Salmeterol);
• xanthines are used as aid(Eufillin).

Glucocorticosteroids stop exacerbation by inhibiting enzyme activity (Prednisolone, etc.).

Antibiotics suppress the development of infection in stagnant mucus (Penicillin, Cephalosporin, etc.).

In severe cases, the patient coughs up blood, and therefore doctors prescribe surgery to remove problem areas. In clinical practice, the method of lung transplantation has proven itself well, which allows a person to breathe in a new way. But this extreme measures, and resort to them infrequently.

When the disease worsens, the patient suffers from a lack of life-giving air. If medications do not alleviate the condition, doctors will refer you for oxygen therapy. This treatment is carried out for up to 15 hours a day until the disease goes into remission.

This method is usually used in severe forms, when cor pulmonale and hypertension are diagnosed, but the doctor can prescribe manipulation at his own discretion.

Modern pharmaceutical developments cope with the disease at an early stage very effectively. If doctors determine a severe or extremely severe form of the disease, then medications will not be able to reverse the destructive process completely. But this does not mean that you need to fold your arms, give up and wait for inevitable death!

In combination with medications, treatment with folk remedies, for which there are plenty of recipes, has proven to work well for COPD.

Iceland moss

The healing power of Icelandic moss has been known for a long time. The plant facilitates breathing and promotes expectoration, so it is recommended at all stages of the disease:

1. Raw materials (20 g) are poured with water (1 l).
2. Bring to a boil over low heat.
3. They insist for half an hour.
4. Drink 30 g of the drink three times a day before meals.

If it is not possible to regularly drink the infusion, then prepare tea from Icelandic moss and take it before bed:

1. 1 tsp brew in 1 tbsp. boiling water
2. Leave for 10 minutes.
3. Drink every evening for three months.

Treatment of COPD with folk remedies in adults is carried out with heather, common in the temperate zone. Healing power herbs have anti-inflammatory, expectorant and antibacterial effects, and they are prepared as follows:

1. The above-ground part of the plant is dried and crushed.
2. Pour 1 tbsp. raw materials 1 tbsp. boiling water
3. Leave for 1 hour and filter.
4. Drink 1 glass 1 day in 4 doses.

Watch

The plant grows only in temperate latitudes Northern Hemisphere, and finding it is not so easy. The watch makes breathing easier, strengthens the body and increases vitality.

1. 10 g of leaves are poured into 100 g of boiling water.
2. Leave for 2-2.5 hours.
3. Use 1 tbsp. three times a day.

Complex collection

Complex medicinal herbs will relieve spasm of the smooth muscles of the lungs and promote the removal of phlegm. To prepare the recipe you will need oregano and sage herbs, mallow and chamomile flowers, which are taken in a ratio of 1:1:2:2.

1. The plants are dried, crushed and mixed.
2. 1 tbsp. raw materials pour 1 tbsp. boiling water
3. Leave for half an hour and filter.
4. Take 2 times a day for 2 months.

Excessive accumulation of mucus in the lungs causes shortness of breath. It allows you to get rid of this symptom drug therapy COPD, treatment with folk remedies, breathing exercises and normal intake of necessary nutrients into the body. In order to improve lung ventilation, doctors recommend performing the following exercises 4 times a day for 5 minutes:

"Candle":

• inhale through your nose;
• exhale through closed lips 4 times longer, imitating blowing out a candle or cooling tea.

"Bubbles":

• inhale through your nose;
• Place a thin tube in a glass of water and exhale through it.

In music schools they use a system to improve breathing according to the method of A.N. Strelnikova, singing teacher. This method is based on rapid nasal inhalation and is suitable for treating patients with COPD, but patients will have to tune in to the result and follow the recommendations.

The author of the complex advises to inhale air through your nose sharply and energetically, and exhale arbitrarily, without expending additional effort. Perform each exercise in multiples of four, and important point there is rhythm, without which it is quite easy to get lost.

This gymnastics is combined with physical movements that allow you to achieve relaxation of the respiratory muscles:

"Pump":

• stand up straight, tilt your shoulders and hang your arms;
• inhale and lower the virtual pump handle;
• exhale and return to the starting position.

"Cat":

• stand up straight, bend your arms at the elbows, while relaxing your hands;
• inhale and squat, turning your body to the right;
• while exhaling, stand up;
• repeat with a left turn.

"Epaulettes":

• stand up straight, put your fists on your belt;
• while inhaling, lower your hands and unclench your fingers;
• exhale and return to the starting position.

Prevention

It is not always possible to cure COPD. In this regard, doctors recommend avoiding bad habits that disrupt the normal functioning of the body. And if we consider the causes of the disease in complex, then preventive actions are as follows:

Education: Donetsk National University, Faculty of Biology, Biophysics.

Petrozavodsk State University Faculty of Medicine

Specialty: general practitioner