Progressive lung disease. Lung diseases. Is COPD as dangerous as they say?

Chronic obstructive pulmonary disease ( COPD) is a slowly progressive chronic disease with damage to the distal respiratory tract, caused by an inflammatory reaction, and the lung parenchyma, manifested by the development of emphysema, and accompanied by reversible or irreversible bronchial obstruction.

According to WHO, the prevalence of COPD among men is 9.34:1000, among women - 7.33:1000. People over 40 years predominate. In Russia, according to official statistics from the Ministry of Health of the Russian Federation, there are about 1 million patients with COPD. However, according to epidemiological studies, their number may exceed 11 million people. There is a pronounced tendency towards an increase in this disease mainly in women (in men - by 25% and in women - by 69% for the period from 1990 to 1999). At the same time, mortality from COPD is increasing. Among the leading causes of death in the world, this disease is in 6th place, and this figure doubles every 5 years.

Etiology and pathogenesis

COPD is a consequence of chronic obstructive bronchitis, emphysema and bronchial asthma, the etiology and pathogenesis of which were described earlier. These diseases are combined into one group - COPD - from the moment when obstruction develops and FEV 1 becomes less than 40%. The main etiological factors of COPD are smoking, air pollution, occupational hazards, infections, family and hereditary factors.

The pathophysiological essence of COPD is an increase in airway resistance in bronchitis and bronchial asthma due to primary damage to the bronchi and in emphysema - due to a decrease in the tensile force of the bronchi and a decrease in the rate of forced expiration. In COPD, the normal ratio of lung volumes is disrupted: the residual volume, FOB and total lung capacity increase. Increased airway resistance, decreased elastic traction of the lungs, or a combination of both lead to an increase in the time of complete exhalation, which does not have time to complete as the disease progresses. This leads to an increase in FOB and positive pressure in the alveoli before inhalation, which is accompanied by an increase in the work of the respiratory system.

With COPD, gas exchange worsens and BAC indicators change. Alveolar ventilation, an indicator of which is PaCO 2, can be increased, normal or decreased depending on the ratio of tidal volumes and the volume of dead space. When ventilation of normally perfused areas of the lungs is impaired, intracellular blood discharge develops from right to left, and P (A-a) O 2 increases.

COPD is characterized by both a decrease in the perfusion of certain parts of the lungs and pulmonary hypertension at rest of varying severity, and its disproportionate increase in cardiac output during exercise. Pulmonary hypertension is caused by a decrease in the total cross-sectional area of ​​the pulmonary vascular bed and hypoxic pulmonary vasoconstriction, which is more important than the cross-section of the vascular bed. Acidosis, which develops during acute and chronic respiratory failure, increases pulmonary vasoconstriction and causes erythrocytosis, which worsens the rheological properties of the blood. Persistent pulmonary hypertension leads to overload of the right ventricle, its hypertrophy and right ventricular failure.

Classification

According to the international recommendations GOLD 2003 (Global Initiative for Chronic Obstructive Lung Disease), the diagnostic criterion for all stages of COPD is a decrease in the ratio of FEV 1 to forced vital capacity, i.e. Tiffno index

According to the severity of the disease, four stages are distinguished. The classification does not include stage zero, which is characterized by clinical symptoms (cough with sputum and the presence of risk factors), but lung function is not changed. This stage is considered as a pre-disease, which does not always develop into chronic obstructive pulmonary disease.

Classification by severity
Stage	Clinical picture	Functional indicators
I	Mild COPD is characterized by periodic cough with sputum. There is no or slight shortness of breath.	FEV 1 /FVC FEV 1 ≥ 80% of the required values.
II	Moderate COPD. Patients experience shortness of breath during exercise. The cough becomes constant with sputum production. Obstructive disorders are increasing. Sometimes exacerbations of the disease develop.	FEV 1 /FVC 50% ≤ FEV 1
III	Severe COPD. Shortness of breath increases and appears with little physical exertion, cough with sputum and wheezing in the chest are always present. There is a further increase in airflow restriction. Exacerbations occur frequently and worsen the patient’s quality of life.	FEV 1 /FVC 30% ≤ FEV 1
IV	Extremely severe COPD. The disease leads to disability; exacerbations can be life-threatening for patients; as a rule, cor pulmonale develops. Bronchial obstruction becomes extremely severe.	FEV 1 /FVC FEV 1 Characteristic respiratory failure: PaO 2

Symptoms

The main complaints in chronic obstructive pulmonary disease are cough with sputum and shortness of breath. The cough is initially periodic, observed in the morning and afternoon. As the disease progresses, the cough becomes constant and may develop at night. The sputum is usually mucous, and no more than 40 ml is released in the morning. An increase in the amount of sputum and its purulent nature are signs of exacerbation of the disease. Hemoptysis is usually absent. Dyspnea is expiratory in nature, usually appears on average 10 years later than cough and has varying degrees of severity. Initially, shortness of breath occurs during normal physical activity. As the disease progresses, shortness of breath develops with less exertion, becomes constant and intensifies with a respiratory infection.

When questioning, it is necessary to study the smoking history and calculate the smoker's index (SI) (pack/years) using the formula:

IR (pack/years) = Number of cigarettes smoked (days) ∗ Smoking experience (years) / 20

IR = 10 pack/year is a significant risk factor for COPD. It is necessary to find out the presence of other risk factors (dust, chemical pollutants, alkali and acid vapors), previous infectious diseases (especially ARVI) and genetic predisposition (α1-antitrypsin deficiency). Physical examination reveals an emphysematous (“barrel-shaped”) shape of the chest, and the participation of auxiliary muscles in the act of breathing. The percussion tone is boxy, the borders of the lungs are lowered, the mobility of the lower edge of the lungs is limited. On auscultation - weakened vesicular breathing, less often harsh, dry buzzing and whistling wheezing, increasing with forced breathing.

There are two clinical types of chronic obstructive pulmonary disease in patients with moderate and severe disease - emphysematous and bronchitis.

1. Emphysematous type. Patients with this type are called “pink puffers”, since there is no cyanosis against the background of severe shortness of breath. The physique of this type of chronic obstructive pulmonary disease is asthenic, emaciation and a mild cough with scanty mucous sputum often develop. Physical and functional examination reveals signs of pulmonary emphysema.
2. Bronchitic type. In patients with this type, symptoms of chronic bronchitis predominate. These patients are called “blue edema” because they are characterized by cyanosis and edema caused by right ventricular failure. The leading symptom is a cough with sputum for many years.

The main differences between the types of chronic obstructive pulmonary disease are presented in the table. Emphysematous and bronchitis types of COPD are extreme manifestations of the disease. Most patients have symptoms characteristic of both, with some predominance of one of them.

Diagnostics

Laboratory research. In a general blood test, changes are usually not detected. In some patients, polycythemia is possible. With exacerbation of the disease, neutrophilic leukocytosis, band shift and increased ESR are observed. The emphysematous type is characterized by a decrease in the blood serum content of α1-antitrypsin. In the sputum, a cellular composition is detected that characterizes chronic inflammation. Bacteriological research allows you to identify the pathogen and determine its sensitivity to antibiotics. A double bacterioscopic examination is required to exclude pulmonary tuberculosis. A blood gas composition study is carried out to detect hypoxia and hypercapnia.

Instrumental research. A study of pulmonary function (PRF) is mandatory to establish a diagnosis for all patients, even if they do not have shortness of breath. Early diagnostic signs of COPD are FEV 1/FVC less than 70% and daily fluctuations in PEF less than 20% with peak flow monitoring.

Bronchodilator test is carried out:

1. with short-acting β2-agonists (inhaled salbutamol 400 mcg or fenoterol 400 mcg), assessed after 30 minutes;
2. with M-anticholinergics (inhalation of ipratropium bromide 80 mcg or a combination of fenoterol 50 mcg and ipratropium bromide 20 mcg (4 doses)), assessment is carried out after 30 - 45 minutes.

The increase in FEV 1 is calculated using the formula:

((FEV 1 dilate (ml) − FEV ref (ml)) / FEV 1 ref) ∗ 100%

An increase in FEV 1 >15% (or 200 ml) of the predicted value is a positive test, indicating the reversibility of bronchial obstruction. In the absence of an increase in FEV 1, but a decrease in shortness of breath, the prescription of bronchodilators is indicated.

Primary X-ray examination allows us to identify changes in the lungs and hilar areas corresponding to emphysema and chronic bronchitis, and other lung diseases with clinical symptoms similar to COPD (lung cancer, tuberculosis). During exacerbation of COPD, pneumonia, spontaneous pneumothorax, pleural effusion and others are excluded.

An ECG is used to exclude possible heart pathology leading to stagnation in the pulmonary circulation with a clinical picture of left ventricular failure, and to identify right ventricular hypertrophy - a sign of cor pulmonale. EchoCG is used to determine the morphometric parameters of the left and right ventricles and calculate the pressure in the pulmonary artery.

Bronchoscopic examination is carried out for the differential diagnosis of COPD with diseases of the bronchi and lungs that have similar symptoms. Bronchoscopy is performed during frequently recurring exacerbations of COPD to obtain secretions and bacteriological examination and lavage of the bronchial tree. Bronchographic examination is indicated for suspected bronchiectasis, obliteration of small bronchi and bronchioles, cicatricial bronchial stenosis.

Differential diagnosis. Differential diagnosis is made with lung cancer, which may include coughing with blood, chest pain, weight loss and lack of appetite, hoarseness, and pleural effusion. The diagnosis of lung cancer is confirmed by cytological examination of sputum, bronchoscopy, computed tomography and transthoracic puncture biopsy. In some cases, differential diagnosis is carried out with chronic heart failure, bronchiectasis, pneumonia, tuberculosis, bronchiolitis obliterans.

Treatment

General recommendations. The goal of treatment is to slow the progression of the disease. One of the main measures for the treatment of COPD is smoking cessation, which gives a more pronounced and persistent slowdown in the decline in FEV 1 Smokers should be helped to give up this bad habit: a date for quitting smoking should be set, the patient should be supported and helped to implement this decision. To combat nicotine addiction, some patients may be advised to use a nicotine patch or chewing gum with nicotine, which significantly increases the number of people who quit smoking. But only 25-30% of patients refrain from smoking for 6-12 months.

If there are harmful factors in the external environment that cause COPD, a change of profession or place of residence can be recommended. But these recommendations can cause great difficulties for the patient and his family. They recommend combating dust and gas pollution in the workplace and at home, and avoiding the use of aerosols and household insecticides.

Vaccination against influenza and pneumococcal infection is mandatory. Exercise therapy is useful for increasing tolerance to physical activity and training the respiratory muscles.

Drug treatment. Treatment of patients with chronic obstructive pulmonary disease with a stable course is carried out with bronchodilator drugs. Typically, short-acting inhaled brochodilators are used: β2-agonists (salbutamol and fenoterol) or M-anticholinergics (ipratropium bromide, tiotropium bromide), after 4-6 hours. Long-term monotherapy with short-acting β2-agonists is not recommended. For some patients, if inhaled oronchodilators are insufficient, long-acting theophyllines are recommended.

Treatment of exacerbations on an outpatient basis. Exacerbation of COPD is manifested by increased cough with purulent sputum, increased temperature, increased shortness of breath, and weakness. For mild exacerbation of COPD, increase the dose and/or frequency of bronchodilators. Patients who have not used these drugs are prescribed combinations of bronchodilators (M-anticholinergics with short-acting β2-agonists), and if their effectiveness is insufficient, theophylline is prescribed.

With an increase in purulent sputum and increased shortness of breath, antibacterial therapy is carried out. Amoxicillin, new generation macrolides (azithromycin, clarithromycin), second generation cephalosporins (cefuroxime) or respiratory fluoroquinolones (levofloxacin, moxifloxacin) are prescribed for 10 to 12 days.

With the development of bronchial obstruction for the first time, anamnestic indications of the effectiveness of treatment with glucocorticoids for previous exacerbations and a decrease in FEV 1

Treatment of exacerbation in a hospital setting. Indications for hospitalization are the following criteria:

1. deterioration of the patients' condition during treatment (pronounced increase in shortness of breath, deterioration in general condition, sharp decrease in activity);
2. lack of positive dynamics from long-term outpatient treatment, including glucocorticoids, in patients with severe COPD;
3. the appearance of symptoms characterizing increased respiratory and right ventricular failure (cyanosis, swelling of the jugular veins, peripheral edema, liver enlargement), and the occurrence of rhythm disturbances;
4. elderly age;
5. severe concomitant diseases;
6. unsatisfactory social status.

Therapy should begin with oxygen treatment using nasal catheters or face masks 4 - 6 l/min with a fractional oxygen concentration in the inhaled mixture of 30 - 60% and humidification. Blood gas composition should be monitored every 30 minutes. PaO 2 should be maintained at 55 - 60 mm Hg. Art.

Bronchodilator therapy. Inhalation combinations of β2-adrenergic agonists and M-anticholinergics are prescribed. Solutions of ipratropium bromide 2 ml should be used: 40 drops (0.5 mg) through a nebulizer with oxygen in combination with solutions of salbutamol 2.5 - 5.0 mg gilifenoterol 0.5 - 1 mg (0.5 - 1 ml 10 - 20 drops) every 4-6 hours. If inhaled drugs are insufficiently effective, aminophylline 240 mg/hour up to 960 mg/day is administered intravenously at a rate of 0.5 mg/kg/hour under ECG monitoring and the concentration of theophylline in the blood, which should be 10-15 mcg/ ml.

If bronchodilators are not effective enough, or if the patient is already taking systemic glucocorticoids, it is necessary to increase the oral dose. Oral prednisolone is prescribed at 0.5 mg/kg/day (~ 40 mg/day). It is possible to replace prednisolone with another glucocorticoid in an equivalent dose. If there are contraindications to taking the drug orally, prednisolone is prescribed intravenously at a dose of 3 mg/kg/day. The course of treatment is 10-14 days. The daily dose is reduced by 5 mg/day after 3-4 days until complete cessation of use.

If signs of a bacterial infection appear (increased volume of purulent sputum and increased shortness of breath), antibacterial therapy is carried out. The causative agents of bacterial infection are most often Haemophilus influenzae, Streptococcus pncumoniae, Moraxella catarrhalis, Enterococcus spp, Mycoplasma pneumoniae. The drugs of choice are amoxicillin / clavulant orally 625 mg 3 times a day for 7 - 14 days, clarithromycin orally 500 mg 2 times a day or azithromycin 500 mg once a day or 500 mg on the first day, then 250 mg /day for 5 days. It is possible to prescribe pneumotropic fluoroquinolones (levofloxacin orally 250-500 mg 1-2 times a day or ciprofloxacin orally 500 mg 2-3 times a day).

In case of complicated exacerbation of COPD in elderly patients and FEV 1

Sputum discharge. For COPD, treatment is aimed at improving sputum production. For debilitating nonproductive cough, postural drainage is effective. To thin sputum, expectorants and mucolytics are used orally and in aerosols. But the same effect can be obtained by simply drinking plenty of water.

Surgery. There are surgical treatments for COPD. A bullectomy is performed to relieve symptoms in patients with large bullae. But its effectiveness has been established only in those who quit smoking in the near future. Thoroscopic laser bullectomy and reduction pneumoplasty (removal of an overinflated part of the lung) have been developed. But these operations are currently only used in clinical trials. There is an opinion that if there is no effect from all the measures taken, you should contact a specialized center to resolve the issue of lung transplantation.

Forecast

Chronic obstructive pulmonary disease has a progressive course. The prognosis depends on the age of the patient, elimination of provoking factors, complications (acute or chronic respiratory failure, pulmonary hypertension, chronic pulmonary heart disease), a decrease in FEV 1 and the effectiveness of the treatment. In severe and extremely severe cases of the disease, the prognosis is unfavorable.

Prevention

The greatest importance for prevention is the elimination of risk factors that contribute to the progression of the disease. The main components of prevention are smoking cessation and prevention of infectious respiratory diseases. Patients must strictly follow the recommendations of doctors; they must be informed about the disease itself, treatment methods, trained in the correct use of inhalers, self-monitoring skills using a peak fluorometer and decision-making during an exacerbation.

Chronic obstructive pulmonary diseases is a disease characterized by irreversible or partially reversible, progressive obstruction (impaired patency) of the bronchi. These are diseases that cause the air passages (bronchi) to become blocked or the small air sacs (alveoli) in the lungs to become damaged, causing difficulty breathing. Two main diseases; included in this group are emphysema and chronic bronchitis; Many people with chronic obstructive pulmonary disease experience both of these conditions.

Chronical bronchitis- This 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 beyond a certain degree, the tiny cilia (hair-like projections) that normally catch and expel foreign objects stop working properly. Increased irritation leads to excessive mucus production, which clogs the air passages and causes severe coughing, characteristic of bronchitis. Bronchitis is considered chronic when the patient coughs with phlegm for three months, and this repeats for two years in a row.

Emphysema- This is the 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 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. Loss of elasticity, often combined with narrowing of the small air passages in the lungs (sometimes completely blocking them), causes used air to be retained instead of being allowed to escape. Thus, the affected air sacs are unable to supply oxygen to the blood or remove carbon dioxide from it; this causes the shortness of breath characteristic of emphysema. Lung damage may progress until difficulty breathing becomes severe; from this point on, 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. Many years pass before symptoms appear, by which time the disease has already reached a significant stage. Lung damage is permanent, 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 a disease of the second half of life. The usual age of patients is over 40 years. Men get sick more often. The disease is more common in socially prosperous countries.

Symptoms

COPD is a very insidious disease characterized by a slow progressive course. From the actual onset of the disease to its manifestations, it takes from 3 to 10 years. Symptoms of COPD begin to appear only in the second stage of the disease.

Constant cough with mucus, especially in the morning (a sign of chronic bronchitis).

Chronic dry cough (a sign of emphysema).

In severe cases, symptoms of chronic obstructive pulmonary disease may include coughing up blood, chest pain, and a purple complexion.

Swollen legs and ankles from right heart failure (cor pulmonale).

Difficulty breathing.

Causes

Smoking is the most common cause of chronic obstructive pulmonary disease.

Air pollution may also be a contributing factor.

Industrial emissions or fumes containing chemicals can damage airways.

Repeated viral or bacterial lung diseases can thicken the walls of the bronchi, narrow the air passages, and stimulate excessive mucus production in the lungs.

Inherited deficiency of the enzyme alpha-1 antitrypsin can lead to damage to the walls of the alveoli.

People who are more susceptible to emphysema are those whose occupations regularly expose them to dust, chemicals, or other lung irritants, as well as those whose occupations require constant heavy use of the lungs, such as glassblowers or musicians who play wind instruments.

Young children living near smokers are more susceptible to chronic airway inflammation.

Diagnostics

A medical history and physical examination are necessary.

A saliva sample may be taken for analysis.

Blood tests from the artery and vein (to measure oxygen and carbon dioxide levels) are needed.

A chest x-ray is required.

Spirometry and other tests of lung function that measure breathing capacity and lung capacity are needed.

Measurements can be taken of the strength and efficiency of the heart muscle.

Treatment

Do not smoke; Avoid smoky rooms.

Drink more fluids to loosen mucus.

Avoid caffeine and alcohol as they are diuretics and can lead to dehydration.

Humidify the indoor air.

Avoid going outside on cold days or when the air is polluted, and avoid cold, wet weather. If bronchitis has reached an advanced stage and is incurable, you may want to consider moving to a warmer, drier climate.

Do not use cough suppressants. Coughing is necessary to clear accumulated mucus from the lungs, and suppressing it can lead to serious complications.

A viral respiratory tract infection can cause an exacerbation of the disease; Reduce your risk of infectious disease by minimizing contact with people with contagious respiratory illnesses and wash your hands frequently. Get vaccinated against flu and pneumonia annually.

A bronchodilator may be prescribed to widen the bronchial passages. In more serious cases, oxygen may be prescribed.

A doctor may prescribe antibiotics to treat or prevent bacterial lung infections, since patients with chronic obstructive pulmonary disease are more susceptible to them. Antibiotics must be taken for the entire prescribed period.

Your doctor may instruct you on how to clear mucus from your lungs by moving your head lower than your body.

Breathing exercises can be of some benefit.

In very serious cases where there is severe lung damage due to emphysema, a lung transplant may be performed (if the disease has weakened the heart, a heart and lung transplant is recommended).

1. Treatment of mild severity

At this stage, the disease, as a rule, has no clinical manifestations and does not require constant drug therapy. Seasonal vaccination against influenza and mandatory vaccination against pneumococcal infection once every five years are recommended (for example, with the PNEUMO 23 vaccine).

For severe symptoms of shortness of breath, short-acting inhaled bronchodilators may be used. Drugs Salbutamol, terbutaline, ventolin, fenoterol, berrotec. 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 inhalation correctly. If you have been prescribed such a drug for the first time, it is better to take the first inhalation with your doctor so that he can point out possible errors. The drug must be inhaled (injected into the mouth) precisely against the background of inhalation, so that it gets into the bronchi, and not just “down the throat”. After inhalation, you need to hold your breath at the height of inspiration for 5-10 seconds.

Separately in this group is the drug Berodual. Its distinctive features are the duration of action of at least 8 hours and a good severity of the therapeutic effect. The first two days of taking the drug may cause a reflex cough, which then goes away.

If there is a cough with sputum discharge, patients are prescribed Mucolytics (drugs that thin sputum).

Currently, there are a large number of drugs with this effect on the pharmaceutical market, but, in my opinion, preference should be given to drugs based on acetylcysteine.
For example, ACC (packages for preparing a solution for oral administration, 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 ​​solution for inhalation 20%) for inhalation using a nebulizer. A nebulizer is a device for converting liquid medicinal substances into aerosol form. In this form, the medicinal substance enters the smallest bronchi and alveoli and its effectiveness increases significantly. This method of administering drugs is preferable for patients with chronic diseases of the upper respiratory tract.

2. Treatment of moderate forms

Long-acting bronchodilators are added to the drugs used for stage 1 (mild) of the disease.

Serevent (salmeterol). Available in the form of a metered dose inhaler. The recommended daily dosage for adults is 50-100 mcg / 2 times a day. It is necessary to strictly monitor the inhalation technique.

Formoterol (foradil). Available in capsules containing powder for inhalation using a special device (handihaler). Recommended daily dosage is 12 mcg/2 times a day.

As an alternative, you can use Berodual regularly. If the drug is used in the form of a dosed aerosol, then take 2 inhalations (2 inhalations) of the drug three times a day: in the morning, at lunch and in the evening. The drug is also available as a solution for inhalation via a nebulizer. In this case, the recommended dosage for an adult is 30-40 drops through a nebulizer - 3 times a day.

A relatively new, but already proven drug from this group, Spiriva (tiotropium bromide). Spiriva is prescribed once a day and is available in capsules for inhalation using a special device. One of the most effective drugs for the treatment of COPD at present. Active use is limited only by a fairly high cost.

3. Severe treatment.

At this stage of the disease, constant anti-inflammatory treatment is necessary.

Inhaled glucocorticosteroids are prescribed in medium and high doses. Drugs: beclazone, becotide, benacort, pulmicort, flixotide, etc. They are usually produced in the form of metered aerosols for inhalation or in the form of solutions (pulmicort) for inhalation through a nebulizer.

Also, for this degree of severity of the disease, combination drugs containing both a long-acting bronchodilator and an inhaled corticosteroid can be used. Drugs: seretide, symbicort. Combination drugs are currently considered the most effective means of treating COPD of this severity.

If you have been prescribed a drug containing an inhaled corticosteroid, be sure to ask your doctor how to do the inhalation correctly. Improper procedure significantly reduces the effectiveness of the drug and increases the risk of side effects. After inhalation, be sure to rinse your mouth.

4. Extremely severe severity

In addition to the medications used for severe forms of the disease, oxygen therapy (regular inhalation of oxygen-enriched air) is added. For this purpose, in medical equipment stores or large pharmacies you can find both fairly large devices for home use and small cans that you can take with you on a walk and use when shortness of breath increases.

If the condition and age of the patient allows, surgical treatment is performed.
If the patient's condition is extremely severe, artificial ventilation may be required.

When an infection occurs, antibacterial agents are added to the therapy. The use of penicillin derivatives, cephalosporins, and fluoroquinolones is recommended. 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 case of liver and/or kidney pathology, the dosage is reduced.

Prevention

Don't smoke (smoking is the number one cause of chronic obstructive pulmonary disease).

Avoid spending a lot of time outside on days when the air is polluted.

Call your doctor if your symptoms become severe, such as if your shortness of breath or chest pain gets worse, your cough gets worse or you are coughing up blood, you have a fever, are vomiting, or your legs and ankles are more swollen than usual.

Make an appointment with your doctor if you have had a persistent cough with phlegm for the past two years or if you experience persistent shortness of breath.

Attention! Immediate medical attention is needed if your lips or face become bluish or purplish.

Smoking is the leading cause of COPD, and most people with the disease either still smoke or have smoked in the past. Long-term exposure to other pulmonary irritants, such as air pollution, chemical fumes or dust, may also contribute to the development of COPD.

What is chronic obstructive pulmonary disease (COPD)

The air you inhale flows down through the breathing tube into branches of the windpipe called the bronchi.

In the lungs, your bronchi branch into thousands of small, thin tubes called bronchioles. These tubes end in clusters of tiny round air sacs called alveoli.

Small blood vessels called capillaries pass through the walls of the alveoli. When air reaches the alveoli, oxygen enters through their walls into the blood in the capillaries. At the same time, carbon dioxide (carbon dioxide) moves from the capillaries to the alveoli. This process is called gas exchange.

The airways and alveoli are elastic, and when you inhale, each alveoli fills with air, like a small balloon, and when you exhale, the alveoli become smaller.

With chronic obstructive pulmonary disease, less air enters the lungs and, accordingly, less air leaves them. This happens for one or more of these reasons:

• The airways and alveoli lose their elasticity.
• The walls between many alveoli are destroyed.
• The walls of the airways are swollen and inflamed.
• The airways produce more mucus than usual, which can clog them.

The term COPD includes two main diseases - emphysema and chronic bronchitis. With emphysema, the walls between many of the alveoli are damaged or even destroyed. As a result, the alveoli lose their shape, resulting in the formation of fewer shapeless large alveoli instead of many small ones. If this happens, gas exchange in the lungs worsens.

In chronic bronchitis, the mucous membrane of the respiratory tract is constantly irritated and inflamed. This leads to swelling of the mucous membrane and narrowing of the airways. During chronic bronchitis, thick mucus is present in the respiratory system, which also makes breathing difficult.

Most people with COPD also have emphysema and chronic bronchitis. Thus, the general term "COPD" is more accurate.

Forecast

COPD is a leading cause of disability and is the third leading cause of death in developed countries. Currently, chronic obstructive pulmonary disease is diagnosed in millions of people. And many more people may have this disease and not even know it.

COPD develops slowly. Symptoms often worsen over time and may limit your ability to carry out daily activities. Severe COPD can be almost completely incapacitating, preventing you from even basic activities such as walking, cooking or taking care of yourself.

Most cases of COPD are diagnosed in middle-aged or elderly people. The disease is not spread from person to person, so you cannot catch it from someone else.

COPD currently has no cure because doctors do not know how to reverse the damage to the airways and lungs. However, existing treatments and lifestyle changes can help you feel better, stay more active, and slow the progression of the disease.

Causes of COPD

Long-term exposure to irritants that damage the lungs and airways is usually the cause of COPD.

The most common irritant that causes COPD is tobacco smoke. Tobacco smoke from smoking a pipe, cigar, cigarettes, etc. can also cause chronic obstructive pulmonary disease, especially if the smoke is inhaled directly into the lungs.

Passive smoking, air pollution, chemical fumes or dust from the environment or workplace may also contribute to the development of COPD. (Passive smoking is inhaling tobacco smoke when other people smoke near you.)

In rare cases, a genetic disorder called alpha-1 antitrypsin deficiency may play a role in COPD. People with this disease have low levels of alpha-1 antitrypsin (AAT), a protein made in the liver.

If a person has low levels of AAT protein, it can cause lung damage and the development of COPD if you are exposed to smoke or other lung irritants. If you have this condition and you smoke, COPD can get worse very quickly.

Although rare, some people with asthma may develop COPD. Asthma is a chronic lung disease that causes inflammation and swelling of the airways. Treatment can usually reverse inflammation and relieve swelling. However, if asthma is not treated, COPD may develop.

Who is at risk for developing COPD

The main risk factor for developing COPD is smoking. Most people with COPD currently smoke or have smoked in the past. People with a family history of chronic obstructive pulmonary disease are usually more likely to develop this disease if they smoke.

Long-term exposure to other lung irritants is also a risk factor for developing COPD. Such irritants include:

• passive smoking
• air pollution
• chemical fumes
• dust in the environment
• house dust

Symptoms of chronic obstructive pulmonary disease usually begin to develop in people age 40 or older. It is quite rare for people under 40 to develop COPD. This can happen if a person has alpha-1 antitrypsin deficiency (an inherited disorder).

What are the signs and symptoms of COPD

First, COPD may cause no symptoms or only mild symptoms. As the disease progresses, symptoms usually become more severe. Common signs and symptoms of chronic obstructive pulmonary disease are:

• A persistent cough or a cough that produces a lot of mucus (often called "smoker's bronchitis").
• Difficulty breathing, especially during physical activity.
• Shortness of breath (wheezing or wheezing when breathing).
• Tightness in the chest.

If you have COPD, you may also get frequent colds or flu.

Not everyone who has the symptoms described above has COPD. Additionally, not every person with COPD experiences these symptoms. Some of the symptoms of chronic obstructive pulmonary disease are similar to those of other diseases and conditions. To make an accurate diagnosis, you need to see a doctor.

If your symptoms are mild, you may not even notice them, or you can make some lifestyle changes to make breathing easier. For example, you can use the elevator instead of the stairs.

Over time, COPD symptoms may become severe enough to require you to see a doctor. For example, you may develop shortness of breath during physical activity.

The severity of your symptoms will depend on how badly your lungs are damaged. If you continue to smoke, the destruction of lung tissue will occur faster than if you quit smoking.

Severe COPD may cause other symptoms, such as swelling in the ankles, feet, or legs, weight loss, and decreased muscle endurance.

Some severe symptoms may require hospital treatment. You or your loved ones (if you are unable) should seek emergency medical help if:

• You have severe difficulty breathing (you feel out of breath and find it difficult to speak).
• Your lips or nails turn blue or gray. (This is a sign of low blood oxygen levels.)
• Your brain functions have deteriorated (impaired thinking, poor understanding).
• Your heartbeat is very fast.
• Recommended treatment for symptoms that are getting worse is not working.

Diagnosis of COPD

Your doctor will diagnose COPD based on your symptoms, your medical and family history, and the results of tests and diagnostic procedures.

Your doctor may ask if you smoke or are exposed to lung irritants such as secondhand smoke, air pollution, chemical fumes, or dust.

If you have a chronic cough, you need to tell your doctor about it (how long you have been suffering from a constant cough, how much mucus you cough up). In addition, if you have a family history of COPD, you should also tell your doctor.

The doctor will examine you and listen to your lungs with a stethoscope to check your breathing for wheezing or other unusual sounds in your chest. He or she may also recommend one or more diagnostic procedures to diagnose COPD.

Pulmonary function test

A pulmonary function test measures how much air you can inhale and exhale, how quickly you can exhale, and how well your lungs deliver oxygen to your blood.

The main diagnostic procedure for diagnosing COPD is spirometry. Other pulmonary function tests, such as the lung diffusing capacity test, may also be used.

Spirometry

During this painless procedure, the diagnostician will ask you to take a deep breath. Next, you will blow into a tube attached to a small device as hard as you can. This device is called a spirometer.

This device measures the amount of air you exhale. It also measures maximum expiratory flow.

Your doctor may give you a medicine to inhale to help open your airway, and then ask you to blow into the tube again. He can then compare test results before and after taking the medication.

Spirometry can detect COPD before symptoms appear. Your doctor can also use the test results to find out how severe your COPD is and to help set treatment goals.

Diagnostic results may also help identify another condition, such as asthma or heart failure, as these may also be causing your symptoms.

Other diagnostic procedures

• Chest X-ray (computed tomography or CT scan). Diagnosis using a CT scan takes pictures of the internal organs of the chest, such as the heart, lungs and blood vessels. Images may show signs of COPD. They may also show another medical condition, such as heart failure, that may also be causing your symptoms.
• Arterial blood gas analysis. This blood test measures oxygen levels in the blood using a blood sample taken from an artery. The results of this test can show how severe your COPD is and whether you need oxygen therapy.

Treatment of COPD

Chronic obstructive pulmonary disease cannot be cured. However, lifestyle changes and treatment can help you feel better, stay more active, and slow the progression of the disease.

Treatment goals for COPD:

• Relief of your symptoms.
• Slowing down the progression of the disease.
• Feeling better when you exercise (increasing your ability to stay active).
• Prevention and treatment of complications.
• Improved overall health.

In order to begin treatment for your disease, you need to see a pulmonologist (a doctor who specializes in diseases of the respiratory tract).

Lifestyle changes

Quit smoking and avoid exposure to lung irritants

Quitting smoking is the most important step you can take to treat COPD. Talk to your doctor about programs and tools that can help you quit smoking.

Also, try to avoid secondhand smoke, stay away from smoking areas, dusty areas, and avoid inhaling chemical fumes or other toxic substances that you may inhale.

Other lifestyle changes

If you have chronic obstructive pulmonary disease, you may have trouble eating enough food due to symptoms such as shortness of breath and fatigue. (This problem is more common in severe cases of the disease.)

As a result, you may not be able to get enough calories and nutrients, which can make your condition worse and increase your risk of developing infections.

Talk to your doctor about a nutrition plan that suits your body's needs. Your doctor may suggest eating smaller amounts more frequently; rest before eating; and take vitamins or nutritional supplements.

Also, talk to your doctor about what activities are safe for you. You may find that it is quite difficult to be active with COPD symptoms. However, physical activity can strengthen muscles that help you breathe and improve your overall health.

Medicines

Bronchodilators (bronchodilators)

Bronchodilators relax the muscles in the airways. This helps open the airways and makes breathing easier.

Depending on the severity of your COPD symptoms, your doctor may prescribe short- or long-acting bronchodilators. Short-acting bronchodilators are medications that last about 4-6 hours and should only be used when needed. Long-acting bronchodilators last approximately 12 hours or more and are used daily.

Most bronchodilators are taken through a device called an inhaler. This device allows the medicine to be delivered directly to the lungs. Not all inhalers are used in the same way. Ask your doctor to show you the correct way to use your inhaler.

If your COPD symptoms are mild, your doctor may prescribe only short-acting bronchodilators. In this case, you can only use medications when symptoms appear.

If you have moderate to severe COPD, your doctor may prescribe regular use of short-acting and long-acting bronchodilators.

Combining bronchodilators with inhaled glucocorticosteroids (ICS)

If COPD symptoms are more severe, or if your symptoms occur frequently, your doctor may prescribe a combination of medications such as bronchodilators and inhaled steroids. Steroids help reduce airway inflammation.

In general, the use of inhaled steroids alone is not the preferred treatment option.

Your doctor may recommend that you try using inhaled steroids along with a bronchodilator for 6 weeks to 3 months to see if adding a steroid helps relieve your breathing problems.

Vaccines

Flu shot

Flu can cause serious problems for people with COPD. Flu shots may reduce the risk of contracting the flu (not proven - may be life-threatening). Talk to your doctor about getting an annual flu vaccine.

Vaccination against pneumococcal infection

This vaccine reduces the risk of developing pneumococcal pneumonia and its complications. People with COPD are at higher risk of developing pneumonia than people without COPD. Talk to your doctor about whether you should get this vaccine.

Pulmonary rehabilitation

A pulmonary rehabilitation (recovery) program helps improve the condition of people suffering from chronic breathing problems.

Rehabilitation may include an exercise program, disease control education, nutritional counseling, and psychological support. The goal of the program is to help you stay active and carry out your daily activities.

Doctors, nurses, physiotherapists, pulmonologists, rehabilitation specialists and nutritionists will help you with this. These health professionals will help you create a program that meets your needs.

Oxygen therapy

If you have severe COPD and low oxygen levels in your blood, oxygen therapy may help you breathe better. With this type of treatment, oxygen is pumped into your lungs through nasal prongs or an oxygen mask.

You may need extra oxygen all the time or only at certain times. For some people with severe COPD, using oxygen therapy for most of the day may help with the following:

• Perform tasks or activities while experiencing fewer symptoms.
• Protect your heart and other organs from damage.
• Sleep more during the night and improve alertness during the day.
• Live longer.

Oxygen therapy for chronic obstructive pulmonary disease

Surgery

Surgery may benefit some people with COPD. Surgery is usually a last resort for people experiencing severe symptoms that do not improve with medication.

People with chronic obstructive pulmonary disease, which is primarily associated with emphysema, usually have a bullectomy, or lung volume reduction surgery. A lung transplant may be an option for people with very severe COPD.

Bullectomy

When the walls of the alveoli collapse, large air spaces called bullae begin to form in the lungs. These air spaces can become so large that they begin to interfere with breathing. During a bullectomy, doctors remove one or more very large bullae from the lungs.

Surgery to reduce lung capacity

During lung volume reduction surgery (LVRS), surgeons remove damaged tissue from the lungs. This helps the lungs function better. This surgery is only performed on some people with COPD, and successful surgery can help improve a person's breathing and quality of life.

Lung transplant

During a lung transplant, your damaged lung is removed and replaced with a healthy lung from a deceased donor.

A lung transplant can improve your lung function and quality of life. However, there are many risks associated with lung transplantation, such as infections. The surgery can lead to death if the body rejects the transplanted lungs.

If you have very severe COPD, talk to your doctor about whether a lung transplant is necessary for you. Ask your doctor about the benefits and risks of this type of surgery.

Complications of COPD

COPD symptoms usually get worse slowly over time. However, they can also get worse suddenly. For example, a cold, flu, or lung infection can cause your condition to worsen quickly, causing you to have significant difficulty breathing. You may also experience increased chest tightness and cough, a change in the color or amount of mucus coming from your lungs, and a rise in body temperature.

Call your doctor right away if your symptoms suddenly worsen. To help you breathe, he may prescribe antibiotics to treat the infection, as well as other medications such as bronchodilators and inhaled steroids. Some severe symptoms may require hospitalization.

Prevention of COPD

You can start taking some steps to prevent the development of COPD before it starts. If you are already suffering from this disease, you can take steps to prevent complications and slow the progression of the disease.

Preventing COPD before it starts

If you don't smoke, never try to start smoking, as smoking is the main cause of chronic obstructive pulmonary disease. If you already smoke, you need to completely quit this bad habit. If you smoke and want to quit but are unable to do so on your own, talk to your doctor about programs and tools that can help you quit smoking.

Also, try to avoid inhaling harmful substances that irritate the lungs, as exposure to them may contribute to the development of COPD. Passive smoking, air pollution, chemical fumes and dust can cause the development of this disease.

Preventing the development of complications and slowing the progression of COPD

If you are already showing the first signs of COPD, the most important step you can take is to quit smoking completely. This may help you prevent complications from developing and slow the progression of the disease. You should also avoid exposure to the lung irritants mentioned above.

Follow the COPD treatment plan your doctor has given you. This can help you breathe easier, stay more active, and avoid developing and keeping severe symptoms under control.

Talk to your doctor about whether you should get flu and pneumonia shots. These vaccines may reduce the risk of these diseases (not enough evidence - vaccines can be life-threatening), which are the main health risks for people with COPD.

Living with COPD

Chronic obstructive pulmonary disease currently has no cure. However, you can take steps to control your symptoms and slow the progression of the disease. You need:

• Receive ongoing care
• Keep the disease and its symptoms under control
• Prepare for emergencies

Avoid lung irritants

If you smoke, you need to quit smoking. Smoking is the main cause of COPD. Talk to your doctor about programs and tools that can help you quit smoking.

Also, try to avoid inhaling lung irritants, as they may contribute to the development of COPD. The main irritants of the lungs are:

• passive smoking
• air pollution
• chemical fumes

Try to keep these irritants out of your home. If your home is painted or has been pest controlled with insect repellent sprays, you should spend some time away from home if possible.

If there is severe air pollution and dust, keep windows closed and stay home (if possible).

Receive ongoing care

If you suffer from chronic obstructive pulmonary disease, it is very important to receive ongoing medical care. Take all medications your doctor prescribed. Bring a list of all the medications you take to your regular medical appointments.

Talk to your doctor about whether you should get a flu and pneumonia vaccine. Also, ask him about other diseases that COPD may increase your risk of developing. These may include heart disease, lung cancer and pneumonia.

Controlling COPD Symptoms

There are some steps you can take to control your COPD symptoms. For example:

• Perform physical activities slowly.
• Place items you use frequently in one place so they are easy to reach.
• Find very simple ways to cook, clean and do other housework.
• Wear clothes and shoes that are easy to put on and take off.

Depending on how severe your illness is, you may want to ask your family and friends for help with daily tasks.

Prepare for emergencies

If you have COPD, you need to know when and where to seek help in an emergency. You should seek emergency medical attention if you have serious symptoms such as shortness of breath or inability to speak normally.

Call your doctor if you notice your symptoms getting worse or if you have signs of infection such as fever. Your doctor may change or adjust your treatments to relieve and treat the symptoms of chronic obstructive pulmonary disease.

Keep the phone numbers of your doctor, hospital, or anyone who can provide you with medical care handy. You should also have a doctor's referral and a list of all medications you take on hand.

The disease in question is an inflammatory disease that affects the distal parts of the lower respiratory tract, and which is chronic. Against the background of this pathology, the lung tissue and blood vessels are modified, and the patency of the bronchi is significantly impaired.

The main symptom of COPD is the presence of obstructive syndrome, in which patients can be diagnosed with bronchial inflammation, bronchial asthma, secondary emphysema, etc.

What is COPD - the causes and mechanism of chronic obstructive pulmonary disease

According to the World Health Organization, the disease in question tops the 4th place in the list of causes of death.

Video: Chronic obstructive pulmonary disease

This pathology is formed under the influence of not one, but a number of factors, which include:

• Tobacco smoking. This bad habit is the most common cause of COPD. An interesting fact is that among village residents, chronic obstructive pulmonary disease occurs in more severe forms than among urban residents. One of the reasons for this phenomenon is the lack of lung screening among smokers after 40 years of age in Russian villages.
• Inhalation of harmful microparticles at work. In particular, this applies to cadmium and silicon, which are released into the air during the processing of metal structures, as well as due to fuel combustion. Miners, railway workers, construction workers who often come into contact with cement-containing mixtures, and agricultural workers who process cotton and grain crops are at increased risk.
• Unfavorable environmental conditions.
• Frequent respiratory infections in preschool and school periods.
• Associated ailments of the respiratory system: bronchial asthma, tuberculosis, etc.
• Prematurity of babies. At birth, their lungs do not expand completely. This affects their functioning and can cause serious exacerbations in the future.
• Congenital protein deficiency, which is produced in the liver and is designed to protect lung tissue from the destructive effects of elastase.

Against the background of genetic aspects, as well as unfavorable natural factors, inflammatory phenomena occur in the inner lining of the bronchi, which become chronic.

This pathological condition leads to a modification of the bronchial mucus: it becomes larger, its consistency changes. This causes disruptions in the patency of the bronchi, and provokes the development degenerative processes in the pulmonary alveoli. The overall picture may be aggravated by the addition of bacterial exacerbations, which provokes re-infection of the lungs.

In addition, the disease in question can cause disturbances in the functioning of the heart, which is reflected in the quality of blood supply to the respiratory system. This condition in chronic forms is the cause of death in 30% of patients diagnosed with chronic obstructive pulmonary disease.

Signs and symptoms of chronic obstructive pulmonary disease - how to notice in time?

At the initial stages of development, the pathology in question is often doesn't show itself at all. The typical symptomatic picture appears in moderate stages.

Video: What is COPD and how to detect it in time?

This pulmonary disease has two typical symptoms:

1. Cough. It makes itself felt most often after waking up. During the coughing process, a certain amount of sputum is released, which is viscous in consistency. When bacterial agents are involved in the pathological process, the sputum becomes purulent and profuse. Patients often associate this phenomenon with smoking or working conditions; therefore, they do not often go to a medical institution for advice.
2. Shortness of breath. At the beginning of the development of the disease, a similar symptom appears when walking quickly or climbing a hill. As COPD develops, a person becomes out of breath even when walking a hundred meters. This pathological condition causes the patient to move more slowly than healthy people. In some cases, patients complain of shortness of breath while undressing/dressing.

According to its clinical manifestations, this pulmonary pathology is divided into 2 types:

• Bronchitic. The symptomatic picture here is clearly expressed. This is associated with purulent-inflammatory phenomena in the bronchi, which is manifested by a strong cough and copious mucous discharge from the bronchi. The patient's body temperature rises, he constantly complains of fatigue and lack of appetite. The skin acquires a bluish tint.
• Emphysematous. It is characterized by a more favorable course - patients with this type of COPD often live up to 50 years of age. A typical symptom of the emphysematous type of disease is difficulty breathing. The sternum becomes barrel-shaped and the skin becomes pinkish-gray.

Chronic obstructive pulmonary disease affects not only the functioning of the respiratory system; almost the entire body suffers.

The most common violations include:

1. Degenerative phenomena in the walls of blood vessels, which provokes the formation of atherosclerotic plaques - and increases the risk of blood clots.
2. Errors in heart function. Patients with COPD are often diagnosed with a systematic increase in blood pressure and coronary heart disease. The possibility of acute myocardial infarction cannot be excluded.
3. Atrophic processes in muscles that are involved in respiratory function.
4. Serious impairment of kidney function.
5. Mental disorders, the nature of which is determined by the stage of development of COPD. Such disorders may include sleep apnea, poor sleep, difficulty remembering events, and difficulty thinking. In addition, patients often feel sad and anxious and often become depressed.
6. Reduced defense reactions of the body.

COPD stages - classification of chronic obstructive pulmonary disease

According to the international medical classification, the disease in question goes through 4 stages.

Video: COPD. Why is it not easy for the lungs?

At the same time, when dividing the disease into specific forms, two main indicators are taken into account:

• Forced expiratory volume - FEV .
• Forced vital capacity - FVC – after taking medications that relieve symptoms of acute bronchial asthma. Normally, FVC should not exceed 70%.

Let us consider the main stages of development of this pulmonary pathology in more detail:

1. Zero stage. Standard symptoms at this stage are a regular cough with slight sputum production. At the same time, everyone’s lungs function without disturbance. This pathological condition does not always develop into COPD, but there is still a risk.
2. First (mild) stage. The cough becomes chronic and sputum is produced regularly. Diagnostic measures can reveal minor obstructive errors.
3. Second (moderate) stage. Obstructive disorders intensify. The symptomatic picture becomes more pronounced with physical activity. There are difficulties with breathing.
4. Third (severe) stage. The air flow during exhalation is limited in volume. Exacerbations become a regular occurrence.
5. Fourth (extremely severe) stage. There is a serious risk to the patient's life. Typical complications at this stage of COPD development are respiratory failure and serious disruptions in the functioning of the heart, which affect the quality of blood circulation.

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Chronic obstructive pulmonary disease or COPD is a group of diseases in which the airway is obstructed, making it difficult for patients to breathe.

Emphysema and chronic asthmatic bronchitis are two of the most common diseases from the COPD group.

In all cases of COPD, there is damage to the respiratory tract, disrupting the exchange of oxygen and carbon dioxide in the lungs.

Chronic obstructive pulmonary disease is one of the leading causes of disability and mortality worldwide. Most obstructive pulmonary diseases are caused by long-term smoking and could have been prevented if patients had quit the habit in time. In COPD, lung damage is largely irreversible, so treatment is aimed at controlling symptoms.

Causes of COPD

In COPD, lung damage is predominantly caused by chronic asthmatic bronchitis or emphysema. Many patients with COPD have both conditions.

Chronic asthmatic bronchitis.

This is a chronic disease that causes inflammation and narrowing of the airways. This can lead to shortness of breath, coughing and wheezing when breathing. Chronic asthmatic bronchitis increases mucus production in the bronchi, which further blocks the narrowed airways.

Emphysema.

This progressive disease damages the delicate air sacs at the ends of the bronchioles, the alveoli. The alveoli are clustered together like bunches of grapes, and emphysema gradually destroys the inner walls in these “grapes,” reducing the surface area available for gas exchange. In addition, emphysema makes the walls of the alveoli soft and less elastic, causing them to collapse when air is exhaled. Patients with emphysema have shortness of breath and actively work with accessory muscles when breathing. Patients with emphysema cannot tolerate heavy exercise.

COPD is usually caused by long-term exposure to airborne irritants:

Cigarette smoke.
Dust particles.
Industrial smog.
Harsh chemicals.

Risk factors for COPD

The main known risk factors for chronic obstructive pulmonary disease include:

1. The influence of tobacco smoke.

Smoking is the most significant risk factor for COPD. The longer you smoke cigarettes, the more likely you are to develop obstructive pulmonary disease. People exposed to secondhand smoke are also at risk. Some evidence suggests that inhaling marijuana smoke can cause lung damage similar to tobacco smoke.

2. Influence of dust and chemicals.

Prolonged exposure to such airborne irritants at work leads to inflammation and obstructive changes in the lungs. Many occupational diseases among workers in “dirty” industries, chemical plants, and coal mines are associated with this.

3. Age.

COPD progresses slowly over many years, so most people do not begin to experience symptoms until they are at least 30 or 40 years old.

4. Genetics.

A rare genetic disorder called alpha-1 antitrypsin deficiency is responsible for some cases of COPD. Researchers believe that genetic factors make individuals more susceptible to the damaging effects of tobacco smoke. If these people smoke, they develop lung problems faster.

COPD symptoms

In general, COPD symptoms may not appear until the patient's lungs are seriously damaged. Symptoms of the disease only worsen over time, especially if the person continues to smoke or does not receive treatment. Patients with COPD occasionally experience exacerbations of their disease, when their symptoms suddenly worsen. The symptoms of different obstructive pulmonary diseases may vary.

Most people with chronic obstructive pulmonary disease have more than one of the following symptoms:

Dyspnea.
Wheezing when breathing.
Tightness in the chest.
Chronic cough.

Diagnosis of COPD

If you have symptoms of COPD or a history of past exposure to airborne irritants (especially tobacco smoke), your doctor may order one of the following tests:

1. Chest X-ray.

In some people, x-rays may show emphysema, one of the most common forms of COPD. More importantly, x-rays can rule out lung cancer and some heart diseases.

2. Computed tomography.

A CT scan takes a series of pictures from many different angles, providing detailed "slices" of a patient's internal organs. Lung scans can detect emphysema, tumors and other abnormalities.

3. Analysis of arterial blood gases.

This blood test shows how well the lungs oxygenate our blood and remove carbon dioxide. Blood for testing can be taken from an artery that runs through your wrist.

4. Sputum analysis.

Testing the cells in the sputum you cough up can help identify the cause of your lung problems and rule out cancer. If you have a productive (wet) cough, your doctor will order a sputum test to determine the infection that is causing the illness.

5. Pulmonary function analysis.

Spirometry is a common way to check how well your lungs are working. During this procedure, you will be asked to breathe into a special tube. The machine will measure the amount of air your lungs can hold, as well as how much air you can exhale. Spirometry can detect chronic obstructive pulmonary disease at an early stage, even before symptoms of the disease appear. This test can be repeated several times at certain intervals, which will help the doctor monitor the development of the disease.

Treatment of chronic obstructive pulmonary diseases

Chronic obstructive pulmonary disease cannot be completely cured because the damage is usually irreversible. But treatment will help control the symptoms of the disease, reduce the risk of complications, reduce the frequency of exacerbations and improve your quality of life.

1. Stop smoking.

This is the most important step in treating COPD if you still smoke. Quitting smoking is the only way to stop lung damage, which can ultimately even lead to death. But quitting smoking has never been easy. And you may need the help of a doctor. Talk to your doctor - he or she may prescribe a nicotine patch or other nicotine substitutes.

2. Drug treatment.

The following groups of medications can be used to treat COPD:

Bronchodilators. These drugs are usually prescribed in the form of an inhaler. They relax the smooth muscles of the bronchi and expand the airways. As a result, it becomes easier to breathe. Depending on the problem, you may need two inhalers: a long-acting inhaler (for daily attack prevention) and a short-acting inhaler (for stopping an attack and before physical activity).
Inhaled steroids. Inhaled corticosteroid hormones are a convenient way to relieve airway inflammation. But long-term use of these drugs can cause osteoporosis, hypertension, diabetes, cataracts and other serious complications. These drugs are usually prescribed to people with severe COPD.
Antibiotics. Respiratory infections such as acute bronchitis can aggravate chronic obstructive pulmonary disease. Antibiotics help suppress pathogenic flora in the respiratory tract, but they are recommended to be taken only when absolutely necessary.

3. Non-drug treatment.

Oxygen therapy. If you don't have enough oxygen in your blood, you may need extra oxygen. There are many different devices for supplying oxygen, including small and convenient devices that you can carry around the city. Some patients only need oxygen during exercise or sleep. Others need an oxygen mask constantly.
Rehabilitation programs for patients with COPD. These programs usually combine education, exercise, nutritional advice and psychological counseling. In developed countries, these programs are widespread. They work at many major medical centers in the United States. They involve pulmonologists, physiotherapists, nutritionists, and psychotherapists.

4. Surgical treatment for COPD.

Surgery is required for some patients with severe emphysema who do not respond to medical treatment:

Reduced lung volume. In this operation, the surgeon removes small pieces of damaged lung tissue. This creates additional space in the chest cavity, allowing the remaining lungs to work more efficiently. This surgery is very risky, and its long-term benefits compared to drug treatment are not clear.
Lung transplantation. For severe emphysema, one solution may be a single lung transplant. This surgery improves the ability to breathe and live a more active life. But studies have not shown a significant prolongation of life for such patients. In addition, you may have to wait a long time for a suitable donor. Therefore, the decision to undergo a lung transplant is quite difficult.

5. Prevention of exacerbations.

Even with treatment, you may experience sudden flare-ups of the disease. Exacerbations can be so severe that they lead to pulmonary failure. Such episodes occur as a result of respiratory infections, cold weather outside, and high air pollution. If your symptoms suddenly get worse, tell your doctor as soon as possible.

If you have COPD, the following measures may help:

Breath control techniques. Your doctor will show you the best positions and techniques to control your breathing during attacks.
Clearing the respiratory tract. In COPD, mucus accumulates in the bronchi. For better mucus removal, you need to breathe humidified air and drink plenty of fluids. Your doctor may prescribe an expectorant.
Regular exercise. Of course, COPD patients have difficulty breathing during physical activity. But regular therapeutic exercises can strengthen your breathing muscles. Your doctor will advise you on a suitable set of exercises.
Healthy diet. A healthy diet will keep you strong. If you are obese, you need to get rid of those extra pounds. If you are underweight, your doctor may recommend special dietary supplements and increased nutrition.
To give up smoking. Remember that smoking is the leading cause of COPD. Second-hand smoke is also harmful to the lungs, so if there is a smoker in the house, influence them. Stand up for your right to healthy air at work if your colleagues smoke. In many countries, the rights of non-smoking employees are protected by law.
Vaccination. Respiratory infections provoke exacerbation of chronic lung diseases. Annual vaccinations against influenza and other seasonal illnesses can help you avoid flare-ups.
Avoid crowds. If you need to go to crowded places, don't forget a protective mask.
Don't breathe cold air. Remember that cold air provokes bronchospasm - cover your mouth and nose with a scarf or handkerchief if you are walking in the cold.

Possible complications of chronic obstructive pulmonary diseases

Respiratory infections. If you suffer from COPD, you are more likely to get colds and their complications - bronchitis, pneumonia. Plus, respiratory infections make it difficult to breathe and cause further damage to your lungs.
Pulmonary hypertension. COPD can cause increased blood pressure in the pulmonary arteries - pulmonary hypertension. This leads to increased load on the right ventricle of the heart, resulting in impaired blood circulation. Swelling in the legs may occur.
Heart problems. With COPD, the risk of heart disease, including myocardial infarction, increases. This risk increases significantly if the patient continues to smoke.
Depression. Lung disease can keep you from doing the things you love and living a fulfilling life. The result is dissatisfaction with life and depression, even suicidal mood. Feel free to talk to a therapist about your problems.

Prevention of chronic lung diseases

Unlike many other diseases, COPD has a clearly defined cause and reliable methods of prevention. The most important of them is giving up cigarettes. It's best to never start smoking. But if you already smoke, you can at least stop the destruction of your lungs by quitting as soon as possible.

Exposure to dust and corrosive substances at work is another important cause of lung disease. There are two options here - change jobs or ensure reliable protection in the workplace. If you already have COPD, talk to your doctor about what to do.

Health and life are more valuable than any job.